Today the Salem City Club meeting featured a Zoom program, "Lessons Learned Combatting COVID in the Mid-Willamette Valley."
The Salem Reporter has a good story about the program. So I'm going to focus on how I viewed what the speakers said.
Here's a screenshot of two of the speakers, Jacqui Umstead, RN, Public Health Administrator for Polk County Health Services (top) and Katrina Rothenberger, MPH, Public Health Director for Marion County Health & Human Services (bottom).
I haven't been impressed with how the Marion County Board of Commissioners -- three Republicans -- have handled Covid-related affairs. They've resisted the governor's public health orders and have expressed skepticism about vaccine mandates.
So Rothenberger deserves a public health medal for doing her best to get Covid under control in Marion County, since she has had to balance the politics of keeping the Board of Commissioners happy while doing what was needed based on evolving scientific understanding of the pandemic and orders from Governor Brown.
At the end of this blog post you'll find screenshots of the slides that Rothenberger and Umstead shared. Some of the content of the slides will seem cryptic without their narration, but you'll get a feel for the lessons they learned during the Year and a Half of Covid Hell.
One clear lesson I want to emphasize is how public health and prevention needs to be a much higher health care priority. It's crazy that our country has spent trillions of dollars dealing with Covid, yet an investment of mere billions would have gone a long way toward making the United States much better prepared for dealing with the pandemic when it hit our shores.
I'm reminded of a recent New Yorker article about how Costa Rica vastly improved the health of people there by taking a public health community-based approach toward health care rather than a treatment approach centered on individual problems.
Sure, treatment is necessary when prevention fails.
However, the United States is way over-balanced toward expensive medical care rather than disease prevention. The speakers noted that the first few months of the pandemic were really tough for their understaffed/underfunded public health departments until money started arriving from the federal government.
The third speaker was Cheryl Nester Wolfe, RN, MSN, NEA-BC, President and Chief Executive Officer, Salem Health.
In a way Salem Health is the flip side of the public health departments. Lots of money. Lots of staff. High visibility. Focused on treatment rather than prevention. However, the vaccination clinics Salem Health organized at the fairgrounds were absolutely key to getting Covid under control this year -- before the Delta variant got things out of control again.
Wolfe shared this slide that shows Salem Hospital's Covid patient census since the start of the pandemic. The yellow line is breakthrough cases that had to be hospitalized, which I gather are a subset of the blue line showing all Covid patients.
She said that 91% of Covid patients are unvaccinated.
Wolfe said the hospital was extremely busy prior to the pandemic, which had led them to plan for additional beds. When Covid hit, hospital capacity was stretched even thinner, at times surpassing 100% of traditional capacity, as shown in the figure below.
She correctly noted that Oregon has one of the lowest (maybe the lowest) ratio of hospital beds per 1,000 population in the country. So just as the pandemic showed the downside of "just in time" supply chain/inventory management, which leaves little margin for error when unexpected events happen, the same is evident with hospital beds in Oregon.
(I bear some responsibility for this, since many years ago I worked for the State Health Planning and Development Agency, which handled requests from hospitals to expand capacity and services, something we planners were very cautious about in order to keep costs down. That was good, but sometimes there can be too much of a good thing.)
During the question and answer period I submitted a written question about why Marion and Polk counties have vaccination rates quite a bit below the state average of 68% with 1+ dose. Marion County is at 62% and Polk County is at 61%. But the moderator wasn't able to ask my question before the City Club meeting ended.
As noted above, I suspect that a lack of strong support for vaccines by conservative county commissioners is part of the reason for Marion and Polk lagging the state average. There's surely quite a few other reasons also, though.
CovidActNow.org has a nice compilation of Covid-related data for the entire United States. Here's how that web site discusses the vulnerabilities of Marion County. As you can see, they cite "Minorities & non-English speakers," "Population density," and "Housing and transport challenges" as the three Very High sources of Covid vulnerability that lead to an overall High rating.