Here’s the good news, Oregon: It worked.
A month has passed since Gov. Kate Brown signed her executive order telling you to stay home and save lives. You listened.
Rush hour disappeared. We sent ventilators to New York to save strangers. Transmission of the virus plummeted 60%, maybe 70.
And yet you also know the staggering price. At least 86 people have died, including some of Oregon’s most vulnerable. Elders. Friends. Parents. Loved ones.
Funerals have been postponed, jobs lost, medical procedures put on hold, lives upended. The virus has been discriminating, disproportionately infecting the Latino population.
But you helped Oregon stave off catastrophe. The hospital system held up. You bought valuable time. You kept an estimated 1,500 people from being hospitalized and some of them from dying.
Ready for the bad news? It’s not over yet. Not by a long shot.
The Oregonian/OregonLive talked to epidemiologists, scientists, doctors and state leaders charting the state’s path forward. They made one thing clear: Oregon is not trying to stamp out the virus.
In the critical coming weeks, they’re trying to make sure that whenever restrictions are lifted the virus doesn’t resume its out-of-control spread.
Here’s a progress report – where the coronavirus spread stands today in Oregon, what you should watch in the weeks to come and how state leaders can make sure they aren’t rushing Oregon into what risks being an unmitigated disaster.
What social distancing did for Oregon
Peter Graven, lead data scientist at Oregon Health & Science University, sounded an alarm in March. At the rate the coronavirus was spreading, he predicted Oregon’s hospital system would be overwhelmed by mid-April. His analysis helped catalyze Oregon’s action.
It’s now clear, he said, that before Oregon acted, the virus was spreading even faster than he expected: Doubling every five days, not every six.
How well did Oregon Gov. Kate Brown’s March 16 school closure and March 23 stay-home order restrictions work?
“As well as you could’ve expected,” Graven said. While it’s hard to separate the effects, “the combination of the two was a pretty big impact.”
Graven points to these numbers as the clearest way to see. They show hospital admissions for confirmed COVID-19 patients, by the day they were admitted. Admissions were accelerating in March and appeared to peak on March 28 – 12 days after the school closure order. It takes about 12 days from the time of exposure to be hospitalized, Graven said.
Daily confirmed COVID-19 admissions to Oregon hospitals
“That to me was super convincing that the policies were working,” Graven said. “There’s no reason it would do that on its own.”
There are other signs. The total number of confirmed COVID-19 patients on ventilators, in intensive care units and in hospital beds has declined in the last two weeks, the only timeframe for which the state has disclosed the figures. They show ventilator use and ICU bed occupancy down sharply; hospital bed occupancy less so.
But those measures are less accurate indicators. Graven said they can mask underlying trends, failing to account for the length of stay. One person on a ventilator for seven days looks the same as seven people who cycle through ventilators for seven straight days.
Confirmed COVID-19 patients in Oregon hospitals
The rate of positive tests has dropped slightly. Oregon has one of the nation’s lowest positive rates at about 4%. That’s a good sign, but not a consistent way to measure performance. Testing has been limited and the guidelines for who could get tested have repeatedly changed. “It’s a lot noisier,” Graven said, harder to tell what it means.
How Oregon reopens anything with the virus still present
This is Oregon’s new reality: The coronavirus isn’t going away any time soon.
Not without immunity or a vaccine, state leaders say. Not when estimates show as many as 40% of infected people could display no symptoms when they’re capable of infecting others. Not in a large country with the world’s worst outbreak and a patchwork response, where states like Georgia have already reopened gyms, hair salons and bowling alleys and others never adopted restrictions.
While islands like New Zealand and Iceland are trying to eliminate the virus from their borders, “we have to figure out how to live with the virus,” said Nik Blosser, Gov. Brown’s chief of staff. “There have already been dramatic changes in our lifestyle to date. They’ll have to continue. How they continue is what we’ll figure out in the coming weeks.”
Oregon’s aim has been flattening the curve, public health officials said, not eliminating the disease altogether.
“Our goal is not to completely stamp it out, I don’t think that’s possible,” said Dr. Jennifer Vines, the Multnomah County health officer. “Our goal is to use public health tools to keep a handle on this virus by making sure people who have it know it and their contacts know it and they stay away from others.”
It initially looked like Oregon could drive down the prevalence of the coronavirus more than it has. Oregon’s initial estimates showed social distancing could reduce active infections from 1,000 in late March to about 500 by early May.
That didn’t happen. Now, the state estimates there are about 3,000 active infections, a number that is slowly declining.
There’s a huge warning in the state’s projections. As soon as the stay home order is lifted, even if schools stay closed and large gatherings are banned, infections will take off: 30,000 within six weeks.
But that doesn’t account for the strategies the state is developing right now. Health officials are planning for how they will use testing to try to make sure people who are contagious know it and that a sick person’s contacts are warned about the exposure.
It’s a major challenge. It’s unclear whether the state is capable of pulling it off without unleashing a second wave of infections. But state leaders said they need to try.
“It’s totally untenable to stay where we are today until there’s a vaccine or an effective treatment,” said Patrick Allen, director of the Oregon Health Authority. “The idea is to lift these restrictions to allow some kind of normal life to come back. We’re not going to be normal-normal for a long time.”
As Oregon plans for reopening parts of the economy, Dr. Dean Sidelinger, the state epidemiologist, said the aim is to ease restrictions “in a safe manner so we can control the cases that do come in and keep those numbers decreasing, hopefully at the same rate.”
The state has not yet announced its plans for testing, tracing and isolating coronavirus cases. While Gov. Kate Brown has said she wants robust testing and tracing in place, it’s unclear exactly how many tests or tracers are needed.
The governor has cited 15,000 tests a week and 600 tracers as targets. Oregon is currently capable of reaching the testing number. But that’s far less ambitious than what many national public health experts say is needed. The state’s modeling team, the Institute for Disease Modeling, has called for “enormously increased testing capacity.”
Sidelinger explained the math: Assume Oregon has 350 new infections a day. That allows the state to test five of their contacts, while leaving 2,500 tests per week for nursing homes and congregate settings like prisons, group homes and shelters. About 47,000 Oregonians live in nursing homes; 14,000 are in prison.
Multnomah County is currently trying to figure out how many tests it needs and how many people tried but were unable to get tested. Kim Toevs, the county’s communicable disease director, said widespread testing will be vital because people who test positive are more likely to isolate themselves.
Within a week, Toevs said the county will know how many tests and contact tracers it needs, with at least a 10-fold increase in tracers expected from the 15 people currently doing it. Scaling up will take another few weeks, she said.
“The headline would be: ‘We’re doing great, please continue to be patient,’” Toevs said.
For weeks, so much has focused on short-term steps: Will schools close? Will a stay-home order come? Will we reopen? But Oregonians need to be prepared to deal with the novel coronavirus for months and perhaps years to come.
Eric Lofgren, an infectious disease epidemiologist and assistant professor at Washington State University, said “for the next few years, we may occasionally have to do this for long enough to tamp down occasional re-emergences of this. We think about flu season, it’s possible we’ll need to think about a COVID season.”
Lofgren likened the response to hurricane season evacuations. That’s easier, he said, “than it is to ride it out” – letting the disease spread unabated – “or remain in lockdown long enough to say we’re never going to have to do that again. That’s a much longer timeframe than anybody is comfortable saying we need to attempt.”
Two ways we’ll know if the virus surges again
Here, again, is some good news.
Despite the dearth of testing in Oregon and the United States, it won’t take an increase to know whether the state has gone too far in loosening its restrictions.
While hospitalizations are a good way to see the overall trend, said Graven, the OHSU data scientist, they’re a lagging indicator: It would take 12 days to see a spike and more to see it wasn’t a fluke.
But if the rate at which people are testing positive begins to increase, 500 daily test results will be enough “to tell that you’ve goofed soon enough to make a change,” Graven said.
Oregon is currently reporting about 1,300 test results a day, although it has the capacity to do 3,000.
Lofgren, the Washington State professor, said state officials should also closely monitor the results of contact tracing – the laborious task of tracking down where people who test positive have been and notifying their close contacts about the potential exposure.
“Contact tracing will tell you when things are starting to get out of hand,” he said. “When the first person shows up sick who hasn’t been in contact tracing, that’s a bad sign, that means there are chains of infection you can’t see.”