Multnomah County Public Health officials warned the Board of Commissioners on Tuesday that the number of Black and African American residents who are sick enough with COVID-19 to need hospitalization has climbed in the past two months — even as overall rates of COVID-19 countywide have gone down and Oregon looks to fully reopen later this month.
Overall, African Americans in Multnomah County are twice as likely as White people to test positive for COVID-19, 80 percent more likely to be hospitalized, 40 percent more likely to test positive in an urgent care setting or emergency department, and 40 percent less likely to be vaccinated. Those trends even reach across all age groups.
“This is not individual behavior. This is a system failing one set of community members in our county,” Health Officer Dr. Jennifer Vines told the Board.
Health Officers issued an alert last week, asking clinicians to reach out to their Black and African American patients to discuss when to seek testing, when to seek care, vaccine safety and access, and to discuss culturally relevant management of chronic conditions. As part of its work to prepare for reopening, the County created a state-required equity plan built on culturally specific education and partnership opportunities to narrow the deep disparities around vaccines and other health factors that put some communities of color at greater risk of contracting the virus.
The County is working with neighboring counties, state leaders, coordinated care organizations and health systems, as well as continuing to support the work of REACH, which has established a network of community relationships to hold educational forums and stand up testing and vaccine clinics.
Commissioner Susheela Jayapal said she has been concerned about a lack of access to testing among communities of color. She asked if that could cause people not to seek care before it becomes life-threatening.
“We think it is,” said Vines. “It suggests there is spread that could be prevented. That is one piece of how we are failing to serve this community.”
Jayapal said she had been pushing the Oregon Health Authority to relax its guidelines for testing, expanding those recommendations for Black, Indigenous and other communities of color so that people don’t need to show they were knowingly exposed to the virus before seeking testing.
“We have put that request out to healthcare providers,” Vines said. “We don’t talk about testing as much as we used to, but it still has a role to play, related to interventions that prevent spread. And people deserve to know they are positive, in case they later go on to develop complications.”
Vines said she would raise the conflicting guidance with OHA. “There are some system pieces we need to work on to make this more available,” she said.
Lifting statewide restrictions
In the midst of these ongoing challenges, Public Health prepares for the state to lift safety restrictions as soon as late this month.
Overall, cases of COVID-19 are dropping in Multnomah County — by nearly 50 percent last week alone. Outbreaks are declining, and the percentage of tests that come back positive has dropped below 5 percent, the threshold where public health officials say they can begin to relax.
Last month, more than 16,000 Oregonians caught COVID-19; and 98 percent were not yet fully vaccinated. In Multnomah County last month, more than 90 percent of those hospitalized with the virus had not received a vaccine.
“There is a wide variation of vaccine uptake across the state,” Public Health Director Jessica Guernsey warned. The Tri-County area, with a larger percent of the state’s population and among the highest rates of vaccination, masks pockets of the state with much lower rates.
Yet once 70 percent of adults receive at least one COVID-19 vaccine dose, the Governor has said she will lift a statewide risk framework and nearly all the prevention measures, including masking, distancing and capacity limits. The state will also lift vaccine verification requirements for businesses. Mask requirements will remain in certain settings, such as on public transit, in airports, in medical facilities and in detention settings.
Multnomah County health officials advise people to continue taking precautions after the Governor lifts statewide restrictions, including that people who are not fully vaccinated continue to wear a mask indoors.
About 70 percent of people 16 and older in the County have at least one shot of the COVID-19 vaccine, and those rates are highest among Native Hawaiian and Pacific Islander residents, more than 90 percent of whom have already gotten a shot., Guernsey told the Board.
“By age, we have seen some advances in the youngest age group. But we have work to do with older teens,” she said.
Expanding vaccine access
While vaccination rates are still significantly lower for Black and Latinx communities in Multnomah County, those rates are growing more quickly now than the rate for White residents. Public Health is still expanding its vaccine clinics and models, with larger standing clinics acting as hubs for smaller mobile clinics that can reach shelters, camps, apartment complexes, factories and other locations where people may face barriers to reaching a larger community clinic.
Multnomah County’s Health Centers have reached more than 8,000 of their patients, about 70 percent of whom identify as people of color and about half of whom received care with the help of an interpreter. Adrienne Daniels, deputy director of the Health Centers, said about a third of those patients were uninsured and noted an increasing number of patients with Medicaid and Medicare, the result of expanded eligibility under President Joe Biden.
The Health Centers Program has partnered with Public Health to establish vaccine clinics like one upcoming at the Fabric Depot building in east Portland on S.E. 122nd and Stark streets. They’re also expanding their models to include a walk-in vaccine clinic at the North Portland Health Center, which serves an area with a lower vaccine uptake rate.
“We’re hoping that by offering walk-in access, it can increase interest and decrease barriers,” Daniels told the Board.
The Health Centers will also weave COVID-19 vaccine access into the program’s Baby Day Dental program, which familiarizes the County’s youngest clients with healthy dental care, while parents get tips on brushing, nutrition and bottle use.
The clinic system is also partnering with school districts to hold vaccine clinics, with daily appointments at the Parkrose Student Health Center starting Wednesday, June 23, for clients 12 and older, and their families.
Pop-up clinics are scheduled at Centennial High School’s Student Health Center on Tuesday, June 29, and Roosevelt High School’s Student Health Center on Wednesday, June 30.
The Health Center is accepting new patients. Just dial 503-988-5558