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Amended plan to be submitted to Gov. Kate Brown, Oregon Health Authority by Friday

Clackamas County's Board of Commissioners voted unanimously Tuesday, May 19, to approve the county's phase-one reopening plan with minor amendments.

Commissioners received the plan Friday afternoon and reviewed it ahead of this week's meeting. Staff from the county's emergency operations walked elected officials through the plan, including Disaster Management Director Nancy Bush, County Public Health Operations Manage Philip Mason-Joyner and Public Health Officer Dr. Sarah Present.

The next step will be for the amendments suggested by the commissioners — which center around using campsites within the county as isolation facilities — to be made to the reopening plan, and a letter drafted and signed by Board Chair Jim Bernard and County Administrator Gary Schmidt be sent to the Oregon Health Authority and Gov. Kate Brown. Those steps are expected to be completed as early as May 20, or as late as Friday, May 22. Phase-one guidelines provide for the reopening of businesses such as restaurants, bars, personal services, shopping centers and gyms.

Commissioners were quick to remind those tuned in to their virtual meeting that just because they submit the county's reopening plan doesn't mean things are ready to open — in fact, the governor and OHA could reject the plan and require the county to come back and resubmit.

According to staff, Clackamas County is meeting most of the state's seven guidelines that counties have to meet or provide plans for ramping up to be approved for reopening. Those include a declining percentage of emergency department visits for COVID-19-like illnesses, and one less than the historic average for flu at the same time of year; the ability to administer COVID-19 testing at a rate of 30 per 10,000 people per week and maintain a certain number of testing sites to accommodate their population; having a minimum of 15 contact tracers for every 100,000 people and be prepared to trace 95% of all new cases within 24 hours; having hotel rooms for people who test positive and can't self-isolate; adherence to statewide guidelines to protect employees and consumers; the ability to accommodate a 20% increase in suspected or confirmed cases compared to when the governor's executive order was issued; and having a 30-day supply of personal protective equipment (PPE) at all large hospitals, and a 14-day supply at small and rural hospitals.

According to Mason-Joyner, Clackamas County has seen a decline in severely ill patients seeking hospital care for COVID-related illness and symptoms, but as the county moves into phase one, they expect a small influx in hospitalizations and even deaths.

The county is also meeting the minimum testing requirements required by the Oregon Health Authority, which is 1,245 per week. Clackamas County is currently at 2,234 tests conducted each week.

Part of the plan includes making sure the county also has contracts in place for rapid response testing teams that can go out, if warranted, in congregate settings such as long-term care facilities or the county jail. Mason-Joyner told the commissioners that data is showing the county's Latinx population is at high risk for severe illness linked to COVID-19, many of whom are essential workers on farms, food-processing facilities and other service industries.

"There's a lot of concern about the ability for this population to have access to testing and health care, so we're looking to contract with some culturally specific organizations to meet those populations needs," Mason-Joyner said.

The contract-tracing portion of the reopening guidelines have perhaps been one of the most opaque pieces of governor's criteria. Contact tracing is the practice of investigating people who have been contacted by an infected person.

How it works is Clackamas County Public Health's Infectious Disease Control and Prevention Program receives lab reports of confirmed cases and contacts the infected person. They then interview them and provide public health consultation and guidance. They also identify all of those who have been in close contact with them, then interview and connect with those people as well to try to prevent spread.

"This is something that public-health agencies in our country have done for a very long time," Mason-Joyner said. "There are over 70 reportable diseases in Oregon that this work occurs with, of course, there's just more attention and need to ramp up services for COVID-19 response."

The county had seven staff members within its public health division who work on contact tracing. Since the outbreak, the county has beefed that number up to 25 contact tracers, with plans of hiring 38 more to bring the total to 63, just north of 15 per 100,000 population ratio requirement.

Mason-Joyner told the commissioners that the OHA has taken on the responsibility of collecting people who are interested in working as contact tracers and have published a form on their website to keep inventory and review qualifications of those who apply.

The county also has a partnership with the Oregon Health & Science University to provide four medical students to the public-health division, three of whom will be staying on as temporary employees.

On siting of isolation facilities, the county has identified eight different locations to house individuals experiencing homelessness who need to self-isolate for 14 days due to COVID-19, or any other individual needing isolation such as migrant workers or those in recovery housing.

Those sites include the Collins Conference and Retreat Center in Eagle Creek, The Grove Camp & Retreat in Canby, SnoozInn-Wilsonville, the Best Western-Rivershore Hotel in Oregon City, Mt. Hood Kiwanis Camp in Government Camp, Mary S. Young Park in West Linn and the North Clackamas Parks Complex in Milwaukie. According to Mason-Joyner, the OHA has pledged $10.4 million to local counties to help pay for those sites to be used as isolation facilities.

In terms of hospital capacity, Clackamas County's four local hospitals all provided letters of attestation that the county meets the criteria for reopening and are prepared to handle a potential surge in cases that will assuredly be seen once metro counties begin reopening.

Mason-Joyner added that the county is getting low on PPE gowns, but the state announced recently they're expecting a shipment to help close the local deficit, which would fulfill the PPE requirement in reopening.

Clackamas County the first county in Oregon to declare an emergency on Feb. 28 and began shutting down county operations March 17.

It is now one of five counties yet to reopen following Gov. Brown's announcement earlier this month that allowed counties to submit applications and begin reopening last Friday, May 15. Marion and Polk counties submitted applications but were denied, whereas Clackamas, Multnomah and Washington counties have not submitted applications yet.

On Clackamas County's part, that's partially due to being tethered to the local health region — which includes Multnomah, Washington, Columbia, Clatsop and Tillamook counties — on some of the governor's criteria, such as hospital capacity.

The other reason is that the Board of Commissioners and county staff aren't willing to dive into a half-cocked reopening plan that causes a major spike in new cases of COVID-19 infection and causes the county to close once again.

Bernard told his fellow commissioners that he intends for this reopening plan to be paired with critical messaging around the fact that it's everyone's responsibility to keep each other safe by wearing masks in public when applicable, continuing to wash hands and practice social distancing.

"It's imperative we continue this… it could get out of control and we could lose a lot of lives, cost the taxpayers a lot of money, and these folks have worked really hard to keep this curve flat and protect the citizens of Clackamas County," Bernard said. "It's kind of a Catch-22 in that when you do a good job, people think everything's fine. And we've done a good job, and we've saved a lot of lives and reduced the incidence of infection somewhere between 60-70%. Let's continue the hard work so our economy can open back up and we can get back to work."


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