Oregon is moving into the third stage of the COVID-19 pandemic crisis, but still has a long way to go until it is over, the House Interim Committee on Health Care heard Thursday.
Lawmakers met via a videoconference, with Rep. Andrea Salinas, D-Lake Oswego, the committee chair, joking she had found a rubber mallet in her garage to replace the traditional wooden gavel used in Capitol hearing rooms. The meeting was the committee’s first since the coronavirus swept into Oregon in March, killing 147 and sickening more than 3,800 since. Though hearings during the interim between legislative sessions cannot consider legislation, they are often used to shape bills to be drafted in the future.
Patrick Allen, director of the Oregon Health Authority, gave an overview of the pandemic. Allen credited early action to shut businesses and ask residents to stay at home with the relatively low number of infections and deaths in Oregon. The virus, which originated near the end of 2019 in China, has killed an estimated 336,000 people worldwide, including more than 95,000 in the United States.
The economic fallout pushed the unemployment rate in Oregon from a record low of 3.5% in March to 14.2% in April. That percentage is expected to grow.
Allen said Oregon is in the third phase of fighting the COVID-19 pandemic, shifting from containment, then mitigation, and now suppression.
Though the state is allowing some businesses to reopen and relaxing some restrictions on public life, Allen said the pandemic was far from over.
“We will be at this with coronavirus for 12 to 24 months,” Allen said. “That is a disheartening figure.”
Allen said the state knows that infections will not drop as the economy restarts.
“We know there will be more coronavirus cases in the state,” Allen said, adding the goal was to “keep the increase at a rate that doesn’t tax our health care system.”
The goal is to manage the pandemic in Oregon in a way that will possibly allow schools to reopen in the fall and additional restrictions to be lifted.
Oregon has the fifth lowest per capita rate of positive cases in the 50 states, and the fifth lowest number of deaths per capita, Allen testified.
Allen outlined some of the lessons learned by state officials during the crisis.
The state believed local health care providers would be able to use personal protective equipment — known as PPE — already on hand, then dip into state supplies, which in turn would be restocked by the federal government. It didn’t work out that way.
“Private supply chains locked up at the very beginning,” he said.
Much of the state supply was left over from the N1H1 flu crisis in 2009, a large share of which was at or past the expiration date for safe use. Federal supplies were difficult to obtain.
“We need to modernize our stockpile of PPE,” Allen said. “We must be better prepared.”
Because of the coronavirus, residents — especially children — were not getting immunized for other diseases out of fear of visiting health care providers. This could lead to secondary health problems in coming months.
“The immunization rate has fallen off a cliff,” Allen said.
Overlapping areas of responsibility put federal, state and local agencies at odds. There were criss-crossing and sometimes contradictory announcements, directives and rules. Health care providers and food processors were among those most affected by revisions. Better coordination is needed in the future to cut confusion, Allen said.
Long-term health care facilities, especially for older and more ill residents, have accounted for a large percentage of coronavirus deaths nationwide. While the effect was felt in Oregon, the state has not had the “horrifying” level of concentrated deaths in the facilities found in Washington, New York and other states. Allen said he was working with the Department of Human Services on plans for how to handle the ongoing pandemic and also prepare for future disease outbreaks in long-term care facilities.
Allen said health officials must improve on delivering on the state’s commitment to health equity, ensuring access to testing and care is not driven by economic status, race or geographical location.
“In a crisis, everyone’s field of vision shrinks,” he said. “We go back to the way we used to do things.”
Not all the lessons have been negative. The use of telemedicine — with doctors or nurses talking to patients via virtual meetings on computers or smartphones — has advanced swiftly because of the virus.
“We have been pushing the telemedicine rock uphill for years and years,” Allen said. “We were able to flip a switch during the pandemic.”
Allen said Oregon was working with California and Washington states to urge the federal government to make the emergency waivers governing telemedicine visits permanent.
“We don’t want to leave these improvements in the system behind,” he said.
The state is also looking at keeping the practice of asking law enforcement dispatchers to question callers asking for assistance whether anyone at their address has a contagious illness. Officers will respond regardless of the answer, but can better prepare by outfitting with protective equipment if needed.
Access to protective equipment
The committee also heard from a variety of state officials, health care professionals and advocacy groups about experiences during the pandemic.
Dana Hargunani, chief medical officer of the Oregon Health Authority, said access to protective equipment still differs around the state, especially between urban and rural areas.
“It continues to be heavily inconsistent,” she said.
While the shortage of N95 face masks has been alleviated, hospitals are reporting a shortage of medical gowns.
The lack of equipment has caused a high infection among health care workers. Hargunani said about 16% of all those infected in Oregon are health care workers, with 75% of those involved in direct care of COVID-19 patients.
Sarah Laslett, executive director of the Oregon Nurses Association, said the group’s members are concerned the state may be moving too quickly to open up businesses when there isn’t an adequate supply of protective equipment everywhere.
“Safe enough isn’t good enough,” she said. Members are “furious we are not wearing face shields all the time with all patients.”
Chris Strear, president-elect of the Oregon Chapter of the American College of Emergency Physicians, said hospitals continue to operate on a crisis basis.
“We are deeply worried about safety of our patients, our families, ourselves,” he said.
Strear told of one doctor who said the shortage of proctective equipment at the height of the crisis has led to trying to sterilize equipment at home using a crockpot.
Some emergency medical personnel had moved into their basements or stayed in recreational vehicles parked in their driveways rather than risk unknowingly infecting their families when they come home after a shift.
“On a personal note, I haven’t seen my children since March,” Strear said.
Courtni Dresser, director of government relations for the Oregon Medical Association, said only one-third of Oregon doctors in the group said they currently had access to an adequate supply of proctective equipment.
Doctors are not seeing many patients with ongoing medical conditions, which could lead to medical issues and possible liability claims in the future. It also chokes off income used to pay staff, who have often been furloughed or had their pay cut. Doctors are working long hours under stressful conditions, leading to physician burnout.
“This is not sustainable,” Dresser said. “We are going to need additional assistance to keep the state health care system intact.”
‘A whole new inequity’
Brenda Johnson, chief executive officer of La Clinica, a community health care group serving the Hispanic community, said that while telemedicine was an important new tool, there is a lack of access for the poor and minority communities .
With rising unemployment, community health centers will be seeing a larger share of people seeking medical help, Johnson said.
They lack the leverage of hospitals and for-profit medical groups to get lower prices on equipment.
Barry Taylor, president of the Oregon Dental Association, said his members were often overlooked when needs of the community during the crisis are considered. He said 70 % of offices reported layoffs of staff.
“The dental industry is the hardest hit,” he said.
Patients are delaying care, causing an increasing number of emergency visits. Dentists first volunteered, then were asked by the state, to give proctective equipment to medical providers during the onset of the crisis in March. Now dentists are finding it difficult and expensive to replace.
Lawmakers asked the state agencies to come back with more information about the financial impact on state health care agencies, and to get deeper data on the virus and its impact on groups such as agricultural workers that have a higher than average infection rate.
Olivia Quiroz of the Oregon Latino Health Coalition said that 32% of infections were among the Latino community even though they make up only 12% of the state population. She said the problem is due to overcrowded housing, loose working conditions in agriculture, a lack of access to medical care and fear from some that seeking help will lead to reports to federal immigration authorities.
“COVID-19 didn’t create these inequities, but it has exposed them,” Quiroz said.
Dean Sidelinger, state public health officer for the Oregon Health Authority, said state officials are well aware the pandemic is exposing problems within the health care system.
“Some of these conversations didn’t happen early enough,” he said.