Oregon Gov. Kate Brown is re-imposing a statewide mask mandate, reacting to the rapid spread of COVID-19 that is projected to outpace the state’s supply of staffed hospital beds.
Almost all those getting severely ill from the virus are unvaccinated and officials once again urged Oregonians to get vaccinated.
The outlook is grave. An Oregon Health & Science University forecast released Tuesday predicts the surge of people seriously sick with COVID-19 will leave the state short 400 to 500 staffed hospital beds by Labor Day.
Oregon hospitals on Wednesday marked a record-setting number of people hospitalized with COVID-19: 665. That represents nearly 10% of Oregon’s supply of 6,913 staffed hospital beds. Combined with patients who have other medical needs, it strains hospitals nearly to the breaking point, especially in intensive care units.
But that demand is projected to grow even more by Labor Day. The expected number of people hospitalized on that day with COVID-19: 1,000.
The anticipated bed shortage takes into account the expected rise in COVID-19 cases as well as the demand for hospital beds by people with other medical problems.
The rapid growth of serious cases, much of it fueled by the delta variant, started just a month ago. The OHSU forecast predicted it will peak in the early fall and decline by the end of the year.
Oregon reached its record-setting 665 COVID-19 hospitalizations quickly.
The hospitalizations are more than fivefold the level in Oregon earlier this summer. Just 112 Oregonians were in the hospital with COVID-19 on July 12, state data show.
“The harsh reality is that delta is a different virus,” Brown said Wednesday in a press conference. “It has changed everything.”
Brown’s mandate will apply to indoor public places for people regardless of vaccination status. The mandate starts on Friday and applies to adults and children older than 5. In public transit systems, the mandate applies to children older than 2.
Brown said the spike in COVID-19 hospitalizations demands rapid attention, so all Oregonians know they can get treated in a hospital if necessary, whether it’s a patient with the virus, someone suffering a heart attack or an injured firefighter.
State officials project that the mask mandate can reduce the 500-bed hospital shortage to 250. The state’s also taking other steps, like mobilizing nurse crisis response teams so hospitals can operate more beds.
“We can literally cut that number in half,” Brown said.
Brown is resorting to the mask mandate after taking a hands-off approach and reopening the state in late June during the push to vaccinate 70% of Oregon adults. For a while, the state left it to county and local public health officials to decide if local outbreaks warranted restrictions such as masks.
All local Oregon leaders, except for Multnomah County commissioners, declined to adopt mask mandates. Multnomah County’s mandate, announced this week, would have started Friday.
Pressed if Oregon reopened too soon, Brown responded, “No. Delta has changed everything.”
She said she had hoped the state could return to a traditional public health system where local officials make decisions about restrictions during outbreaks. But local officials declined to issue mandates, even after hospital executives made pleas and warned of surging patient caseloads.
“For the most part, local elected officials were not willing to make the tough decisions,” Brown said.
In Deschutes County, the St. Charles Hospital System asked county commissioners to consider mask requirements. Hospital officials also approached the Bend City Council.
Those appeals were met with silence, said Dr. Jeff Absalon, executive vice president of the health system.
"We appreciate that Multnomah county made a statement yesterday (in) this regard," Absalon said. "Unfortunately in our local communities ... there’s not been any movement forward with regard to masking mandates."Leaders in Oregon and across the nation had been loosening restrictions and opening up their economies in the hopes the worst of the pandemic was behind them. The rapid spread of the delta variant among those who resisted vaccination changed all that.
Oregon leaders and others across the United States have sought to boost vaccination rates, but that work has slowed to a trickle of people in clinics compared to the mass vaccination events that drew thousands willing to wait in line for hours. Now, Oregonians can walk into public health clinics, pharmacies and their providers to get vaccinated. Public health officials also are targeting vaccination outreach to marginalized communities, such as low-income people, minorities and disabled people and seniors.
Still, the virus is making rapid inroads among the many who remain unvaccinated.
St. Charles Health Care Workers ‘Despairing’
The four-hospital St. Charles Health System in central Oregon is one example of the dire situation that the state’s hospitals are in. Every night patients languish in the emergency department waiting for a bed so they can be admitted into the hospital. Other patients that could leave are stuck because there are no spots for them in nursing homes, assisted living facilities or other facilities. St. Charles has had to delay hundreds of surgeries to make room for the sickest people -- including many COVID-19 patients who are staying longer in the hospital than they did before.
“There is no way to sugarcoat it,” Aaron Adams, president of St. Charles in Bend and Redmond, said Tuesday during a virtual news event. “We are in a difficult situation.”
The delta surge comes during what’s typically the trauma season at hospitals in Oregon, with people injured in boating or hiking accidents. But this year the crunch is intensified with demand from patients who delayed care last year for chronic diseases like heart conditions and diabetes because they were worried about going to the hospital as the pandemic raged and providers were busy.
“They’ve gained weight, they’ve been isolated, they suffer from depression, alcoholism, we’ve seen all of those elements increase,” Adams said.
Many patients are sicker than usual.
St. Charles has seen a 20% spike in demand for emergency care, said Dr. Doug Merrill, chief medical officer for the Bend and Redmond hospitals.
Patients wait for hours for emergency care but even then providers can’t accommodate everyone.
“The outcome of these high volumes is patients are not able to get into hospital and get a bed,” Merrill said. “Three to 10 percent of patients leave without being seen because the wait is so long.”
Those who manage to claim a gurney or stretcher end up sleeping overnight in the emergency room or in post-operative suites that the health care system is using temporarily to board patients.
And there’s no end in sight for a workforce that has endured an 18-month long pandemic.
“Our providers and caregivers are indeed exhausted,” Merrill said. “They’ve been working hard that entire time; they’re tired; they are despairing (without) a light at the end of the tunnel as we see each (COVID-19) variant come up and we realize that our communities still have sizable numbers of folks who are not vaccinated.”
Rural Vaccination Rates Low
Just over 72% of adults in Deschutes County are vaccinated, which is close to a state high. But the levels are much less in other areas of Eastern Oregon. Only about 52% of Crook County adults have gotten a shot, and about 57% of adults in Jefferson County.
Compounding the problem, about a quarter of the workforce at St. Charles is not vaccinated. By state law, health care companies cannot force employees to be vaccinated, but Brown called on the Oregon Health Authority to issue a statewide rule that skirts that issue by allowing hospitals to make COVID-19 vaccinations mandatory, and requiring that employees who refuse must be tested weekly.
Statewide, nearly 73% of adults have received at least one dose of the vaccine, or about 2.5 million Oregonians. Of those, 2.3 million who have received both doses.
Oregon Health Authority Director Patrick Allen said there has been a 44% increase in the last two weeks in people who get vaccinated each day. That includes more involvement from areas that have struggled to boost vaccination rates.
But it’s not enough yet.
“Delta is the game-changer,” Allen said. “Get vaccinated before the delta variant finds you.”The vaccination numbers are going to have to go up significantly in Oregon to quell the pandemic.
“We really need to be closer to 85% to reach herd immunity because of the increased transmissibility of this virus,” said Dr. Cynthia Maree, chief infectious disease officer for St. Charles.
COVID-19 Outlook In Oregon
OHSU officials said their projection of 400 to 500 staffed hospital beds short by Labor Day is a “shocking number” that demands immediate action.
If the scenario became a reality, people who need treatment for heart attacks, surgeries and accidents could be arriving at packed hospitals.
Before Brown announced her mandate, hospital administrators recommended Oregonians do at least two of the three steps: wear a mask indoors in public places and outdoors when physical distancing is impossible; limit gatherings or do them outdoors; and physically distance when possible. Those recommendations apply to people regardless of vaccination status.
“The situation across the state is frankly dire,” said Dr. Renee Edwards, chief medical officer at OHSU.
At OHSU, 30% of its intensive care unit capacity is used by COVID-19 patients and 95% of them are unvaccinated, Edwards said. This means OHSU has had to reject transfer requests it receives from around the state.
“We’re in crisis,” Edwards said.
Peter Graven, lead data scientist at OHSU, said COVID-19 cases are increasing in all regions of the state.
“It’s created a real catastrophe across the state in terms of hospital capacity,” Graven said.
Hospital officials urged people to get vaccinated. It’s not an immediate solution, though. In the two-dose vaccine, the second dose must be administered three or four weeks after the first, and it takes two weeks after the second dose for antibodies to kick in fully.
However, the “giant wave” of cases is projected to occur during the next four weeks, adding urgency to the steps Oregonians can take, Graven said.
Vaccinated people can still carry the delta variant and pass it on to others. There’s a small chance that a vaccinated person can become ill through the virus, but in most cases it’s not severe. About 95% of hospitalized cases involve unvaccinated people.
“If you are unvaccinated, please limit unnecessary interactions with the community and stay home,” said Dr. Dawn Nolt, a professor of pediatrics at OHSU School of Medicine who practices at OHSU Doernbecher Children’s Hospital.
There currently is no vaccine approved for children under 12.
That’s a concern as the delta variant has hit younger people more than the earlier waves of COVID-19. While children who become infected can recover, Nolt said, the long-term effects of COVID-19 for children remain unknown.
The key goal of the public health measures is to slow the surge and buy time to vaccinate more people, Graven said.
Brett Tyler, director of Oregon State University’s Center for Genome Research and Biocomputing, said vaccinations are key to the long-term outlook.
“It will probably depend on how many of the unvaccinated folks in our unvaccinated population change their minds about getting vaccinated,” he said.
He noted that the United Kingdom had a severe delta surge that’s now on the downturn.
“They attribute that to pushing really hard to increasing the number of vaccinations as well as placing some restrictions on what people can do,” Tyler said. “We have a challenge in front of us but there also is some good news there if people step up and get vaccinated and be diligent about wearing masks, that will help a lot.”
Vaccines Mandated For Most State Workers
Brown also announced mandatory vaccinations for executive branch state government employees. Her order doesn’t apply to those in the judicial or legislative divisions of state government, but does apply to all other state agencies
Executive branch state employees must be fully vaccinated either by Oct. 18, or six weeks after a COVID-19 vaccine receives full approval from the U.S. Food and Drug Administration, whichever date comes later. The vaccines are currently approved through FDA’s emergency use authorizations. Those authorizations are granted when there are no other alternatives to diagnose, treat or prevent life-threatening medical conditions. All the vaccines under the emergency use authorization still went through clinical trials before they went out to the public.
Employees will have to show proof of vaccination and can qualify for an exemption if they have a disability or sincerely held religious belief that qualifies under law.
Oregon employees won’t have the option of weekly testing instead of showing proof of vaccination.
Brown encouraged other employers, public and private, to take the same approach.
“Vaccines are safe and effective, and they are the surest way to prevent Oregonians from ending up in intensive care units,” Brown said. “I am taking action to help ensure State of Oregon workplaces are safe for employees and customers alike, and I am strongly encouraging all public and private employers to follow suit by requiring vaccination for their employees. The only way we can stop the spread of COVID-19 for good is through vaccination.”
But the governor’s vaccination mandate for health care workers faces resistance from leaders of the Service Employees International Union 503, which represents 24,000 rank-and-file Oregon state government employees. The union has issued a demand to negotiate the vaccination mandate and wants workers to secure compensation such as paid time off for workers to get the vaccine and recover from any side effects.
In a joint statement, Melissa Unger, Executive Director of SEIU 503 and Mike Powers, President of SEIU 503, said it’s an issue for the bargaining table.
“It is our analysis that once FDA approval is final, employers have the legal right to mandate vaccines,” they said. “However, the state can not simply declare a vaccine mandate and walk away. They must listen to essential workers and address our concerns with how this policy is implemented.”
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.