Q&A with OHA: Oregon’s Public Health Conversation

Posted by on Jul 17, 2020

The Oregon Health Authority (OHA) has been spearheading dozens of efforts to quell the COVID-19 pandemic–massive data collection, testing expansion, policy changes, guidance development, standing up the field of contact tracing, research into emerging medical evidence from here and around the world, and so much more. In addition to that work, they have created regular ways to communicate this work with various communities in Oregon. As part of the community service array in Oregon, OSSA has been joining the weekly Community Partner information calls that OHA has hosted. We have also joined a few of the media conferences hosted by OHA for media questions and answers. Today we’ll share some of the interesting discussions we’ve heard regarding COVID-19 in Oregon.

The daily case counts are on the rise. Where are these new cases coming from?

The combined numbers are scary, but it is good that we have more specific information now than we did when this began to ramp up in early Spring. We know that Oregon’s latest numbers have come from a few key areas: transmission among family and friends, congregate living environments, and workplace outbreaks.Shared living situations, where caregivers must come and go regularly, are extremely difficult to control, and often serve a population at high-risk for complications from COVID-19. Oregon has poured efforts into controlling infection in these locations, and will continue to target testing efforts and practical restrictions. Workplace outbreaks are being addressed by agencies like the Occupational Safety and Health Administration (OSHA) as well as OHA. You can go to the OHA COVID-19 website and check out their weekly reports to see specifics on the current outbreaks in care facilities and workplaces around Oregon.

The Governor’s early July order to limit in-person private gathering to 10 people or less is focused on controlling the family/friend in-person transmission. Contact tracing is showing that these are situations that are greatly contributing to Oregon’s uptick in COVID-19 cases. Why is this happening? Gatherings of friends and loved ones are familiar; people let their guard down, relax, and get close. They forget, or begin to feel silly wearing, personal protective equipment like masks. Recreation might involve alcohol or marijuana use, which also contributes to relaxing our safety practices. This is human nature. The order to limit groupings is meant to recognize the very normal behavior to which we are all subject–our human need for connection and closeness. To keep this closeness from spreading disease, we must limit the number of people, and thus the number of households coming together at any given time.

Do I need to be worried about aerosolization–tiny particles of virus hanging in the air, able to infect me for hours after they have been released?

Short answer: yes, and no. OHA physicians have been very clear that the evidence is still emerging on this issue, and they continue to share what is the most current understanding of this novel disease. The COVID-19 virus can likely be spread through the air in this manner, but it is not the primary mode of transmission. In addition, we can take assurance that our precautions against this kind of spread remain the same ones we have been using: wear a face covering, maintain at least six feet of distance from others, avoid prolonged time in indoor public spaces whenever possible, and keep good hand hygiene (wash your hands, don’t touch your face, use hand sanitizer as needed for a stop-gap measure).

Why aren’t we seeing announcements about where a person has been after they test positive?

From an OHA call in May: “For the purpose of Contact Tracing, a contact will be defined based on the length of time exposed. So, potential exposures in public situations without much time or contact, are unlikely to be included in tracing efforts. But, when they are contacted by a Contact Tracer, people should report their activities from the previous few days, prior to becoming symptomatic. A family gathering, a church, a picnic–these should be related to the Tracer. But a quick trip to the grocery store, unless they had prolonged contact with an individual with a close range, that will not be considered a contact. Keep in mind, this is primarily spread through droplets–coughing, active spewing; this disease is not usually just hanging in the air for hours. Measles is one that hangs in the air for hours, so you see public announcements when there is an occurrence of that disease.”

It’s scary when there is a case of someone testing positive in your neighborhood or local community. Your risk of contracting it from that person, however, is still tied to how much direct exposure you had to them. Simply patronizing a drive-through restaurant where a worker tested positive, for example, is not very likely to infect you. It is important to consider your personal risk every time you leave the house, and take precautions where you can to keep yourself safe. But, for your personal mental health, and to control your anxiety, it’s also important to know where the evidence tells us there is high risk, and where it does not.

Why isn’t Oregon leadership doing more?

This is a theme of many questions I’ve heard people ask–why isn’t the Governor shutting down restaurants and bars again? Why aren’t businesses being closed that don’t comply? Why aren’t people being arrested if they don’t follow masking guidance? The typical answer is: force isn’t usually the best tool to use in these cases. The harder our institutions come down on community behavior, the stronger the backlash. There is no one magic message that has brought everyone into compliance.  We have to continue to work on hearts and minds who resist these precautions, for the health of all Oregonians.

Another piece to consider: the sweeping measures that we took on at the start of the pandemic, in the absence of data, are not always supported by the data we have now. To illustrate, there were lots of questions about re-closing businesses—restaurants, bars, hair salons, etc. The simplest answer for why that is not being done right now: the data is showing no evidence for these sites being a significant contributor to Oregon’s COVID-19 case counts. The OHA and our state leadership are trying to find balance between negatively affecting the economic health of Oregonians (which also translates to food security, medical security, and other direct health impacts), and containing the spread of COVID-19. This answer from a late-May call with OHA physicians helps get at this balancing act: “Keep in mind that the state aggregate is one set of data, but the county, and even the zip codes, are another. They give us the ability to look more critically, and act more strategically. The pressures down on the curve are: physical distancing, hand hygiene, staying away, closure of schools and businesses, and people staying home. And the effect of all that on the economy is also potentially deadly. So, it’s a balance of those pressures. It’s a matter of finding the path forward that results in the least harm. If it were only disease control, we would stay closed for much longer, and people would run out of food and necessary items.”

Why is this such a big deal? Isn’t COVID like the flu?

Influenza has been a part of the human experience for centuries. In the modern scientific era, we’ve studied it, developed a process for seasonal vaccinations, and taken measures to control the spread. Despite these efforts, thousands of people do die from flu every year. However, COVID-19 is new to the human experiences, it is a “novel” virus. Our immune systems are not experienced in fighting it off. We do not have substantive research and data to tell us exactly what it does to our bodies or exactly how people are at risk. We do not know, at this point, how much immunity is gained after a person contracts COVID-19 and survives. Immunity may last only a few weeks, or it may be longer, but there is no long-term data to tell us any of this with confidence yet.

And, what we don’t know can most certainly hurt us. New evidence is painting a picture of serious, possibly long-term damage done to the bodies of COVID-19 survivors. COVID-19 has been characterized as a respiratory disease up until recently, but evidence is emerging that blood clots, circulation disruptions, and serious brain disorders are being seen in people who survive the virus–even those who experienced only mild respiratory symptoms. There is still much to learn about what COVID-19 does to the bodies it infects. Unlike the flu, this newcomer has not had time to show us its true colors.

In addition to operating without long-term information, COVID-19 does appear to have some significant differences from the flu. COVID-19 is transmitted person-to-person, the same as the flu. However, COVID-19 is significantly easier to transmit from one person to another–it is a more contagious disease. This means that it travels faster and more easily through our population. The duration of COVID-19 also appears to be longer, even though severity varies from person to person. The time between contracting the disease and the development of symptoms also appears to be longer, which leaves us more open to spreading the disease unwittingly. As for how deadly the disease is, according to an article by Johns Hopkins Medicine comparing the two viruses, “doctors and scientists are working to estimate the mortality rate of COVID-19, but at present, it is thought to be substantially higher than that of most strains of the flu.”

What should I do when I see that someone out in public is not wearing a mask?

Per the OHA physicians and mental health specialists, the best thing you can do for all varieties of pandemic response is to be prepared. In this case, prepare yourself to respond appropriately to community behavior. Start by acknowledging that there may be context for the person’s lack of mask that you do not know about. Next, consider that your behavior is setting a good example for your community. With time, and more people adopting these measures, it will help peer pressure those who are choosing not to be safe. By wearing your mask, you are also telling people who cannot wear masks that you care about them. Know that it is not safe to engage a non-masked person in a heated environment–yelling in close proximity is not at all healthy for bodies or minds. But, also know that your risk in passingly interacting with someone who is not masked is very low, so long as they are not actively coughing or sneezing. If you still feel unsafe, remove yourself from the situation. If you feel that a business is not doing enough to enforce the Governor’s Orders about this, you can file a complaint with OSHA (Occupational Safety and Health Administration) to have them follow up.

It’s getting hot, is it safer to use AC or fans to cool off in shared spaces without spreading COVID-19?

There have been a lot of questions coming from the community about ventilation, especially as Oregon communities have started to “open back up” early this summer. A good, well-maintained air conditioning unit that pulls air from the outside is the best option for infection control. The more outside air, the better; recirculated air is not as good. Be sure to change filters regularly on any unit you are using. OHA recommends avoiding use of fans in shared spaces with multiple households, if possible. (They are fine to use in your home with your own family unit of shared exposure.) If you must use fans in a community environment, have an HVAC technician consult on installation, to ensure that air isn’t blowing from one person’s airspace to another.