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Oregon Coronavirus Update: Numbers rising, Testing update, rethinking school

  • Writer: Lisa Reynolds, MD
    Lisa Reynolds, MD
  • Oct 13, 2020
  • 5 min read

Oregon Coronavirus Update

Lisa Reynolds, MD, pediatrician and Democratic nominee for Oregon House District 36.

10/13/20 (numbers below are from 10/11/20)


Summary: Oregon’s COVID numbers are on the rise. Oregon is slated to receive rapid COVID tests from the federal government which will double Oregon’s testing capacity and should help facilitate tracing and, thus, help slow the spread of COVID. Oregon continues to have outdated masking guidelines and is still low on the PPE needed to protect frontline workers and make schools safe for in person learning. There are some promising vaccines on the horizon. We are still a long way from “back to normal” and need to find a middle ground, especially when it comes to return to school.


COVID in the World

We have surpassed a chilling milestone: At least a million people worldwide have died due to COVID19 and 37m have been sickened by the disease.


COVID in the US

Cases: 7.7 m Deaths: 214,000

So while the US makes up 4.4% of the world’s population, we make up over 20% of the world’s deaths. And we are the richest, most advanced country in the world. (Although the US has the highest degree of wealth inequality in the world.)

Cases are increasing - 12% over a two week period, especially in the upper Midwest and Rocky Mtn areas, with some uptick on the east coast.


COVID in Oregon

Cases: 37,000 (875/100K) - we had 3 days in a row of >400 cases (reported Thu, Fri, Sat) with 337 cases noted today.

Deaths: 600 (14/100K)

This is among the 10 best in the nation.

Our numbers/rate are increasing.

Clusters: Prisons: 1335 cases (5 locations), food processing 615 (5 locations), colleges/univ 504 cases (16 schools), Nursing homes 226 (3 locations)



Not happening in Oregon that needs to happen:

[Caveat: We must acknowledge: FEDERAL failure.]

  • Enforcing/monitoring Workplace Safety: Workplace surveillance/follow up on unsafe practices (Occupational Safety & Health Admin: OSHA). We have continued workplace outbreaks, including Pacific Foods in Clatsop county (77 cases).

  • Contact Tracing - no retrospective tracing of contacts of COVID+ people (the COVID+ people are being contacted, but not going retrospective….)

  • Testing Testing Testing - we’ve been outbid by larger states and Oregon has had among the lowest testing rates in the US. We have inadequate testing supply for reasons that are inexplicable.

    • Good news: Oregon expects tests from Fed Govt: 60,000-80,000 per week, rapid antigen tests (which can be falsely negative). ; Doubles current capacity. (Will maintain strategic reserve.)

    • This spurred a change in OHA criteria for testing: Any one with symptoms, OR anyone who has been in contact with someone who is COVID+

    • I maintain policy should follow science, not supply of tests.

  • Masking/Face Shields

    • Needed: Better Public Education and Enforcement of Masks and social distancing

    • SHIELDS alone are not adequate but are still allowed by OHA (CDC does not allow shield alone as sufficient protection from COVID).

PPE- decentralized - there is no state level action and counties are competing with each other or even with places like CA. There continues to be a PPE shortage in Oregon. This impacts health care and the ability for schools to reopen.


Recent survey (Aug 27-Sept 11; 1000 Oregonians):

  • Half say they attended 0-3 social gatherings in past 2 wks; 80% of these <10 people

  • ⅓ attended 4-10 gatherings in the past 2 weeks.

  • 84% almost always wear a mask indoors

  • Still alot of folks think COVID is not a huge concern/less likely to mask/quarantine etc


Schools in Oregon

Oregon: metrics for school reopening (these are being re-considered, in acknowledgement of the difficulties in meeting these metrics and the urgency in getting at least some students back to in person learning.)

  • County Metrics-metrics to be met three weeks in a row:

Case Rate ≤ 10 cases/100K in preceding 7 days (Mult: 41/; Wash: 42/

Test positivity ≤5% in preceding 7 days (Mult cty: 6.4%, Wash: 5.5%)

  • Test positivity ≤5% in preceding 7 days (current: 6.3%)

  • Local District announcements: PPS - virtual until Jan; BSD - virtual until Feb

There are risks to virtual learning.

  • School closures are especially difficult for working class families who cannot afford tutors, pods, or private schools.

  • Mental health issues - isolation, toxic stress

  • Achievement Gap - those already falling behind are most affected

  • Less active/less outdoor time.

  • Attendance is less than par. (Dr Hayes - 2 kids hadn’t registered yet)

  • WIFI and hardware challenges.

  • Is there a way to open schools to the most vulnerable (how to define?)

  • Can we shore up our schools NOW to prepare for in person learning sooner?


School Elsewhere (56 m kids in school starting in Mid Aug). Emily Oster/Brown Univ gathering data: COVID19 School Response Dashboard; https://www.theatlantic.com/ideas/archive/2020/10/schools-arent-superspreaders/616669/

So far, the mitigation that is most linked with preventing COVID spread is group size <25

  • Schools do not appear to be super-spreaders (rates of <<0.5% of kids getting COVID, much lower than feared.)

  • (Kids <12 y/o spread the virus less; kids have milder disease.)

  • WE NEED TO ACCEPT RISK THAT MAY BE HIGHER THAN ZERO.

  • Universities have much higher rate of outbreaks.



Herd immunity

  • Thru vaccine, illness/recovery or both

  • If we continue with safety measures (handwashing) we can achieve herd immunity with a lower % “protected”.



COVID Therapies

Remdesivir: Shortens the course of illness in hospitalized patients with pneumonia.

Steroids (Dexamethasone): Helps blunt inflammation in hospitalized patients.

Monoclonal antibodies (investigational): Mass produced antibodies that are mimics of the molecules the body produces against the COVID virus. These molecules work in a variety of ways, including preventing the virus from infecting cells, or tamping down the number of virus in an infected patient. MAY EVEN BE USED as a preventative: giving the antibodies to those who have been exposed.

  • Eli Lilly product - paused clinical trials 10/13/20 d/t illness of a patient

  • Regeneron product - given to Trump

Hydroxychloroquine: not useful in treating COVID.


COVID Vaccine: Testing

Goal: Safe vaccine with at least 50% efficacy.

Need: understanding of genetic and molecular structure of the virus - record scientific breakthroughs on this.

Process (may be accelerated by combining phases, eg test on 100s of humans early.): Preclinical phase: test in cells, then in animals (mice, monkeys) to see if it triggers immune response. 91 vaccines

Phase 1 Safety: Small numbers of humans, for safety, dosage, and for immune response. 29 vaccines.

Phase 2 Expanded: Hundreds of humans of different ages, etc, for safety, dosage, and immune response. Does it vary with age group, gender? 14 vaccines.

(China and Russia have allowed early approval of 5 vaccines before results of Phase 3 available.)

Phase 3 Efficacy: Thousands of humans. Vs Placebo. Efficacy and safety (rare side effects). 11 vaccines.

Approval: 0 vaccines.




COVID Vaccine: Types/Leading Contenders

Genetic: Vaccines deliver viral genetic material into our own cells to produce viral proteins that trigger immune response. There has never been a successful vaccine using this technique.

  • Moderna vaccine (Phase 3): mRNA in lipid coat that “slides” into cells. mRNA codes for the spike proteins found in the coat of COVID (spikes give crown-like/corona appearance and are the proteins that bind to receptors in host cells), so cells start making these spikes. Immune system react to the (“foreign”) spikes with antibodies and other responses.

  • Pfizer (Phase ⅔):

Viral Vector: Vaccines contain viruses that carry coronavirus genes: (a) viral vectors enter cells and cause them to make viral proteins or (b) viral vectors slowly replicate, carrying covid proteins on their surface. There is an oral version of this type of vaccine in the works.

  • Oxford vaccine (Phase 3) w Astra Zeneca: weakened chimpanzee adenovirus (cannot replicate) with gene for COVID spike vaccine - triggers antibodies and other immune responses. “Live” vaccine may confer stronger/longer immunity but carries risks to immunocompromised.

[one case of transverse myelitis paused vaccine trial, now resumed]

  • CanSino (Phase 3): weakened human adenovirus.

  • Johnson & Johnson (Phase 3): weakened adenovirus, used same scaffold for Ebola vaccine. On pause for one ill patient, possibly vaccine related.

Protein-Based: COVID protein or parts of proteins, some are packaged on nanoparticles.

  • Novavax (Phase 3): Spike proteins stuck to nanoparticles + adjuvant (wc boosts immune system).

Inactivated or Attenuated Viruses: killed or weakened with chemicals

  • Sinovac (China) (Phase 3): CoronaVac in limited use in China. Inactivated - may need booster.

  • SinoPharm (Phase 3): in limited use in China/UAE

Repurposed: Vaccines designed for other diseases that may protect against 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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Lisa Reynolds, M.D., Announces COVID-19 Pandemic Recovery 

Legislative Framework

Proposed framework prioritizes health of all Oregonians, with phased restart of state’s economy

 

April 17, 2020 (Portland, OR) - Lisa Reynolds, M.D., a physician and candidate for Oregon House of Representatives-District 36 (NW/SW Portland), released a legislative framework called the Oregon Pandemic Recovery Act, with the goal of making this the first bill of the 2021-22 legislative session (HB-1). 

 

“In the next weeks and months ahead, I plan to work with state leaders, as well as community and business leaders, to help design Oregon's transition and recovery from the pandemic,” said Reynolds. “If we do this right, Oregon can come out better than ever. And of course, I will continue to reach out to Oregonians about what they need right now so we can help.” 

 

The Oregon Pandemic Recovery Act, a bold response to COVID-19’s unprecedented threat to Oregonians lives and livelihoods, consists of three major components:

 

  1. A large-scale and ongoing public health response that utilizes universal testing, contact tracing, and isolating the ill and the exposed.

  2. The moonshot goal of achieving widespread (“herd”) immunity (80-90 percent) to COVID-19 through demonstrated antibodies and/or vaccination. This is a prerequisite to full economic and societal opening.

  3. Post-pandemic massive investment to modernize Oregon’s healthcare system, schools and infrastructure through the sale of Oregon COVID Bonds.

 

Oregon COVID Bonds would allow Oregonians, as well as others around the country and the world, to invest in Oregon. “This will allow the state to build a healthcare system that improves the health of every Oregonian, to complete long-neglected infrastructure projects and to modernize our schools,” stated Reynolds.  

 

“I want everyone to understand that the 2021-22 legislative session must be focused entirely on pandemic response and recovery,” said Reynolds. “I believe we can rebuild Oregon and make us stronger and more equitable in the process.” This legislative framework also accounts for a lack of federal leadership, positioning Oregon as a national leader.

 

The latest numbers in Oregon show that the state is predicted to peak on April 26. As a result of Governor Brown’s Stay Home Order, Oregon’s hospital systems have sufficient capacity to care for those sickest with COVID-19. Reynolds says that eventually, the cumulative number of new illnesses and deaths will plateau. Oregon will then enter a period of transition, and once sufficient herd immunity is achieved, we can move into post-pandemic recovery.

 

“As a physician, I have prepared my entire career for this moment,” says Reynolds. “We cannot rely on the status quo or politics as usual. We need leaders with medical expertise who can work across the aisle and bring fresh perspectives at this critical time in our history. We need courageous and bold action to make sure that Oregon comes out of this crisis stronger and more equitable than before.” 

 

Reynolds, who was recently endorsed by the Portland Tribune “[for] her invaluable insight for these troubling times”, also says that, “every state policy and every state agency will need to prioritize spending and services through the lens of the pandemic.” 

 

Read the full legislative framework here. Visit Reynolds’ COVID-19 website at oregoncoronavirusupdate.com or her campaign website LisaForOregon.com. Follow Dr. Reynolds on Facebook, Instagram, Twitter (@lisafororegon).

 

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Oregon Pandemic Recovery Act Legislative Framework

 

Following is a legislative framework for a successful and equitable recovery from the COVID-19 pandemic called the Oregon Pandemic Recovery Act (HB-1). This legislative framework was drafted by Lisa Reynolds, M.D., candidate for Oregon State House of Representatives-District 36. Dr. Reynolds, who will solicit feedback from voters about what the Oregon State Legislature needs to focus on in the upcoming 2021-2022 legislative session. 

 

Dr. Reynolds will also work with state leaders, as well as community and business leaders, to identify the most impactful and cost-effective steps to get Oregonians back on solid ground. The Oregon Pandemic Recovery Act is a bold response to COVID-19’s unprecedented threat to Oregonians’ lives and livelihood. The framework consists of three major components:

 

  1. A large-scale and ongoing public health response that utilizes universal testing, tracing of all contacts, and isolating the ill and the exposed. Extensive, if not universal, testing, both for the presence of the virus, that is, contagiousness, and presence of antibody, or immunity, is necessary before any significant reopening of the economy. Testing must be followed up with tracing of the contacts of all COVID-19 cases, and isolation for those infected or exposed.

  2. The moonshot goal of achieving widespread (“herd”) immunity (80-90%) to COVID-19 through demonstrated antibodies and/or vaccination. This is a prerequisite to full economic and societal opening. True economic reopening requires widespread immunity, either through previous COVID-19 illness or through widespread vaccination.

  3. Post-pandemic massive investment to modernize Oregon’s healthcare system, schools, and infrastructure through the sale of Oregon COVID Bonds.

 

Any full scale ‘re-opening’ in the near future would risk Oregonians’ lives. Rather, restrictions must be lifted methodically and incrementally. The state needs to start planning for a massive vaccine campaign as soon as the vaccine is available. Oregon should be the first state with demonstrated ‘herd immunity’ so that Oregonians can resume safe interactions with friends, family, and neighbors. 

 

HB1: The Oregon Pandemic Recovery Act of 2021-2022 Outline

 

Intra-Pandemic: Stay Home, Save Lives

  • Goals

    • Primary Goal: Save as many lives as possible

    • Secondary Goal

      • Educate and feed children

      • Protect the vulnerable from economic damage

  • Strategic Initiatives

    • Test/trace/isolate - build a public health workforce 

    • Tech for schools - provide robust learning for every Oregon student

    • Table - feed the hungry, allocate unemployment benefits, provide rent relief and continue to ban evictions

 

Transition: reopening (gradual and partial)

  • Goals

    • Primary Goal: Save as many lives as possible

    • Secondary Goal:

      • Safe return to economic life (incremental, methodical)

      • Safe return to school 

  • Strategic Initiatives

    • Universal testing/tracing/isolation - database

    • Statewide Alert system for Oregonians for disease hot spots

    • Build a vaccine fund - and a system to vaccinate all Oregonians

 

Post-Pandemic (herd immunity; post-vaccine) - a stronger, more equitable Oregon

  • Goals

    • Economic recovery 

    • Prepare Oregon for its greatest decade of economic growth

    • Improved lives for all Oregonians

  • Strategic Initiatives

    • Oregon COVID Bonds - to raise and invest $4B/year for 5 years

      • Basics

        • Modernize public health and healthcare systems

        • 21st-century schools from PreK-post secondary

        • Build Infrastructure - bridges, public transport, bike lanes

        • Build Housing - affordable & supportive housing

      • Boosts: Climate action

        • Give preference and priority for projects that reduce carbon, increase climate resiliency, and increase economic opportunity equitably. 

 

The proposed funding would be through COVID-19 Bonds. This approach would allow Oregonians, as well as others around the country and the world, to invest in Oregon. This will allow the state to build a healthcare system that improves the health of every Oregonian, to complete long-neglected infrastructure projects and to modernize our schools. 

 

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