On April 20, 2020, Oregon Governor Kate Brown issued a document entitled Reopening Oregon: A Public Health Framework for Restarting Public Life and Business.
While elements of reopening have been put into motion, other elements remain understudy and continued review. Guidelines for reopening Umatilla County are based upon the advice of local medical officials and authorization from the State of Oregon. Commissioners will not implement any general procedures in excess of those approved by the State nor will they authorize any reopening procedures in conflict with state guidelines.
On May 1, authorization was granted for the conduct of elective surgeries that also permits hospitals and clinics to generally return to normal business utilizing extensive cautionary procedures. It also provides a green light for other entities such as dentists, optometrists, and others to resume business. In all cases, strict protocols are in place. Communication from dentist offices makes it clear they are prepared to open and are committed to following strict procedures.
Umatilla County Proposes the initiation of Phase 1 of the Oregon plan by May 15, with all applicable facilities following the finalized statewide sector guidance.
Critical Elements for Reopening:
- The initiation of procedures and accommodation for the health and safety of employees
- A continued commitment to physical distancing and extra attention to hygiene
- Assurance of sufficient personal protective equipment
- Encouragement of those who are sick to remain home
- Minimizing non-essential travel
- Continued reliance on video or phone conferencing options
- Encouragement of vulnerable individuals to continue sheltering in place
- Avoidance of socializing in groups of ten or more
Elements of Phase One Opening:
- Schools and organized youth activities would remain closed
- Playgrounds would remain closed
- Visits to hospitals and senior living facilities would remain prohibited
- Large venues such as sports events and theaters should remain closed
- Churches can already be open for serving parishioners and small meetings. Larger services would be permitted in line with protocols currently being developed by local churches as long as they comply with gathering sizes and health protocols
- Sit-down dining – permitted with accommodation for distancing and extra sanitation protocols
- Bars – same provisions as for dining with reduced occupancy levels
- Personal services – permitted to reopen with accommodation for extra levels of sanitation and distancing as well as protection for staff
- Retail – retail outlets would be permitted to reopen using procedures for sanitation and distancing
- County parks could be open for day use and overnight stays except playgrounds would be cordoned off
Emergency Department Visits for COVID-19-like symptoms – Less than historic averages.
Percentage of visits for COVID-19 illnesses – Hospitalizations have remained about one or two and would likely be at or below that number on May 15. It is hard to measure declines when hospitalizations have been negligible.
Minimum testing requirements – Umatilla County would require a capacity for 240 per week. Interpath Laboratories headquartered in Pendleton has the capacity to test 300 individuals per day for 6 days a week. They are receiving additional reagents the week of May 11th and capacity may increase with these supplies. Interpath also has an active HRSA grant to pay for COVID-19 testing for self-pay clients, which includes provider or patient collected specimens. Good Shepherd and St. Anthony Hospital both have the capacity to test 30 per day at each Hospital. St. Anthony also has the ability to test 30 per day at their clinic. They are working with Incyte laboratory to test on Saturdays.
Sufficient testing sites available to underserved communities – Again, testing is available within the county. Due to the location of the county, residents also patronize hospitals in Walla Walla and the Tri-Cities for easier accessibility.
County has 15 tracers per 100K – Umatilla County has created a new tracing center on the third floor of the Courthouse that includes appropriate supplies, materials, and equipment with exceptional distancing provisions. The County has also taken it upon itself to hire more tracers than required in advance of outside potential assistance in order to meet the May 15 deadline.
Provision for demographics – County has provided for language facility – primarily Spanish.
Umatilla County has a close working relationship with the Confederated Tribes of the Umatilla Indian Reservation (CTUIR). UCo Health has an up-to-date Mutual Aid agreement that allows for us to support CTUIR and Yellowhawk Tribal Health Center, a federally-qualified health center, as needed. In addition to screening individuals for REAL D as required by law, UCo Health also screens individuals for primary care providers. This allows for us to better assist with continuity of care, and when individuals identify Yellowhawk Tribal Health Center as their primary care, UCo Health cross reports that information. All communicable disease reports that pertain to tribal members who reside on the reservation, are followed up on by Yellowhawk. The Reservation is a sovereign nation and Umatilla County does not have jurisdiction over tribal members living on the reservation.
County is prepared to trace 95% of all new cases within 24 hours – County tracing center is fully functional 7 days per week. This began on May 10. UCo Health thus far has conducted full contact tracing on all confirmed and presumptive cases as of March 1, 2020.
Counties have hotel rooms available for those who cannot self-isolate – Umatilla County just went through a major flood that resulted in the necessity for having dozens of rooms available for those who were displaced. These same rooms are now available for others who might need to self-isolate. Many other beds are also available due to the absence of travel since this is a major tourist destination.
UCo Health has established working relationships with the local hotel advisory board for connecting with hotels willing to host COVID-19 individuals. Through this we identified a location in both Pendleton and Hermiston who are able to host COVID-19 individuals. Both locations have outward-facing doors and individual heating and cooling systems for each room. Verbal agreements obtained with both and pursuing contacts.
Response to a potential outbreak – see attachment
Accommodation of increases in hospitalizations – Umatilla County has two hospitals – Good Shepherd and St. Anthony – both of which have significant capacity at this time. Residents also access three hospitals in the Tri-Cities and St. Mary’s Hospital in Walla Walla.
Reporting of daily PPE supply through HOSCAP – Umatilla County complies.
Hospitals in the region must have a 14 or 30-day supply of PPE depending on their size and location – County exceeds this requirement on both counts.
Counties must have sufficient PPE for the first responder – County is well-supplied.
This plan was prepared under the authority of the Umatilla County Commissioners through emergency procedures authorizing Commissioner George Murdock to act on behalf of the Commissioners as the liaison to the Public Health Department.
It has been prepared in concert with the Medical Director Dr. Jonathan Hitzman, Director of Public Health Joe Fiumara and appropriate county medical care facilities.
Umatilla County Commissioner
Dated Friday, May 8, 2020
Prisons and Jails – Umatilla County is home to EOCI and TRCI as well as the Umatilla County Regional Jail. Department of Corrections officials have made it clear they wish to handle cases themselves. To date, we have had one instance of an inmate who was confirmed positive and he was moved immediately to a special isolation area at Snake River. However, we are accustomed to having prisoners in our local hospitals. Our jail population has been reduced from 235 down to just over 150 in order to provide more distancing. In addition, our jail staff have adopted a comprehensive plan for preventing and dealing with COVID-19 including taking steps to reduced intakes. In the event that there was a case in the Umatilla County jail, UCo Health would work closely with the jail staff to conduct contact tracing and provide guidance to decrease the spread of COVID-19 to inmates and staff, which would include testing recommendations, cleaning, and isolation.
Long Term Care Facility (LTCF) – To date we have had no confirmed cases in our long-term care facilities. We would like to think that is a result of extensive steps that have been taken to prevent an outbreak. This certainly includes no visitations, special precautions with staff, and limited instances of admissions. All of that being said, we believe we are prepared to handle a new case in line with general procedures for coping with an outbreak.
Over the last two months UCo Health has maintained a close working relationship with the LTCF’s in our County. We have shared prevention guidelines as they come out, reviewed these guidelines with facility representatives, discussed PPE supplies, and connected facilities with testing when needed. Test kits available at UCo Health have been and will continue to be shared with LTCF’s on an as needed basis. In the event that there was a COVID-19 exposure within a LTCF, we would immediately work with the facility to implement isolation precautions, conduct contact tracing, and review prevention guidelines and cleaning procedures.
Food Processing – Our largest food processor is Lamb/Weston in Hermiston and from day one, and perhaps even before, they have been a leader in coping with COVID-19. Workers who are ill are told to stay home with pay. If it is discovered someone has traveled outside of the area, they are sent home for 14 days. The company has also taken extra steps to provide distancing, protective equipment, and has made provisions for sanitation and hygiene.
UCo Health has worked closely with food and agriculture based facilities that have been affected to date. These facilities have been receptive to education provided to help reduce the spread of COVID-19 at their worksite. At identified facilities, through partnership with a local area hospital, testing was provided to close contacts to COVID-19 cases to better understand the spread and affect on the facility. UCo Health also has a close working relationship with the local Department of Agriculture food safety staff and would coordinate prevention efforts and education with them.
Mass Testing Capacity - UCo Health has access to 150 test kits onsite for sending to OSPHL for testing. These test kits can be given to congregate settings above for collecting testing. UCo Health has a 4 day per week scheduled pickup with OSPHL for submitting collected specimens. We have also previously and continue to have the ability to overnight FedEx ship specimens if shipments are needed outside of scheduled pickup windows. In previous COVID-19 outbreaks identified in Umatilla County, UCo Health was able to partner with local area hospitals to have identified individuals schedule a time for drive-through testing at their facility. These partnerships demonstrate successful drive-through testing capacity at local area hospitals that may be used in the future.
In the event that a mass testing was needed in a facility, UCo Health would follow the OHA Specimen Collection Planning Guidance document. These guidelines have already been reviewed by the Planning Section of UCo Health’s IMT. The following elements of the guidance have already been addressed:
- Location: There are already identified possible locations for drive-through screening capacity in Hermiston, Pendleton, and Milton-Freewater. These locations have been used in previous hospital or UCo Health sponsored drive through vaccination clinics. Also, both hospitals are already conducting drive-through COVID-19 testing.
- Staffing: UCo Health has sufficient staff trained in the various roles identified in the Guidance document. Most staff participated in a drive-through mass vaccination clinic in November that will lend toward preparedness for a mass screening event. Training resources specific to a COVID-19 testing event have been identified for just-in-time training for staff at the event.
- Specimen Collection: UCo Health has 6 RN’s and 1 NP with the ability to collect NP/OPs. All staff have reviewed training videos. We have identified a separate stock of NP swabs for practicing the skill prior to a mass event, if deemed necessary.
- PPE calculations needed for such an event have been completed. Based on UCo Health’s personal PPE stock, a mass testing event would require support from the Umatilla County stockpile under management of the Umatilla County Emergency manager.
For smaller testing needs, specific to testing done onsite at congregate settings. UCo Health would consider all of the above along with partnership with the facility to conduct testing. UCo Health has been working with LTCF and Jails with previously identified COVID-19 testing needs and have successfully con