Deborah Kafoury
Multnomah County Chair

Monday, Aug. 3, 2020

To the Honorable Governor Kate Brown and Oregon Health Authority Director Patrick Allen,
We write to you today as the Chairs of the three counties that are home to 44 percent of
Oregon’s population and nearly half the state’s cases of COVD-19. If our region has any hope of
seeing lasting declines in the rate of infection, the three counties and the Oregon Health
Authority must coordinate our efforts even more effectively.
On July 30, Multnomah County was added to the COVID-19 Watch List of Oregon counties
experiencing an unmanageable sporadic spread of the virus. Increases in sporadic cases are
related to the movement, work and social gathering of people, all forces that public health can’t
alone control. We’ve found that social interactions in particular cross geographic boundaries,
making a distinct Metro-area strategy imperative when looking at statewide metrics.
In response to being placed on the Watch List, and in recognition of Multnomah County as part
of a region inseparable in its borders from neighboring counties, we ask the state for the
following to better support of our COVID-19 response:

Systems Changes
Hiring additional staff does allow us to expand our response,​ but people alone are not the
sole solution we need​. The following adjustments in the state’s disease response system will
allow those staff to be more efficient and effective:
● Change the thresholds for outbreaks to prioritize our response on the most urgent and
largest outbreaks.

● Omit household contacts from employer outbreaks reported weekly to eliminate
confusion. For example, a workplace “outbreak” may only have two employees
and three household members, but the public is interpreting the case count of
five as five ill employees.
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Create a process to report outbreaks electronically in order to streamline reporting.
Create a data dictionary for Opera, the state’s COVID-19 database, so that county staff
have a clear definition of terms. This is especially important as we train new employees
and expand our workforce.
Develop additional training supports for case investigators and contact tracers in
partnership with local public health, including interview training videos and a guide that
addresses each data entry field for completing an interview in Opera.

501 SE Hawthorne Blvd., Suite 600, Portland, Oregon 97214
(503) 988-3308 ​ ​ ​mult.chair@multco.us

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Clarify that OHA assumes management of all complex worksites outbreaks, such as
those that cross jurisdictions.
Update guidance language to ensure all businesses — not just those with public access
— require face coverings be worn at all times unless there is continual ability to maintain
6 feet or more of distance between employees.
Employ a Personal Protective Equipment (PPE) distribution model that aligns with
current epidemiological data. Multnomah County has had 23 percent of the State’s
positive cases and 28 percent of the States fatalities. We believe a model using either of
these percentages for future PPE dissemination is more appropriate than current
models.
Expand routine, ongoing and prompt low-barrier testing access across the Tri-County
region.
Strongly discourage documentation of negative test results for employment and
out-of-state travel in order to free up testing capacity​.

Partnership
When we look at our COVID-19 statewide response, one size does not fit all. We’ve seen
exceptions made to metrics or guidance for rural counties, which makes sense. We would now
like to work with OHA to create an approach that makes sense for the Metro region. That
includes:
● Clear conversation with OHA about what existing metrics mean in the context of the
Metro area, and what other metrics might better capture disease risk and response.
● Allowing local health departments to confer with one another and respond as new
questions are considered for addition to Opera and Orpheus.
● Discuss what different approaches might be needed for funding of Metro counties.
● Support local public health response by providing data to show what interventions are
working. For example, are people adopting interventions such as quarantine and
isolation? What barriers are employers facing in working with us? And what are the
barriers at the household level?

Communications
Disease spreads because of behavior and the environment and as a result, contact
tracing alone cannot suppress cases.​ We need public support to modify behaviors, and
employer support to modify high-risk worksites. The state can support the Tri-County region by
providing financial assistance for:
● Age-specific multimedia communications and partnerships with social media influencers.
● Messaging in multiple languages through partnerships with trusted community leaders,
including faith leaders and activists.
● Trained bi-lingual and bi-cultural multimedia creators to support the region’s public
information response through its emergency operations centers.
● Employer-specific messaging that motivates employers to work with public health:

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Enforcement notices sent to employers who are not cooperating with
investigations
Opportunities to educate businesses about the technical assistance public health
will offer, including myth busting.
Sector-specific materials and technical assistance for employers experiencing
outbreaks.

Other barriers
Financial support for investments in protective gear and community organization staffing will
also support a prompt and effective response in the region. The state can provide financial
assistance for:
● Hiring the financial, compliance and program staff needed to integrate the state-funded
community based organization into the local public health response.
● The purchase of adequate reusable, washable face coverings to assure that every
Multnomah, Clackamas and Washington County resident has at least two face
coverings.
● Adequate financial support for all three Counties, including Clackamas County which has
struggled even more with limited CARES ACT funding. The virus does not stop at any
one counties borders. These partnerships are key to battling increasing numbers of
positive tests in Multnomah, Washington, and Clackamas County.
We appreciate your hard work and continued leadership in responding to COVID-19. We see
these steps as an opportunity to further streamline, coordinate and advance our public health
response in the Tri-County region.
Sincerely,

Deborah Kafoury, Chair, Multnomah County Board of Commissioners

Kathryn Harrington, Chair, Washington County, Board of Commissioners

Jim Bernard, Chair, Clackamas County Board of Commissioners