A Year After Deep Cuts, Harney County Hopes Public Health Can Save Its Economy

UPDATE (11:17 a.m. PT) — A year ago, Jolene Cawlfield stood before hundreds of Harney County residents to argue for the existence of public health services.

The county’s health director shared how her department was vital to the community at a packed fairground building one evening last May — stats like how many children were spared illness due to vaccination, or how many unintended pregnancies never happened, and which primary care services fall to county-employed providers like herself in this sweep of eastern Oregon, where there are more square miles of high desert than people.

But the health department budget was in the red. And at the head of the room sat three county commissioners mired in a financial crisis. They were poised to drop public health from the budget. They spoke of privatization and bottom lines. In the end, the health department narrowly escaped complete erasure, but not the furlough days, nor the loss of two positions and the need to share staff with a rural health clinic.

“We're getting by on skeleton staff now, because our budget has been so severely cut, because of the county's financial constraints last year,” Cawlfield said this week.

But now, her department’s readiness to identify and track coronavirus cases is at the core of a proposal to reopen the state’s economy.

Harney County has no confirmed cases of the virus as of April 21. Last week, two eastern Oregon lawmakers sent Gov. Kate Brown a proposal to make it the first place in the state to reopen restaurants, bars and other businesses shuttered by the governor's stay at home order. But Brown has said certain things must be in place before she'll ease those restrictions, chief among them is "a robust public health framework."

That means testing, contact tracing and the ability to isolate exposed or sick people regardless of their personal circumstances.

By those standards, Harney County isn’t ready, even as elected officials and business owners push for a May 1 deadline to reopen.

“I think that would be at least two weeks too early,” Cawlfield said.

Related: Antibody Testing Is Coming To Oregon's Coronavirus Front Lines, With Big Caveats

She pointed to issues with the supply chain for testing, the low capacity for contact tracing work and more long-standing limitations.

“One of the biggest concerns is that we only have two paramedics. So if we have to do [patient] transfers, that's going to strain the system really quickly,” Cawlfield said.

Another worrisome wrinkle: There are an “unprecedented” number of expectant mothers in Harney County right now — 15 women — all due in May.

As for contact tracing — an investigative process to identify people exposed to the virus — the county's communicable disease nurse is relying on help from two retired health workers as volunteers. They could cover three positive cases, working with existing public health staff in the region, Cawlfield said, and that’s it.

The region’s only hospital, Harney District Hospital, has said it’s “also feeling the economic effects of the virus and is losing substantial sums of money,” according to a joint statement issued with the public health department last week.

“Our biggest challenge right now is access to COVID-19 tests with a demonstrated high degree of accuracy and a reasonable turnaround,” health officials said in their statement.

The tests are shipped to faraway labs, with a three- to five-day wait for results. The hospital has a machine on site capable of testing people with a 45-minute turnaround, but it hasn’t been able to secure cartridges to run it.

Harney County's plan

One of the lawmakers advancing the pilot proposal called the county’s ask for a May 1 reopen date “aspirational.”

State representative and former Harney County Commissioner Mark Owens said he doesn’t expect the virus to skip over his community.

“Nowhere in my mind do I think we are going to escape this pandemic. ... I’d rather see our economy start, and us start to work through that sooner rather than later because the economy and the health of people go hand in hand,” Owens said.

An April 17 letter from Owens and state Sen. Lynn Findley to the governor says more state support will be necessary for businesses to reopen with strict physical distancing remaining. Bars and restaurants would leave space between tables, while shops would limit the number of customers inside. Barbers and hair stylists would wear masks. Workout equipment would be segregated at "small and boutique gyms," though there's only one gym in Harney County.

The letter argues these measures “would be invaluable for the state to identify lessons learned and apply them for broader implementation.”

In theory, the governor's chief of staff agrees.

“It’s useful, if it can be scaled up,” Nik Blosser said in an interview with OPB this week, adding, “We would need to have a framework that any county could understand what needs to be done.”

The state is putting in requests nearly every day for more testing materials, protective gear and coveted testing cartridges from the federal government, but “those are outside our control,” Blosser said.

Brown's plan

Since the moment Brown issued a stay-at-home order shuttering the state’s economy, "we started thinking about reopening," Blosser said.

Pressure is mounting on the governor, particularly from rural areas that have yet to see a confirmed COVID-19 case, to step in and help revive their economies before the devastation becomes insurmountable.

Related: When Can Oregon Reopen? Not Anytime Soon, Officials Say

The governor is working on a plan to ease the restrictions. So far, her plan largely mirrors a road map released by the Trump administration.

Brown said she needs to be assured there is enough protective gear for health care workers, a declining rate of cases, enough hospital beds to handle a surge, the ability to trace and isolate people who become infected and enough testing capacity statewide before she would feel confident reopening Oregon.

“Our reality is we will be living with the virus until there is immunity, which is many months off,” a draft document outlining the governor's proposal reads.

Brown’s draft proposal calls for assurances from hospitals, county public health officials and a county’s governing board stating they have enough protective equipment for first responders before she would be willing to consider lifting restrictions.

After that, the governor envisions easing restrictions in phases.

The first phase would take a close look at how certain businesses, such as sit-down restaurants and bars could reopen while maintaining strict social distancing. Brown’s proposal does consider reopening child care facilities in the initial phase. Large gatherings and nonessential travel would still likely be discouraged.

If, after 14 days, there doesn’t appear to be a spike in cases, phase two would include some non-essential travel, schools and gyms that could likely reopen as long as they follow social-distance guidelines. Phase three could include more seating in restaurants and bars, larger groups allowed to gather and visitors returning to see loved ones in nursing homes.

Still, the governor has not given an indication of exactly when such a phased easing of restrictions would begin.

Burns' plight 

Burns business owners like Jen and Forrest Keady feel powerless. The couple has been a force for the redevelopment of Harney County’s historic downtown. Now, they’re watching the main street they helped revive with locally owned businesses go into death throes.

“The first two weeks most people were like, ‘OK, you know what, we're in this together. We'll follow whatever we need to follow.’ Everybody closed. And now, for week five, everybody's just getting hopeless and restless, and wondering what's next. Is it a matter of even turning the lights back on for some of these people?” Jen Keady said.

She’s the town eye doctor and runs a boutique hotel. The couple also owns and rents out other retail spaces.

“One gal just opened a brand new shop in November and it was going amazing. She's feeling despair,” Jen Keady said.

The Keadys waived rent for their tenants this month, while refunding hotel reservations as far out as August. They reported losses in excess of $160,000 and climbing, with zero relief from the federal government to date.

“The virus is coming,” Keady said. “But the livelihoods that are going to be destroyed if we don’t open is going to far outweigh the effects of the virus on Harney County.”

Editor's note: This story has been updated to clarify Harney County's plan for contact tracing.