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COVID-19 in the mid-valley: How testing and tracing are taking shape
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COVID-19 in the mid-valley: How testing and tracing are taking shape

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For Leslie Scott, it started as a cough. 

Then came the fever and the shortness of breath.

Symptoms continued for a few days before the Sweet Home resident decided to visit her doctor because in a pandemic, it's better to be safe then sorry. 

"My health insurance is through my work and they partner with Kaiser Permanente so even though I live in Sweet Home, I had to drive to Salem to be tested," she said. 

Scott eventually tested negative after having her nose swabbed and suffering from a nosebleed she attributes to the test, but her experience raises questions as the mid-valley copes with COVID-19. 

Who can get tested and where? How is local government handling quarantine procedures? And just what do all the numbers mean?

The numbers

As of Friday, the state of Oregon reported 18,492 cases of COVID-19, an increase of more than 2,000 cases in seven days. But that doesn't mean more than 16,000 Oregonians are currently struggling with the virus. The number is cumulative and doesn't include those who have recovered.

In fact, the Oregon Health Authority has not released new information concerning recovered cases since the beginning of May when the department noted that prior to May 1, when the definition of recovery was altered, the department contacted 1,885 individuals who had been diagnosed with COVID-19. Of that group, 86.7% are considered to have recovered while about 12% either haven't recovered yet or no information is available for those individuals. 

On Thursday, the department unveiled a new dashboard that tracks testing rates per county and recovered cases. According to the dashboard, 3,872 people have recovered, though OHA has not released information surrounding the criteria needed to identify someone as recovered. Additionally, nationwide recovered patients have reported symptoms such as loss of smell, taste, heightened heart rates and shortness of breath lasting well beyond their recorded recovery. 

Tracking recovered cases, is hard. The definition of recovered has changed at least once in Oregon and continues to be a moving target nationwide. Those who have received negative tests may still have symptoms such as the loss of taste or smell. In extreme cases, some are reporting long-lasting impacts of the virus such as asthma when they did not suffer from the condition previously. 

At the county level, recoveries are not being counted either. 

"There is variable and sometimes conflicting guidance around exactly what qualifies as 'recovered,'" said Benton County Health Director Charlie Fautin. 

And what of the daily caseloads released by the Oregon Health Authority?

The numbers include both the verified positive cases and presumptive cases. That means cases that have symptoms, had close contact with a confirmed case and are assumed positive but are waiting for a test result. 

Additionally, confusion surrounds the relationship between testing and the state's positive rate. For the past month, the positive rate has steadily increased from 3% to 6.6%, before dropping last week to 5.1%. Some residents have incorrectly attributed the rise to an increase in testing, insisting that more tests will yield more cases.

However, the positive rate is not directly related to a testing increase. It's a percentage that — as it rises — shows more people are being infected with the virus, independent of an increase in testing than their had been before. 

Between July 13 and July 19, there was a 26% increases in cases over the previous week. 

In Linn County, between July 26 and Aug. 1, seven people tested positive of the 241 who were tested or about 3%. In Benton County, the number was 2% with 3 out of 150 people testing positive. For comparison, Marion County, a state hot spot,tested 936 people in the same time frame with 71, or 7.6%, testing positive. In Multnomah, it was 5.9% (158 out of 2,678) and in neighboring Lane County, 32 people of the 1,475 tested were positive. 

But how much does testing contribute to positive case loads? Who can get tested and how many tests does each county have? The answers, like the pandemic itself, can lean toward ambiguity. 

Testing

Linn County is currently conducting between 200 and 300 tests a day. The goal, said Linn County Health Administrator Todd Noble, is to create the capacity for thousands of tests a week. 

But the county is unique. 

One of the first outbreaks of the virus in Oregon was in Lebanon at the Edward C. Allworth Veterans' Home. But testing supplies were hard to come by and the state had yet to find a concrete plan for how or why people would be tested. 

Enter the Linn County Board of Commissioners

The three-member body made a deal with Willamette Valley Toxicology, an independent lab in Corvallis. By April, the lab agreed to test up to 1,000 people a week for eight weeks for $500,000. 

After hitting a roadblock in finding testing supplies, the county's testing program has been up and running ever since and is not dependent on the state. The county tested every person at the Veterans' home, symptomatic or not and Commissioner Will Tucker says, anyone in Linn County who wants a test can get a test. 

In Benton County, Fautin says the same rule applies: Whomever wants a test can get a test if they meet certain criteria. Both Noble and Fautin, however,  note that that is the policy but not always the practice. 

"Basically it’s up to a provider," Fautin said. "There is standard guidance about what symptoms are. It will depend on the level of contact. If someone meets contact criteria then they’re put through the system and tested."

That criteria is set by the state, Fautin said and includes contact they may have had with a confirmed case and having at least two symptoms of COVID-19. 

"There are a lot of other things that can cause shortness of breath and even loss of taste and smell," he said. "Unless people have no other access, testing is being directed to their primary care provider."

The reason, Fautin said, is due in part to capacity. 

"It’s frustrating for people I know who want to be tested," he said. "Part of the problem is that the medical labs continue to be overwhelmed and so on-demand testing that’s available in some areas ... we don’t really have the capacity here for that." 

Between July 14 and July 20, Benton County tested 166 people. But that doesn't mean others aren't testing in the area. Oregon State University is also offering tests through a neighborhood-based program while also partnering  Willamette Valley Toxicology. 

Tracing

Once a test comes back positive, the process begins to track its origins. The hope is that enough information can be gathered so a county can avoid an outbreak and those who may be infected, quarantined until the virus' incubation period passes. 

But not everyone is helpful. 

Contact tracing works by having people hired by the county contact those who have had a positive test to ask them where they have been over the past two weeks or so. But fears about the virus and all out conspiracy theories has led some people to be uncooperative. 

When people refuse to speak to contact tracers, it limits the county's response. And when they refuse to quarantine, it outright endangers the community. 

"Tracing and tracking are two critical things," Tucker said. "People complying with us when we make our phone call to help us with that tracing is absolutely critical."

The process is actually two-fold, Noble said. 

"It's a disease investigator. When we have a positive they are actually tracing the cases. Usually a staff person can do two to three of those a day because, if you can imagine, one case can illicit dozens if not hundreds of phone calls," he said. "And then on the back end, the actual tracers, they’re making routine calls on a daily basis, checking up on the cases. Do you have any needs? How are you doing with isolation? Things like that. On a consistent basis we have about five people seven days a week handling the investigations. The can do two or three a day and that can be concerning if we have a large outbreak." 

Currently, Linn County has 33 tracers. Benton has nine full-time and 12 part-time tracers.

Both counties are hoping to increase the number of staff tracers, noting that if the county caseloads increase dramatically, it will be a necessity. Benton will bring in Oregon State University interns and is hoping to hire another five individuals. Linn County is hoping to add six. 

Quarantine

Those with symptoms waiting for a test are asked to self-isolate. Once a test comes back positive, quarantine sets in. But not everyone can stay home. And the county can't force those who can to do so. 

"In the past few weeks getting results back has taken longer than we experienced earlier and that does make it more difficult to get someone to quarantine when they don't have symptoms," Noble said. "This week, the turn- around time has improved and we're getting back down to three days. Some people  are very cooperative, but we can't force them (to quarantine) and so we provide a lot of education." 

And for some people, quarantining — recommended to be 14 days by the CDC and OHA — isn't an option because of their housing status. 

"Every county has a state requirement to be able to provide shelter for COVID- positive people who either don’t have shelter or cannot remain in their own home or shelter," Fautin said. 

But finding shelter has been difficult. According to Fautin, no hotel or motel in Benton County was willing to take individuals diagnosed with an infectious disease and so the county partnered with Linn County where one hotel has become an option for those without housing in need of quarantine. Due to privacy concerns and laws surrounding medical privacy, the county is not releasing the name of that hotel which is still taking reservations from other customers as well. 

According to Tucker, strict cleaning protocols are in place and the county provides cleaning services to the facility, supplementing the hotel's cleaning crew. 

"It's all done to a hospital level," he said, noting that any of the guests traveling through the hotel has the potential to carry COVID-19, not just those diagnosed or quarantining there. 

Benton also has county housing for those who may have to isolate for their families or whose families have to isolate from them. 

"Everything is not perfect and we don’t have all the solutions we want," Tucker said. "When we needed to isolate folks from the vets home we needed to put them in isolation not just quarantine, we supported the home in their renting of an apartment and getting health checks and food deliveries. We have a hotel voucher program that we’ve had for years and right now only one hotel will take COVID people. For that one hotel we’re looking to improve by getting them extended limits of liability."

Another population in need of housing to quarantine are those who were released from jail but had contact with positive COVID-19 cases.

A tent, Tucker said, has been erected at Albany Helping Hands for those people to quarantine. 

"We don’t have enough isolation or quarantine space if we have a major outbreak," Tucker said. "So supporting mask wearing efforts."

The future

For now, Oregon has COVID-19 somewhat under control. But the latest numbers show a situation ripe for chaos. 

Over the last five weeks, the number of cases has increased over the previous week and the state's positive rate continues to climb. The increase, according to Oregon Health Authority, is being attributed to community spread. Half of Oregon's cases, the state said this week, cannot be traced back to an original sick patient meaning the virus is widespread in the communities and continues to spread amongst friends and family.

For the first time last week, the state's positive rate fell from 6.6% to 5.1% but that number is still too high to open schools under Governor Kate Brown's new requirements. 

Daily caseload numbers have not fallen below 100 in more than a month, more often climbing into the 200 and 300s. 

Both counties are working to increase their testing, tracing and ability to help people quarantine, all of which takes time and money. The easiest way to avoid large outbreaks and overwhelming the system, experts say, is to social distance and wear a mask. 

"All I know, is that if I can keep a (hospital) bed available for everyone who needs one and to do that all I need to do is wear a mask?" Tucker said. "That grandmother, that aunt, uncle? Boy, isn't that great? I just have to wear a mask (to keep them safe) I'm going to do that." 

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