May 13, 2020 — On May 8, Lane County submitted its proposal to the state of Oregon on its plans to begin the process of reopening after two months of restrictions to help prevent the spread of COVID-19. The 40-page submission lists details on the county’s preparedness, including rates of hospitalizations, plans for a resurgence of the virus and testing capabilities.
While at press time the state has not officially announced whether or not the county will be allowed to reopen on May 15, representatives have stated that the “majority” of counties that have applied will see applications approved.
“The health and safety of Lane County residents must be the top priority as Lane County prepares to relax restrictions implemented as part of Governor Brown’s Stay Home, Save Lives executive order,” the county wrote in its application for reopening. “While there is no expectation that COVID cases will get to zero in the near future, a phased approach to reopening the community and allowing commerce to resume will help limit the number of people impacted by the new disease.”
Lane County’s application stated that during the past weeks, it has been carefully planning and building capacity to limit the spread of COVID as the community resumes more normal levels of activity. With low infection rates, sufficient testing capacity, the ability to expand contact tracing and an adequate supply of personal equipment, the county said it believes it is ready to begin reopening.
Phase 1 of reopening will last for 21 days and will include expectations for residents to practice good hygiene and staying home when sick.
“Employers would develop appropriate policies for social distancing, protective equipment, temperature checks, sanitation and monitoring employees for symptoms,” the county wrote.
Vulnerable populations will be asked to stay home, telework will continue where possible, and non-essential travel will be discouraged.
After that initial phase, if the county can show it has kept the spread of COVID-19 down, non-essential travel could resume while schools and gyms could be reopened — all with social distancing guidelines in place.
After at least 21 additional days, worksites could have unrestricted staffing, visitors to nursing homes would be allowed and restaurants and bars could have more seating.
“Each incubation period lasts 14 days, so the phased plan requiring communities to wait 21 days at each phase would take into account any changes over an incubation period — plus a week — to assess the current status prior to moving to the next phase,” the county wrote. “In Lane County, we have not had significant growth of cases during the pandemic…”
However, because testing was very limited during the beginning of the pandemic, only those who had severe, specific symptoms (fever, shortness of breath and cough) and needed hospitalization were tested. Therefore, the actual data regarding prevalence of COVID in Lane County is incomplete and not entirely known.
To get around this, the county is using the metric of emergency department visits and hospital admissions.
Regarding emergency department visits for COVID-like illnesses, counties must be less than “the historic average for flu at the same time of year,” per state regulations.
According to data from the county, emergency department visits have been in the “normal” range since April 10.
As for a decline in hospital admissions, only 15 Lane County residents with confirmed COVID cases have been hospitalized since March 1.
“The maximum number of Lane County residents hospitalized at one time was eight people on April 11 and 12,” the county reported. “There have been no confirmed hospitalized cases since April 24.”
At the time of the county’s submission, the county had 16 active cases of COVID, and zero hospitalizations.
“In order to quickly detect any changes in the growth rate or localized outbreaks, the community needs access to widespread testing, particularly in the event that cases are increasing on the disease curve,” the county wrote.
Counties are required to administer a weekly testing at a rate of 30 people per 10,000. Lane County estimates that would mean 1,071 tests per week — or 153 tests per day.
According to the application, “Based on the daily average number of tests for the week ending May 3, Lane County is currently conducting about 185 tests per day and just under 1,300 per week.”
PeaceHealth and McKenzie-Willamette hospitals have capacity to administer up to 400 tests per day and each hospital has committed to processing up to 50 tests per day for Lane County Public Health (LCPH) as part of outbreak investigations, sentinel surveillance and other urgent needs.”
That combined capacity could mean up to 3,500 residents could be tested weekly, if needed.
The county must also provide testing sites that are accessible to underserved communities. Lane County stated it had multiple sites where testing can be done with a doctor’s order. According to Lane County, McKenzie-Willamette Medical Center, in cooperation with the University of Oregon, is operating a testing site at the Springfield hospital where anyone with a doctor’s order can get a test. Most primary care providers can take a sample and have contracts with labs and can perform the test.
Nova Health urgent care, with locations in Eugene, Springfield and Cottage Grove can perform the tests and have them analyzed at McKenzie-Willamette’s lab.
Both McKenzie-Willamette and PeaceHealth hospitals are testing all admitted patients.
“Lane County Public Health is currently conducting surveillance testing for staff and clients at homeless respite sites and homeless shelters,” the county wrote. “During May, this will expand to testing staff and residents at long-term care facilities and surveillance testing in the Latinx community in cooperation with trusted partner organizations.”
While the county will be able to increase daily testing beyond its current number, it states that the minimal number of testing each day should average 500, representing approximately 1 percent of the population being tested each week.
“Optimal levels would be closer to 1,000 tests per day administered to residents,” the county wrote. “As testing resources become more available, the state is relaxing the guidelines for who is eligible for testing — when the testing resources were scarce, access was limited to only those who were most ill or had other specific risk factors.”
Overall, testing in Oregon still falls short. Lane County admitted that, while its testing has increased, it is “still lagging.”
While the county can reach minimum testing to relax restrictions, “ultimately the community also needs expanded sentinel and surveillance testing,” the county wrote.
Contact tracing involves identifying and reaching out to the contacts of someone who tests positive for an infectious disease. Contacts are then tested and, for those who test positive, the process is then repeated for their contacts, and so on, until the chain of transmission is interrupted.
Until recently, only those with COVID that needed to be hospitalized met the strict testing criteria, so contract tracing has been minimal.
“As testing becomes more widely available, Public Health will implement more extensive contact tracing, which is expected to include isolation and quarantine of known and suspected cases,” the county wrote. “In some cases, people who are isolated or quarantined at home will need support and resources, such as groceries, laundry and prescription medicines.”
Those who are unhoused or unable to return to their homes will also need additional accommodation.
“It is not yet clear how widespread infection is in Lane County. Therefore, it is difficult to estimate the resources that will be needed locally,” the county wrote.
To reopen, the state requires 15 contract tracers per 100,000 people.
“To meet this requirement, Lane County would need 56 contract tracers, even though we currently only have 13 active cases,” the county wrote. “Lane County Public Health’s contract tracers work in teams of six, supervised by a nurse or disease investigation specialist. Based on past experience, eight FTE are needed to do adequate contact tracing for up to 10 active COVID-19 cases.”
The county currently has a pool of staff and volunteers to bring the capacity up to 20 FTE traces, enabling research of up to 50 active cases. But with partnerships between Lane County Sheriff’s Search and Rescue, the University of Oregon and the Oregon Health Authority, the county will have a pool of 200 staff and volunteers who can “be mobilized quickly to work under a nurse or disease investigation specialist to conduct contact tracing if a surge in disease requires expansion to 56 tracers,” the county said.
The county said it will also ensure that there will be at least one bilingual (Spanish/English) contract tracer and cast investigator per team. Existing contacts with tribal communities will also provide tracing for tribal populations that speak Mam, Q’anjab’al, Q’eqchi and Mixtec.
“Lane County currently investigates 95 percent of all new cases within 24 hours and expects this to continue,” the application stated.
The application referenced the Roadmap for Reopening from the American Enterprise Institute, which states that one of the triggers for reinstituting stay-at-home orders is a doubling of cases every 3-5 days.
“Because the virus is so contagious, it’s critical that the situation is closely monitored, and that the healthcare system is able to quickly respond in the event that increased disease is detected,” Lane County said.
Hospitals will need to have capacity for severe cases, and health care providers need to have sufficient PPE (personal protective equipment). The community also needs to be prepared to activate stay-at-home strategies if needed to combat a significant outbreak.
Currently, hospitals have the ability to increase beds by 20 percent in case of a rise in cases.
“Lane County currently has sufficient facilities to isolate 15 individuals … and will have facilities in place for at least 55 individuals by May 15,” the county wrote.
In Cottage Grove, one hotel has agreed to provide up to five rooms, while three hotels have volunteered their rooms in Florence.
“Sponsors have provided 10 tiny homes to Lane County for use by homeless individuals who need to be isolated or quarantined,” the county wrote.
Recently, the county has also purchased a property with 40 rooms that can be used for isolation. The facility is expected to be ready to open on May 15.
In addition, Lane County manages the local clearinghouse that is used to support healthcare providers in the event of a surge. There are currently 216,350 procedure masks, 48,452 N-95 respirators, 12,576 gowns, 265,244 gloves and 5,949 face masks.
“We are committed to the health and safety of our residents and all Oregonians; therefore we have put together a blueprint that will guide us in monitoring the spread of COVID-19 and outlines our plan to adhere to state guidance on Phase 1,” the county wrote. “Should data and conditions indicate a need, we are prepared to re-impose physical distancing measures either county-wide or in affected areas.”