One hundred thirty three — that’s the number of Oregonians in hospital intensive care units battling COVID-19, according to official numbers out this week.
That’s the highest it’s been in the last eight months, and just 10 people fewer than the highest number of ICU patients all pandemic, set when COVID-19 peaked in December. In Southern Oregon, the records set over the winter are being broken this summer
Dr. Renee Edwards, the chief medical officer at OHSU Health, said that in large measure the people she’s seeing in the hospital are unvaccinated. Many are sick with the more contagious delta variant.
The delta variant has been blamed for a recent surge in COVID-19 cases across the country, with many states posting record-high case counts. While vaccines protect people from catching COVID-19 and getting seriously ill, the delta variant has undone all the progress vaccines made at slowing transmission of the virus.
And the patients falling ill with the delta variant are younger than in past waves. They seem to get sicker, faster, and appear more likely to get seriously ill. It’s no longer a disease that just hospitalizes the old.
“Patients who are presenting with this delta variant who are being hospitalized do tend to be sicker and more likely to require ICU level care,” Edwards said.
Since the pandemic started, doctors treating COVID-19 have learned how to treat patients and how to keep them out of the ICU. That means that once patients are admitted to an ICU, they are extremely sick.
“PTSD is common in this patient population, because they’re drowning in the air,” said Dr. Sabra Bederka, an ICU nurse at Providence in Portland. “They literally cannot get air into their lungs, no matter how hard they try, no matter how hard we try. And they’re terrified. It’s a panic situation.”
Then it’s on nurses to calm the panicking patients down and reassure them.
“It’s terrifying for us, because we’re in the middle of it,” Bederka said.
She said that after recovery some patients are triggered every time they become short of breath.
Before delta, COVID-19 was a disease that took its time. Patients would be sick for a week or two weeks before they required hospitalization.
Not any longer, Bederka said. “Now, it’s this, ‘I started feeling sick two days ago,’ and now they’re in the hospital. It’s clobbering them, quickly and mercilessly.”
Bederka said she’s losing “too many” people. And many of them are young — even in their 20s and 30s.
“They’re my age and younger, and they’re still not making it. And they’re leaving families and young children behind.”
Physical recovery can take a long time.
“We can’t fix you,” Bederka said. “We can treat you, but we can’t cure you. You have to cure yourself. It’s a waiting game: It’s seeing how much your body can recover from the damage that has already been done by this virus.”
Records set in Southern Oregon
Southern Oregon’s Jackson and Josephine counties have reported the highest numbers of infections and hospitalizations since the pandemic began.
“We are in a bad place for our public health and health care infrastructure, and for the health of our community,” Jackson County Health Officer Dr. Jim Shames said. “Our public health and health care systems are nearing capacity, at capacity or have surpassed it.”
Asante Health said its three hospitals are at capacity. They are no longer performing elective surgeries and are not accepting transfer patients from other hospitals that normally send patients in need of critical care.
In addition, Asante is unable to discharge patients to long-term care, because those facilities are full as well.
“We’re boarding about 60 patients a day who no longer need hospital-level care, but there are no open LTCs to discharge them to,” said Asante spokeswoman Lauren Van Sickle.
Statewide, the increase in COVID-19 hospitalizations has hit hospitals at a time when their capacity is already stretched thin due to staff fatigue and the need to care for patients who deferred regular medical care and cancer screenings earlier in the pandemic. Some of these patients are now showing up in need of treatment for more advanced conditions.
“As we are seeing this rise of the delta variant, we’re in a different place than we were a year and a half ago when COVID was first coming to Oregon, because we’re already busy with so many conditions of care we have fewer available hospital beds,” said Dr. Renee Edwards, chief medical officer for OHSU Health.
With COVID-19, there are no borders
Unlike previous waves of COVID-19, which were presaged by mask mandates and increased restrictions, this wave arrived with little fanfare. There were no statewide press conferences warning of impending hospital overflows. There were no imposed social distancing measures.
There was just a written recommendation, non-mandated, that all Oregonians resume wearing masks in indoor public spaces. It was issued the day after the U.S. Centers for Disease Control and Prevention recommended indoor mask use in areas where circulation was high.
The lack of state response baffles Bederka.
“It’s their job to make decisions about masks and vaccines and mandates, and sometimes I feel that they’re more worried about their jobs than the lives of the people they are trying to serve,” she said. “Shame on them for being afraid or hesitant or blind to what is happening.”
The state’s hands-off approach is consistent with a June decision to turn most managements of COVID-19 response over to local authorities, assuming that any new outbreaks would be smaller and more localized. Any mandates or stay-home orders would be up to the counties, according to Oregon Gov. Kate Brown. Other than mask mandates inside of schools, protocols for public education are also being hammered out at the local level.
“We have county lines, but it’s not like there’s a plexiglass border between Multnomah County and Lane County and whatever county in Southern Oregon,” Bederka said. “There’s no such thing as a border anymore.”
It’s summer, and people are traveling more, and they’re bringing the coronavirus from one community to another. And with news that vaccinated people can still transmit the delta variant, any hopes of surrounding less-vaccinated communities with more-vaccinated ones is moot, Bederka said. “People don’t understand that the risk is always going to be there, as long as one group is super sick and transmitting.”
She’s echoing the concerns of epidemiologists across the country, who worry that unvaccinated “pockets” will let the virus gather momentum before inevitably spreading to the rest of the population.
Health care workers have always known that COVID-19 is a disease without borders. A flood of cases at one hospital can quickly spread to others. Although cases are lower in Multnomah County than they are in some Southern Oregon counties, Bederka said, her hospital sees patients from across the West Coast.
‘Sometimes you divert them to a new hospital. And sometimes those hospitals are full, and we’ll divert again. But those patients have to go somewhere. It’s like, ‘I’m sorry, you’re full, here’s your next patient. I’m sorry, you’re full, here’s the next patient,’” Bederka said.
And moving and transferring patients can take a big toll.
“We have patients that have been transferred from other hospitals, and they have no idea they’ve been airlifted. They wake up, and they’re like, ‘Who are you?’” Bederka said.
She has to tell them that she’s their nurse, that they’re in Portland.
“Now they’re in another city or another state with a whole bunch of strangers trying to keep them from dying,” Bederka said. “I don’t wish that on anybody.”
A preventable tragedy
Vaccines may not stop a sick person from transmitting the delta variant, but they can stop people from getting sick in the first place. And if people do get sick, vaccines can keep them out of the ICU.
”This is all preventable, I keep saying that. This is all preventable,” Bederka said.
She understands that people are afraid of the COVID-19 vaccine, but if they saw what doctors and nurses saw every day, she thinks they’d be more afraid of COVID-19.
”And the technology isn’t new. People keep saying it’s new, or it was rushed, and it wasn’t,” Bederka said.
Although the Pfizer and Moderna vaccines are the first mRNA vaccines against communicable disease, and the first to hit the market, they’re not the first mRNA vaccines ever made.
Cancer researchers have been studying mRNA vaccines for over a decade in clinical trials. The idea is that by training cells to recognize cancer DNA — just like the COVID-19 mRNA vaccines train cells to recognize the coronavirus — the immune system can start attacking cancer cells, too.
The technology had already been shown to be safe. It just took a pandemic and an unprecedented scientific effort to get it over the finish line.
While vaccines can keep people out of the ICU, as long as COVID-19 circulation is still high, they are not enough. Children younger than 12 are unvaccinated, and many people are immune-compromised. Masks are key to stopping the transmission of the disease to those people.
Before people go somewhere, Bederka asks that they consider others.
“Look outside your own bubble,” Bederka said. “Realize the next person you inadvertently breathe on could get sick and could die.”