May 2, 2020 — On April 28 on his public Facebook page, Western Lane County Commissioner Jay Bozievich posted, “25 of 36 counties have had zero deaths. The two deaths and 48 of 50 cases in Lane County were in the Eugene-Springfield metro area. Just two cases were located outside in the rest of Lane County and therefore the chances are that zero cases were ‘confirmed’ in coastal Lane County but testing is so limited that there are probably unconfirmed cases all over. It does seem that the coast has been relatively unscathed and that reopening should begin as the damage to people from the closure is now starting to outweigh the damage from the virus.”
Oregon has lost 360,000 jobs due to the pandemic, equaling 18 percent of all jobs in the state. The state predicts massive losses in tax revenue that will affect the state long-term, while nationally there are signs the U.S. has already entered into a recession. Locally, the shutdown has already cut deep as businesses have shuttered and major local economic events, such as the 113th Rhododendron Festival, have been cancelled.
However, the commissioner did not recommend reopening without restrictions.
“It should be done thoughtfully, like allowing campgrounds to host fully contained RV campers but not tent and car campers that need to share bathroom facilities,” Bozievich wrote. “Maybe allowing a rural single-chair hair salon to re-open with precautions like both staff and customers wearing masks and sanitizing the station, equipment and hands between customers.”
Finally, he stressed that local input on reopening is crucial.
“I think maximizing local control of the reopening is important as each locality understands their community’s risks better than higher levels of government,” the post said. “I also believe business owners and their customers can be the best judges of personal risk.”
The importance of getting the community behind reopening is crucial to the health of businesses that take the financial risk of reopening; they could face the possibility of reclosing if clientele do not feel safe enough despite easing restrictions.
An April 5 Gallup poll asked, “If there were no government restrictions and people were able to decide for themselves about being out in public, how soon would you return to your normal day-to-day activities?”
The respondents favored caution, with 80 percent saying they would base their decisions on the number of reported cases — regardless of the restrictions.
However, without wide testing currently available — particularly in rural areas — the number of reported cases in relation to actual cases is likely far from accurate.
“We don’t really know how much COVID is here in the community,” said William Foster, PeaceHealth Peace Harbor’s emergency department medical director. “I’m positive there’s more than 50 cases here.”
Both Foster and Bozievich have stated there are more cases in the region, but exactly how many more is unknown. And what is known is incomplete.
In an effort to give the public a clear view of the situation, Foster sat down with the Siuslaw News to speak on the science behind reopening, including how prevalent COVID-19 is in Oregon and the Siuslaw region, the setbacks in current testing, herd immunity, possible treatments, the lack of peer review in studies and the promise of a vaccine.
His comments inevitably reverted back to the same thing: very little is known about COVID-19.
“It seems like for every one question we get answered and learn more about the virus and how to treat it, we create another question that needs to be answered,” Foster said.
While Foster declined to give specifics on how he thinks Lane County should reopen, he was able to give as full a picture as possible as to where the Siuslaw region currently is with the virus, where it has been and where it could go from here.
“I think Florence has been relatively spared...”
As the national conversation has turned to reopening the economy, Americans are looking at their own experiences during the first phase of the pandemic to formulate their opinions. For the Siuslaw region, the experience has been mild.
“I don’t think we saw a huge rush of people with COVID symptoms,” Foster said. “We saw people with shortness of breath, cough and fever. Before, we would have thought it was pneumonia or the flu. Now we just added COVID onto that list. But it wasn’t a huge number more that came in, at least to the emergency department and the clinics.”
PeaceHealth Sacred Heart Medical Center at RiverBend, located in Springfield, acted as the central hub in the region for patients with COVID-19. It also dodged the patient overloads seen in other states. Last week, RiverBend only had one positive COVID-19 patient, while there were just three others awaiting results.
“And it’s been that way for a couple of weeks,” Foster said. “There’s been two or three patients in the hospital at one time with positive COVID tests, and anywhere from three to 10 are waiting. And a lot of those tests are coming back negative.”
Oregon ranks 39th in the country for COVID-19 cases, and the deaths per capita is one of the lowest in the nation at just 2 per 100,000, compared to Washington’s 11. By comparison, New York has 121 deaths per 100,000.
While the veracity of Oregon’s numbers can be debated, there is also ample anecdotal evidence that the state did not see a huge surge in cases. Newspapers haven’t seen a rise in death notices, which could have pointed to unconfirmed COVID-related deaths, and there have been no reports of isolated outbreaks akin to those seen in rural meat packing plants and group homes.
How did a state with one of the earliest known cases of the disease, surrounded by other states with growing cases, avoid a large outbreak?
“I think there are two reasons for that, with one being how much of the virus actually got here,” Foster said, surmising that international travel allowed the virus to take hold “directly into Seattle, New York, New Orleans.”
But for reasons unknown, Portland was seemingly spared and, instead, the virus appears to be spreading up and down the I-5 corridor. When social distancing orders began to be put in place, Oregon had not yet entered an overload situation.
“Washington had pretty similar social distancing at the same time we did,” Foster said. “But when they started their social distancing, they already had multiple cases. We didn’t.”
While Washington and California orders were working to contain what was already in their states, Oregon’s stay-at-home orders worked to help keep COVID-19 out.
“I don’t think we had a lot of it here. And I think social distancing has been a big part in keeping it that way,” Foster said.
Polls have shown the majority of Americans believe strict social distancing is unsustainable long term, with support dropping after three months. But finding a responsible way out of the mandates is difficult, as the majority of information on the novel coronavirus is still largely incomplete.
“The community has come to believe itself immune and that is dangerous”
“We didn’t have that many tests in the beginning,” said Foster, who explained that only those who were ill enough to be admitted to the hospital were allowed testing, and they were required to exhibit the known symptoms of COVID-19 at the time — fever, cough and shortness of breath.
“Even if they came to the emergency department with those symptoms, as long as their oxygen wasn’t low and they weren’t significantly sick, I would not be able to test them due to the limited number of tests available,” he said.
As a result, people with noticeable symptoms were being turned away.
“I am pretty sure I have contracted it,” one reader who asked to remain anonymous wrote to Siuslaw News on April 6. “I first began to have atypical symptoms on April 1 (yes the joke was on me), mostly a bad headache and the feeling I’d come down with something. But over the weekend I have become much worse, with fever, shortness of breath, cough and some of the other less dominant symptoms, diarrhea, loss of smell and taste.”
They isolated themselves the moment they began exhibiting symptoms and contacted Peace Harbor for guidance.
“They told me to just stay home,” the reader wrote. “Since the symptoms have progressed, I contacted them again this morning wondering about getting tested but have not yet heard back from them. It sounds like my chances of getting tested are slim to none. When I contacted PeaceHealth to let them know I was sick, the response shocked me. It was ‘Okay, well we will cancel your next few [therapy] appointments.’ That was it. This community has come to believe itself immune and that is dangerous.”
Without verifying the report, Foster agreed that such an incident could occur. But exactly how many people were turned away was impossible to know, though the Siuslaw News has been contacted by at least a dozen members of the community who believe they have symptoms.
Then, even if a person was tested, there are questions on whether or not the results were accurate.
“There’s a question of, ‘Did you get a good sample?’” Foster said. “Initially, we thought you had to get a sample all the way in the back of the nose. The patient pulls back and you’re only sampling the first part of the nose, it might be negative because you didn’t get a good specimen. How much virus you have, or the more virus you have, the more likely you are to have a positive test. If you had a very small amount, it might be a negative test. And then three days later, as you got sicker, you would have more virus and the test would be positive.”
Complicating issues were the multiplying symptoms of COVID-19. Doctors were focused on the three main symptoms at first, “but some people will have a sore throat and runny nose,” Foster said. “Not as prominent, but yes, it’s a possibility.”
Then the number of symptoms kept expanding.
“Some people have some GI (gastrointestinal) issues — vomiting, nausea is a possibility. Body aches. The lack of smell and taste thing seems to be a bigger thing now,” Foster said. “It’s a virus that can affect any part of your body, so any symptom is possible. Kind of like the flu. Some people have more upper respiratory problems, some lower, some GI — it depends.”
At the same time, not everyone with symptoms has COVID-19. Siuslaw News has also fielded numerous rumors that outbreaks were occurring in local nursing homes. One recent rumor stated that Spruce Point had two patients already, while another rumor indicated that an employee had symptoms and would not get tested. Spruce Point denied the rumors, and Peace Harbor praised the work of local nursing homes.
“I think they’re being very cautious,” PeaceHealth Peace Harbor CAO Jason Hawkins said. “They’re doing a great job of protecting the most vulnerable. If they have any suspicions, they’re locking things down. They’re putting measures in place so it doesn’t escalate. When you hear rumors of patients being isolated or employees, perhaps they have some sort of symptoms, but they test them thoroughly and they find out it’s okay.”
When asked if he knew of any cases in the Siuslaw region, Foster only said, “We have had no positive cases or tests here at our hospital.” However, he also stated that patients who were truly suspected of COVID-19 could have gone directly to RiverBend, bypassing Peace Harbor altogether.
With the multiple variables involved, it’s impossible to guess how many people actually have COVID-19 in the region. But is it a number that’s important to know?
“Testing is important”
“For an individual patient, it doesn’t make much of a difference if they’re tested,” Foster said. “There’s no pill that we can give and then Boom! COVID is gone in two days. So, for a person who is only mildly sick, knowing they have COVID or not, in my mind, isn’t as important.”
Testing could also provide a false sense of security for people.
“Even if your COVID test was negative today, it could be positive two days later,” Foster said. “So, you get a negative test saying, ‘Oh I’m fine,’ and you’re going around coughing on everybody. We may test you three days from now and you might be positive. So, I’m a little leery of people getting a negative test and thinking they’re fine.”
A lack of diagnosis may even hurt a patient’s employment; if they don’t have proof of infection, businesses may be unable to allow time off for a quarantine period. But regarding patient care, a diagnosis does little unless the case is severe enough for hospitalization.
Still, most agree testing is important to ensure the hospital does not become overwhelmed should another wave of the virus come.
Recently, Peace Harbor has introduced rapid testing into the walk-in clinics, and expanded testing criteria to include many of the new symptoms that were not considered in the beginning.
Still, not everyone is getting tested. Only those in at-risk categories (above the age of 60) or with underlying conditions, such as hypertension, can receive tests.
“If they were 20 and healthy, they would probably not receive a test. We haven’t moved quite to that level. Not yet,” Foster said.
The hospital is also testing all admitted patients, regardless of symptoms. However, the rise in testing does not mean Peace Harbor is expecting an imminent surge.
“I don’t think there are a lot more serious cases, since we’ve only seen the two deaths,” Foster said. “It’s not like it’s simmering in New York and all of a sudden hundreds of people are going to die in the next week. I don’t think that’s realistic at all.”
But broadening testing helps the hospital anticipate and prepare for any possible surge in the wake of a county or statewide re-opening.
“If we start seeing an uptick in that, we would start saying, ‘Maybe we need to go slower,’” Foster said.
At that point, the hospital would work with PeaceHealth and various governments and emergency groups. They could begin contact tracing to pinpoint where positive cases began.
“When it first hit us, we didn’t have that ability at all,” Foster said “But now we have that ability. If we start to see positive cases, we can say, ‘Where were you?’”
However, if the goal is to prevent such a surge from occurring in the first place, more testing needs to be done.
“Testing is important for a couple of things,” Foster said. “One, it gives us a much better snapshot in time for how this disease is acting and who’s getting it. How many people are getting sick from it? Testing is very important in getting us a clear picture of the disease, when you test a large enough portion of the population.”
Foster spoke of testing random people in the thousands, while also gathering data on symptoms.
“What percentage of the people had it? Who had symptoms? Who didn’t? Age distribution, all that,” Foster said.
This information could also help inform perceptions of business owners, tourists and residents.
If testing found that 70 percent of the Siuslaw region had contracted the virus, it would show that the rural area had reached herd immunity and did so without a swell in patients. That information could actually boost confidence across the board.
If only five percent of the population had it, then the community could have some control in deciding what steps need to be taken to limit the spread and how quickly to reduce — or not reduce — restrictions.
“We haven’t gotten anywhere near that level,” Foster said. “We’re still testing symptomatic people, or mildly symptomatic. National antibody testing will help a lot. It will help to get that big picture of, ‘Well, 10 percent of the population, or 20 percent had it. And this percent had symptoms, and this did not.’ It would give us a much better picture of this disease, and how it’s spread and why it’s spreading.”
Mass antibody studies been done throughout the country, but the tests have created a controversy over peer review, death rates and the efficacy of antibodies. But on Friday, Oregon Gov. Kate Brown announced a plan that could sidestep many of the issues, with a focus on testing future patients.
In the next issue of the Siuslaw News, Foster and Hawkins will discuss issues with testing, as well as the status of treatments, the search for a vaccine, herd immunity and navigating the “new normal” for communities in the Siuslaw region and beyond.