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State and county public health departments adjust to increase in coronavirus cases

This week Multnomah County, the Oregon Health Authority and the U.S. Centers for Disease Control and Prevention all issued guidance recommending that everyone — including vaccinated people — wear masks indoors again in many places. That comes as the number of coronavirus cases across the country are surging again, with the highly transmissible delta variant leading the way. Oregon Health Authority Public Health Director Rachael Banks and Multnomah County Public Health Director Jessica Guernsey talk to us about what these rising numbers mean for Oregonians.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. In recent days, the Delta variant has upended masking guidelines all across the country. On Monday, Multnomah County started recommending that everyone, including vaccinated people, once again wear masks in indoor public spaces. The state of Oregon followed with a similar recommendation a day later. Meanwhile, the CDC stopped short of a universal masking recommendation, but it has also updated its guidance. It now says that vaccinated Americans should wear masks indoors if they are in counties with substantial or high coronavirus transmission. For more on these changes and where we go from here, I’m joined by Jessica Guernsey, Public Health Director for Multnomah County and Rachael Banks, the Oregon Health Authority’s Public Health Director. It’s good to have both of you on the show.

Rachael Banks: Hi Dave.

Jessica Guernsey: Thank you. It’s great to be here.

Miller: Jessica Guernsey, first, from Multnomah County’s perspective, what led you to put out this recommendation at the beginning of the week?

Guernsey: Well, it was really a combination of things. In public health, we obviously use data to inform our public health decisions, but also listening to community voice and community wisdom. So it is really a combination of looking at our data, our positivity rate for COVID testing, and also hearing from the state with regards to how much delta variant we’re seeing among the samples that are being tested. Those two data points combined, along with some health disparities in relation to hospitalizations among different communities, as well as hearing from community leaders about concerns that they were having regarding masks, as a piece of the protection puzzle, so to speak.

Miller: What were the health disparities in particular that caught your attention?

Guernsey: We, along with our regional and state partners, have been watching very carefully the hospitalization rates across age groups for Black, African American, and African and immigrant and refugee communities. We’ve had a number of hospitalization disparities over the last 17 months that have hit different BIPOC communities very hard, including Latinx, Pacific Islander, and Native American. But we’ve had a particularly concerning trend in the Black, African American, and African immigrant and refugee community that’s been on a steady trend.  That has come down, but we’ve been watching it really carefully and have been focusing quite a bit of effort on that. So that definitely factored into the decision.

Miller: And just so I understand this, the numbers you’re seeing here for Black, African American, Black immigrants, that’s specifically about COVID illness. People who tested positive for COVID who are in hospitals right now?

Guernsey: Exactly.

Miller: Rachel Banks, ow did the state decide on this new statewide masking recommendation?

Banks: We’re really aligning with the Centers for Disease Control’s recommendations. I would underscore the things that Jessica raised. Obviously, we’re also watching those hospitalizations and really want to be focused on equity. The Delta variant is a huge concern as we’ve seen. Not only are cases rising, for example, there’s been a 277% increase in the seven-day moving average of new cases from July 5th to July 27. We also know that the Delta variant has increased from, for the cases that we’re sequencing from 30 to 50% during the most recent week and made a 10-fold increase over the past prior two weeks. Those things, and clearly along with aligning with the Centers for Disease Control’s recommendations for indoor masking, are the reasons that we wanted to follow suit.

Miller: Statewide, what can you tell us right now about who is getting hospitalized and who is dying from COVID?

Banks: Unfortunately statewide, as we’ve seen in national trends, who’s being hospitalized and dying from COVID is largely unvaccinated Oregonians. In the very high, 9 out of 10 folks who are being hospitalized are unvaccinated.

Miller: Do you have any data about who follows these kinds of recommendations? This is, as we’ll talk about, this is a recommendation, it’s not an order.

Banks: We have anecdotal information. We know that there’s been a variety of comfort with state level guidance across the state. I will say that the hope is that, sincerely across every county, that Oregonians are following the guidance for indoor masking and that we can bring down the hospitalization rates. I will say that across the state hospitals are stretched. Capacity is a huge concern for us and we know that, because of COVID, increases in COVID cases and hospitalizations. But as we also are looking at an all hazards approach with heat and wildfire, we want to make sure that anyone who needs that hospital care is able to have it. It really is such a sincere request, near begging for people to follow the recommendations so that we can save lives and make sure that people who have the need of care can get it.

Miller: A sincere request, near begging. Those are powerful emotions. But at the state you have the power to do much more than beg or hope. You can require. That is something that L. A. County has done. The mayor of Washington, D. C. just announced that today. The state of Nevada has done that for almost the entirety of the state going into effect just tomorrow. Why not make this a new emergency mandate as opposed to a strenuous recommendation?

Banks: I think we’ll continue to have conversations starting with the recommendation and putting out public information so people understand the seriousness of it. We’ll continue to be working with OHA with our Governor’s office to address the situation at hand and where we’re at now. Once again it is aligning with the CDC, which is also making a recommendation. So that’s what we did at the state as well.

Miller: Is it the case where if numbers continue to rise, that would be, for example, that the kind of new data that would lead to a different decision?

Banks: We’re looking at a number of factors. Clearly cases rising, clearly hospitalizations. [We’re] very concerned with the variant, the Delta variant, which is the predominant variant in Oregon at this point, as well. We’re looking at test positivity. So there’s a variety of factors that we’re looking at. And as I mentioned, we have a critical eye on hospital capacity, EMS capacity, which is strained at this time.

Miller: Jessica Guernsey, from Multnomah County’s perspective, I have to say my assumption is that right now, the majority of people who would voluntarily wear a mask based on this recommendation, follow this this county and state recommendation when they don’t have to and when no one’s going to most likely force them or ask to look at vaccination status, that those are basically the same people who have already gotten vaccinated. That’s just my gut feeling about how this is going to work. I’m curious what your gut feeling is. Do you agree with my assumption?

Guernsey: Well, I think we have to be careful with assumptions. I can tell you what I’ve seen from my experience just in what I call windshield epidemiology. I saw people putting on masks before we did the advisory in Multnomah County because I think people are smart and when we give them information around making decisions about their own health and other people’s health and we’re transparent about what’s happening that we can take an education first approach, which is what we’ve decided to do is give the facts to folks about what we’re seeing. This is a global pandemic that we’ve never experienced before. We need to pivot quickly. I know it’s frustrating for folks because it feels like a step backwards, but we’re looking at this data carefully, listening to community leaders carefully and making decisions based on that. But I can tell you quite literally before we put out the Multnomah County advisory for masks, I saw more mask wearing than I had seen the previous week. And I think that’s largely because of all of the information that has been released regarding the Delta variant and concerns around the uptick in numbers. So we take an education first approach. I don’t really have quantitative data that would tell me absolutely if your assumption is correct or not. I’m pretty careful about making those kinds of statements.

Miller: Fair enough. Jessica Guernsey, in the statement announcing this new recommendation earlier this week, you were quoted as saying this: “Masking is a step we can all take right now to keep businesses open and move ahead with our plans for the school year.” What did you mean?

Guernsey: Right now in Multnomah County, we have a couple main goals. For our public health responses, we continue to move through COVID 19. As Director Banks mentioned, we are obviously focusing on minimizing hospitalization and deaths, avoiding health systems overload. And again, that’s not just for COVID. If you have a heart attack or if you are in an accident and the hospitals are full, you could not get the care that you need if the health systems and hospitals are overloaded. Then one of our strongest focuses in learning from last year is making sure that kids can get back to school safely and have a full school year. There are other consequences that can and have occurred as a result of kids not being in school. We know that that’s tied to lots of other health outcomes. Obviously educational and community outcomes.

So we can all do a couple of things right now to make sure that happens: one, obviously, we can get vaccinated. If you’re under 12 right now, you can’t get vaccinated. So it makes it all the more important for those that can to get vaccinated. That protects us. That vaccine could save your life. We know that, and then masking. For masking, we are masking for other people. The vaccine really protects both us and other people, but the mask really protects other people. So that’s something that we can do to reduce community spread while we’re increasing vaccine uptake because school transmission does not happen in a vacuum. It happens as a result of community transmission. We have great guidelines across the state. We’ve been working really closely with our school districts on implementing those guidelines. I believe the governor today just announced universal masking in schools, which makes the state recommendations in line with CDC, which we support. But the goal there is really focusing, in this last stretch of summer, to getting to the school year and keeping kids in school for a full year.

Miller: Rachael Banks, what more can you tell us about what you think the school year is going to look like? I’m glad that Jessica Guernsey just mentioned this recent news from the Governor’s announcement that she’s directing the Oregon Health Authority and Department of Education to require masks indoors for all K-12 schools across the state. When the school year begins, what more can you tell us about what school could be like?

Banks: Well, I think the vision that I’d like to see is that those 12 and above are vaccinated, [and[ that folks are consistently masking. What that allows us, in the case where there are cases that are outbreak investigations, that we can keep kids in schools for longer. I think that’s one of the most positive things about masking in schools. Clearly, in addition to stopping disease spread is that it allows kids to be in schools for longer without some of the interruptions of having to quarantine or stay isolated for a number of days. I think we’re all looking forward to kids being able to be back in school in person full time for the year and for as much duration with as limited distractions or interruptions as possible.

Miller: A few months ago, Governor Brown announced that, when we got to 70% vaccination rate among people who are eligible for vaccinations, that’s when the vast majority of the state-based restrictions on public life would be lifted. We got to that point and she reduced those restrictions. What should we be looking for now, for the rescinding of this recommendation? What are our data points or actual numerical metrics that we should be paying attention to?

Banks: I don’t know that those specific metrics have been set in terms of what’s the magic number, before this pandemic, before everything goes away. I think what we need to be paying attention to clearly is the Delta variant. We need to make sure that our hospitals have capacity, that we are continuing to vaccinate people.

One of the metrics that keep front of mind is really making sure that we have equity in terms of our communities across Oregon, both geographically and looking at race and ethnicity. We have many communities of color and gaps in communities who didn’t have vaccine accesses early on. And we’re really looking to continue to get to 80% vaccination rates with communities and in Oregon. 70%... it was a milestone. It was a momentous milestone. We all knew that we needed to keep going and that we want to see 80% of Oregonians vaccinated. We want to see that those gaps between communities are eliminated.

Miller: But as you know, so far that has not happened. The disparities in vaccination rates among a few key racial and ethnic groups, in particular for Black, Latinx and Native American Oregonians, have been really stubbornly persistent for months now. The graphs, they look more or less the same now as they did in the beginning of May. Why do you think these current efforts, and this is something we’ve talked about a number of times on the show, including with you, Rachel Banks. Why do you think they haven’t yet had a bigger impact?

Banks: I will say definitely, it’s not as fast as I would like to see it and the community leaders, for sure. But we do see communities of color accelerating and this has been a steady trend, and twice or more than twice the rate of white Oregonians. So we know that that is closing the gap. It’s clearly slower than we would like to see. What we’ve heard from communities is that we need to have ongoing education, that people need to see folks who look like them. They need to have access to information and languages by people that they trust. And many people just need access to asking more questions. We’ve gotten more specific in terms of really nuanced education. Like, what about if I have an underlying health condition? And making sure that those folks who may have less access to a healthcare provider earlier on to answer those questions, that we are providing that education and access. Clearly, systemic barriers or things that we’ve worked on throughout the pandemic and continue to work on, transportation, making sure that folks are able to leave work or have convenient hours and all of those sort of strategies. So it’s really about persistence, continuing to work with community and continuing to offer education and multiple modes of communication.

Miller: There you’re talking, it seems, about people who just need the right set of criteria in order for them to either feel comfortable or have the access or have the means to get vaccinated. But there is absolutely another category of people who have so far made the decision, which has been pretty consistent, that they do not want to get vaccinated. Nationwide,

it’s not an insignificant number of people, we’re talking about 20 or 25% of people in various polls, who have consistently said that from before vaccine was available to today. When you look in the longer term picture, is it possible that we’re going to just have a significant percentage of Americans who choose to not get vaccinated and then a whole series of variants of this once novel coronavirus that keep making their way through society and having everybody else stuck with wearing masks and stuck with a persistent virus that just will not leave us?

Banks: I think that’s definitely a concern. And as we’ve seen with the Delta variant, that’s a possibility. So we hope that the folks are seeing that possibility. This is a novel virus, and so as folks are learning about it, both public health people and folks who work in health. But also the general public is seeing what can happen. I do believe that as COVID touches closer to home… of course, this is not what we want to see... but people have a variety of different reasons to get vaccinated or concerns with vaccination. I do think we’ll continue to see people get vaccinated as they are around more people that have been vaccinated, and unfortunately as they’re having more experiences or closer experiences with people that they know, that they love who are being impacted and sure we hope that that impact doesn’t include death

Miller: Jessica Guernsey, just briefly, is it your guess that a year from now in a Multnomah County supermarket, a significant percentage of people are going to be wearing masks?

Guernsey: I was waiting for you to ask me the hard question. I feel like you’ve been asking Director Banks the hardest questions. I think we may see that. I think we may, for a variety of reasons, some of what you just stated. I don’t know exactly how things will play out with full vaccination. My hope is that more and more people will take the time that they need to have conversations with people they trust to make a decision for their health, which seems reasonable to me. We’ve learned a lot from mask-wearing this last year. I don’t know about you all, but I definitely did not get sick this year. That’s largely because of our physical distancing and mask wearing. We saw almost no flu and RSV. So I think there’s broader questions to ask about the future of things like using masks overall, especially during cold and flu season. Flu is also no joke. We also see racial disparities in flu outcomes. So, it’s hard to look into the COVID crystal ball week to week and know exactly what’s going to happen. But I wouldn’t be surprised if some element of mask wearing stays with us for a variety of reasons.

Miller: Jessica Guernsey and Rachel Banks, thanks very much for joining us.

Banks: Thank you. Pleasure.

Guernsey: Thank you.

Miller: Jessica Guernsey is the Public Health Director for Multnomah County. Rachel Banks is the Oregon Health Authority’s Public Health Director.

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