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Reopening Oregon: A Public Health Framework for Restarting Public Life and Business Governor Kate Brown April 20, 2020 1 Version 4/20/2020 13:48 ---PAGE BREAK--- 2 You don’t make the timeline. The virus makes the timeline. – Dr. Anthony Fauci ---PAGE BREAK--- 3 Our reality: We will be living with the virus until there is immunity, which is many months off. ---PAGE BREAK--- Goal: Keep the Curve Flattened 4 Experience in other countries and modelling says: reducing social distancing too quickly will create a spike in cases. COVID-19 hospitalizations Source: Institute for Disease Modelling ---PAGE BREAK--- Opening Up America Again Guidelines Released by President Trump on April 16, 2020 5 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. ---PAGE BREAK--- Framework Overview 1. Gating Criteria: 3 components – declining numbers Cases – declining numbers Hospital capacity – regular procedures and adequate testing 2. Core State Preparedness: 3 components 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 ---PAGE BREAK--- Three Gating Criteria Applied on a state or regional basis Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period -AND - Downward trajectory of COVID-like cases reported within a 14-day period CASES Downward trajectory of documented cases within a 14-day period - OR - Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests) HOSPITALS Treat all patients without crisis care - AND – Robust testing program in place for at-risk healthcare workers, including emerging antibody testing 7 DRAFT – Oregon will likely use modified metrics, especially for rural counties who have small numbers. ---PAGE BREAK--- Core State Preparedness: I and II 8 I. TESTING & CONTACT TRACING Screening and testing for individuals Test illness-indicated persons Ensure sentinel surveillance sites are screening for cases (sites operate at locations that serve older individuals, lower-income Americans, racial minorities, and Native Americans) Contact tracing of all COVID+ cases II. HEALTHCARE SYSTEM CAPACITY Sufficient Personal Protective Equipment (PPE) Ability to surge ICU capacity ---PAGE BREAK--- Core State Preparedness: III 9 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 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 ---PAGE BREAK--- Phase One Phase One begins at Governor’s direction after all Gating Criteria and Core Preparedness items are met 10 ---PAGE BREAK--- Phased Approach: Guidelines for all Phases Guidelines for Individuals Practice good hygiene Strongly consider wide use of face coverings in public Stay home if sick Guidelines for Employers Develop and implement appropriate policies: social distancing, protective equipment, temperature checks, sanitation. Monitor workforce for indicative Contact tracing policies for positives. 11 ---PAGE BREAK--- Phase One: Individuals & Employers ALL VULNERABLE INDIVIDUALS should continue to shelter in place. All individuals, WHEN IN PUBLIC parks, outdoor recreation areas, shopping areas), should maximize physical distance from others. Avoid SOCIALIZING in groups of more than 10** people. Close COMMON AREAS where people are likely to congregate and interact. MINIMIZE NON-ESSENTIAL TRAVEL ContinueTELEWORK whenever possible. 12 NOTE: Needs review by Oregon Health Authority, Governor’s Medical Advisory Panel and local public health. ---PAGE BREAK--- 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 sanitation protocols” Likely remain closed during Phase One Sit-down dining “Strict physical distancing and sanitation protocols” Work group to propose Phase One plan Gyms “Strict physical distancing and sanitation protocols” Likely remain closed 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 Phase One: Specific Types of Employers NOTE: Needs review by Oregon Health Authority, Governor’s Medical Advisory Panel and local public health. ---PAGE BREAK--- Geographical considerations: • Declining growth in cases • Regional testing capacity • Regional hospital capacity • Regional contact tracing capacity • Regions work with OHA on plans 14 ---PAGE BREAK--- 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 ---PAGE BREAK--- Phases Two and Three Wait 14 days, pass the gating criteria again, then move to the next phase. 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 NOTE: Needs review by Oregon Health Authority, Governor’s Medical Advisory Panel and local public health. ---PAGE BREAK--- High-Level Framework Community Presentations High-level framework presentations: Begin April 17 Governor’s Economic Advisory Council Regional Solutions Regional Advisory Councils (ERTs) Local elected officials: Counties, cities, legislators County health departments Outdoor recreation sector Healthcare stakeholders Business community Communities of color, Tribes, and community organizations Many more… 17 ---PAGE BREAK--- Sector-specific Discussions: Owners/practitioners, workers, and health professionals Sector-specific discussions: starting week of April 20 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 ---PAGE BREAK--- Next Steps 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 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 ---PAGE BREAK--- Reopening Resources White House and CDC: Opening Up America Again American Enterprise Institute: National coronavirus response: A road map to reopening 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 ---PAGE BREAK--- APPENDIX 21 ---PAGE BREAK--- 22 Element Process/Sub-tasks Timeline Gating Criteria: & Cases • Need ILI and case data by county to see trends by county • Cases: Have this data Gating Criteria: Sufficient PPE • Multiple orders placed – private vendors, FEMA, etc. • Request for large mask sterilization machine placed with FEMA • Various Oregon manufacturing ventures started • Hospital inventories and usage rates are incomplete Dependent on delivery Oregon Immediate To-Dos: Gating Criteria ---PAGE BREAK--- 23 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 Oregon Immediate To-Dos: Core Preparedness ---PAGE BREAK--- 24 Element Process/Sub-tasks Timeline Systems for hardest-hit and vulnerable populations • COVID-positive nursing home currently being stood up • Additional operational plans for other populations being drafted • Needs review by local public health and MAP • Need specific test/track/isolate plans for hardest-hit groups Draft within two weeks Oregon Immediate To-Dos: Added Components ---PAGE BREAK--- Definition of Vulnerable Individuals Opening Up America Again Vulnerable Individuals Definition 1. Elderly 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