Oregon health officials Tuesday pinned Union County's spike of COVID-19 on one church.

Union County on Tuesday added 119 confirmed cases of COVID-19, boosting the count in the county to 240, according to the Oregon Health Authority. Thomas Jeanne, deputy state health officer and epidemiologist, said during a Tuesday afternoon call with media members that 236 cases were connected to Lighthouse Pentecostal Church in Island City.

The outbreak is officially the largest to date in Oregon.

"This accounts for roughly 47% of the 462 cases reported (in the state) over the past two days," Jeanne said.

The state is hoping that is the extent of it. Jeanne said there were no outstanding test results pending after 356 members of the church were tested over the weekend. Health officials indicated it is too early to tell what effects the outbreak will have on the county's place in Phase 2 of reopening but will continue to monitor the situation.

Jeanne also said there have been five hospitalizations related to the outbreak. He said he was not able to share how many patients are in the ICU or on ventilators "due to privacy concerns."

The Island City church held services in April and May, according to since-deleted posts on the church's Facebook page, despite Gov. Kate Brown's executive orders limiting gatherings. As more information becomes available about the Union County outbreak, Jeanne said the state is sticking to its protocols for contact tracing and hope their methods will continue to reveal any instances of mass outbreaks spreading in the state's small, rural communities.

"Once you get even a handful of cases in the same time frame who are reporting that they attended church on a given day, that gives us a clue that there might be a potential outbreak," he said. "That helps us direct our resources and know where to look, but it really comes down to a quick public health response to figure out who they're connected to and how many others are going to be getting sick."

Spike could lead to rollback

Brown said Tuesday the state could reverse the "reopening" of Union County if the sharp spike in positive cases of COVID-19 isn't contained.

The state reported 278 new infections, surpassing the previous single-day record of 184 cases set Monday. Union County's 119 new cases drove the spike, according to the official count from Oregon Health Authority and Center for Human Development, the nonprofit that oversees public health in the county. According to a release from CHD Tuesday, two of Union County's cases are presumptive positive cases. This means they are people who were in close contact with a confirmed case and are symptomatic but have not yet tested positive for the virus.

Health officials on Tuesday said they believe they tested all the congregation members who might be infected and hope contact tracing will keep the outbreak in check, but added "all options are on the table," including removing the county from Phase 2 reopening — which would mark the first reversal since the state plan to lift pandemic restrictions began last month.

Union County's total now is the fifth highest of any county in Oregon regardless of population, sending the county past the larger Lincoln, Deschutes, Umatilla, Linn and Polk counties. It's the sixth county to have at least 200 cases. Multnomah, Marion, Washington and Clackamas are the counties with the most cases in Oregon.

"Our mission has never been clearer, and we are doing everything possible to protect the health and safety of our community," Carrie Brogoitti, CHD public health administrator, said in the press release. "Right now, more than ever, we need our community to work together to help limit the spread of this virus and protect our most vulnerable populations."

Nearly 1% of the population in the county now has COVID-19, making it by far the hardest-hit section of the state per capita.

Hospital prepared to expand

Mardi Ford, director of communications and marketing at Grande Ronde Hospital, La Grande, said the hospital could not disclose why a person is in the hospital due to patient privacy laws, but as of Tuesday afternoon Grande Ronde's census — the number of patients in the hospital for any purpose — was below the threshold of the hospital's bed limit. The average daily census is between 10 and 20 depending on the season.

The normal capacity for the hospital is 25, but in the release from the Center for Human Development, the hospital also included a statement that in an emergency situation it could expand capacity to 40. If needed, the GRH Pavilion near downtown La Grande could serve as an alternative site capable of taking another 160 additional patients.

"We've been preparing for this since March 2," Ford told The Observer. "We are prepared."

In the event that hospitals within the county were overwhelmed, Jeanne noted other Eastern Oregon hospitals may be able to help take transfers and there is additional capacity at nearby metropolitan areas such as Boise, Idaho.

"It's certainly possible that with an outbreak and a bunch of people getting sick that you could see more people need to be hospitalized than there are there," Jeanne said.

He noted the Oregon Health Authority has dedicated 10 additional contact tracers, two on the ground in Union County and eight working remotely, to assist the five local public health staff working on investigations.

"At this time it is enough for the outbreak," Jeanne said. "We'll have to keep monitoring that, but we think this is enough at the time."

The county's count was among the lowest totals in the state a week ago with just six cases. That number jumped to 13 by Friday and passed 20 over the weekend before 99 new cases were added Monday.

In all, 1,069 tests have been processed in Union County as of Tuesday, with 240 of those being positive and 829 negative. This means more than 22% of tests have come back positive. The infection rate in the county is 0.93%, which is nearly double the next highest county in Oregon — Lincoln, which is at 0.48%. One in every 107 people in the county has tested positive for the virus.

CHD on Monday also said the recent positives are not confined to one location.

Seven of the cases in Union County are patients who have recovered, meaning 233 of the cases are active. There have not been any deaths in the county due to the virus.

Businesses closing voluntarily

Local businesses are closing their doors to protect employees and clients after reopening a little more than a month ago.

"I volunteered to close to protect my family and friends, and not put any of my clients at risk," said Chelsea Weber, an esthetician at Skinplicity at Blue Mountain Mermaid, a salon in Elgin.

She explained even though her businesses can take precautions in protecting clients, such as frequent sanitation and prescreening customers before they enter, her line of work makes it difficult to keep a proper distance between clients.

Blue Mountain Outfitters, John Howard & Associates Real Estate and Community Kindness of Northeastern Oregon, all in downtown La Grande, announced temporary closures because of the outbreak.

"The last few months have taught me a lot about acting on personal conviction in the absence of further direction from state authorities, so we have always erred on the side of caution in our policies around sanitation and opening/closing," said Jim Whitbeck, owner of Blue Mountain Outfitters.

"We all need to do our part to prevent the spread of the COVID-19 virus, and that includes wearing masks out in public and maintaining social distancing," John Howard of John Howard and Associates wrote on Facebook. "Our actions do affect the community we live in, the business community and especially those who are in a compromised health condition. As a business owner, I think it's important we be responsible and take actions ourselves rather than waiting to be told we have to by state authorities."

Closures come with costs

Some local eating establishments also are going back to takeout and delivery only. Moy's Dynasty Restaurant and Local Harvest Eatery and Pub, both in La Grande, and Cowboys and Angels Place and Timber's Feedery, both in Elgin, announced they would be closing for dine-in service until further notice.

"We feel with these current outbreaks and the possibility of many more that this is our only option at this point to keep our staff and customers safe," Bruce Rogers, owner of Local Harvest and Timber's Feedery, said. "We need to be responsible to our community, and until someone really knows what is going on, there is a possibility that not being responsible could make things worse."

These closures do not come without a cost.

Weber said she worries that, even if she can come back, the services she offers still may be restricted and that could mean losing clients who came to her specifically for those services. Additionally, she said those whose jobs depend on a license to work are sitting idle as "time on the meter runs," and Weber said she hopes the government will consider extending licenses.

"Whether I believe this is 'real' or a 'political fight' or not, I am going to do my part to keep those around me healthy and safe," Weber said.

Whitbeck said the decision to close comes at a time of heavy traffic to the store.

"As a retail business entering a high traffic part of our season, we felt our staff would have to endure a high level of exposure in order for us to remain open," he said. "That traffic also also puts us in a position to potentially help slow the spread of the current outbreak."

Many are taking the closures on a week-by-week basis. Rogers said his restaurants are in no rush to reopen, and while it is important people continue to work, employee and customer health is the most important. Weber said she would like to see a drop in cases before she reopens her practice.

"I would certainly want to see new cases level off and existing in decline, but from everything I've seen this will get worse before it gets better, and circumstances seems to change every 20 minutes, so I'm not in a position to set a time table," Whitbeck said about reopening. "Other variables that will get figured in to the reopening calculus include unemployment availability for staff, general comfort level with exposure, ability to mitigate risk and, of course, how the business can actually survive with the doors closed."

Take precautions

The Center for Human Development in its press release also encouraged people to take precautions to a higher level.

"Please avoid social gatherings with those not in your household," the release states. "Continue to practice physical distancing, stay home when you are sick, wash your hands or use hand sanitizer often, and wear cloth face coverings when public."

CHD listed three instances where a person must quarantine for 14 days: if they are a confirmed positive case, if they have been in close contact (within 6 feet for more than 15 minutes) with a confirmed positive case, or if they are symptomatic. Symptoms include "fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea."

Tuesday afternoon, the outbreak in Union County led to La Grande Parks & Recreation immediately closing "all park restrooms, Veterans' Memorial Pool and Summer Day Camp programs." The release added that Morgan Lake will remain open.

Oregon now is at 6,098 cases. Two more deaths have been attributed to COVID-19 in the state, which now has seen 182 deaths related to the virus.

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EO Media Group reporter Alex Castle and The Bend Bulletin contributed to this article.

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