Multnomah County Commissioner Sharon Meieran has two jobs. She works emergency room shifts as a doctor at Kaiser Permanente hospitals. And she repeatedly and publicly demands that Oregon more aggressively battle COVID-19.
Perhaps no one in Oregon has so consistently warned how ill-prepared the state has been for a pandemic. This week, she has every reason to keep sounding that alarm.

As Portland reopens restaurants, bars, salons and gyms, COVID-19 cases are rising. And not just in Portland; much of the state is seeing a spike in positive tests. Nearly 1 in 5 of the total COVID-19 cases in Oregon were reported since Memorial Day.

Oregon isn't usually mentioned in the same breath as states such as Florida, Texas and North Carolina that are seeing a large-scale outbreaks and reporting more than a thousand new cases a day.

But in the past two weeks, as of June 22, Oregon has seen the sixth-highest rate of increase in the country. (Only Wyoming, Oklahoma, Montana, Hawaii and Florida have seen their cases rise faster.) Cases are up 152 percent in Oregon, according to the national database Covid Exit Strategy.

To be sure, our case count per capita is middle of the pack, and comes as Oregon is testing more—although the percentage of positive test results is also increasing. The state has also experienced a low death rate, and hospitalizations in Portland are growing only moderately, possibly in part because many of the people getting infected are young.

"We've seen a very large increase, but we are still reporting hundreds of cases a day, not thousands," says Numi Lee Griffith, a health care advocate at the Oregon State Public Interest Research Group. "It's a very worrisome trend. It's too early to say how the situation will play out. It's down to whether people are following the public health guidelines—people keeping their distance, wearing their masks—to keep things under control."

Oregon avoided calamity early in the pandemic in part by listening to Meieran. She pushed the governor to shutter schools and order Oregonians to stay home; she supported testing all nursing home residents more than six weeks before the state agreed to do so; and she has most recently supported a directive for all Oregonians to wear masks in public.

This week, as Multnomah County reopened, we asked her what to do now.

WW: Portland is reopening as cases spike. What's your greatest fear right now?
Sharon Meieran: My greatest fear is that this isn't just an isolated spike based on increased testing, but it represents a true resurgence in cases. That could have a devastating impact on people's lives and the economy.

Do you think Multnomah County should be opening right now?
Given that reopening happened, I would not go backwards, but we have to be absolutely certain we are doing everything possible to mitigate risk of transmission of the virus. And we need to be monitoring exceedingly closely.

What else should the county, the Oregon Health Authority and the governor be doing?
We've known from the very beginning of the pandemic, at least as early as this stay-home order was issued, that we would reopen. We always knew there's never going to be zero risk.

The state, to be honest, has been caught up in sort of false debates for months: Should we reopen or should we stay closed? Should hair salons be in Phase 1? All of these distracting questions lose sight of that big picture—if we ever had a big picture to begin with—which is all about that lessening of risk.

[During the stay-home order] was the perfect time for the state to devise a proactive plan. I believe that opportunity was squandered. We've been at times responsive to the crisis. I would say we virtually never have been proactive.

To be fair, the real blame at the very top goes to the federal government. The president did not take this seriously from the get-go.

What's an example of something you don't think there's a plan for?
Nursing homes. A proactive plan would be a strategy to ensure testing happens and, if people are positive, they're sequestered and separated. And then to have a plan what to do around obtaining supplies for testing, for personal protective equipment, and to have a plan for if staff became sick.

We told nursing homes that visitors shouldn't come, and we gave them some guidelines about how they could decrease transmission of the coronavirus. That's a reaction, it's not a proactive plan.

OHA said for months we don't need to test everyone at nursing homes. And now they're testing everyone. What's your reaction?
I am very pleased it's happening. I wish it had happened sooner, because perhaps lives could have been saved.

What's your reaction to the assertion that masks are maybe too expensive for some people and they'll make Black people a target of racism?
Those are absolutely essential considerations. But that doesn't mean we should carte blanche say we are not going to do one of the only public health interventions that can help prevent transmission of this deadly disease that we know disparately impacts communities of color.

Are there other differences between the governor's order on masks and what you would recommend?
The first is that you don't say masks are essential and then wait a week before requiring them.

I would have felt most comfortable with a [public health] directive saying: This is something that is essential to do because it saves lives. It would have required engaging in a very strenuous communications and engagement and public education strategy—so people don't just hear a mandate to wear masks, but actually understand why.

So given that Portland is opening with case counts rising, do you think we will ever be able to order people back in their homes?
If we have to do it, we will do it. It'll be tough. It'll take a lot of education, a lot of outreach, a lot of communication. If there is a sustained significant increase in cases, then we should absolutely go back to stay home.

You've issued several warnings during these past few months. Were you ever worried you might be wrong?
I have worried about all of them, because all of these interventions are significant. But the risks of not doing the interventions are so great.

I think a lot of times it doesn't feel real to people. Frankly, we've been lucky in Oregon. We haven't seen the same type of devastation, for example, in Washington or over in New York.

I have continued to work as an emergency physician, and I've seen people come in with COVID and COVID-like symptoms. And if you do "Stay Home, Save Lives," you're erring on the side of saving lives. And I will do that any day.

Did America give up? Is Oregon giving up?
We have become tired of this disease, and we're not even through the first wave. The disease is not tired of us.

That second wave is going to be harder. And if we're not prepared, it's going to do a whole lot more damage to our economy. It will result in so much more loss of life, because we felt like we didn't want to wear a mask, or we just had to get back out to the mall or whatever it was.

I am worried that it feels like we are giving up. When we're not personally impacted and the weather's beautiful and stores are opening, it can feel like it truly is over. But it's not, and we can't afford to make that mistake.