Multnomah County Weighs Impact to Communities of Color in Decision to Re-Open

While all other counties in Oregon have applied to the governor to reopen, Multnomah County stands alone for not yet having submitted an application. Yesterday during a briefing, Deborah Kafoury announced the county will submit its application to enter Phase 1 of reopening on June 5, with the goal to reopen June 12. Some local leaders, specifically from communities of color, are voicing support for the initial delay.

Marcus Mundy, Executive Director, Coalition of Communities of Color (photo courtesy of Coalition of Communities of Color)“I appreciate all the counties that have taken their time and been cautious about reopening because communities of color are the first fired, we experience the worst health conditions, we tend to live in the most intergenerational and stacked-up housing, and we are the ones with the most underlying health conditions,” Marcus Mundy, executive director of Coalition of Communities of Color, told The Skanner.

“For us, haste makes waste. Washington and Multnomah Counties are actually taking the time to ask the Black, Indigenous and people of color communities, ‘How should we reopen?’ They are actually checking with the community. Multnomah County has done a decent job, and I think they’ve invited us to opine quite a bit on what’s going on.”

Higher Threshold

During a Multnomah County Board of Commissioners briefing May 19, officials reviewed state, regional and county requirements for the first phase of reopening at this stage of the covid-19 pandemic. Chris Voss, director of the Office of Emergency Management for Multnomah County, explained the county had added three of its own additional metrics to be met prior to reopening, including reduced impact on communities of color.

In its criteria for reopening, the county states: "In addition to state metrics on disease spread, Multnomah County will pay particular attention to transmission in communities of color to evaluate when and how to move forward with reopening and proactively work to prevent spread."

Multnomah County Public Health Director Rachael Banks explained the county's approach to COVID-19 contact tracing during a May 19 briefing with the Multnomah County Board of Commissioners. At least 40% of COVID-19 cases in Multnomah County were experienced by Black, Indigenous, and other people of color, according to data released by Multnomah County’s public health division. Providing these communities with support largely comes down to the process of contact tracing, Multnomah County Public Health Director Rachael Banks explained.

“From a numbers perspective, the reopening criteria is that we would have 15 contact tracers per 100,000 people,” Banks said. “And we want to have a contact tracing workforce that is reflecting of the county, but we want to go further and say that it’s also taking into consideration that we need to have a workforce that is matching what this actual disease looks like in our county, and is prepared for what we know in terms of what could happen with underlying conditions.”

Banks said that linguistic and cultural requirements for contact tracers were analyzed based on the number of cases within specific communities, rather than the population percentage each community comprises.

A Collaborative Process

Kim Toevs, communicable disease director for the Multnomah County Public Health Department, explained that information in the contact tracing database is confidential and is subject to even more stringent legal protections than regular medical records.

“It is voluntary when people share that information with us,” Toevs said. “We can’t compel them to answer, and we’ve found it actually works quite well to have a collaborative relationship with that person. That’s why it’s so important, at every single level of our system, to have a team of multilingual staff who can understand and work with folks from a bunch of different cultural backgrounds and help establish that understanding of what we’re doing, and what’s going to happen to their information.”

Toevs said the county would be leaning on community-based organizations for the contact tracing process.

“It’s folks who are already well familiar with certain culturally specific communities, have different language capacity, and understand the full realm of social service and health services that are available, to be able to help link people,” Toevs said. “They need to be organizations that are already well known to the community, trusted and credible.”

Mundy shared Toev’s opinion.

“We already know this community,” Mundy said.

“Use those organizations. Don’t try to build up an entire infrastructure in 60 days to respond to this. Use the existing conduits you have. Use them, pay them something of course, and you’ll save yourselves so much money with fewer people presenting at hospitals.”

Toevs explained that such organizations would help not only identify cases, but also connect those who test positive for covid-19 with resources to help them self-isolate.

“If folks need food, cleaning supplies, whatever they need to keep their household safe, then we can provide that,” Toevs said. “We have financial support built in for folks. I think we’ve got a number of different places in the budget where DHS, or the joint office, already have mechanisms in place for rental assistance, for food security. The goal is that we make sure that the community health workers are up-to-date on any of the expanded programs that we’re all able to offer as we think about responding to this.”

Acknowledging Inequity

“It’s just unprecedented, so I don’t know how to define ‘doing enough’ in this context,” Michael Anderson-Naithe, former Chief Equity & Engagement Officer at Health Share of Oregon, told The Skanner. “It seems like Multnomah County is taking a lot of actions that I would expect and hope our public health department would be doing at this time. Some things that are giving me optimism is that they’re making sure our contact tracers are representative of the disparities (in covid-19 cases). They’re looking at providing additional supports to individuals and families that need to isolate, and that’s going beyond what I see others doing. They have information on their website in 25 languages. They are meeting with leaders and communities of color to develop a plan for what those communities need.

"And I love that Multnomah County is not shying away from naming how racism is playing out in this pandemic.

"They acknowledge the difficulty of the lived experience of people of color being asked to wear face masks ⁠— that’s a great thing.”

“Everything we’re looking at, it all boils down to, what are you doing to keep us safe? What are you doing to prevent a rise in the number where we’ll lose all the progress we’ve made by freezing things?” Mundy said. “The decisions they’re making in this little tiny quick crucible of time is going to have a decade or two of impact on the winners and the losers, so they’re not messing around. They have to get this right for these communities of color.”

For status updates on how Multnomah County is meeting re-opening metrics, visit multco.us/novel-coronavirus-covid-19/reopening-multnomah-county-amid-covid-19.