Framework For Restarting Public Life And Business

Reopening Oregon:A Public Health Framework forRestarting Public Life and BusinessGovernor Kate BrownApril 20, 2020Version 4/22/2020 09:151

You don’t make the timeline.The virus makes the timeline.– Dr. Anthony Fauci2

Our reality:We will be living with thevirus until there is immunity,which is many months off.3

COVID-19 hospitalizationsGoal: Keepthe CurveFlattenedSource: Institute for Disease ModellingExperience in other countries and modelling says: reducingsocial distancing too quickly will create a spike in cases.4

Opening Up AmericaAgainGuidelinesReleased by President Trump on April 16, 2020NOTE: The Governor’s Medical Advisory Panel and the Oregon HealthAuthority have not thoroughly reviewed the Opening up America AgainGuidelines. After review, criteria could be added or modified to better meet thesituational needs of the state of Oregon.5

1. Gating Criteria: 3 components Symptoms – declining numbers Cases – declining numbers Hospital capacity – regular procedures and adequate testing2. Core State Preparedness: 3 componentsFrameworkOverview Robust testing and contact tracing Healthcare system capacity, including PPE and surge capacity Plans for health and safety3. Phased lifting of restrictions: 3 components Phase 1 Phase 2 Phase 36

SYMPTOMSDownward trajectory of influenza-like illnesses (ILI) reported within a 14-dayperiod- AND -Downward trajectory of COVID-like syndromic cases reported within a 14-dayperiodThree GatingCriteriaCASESApplied on a state orregional basisDownward trajectory of positive tests as a percent of total tests within a 14-dayperiod (flat or increasing volume of tests)DRAFT – Oregon will likelyuse modified metrics,especially for rural countieswho have small numbers.Downward trajectory of documented cases within a 14-day period- OR -HOSPITALSTreat all patients without crisis care- AND –Robust testing program in place for at-risk healthcare workers, includingemerging antibody testing7

I. TESTING & CONTACT TRACING Screening and testing for symptomatic individuals Test syndromic/influenza-like illness-indicated persons Ensure sentinel surveillance sites are screening forasymptomatic cases (sites operate at locations that serve older individuals,lower-income Americans, racial minorities, and Native Americans)Core StatePreparedness:I and II Contact tracing of all COVID casesII. HEALTHCARE SYSTEM CAPACITY Sufficient Personal Protective Equipment (PPE) Ability to surge ICU capacity8

III. PLANS Protect the health and safety of workers in critical industries Protect the health and safety of those living and working inhigh-risk facilities (e.g. senior care facilities) Protect employees and users of mass transitCore StatePreparedness: III Advise citizens regarding protocols for social distancing andface coverings Monitor conditions and immediately take steps to limit andmitigate any rebounds or outbreaks by restarting a phase orreturning to an earlier phase, depending on severity9

Phase OnePhase One begins at Governor’s direction after allGating Criteria and Core Preparedness items are met10

Guidelines for Individuals Practice good hygiene Strongly consider wide use of face coverings in public Stay home if sickPhasedApproach:Guidelines forall PhasesGuidelines for Employers Develop and implement appropriate policies: socialdistancing, protective equipment, temperature checks,sanitation. Monitor workforce for indicative symptoms Contact tracing policies for positives.11

ALL VULNERABLE INDIVIDUALS should continue to shelterin place. All individuals, WHEN IN PUBLIC (e.g., parks, outdoorrecreation areas, shopping areas), should maximize physicaldistance from others.Phase One:Individuals &Employers Avoid SOCIALIZING in groups of more than 10** people.Close COMMON AREAS where people are likely tocongregate and interact. MINIMIZE NON-ESSENTIAL TRAVEL Continue TELEWORK whenever possible.** NOTE: Needs review by Oregon Health Authority, Governor’s MedicalAdvisory Panel and local public health.12

Phase One:Specific Typesof Employers** NOTE: Needs review by OregonHealth Authority, Governor’s MedicalAdvisory Panel and local publichealth.Phase One – FederalproposalOregon ModificationsUnder Consideration**Schools andorganized youthactivitiesRemain closedAdditional childcarereopening in Phase OneVisits to hospitals andsenior living facilitiesProhibitedLarge venues: sports,theaters, churches“Strict physical distancing and Likely remain closedsanitation protocols”during Phase OneSit-down dining“Strict physical distancing and Work group to proposesanitation protocols”Phase One planGyms“Strict physical distancing and Likely remain closedsanitation protocols”during Phase OneBarsRemain closedWork group to proposePhase One planNon-emergencyprocedures“can resume, as clinicallyappropriate”Oregon regional policyunder reviewPersonal servicesNot called out specificallyWork group to proposePhase One plan13

Geographicalconsiderations: Declining growth in symptoms/cases Regional testing capacity Regional hospital capacity Regional contact tracingcapacity Regions work with OHA onplans14

Additional prerequisite for opening a county inOregon: a formal request to the Governor:FOR DISCUSSION- UNDERCONSIDERATION Letter from the CEOs and CMOs of hospitalswithin the county committing to daily PPEreporting to OHA, PPE supply chain reliabilityand hospital bed surge capacity. Recommendation letter from the County PublicHealth Officer. Vote of the County governing body certifyingPPE for first responders is sufficient.15

Phases Two and ThreeWait 14 days, pass the gating criteria again, then move to thenext phase.** NOTE: Needs review by OregonHealth Authority, Governor’s MedicalAdvisory Panel and local publichealth.Phase 2: ** Gatherings increase to 50, non-essential travel canresume, schools and gyms can open under physical distancingPhase 3: ** Mass gatherings size increases, worksites haveunrestricted staffing, visitors to nursing homes allowed,restaurants and bars can have more seating16

High-level framework presentations: Begin April 17 Governor’s Economic Advisory Council Regional Solutions Regional Advisory Councils Local elected officials: Counties, cities, legislators County health ns Outdoor recreation sector Healthcare stakeholders Business community Communities of color and community organizations Tribes Many more 17

Sector-specific discussions: startingweek of April 201. Restaurants/Food service2. ers,workers, and healthprofessionals3. Personal services (hair and nail salons,massage, tattoo parlors, etc.)4. Childcare5. Transit6. Outdoor recreation (parks, trails, etc.)18

1. High-level framework presentationsacross the state: Begin April 172. Consult with most-affected industries:Restaurants, Retail, Outdoor Recreation,Personal Services: Week of April 203. Complete details of framework, includingoperational plans and geographic criteria:Week of May 4Next Steps4. Finalize discrete steps and guidelines inthe Step-by-Step Reopening Oregon Plan:Week of May 45. Ongoing coordination with West Coaststates19

White House and CDC: Opening Up America AgainAmerican Enterprise Institute: National coronavirusresponse: A road map to reopeningReopeningResourcesIfo Institute: Making the Fight against the CoronavirusPandemic SustainableCenter for American Progress: A National and StatePlan To End the Coronavirus Crisis20

APPENDIX21

Oregon Immediate To-Dos: Gating CriteriaElementProcess/Sub-tasksTimelineGating Criteria: Symptoms: Need ILI and syndromic case data by county to seeSymptoms & Cases trends by county Cases: Have this dataGating Criteria:Sufficient PPE Multiple orders placed – private vendors, FEMA, etc.Dependent on Request for large mask sterilization machine placed with FEMA delivery Various Oregon manufacturing ventures started Hospital inventories and usage rates are incomplete22

Oregon Immediate To-Dos: Core al Capacity Alternative care sites identified Oregon Medical Station set up at State FairgroundsGenerallycompletedRobust testing,tracing andisolation strategy Testing strategy in draft form; has had initial review by MAP;needs lab details added Contact tracing plan being drafted, including staffing andtechnology; needs review by local public health and MAP Isolation strategy and alternative sites being drafted andidentified; needs review by local public health and MAPComplete draftwithin twoweeksGuidelines forspecific sectors Plan for restarting non-emergency and elective proceduresbeing drafted by OHAReviewed byMAP on April 16 Workgroups for six sectors being established: Restaurants,Retail, Childcare, Personal Services, Transit, Outdoor Recreation.Draft guidelineswithin twoweeks23

Oregon Immediate To-Dos: Added ComponentsElementProcess/Sub-tasksTimelineSystems forhardest-hit andvulnerablepopulations COVID-positive nursing home currently being stood upDraft within two Additional operational plans for other populations being drafted weeks Needs review by local public health and MAP Need specific test/track/isolate plans for hardest-hit groups24

Opening Up America Again Vulnerable IndividualsDefinition1. Elderly individuals.Definition ofVulnerableIndividuals2. Individuals with serious underlying health conditions,including high blood pressure, chronic lung disease,diabetes, obesity, asthma, and those whose immunesystem is compromised such as by chemotherapy forcancer and other conditions requiring such therapy.25

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, G