UPDATE (12 p.m. PT) – Gov. Kate Brown said on Friday a new study with 100,000 randomly selected Oregonians could shed light on how far the coronavirus has spread throughout the state and will help guide the state's decisions to reopen the economy.
It was one month ago the governor ordered everyone to stay home to help stop the spread of COVID-19.
“But holy smokes, it feels a lot longer than that,” the governor said on Friday.
At a press conference, Brown unveiled new details on how the state plans to expand COVID-19 testing and trace people who have been exposed to the coronavirus. Both measures are crucial to reopening the economy, which the governor said could start happening in some regions of the state as soon as May 15.
The governor warned reopening Oregon wouldn’t happen all at once and would be slower than what anyone wants.
“This is not like a light switch,” Brown said, adding it will be more like a dimmer.
An OHSU research team will randomly select Oregonians to voluntarily participate in the study. The study will focus on vulnerable populations and will help the state create a better map of where the virus exists in the state and how it affects certain populations.
The research team will track the temperatures and other COVID-19 symptoms of the participants. Those invited to participate will receive a letter and would agree to be tracked for up to one year.
‘This is not without risk’
Brown and her advisers were clear that easing social distancing will come with a cost: More people will become infected with COVID-19 and some of them will die.
“This is not without risk. If we move forward and open up, there will be more cases,” Patrick Allen, director of the Oregon Health Authority, said in a briefing before Brown addressed reporters.
The OHA released a plan Friday that details a new plan for testing and contact-tracing — finding and monitoring those who have come into contact with someone who has the disease. It’s everything they need to have in place so Oregon can re-open more safely, Allen said.
These are “the foundational pieces that need to be in place to be able to move forward,” Allen said.
Participating is voluntary and people will receive an invite to participate. Brown called it a game-changer. If asked, Brown urged people to “heed the call.”
“We are all in this together,” the governor said. “Make no mistake, physical distancing will remain part of our daily lives until we have security of a vaccine or a treatment for the disease,” Brown said.
Contact tracing’s key role
One of the keys to Oregon’s plan for reopening is to increase testing and contact tracing.
“Contact tracing is what public health does,” Oregon State Epidemiologist Dean Sidelinger said. “We’ve been identifying individuals who can do this in the short term while we set up a permanent network of contact-tracers who know what works best in their community.”
The state plans to hire 600 people to do contact tracing. Until the new staff members are trained, they’ll redeploy existing staff to fill the gap. The agency also is rewriting its investigative guidelines.
“We’re making sure we have the latest tools to do those investigations, hiring new people, and increasing training opportunities,” Sidelinger said in the briefing.
Sidelinger said that shortly after the lockdown began, OHA started looking into what it would take to ease those restrictions, he said.
But first, they needed time to get everything together. The initial cases were overwhelming. As social distancing slowed transmission, they started looking into how to implement a reduced version of social distancing, while simultaneously ramping up testing, contact tracing and isolating patients at home and quarantining their contacts.
“This is going to be more difficult now than we thought at the beginning because of asymptomatic transmission. Before they even come down with the disease, it will be spreading,” Sidelinger said. They’re trying to factor that into their assumptions and models, he added.
Testing on the rise
The state has been able to increase the number of tests in recent weeks to about 9,000 tests per week. Overall, the state has tested about 56,000 people.
The number of positive tests has declined from 9% from the start of the pandemic to closer to 4.8%, which is lower than most states, according to the state’s health authority.
The governor praised Oregonians for abiding by her "stay home, save lives" order. The state estimated by staying home more than 70,000 COVID-19 infections were avoided and more than 1,500 hospitalizations prevented.
As part of its contact-tracing effort, Oregon will be doing more outreach in the communities that are disproportionately affected by COVID-19. In Oregon, Latino communities have been hard-hit by the disease.
“People in farm work situations especially have unique challenges,” Allen said. He acknowledged that many immigrants have reason to distrust government officials, and may be in vulnerable financial situations.
Contact tracers can ask intrusive questions, so it’s especially important to make sure that the people who do it are trusted by their community.
They’ll also be reaching out to Native American tribes to develop plans together and make more testing available.
Oregon can only do contact tracing rapidly and accurately if it has the ability to do more testing. OHA’s plan outlines ways to increase testing capacity in more rural parts of the state. The agency plans to employ couriers to make sure tests are where they’re needed, and Sidelinger said the state is working with the state's hospital network to develop a plan to treat all of their internal testing strategies as one cohesive unit.
“We’ve been working on improving testing since the beginning of the outbreak, but we’ve really begun to make progress. It’s jumped dramatically, we actually got some breakthroughs on our supply chain,” said Sidelinger. A global shortage of the chemicals needed to run the tests had slowed efforts before. The long-awaited test kits for the ABBOTT rapid tests provided by the federal government have arrived, too, so rural hospitals will be able to test some patients on site.
Finding sick people
With more, better-distributed testing, OHA hopes to be able to look for spikes in cases in certain regions of the state. Then, they can respond to that region in particular, find sick individuals and ask them to isolate — they should not be near anyone who isn’t actively sick. People who have been exposed to the virus will be asked to quarantine to see whether they get sick, so they don’t spread the virus into the larger community. Once they develop symptoms, they’ll be asked to isolate.
These measures are voluntary, and there is no punishment for not following them. Instead, the plan is to educate individuals on how and why they should quarantine. These individuals will be asked to sign an agreement to stay home, provided a resource packet that includes a way to document symptoms, and possibly a thermometer. Help will be provided to people who can’t isolate at home find another option. They’re also looking to acquire pulse oximeters, which would allow people to monitor their blood oxygen at home, so they could get early warnings before they crash.
Oregon’s isolate-and-quarantine strategy will require a lot of support from public health systems, Allen said. Part of the plan involves linking individuals in underserved communities to the services they need.
For example, people who are confirmed COVID-19-positive will be asked to isolate themselves. But depending on the individual’s living situation, OHA may need to find them alternative housing if they live with other people, or find a place for them to isolate at all if they’re experiencing homelessness.
“Support could also be linking to them to food or services that have medication. If they’ve been laid off, we could link them to the Oregon Health Plan,” Allen said. “We’re still kind of working out those details. It will look different in each community.”
Small changes, big impacts
It’s unclear what order social distancing restrictions will be eased. The government is still working on that plan, and it may look different in less densely-populated counties than it does in urban areas. Large workplaces, for example, won’t re-open for a while. Sidelinger said the agency plans to watch what happens in states that have already eased some social distancing restrictions, and learn from what happens there.
What is clear is that very small changes can have a large impact on the spread of COVID-19 in Oregon.
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State-produced models looked at several different scenarios. Right now, Oregon’s social-distancing measures seem to be reducing the transmission of the virus by about 70%. The state modeled what the pandemic could look like in Oregon if it continues this level of social distancing, and also looked at what would happen if it eased social distancing guidelines so the transmission was reduced by 60%, 50%, and 30%.
The results are stark. If Oregon keeps the current restrictions, the modeling shows about the same amount of transmission as the current levels.
If some social distancing is eased, and there is a 60% reduced transmission, over the next six weeks cases will go up and more people will die, but hospitals would not be overwhelmed. By June 4, there would be about 200 more new infections per day. But if Oregon lifts social distancing restrictions just a little bit more, to 50% reduction, by June 4 there would be about 600 new infections each day.
As with all models, these aren’t predictions. They’re designed to estimate the impact that small changes in behavior can have on the spread of disease. Real people are a lot more complicated than computer simulations. It’s less important to look at the actual numbers than it is to look at the trends.
The models also only look forward six weeks, because the farther into the future the models work, the less accurate their numbers will be