Flying an incomplete airplane
For Tanya Phillips, dealing with COVID-19 in Jackson County the past year has been like flying an airplane as it’s being built, with her and other health officials learning as they went full speed ahead.
Years of science-based guidance for handling the disease weren’t available, said Phillips, health promotion manager for Jackson County Public Health. Especially in its infancy, the fast-changing pandemic made public messaging and protocols difficult day-to-day, week-to-week.
“Everyone was learning something new, because this is a brand-new virus, and so that was definitely difficult,” Phillips said on a Zoom call.
As of Friday, 120 Jackson County residents had died from the illness, among the 2,373 lives lost across Oregon, and 163,295 cases had been recorded statewide, including 9,084 in Jackson County. More than 600 Jackson County residents have been hospitalized with the illness.
Just over a year has passed since Gov. Kate Brown’s original issuance of the “Stay Home, Save Lives” order, which required many temporary business closures and asked state residents to stay home as much as possible in an attempt to limit the spread of the virus.
Cases have recently begun to trend slowly downward in Jackson County. There were 274 new cases recorded the week of Feb. 21, and 169 the week of March 14, according to county public health data. Regional hospitalizations, however, have started to creep back up, rising from 11 patients in Jackson and Josephine counties March 14 to 22 March 25.
As of Friday, Jackson County’s COVID-19 risk level remained at “high,” meaning restaurants can operate at 25% capacity for indoor dining, with additional restrictions for faith-based institutions, entertainment establishments and gyms.
We’re not out of the woods yet, health officials say. We’re still building the airplane.
“So we have some challenges, we have some big unknowns, but, you know, in terms of how are we doing right now? I think we’re doing pretty well,” said Dr. Jim Shames, county medical director. “I mean, there’s a lot to be concerned about, but in general, I think the vaccine’s been a game changer.”
More than 1 million Oregonians have received at least one vaccine dose, according to the Oregon Health Authority, with 614,865 Oregon residents considered fully vaccinated as of Friday, and 455,851 others who had received the first shot in a two-dose regimen.
In Jackson County, 27,552 people were fully vaccinated, and 19,651 others had received one of two doses.
Starting Monday, the county will expand its vaccine eligibility, allowing people between 45 and 64 years old and with underlying health conditions to receive vaccinations. Newly eligible groups on that date will also include people displaced by the September wildfires, wildland firefighters, migrant and seasonal farm workers, workers in the seafood, agricultural and food processing industries, people living in low-income senior housing, senior congregate and independent living facilities, homeless people, and pregnant women 16 and older, according to Jackson County Public Health.
Gov. Brown announced Friday that starting April 5, Oregonians who are frontline workers, multigenerational household members, and adults 16 or older who have underlying medical conditions will be eligible. All Oregonians 16 and older will be eligible May 1.
During the initial round of vaccines, phone lines at Asante were constantly ringing, said Doug Ward, vice president of operations at Asante Physicians Partners. That initial surge has leveled off, but Ward thinks the increased eligibility will ramp vaccine interest back up.
“With more availability of vaccine, I think that demand will be met fairly soon,” Ward said. “I think we’re doing a pretty good job of getting vaccines into arms and managing this as a whole.”
The presence of virus mutations has meant increased urgency for the medical community to continue vaccinating, Shames said.
“The fact that we have variants that are spreading, and that the variants seem to increase the infectivity of the virus, and, in some cases, the severity of the virus, there really is a race going on,” Shames said. “And the race is to knock down the transmissibility of the virus enough that these variants will not continue to spread aggressively.”
On Friday, OHA officials reported 19 variant cases “of either interest or concern” in the state of Oregon, State Health Officer Dr. Dean Sidelinger said.
Variants of interest are defined as variants with “specific mutations that are predicted to affect how the virus spreads, can be detected or can be treated,” he said. Variants of concern are variants with “evidence for increased transmission or disease severity or evidence of an affect on testing, treatment or vaccine effectiveness.”
The OHA added that laboratories at Oregon Health & Science University, the University of Oregon and Oregon State University are studying the mutations. On Monday, the Oregon State Public Health Laboratory will join them in similar work.
“This will significantly expand our capacity to monitor changes in the COVID-19 virus, along with other diseases of significance,” Sidelinger said.
Even with vaccines flowing, medical officials urge the public to continue wearing masks, and practice thorough hand washing and physical distancing.
Much of the initial resistance to masks has tempered, Phillips said. It was a challenge from a public health standpoint, especially because of the initial discouragement against the practice due to personal protective equipment shortage concerns.
“To see the evolution, it’s been great,” Phillips said. “I love looking at people’s masks in the store. You definitely see statements made.”
Dr. Dan Weiner, chief medical officer for Rogue Community Health, said an alignment of messaging has been beneficial.
“I think over the course of the past year as the evidence mounted for the value of these things, it became indisputable,” he said. “Masking works.”
The increased use of telemedicine and video visits has also helped with physical distancing at clinics and doctors offices.
“We went from maybe 10% of our visits being video or phone to 90% within just a few weeks,” Ward said. “That bought us enough time to develop pathways for people to continue to get into the doctor safely and open the doors back up for people to be seen in person.”
Masking has come with a related benefit, health officials say. It’s contributed to a sharp drop in the number of cases of less contagious viruses such as the flu, both in Oregon and across the U.S.
OHA has not recorded any influenza outbreaks anywhere in the state for the 2020-21 flu season. The number of weekly positive tests for flu in the state has never reached 10, data show. Most weeks, it never hit five. Percentage-wise, there wasn’t a week where the number of positive tests reached the 1% mark. In Jackson County, influenza is considered widely circulating in the community if at least 10% of test results from participating health agencies come back positive two weeks in a row.
“We never came anywhere close (this year),” Phillips said.
CDC data show similar low percentages for the flu, with weekly test data never hitting 1%. Pediatric deaths from the illness were also low. The past three flu seasons, recorded pediatric flu deaths in the U.S. were between 140 and 200, with 188 for 2017-18, 144 for 2018-19, and 196 for 2019-20. As of last week, there had been one for all of 2020-21.
“It’s profound,” Shames said. “Clearly we haven’t done anything different except there’s lots of masking and social distancing and hand washing. And it really has worked.”
COVID-19 hospitalizations across the state have continued to drop gradually. As of Thursday, the 108 people hospitalized with COVID-19 in Oregon reflected a 77% decline for 2021 thus far, OHA officials said.
Hospitalizations in Jackson and Josephine have started to creep back up, OHA data show, with 11 hospitalizations for the two-county region March 14 and rising to 22 by March 26. The high point came Jan. 2, when 69 people were hospitalized in the two counties.
An expanding knowledge base about the virus has continued to inform area hospital protocols.
“I think we understand a lot more about the transmissibility, about the protective measures that our caregivers need to take around isolation,” said Dr. Jason Kuhl, chief medical officer for Providence Medford Medical Center. “More than that, I think (it’s) the therapeutic approaches, understanding how the respiratory physiology works when people get afflicted by the virus.”
Kuhl added that the use of intensive care beds and ventilators is less necessary now than at the beginning. Antiviral therapies such as Remdesivir are also being utilized more, Kuhl said.
“There’s a lot more of what’s called passive hypoxia, where (doctors) are not trying to manage so aggressively the oxygen levels as they were at the beginning,” Kuhl said.
“The comfort level of staff caring for the patients has increased,” he added. “The anxiety of having a COVID-positive patient in house persists, but it is much less than what it was.”
As the plane continues to be built, lessons continue to be learned.
The pandemic showed the gaps in public health and health care infrastructure, Phillips said.
“For me, that’s been probably one of the hardest pieces,” she said. “On a day-to-day level ... our health systems aren’t equipped to respond to the pandemic as we did. Did we ramp up, and have we been working to do that? Absolutely. But for public health, it’s not an infrastructure that is funded on a day-to-day basis to really be able to respond to something like this. I think that has been seen across the nation. I don’t think anybody would have a different opinion on that.”
Locally, the September wildfires strained the system further, she said. Suddenly, public health officials were helping displaced individuals while working on air quality concerns as the pandemic wore on.
“So we had three disasters that we were working within, and you have a few people doing that, so you don’t have the depth to where you can keep COVID, have your team deploy someone else to go do the fires, and the wildfire smoke,” Phillips said. “It was still that one team doing all three.”
The past year has been revealing for inequities in health care, Shames said, especially among people of color, multigenerational families, and those who could not afford to work from home.
“Those were fundamental structural inequalities that were brought forward by this pandemic,” Shames said. “That’s always been the role of public health, to look at health care through an equity lens, but the pandemic really put a spotlight on it.”
Other health officials pointed to the ongoing impact to businesses.
Moving forward, however, Shames feels a sense of encouragement, inspired by the cooperation he’s witnessed.
“You know how people talk about the heroes and the (emergency departments) and the nurses who are working long hours?” Shames said. “You could really sort of step back and look at that with health care providers that have other roles to play in the community. The small clinics that stepped forward and gathered volunteers and delivered vaccines in the parking lot, or the hospital systems who are usually competitors who figured out how to work together to create a high throughput, high volume vaccine clinic in our community.”
“I think we’ve seen that sort of thing play out over the year,” he added. “And that’s the kind of thing I would love to institutionalize, and to support and kind of look at the system and figure out a way that we can keep those things, because they really benefit our community, and they will do so into the future.”
Reach Mail Tribune web editor Ryan Pfeil at 541-776-4468 or firstname.lastname@example.org. Follow him on Twitter at @ryanpfeil.