Keeping Tillamook County Safe in the COVID Era

Recently the Pacific City Chamber hosted a COVID-19 town hall. There were two comments that stood out and paralleled my efforts to collect COVID-19 data to better forecast and understand how to help my business survive in the new abnormal that we now find ourselves in.

 

 

 

The first comment came from Commissioner Yamamoto. He asked the rhetorical question ‘Why does Tillamook county have so few cases?’

 

 

 

The second was from one of the Tillamook County Public Health nurses. Her comment was that the greatest COVID-19 exposure risk for the people in the room was community spread.

 

 

 

These were two topics for which I had already gathered significant data and understanding how they relate to keeping Tillamook County safe is crucial.

 

Why does Tillamook County have so few cases?

The easy answer is maybe we are just lucky. However, examination of county level COVID data suggests that there is much more than just luck at play. Looking at total number of positive cases by county, Tillamook County is in the top 10 best performing counties in the state.

 

The top 10 best performing counties and case numbers are:

 

 

 

Rank

County

Cases

1

Wheeler

0

2

Grant

1

3

Gilliam

2

4

Harney

2

5

Sherman

5

6

Curry

9

7

Baker

13

8

Wallowa

15

9

Crook

20

10

Tillamook

20

 

 

 

Sadly, the picture on the other end of the spectrum is quite grim.

 

 

 

The top 10 worst performing counties and case numbers are:

 

 

 

Rank

County

Cases

1

Multnomah

3095

2

Washington

1994

3

Marion

1975

4

Umatilla

1141

5

Clackamas

1051

6

Malheur

449

7

Union

376

8

Lincoln

362

9

Lane

324

10

Deschutes

288

 

 

 

Overall Oregon is doing quite well compared to other states ranking 14th best, and Oregon’s leaders deserve credit for navigating the crisis admirably. 

 

 

It really is amazing that Tillamook County has fared so well. I think all of us had moments of panic as we realized that the number of visitors to our county is much larger than our population, which puts all of us at increased risk.

 

 

 

Knock on wood, that risk so far has not materialized into actual cases. But why? Tillamook County would seem to be almost the perfect if unwitting experiment for an examination of COVID-19 community spread given the number of tourists visiting from higher COVID case areas.

 

 

 

In fact, the Tillamook County Commissioners were so concerned about this threat, and rightfully so, that they closed county parks, beach access, and ultimately transient lodging entirely.

 

 

 

Tillamook County was approved to move in to phase 1 of reopening starting May 15. On that date Tillamook had 6 cases of COVID. Phase 1 reopening aligned almost perfectly with Memorial Day Weekend, and local closures didn’t stop people from visiting the beach for the traditional start of summer, yet Tillamook didn’t lodge another positive case until June 23. Transient lodging reopened on May 29, and the county case count stayed flat for 23 more days.

 

 

 

The three North Coast counties of Clatsop, Tillamook, and Lincoln all have popular beaches and are within a two-hour drive of the Portland metro area, so the influence of COVID community spread via tourism should be somewhat similar.

 

 

 

Unfortunately, both Clatsop and Lincoln counties have higher case counts than Tillamook, and both those counties have had workplace outbreaks at food processing facilities. Specifically, both counties have had outbreaks at Pacific Seafoods, and given there is also a location in Tillamook County we all should be on guard. While Clatsop County’s case count is concerning, Lincoln County’s is alarming.

 

 

 

The Oregon Health Authority documents outbreaks in care facilities, workplace and child care sectors and if we again look at the 10 best counties and 10 worst counties, and also include case counts for the care facility, workplace, and child care outbreaks that are publicly released by the Oregon Health Authority we see a very strong correlation.

 

Top 10 best performing counties:

 

 

 

Rank

County

Cases

Outbreak Cases

1

Wheeler

0

                          0

2

Grant

1

                          0

3

Gilliam

2

                          0

4

Harney

2

                          0

5

Sherman

5

5

6

Curry

9

                          0

7

Baker

13

                          0

8

Wallowa

15

                          0

9

Crook

20

                          0

10

Tillamook

20

                          0

 

 

 

 

 

Only one of the top 10 best performing counties has had an outbreak and it is only 5 cases so far.

 

 

 

Top 10 worst performing counties:

 

 

 

Rank

County

Cases

Outbreak Cases

1

Multnomah

3095

629

2

Washington

1994

189

3

Marion

1975

512

4

Umatilla

1141

275

5

Clackamas

1051

408

6

Malheur

449

160

7

Union

376

287

8

Lincoln

362

257

9

Lane

324

11

10

Deschutes

288

                          0

 

 

 

9 out of 10 of the worst performing counties have had reportable outbreaks.

So, 90% of the best performing counties have not had outbreaks, and 90% of the worst performing counties have had outbreaks.

 

 

 

Tillamook County is the only county in the top 10 best performing counties west of the Cascades and the group’s closest tourism destination to the Portland-Eugene corridor.

 

 

 

Given its tourism potential, proximity to major population centers, lack of reportable outbreaks and low case numbers Tillamook County is almost an ideal control case for the influence of COVID community spread.

 

 

 

While Tillamook County may indeed be lucky, its relative safety is likely due to its lack of workplace, child care and care facility outbreaks.

 

 

 

Looking at the epidemiological link chart (Fig. 1) in this week’s OHA weekly COVID report there is a very similar pattern with a two-week lag phase between outbreaks and sporadic cases starting mid May. This could suggest that contact tracing may only be identifying half of outbreak cases. Given that the outbreaks reported in the weekly report officially account for 25% of all cases, and maybe even as high as 50% or more of all cases, it is highly likely that outbreaks are the driving force in the recent spike in cases. And food processors make up 60% of all reportable outbreak cases.

 

But what is truly alarming is that these same sectors that OHA is documenting in weekly outbreak reports are not covered by any existing mask mandates.

 

Governor Brown’s statewide mask mandate does not include these sectors in the definition of Businesses covered by the mandate. Furthermore, these sector’s individual sector guidance documents very clearly state that face coverings are not required. The public is now required to wear masks outside when they can’t maintain 6 feet of social distance, but food processors and child care facilities have no indoor mask requirement and no indoor 6 foot distancing requirement. They do have recommendations, but why would we think that industries that have mis-treated their employees for decades would be any more inclined to follow suggestions than the general public?

 

 

 

On the other hand, bars and restaurants have been under a mandatory mask requirement since reopening began and they account for only a handful of the cases in the outbreak reports. 34 cases came from restaurants in Newport that had direct links to the outbreak at Pacific Seafoods, and realistically should be counted as part of the Pacific Seafood outbreak. 2 other restaurants have had 10 cases. That’s 0.3% of all outbreak cases. Meanwhile food processors account for 60% of all reportable outbreaks. The OLCC was out in force over the 4th Holiday weekend and found 91% of bars and restaurants were in compliance with social distancing and face covering requirements. This is a pretty strong suggestion that face coverings reduce the potential for outbreaks to develop.

 

 

 

 

 

 

 

The influence of community spread

The term ‘community spread’ has had varying definitions and has been used inconsistently throughout the COVID crisis. Early on ‘community spread’ was a catch all category for new cases that were not directly linked to an outbreak or a known source case. More recently the term has been deprioritized and replaced with its more accurate component parts: household, sporadic, and cluster. Household, cluster, and outbreak are terms defining various links to known source cases. Sporadic cases are positive cases where an epidemiological link to a known source is unverifiable.

 

There has been a tendency to sometimes use these terms interchangeably which has caused some confusion.

 

 

 

Additionally, the terms ‘asymptomatic case’ and ‘asymptomatic spread’ are used interchangeably which further compounds the confusion.

 

 

 

Asymptomatic spread of any kind should be serious cause for alarm. Asymptomatic spread from links to known source cases can be mitigated by fast, effective contact tracing and self-quarantine. However, the truly scary scenario is increasing instances of asymptomatic sporadic spread. We have no idea the degree to which this type of transmission is occurring, but some notable medical professionals have estimated it could be as high as 40% of cases.

 

 

 

One of the largest barriers to accurate estimations of asymptomatic or presymptomatic spread is the reliance on self-reporting of symptoms and activities and the incidence of Social Desirability Bias.

 

 

 

Social Desirability Bias is the tendency for people to self-report information that is viewed more favorably by public health professionals.

 

 

 

Social Desirability Bias in self reporting can lead to large variances and margins of error in data. Self-reports of drinking habits, substance abuse and sexual behavior are often widely inaccurate. Here in Oregon many patients deliberately underreport their substance use to medical professionals because there are threshold levels that trigger the filling out of another set of paperwork forms. Given the enormity of COVID-19 and the very real social stigma of being infected and or participating in disease spread, combined with mistrust of government officials and cultural and language barriers, the influence of social desirability bias is likely quite high.

 

 

 

Social Desirability Bias could very well be overstating asymptomatic spread and understating outbreak and cluster spread. OHA’s epidemiological link chart is consistent with this.

 

 

If we define community spread as non-linked spread, then thus far a majority of Tillamook County’s cases probably fit within this category. However, Commissioner Yamamoto stated last week that there were two potential outbreak scares-one at the Tillamook Country Smoker and one at the jail.

 

Given that Tillamook’s cases have been steadily if slowly rising over the last two weeks, it may be that a small outbreak is brewing and has evaded contact tracers or not yet hit the reportable threshold. Or, it could be that any effects of the Fourth of July holiday visitor surge are beginning to show up as community spread.

 

 

How do we keep Tillamook County safe moving forward?

While Community Spread may very well be the greatest risk for most Tillamook County residents, the greatest threat to the County as a whole is from potential outbreaks. This is what has been driving the recent spike in cases and has the greatest potential to dramatically increase Tillamook County’s exposure to COVID-19. We know that two of Tillamook County’s food processing companies have had outbreaks in other counties: The TCCA in Morrow County and Pacific Seafoods in both Clatsop and Lincoln counties.

 

 

 

We know that public health officials in both Clatsop and Lincoln counties made requests to the Oregon Health Authority to recommend mandatory COVID 19 testing for essential workers at seafood plants in advance of the outbreaks at Pacific Seafood and that the OHA refused. And we all know how that worked out.

 

 

 

We know that Oregon has continually refused to issue mandatory face covering requirements to seafood and food processors even though they are the single largest sources of COVID-19 spread.

 

 

 

We know that in Union county, which has a similar population and demographic as Tillamook county, a large gathering of people close together, indoors and ignoring face covering requirements created an outbreak that took Union County from 6 cases to 372 in a month.

Public Health experts have told us over and over and over again that face coverings dramatically reduce COVID-19 transmission. So why aren’t there mandatory face covering requirements for food processors? I can understand the policy implications of shutting down essential services.

 

 

 

But it is unconscionable that we are willing to shut down bars, restaurants, salons, spas, hotels and especially schools to prevent the theoretical spread of COVID-19 but aren’t willing to issue mandatory face covering requirements to prevent the very real spread at food processors. Choosing shrimp cocktail over education and small business might be a legitimate policy decision, but it is a bad one.

 

 

 

Coronavirus infections are rising fastest in Oregon among children under the age of 10 yet there is no face covering mandate for the child care sector.

 

 

 

The CDC recently released a report that showed that among infected meat and poultry processing workers with reported race and ethnicity, 87% were racial or ethnic minorities.