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The original item was published from 5/1/2020 11:26:34 AM to 5/3/2020 12:00:01 AM.

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Posted on: May 1, 2020

[ARCHIVED] New COVID-19 testing, tracing plans announced

Oregon releases new details of coronavirus testing, tracing, reopening plans

By Brad Schmidt | The Oregonian/OregonLive

Oregon Gov. Kate Brown and public health officials unveiled new details Friday of the state’s plan to beef up testing and contact tracing as businesses look to reopen amid the coronavirus pandemic.

State officials are trying to balance the desire to restart the economy against the threat of more deaths, suggesting that risks can be managed by adding 600 people to perform public health investigations and ensuring 15,000 Oregonians can be tested for the virus each week.

Dr. Dean Sidelinger, the state health officer and epidemiologist, said he’s confident the plan will allow Oregon businesses to gradually reopen while preventing a dramatic surge in coronavirus infections. Some rural counties could begin reopening by mid-May, he said, but expanded contact tracing must begin first.

“We’re not going to be able to prevent every case,” he told The Oregonian/OregonLive ahead of a planned 10:30 a.m. news conference Friday. “And I think we will see cases increase as people start to move about more.

“But we feel this is a plan where we can best manage that and try to keep the increase in cases to a minimum.”

Oregon has not seen a high rate of coronavirus infections compared to the rest of the nation, identifying about 2,500 Oregonians with the virus through limited testing. Yet officials are taking a more cautious approach to reopening than in some other states, such as Georgia, which began easing stay-home restrictions last week. Some Oregonians, particularly in rural areas with the fewest number of cases, are pressing to reopen businesses and resume some semblance of daily life.

But new modeling shows that easing restrictions runs the risk of sharply increasing coronavirus infections in Oregon. The modeling suggests that Brown’s March stay-home order reduced infections by about 70 percent from what it could have been – and doing anything different creates uncertainty.

“The problem is, we’re a little hampered in knowing exactly how much decrease in transmission we can do with these measures,” Sidelinger said.

If restrictions reduced infections by only 60 percent, Oregon might see only modest increases in active infections and deaths, the modeling suggests. “At 60 percent, we can manage the increase,” Sidelinger said.

But at 50 percent, active infections could jump quickly and a greater number of deaths could ultimately follow, the modeling suggests.

“If we can only decrease disease by about 50 percent from baseline, the curve does rise rather steeply,” Sidelinger said.

Sidelinger said the modeling, used for planning, suggests that Oregon can reopen safely while officials aggressively monitor infections and hospitalizations to determine if coronavirus spreads too rapidly.

“I’m confident that we can keep it at 60 percent,” he said. “And if we’re seeing increases, then we will roll out easing of measures.”

Documents released Friday provided new details about how Oregon hopes to contain the spread of coronavirus through testing and contact tracing. State officials have said they want to have the ability to test 15,000 Oregonians a week, and now the underlying assumptions behind that number are becoming clearer.

The state has assumed that at any given time 2,800 Oregonians are infected with the virus. Dividing that number by eight days, the assumption for how long each person is infectious, the state believes 350 people are infected each day.

The state wants to have testing capacity so each new infection could ensure the testing of five people. That would require a total of 1,750 a day, or 12,250 a week, according to the state. Officials also want to perform targeted testing for outbreaks and broader surveillance, taking the total to 15,000.

No state is conducting widespread testing because of limitations in supplies. But Oregon’s plan would allow for testing of less than 0.5% of the population each week, below the level many experts say is needed.

State officials on Friday also broadened their guidance about testing to include new symptoms previously announced by the Centers for Disease Control and Prevention. The Oregon Health Authority this week had previously declined to answer questions from the newsroom about whether its testing guidance would be expanded.

The new guidance recommends testing for people in high-risk groups with symptoms that include fever, cough or shortness of breath, or two of the following: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.

“We’re making the medical decision to really recommending more” testing, Sidelinger said. “Because we believe we have the capacity there.”

State officials also provided new but limited details on their plan to ensure 600 more people are hired to perform contact tracing. Tracers would talk with infected Oregonians, identifying who they could have infected and notifying those people to stay home to prevent spread.

The health authority said Oregon has at least 100 tracers now. Officials plan to add 600 more workers for tracing based on a projections of 15 workers for every 100,000 residents.

But national health organizations have said that ratio should be a baseline, and during this pandemic it should be twice as high. That would suggest an appropriate number of more than 1,300 tracers in Oregon.

Asked whether 600 new tracers is sufficient, Sidelinger said: “This is where we’re going to start. We’ll continue to evaluate to see how we’re doing.”

Tracers would be hired over the next month or so. Each tracer would be responsible for contacting 15 people at any given time, Sidelinger said, noting that many of them may be new to public health investigations.

“We want to keep their workload manageable,” he said, adding: “We’ll see if that’s the right assumption or if we need to change that.”

This story will be updated.

-- Brad Schmidt; bschmidt@oregonian.com; 503-294-7628; @_brad_schmidt



From ohsu.edu/keystudy


Key to Oregon Study on COVID-19

OHSU, the state of Oregon and the OHSU-PSU School of Public Health will conduct a statewide COVID-19 research study to inform the approach for reopening Oregon.

The Key to Oregon study will seek to better understand the coronavirus’s infection patterns with testing and precise, real-time mapping. The study will gather essential data to help leaders make decisions at the state and local levels. The goal is to get people back to school and work faster while avoiding a second wave of infections.

The study will include attention to vulnerable communities, including Native Americans and people of color.


How the study will work

An OHSU research team will enroll 100,000 randomly selected Oregonians to voluntarily join the study. The team will track the temperatures and other COVID-19 symptoms of all participants to make quick decisions.

Participants will:

  • Be selected at random to represent the state’s ethnic, socioeconomic and geographically diverse population.
  • Receive an invitation to enroll, via U.S. mail, starting the week of May 11.
  • Monitor their temperature and other symptoms every day over 12 months using state-of-the-art technology, such as Kinsa smart thermometers, to collect real-time data.
  • If they show symptoms, they will receive a home test kit. This will enable them to detect the virus at its earliest stage so they can better protect themselves, their family and the community.
  • Be referred to the Oregon Health Authority for follow-up and appropriate action as needed.

In addition, up to 10,000 randomly selected participants will also receive home testing kits to provide data about symptom-free infections, and to prevent wider spread in the community and state.

All test results will be reported to the Oregon Health Authority to help with contact tracing and home isolation of those who test positive. In contact tracing, people who may have come in contact with an infected person are identified to raise awareness of COVID-19 symptoms and to take steps to limit disease spread in their household and the community.

All study participation is voluntary, and the study will follow strict patient privacy guidelines. Participating in the Key to Oregon study is not a substitute for COVID-19 health care. Anyone with symptoms should contact a health care provider.

An initial investment of $6 million has been committed by the state of Oregon to help fund this study. OHSU and the governor are seeking additional funding through public and private partnership.


Expected results from the study

The study will give leaders a more accurate understanding of Oregon’s infection rate. In addition, the study will:

Gather data about the virus in Oregon to determine the link between easing physical distancing measures and any rise in infections.

Identify COVID-19 cases in their earliest stages, so swift contact tracing and isolation can help control the spread of the disease.

Provide early warnings of virus hot spots, so swift action can limit spread before community physical distancing measures need to be reinstated.

Identify asymptomatic (without symptoms) outbreaks and infected people — infections that would otherwise be an invisible factor in the spread of the coronavirus.

Focus special attention on high-risk populations and underserved communities to make sure no groups are left out or left vulnerable as our society emerges from this pandemic.


The research team

A team of OHSU researchers, including experts from the OHSU-PSU School of Public Health, developed the study. The team includes:

David Bangsberg, M.D., M.P.H., founding dean of the OHSU-PSU School of Public Health

Brian Druker, M.D., director of the OHSU Knight Cancer Institute

Principal investigators: Jackie Shannon, Ph.D., M.P.H., and Paul Spellman, Ph.D.

Consultants: OHSU Chair of Pathology Donna Hansel, Ph.D., M.D.; OHSU infectious disease experts; and researchers across OHSU, including from the Vaccine and Gene Therapy Institute

Questions? Please email keystudy@ohsu.edu.

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