Oregon’s COVID-19 hospitalizations could be peaking, but it’s a long way down

Oregon’s COVID-19 hospitalizations could peak over the course of next week — and possibly, begin to decline, according to a new model out of Oregon Health and Sciences University. But that will only happen if Oregonians continue to wear masks and take precautions.

But while hospitalizations might be peaking, that means they’re higher than ever before. In a press release on Friday, Oregon Gov. Kate Brown asked Oregonians to avoid risky activities over Labor Day weekend to keep hospital emergency departments empty.

Oregonians fought previous surges by wearing masks and abiding by strict social distancing measures. This time around, the masking is helping to flatten the curve -- but another big reason is that there aren’t as many people left for the virus to infect.

“This is the exact place that we were trying to avoid, with 1,200 hospitalizations, and nearly all hospital systems feeling overwhelmed or having to postpone or cancel other types of care. This is what we were trying to avoid. We are in that crisis,” said Dr. Peter Graven, lead data scientist at OHSU.

Oregon’s hospitals are full and have been for several weeks. That isn’t going to change any time soon.

“Right now, we’re at a flattening point where, you know, frankly, it’s probably going to bounce around a little bit. We’ll probably see some up and down yet before it really starts going down,” Graven said, “Is it slowing down? Yes, but it’s far from better. I think we have two months of pain to go through before this is manageable again.”

Any progress the state has made combatting the delta variant of the coronavirus is fragile. There are still a lot of people in Oregon who don’t have immunity. Graven said that Oregonians have been wearing masks, and have been avoiding large crowds and indoor dining at bars and restaurants, and that’s really helped flatten new infections. But he expects to see an increase in transmission tied to people’s socializing this Labor Day weekend. And as fall comes people will be spending more time inside, which could change transmission rates, too.

“It’s not like we’re past anything. Vigilance is obviously key, every bit of transmission we prevent now clears out the hospital a little quicker. And it doesn’t matter if [cases are] going up or going down, it still prevents the transmission,” Graven said.

And then, of course, there are kids: thousands of children under 12, who have not yet received a COVID-19 vaccine, are returning to school.

In the spring, few outbreaks were linked to in-person learning. But now cases are much higher, and that means there’s a bigger chance of outbreaks in school. And the delta variant wasn’t a factor in the spring of 2021: now it’s a game-changer.

“I think [schools] that are taking all of the precautions can feel pretty good about that. But it’s something we need to monitor and maybe make changes as we go,” Graven said.

As schools have opened around the country, some states have seen a spike in cases in children. Others haven’t. It’s still not clear if the delta variant of the coronavirus is more dangerous to children.

Still, the St. Charles Health System in Bend and Redmond is currently doubling the size of its pediatric intensive care unit.

“Just in case,” said Dr. Doug Merrill, chief medical officer at St. Charles.

Some regions are still hot zones

The modeling Gravens has done focuses on the state of Oregon as a whole. And that’s important because when so many people are sick, hospitals rely on each other to transfer patients and find available beds.

But the model’s predictions are an average taken across the state. “Cases will continue to go up in some places and down in others,” Graven said.

Hospital region 7, which includes Bend, Redmond, and several counties to the south and east, is one area where cases could keep going up.

“Our folks are estimating a peak 11 days later, with September 17 being our projected peak,” St. Charles’ Merrill said.

Three weeks ago, about 50 people with COVID-19 were hospitalized in the St. Charles system, and the patients were already waiting — sometimes for days — to be admitted from the emergency room to the hospital. Today, there are over 80 people hospitalized, down from over 90 a few days ago.

Most of the people who left the ICU did so in body bags.

Merrill said their modeling expects the health system to peak locally with about 120 patients hospitalized for COVID-19 at a time.

“We’re at 220, 225 adults hospitalized right now. And normally that number is in the 180s when we are full,” Merrill said.

Despite the record-high numbers, things aren’t quite as dire as Merrill had worried they would be previously, but that’s because traveling nurses and doctors have arrived from other states to help, and the Oregon National Guard was deployed to the region’s hospitals to help manage the surge of cases, too.

“We are loving the guards folk who are with us, and we’re so grateful for the staff we’ve gotten from the state and through our own contracts,” Merrill said.

Staff is still working overtime and extra shifts, and many COVID-19 patients are currently placed two-per-room.

“It’s just such a stressful environment. It would be wonderful if we could say, you know, hang in there for another couple of weeks and things are going to get better,” Merrill said. “And the fact that we can’t say that just adds to the stress.”

Health care workers brace for long haul

Although the Portland metro area has been less hard-hit than other parts of the state, due in part to high vaccination rates, the metro area hospital system is also overwhelmed. Both Providence Portland Medical Center and Providence St. Vincent Medical Center ordered “fatality management trucks”: temporary morgues.

“We still see our COVID-19 numbers increasing. And we want to be ready for that,” Rosa Cone, the director of nursing at Providence St. Vincent said.

Hospital morgues usually have room for fewer than 10 deceased people at a time. But the delta variant is killing people so fast, the morgues can’t keep up.

“It’s so difficult for the staff, it really takes a toll on them emotionally and physically, especially because these patients are much sicker than our first or second surge of COVID-19,” said Amanda Hanley, the nurse manager of Medical Unit B at Providence St. Vincent. The number of people needing supportive respiratory care has about doubled, and the hospital filled up much faster than in previous surges.

Medical Unit B has been turned entirely into a COVID-19 ward. It’s the first place many COVID-19 patients go when they are admitted to the hospital.

Abigail McDonald, a charge nurse in Medical Unit B, said the last few weeks have been incredibly difficult.

“Our patients aren’t as sick as they are when they go to the ICU. You build relationships and know them from the beginning, to when you see them enter intensive care, and know they might not come back,” McDonald said.

Health care workers at multiple hospitals told OPB that pre-pandemic when patients entered the ICU, there was a good chance they would be discharged. There was reason to be optimistic. That’s not the case now, they say.

“We do normally care for some patients at the end of life, but it’s much different when the patient has lived a full life, and it’s something they’ve expected and planned for,” McDonald said. Now she’s transferring patients in their 30s to critical care. These are people who never thought they’d be in this position, who haven’t made decisions about resuscitation or end-of-life care.

Now, McDonald and Hanley sometimes hear the last conversations patients will ever have with their family: conversations had over the phone or over Zoom, without anyone they knew before the hospital nearby.

This surge has hit health care workers particularly hard. Some of it is that many cases are preventable: people who would not have needed to be hospitalized if they had received the COVID-19 vaccine.

But more than that, they say, it’s the ebb and flow of hope that’s getting to them. Even if cases and hospitalizations and deaths start to decline, it’s hard to feel optimistic.

‘We’ve seen the light at the end of the tunnel so many times throughout the pandemic. And then to come to a surge like the one we’re facing now, it’s a roller coaster of emotions,” Cone said. “It makes me hold my breath at the light.”