Will omicron overwhelm Oregon’s hospitals? Here’s what we know so far

Statewide, hospitals reported 510 patients positive for COVID-19 on Tuesday, a 50 percent increase in less than two weeks, likely driven by the spread of the omicron variant.

Just last month, the state had recorded the lowest weekly number of new hospital admissions for COVID-19 since the summer.

“It’s so transmissible,” said Dr. Katie Sharff, infectious disease specialist with Kaiser Permanente. “It’s like nothing we’ve ever seen.”

With Oregon Health & Science University’s statewide forecast predicting that the total number of hospitalized COVID-19 patients could soon exceed the delta wave peak, hospitals are yet again revisiting their surge capacity plans and OHA is preparing to roll out new crisis standards of care.

Yet there’s also mounting evidence worldwide that the variant causes milder infection, briefer hospital stays, and is less likely to progress to deadly pneumonia in most patients.

Here’s what we know so far about the impact of omicron from contacting the four major health systems in Portland:

1. Hospitalizations are up across the four largest health systems in the metro area

In interviews and emails, OHSU and Kaiser Permanente reported their numbers of COVID-19 positive patients have almost doubled in the past month. Legacy Emanuel and Providence reported smaller increases of 40 and 25 percent, respectively.

At the national level, the CDC estimates that omicron is now responsible for about 95 percent of COVID-19 infections.

At the local level, Sharff, the Kaiser infectious disease specialist, suspects the increase in hospitalizations is due to omicron, not delta, but it’s hard to say for sure due to the weekslong lag in genomic sequencing.

“On the ground as a clinical provider, there’s really no way to know if the patient coming in with COVID has the delta variant or the omicron variant,” Sharff said.

However, due to the speed of the surge in hospitalizations, Sharff believes omicron is responsible. “This seems different than what we saw with our prior delta surge. I would say, it’s omicron,” she said.

2. The sickest patients are almost all unvaccinated

So far, the omicron surge appears consistent with past surges in one key respect: The sickest patients who require ICU care are still almost entirely unvaccinated people.

At OHSU, for example, 13 out of the 15 patients in the ICU are not fully vaccinated, and all 9 patients on ventilators are not fully vaccinated.

Dr. Matthias Merkel says vaccination and a booster — while it may not prevent you from a mild infection — remains the best way to reduce your chances of needing intensive care.

“It is holding very strongly that it largely protects us from severe illness which is really the key part of a vaccine strategy,” Merkel said.

Other health systems reported a similar trend.

“About 80% of our hospitalizations are in unvaccinated people, which shows the vaccine’s effectiveness,” said Legacy spokeswoman Kristin Whitney.

3. Some of the “COVID-19 hospitalizations” aren’t people hospitalized by the virus

A majority of the COVID-19 positive patients in hospitals are probably there due to their COVID infections — but some are asymptomatic or mildly symptomatic cases picked up by hospital infection screening.

Omicron is more transmissible and likely milder, and that’s made hospitalization numbers harder to interpret.

In omicron hotspots, like New York and South Africa, some hospitals have reported that a significant percentage of their COVID-19 positive patients are mildly symptomatic or tested positive as part of patient screening.

Providence was the only Portland metro area health system with an estimate of this metric. A spokesman said about one third of its COVID-19 positive cases are people who tested positive as part of the hospital’s screening for infections, while two thirds are in the hospital due to COVID-19 illness.

OHSU and Kaiser said they aren’t tracking that metric. Kaiser’s Sharff said staffing shortages make it too challenging, but based on her familiarity with the cases at Kaiser, a majority are people admitted for COVID-19.

OHSU’s Merkel said that it can be a tricky distinction to draw, because COVID-19 often compounds underlying health conditions like diabetes, and patients frequently present in the emergency department for multiple reasons.

One additional clue in statewide data suggests the rising number of hospitalizations is not just a case of hospitals catching more mild cases through routine screening..

The percentage of emergency room visits for COVID-19 like illness has gone up from around 4% in mid December to 6.6 % last week.

4. Hospital crunch may be moving from intensive care to the emergency room

ICUs may see less of a burden due to omicron than they did during the delta wave. But hospital officials say emergency departments and acute care are already overwhelmed. Merkel, who handles capacity management for OHSU, says the hospitals’ emergency department is already filling up with patients.

“It gets harder and harder every day every hour to find beds,” he said.

However, it’s not the more specialized, staffing intensive ICU beds that are in the shortest supply, but rather acute care beds. Merkel says OHSU currently has patients in its ICU who are ready to step down to a lower level of care within the hospital — but the hospital doesn’t have a regular bed to transfer them to.

According to Merkel, OHSU can free up more of its beds by cancelling more elective surgeries, but the hospital is trying to avoid that based on what it learned during past surges.

“Just not doing these surgeries is really bad for our patients,” he said. “We’re trying to kind of find this balancing act — how many surgeries can we do on a given day, while still kind of taking patients out of our emergency room.”

Statewide, there are 111 COVID-19 positive patients in intensive care beds, and 30 on ventilators. Those numbers have remained essentially flat through December. While that could be due to acute illness being a lagging indicator, it could also be in part due to omicron’s lower likelihood of causing severe illness.

5. The key problem will be staffing

Omicron is already undermining the health system in a way that delta, for all its virulence, did not: its ability to cause mild infections in vaccinated hospital staff.

Kaiser, Providence and OHSU all noted staffing impacts due to breakthrough infections.

“At a time where we already have critical staffing shortages, just from the longevity of this pandemic, to add that additional illness to the mix is really unfortunate,” Sharff said.

The omicron situation is “a perfect storm,” according to Merkel, with intensified staffing shortages likely at the same time hospitals are bracing for increased demand for emergency and acute care.

The Oregon Health Authority, meanwhile, is planning to announce new statewide crisis standards of care in the event hospitals have to triage patients.

6. Now is not the time for nihilism

Between pandemic burnout and omicron’s extreme transmissibility and ability to cause breakthrough infections, it’s easy to feel like giving up.

But Sharff and Merkel both stress how much of an impact people can have on curbing hospitalizations by getting vaccinated or boosted, wearing a well-fitting mask, and keeping their social circles small.

“The essential message hasn’t changed,” Sharff said.

And reducing hospitalizations due to COVID-19 remains critical to ensuring that all of us can get emergency care when we need it.

“We talked in the past about flattening the curve,” Merkel said “This is what we need right now.”