County public health: What you need to know about COVID-19
Children may be the carriers of the novel coronavirus that causes the disease COVID-19. Federal guidelines mean cases are being missed. And people who are sick can use masks to protect others.
These were some of the takeaways from an interview Tuesday with Multnomah County Health Officer Jennifer Vines, who talked about what county officials are doing to slow the spread of the outbreak and what's on their minds. The interview has been edited for clarity and brevity.
Portland Tribune: What exactly is the role of your people in the public health division at the county.
Jennifer Vines: When something affects multiple counties, the state is the lead. (The county's) is a slightly different role in terms of being hands-on, identifying potential contacts, working on specific community needs and that kind of stuff.
Tribune: So in this particular outbreak, can you give me an idea of what your folks are doing?
Vines: We're doing a lot of things They fall into three big categories. One is case investigation and contact follow up. So when you hear about a confirmed case and you hear about contacts getting identified through public health interviewing and figuring out other people's risk factors, that's all done by county staff.
The next is communication. So broadly, either pushing the state message out (or) pushing out messages to specific populations within our counties where there's a need for that. And then another arm of our response that's really cool is, the county is training our community health workers to train the trainers so that we give them the information and messages that they need. We send them out to their communities to relay those messages and then to gather questions, fears, concerns and bring those back so that we can really do our best to reach everyone in the county.
Tribune: So your folks are not actually doing the tests or running the tests?
Vines: Correct. We are fielding calls from health care providers about whether or not a certain individual meets testing criteria and that is laid out by the (U.S. Centers for Disease Control and Prevention). If we feel like something reaches a threshold for testing or is close and we call the state for approval, then it's on the county to usually facilitate getting the specimen to the state public health lab. But usually that's a person in care, so that person is somewhere where they can get their nose swabbed and their mouth swabbed. So the counties then follow the specimen, make sure it gets to the lab, and then start to think about close contacts to the (patient) and what kind of follow up might be needed if they test positive.
Tribune: So your job is to communicate the guidance, but not to actually do the work of testing.
Vines: As far as actually swabbing somebody, yes
Tribune: But at county clinics, I assume people are swapping when necessary, when called for.
So we are the Public Health Division, which is different from the primary care clinic system. So yes, they could be like any other clinic, somebody could come in and qualify for testing.
Tribune: Do you have a handle on how often that is happening?
Vines: I think so far for our clinic, I think it's been rare.
Tribune: As Dr. Dean Sidelinger of the Oregon Health Authority said to all the reporters yesterday, thing here are probably similar to what's happening in Washington State, where previously they'd talked about a few hundred cases, meaning most of them are undetected. Do you personally have an educated belief on the extent of the disease in in Oregon?
JV: I don't have numbers to give you. I can say the way that the Centers for Disease Control has set up the testing criteria, we're pretty much set up to detect cases that are imported, so cases coming from travelers, and the worst of any cases without travel. So the CDC has set the testing criteria bar very high for someone without a travel risk. They have to be severely ill to be tested. If we are picking up only the sickest of the sick with the virus, then we potentially are missing all of the people who have mild illness or no symptoms at all. Data from other countries shows about 80% patients with the disease have mild illness — again rough numbers — 15% have severe, and then 5% critical.
Tribune: It sounds like, yeah, we have at least hundreds of undetected as Dr. Sidelinger indicated was likely yesterday.
Vines: It's here. It's not clear how widespread it is. It's not clear how recently it was introduced in our community. So our overarching priorities are … trying to go with the case investigation model that I described to you. But overarching is, we need to protect health care system resources, like we need to protect the workers and we need to protect those resources. And we need to do what we can in public health to try to spread out, if we're going to have severe cases try to spread them out over time so that they have a chance at the health care needs that they may have rather than having everybody get sick at once, if that makes sense.
Tribune: You talk about protecting the health care worker resource Part of that, I assume, is protecting the supply of masks?
Vines: Yes, a lot of talk about masks and supplies in general, and a lot of mobilization figuring out what counties and states have on hand and how we're going to prioritize those.
Tribune: How is the county doing on masks?
Vines: I would have to check with logistics. I don't have a status or a number to give you.
Tribune: Are you putting out any sort of guidance on mass gatherings?
Vines: For now we're going with Center for Disease Control guidance, which basically says there's no public health recommendations to cancel your mass gathering, but here are the things you need to have in place. … It's like making sure people who are sick don't come to your gathering, making sure that you have a place for people to go as they become sick during your gathering. A lot of signage around, you know, covering hand hygiene, and then just making sure that like whatever your event is, to plan for people who may be coming in sick and kind of a backup plan for the essential pieces of your gathering.
Tribune: When I look at the CDC interim guidance it seems to provide recommendations for before an outbreak, during and after. Is it safe to assume that in Multnomah County we are "during" an outbreak?
Vines: I think it's safe to say we're in an outbreak. It's not clear to me whether we're early and whether cases have gone undetected like the Seattle study suggests or if we're in it.
Tribune: So, the CDC guidance talks about providing COVID-19 prevention supplies to event staff and participants. Ensure that your events have supplies for event staff and participants such as hand sanitizer, tissues, trash baskets, disposable face masks, and cleaners and disinfectants. So it seems to suggest that there is a need for disposable facemasks.
Vines: If somebody does become sick one of the first things we want them to do is cover their cough. An easy way to do that is have a mask to slip on if they're coughing. But to be very clear they don't have a recommendation for mask use by the general public who's out and about.
Tribune: So what do you think comes next as you look later in the week?
Vines: Lots going on. We have prioritized health system coordination, we mostly have our communication channels set up for that and got interpretation and guidance from CDC for our homecare partners. We are in early planning stages for what to do with people who are unhoused or in shelter settings, so we are moving that forward with stakeholders. Next on my list is long term care facilities. Based on the Washington experience, we need to make sure that those facilities have what they need. And then I think as more people get tested in Oregon, test results start filtering back, I'm hoping there's going to be some information there that will give us some clue as to what it is we're dealing with, whether we're early in the outbreak, whether we're well into it, and you know, who are the people who are getting this virus and how do we think it's getting spread in our community.
Tribune: Did you see that one tidbit about the child who tested positive but had zero symptoms?
Vines: I'm not sure exactly what you're referring to, but there is an emerging concern. It's sort of double-sided. One is that experience from other countries suggests that children don't get severe disease. That coupled with this idea that you can test positive for the virus even without symptoms. It raises a concern that kids might actually be the spreaders and that's why school closure in public health becomes a tool. We're not looking at school closure at this point. But that's the way public health sort of thinks about kids and the role of schools in terms of the mixing and the spreading of a virus. And influenza was a really good example of that.
Tribune: So what are the county's plans for the sheltered community?
Vines: It's basic infection control guidance around separating sick from well. It's emphasizing things like hand hygiene, you know, trying to create buffers between sick and well, at 6 feet if possible.
Tribune: Will there be any particular specific guidance to schools as far as closures or telling people to stay home?
Vines: Guidance has gone out to schools and so far that emphasis has really been on keeping sick kids home. Public health officials and … the various counties plus our state, I think we're always thinking through the school closure questions. You saw that come up in Clackamas County late last week. So it's a conversation that sort of gets revisited every day. To the best of my knowledge, there's no plan for widespread recommendation of closing schools, at least at this point.
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