Multnomah County on Monday published the region’s first dashboard of COVID-19 case data — unveiling a data visualization tool that will help disease detectives better track the illness by showing how quickly it spreads, who gets sick and how sick those patients get.
The project builds on an existing data-analysis partnership with Clackamas, Washington and Yamhill counties to improve public health’s response to communicable diseases, as part of Oregon’s Public Health Modernization initiative.
The dashboard, combining information from each of those counties, shows testing and case trends over time, breaks down cases by race and sex, and details common symptoms and coexisting conditions. Lead regional health officer Dr. Jennifer Vines, speaking at a news briefing Monday, said that data will help public health better anticipate how the disease will move and who it will target.
“What strikes me is the age ranges,” she said. “While elderly people are more likely to die, the disease can be severe in younger people. That sends a message to everyone: It’s not just for those at extra high risk. It’s really for everybody.”
Real-time tracking
The dashboard details cases of COVID-19 — both by county and across the region — over time. This time-lapse is often referred to as the epidemiological or “epi” curve. For cases in Multnomah County, viewers can also track the most common symptoms and the rates of coexisting conditions.
Multnomah County fought hard to receive the state funding promised in the health modernization program. Because that funding was in place before a pandemic, the region’s epidemiologists were ready to quickly launch a dashboard when a crisis finally came.
“Our goal was to modernize our public health data systems,” said Senior Epidemiologist Taylor Pinsent. “One of those was building a real-time dashboard for disease tracking if a pandemic started.”
The data shows a weekly rise in cases, with most illness among people in their 40s, 50s and 60s. Of the 74 people counted as hospitalized in the four-county region on the dashboard as of March 30, a quarter were in their 60s, and nearly a quarter were in their 40s. No one under the age of 20 was counted as hospitalized.
In Multnomah County, as of March 30, the dashboard showed , only about 63 percent of those who tested positive for COVID-19 had a fever of 100.4 or greater, while nearly 90 percent of people had a cough, about 85 percent felt tired and nearly 80 percent reported chills.
About half of those who tested positive in the County also reported having seasonal allergies, while a quarter had underlying lung disease, and nearly one-in-five had diabetes.
Pinsent, who helped create the dashboard, explained the number of cases displayed in the dashboard are fewer than those posted by the Oregon Health Authority. That’s because it takes about a day for the state’s data to feed into the dashboard. The narrative — how this virus acts and who it attacks — will change as the region’s numbers grow, she said.
Also on Monday, Communicable Disease Manager Lisa Ferguson detailed for the public how Multnomah County’s Communicable Disease Services program is responding to COVID-19. It’s the same way her team reduces the spread of other diseases, she said, by supporting individuals who have contracted or been exposed to certain reportable diseases.
How disease detectives track COVID-19
As part of every disease investigation, a communicable disease nurse or epidemiology investigator works with an ill person to ask where that person has been and who they have been near. Then the investigator will notify contacts as medically appropriate and educate them about possible symptoms to watch for.
“We’re following the same process with COVID-19,” Ferguson said.
[From the investigators: how public health tracks COVID-19]
Communicable Disease Services considers someone at high risk for exposure for COVID-19 when there is face-to-face contact for a prolonged time. If an individual is high risk, is vulnerable to severe illness, or works in a setting that could expose others who are vulnerable, the Health Department will notify those people and educate them about possible symptoms.
If public health finds there is a risk to multiple people in a high-risk setting, such as a long-term care facility, it would reach out to that facility. Otherwise the Health Department might not reach out to employers.
With some exceptions, people who might have been exposed but are without symptoms are not generally asked to stay home from work.
During Monday’s media briefing, one reporter asked why doesn’t the county doesn’t issue a public notice when an individual with COVID-19 has been in a public place, like on a bus.
COVID-19 is believed to spread through droplets when a sick person coughs or sneezes. Those particles are heavy, and fall to surfaces, Ferguson said. An exception is in certain healthcare settings, when an aerosol-generating procedure can cause those particles to hang in the air.
Otherwise, it’s not like measles, which does spread through the air, Ferguson said. In those cases, if health officials can’t identify all individuals who might have been exposed, they may make an announcement about the exposure site.
Ferguson said her team's best advice right now is the same for people who are well and for those who may have been exposed.
“Our general recommendation is that people stay at home,” she said. In their investigations, Ferguson said, her team is finding that people are doing the right thing. They’re staying home. They’re limiting the number of people they might have exposed. “We generally find people are doing what we are asking them to do. That message is out there.”
It’s too soon to tell whether physical distancing measures are working, Dr. Vines said, and whether the data is trending in the right direction — flattening that curve. That’s why people need to stay motivated and stick to the state mandate to stay home unless absolutely necessary.
“Rather than explode in one big wave, we’re hoping that by spreading people out, we slow the spread and buy ourselves some time to get our health systems ready,” she said.
This is crucial time to secure more protective gear and testing supplies.
“Every day that goes by, I don't see numbers doubling and tripling. That is a good sign,” she said. “But whether or not we have spread this out remains to be seen.”
