The following letter was sent to Governor Brown’s office today in response to Malheur County being put in Phase 1.

Dear Governor Brown,

Thank you for your ongoing support and care for Oregonians, including the people in Malheur County. With 0.7% of the state population, we have a smaller infrastructure to respond to public health emergencies, but the capacity needs are not much different than they are in urban counties when it comes to COVID-19 prevention and outcomes. This provides many new opportunities for the future of public health modernization and investment in Malheur County and across the state. We will do our best to rise to the current challenges and ask for your continued assistance as we respond to the change to put Malheur County back to Phase 1 and want to prevent the possibility of a stay home order that does not address the reasons we see community spread and increased outbreaks, which are detailed in part below.

Situation Update

With COVID-19 cases continuing to rise in Malheur County, there are a few concerns important to keep in consideration. With over 7,300 COVID-19 cases in Idaho counties that share a border with Malheur County, the possibility of Malheur cases being linked to Idaho cases is high, yet Orpheus, the Oregon electronic disease surveillance system, does not share information with the Idaho communicable disease reporting system. This means that a number of Malheur cases are not able to be linked to known cases in Orpheus, even if they are already entered as a Person Under Monitoring (PUM) to an Idaho case. It will be difficult to get the percentage of cases linked to a known case down if only Oregon cases are counted.

As of the last OHA Weekly Update, pulling data from August 9^th, 176 COVID-19 cases were reported as an outbreak at Snake River Correctional Institution (SRCI). That same day, Malheur County reported a total of 800 cases, making the SRCI numbers 22% of total cases. With the majority of those cases in Adults in Custody, we recommend removing those cases when evaluating future changes in phases. We have concern and care for Adults in Custody and the staff at SRCI and have a positive relationship with leadership locally and at the Department of Correction.

The metric for positive rate of cases to be less than 5% was absolutely a goal for the first several months of testing in Malheur County, but is an unreasonable percentage at this point because such a high percentage of the county has already been infected. With each new positive case, if the person had a negative test, that number would be deducted from the negative count and added to the positive. With 4,550 tests already reported in the county as of August 14th, 14.7% of the county is already represented. We would have to have an 16,172 additional people (over half of the population of the county) to test negative to bring the rate to 5%. This is not a realistic goal with current testing capacity of limited testing supplies and low accessibility of testing through health care providers for people without symptoms.

Malheur County Health Department (MCHD) Case Investigators report that a high percentage of cases are of people with many close contacts, who are essential business workers or share households with essential workers, and in a large percentage of people who have chronic underlying health conditions, especially obesity and diabetes, making the risk of severe cases higher. Hesitance to be tested or access health care have also been frequently reported. Going to the baseline phase of a stay at home order would not directly address these trends, because most of the industries in Malheur County where we see COVID-19 cases increasing are considered essential, primarily agriculture and food processing. What would be impacted is the availability of child care, while schools are closed for in person instruction, and additional economic hardships across the county that pose other risks exacerbating the 30% childhood poverty rate, lack of access to remote work, and decrease in behavioral health treatment.

Malheur County Action

MCHD plans to increase our COVID-19 response in several ways detailed below that will directly address reasons for the spread of COVID-19 and hopefully allow reentry to Phase 2 while reducing the number of cases and outbreaks in the county.

One of the ways the Malheur COVID-19 Taskforce is addressing the public health needs during the pandemic is to prioritize free COVID-19 testing. The Taskforce’s drive-up test sites across Malheur County’s largest towns have been coordinated over the last four months and next week we will complete the 12^th test site. After a series of long turn around times for test results when sending specimens to Quest Laboratories, we are grateful to now send specimens to the Oregon State Public Health Lab and have results quickly. Part of the surge in cases in July could be attributed to people waiting 14-19 days for test results and not staying home while potentially infectious. We are considering continuing the drive-up test sites with assistance or to convert to monthly flu vaccine Points of Distribution (PODs). With many people being treated for the flu each year, concern for health care system capacity, and the need to isolate with flu-like symptoms, the flu vaccine is an important part of our COVID-19 response heading into the fall.

Another plan is to increase the “Keep Malheur County Open” campaign in English and Spanish with direct outreach to cities, churches, and community based organizations with flyers, social media graphics, two billboards, and banners. Additionally, we will promote the “Mask Up Malheur County” Public Service Announcement and share other PSAs created by the State and CDC with local media.

On July 15, 2020 the statewide ban took effect for indoor social gatherings of 10 or more individuals and requiring face coverings for all indoor and outdoor gatherings when 6’ distance can not be maintained. That same day, the Malheur County Court approved the Malheur County COVID-19 Taskforce request to support the state rules and to limit outdoor social gatherings to no more than 25 individuals. The resolution was extended for another three weeks on August 6, 2020. While we have taken greater efforts to reduce the high risk of large gatherings in Malheur County, social gatherings in Idaho, including large events like fairs and rodeos, have been a draw for people from Malheur County. We will continue to support limits to high risk gathering in requests to the County Court and in wide spread, multi-lingual messaging.

With Community Based Organizations (CBOs) beginning COVID-19 work with Local Public Health Authorities over the next month, outreach and wrap around services will be enhanced. With new perspectives and approaches, more people will hear the public health messages for COVID-19 to prevent infection and stay home and access health care when needed if sick. Wrap around services, including food box delivery, financial assistance, and other social services have slowly been utilized more in the last month and with the CBO assistance, we expect far more wrap around supports to encourage people to stay home when in isolation or quarantine. We are in negotiations with a local motel to purchase a block of 16 rooms a month at a time to set up reliable quarantine and isolation facilities for individuals who cannot isolate at home or who do not have stable housing.

Through partnership with leadership, Valley Family Health Care, a Federally Qualified Health Clinic, with locations in the three largest towns in Malheur County, will expand COVID-19 testing to individuals without symptoms who are part of groups disproportionately affected by COVID-19, including people with close contact with a case, who are agricultural workers,  who are over age 65, who identify as people of color, identify as having a disability, or who speak English as a second language. By testing more at a lower threshold, the positive rate should go down and asymptomatic cases could be identified.

MCHD has an Abbott test machine from the state and a policy to expand testing to people without insurance. With additional tests and staffing, we would be able to expand testing in the MCHD clinic during the week. Nursing staff is extremely limited. We do have an RN position open and although public health nursing is often not competitive with other nursing positions across the state, we hope to hire soon. We will stay in contact with the OHA about the number of tests used and needed.

MCHD will contract with an Epidemiologist to provide additional reporting and recommendations for the COVID-19 situation and share more about case trends, disproportionate risk, and a more detailed view of where or why people are impacted most. We are hopeful that by being transparent with as much data as possible, while protecting private health information, the public will better understand the increasing risk of COVID-19 transmission in Malheur County. MCHD is in contract negotiations with an additional public health physician to provide weekly medical consult to increase the support for health care providers and case investigators. The OHA has also provided ongoing assistance with on-call Epidemiologists and we appreciate any additional guidance at that level.

Thank you for considering the unique situation in Malheur County. We are geographically larger than nine U.S. states, have a diverse population, a small public health department, and a lack of workforce expertise. Because of the seriousness and complexity of the COVID-19 response, we rely on our state partnerships and welcome coaching, planning, staff for case investigation, public information and epidemiologist support, testing capacity, and other best practices that will help us protect and promote the health of Malheur County residents. The OHA has been helpful and responsive to these needs and we look forward to improving our situation during this time in Phase 1.

Sincerely,

Sarah Poe, Director, and the Malheur County COVID-19 Taskforce