Oregon Faces A Moment Of Reckoning With COVID-19

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Oregon faces a moment of reckoning in the pandemic. 

With cases of COVID-19 growing at an exponential rate, Gov. Kate Brown has ordered a crackdown while hospitals scramble to create room for an influx of patients. Beds are in short supply; so is staffing. Providers are getting burned out, and the public is tired of restrictions.

But the virus is raging.

The number of hospitalized patients increased nearly 50% in the past week and 100% in the past month, Dr. Dean Sidelinger, the state epidemiologist, said at a Friday news conference. It was held to announce a new freeze on activity. 

The new restrictions will test Oregonians, their health care workers and health care facilities. If people follow the new recommendations, officials said Oregon might avert a crisis that has hit other areas where bodies have piled up. Everyone, from Ontario to Portland, has a role to play, Brown said.

The new restrictions will start Wednesday. Restaurants will only be able to sell food for takeout; private and social gatherings -- indoor and outdoor --  will be limited to six people from no more than two households; and churches and other places of worship will be able to have up to 25 people indoors or 50 people outdoors. Grocery stores, pharmacies and retail stores must keep capacity at 75%, and no indoor visits will be allowed at long-term care facilities. The shutdown also applies to gyms, museums and zoos and entertainment venues.

“It’s a very dangerous situation, and our hospitals have been sounding the alarm,” Brown said at the press conference. 

Brown -- and other health officials -- called on members of the public to stay home, wear masks outside, stay at least 6 feet away from others and wash their hands to avoid becoming infected or infecting others.

These restrictions underscore Oregon’s predicament. Cases are spiking and intensive care units are filling up. In the Portland metro area, there were only about 15 open beds in intensive care units on Friday, state officials said.

The restrictions echo those first announced in spring, when Oregon only had dozens of cases. Now the situation is much worse. The state case count is close to 55,000, and more than 750 Oregonians have died. 

For two days straight, the Oregon Health Authority has reported at least 1,000 new cases a day. 

And it’s not just the public that’s getting sick. Outbreaks have hit health care facilities as well. The biggest is linked to Salem Hospital with 76 people sickened so far, according to the health authority. Another 64 have been infected in an ongoing outbreak tied to Good Shepherd Hospital in Hermiston. A similar outbreak linked to Mercy Medical Center in Roseburg has sickened 25. St. Charles Medical Center in Bend, Oregon Health & Science University in Portland and Lebanon Community Hospital have had smaller outbreaks. 

On Friday, medical professionals welcomed the new clampdown.

The Oregon Association of Hospitals and Health Systems called the measures necessary as health care providers continue to fight the pandemic with limited resources.

“If we are not able to slow the spread of COVID-19 now, hospital capacity for all Oregonians could be threatened as COVID-19 hospitalizations continue to grow, jeopardizing the availability of care for us all,” Becky Hultberg, the association’s president and chief executive officer, said in a statement. “Cancer patients need treatments; those with injuries need physical rehabilitation; those in chronic pain need surgery. We urge the public to follow these new guidelines.”

Hultberg said the new steps and established precautions -- social distancing, hand washing and face coverings -- are essential to reducing the spread of COVID-19 and “bring it under control so we can bring normalcy back into our lives.”

The Oregon Nurses Association, which represents more than 15,000 nurses and health care workers around the state, also supported the freeze.

“Today’s restrictions are painful but taking action now will save lives,” said Kevin Mealy, spokesman for the association. “We’re seeing hospitals begin to fill, and the record number of coronavirus cases we’re seeing now will mean higher hospitalizations and critical care spikes in the coming weeks.”

He added: “When hospitals are overwhelmed, and we’re headed towards that inflection point, it will affect the entire community. It won’t just be individuals with COVID. If hospitals are overwhelmed, it will affect everyone who needs care.”

Hospitals Take Different Approaches

Hospital administrators have had to balance the care of COVID-19 patients with people who have other medical needs. To preserve hospital beds, all of the hospital systems in the Portland area have curtailed elective procedures that require one or more days of hospitalization, said Dr. Renee Edwards, chief medical officer for Oregon Health & Science University.

“Every intensive care unit in the Portland metropolitan area is nearly full or full,” Edwards said. 

“We are perilously close to overwhelming them.”

An influx of patients last week triggered the first alert in OHSU’s surge plan, Dr. David Zonies, the hospital’s associate chief medical officer for critical care, told The Lund Report. That prompted the hospital to turn one of its four intensive care units into an ICU for COVID-19 patients only. The hospital has also set a limit on elective procedures but did not provide a number.

“We are evaluating this on a day by day basis,” an OHSU spokeswoman said.

Providence Health & Systems, which has continued with non-urgent procedures as usual, emailed staff on Friday, saying the hospital system is well-positioned to handle a surge of patients. The email said that administrators will take a “deep dive” into the schedule and move some elective inpatient surgeries as needed.

“At some of our hospitals, we anticipate there might be no changes at all,” the note said. “At our larger facilities, we might need to move cases into different days or time periods when we are traditionally less busy.”

Kaiser Permanente has stopped scheduling non-urgent surgeries at its Sunnyside and Westside medical centers through the end of the year, said Michael Foley, spokesman for Kaiser Permanente Northwest. The hospitals also have postponed some procedures. Overall, these actions amount to a 20% cut in surgeries in the Portland area, Foley said.

Legacy Health has taken similar action. On Thursday, it decided to reduce the number of elective procedures requiring an overnight hospital stay by 25% over the next two weeks, said Brian Terrett, spokesman for the health care system. Outpatient procedures will go ahead as scheduled.

“We want to build in some capacity in case we see a surge in COVID-19 patients,” Terrett said.

Legacy’s hospitals are not overwhelmed with COVID-19 patients. Right now they only account for 5% of hospitalizations, Terrett said.

Medical facilities in central Oregon appear to be under less stress than those in Portland.

St. Charles Health System, which has four hospitals in the region, was at 83% capacity on Friday, spokeswoman Lisa Goodman said. Its 30 intensive care unit beds in Bend and Redmond were at 67% capacity. On Friday, 14 COVID-19 patients were in the Bend hospital and three of them were in intensive care, Goodman said. 

Goodman said St. Charles has not canceled elective surgeries yet and continues to monitor the situation, but it is bracing for a surge. It takes about two weeks after infection for people to need hospitalization.

Uncertain Future Ahead

Oregon has been in a better situation than most states. But that’s changing.

In September and October each new COVID-19 case led to an average of less than one other person getting infected, said Dr. Dean Sidelinger, state epidemiologist. The current transmission rate is now 1.5, meaning that each new person who becomes infected passes it along to more than one other person. That means the pandemic is growing exponentially.

The state’s model suggests the current transmission level could rise to about 1,500 new cases each day during the next two weeks. 

“This is likely the most dangerous time here in Oregon,” Sidelinger said. “We can’t pretend that COVID-19 is going away on its own.”

The analysis, however, could change as it is only based on state data through Nov. 6.

In two weeks, the state will reassess the pandemic. But Brown warned that COVID-19 “hotspot counties” face a longer freeze. That includes Multnomah County, which will be under the restrictions for at least four weeks, Brown said.

Unlike last March, when Brown announced the first clampdown, hair salons, child care providers and non-medical massage therapists can continue to operate. Schools that meet state requirements can stay open. 

The state measures were combined with a joint travel advisory by Brown, California Gov. Gavin Newsom and Washington Gov. Jay Inslee. The three states asked residents to avoid non-essential travel like recreation and vacation trips but the recommendations did not include regular commuting.

Brown also asked Oregonians to self-quarantine after they return home from out-of-state trips. For now, the advisory is not mandatory, but Brown said that could change in the future. 

Like Oregon, Washington and California announced restrictions on businesses and the public in hopes of curbing infections.

“No matter our location, we’re all on the line fighting the fire together,” Sidelinger said.

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

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