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Rural Oregon Counties Hit Hardest By COVID-19

Malheur, Umatilla and Morrow counties, where people often can’t work at home, have the highest case rates per capita in Oregon.
Malheur County. | SHUTTERSTOCK
November 24, 2020

Rural Oregon counties face the highest rates of COVID-19 in the state as the virus has spread from urban areas to agricultural and frontier communities.

As a population hub of Oregon, Multnomah County has experienced the most COVID-19 cases. But rural counties have been hit the worst when the case counts are compared with their overall population.

Malheur, Umatilla and Morrow counties have the highest case rates per capita in Oregon. The high rates reflect local geography and the limitations of rural health services during the pandemic. Workers in agricultural jobs cannot work from home. Counties abutting Washington and Idaho have porous borders with traffic from neighboring states. Idaho has laxer restrictions than Oregon to combat the virus.

In Malheur County. More than has had 2,300 people test positive for COVID-19. That’s just a sliver of the state’s more than 66,000 cases and 826 deaths as of Tuesday. But Malheur County, with a population of about 32,000, has the highest case rate in the state: more than 7,200 cases per 100,000 people, according to Oregon Health Authority data. A striking 24% of tests have been positive, compared with 7% statewide. The biggest workplace outbreak in the state is at Snake River Correctional Institution in Ontario, with about 540 cases.

Malheur County health officials couldn’t be reached for comment. 

Umatilla County has the second highest case rate per capita: 5,120 cases per 100,000 people, Just over 4,150 people have tested positive so far.

It, too, has had large workplace outbreaks, with 500 people sickened at the Eastern Oregon Correctional Institution in Pendleton and 190 infected at Lamb Weston, a food processor in Hermiston. At the Walmart Distribution Center in Hermiston, more than 75 people got sick, and Good Shepherd Hospital in Hermiston, has had an ongoing outbreak, with nearly 70 infected.

“We have a lot of workers who are unable to work remotely, at a higher percentage than other parts of the state,” said Joseph Fiumara Jr., public health director of Umatilla County. 

Essential workers such as agriculture employees and staff in food processing plants in Umatilla County tend to come from minority populations, including Hispanics. People of color have been disproportionately affected during the pandemic in part because of workplace exposure to the virus.

In neighboring Morrow County, that’s also the case. Public health officials rely on bilingual public health workers to reach out to Spanish speakers about COVID-19. They also work with community based organizations that advocate for the Latino community.  

“We have a large essential workforce and they need to go to work, and not everybody (who is infected) is symptomatic,” said Diane Kilkenny, acting director of the Morrow County Health Department. “They were not realizing they had COVID.”

The high rates are cumulative, reflecting the course of the pandemic, including outbreaks during the summer.

Ninety-four people have died of COVID-19 in Malheur, Umatilla and Morrow counties, about 11% of all virus deaths in Oregon, state data show. 

There are bright spots for Morrow County. For example, it has a 100% success rate of contacting people who test positive within 24 hours of receiving the test result. The statewide average was about 60% as of last week, well below the state goal to reach 95% of new cases within 24 hours. These post-testing contacts are important. Public health workers use them to find out who the person has had close contact with and where they might have potentially exposed others, such as at schools and nursing homes.

Officials at hospitals in rural areas said they are prepared for the surge that is sweeping the state. 

Good Shepherd Hospital has seven beds in its intensive care unit in Hermiston that can serve COVID-19 patients, and more bed space for COVID-19 patients in the medical and surgical unit. The hospital also has 12 beds set aside in its COVID-19 surge unit, hospital spokeswoman Caitlin Cozad said. Those beds are not currently in use, Cozad said. The hospital has not canceled elective procedures at this time, in contrast to Portland-area hospitals that have voluntarily done so as COVID-19 cases have increased. 

Smaller hospitals can face a steeper financial hit when elective procedures stop compared with urban hospitals, said Robert Duehmig, interim director of the Oregon Office of Rural Health at Oregon Health & Science University. Small hospitals with a narrow patient and revenue base rely on elective procedures to survive. It’s not about profits -- it’s about revenue to cover operational costs and keep the doors open, Duehmig said.

“The economic hit on our smaller facilities is more immediate and a little bit harder to dig out of,” he said. 

Duehmig said the pandemic shows the challenges that remain for rural health systems. For example, providers have expanded telehealth services throughout the state as people have stayed away from clinics, but telehealth may not be an option in rural areas with spotty broadband access.

For now, the rural systems should look for ways to improve, whether it’s in provider access or system funding, he said.

“This won’t be our last pandemic and our last big challenge that we’ve got in rural communities,” Duehmig said.

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.