January 6, 2022

As COVID-19 cases surge to crisis levels – with the more contagious Omicron variant, filling hospitals and sick workers forced home at troubling rates – public health officials in Multnomah County are mounting a dramatic course change in hopes of meeting the growing emergency.

Instead of relying on measures like individual investigations that paid off when case levels were much lower, health officials will now focus on the one strategy that can reliably keep people from getting severely ill from COVID-19 if and when they get infected: expanding access to vaccines and booster shots.

The shift is meant to spare a healthcare system that’s already been put on the ropes as Omicron washes through Multnomah County.

In the last week of 2021 alone, COVID-19 cases of COVID-19 doubled in Multnomah County, with the weekly tally, at 3,161 — more than 1,000 cases higher than any previous week.

COVID-19 epi curve, Jan. 6, 2022

Along with that spike, test positivity rates have risen dramatically, and so have large-scale outbreaks. 

Health systems are preparing their crisis response plans as staff call out sick and beds fill up. Multnomah County emergency calls were up 40 percent above average this week, and hospitals report very few available beds in the region. Several emergency departments were swamped this week, with one, Providence Portland, reporting no more physical space for incoming patients at one point this week.

“This is our challenge for the next few weeks and it’s already started,” Health Officer Dr. Jennifer Vines told Commissioners Thursday during a routine briefing on the pandemic. “We’re really at a moment of change in the pandemic.”

Vaccines still help keep people from getting really sick. Masks of any kind are better than no mask at all. But among the assumptions Omicron has changed:

No longer can someone rest assured simply because they have two doses of a vaccine, not when nearly 60 percent of new cases are breakthrough cases. They must get booster shots, if eligible, to be more fully protected.

No longer is someone considered exposed only if they spent 15 minutes or more within six feet of someone with the virus. Because the Omicron variant appears to be nearly as contagious as measles, exposure can happen with far less contact. 

No longer can someone rely comfortably on a two-ply cloth face covering. Officials have warned that medical grade masks offer much better protection from inhaling particles that carry the virus.

And case investigators no longer have time to call and interview every positive case, not when they are fielding more than 250 new cases each day. And that’s only the cases they learn about, as people increasingly diagnose themselves using at-home test kits; those cases often go unreported to local public health.

That means contact tracing is no longer relevant in an environment where cases are surging so high and when spending time in any indoor public space is essentially considered an exposure for anyone who is not up-to-date on their vaccines. The sheer speed of omicron means people are exposed, infected and contagious before the local health department can even identify an outbreak, much less get word to those who are exposed.

Right now, only 40 percent of adults in Multnomah County are boosted. And with Omicron’s shorter incubation period, by the time someone realizes they may be sick, gets tested, and that test is reported, it is too late for contract-tracing to interrupt disease transmission. That’s why booster shots and vaccinations are becoming even more important than they already were.

“The impact of Omicron is changing our response to the pandemic quickly. We are pivoting in real time to support people in making the best decisions to protect their health and the health of others,” Health Officer Dr. Jennifer Vines said Thursday. “We have more tools now than we did previously, and we are learning what can work to mitigate the worst outcomes, including hospitalization and death.”

Vaccination remains the single most effective tool at preventing serious disease, which is why Multnomah County, acting as the Local Public Health Authority, is reallocating staff and other resources away from case investigations and contact tracing to increase vaccination and boosters among those who are at highest risk of severe illness.

The County hired 44 additional staff to stand up two additional BIPOC-focused community vaccine sites with a strong focus on boosters and increasing capacity at its existing sites, which offer the range of COVID vaccines, serving all age groups. Those efforts will join a much larger vaccination effort led by healthcare systems and state and federal health agencies.

Aside from high-risk settings, Public Health will pause individual or outbreak case investigations or contact tracing. People whose positive test results are reported to Public Health will receive a text message with information on what to do next, with a phone number for questions and resources. They will also receive a letter with more information about isolation and quarantine, what to do if symptoms get worse, and how to notify contacts.

Public Health will also continue to offer a COVID-19 hotline, provide outreach to high-risk settings, and conduct epidemiological analysis. And it will continue its efforts to increase vaccine clinics.

Public Health is urging individuals to take action that works: get boosted, get vaccinated, stay home if exposed or sick, and upgrade your face covering to a higher quality mask.

“It’s hard to find a silver lining with Omicron,” Health Officer Vines said Thursday. “I think we’re in for a difficult few weeks.” 

What you can do

Get boosted. People 16 and older who got a full series more than six months ago (or more than two months for J&J), should get their booster now. Don’t wait. If you are older, have an underlying health condition, this is especially important to avoid severe illness.

Get vaccinated. If you haven’t yet, get your first dose now. Even one dose starts to reduce your risk of severe illness and death, at least for a few weeks. The second and booster doses add much more protection.

Stay home if sick or exposed. If you have symptoms —even if you are vaccinated and especially if you can’t get a test — we are asking you to stay home and isolate to prevent potentially spreading it to others. If you have been a close contact and can’t get a test, quarantine yourself for five days from the date of exposure, and then wear a mask for the next 5 days when you are out in the world.

Wear a quality mask. Wear a well-fitting mask indoors, outdoors in crowded spaces, and when you are around people who are at high risk of severe illness from COVID-19. People should wear the highest-quality mask that they can get that is comfortable to wear.

Get a vaccine. Get Boosted

Anyone can dial 2-1-1 to find the clinic closest to them or check out the vaccine finder at Vaccines.gov

Who to call

  • Multnomah County COVID-19 Call Center: 503-988-8939
  • Multnomah County COVID-19 Business Line: 503-988-3406 or email diseasereport@multco.us
  • Clackamas County COVID-19 Call Center: 503-655-8224
  • Washington County COVID-19 call center: 503-846-8123