Working Together During COVID-19 and Wildfires
October 2020
After months of exhausting work responding to COVID-19, public health officials in Oregon faced a compounded emergency when wildfires burned over a million acres across the state forcing thousands to evacuate their homes. While the pandemic may have taken some public health officials by surprise, everyone knew that wildfires would come. With the trend of wildfire season growing progressively worse each year due to climate change, it wasn’t a question of when the public’s health would face wildfire threats, but how severely would it impact the COVID public health response, as well. For almost 8 months, local public health authorities have engaged in education and outreach, collaborating with community partners, arranging COVID testing events, training contact tracers, and contacting new cases within 24 hours of a positive test result seven days a week. Oregon was starting to lower the curve, but wildfires threatened the progress public health officials were seeing in their communities. The fires and smoke also personally affected many public health officials, and yet they still put their community’s health priorities first.
Marion County was one of the counties most severely impacted by wildfires in September. The Beachie Creek fire, stoked by high winds, quickly grew into a large complex and drove people from their homes and into mass shelters. Karyna Cutting, Public Health Emergency Preparedness Coordinator for Marion County Health & Human Services Public Health Division, quickly integrated her COVID work into preparing fire shelters. Cutting has spent a third of her early public health career immersed in COVID and wildfire response. Reflecting on the challenges she has faced in just a year and a half in the local public health workforce, Cutting explained:
“Personally when this first began I felt like it was a great opportunity to expand my skillset. At times I felt like I was thrown into the deep end but over time I adjusted to it and I feel like I’ve grown tremendously. It can be challenging because especially as a public health professional, I deal with COVID at work and then also in my personal life. Dealing with the wildfire response at the same time, it’s been another push into the deep end. Overall, I’m glad I was able to enter the public health workforce at a time like this.”
Cutting spends most of her time working with her Department Operations Center specifically focused on the COVID response. Marion County’s Emergency Operations Center activated for wildfires on September 8, 2020, and Cutting quickly joined the response.
Washington County and OPHI Work Together to Trace COVID-19
September 2020
When COVID-19 hit the United States, our nation’s leaders called for an army of public health workers to trace the spread of the novel virus. However, that army wasn’t standing at ease ready to act. Local health departments had to respond to COVID cases already in their community and simultaneously build an army as they were already fighting. Rather than take on building and responding at the same time, Washington County Public Health established a partnership with the Oregon Public Health Institute (OPHI) and the California-based Public Health Institute (PHI) to help them build a team of over 167 staff, including county employees, public health nurses, epidemiologists, data analysts, and contact tracers to track COVID-19. Tricia Mortell, Washington County Public Health Division Manager said, “Our Public Health Division workforce was around 110 FTE before COVID. So this response has eclipsed our work across all public health programs.”
Washington County Health & Human Services Public Health Division was already responding to COVID cases when the county hosted an online community forum with local elected officials and the health department to gather feedback on how to best respond to community needs. Emily Henke, Executive Director of OPHI, attended the forum knowing that Governor Brown had just announced that Washington County would need to hire at least 90 people to meet reopening thresholds. Henke recalled, “When the governor announced these requirements, OPHI saw an opportunity to create a local, culturally- and linguistically-responsive workforce that would meet the Washington County community’s needs and the governor’s benchmarks. This idea aligned with Washington County’s own goals, so it was a natural partnership.” OPHI and PHI collaborated with Washington County Public Health to launch contact tracing efforts in just a few days. OPHI and PHI named the effort “Tracing Health.”
Adrienne Donner, acting Public Health Branch Director for Washington County’s Emergency Operations Center, worked with OPHI from the start of their partnership. “We went through a process to figure out a flexible scope of work with OPHI. The bulk of the work is contact tracing, but we came up with other types of employee support, the biggest being epidemiology and data support,” Donner explained.
Oregon’s Public Health Workforce
August 2020
Public health is largely unnoticed when things are going well, but public health officials, such as nurses, health educators, community health workers, and environmental health specialists, are always working behind the scenes. They are ensuring access to safe drinking water, protecting against the disease spread, and promoting healthy behaviors. COVID-19 has wrenched those unseen public health workers to center stage. Now under the spotlight, we see how the underfunded and understaffed public health workforce struggles every day to fill multiple roles to protect communities. This is the moment to prioritize restoring and investing in our public health workforce if we intend to stop the spread of COVID and ensure a strong economic recovery.
According to the National Association of City County Health Officials (NACCHO), the public health workforce started shrinking during the 2008 Great Recession. After the economic downturn, local public health departments across the United States lost 20 percent of their workforce. Since then, 67 percent of local departments continue with either reduced or flat budgets making it nearly impossible to refill lost positions. Meanwhile, the population increased since 2008, health needs got more complex, and disparate health outcomes for Black, Indigenous, and People of Color (BIPOC) communities worsened
Locally, as a recent joint article from Kaiser Health News and the Associated Press outlined, public health staffing per Oregon resident fell 28 percent from 2010-2019, and expenditures per resident fell 17 percent from 2010-20218. Almost half of the remaining public health workforce is headed for retirement or leaving for other reasons. Since the start of the pandemic, one Oregon public health director retired, and three more are scheduled to retire within the next year adding up to 12 percent of Oregon’s 33 total public health directors. Combined with other reasons for turnover during the pandemic, at least 30 percent of local health departments in Oregon will have experienced a change in leadership in just one year. New leadership can be positive, but it’s also difficult to lose institutional knowledge and experience in the middle of a pandemic.
Before COVID, local health department staff size in Oregon ranged from 2 staff in Wheeler County to over 300 staff in Multnomah County. The urgency of COVID called for surge capacity that didn’t exist in March 2020. Rallying surge capacity initially meant pulling staff from their normal jobs to answer community calls, complete contact tracing, and serve in Incident Command for the emergency response.
Public Health and Racial Health Equity
July 2020
Racism and COVID-19 are interconnected public health crises.
Rachael Banks, Multnomah County Public Health Director and CLHO Board Member, was quoted in The Oregonian early in the rise of protests in the City of Portland saying, “‘We’re in a moment where locally and nationally that people feel the only choice they have to be heard is to take to the streets and scream out, ‘I can’t breathe,’” Banks said.” The Oregonian continued, “[Banks] drew a parallel to the disproportionate impacts the coronavirus has had on communities of color. Black people are dying of COVID-19 at rates three to four that of other races, according to early studies” (1). As of June 10th, the Oregon Health Authority Weekly Report on COVID-19 showed that Black Oregonians are experiencing an incidence rate of 18 cases per 10,000 population, which is the third highest among minority groups, and the second highest minority case fatality rate at 4.1%. The report also listed that 12.7% of COVID-19 cases still do not have racial data available, which may contribute to underreporting of racial disparities (2).
It’s impossible to pull apart the impacts of systemic racism and COVID-19 on Black, Indigenous, and People of Color (BIPOC) communities throughout Oregon, and local public health officials are responding to both crises. Members of the Coalition of Local Health Officials (CLHO), including Banks and other public health leaders across Oregon’s 33 local public health authorities, are responding individually in their communities and as a collective.
Local public health officials in Oregon have responded to calls for social justice by urging activists and protesters to protect their health. Health Officers have urged those marching in support of Black Lives Matter to take basic public health precautions such as wearing a face covering, using hand sanitizer, and keeping physical distance as much as possible while demonstrating their social solidarity. Meanwhile, local public health officials continue to respond to COVID-19 outbreaks in their communities, and are working to expand testing access for BIPOC populations who are at a greater risk of infection due to historical injustice. Public health officials are also working with community-based organizations, faith leaders, elected officials, schools, business, hospitals, and many others to keep Oregonians healthy.
Collectively, Oregon’s local public health leaders are taking steps to improve racial health equity in our public health system. Jocelyn Warren, Lane County Public Health Director and CLHO Board Chair, said, “The demonstrations are driving the national examination of the consequences of racism and white supremacy that are critical to achieving racial equity in health. CLHO will continue to advocate for the tools and resources public health authorities need to promote racial health equity locally and in Oregon. And we, the local health administrators, support demonstrators who are confronting the issue of pervasive racism.”
The purpose of CLHO is to advocate for effective and improved public policies, programs, and financing of local public health in Oregon. On a day to day basis this advocacy looks like: lobbying for evidence-based policies in the legislature; communicating the value of public health investments; and providing technical assistance to the local public health workforce. Ever since the CLHO Board of Directors elevated Public Health Modernization as the coalition’s top priority, CLHO has continued to weave elements of the Modernization framework into our own priorities and practices, especially the foundational capability of health equity and cultural responsiveness.
Public Health Modernization and the COVID-19 Response
June 2020
Public Health Modernization ensures that all Oregonians in every corner of the state have basic public health protections that are critical to health. This protection is needed now more than ever. Since 2015, Oregon’s governmental public health system, comprised of 33 local public health authorities and the Oregon Health Authority, have been striving to build up foundational programs that seek to simultaneously prevent and prepare for emerging diseases and conditions that threaten population health. Legislative investments made in Modernization in 2017 and 2019 have been directed towards bolstering communicable disease control programs and hiring skilled and capable public health professionals to support local communities. These investments are paying dividends in the public health response to COVID-19.
While the recent investments fall short of the annual need to fully implement the Modernization model, they have added critical staffing capacity to the local public health authority workforce. Public health staff hired through Modernization investments are supporting the COVID-19 response with their skills in assessment and epidemiology, community partnership development, health equity, leadership, policy and planning, communications, and emergency preparedness and response.
There are currently seven Public Health Modernization partnerships in which public health staff are focused on applying their skills to communicable disease prevention. The partnerships cover 32 of Oregon’s 36 counties. As Oregon moves deeper into the COVID-19 response, CLHO connected with local public health administrators to explore how investments Modernization prepared two of the seven partnerships for COVID-19.
Click “Read More” see the case studies on the Central Oregon Public Health Partnership and the Multnomah, Clackamas, Washington, and Yamhill Partnership.
Lane and Jackson County on the Role of Public Health in Sheltering during COVID-19
May 2020
Public health officials in Oregon are keenly aware of the disproportionate impact COVID-19 has had on vulnerable communities, including: communities of color with underlying chronic conditions; elderly and incarcerated populations in congregate settings; low-income households struggling with the economic burden of “Stay Home” orders; and houseless individuals cut off from support services they rely on. Many public health officials have been working with community partners to find solutions for sheltering the unhoused. Lane and Jackson Counties, two of Oregon’s 33 local public health authorities, shared highlights from the work in their local jurisdictions to protect their communities and shelter individuals during the COVID-19 response.
Local public health officials are filling essential roles in their local Emergency Operations Center (EOC) work. Supporting and sheltering houseless individuals at risk of, or already infected with, COVID-19 has been one of the biggest challenges for the local public health officials and other EOC staff leading Oregon’s emergency response.
Jocelyn Warren, Public Health Administrator for Lane County, says that public health’s role in continual surveillance (even when there isn’t an active emergency response) helped identify issues in the COVID-19 response early on. “We quickly realized that the unhoused would be a special population of interest not because they are a high travel risk, but they are suddenly cut off from all services that they had access to because bathrooms, libraries, and food banks are all shutdown. The homeless were hit the hardest because they are vulnerable. They disproportionately have more chronic disease and also suffer the hard weathering that comes with living on the streets. Even though we are not a homeless service provider in public health, we knew we had to focus on this.”
The Local Public Health Response to Coronavirus
April 2020
The Coronavirus public health crisis has gripped our state and nation as we all try to absorb the constant stream of new information about an uncertain future each day. What many Oregonians still don’t know about is the work that our local public health officials across the state do to prepare for public health emergencies, and how they manage the limited resources they have when it’s time to respond.
On March 5, 2020, a week after the Oregon Health Authority announced the first presumptive case of Coronavirus in Oregon, Katrina Rothenberger testified in the legislature before the House of Representatives Committee on Health Care. Rothenberger, Public Health Director for Marion County Health & Human Services (MCHHS), spoke about the work that local public health officials do all the time to prepare for emergencies.
MCHHS started preparing for Coronavirus in January, about two months before their first case was identified. The first steps included reviewing the county’s pandemic influenza plan, cross-checking their plan with CDC guidance, and informing Marion County commissioners what to expect. Ramping up in February, MCHHS expanded their outreach to other critical partners for fighting a pandemic: EMS and 911 Dispatch, health care providers, schools, and long-term care facilities. Before the first case showed up in Marion County, Rothenberger and her staff needed to determine which of their critical services needed to be maintained, and what public health work could be pushed to the side.
Marion County Health & Human Services Revives Partnership with Local EMS to Prevent Outbreaks
March 2020
Protecting communities from communicable disease is a core public health function. In a time when communities are facing threats from influenza, Hepatitis A, and coronavirus – it’s critical for public health departments to take proactive steps to prevent the spread of illness. Marion County Health & Human Services (MCHHS) has prioritized collaboration as a key, modernized strategy to protect hard to reach populations in, and around, the Salem area.
Nationally, more than 10,000 people have died from influenza this season. Locally, Emergency Medical Services (EMS) in Marion County recognized a concerning trend last year when individuals faced extended times for emergency care at the height of the flu season. There simply wasn’t enough capacity to treat people quickly. EMS providers started to question what could be done to prevent people from needing emergency rooms in the first place.
An answer emerged through conversations between EMS providers and the Public Health Division Director for MCHHS, Katrina Rothenberger. Together, the public health and EMS partners recalled the time when they had a Memorandum of Understanding to distribute flu shots during the H1N1 pandemic in 2010. Rothenberger asked what MCHHS Public Health Division could do to reignite those efforts to combat new emerging threats in the county. Local EMS providers and MCHHS reinstated their MOU in December 2019 to allow for joint flu vaccination efforts, and MCHHS has since leveraged their partnership to expand into prevention for Hepatitis A.