Health officer urges ‘small sacrifices now’ to stem pandemic spike
The term “surge protocol” is back.
As communities everywhere this fall face a large increase in identified COVID-19 cases, health officials are issuing renewed and unprecedented health advisories as the Thanksgiving holiday arrives, bringing strong concerns for super-spread events and renewed outbreaks.
Meanwhile, Hood River County Health Department Director Trish Elliott gave a sobering report last week to the Board of Commissioners on the realities of rising coronavirus cases, an overworked staff and overtaxed pandemic response system.
“With the current surge, we are seeing a huge daily increase in the number of cases and contacts that we are calling,” Elliott said.
Regarding contact tracing, “It’s impossible for our staff to keep up with what we are doing right now,” she said. The revised contact tracing (CT) system will provide “a little less contact with people on a daily basis.
“I think it’s been very stressful,” Elliott said, as she informed the board not only of necessary alterations to the COVID-19 contact tracing program, but to county services overall, partly due to recent loss of staffing.
“It’s hard for people working seven days a week, so we did have (two) nurses who went to jobs in The Dalles; both pay more than what we pay but also both come without need for overtime. One went to a school nursing position, where she will have holidays, weekends, spring and summer break off with her family.”
Elliott met with County Health Officer Dr. Van Tilburg last Tuesday to go over the guidance on increased demand for contact tracing and said Van Tilburg is working with the department team on the development and approval of the county’s surge protocol.
“We have had continual difficulty with keeping up with the demand at the moment for contact tracing,” Elliott said. She announced that case numbers stood last week at more than 330, and that a second death from COVID-19 happened last week. As of last week, the county was doing contact tracing on about 110 people.
Vaccine in two months?
Elliott said “a significant number of the cases are sporadic; social gatherings outside of the workplace are a main source.”
She also told the board that COVID-19 vaccine supplies could arrive in the Gorge “in the next two months possibly.” The Pfizer vaccine would likely be first to go into use, and the super-cold storage units will be provided by Oregon Health Authority (OHA), one to each region, meaning The Dalles would be the likely distribution center based on geographical location.
“There is a lot of planning needed to receive and distribute (vaccines) and work with community partners to get it out in an organized manner,” she said, adding that health care providers including hospitals and long-term care facilities “will get the vaccine first, followed by the general public after the high risk folks are vaccinated.”
For now, the county is striving to keep track of who has the disease and who and where contacts are made.
“We are cutting back to a more manageable stability with staff, and not doing so much work to try to link cases. We will continue to contact cases and close contacts with cases but not on a daily basis,” Ellott said.
“We have reached out to OHA to ask for assistance in dealing with our non-COVID communicable disease cases popping up. This will allow us to focus more on COVID; we have reached agreement (Nov. 16) with OHA to help with tuberculous, STDs and other contagious diseases for the next month at least, and then re-assess.
“Our hope is to have four months of support from them but we are not the only county in the state that is struggling right now,” Elliott said. “We are working with community-based groups, to create a wrap-around (overlapping and coordinated) system to help with people on isolation or quarantine; some of these organizations are having staff trained on CT to assist us with that. We are just waiting on OHA to complete that training.”
“We are also working with Hood River County School District on return to school plans; there is a lot of work to be done with planning for safe return.
Coronavirus Q and A
CGN: With regard to contact tracing, how well is the county handling this need, and what impact do you see on effectiveness overall, from the changes you described in the contact tracing program?
Elliott: “The HRCHD has been able to keep up with contact tracing needs to this point, but with great sacrifice from our staff. We have people working seven days per week and have on-call availability 24/7.
“With the current surge, we are seeing a huge daily increase in the number of cases and contacts that we are calling. We are in the process of adopting a ‘surge protocol’ to be able to prioritize contacts based on risk criteria. This is a version of a protocol put forth by OHA. This protocol will allow us to focus on those with the most need, both medical and social. As always, the effectiveness of contact tracing depends largely on the cooperation of those we are placing in quarantine or isolation. We will, during periods of surge, be reaching out to all identified close contacts, but will not be continuing with daily contact with those at lowest risk. Those at low risk will be contacted day one, when they are identified, provided education, assessed for need and risk, given resources, and then contacted again at the end of their quarantine period. They will be given clear guidance on who to call if they have needs or questions/concerns, or a change in symptoms. As before, we will continue to monitor active cases on a regular basis, though maybe not on a daily schedule. That schedule will depend on medical and social needs and will be clearly communicated ahead of time.
CGN: What is the status of training via OHA on contract tracing by people from other organizations?
Elliot: “OHA Continues to provide contact tracing training to partner organizations on a regular basis. They will also assist in training extra staff that we are taking on with case investigation and contact tracing.”
CGN: With regard to the temporary change in the agreement with OHA, how temporary is it and with regard to other communicable diseases, what other resources will people have in light of this?
Elliott: “OHA has agreed to take on the case investigation related to some of the communicable diseases that we may encounter. Those diseases, specific to tuberculosis, sexually transmitted infections, and other cases such as vaccine preventable disease and other conditions. The agreement is for a one-month period with re-evaluation at that time.”
CGN: Taking this change into account, along with curtailment of appointments due to departure of some of your staff, is the health department approaching an all-COVID-19 response agency for the time being?
Elliott: “The HRCHD is continuing to provide other services by appointment only, and for essential services. For instance, we are providing immunization services and are working on influenza vaccine distribution, as well as doing extensive planning around COVID-19 vaccination plan. WIC services, environmental health, vital statistics, and reproductive health continue. Please call our office with questions.”
CGN: Between standard hiring procedures and the “reaching out for temporary staffing,” how soon can you expect to be back at the previous staffing level or one that will enable you get back to the service level of a few weeks ago?
Elliott: “This can be a tricky question. Recruitment has been difficult this year, as you can imagine. Once staff are recruited and hired, there is training needs, and that training can be extensive. We are keeping our fingers crossed. In the meantime, we are looking into temporary and contract staffing.”
CGN: How are discussions with schools about return to in-person affected by the state-wide freeze or other factors — and can you elaborate a bit on “a lot of work to do” with regard to school reopening?
Elliott: “Schools are exempt from the recent two-week freeze. Statewide and county metrics must be met in order to return to in-person instruction. The school district has gone to great lengths to ensure safety of staff, faculty and students, and have put a lot of work in to their planning. The individual school plans are available on their website. The HRCSD has decided to put a hold on returning to in-person instruction until after the New Year.
“Superintendent (Rich) Polkinghorn has expressed the raising case counts and test positivity rate in Hood River County as a concern for having to reverse a re-opening within a short period of time. There are schools that have been providing in-person instruction in the region and have been successful in maintaining a safe environment.
“Schools have adopted cohorts for segregation of students into small groups with limited interaction between the groups. There are many complicating factors, such as the decrease in students that may be allowed in certain classrooms, the number of cohorts that can interact, transportation challenges with a limited number of students on each bus. Dr. Van Tilburg addressed the HRCSD staff, as well as a public forum to answer questions and address concerns.”
(See School District website, for details on the public forum with Van Tilburg.)
As Hood River County residents make their plans for the upcoming Thanksgiving holiday, health departments are urging people to stay safe amid a surge in COVID-19 cases.
“This is a critical time in the pandemic, when we are seeing a rise in community transmission of COVID-19 in the county, state, nation and worldwide,” said Hood River County Public Health Officer Christopher Van Tilburg, M.D.
The health department reported 12 new county cases on Wednesday, the largest number in a single day. It also announced the second death of a Hood River County resident from COVID-19. Another six cases were announced over the weekend.
“Instead of asking, ‘Is it safe to travel?’ or ‘Can I get a test before traveling?,’ ask, ‘How can I still make a connection with family and friends without traveling or in-person interaction?’” he said.
Consider these safer alternatives to celebrating Thanksgiving in person:
- Trade side dishes with family or friends who live nearby instead of eating together, and say hello outdoors when you deliver them
- Watch live football games in separate houses but text each other throughout the game
- Zoom or FaceTime with the entire family before your meal
- Meet up with family or friends outdoors for an after-dinner walk in your neighborhood or in open spaces
If you have house guests coming for the holidays who are not part of your household — such as students returning home from college — be sure they quarantine before coming; wear masks while indoors; don’t congregate in shared spaces like the kitchen; use separate bathrooms; wipe surfaces regularly; and have hand sanitizer available throughout the house and near key areas like the kitchen table and front door.
This year, the safest way to celebrate Thanksgiving with friends and family who are not part of your household is “apart.”
“Remember, the actions you take now and during Thanksgiving may impact your friends, family and community two to four weeks down the road. You don’t want to cause those you care about to become sick with COVID-19,” Van Tilburg said. “Small sacrifices now may prevent large, deadly sacrifices later.”