TUESDAY, APRIL 21, 2020
Baker City, Oregon
4A
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EDITORIAL
We need to
expand
testing for
coronavirus
Although scientists are learning more about the
coronavirus almost literally on a daily basis, for the
general public a fundamental question remains un-
answered — how many people, in a given area, are or
have been infected?
It’s not just that we don’t have a precise answer —
no reasonable person expects that.
But in Baker County, and in Oregon overall, so few
people have been tested, relatively speaking, that it’s
impossible even to make a meaningful estimate of
this immensely important statistic.
Among other things, having a reasonably accurate
idea of the prevalence of the virus in the population
will help to determine when businesses can begin to
reopen and, ideally, our ravaged economy can begin to
recover.
At least initially during the pandemic, when testing
capacity was limited, it made sense to restrict tests to
people who had severe symptoms or who were health
care workers, nursing home residents or in other
high-risk categories.
But those limits no longer pose an impediment,
according to Dr. Dean. Sidelinger, Oregon’s state epi-
demiologist and health offi cer, in a recent interview
with The Oregonian.
Statewide, Oregon ranks 31st in per-capita test-
ing, with about 8.6 people per 1,000 residents having
been tested.
The national average is about 10.46 per 1,000
residents.
Baker County, at about 3.6 tests per 1,000 resi-
dents, is well below both the national and state
averages.
As of Monday, 61 county residents had been tested,
according to Baker County. Of those, 51 were nega-
tive and 10 had pending results. Baker County is
one of fi ve of Oregon’s 36 counties with no confi rmed
cases.
That’s a good thing, obviously. But that zero doesn’t
mean no one in the county is, or has been, infected.
Indeed it’s all but certain that that’s not the case, as
Baker City physician Eric Lamb, the county’s public
health offi cer, noted when he said, in early April, that
the virus “undoubtedly” will be confi rmed here. State-
wide, about one in 20 tests has been positive.
In one sense the lack of confi rmed cases in Baker
County has had little effect. Our restaurants, bars
and some other businesses have been affected just
as severely by Gov. Kate Brown’s March 17 executive
order as those in counties that have confi rmed cases.
Our schools are closed just as theirs are. And our
residents are striving to comply with social distancing
guidelines.
But in another sense the lack of confi rmed cases
— and the statistical likelihood that this is due to the
scarcity of tests rather than the utter absence of the
virus — has the potential to make residents either
complacent about the importance of social distanc-
ing and other precautions, or skeptical about offi cial
statistics. Neither is a positive situation.
As Lamb said, we should expect that Baker County
will eventually have a confi rmed case. But it’s beyond
dispute that the more we know about how wide-
spread this virus is here — and everywhere — the
better.
There’s reason to be optimistic. According to a
report in the East Oregonian, Interpath Laboratory
in Pendleton will soon start coronavirus testing. And
rapid testing equipment, which can yield positive
results in fi ve minutes and negatives in 13 minutes,
could be available in Baker County relatively soon. If
the virus is as rare here as it appears to be, the more
test results we can get will only bolster the case for eas-
ing the restrictions that have so damaged our economy.
— Jayson Jacoby, Baker City Herald editor
Finding work in the virus era
Roughly 22 million Americans have
lost their jobs since mid-March, when
the coronavirus started spreading
around the country. Many won’t be able
to return to work until the outbreak is
contained. Meanwhile, there’s a proven
strategy for containing infectious dis-
eases, which is notoriously diffi cult to
carry out because it’s so labor-intensive.
Why don’t we solve both problems at
once?
With “contact tracing,” a mainstay
of infectious disease control, health
workers identify people who have been
infected, contact them, learn who they
may have exposed, and reach out to
those people to limit the spread. Right
now, the coronavirus is too widespread
and testing too limited for such a tar-
geted approach to work. But once case
numbers become more manageable,
the U.S. will move away from what epi-
demiologists call the “population-based”
approach, which requires everybody to
self-isolate, and toward one focused on
containing individual cases. This will
be the only way most of us can get back
to normal life without risking devastat-
ing new outbreaks.
It’s a strategy that’s been shown to
work against COVID-19 in New Zea-
land and Iceland. In the U.S., health
offi cials use it to contain mumps and
other diseases. But in the current crisis,
the U.S. doesn’t have enough public
health workers to do the job. Contact
tracing helped snuff out Liberia’s
Ebola outbreak in 2014, but it took
4,000 workers to protect the country’s
5 million citizens. Wuhan, a city of
11 million, reportedly needed 9,000
contact tracers to suppress COVID-19.
Estimates vary, but the U.S. will need
100,000 to 300,000 contact tracers to
contain the coronavirus. That’s a lot of
manpower.
Digital tools, such as apps used in
Singapore and South Korea to auto-
matically alert people who have been
exposed to the coronavirus, can aug-
ment human labor — but they can’t
TRACY WALSH
replace it. This is especially true in the
U.S., where stronger privacy protec-
tions and weaker quarantine authority
limit technology’s reach. The high-
profi le contact-tracing program under
development by Apple and Google will
operate on an opt-in basis — which
could limit its use substantially. As Dr.
Farzad Mostashari put it on Twitter,
“How do you get virtually everyone to
put an always-on app on their phones
that tracks their contacts, eats bat-
tery, and doesn’t do anything to delight
them?”
So state and local health depart-
ments should start thinking about how
they can scale up their work forces. A
pilot program in Massachusetts could
serve as a model for others. The state is
working with Partners in Health — the
Boston-based nonprofi t best known
for its work in Haiti — to hire some
1,000 contact tracers. Since training
will be provided, these entry-level jobs
are open to anyone with a high school
education. The workers will track the
ill and exposed using a web-based
contact-management system, and ulti-
mately connect them with testing and
other services needed for quarantine,
such as food delivery and even housing.
In return, entry-level contact tracers
will earn $27 per hour. That’s consider-
ably more than the state minimum
wage, but given the importance of
fi ghting the virus — and relieving
workers’ distress during this stunning
economic crisis — it will be money well
spent. Epidemiologist Gregg Gonsalves
recently called for “a WPA for public
health,” referring to the Depression-
era program that employed millions to
build roads, parks and other projects
that endure to this day. Eradicating the
coronavirus would require fewer work-
ers, but the employment situation is,
for now, no less dire. And importantly,
containing the virus would allow the
U.S. economy to return to normal as
scientists work on a vaccine.
Many temporary contact tracers
could return to their jobs once the cri-
sis abates. For others, contact tracing
could be a stepping stone to a career in
public health, where workers are des-
perately needed, because more than
50,000 public health jobs evaporated
during the Great Recession. By one
estimate the U.S. is short a quarter-
million such workers — who will need
to be hired if we want to avoid future
pandemics.
Expanding contact tracing is one
of many ways to shore up the public
health workforce. Lawmakers from
both parties have called for a Public
Health Infrastructure Fund, which
would raise $13 per person to ensure
that the public health system can
meet its “foundational capacities.”
That would amount to $4.5 billion, a
tiny fraction of the money allocated
for coronavirus relief so far. Partner-
ships with universities, nonprofi ts and
businesses — such as Massachusetts’
with Partners in Health — might offer
another way for cash-strapped public-
health agencies to scale up.
Until there’s a vaccine for CO-
VID-19 — with luck, sometime next
year — coronavirus is going to be a
problem. We have, broadly speak-
ing, three choices. We could maintain
shelter-in-place orders indefi nitely,
devastating the economy. We could
end it for everyone, leading to more
outbreaks and needless deaths. Or we
could be strategic — identifying the
sick and at-risk through testing and
tracing, suppressing outbreaks, build-
ing up our public health capacity and
keeping laid-off workers employed un-
til the economy has recovered enough
to reabsorb them. The choice is easy.
Tracy Walsh is an editor for Bloomberg
Opinion. She was an editor at the Dish
and Euromoney Institutional Investor.
OTHER VIEWS
Postal Service is an essential service
Editorial from The Los Angeles
Times:
As business skyrockets for Amazon
and other online shipping and delivery
services during the pandemic, it’s tempt-
ing to ask whether it’s time to pull the
plug on the U.S. Postal Service, with its
every-door every-day delivery schedule,
its bricks-and-mortar neighborhood
service centers, its unwieldy pension bur-
den and the enmity of President Donald
Trump and much of the GOP establish-
ment. It’s widely projected to become
insolvent this year, with drop-dead esti-
mates ranging from June to September,
and in any case before October — when
vote-by-mail ballots are due to go out in
much (and perhaps all) of the nation.
Trump’s dislike of the Postal Service is
so intense that he reportedly threatened
to veto the recent $2-trillion economic
relief package if it included any postal
bailout. Private airlines and other giant
corporations, yes; the national lifeline
that reaches virtually every American in
good times and bad, no way.
Yes, the agency is premodern — in a
good way. When the electricity goes out,
the cell tower is down or the internet
isn’t working (all of which could easily
happen during a natural disaster or
enemy attack), the Postal Service and
its employees are the nation’s vital link,
as befi ts a publicly held resource. One
emergency plan not (yet) in use is to
have postal workers quickly deliver to
each American an antidote like Cipro
in the event of a wide-scale biological at-
tack. Who else would be able to do that?
As a recent Wired article notes, the plan
could quickly and easily be retooled for
a pandemic.
The agency plays an essential role
in urban and suburban areas, where
postal workers are the ones who bring
many of those Amazon packages to the
front door. And in rural and hard-to-
reach areas, postal workers are the
only ones who provide regular delivery
service because there’s not enough
money in it for private courier busi-
nesses. Postal delivery is the only way
many Americans can get their essential
medications or pension checks — and
yes, ballots, much to the chagrin of
Trump, who accurately recognizes that
broadening the voter base diminishes
the election chances of Republicans like
himself.
The agency is a little like face masks,
ventilators and test kits — national
goods too easy to forget about when
there is no emergency, and to economize
into oblivion just before you need them.
Congress has hamstrung the agency
with an unsound plan to fund future
retiree pensions. It also has prevented
it from employing modern technologies
or adding services that might compete
with private companies. It should un-
leash the agency.
In the short term, though, Congress
should do exactly what should be done
for the nation’s most essential services
in times of emergency. It should properly
fund the Postal Service to keep it serving
us in normal times and to keep it ready
for times like now.