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Oregon Coronavirus Update Fri 5/8/2020: Oregon's reopening, Latinx, Children, Masks (again).

Oregon Coronavirus Update

Fri 5/8/2020


Lisa Reynolds MD

This is Lisa Reynolds, MD. Portland Pediatrician, mom and daughter. Democratic candidate for State Representative, Oregon HD36.

Today: Oregon’s Governor Brown announces reopening plans: Phase 1. Oregon’s (and America’s) Latinx are disproportionately hit by COVID. Children can get and can transmit COVID. The case for masking (repeat).


Coronavirus: The numbers

  • WORLDWIDE: 3.8 million confirmed cases, 269,000 deaths

  • US: 1.25m confirmed cases, 76,000 deaths;

  • OREGON: 3000 confirmed cases, 115 deaths (last day: 70 new cases, 6 new deaths)

  • In Oregon cases are increasing

  • Week 7 of Gov Brown’s Stay Home Order

  • Unemployment claims: US 33.5m; Unemployment rate: US 15%



Oregon’s plan

Summary: Counties or regions (groups of counties) can apply (starting today) to reopen phase 1 starting 5/15. The county or region must have prerequisites and controls in place. Phase 1 includes bars, restaurants, personal care (salons, gyms, etc) and includes strict social distancing and masking.

Gov Brown held a press conference today (5/7) announcing plans for some reopening Fri 5/15.

  • Several state parks have already opened ⅚, more 5/7 and 5/11. No camping yet. Continue social distancing and consider masks. Update: https://oregonstateparks.org/

  • Non essential medical procedures already being performed

  • Expanded childcare already open (priority essential workers)

  • “Until there is a vaccine, we will not be able to go back to life as we knew it”

  • No large gatherings (concerts, sports events, festivals, conventions) anywhere in the state will be allowed through the end of September. Gatherings up to 25 allowable with social distancing.

  • May 15: Small retailers can open regardless of county phase 1 status

  • Phase 1

  • Restaurants and Bars - with social distancing, required masks for staff, recommended masks for customers, close by 10pm

  • Personal care (salon, tattoo, massage, nails, gyms) - with social distancing, increased sanitation, records for contact tracing, masks and gloves, screen before appt, no waiting rooms

  • Retail businesses - with social distancing, masks for employees

  • Gatherings of up to 25 people, still maintaining social distancing

  • Still promote work from home and high risk people should stay home

  • Counties OR region (see region list below) can apply to reopen starting Fri ⅝; if passes, it can open 5/15: Phase 1

  • Must meet criteria for reopen seven public health criteria

  • declining COVID hospital admissions over 14 days and Hosp ER visits for COVID symptoms are lower than flu-like symptoms for this time of year

  • Testing and contact tracing capacity - capacity to test 30/10K people per week [region] (prioritize those with symptoms, contacts of cases, frontline workers, workers who cannot socially distance); 15 contact tracers/100K people (trace 95% of cases within 24 hrs)

  • Hospital surge capacity and adequate PPE - to accommodate 20% surge in COVID [region]; 30 d supply of PPE

  • Quarantine and isolation facilities (hotel rooms)

  • Communications to businesses - workplaces must be safe

  • A plan to resume restrictions if COVID cases increase

If all goes well after 21 days, can move to phase 2 (undefined)

  • <5% increase in new cases over a week, not increasing % positive

  • >70% of cases are traced to known contact

There is an expectation that folks from higher risk counties not travel to lower risk (open) counties.

Coming soon: Guidelines for childcare, summer school, summer camps and youth programs.

Coming soon: Specifics on Masking Requirements v Recommendations

  • Required by employees in businesses where one cannot maintain social distancing

  • Recommended that business requires customers to mask

  • Strong recommendation for masks in public spaces where cannot maintain sd


Addendum: Health Regions: Health region 1: Clatsop, Columbia, Tillamook, Washington, Multnomah, Clackamas Health region 2: Yamhill, Polk, Lincoln, Benton, Marion, Linn Health regions 3 & 5: Lane, Douglas, Coos, Curry, Jackson, Josephine Health regions 6 & 9: Hood River, Wasco, Sherman, Gilliam, Morrow, Umatilla, Union, Wallowa, Baker, Malheur Health region 7: Jefferson, Deschutes, Crook, Wheeler, Grant, Klamath, Lake, Harney



Latinx

Are getting sick at rates twice their share of the population (front line workers, no sick pay, no health insurance, higher rate of medical risk factors, crowded living esp among farm workers)

Oregon is issuing guidelines for housing and workplace for migrant farmworkers effective May 11

  • Social distancing in workplaces

  • One toilet and sink per 10 workers (double the current) which are sanitized 3 times a day

OHA will be testing farmworkers for COVID



Shield Immunity

Latest research: Those who have been sick with COVID (eventually) make antibodies.

Antibodies to COVID should neutralize COVID virus if a person is infected a second time.

Antibody tests are flawed but improving and are still under study.

Antibody results are not being tracked in OR.

Our understanding of antibodies suggests that COVID antibodies should protect an individual from falling ill to the disease a second time. This is called Shield Immunity. This needs to be confirmed. And it’s not clear how long this immunity will last.

But it can be hoped that those who are antibody positive can return to work, can replace vulnerable individuals.


R0 “R-naught”

https://www.nytimes.com/2020/04/23/world/europe/coronavirus-R0-explainer.html

R0 is a statistical term that “represents the number of new infections (in this case, COVID infections) that are estimated to stem from a single case.”

A R0 of 2.5 means that typically, a sick person infects 2.5 other people.

“An R0 below 1 suggests that the number of cases is shrinking, possibly allowing societies to open back up. An R0 above 1 indicates that the number of cases is growing, perhaps necessitating renewed lockdowns or other measures”.

We arrive at an R0 using mathematical models, our understanding of disease transmission, local factors (crowding, measures in place), average time between infection, etc. Its value changes over time and place and many things, including human behavior, affect it. A tiny increase in R0 can have huge implications. Indeed Angela Merkel described this here.



Children

Summary: Children can get infected and can spread COVID.

https://www.nytimes.com/2020/05/05/health/coronavirus-children-transmission-school.html?referringSource=articleShare

In Oregon - 100 kids <20 have been diagnosed with COVID

In NYT: 15 kids hosp post COVID with Kawasaki/Toxic Shock like vasculitis

NYC: 6 children have died

COVID symptoms include: COVID toes, COVID testicles (inflammation of toes, inflammation of testicles)

Make no mistake, kids can get COVID. Mostly, their COVID illnesses are mild.

BUT Can kids transmit COVID? The answer has huge implications for school reopening.


https://science.sciencemag.org/content/early/2020/05/04/science.abb8001.full

This article in the respected journal Science shows that children are about ⅓ as susceptible to COVID than adults, but when in school, they are exposed to three times as many people as adults so that their risk of getting infected with COVID (and spreading COVID) is similar to that of adults.

A second study shows that when children have COVID infections, they harbor as much virus as adults. This suggests they are as contagious as adults.

Statistics: closing schools in China dramatically slowed the number of new COVID cases.

Still: There are huge reasons to consider reopening schools, even in light of this data. Most kids’ learning has suffered. Kids are missing out on social interactions, and maybe their homes are not safe spaces. Mental health is a concern.

“The experts all agreed on one thing: that governments should hold active discussions on what reopening schools looks like. Students could be scheduled to come to school on different days to reduce the number of people in the building at one time, for example; desks could be placed six feet apart; and schools could avoid having students gather in large groups.” Masks should be required and teachers at high risk for COVID complications should not be in the classroom.

STAY tuned.


The case for Universal Masking (REPEATED from last week.)

https://medium.com/@tomaspueyo/coronavirus-the-basic-dance-steps-everybody-can-follow-b3d216daa343

Universal masking: It’s cheap, it’s easy and it can really stop the spread of COVID!!

  • NYState requires universal masking, as does SF and LA.

  • 25% of countries mandate masks in some public settings.

  • Most countries recommend masking

  • Half of COVID is spread from someone with sx, ½ spread by asymptomatic or presymptomatic.

  • If just 60% of folks wear masks that are 60% effective, we could control the spread!

The spread of COVID

  • Initially thought to be via large droplet from a coughing or sneezing contagious person, which would fall to the ground within 6 feet. So: 6 feet of social distancing.

  • Then - evidence showed that the virus could travel farther - tiny droplets. AND that singing or talking propels virus into the air.

  • Masks will prevent a contagious person from emitting virus by keeping the virus behind the mask. A mask prevents droplets from “entering” a potential victim. Masks can have a tremendous impact on reducing transmission of virus.

  • About half of contagious people are without symptoms (it’s before they develop illness or they are in the minority who can spread the virus without ever having any symptoms). See chart

Why are we NOT recommending universal masking?

  • Misunderstanding of how virus is spread (6 feet separation was felt to be sufficient. This is now discredited.)

  • Concern for shortage of masks for medical personnel

  • But now we know home-made masks are effective for stopping spread

  • Oregon language in OHA “You can wear a mask…” I think we should change to “you should wear a mask.” or even “you must wear a mask”


Okay, so we should be universally masking. What kind of mask?

  • Medical personnel need medical masks

  • OTHERS: Homemade: Most any material will work - the tighter the weave, the better. The more layers the better. See graph

  • Here is a link to quickly make your own mask without sewing. Many sewers are making masks - check fb or etsy.

  • If 60% of us wore masks that were 60% effective at blocking the droplets/virus, we would decrease the transmission rate to one person per positive case. This halts the spread of COVID.


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This website is written by Lisa Reynolds, MD, Portland, Oregon Pediatrician on the front lines of the coronavirus epidemic. Mom and daughter. Candidate for Oregon HD36.

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