The Marion County Health and Human Services headquarters in Salem (Rachel Alexander/Salem Reporter)

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Marion County has more people who have tested positive for COVID-19 than nearly any other county in Oregon but local and state public health officials have been slow to explain how Salem-area people are falling ill.

As of March 25, Marion County reported 55 confirmed COVID-19 cases, county spokeswoman Jolene Kelley said. That number is higher than the current state tally for Marion County because the state numbers are only updated once per day.

Only Washington County with 96 cases has more. The state also confirmed the second death in Marion County, a 73-year-old woman who died of COVID-19 on Monday, March 23.

Marion County now has more cases than Multnomah, Clackamas and Lane counties, despite having fewer people.

Just under half, 24 people, have been hospitalized while ill, Kelley said.

Twenty-six of the patients are 55 or older. Older people are more at-risk for serious cases of illness and death.

Another 23 are between 35 and 54. The remaining handful are in younger adults. No one under 18 has tested positive for the virus in Marion County.

The high number of confirmed patients is likely in part because Salem Health began privately testing residents with symptoms of respiratory illness outside the hospital last week. That change greatly increased the number of local tests being done, and Marion County’s case numbers began climbing soon after.

But private testing is available in other Oregon cities, including the Portland metro area. As of Wednesday, Marion County had 16 confirmed cases of COVID-19 per 100,000 residents, while Multnomah County, which includes Portland, had just four per 100,000.

Kelley cited two other factors to explain the high number of local cases. Marion County was among the first to have someone test positive for COVID-19, so the virus has had more time to spread here, she said. And some local cases have been linked to outbreaks in neighboring counties, including the ongoing infections at a state veterans retirement home in Lebanon, Oregon.

About 9% of tests of Marion County residents have been positive, a higher rate than almost every other county. Over 430 county residents have tested negative for COVID-19.

Three people who were ill in Marion County have recovered from COVID-19, Kelley said last week.

At a Marion County Board of Commissioners meeting Wednesday morning, public health administrator Katrina Rothenberger told commissioners the department was expecting “large increases” in the number of positive COVID-19 tests locally and “considering strategies to focus on vulnerable populations,” including those over 65 and with underlying health conditions, to slow the spread. She did not say what those strategies might be.

Two Marion County residents have died from the disease. The latest victim had underlying medical conditions, the Oregon Health Authority said in a news release.

At least one local case was a Cherriots bus driver, who drove passengers Friday, March 13. Cherriots told their employees of the positive test Tuesday, March 24, but neither the transit agency nor the county publicly released that information until asked by Salem Reporter.

Another was a classroom aide at Mary Eyre Elementary School who’s been hospitalized for over a week with a critical case of the illness, according to her husband. Salem-Keizer spokeswoman Lillian Govus said the school district told the health department about the woman’s close contacts, fewer than 20 students and staff. But again, there was no public announcement from the county that a school employee had tested positive after recently being at work.

Kelley said the county doesn't share information on individual cases because of patient privacy and state guidelines.

Other than noting some local cases have been linked to the Lebanon veterans home, Kelley said she couldn't currently answer questions from Salem Report about how Marion County residents contracted the disease, including how many local cases could be traced to other confirmed cases.

"This is not a simple question and requires further analysis that we do not have the resources to provide at this time," she said.

The county, following state guidance, has not shared the public locations people who later test positive for COVID-19 have been in the days prior to their symptoms.

As Marion County announced its first cases, Rothenberger told Salem Reporter that information wasn’t shared because of the way COVID-19 spreads, which is mostly through close contact, within six feet, with someone who is ill. People who were in the same room as someone carrying the virus were considered at low risk of infection.

Since those early cases, published research in the New England Journal of Medicine has found the virus can live on some surfaces for hours or days, though researchers said the amount of virus remaining after several days is likely not enough to infect a person.

Scientists also better understand how the virus spreads in groups of people, and more data is showing people infected with the virus showing no or mild symptoms drive its spread. Public health researchers at Columbia University, studying data from China, concluded unrecorded cases of COVID-19 were responsible for two-thirds of documented infections.

In response to a request to speak to a state public health expert about how Marion County compares to other Oregon counties, state spokesman Tim Wollerman said in an email Oregon Health Authority “does not comment on variations and trends in cases across counties.”

Asked for an explanation, he wrote the health authority is “experiencing an enormous amount of media inquiries and not providing interviews (at) this time.”

Contact reporter Rachel Alexander at rachel@salemreporter.com or 503-575-1241.