Reopening Oregon: A Public Health Framework for Restarting Public Life and Business Governor Kate Brown April 20, 2020 Version 4/20/2020 13:48 1 You don?t make the timeline. The virus makes the timeline. Dr. Anthony Fauci Our reality: We will be living with the virus until there is immunity, which is many months off. 3 COVID-19 hospitalizations Goal: Keep the Curve Flattened Source: Institute for Disease Modelling Experience in other countries and modelling says: reducing social distancing too quickly will create a spike in cases. 4 Opening Up America Again Guidelines Released by President Trump on April 16, 2020 NOTE: The Governor’s Medical Advisory Panel and the Oregon Health Authority have not thoroughly reviewed the Opening up America Again Guidelines. After review, criteria could be added or modified to better meet the situational needs of the state of Oregon. 5 1. Gating Criteria: 3 components – Symptoms – declining numbers – Cases – declining numbers – Hospital capacity – regular procedures and adequate testing 2. Core State Preparedness: 3 components Framework Overview – Robust testing and contact tracing – Healthcare system capacity, including PPE and surge capacity – Plans for health and safety 3. Phased lifting of restrictions: 3 components – Phase 1 – Phase 2 – Phase 3 6 SYMPTOMS Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period - AND - Downward trajectory of COVID-like syndromic cases reported within a 14-day period Three Gating Criteria CASES Applied on a state or regional basis Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests) DRAFT – Oregon will likely use modified metrics, especially for rural counties who have small numbers. Downward trajectory of documented cases within a 14-day period - OR - HOSPITALS Treat all patients without crisis care - AND – Robust testing program in place for at-risk healthcare workers, including emerging antibody testing 7 I. TESTING & CONTACT TRACING – Screening and testing for symptomatic individuals – Test syndromic/influenza-like illness-indicated persons – Ensure sentinel surveillance sites are screening for asymptomatic cases (sites operate at locations that serve older individuals, lower-income Americans, racial minorities, and Native Americans) Core State Preparedness: I and II – Contact tracing of all COVID+ cases II. HEALTHCARE SYSTEM CAPACITY – Sufficient Personal Protective Equipment (PPE) – Ability to surge ICU capacity 8 III. PLANS – Protect the health and safety of workers in critical industries – Protect the health and safety of those living and working in high-risk facilities (e.g. senior care facilities) – Protect employees and users of mass transit Core State Preparedness: III – Advise citizens regarding protocols for social distancing and face coverings – Monitor conditions and immediately take steps to limit and mitigate any rebounds or outbreaks by restarting a phase or returning to an earlier phase, depending on severity 9 Phase One Phase One begins at Governor’s direction after all Gating Criteria and Core Preparedness items are met 10 Guidelines for Individuals – Practice good hygiene – Strongly consider wide use of face coverings in public – Stay home if sick Phased Approach: Guidelines for all Phases Guidelines for Employers – Develop and implement appropriate policies: social distancing, protective equipment, temperature checks, sanitation. – Monitor workforce for indicative symptoms – Contact tracing policies for positives. 11 – ALL VULNERABLE INDIVIDUALS should continue to shelter in place. – All individuals, WHEN IN PUBLIC (e.g., parks, outdoor recreation areas, shopping areas), should maximize physical distance from others. Phase One: Individuals & Employers – Avoid SOCIALIZING in groups of more than 10** people. Close COMMON AREAS where people are likely to congregate and interact. – MINIMIZE NON-ESSENTIAL TRAVEL – Continue TELEWORK whenever possible. ** NOTE: Needs review by Oregon Health Authority, Governor’s Medical Advisory Panel and local public health. 12 Phase One: Specific Types of Employers ** NOTE: Needs review by Oregon Health Authority, Governor’s Medical Advisory Panel and local public health. Phase One – Federal proposal Oregon Modifications Under Consideration** Schools and organized youth activities Remain closed Additional childcare reopening in Phase One Visits to hospitals and senior living facilities Prohibited Large venues: sports, theaters, churches “Strict physical distancing and Likely remain closed sanitation protocols” during Phase One Sit-down dining “Strict physical distancing and Work group to propose sanitation protocols” Phase One plan Gyms “Strict physical distancing and Likely remain closed sanitation protocols” during Phase One Bars Remain closed Work group to propose Phase One plan Non-emergency procedures “can resume, as clinically appropriate” Oregon regional policy under review Personal services Not called out specifically Work group to propose Phase One plan 13 Geographical considerations: • Declining growth in symptoms/ cases • Regional testing capacity • Regional hospital capacity • Regional contact tracing capacity • Regions work with OHA on plans 14 FOR DISCUSSION - UNDER CONSIDERATION Additional prerequisite for opening a county in Oregon: a formal request to the Governor: – Letter from the CEOs and CMOs of hospitals within the county committing to daily PPE reporting to OHA, PPE supply chain reliability and hospital bed surge capacity. – Recommendation letter from the County Public Health Officer. – Vote of the County governing body certifying PPE for first responders is sufficient. 15 Phases Two and Three Wait 14 days, pass the gating criteria again, then move to the next phase. ** NOTE: Needs review by Oregon Health Authority, Governor’s Medical Advisory Panel and local public health. Phase 2: ** Gatherings increase to 50, non-essential travel can resume, schools and gyms can open under physical distancing Phase 3: ** Mass gatherings size increases, worksites have unrestricted staffing, visitors to nursing homes allowed, restaurants and bars can have more seating 16 High-level framework presentations: Begin April 17 – Governor’s Economic Advisory Council – Regional Solutions Regional Advisory Councils – Local elected officials: Counties, cities, legislators – County health departments High-Level Framework Community Presentations – Outdoor recreation sector – Healthcare stakeholders – Business community – Communities of color, Tribes, and community organizations – Many more… 17 Sector-specific discussions: starting week of April 20 Sector-specific Discussions: Owners/practitioners, workers, and health professionals 1. Restaurants/Food service 2. Retail 3. Personal services (hair and nail salons, massage, tattoo parlors, etc.) 4. Childcare 5. Transit 6. Outdoor recreation (parks, trails, etc.) 18 1. High-level framework presentations across the state: Begin April 17 2. Consult with most-affected industries: Restaurants, Retail, Outdoor Recreation, Personal Services: Week of April 20 3. Complete details of framework, including operational plans and geographic criteria: Week of May 4 Next Steps 4. Finalize discrete steps and guidelines in the Step-by-Step Reopening Oregon Plan: Week of May 4 5. Ongoing coordination with West Coast states 19 White House and CDC: Opening Up America Again American Enterprise Institute: National coronavirus response: A road map to reopening Reopening Resources Ifo Institute: Making the Fight against the Coronavirus Pandemic Sustainable Center for American Progress: A National and State Plan To End the Coronavirus Crisis 20 APPENDIX 21 Oregon Immediate To-Dos: Gating Criteria Element Process/Sub-tasks Timeline Gating Criteria: • Symptoms: Need ILI and syndromic case data by county to see Symptoms & Cases trends by county • Cases: Have this data Gating Criteria: Sufficient PPE • Multiple orders placed – private vendors, FEMA, etc. Dependent on • Request for large mask sterilization machine placed with FEMA delivery • Various Oregon manufacturing ventures started • Hospital inventories and usage rates are incomplete 22 Oregon Immediate To-Dos: Core Preparedness Element Process/Sub-tasks Timeline Hospital Capacity • Alternative care sites identified • Oregon Medical Station set up at State Fairgrounds Generally completed Robust testing, tracing and isolation strategy • Testing strategy in draft form; has had initial review by MAP; needs lab details added • Contact tracing plan being drafted, including staffing and technology; needs review by local public health and MAP • Isolation strategy and alternative sites being drafted and identified; needs review by local public health and MAP Complete draft within two weeks Guidelines for specific sectors • Plan for restarting non-emergency and elective procedures being drafted by OHA Reviewed by MAP on April 16 • Workgroups for six sectors being established: Restaurants, Retail, Childcare, Personal Services, Transit, Outdoor Recreation. Draft guidelines within two weeks 23 Oregon Immediate To-Dos: Added Components Element Process/Sub-tasks Timeline Systems for hardest-hit and vulnerable populations • COVID-positive nursing home currently being stood up Draft within two • Additional operational plans for other populations being drafted weeks • Needs review by local public health and MAP • Need specific test/track/isolate plans for hardest-hit groups 24 Opening Up America Again Vulnerable Individuals Definition 1. Elderly individuals. Definition of Vulnerable Individuals 2. Individuals with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised such as by chemotherapy for cancer and other conditions requiring such therapy. 25