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Wednesday, April 29, 2020
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Oregon has a COVID-19 medical advisory panel. What does it do?
By Dick Hughes
For the Oregon Capital Bureau
When Dr. Bruce Goldberg
encountered a difficult case as a
family physician, he would gather
a bunch of smart consultants in the
room for their advice on how to help
the patient.
That, he said, is what Gov.
Kate Brown has done in creating
her COVID-19 Medical Advisory
Panel. She credited the panel with
helping her decision last week to let
hospitals, clinics and other health
providers resume nonurgent medi-
cal procedures on May 1 under cer-
tain guidelines.
Brown first convened the panel
on April 7. It has been meeting
by videoconference two or three
times a week. Goldberg and the
other seven members come from
urban and rural Oregon and rep-
resent front-line health provid-
ers, hospitals, academia and
government.
“She charged us with helping the
state and her identify blind spots that
we would all need to be aware of as
we face this pandemic together, and
also developing strategies for how
to battle this pandemic,“ said Gold-
berg, a former head of the Oregon
Health Authority and now a profes-
sor of health policy.
Goldberg said there is consen-
sus in Oregon and nationally on the
critical steps in fighting COVID-19
while awaiting development of an
effective vaccine: personal protec-
tive equipment for front-line work-
ers, testing people for the coronavi-
rus, adequate health care resources
and social distancing and other
measures.
But each state is different. Ore-
gon is more rural than many states.
As far as big cities, Goldberg said,
“Portland as a metropolitan area is
really different from New York City
in that we don’t have the type of
crowded mass transit systems. We
don’t have the plethora of tall high-
rises and people living in really tight
quarters.
“I think every community is dif-
ferent and has to be looked at through
that lens,” he said.
Because COVID-19 is a new dis-
ease, scientists, health care providers
and policymakers worldwide learn
more about its symptoms, spread and
treatment every day. During the med-
ical advisory panel’s meetings, mem-
bers discuss the latest data and other
information, provide perspectives
from front-line health workers and
offer input on policies.
Dr. Dana Hargunani, chief med-
ical officer for the Oregon Health
Authority, said: “It’s in part topics
that are brought forward for input.
And it’s in part, what are the hot top-
ics that the group is hearing from the
front lines and in the rest of the com-
munity that we may not be thinking
about on a state level, and how do
we make sure we think about and
respond to those?”
That came into play in discussing
whether nonurgent medical and den-
tal procedures should resume.
“If we relax the policy, then how
can that be instituted in the hospitals
and what does that mean for some of
the other impacts like PPE (personal
protective equipment) and staffing
and allowing people to travel out-
side their homes, which relates back
Oregon board postpones relief for rural
hospitals to allow forgivable loans, grants
By Dick Hughes
For the Oregon Capital
Bureau
Oregon legislators balked
Thursday at loaning $50
million in federal money to
rural hospitals reeling from
the coronavirus pandemic.
Members of the Legis-
lative Emergency Board
tabled the proposal so it
could be reworked to include
forgivable loans or straight-
out grants. Several legis-
lators said hospitals would
be unable to take out loans,
even at zero percent inter-
est for the first year as Gov.
Kate Brown has proposed,
and the allowable uses were
too restrictive.
“This was federal money
given to us to pass on to our
rural hospitals. Why are we
making it a loan program as
the state?” asked Sen. Bill
Hansell, R-Athena. “It’s
wrong. It’s morally incorrect
in my opinion. This money
should be grants from the
beginning. In that way, we
could actually help our rural
hospitals.”
Thirty-three rural hos-
pitals would be eligible.
But Sen. Betsy Johnson,
D-Scappoose, said the plan
envisioned by Brown’s staff
was the equivalent of throw-
ing only a 6-foot rope to
someone drowning 10 feet
offshore.
“We would look so
incredibly foolish if we
allowed hospitals to go
broke on our watch during a
global pandemic,” Johnson
said. “But there is all kind
of stuff wrong with what
the governor’s folks have
written.”
House Speaker Tina
Kotek, D-Portland, noted
that some hospitals are get-
ting federal assistance, with
Congress approving addi-
tional funding this week.
“I think we want to be
cautious about how we don’t
just unilaterally say every-
body needs, frankly, free
money,” she said, “because
there are a lot of businesses
and a lot of places around the
state that need that money,
too.”
After a recess, Senate
President Peter Courtney,
D-Salem, called for tabling
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The Oregon Capitol in Salem.
verton, who is a physician at
OHSU, told her Emergency
Board colleagues. “Every
single health system in the
state is struggling as a result
of this.”
Brown announced Thurs-
day that, as of May 1, she
was lifting the ban on elec-
tive medical and dental pro-
cedures. Steiner Hayward
said that would help, but
hospitals would take time
to ramp up and have lost
significant income in the
meantime.
The board approved the
11 items on its agenda, all on
a bipartisan basis and most
of them unanimously. Much
of the discussion centered
on fiscal accountability for
how relief money is spent
and ensuring that rural areas
benefit.
Legislators approved a
new program under which
businesses employing 25 or
fewer workers could be eli-
gible for state grants or loans
if they have not received
federal aid.
Rep. David Gomberg,
D-Otis, said he had been
concerned that coronavi-
rus assistance had not been
going to the smallest of
small businesses, which are
the economic backbone of
his district.
“People
are
hurt-
ing everywhere,” he said.
“According to the state
economist, they’re hurting
particularly hard in my part
of Oregon.”
The state will contract
with community develop-
ment financial institutions
to run the program, but
Gomberg noted those insti-
tutions primarily are along
the Interstate 5 corridor.
the proposal, saying Brown’s
staff agreed with that move.
No date was set for when
the Emergency Board would
take up the issue again.
The board did approve
coronavirus-related funding
for rental assistance, small
businesses, domestic vio-
lence resources, COVID-19
testing for workers in long-
term care facilities and aid
to jobless workers, such as
undocumented immigrants,
who are ineligible for unem-
ployment insurance.
Many of the details have
yet to be worked out. Leg-
islative Fiscal Officer Ken
Rocco told the Emergency
Board, which for the first
time was meeting by video
conference, that it remained
unclear how much federal
aid Oregon was getting and
what restrictions accompa-
nied the money.
Hospital officials from
across the state had told
legislators earlier in the
week that hospitals cumula-
tively were losing $13 mil-
lion a day due to the costs
of COVID-19 equipment, a
state ban on nonurgent sur-
geries, fewer people receiv-
ing care in emergency rooms
and other factors. More
than 30,000 Oregon work-
ers in the health care and
social assistance fields have
applied for unemployment
since March 15.
Oregon Health & Sci-
ence University announced
Thursday that it was sub-
stantially reducing salaries
and making other cutbacks
to deal with a projected rev-
enue loss during the next 28
months of $1 billion to $1.4
billion.
“It is not just the rural
hospitals that are strug-
gling,” Sen. Elizabeth
Steiner Hayward, D-Bea-
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resuming public life.
“We have to get to a place where
we relieve some of the restrictions
such that our economy can function
and we can all function as a society,”
she said. “But we have to realize
that when we relieve some of those
restrictions, that’s going to result in
some increasing spread of the infec-
tion, which is going to mean some
people getting sick and even some
people dying.”
Dr. Bob Dannenhoffer, the pub-
lic health officer in Douglas County,
said Brown has given Oregonians the
appropriate directions: Stay home
if you possibly can, and definitely
if you are sick. Maintain social dis-
tances to avoid transmission of the
virus. Wash your hands frequently.
And pay attention to your mental
health.
“This is a tough, tough time. This
is a health crisis, an economic crisis
and a social crisis,” he said. “Sleep
well, do fun things, get some exer-
cise and don’t worry about stuff that
really doesn’t make a difference.
“If you have an extra ice cream
tonight, don’t worry about it.”
Oregon’s plan to reopen economy is emerging
By Dick Hughes
For the Oregon Capital Bureau
Oregon’s
economic
reopening likely will be
more gradual than what
President Donald Trump
has suggested. Churches,
theaters, gyms and sport-
ing events initially would
remain closed.
Other business reopen-
ings from the COVID-19
pandemic are under study.
Gov. Kate Brown and
her staff shared her current
thinking with legislators
and county commission-
ers last week. The gover-
nor’s “Reopening Oregon:
A Framework for Restarting
Public Life and Business”
combines concepts Brown
released last week and the
national guidelines that
Trump announced a couple
of days later.
Brown’s staff cautioned
that the ideas were still being
reviewed. The goal is to
release a more detailed draft
plan soon. Work groups are
preparing proposals on per-
sonal services, such as hair
salons; sit-down dining;
bars; and other areas. Addi-
tional child care facilities
also would be reopened in
the first phase, but schools
would remain closed.
Much of the phased plan,
including resumption of
non-emergency medical and
dental procedures, would
roll out regionally.
“A lot of states are taking
statewide approaches, and
the governor has been pretty
consistent in telling us,
‘Look, I want to be able to
do this in a regional way,’”
said Nik Blosser, Brown’s
chief of staff.
Those
geographi-
cal considerations include
the regional capacity for
COVID-19 testing, contract
tracing and hospitalization,
along with evidence that the
growth in cases was sub-
siding. Each county would
have to submit a formal
request to Brown, including
commitments to have ade-
quate personal protective
equipment and, in the event
of a surge in cases, available
hospital beds.
Officials in Harney
County asked Brown to let
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The seal of Oregon at the state
Capitol in Salem.
it become a pilot project for
reopening Oregon. The fron-
tier county has a small popu-
lation, many businesses and
individuals are hurting and
there have been no reported
COVID-19 cases.
“There’s no curve to flat-
ten out here. We never had
a bump in the road. That’s
what’s really eating at peo-
ple,” County Judge Pete
Runnels said, adding that
Oregon must adjust to liv-
ing with the threat of
coronavirus.
To meet the framework
outlined by Brown, the
county would need state
help in acquiring personal
protective equipment. The
local hospital could treat up
to two, possibly three, cases
at a time. Any positive case
would require 20 hours of
research to trace the per-
son’s contacts, according to
Runnels.
During a phone call April
20 with county officials and
Rep. Mark Owens, R-Crane,
the governor acknowledged
the proposal but did not
promise what would hap-
pen, Runnels said.
“I don’t know if they
understand the urgency of
how dire it is for some,” he
said of Brown and her staff.
“They hear us, but they
don’t feel us.”
Dr. Bob Dannenhof-
fer, the Douglas County
health officer and a mem-
ber of Brown’s coronavi-
rus Medical Advisory Panel,
said he knew of nowhere
in the nation that was yet
prepared to meet even the
broad guidelines of the fed-
eral plan. Those guidelines
include sufficient personal
protective gear, robust test-
ing and an army of people to
follow up on cases.
“If somebody can show
me that their area is ready,
I’d love to see that,” he said.
“Nobody has taken me up on
that.”
Dannenhoffer said he
could not forecast when any
Oregon county would be
ready.
“I think anybody who
would try to project the
future is being somewhat
foolish, because we really
have to see what happens
with case counts. We have
to see what happens with
testing. We have to see what
happens with PPE. These
are all things that are out of
anybody’s control,” he said,
emphasizing that the views
were his own and not those
of the governor’s panel.
But Deschutes County
Commissioner Patti Adair
said it’s about time to
responsibly start reopen-
ing the economy by allow-
ing health practitioners to
resume non-emergency pro-
cedures and letting restau-
rants, hairdressers and other
businesses reopen with
effective social distanc-
ing and related protective
measures.
Adair said local busi-
nesspeople have come up
with great ideas, which she
was forwarding to the gov-
ernor’s office.
“I really worry,” she said.
“We have more people in
Deschutes County on unem-
ployment than a lot of other
counties do.”
Adair was not fully reas-
sured by a conference call
that Brown had Monday
with county commissioners
across the state: “The first
thing she said was that the
virus was in charge, and I
found that frustrating.”
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to policy,” said Dr. Renee Edwards,
chief medical officer at Oregon
Health & Science University. “We
are an advisory panel. Her team lis-
tens, collates our thoughts, clarifies
things but ultimate authority abso-
lutely is with the governor.”
As of Monday, nearly 52,000
Oregonians had been tested for the
novel coronavirus. One focus for the
advisory panel is how to expand test-
ing and then trace those who have
come in contact with the infected
individuals.
“How do we understand the com-
munity prevalence? How do we
understand how when one person
gets sick, how many more people
they might spread it to, so that we
can get a better handle on our contact
tracing, which then helps us contain
the disease spread?” Edwards said.
“Those are some of the big topics.”
Oregon’s social distancing and
other restrictions have held down
the rate of transmission compared
with many states, but Edwards said
COVID-19 will be with us for a long
time, so a balance must be found
between protecting public health and
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