Oregon’s state epidemiologist on plans to end the mask mandate

Oregon health officials announced plans this week to drop the statewide indoor mask requirement no later than March 31. This includes masking requirements for schools. We talk with Oregon’s state epidemiologist Dean Sidelinger about the data behind the decision.

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Note: This transcript was computer generated and edited by a volunteer.

Dave Miller: On Monday Oregon health officials announced that the statewide indoor mask requirement will go away no later than March 31st. That includes the requirements in K-12 schools. Oregon is not alone in this. In recent days, a number of states led by Democratic governors have made similar announcements as case numbers from the Omicron wave start to fall. Dean Sidelinger is the state epidemiologist. He joins us now to talk about how the state made this decision and why now. How did you decide to make this announcement?

Dean Sidelinger: We looked at multiple factors about how COVID-19 was impacting the state and our health care system. We know that during the delta surge and omicron surge we’ve seen the highest numbers of Oregonians needing to be hospitalized with COVID-19. And so, looking at that impact on hospitals, following the COVID-19 positive patients in hospitals, and how hospitals were doing with capacity was high on that list. Looking at where we are with our data trend, seeing decreases in cases, decreases in hospitalizations over the last week and a half or so, our projections say we would be at about 400 Oregonians in the hospital by the end of March. That’s about where we were before omicron hit, at a time when hospitals were much better able to care for the patients they had in the hospital without the strain they’re seeing now. Those were the [factors] behind this timeline for removing the mask requirement at the end of March,

Miller: I’m interested in this “400 hospitalizations” number because back in August at the beginning of the delta surge, the mask mandate was reinstated when only around 150 Oregonians were then hospitalized with COVID-19. Why are the metrics so different now?

Sidelinger: We always have to look at the situation in front of us and what are the tools we have to combat that disease. We now have many more Oregonians who are up to date with their vaccinations, including their booster shots. We know that even in the face of Delta and Omicron, which weren’t around when those vaccines were developed, these vaccines remain incredibly effective at preventing disease and more importantly, preventing hospitalizations due to severe disease and death. We know that we have the arrival of more treatments. We have oral antiviral pills that can be used for those who are most at risk for serious complications to prevent them from having those complications and needing to be hospitalized. And while they’re not in large supply, that’s now another tool that we have. We also know that for Omicron, while it caused significantly more disease for the individual who gets the disease, they are less likely to have severe disease. The situation now is very different than in August. Oregonians have stepped up and have worn their masks, are up to date with their vaccines, and have taken other precautions that have helped us get over the worst of it. Now we are starting to see a decline in cases and hospitalizations, thanks to the steps that all Oregonians took.

Miller: Why give a date? Why not just say, “when we get to this specific metric–for example, 400 or fewer hospitalized Oregonians with COVID-19– that day, masks can come off.” What’s magic about saying in advance, March 31st?

Sidelinger: All of us are tired of dealing with COVID-19 and it’s been two years. We know we’ve been following the data. We know that the impact on hospitalizations during the last two surges, delta and omicron, have been tremendous, and that was going to be a key piece for us removing the mask [mandate]. But that seems very theoretical to folks to say, “if we can get the number of Oregonians in the hospital down below this number, then we will lift the mask mandate.” So, looking at the trends and data we see in Oregon, the trends in other states and countries, and what our projections from Dr. Peter Graven at OHSU show, getting down to this level of 400 puts us around the end of March. And that’s a more tangible kind of goal or endpoint for individuals. It also allows people to make plans if they are more at risk for COVID-19 or are a caregiver for someone who is more at risk and think about what they may do differently. It’s time for our schools and businesses and others to plan by having this end point. And the endpoint was derived from this hospital number, but it is a little more tangible for people.

Miller: What if hospitalizations are at 500 or 600 on March 31? How much wiggle room is there? Because you’re saying that that number doesn’t seem tangible, but in fact, it is the opposite of intangible. I mean, it is a real thing that represents real sick Oregonians in hospital beds. So how far away from the current projections would numbers have to be for you and other state officials to say, “you know what we’re going to change what we said, we would do.”

Sidelinger: I think we wouldn’t change what we said we would do, but we would message more if cases aren’t coming down as quickly as we want that especially those individuals who are more at risk for complications from COVID-19, they’re immunocompromised, so perhaps they don’t have as much protection from the vaccine, they’re older Oregonians or have chronic conditions that would put them more at risk, that they may consider not changing their behavior, wearing their masks, limiting their time indoors with others during that time.

Miller: I want to make sure I understand what you’re saying here because it surprises me. You’re saying that [regardless] of the actual situation in terms of hospitalizations or case rates or other hard metrics, that the mask mandate is going to be ended no matter what on March 31st?

Sidelinger: The requirement to wear masks in indoor public places and our K-12 schools will end on March 31st at the latest. I think everything we see in the data, the tools we have in front of us show that that’s going to happen. If we are a little higher than that, it means cases are spreading a little more quickly or something else has changed and we will certainly change our messaging so that people can take actions to protect themselves. But the requirement to wear masks will not be extended beyond that date.

Miller: Even if there is a new, even more serious variant?

Sidelinger: I think if there’s a more severe variant that’s significantly more transmissible causing more severe disease, we will be in the early stages learning about that. We will tell people what we know and don’t know, if it has arrived here in Oregon, and steps that people can take to protect themselves. Certainly, going back to requiring masks in indoor public places could be a step we would take down the road, but the initial steps would be to learn about what’s in front of us, what could potentially be in front of us, and get the best messages out to individuals so that they can take steps to protect themselves, their loved ones, and their neighbors. Right now, omicron is the disease that’s in front of us and we can see cases coming down, we can see the trend from other communities, the trend in our projections, and everything looks good. That’s really a testament to the steps Oregonians have taken to be up to date with vaccines, to wear their masks, and to change their behaviors during this time when disease is spreading fairly quickly in our state.

Miller: You mentioned projections by OHSU’s Dr. Peter Graven who has been on this show a couple of times. More than anybody, it’s his modeling that the state has talked about and used to make a lot of the kinds of decisions that we’re talking about today. But you have noted, and others have noted, that his projections for omicron hospitalizations at their peak, that they would be more than double the high point from the delta variant, and then after that the projections changed. In fact, the peak of omicron hospitalizations didn’t even match the delta variant, let alone being twice it. It’s not the first time that his modeling has been significantly off at various times. How much faith do you put in his modeling right now?

Sidelinger: I put a lot of faith in that model. We also look at some of the other models that are compiled by the Centers for Disease Control and Prevention. We have to remember that while scientists were trying to make projections for Omicron, we were still learning a significant amount about Omicron. From those initial data, reports out of South Africa, some European countries, and data and trends from some east coast states that were a little ahead of us, we learned more about just how transmissible the disease was, the hospitalization rates and severity impacts from omicron as compared to previous diseases, and how well our vaccines were going to work. Those [data] certainly changed and that had some impact on the height of the peak and on some of the timing. But I’m also heartened to see what Oregonians did in response to omicron: From the end of December through the end of January over half a million Oregonians became up to date with their vaccines by getting their boosters, more than 80% of Oregonians reported wearing masks regularly in indoor public places, and Oregonians made sacrifices and changed plans or postponed celebrations and get togethers because case rates were high so they could protect themselves and their loved ones. Those actions that we all took collectively made a difference and helped to get that peak down. We continued to see some slight decreases in the projections of where we would wind up, I think partially due to the actions Oregonians took. Dr. Graven refines his model as do other people who do models and projections based on what we know and certainly we saw that during the omicron surges, we had to react in almost real time to the data in front of us and make assessments of where we are going to wind up.

Miller: You mentioned 80% self-reporting of mask compliance. How concerned are you that by announcing the impending end of the mask mandate more than a month and a half in advance, you could end up giving the signal to a lot of Oregonians that they can take their masks off now?

Sidelinger: I would say to Oregonians, right now is not the time to take off your mask. We still have over 1,000 Oregonians in the hospital who tested positive with COVID-19. While that’s down significantly over the last week and a half, it’s still very high. We know that cases have come down even more dramatically. That decline started beforehand, but every county last week in Oregon would still fall into the CDCs level of high transmission. Similar to on the way up the peak on the way down, there’s going to be a lot of COVID-19 in the next few weeks, and the risk of getting COVID-19 is still high here in Oregon. The projections show that by the end of March we’ll be in a place where that risk is much lower and people should take off their masks then. By picking that day and announcing that date we’re giving people the endpoint so they know that the changes they’re making now and any sacrifices they’re making are happening in this time frame, and that by that point there will be much less sensitive transmission. Individuals, based on their own susceptibility for serious disease and the kind of situations they are in, will make those decisions. I hope they will continue to wear those masks until the mask requirement is lifted on March 31st.

Miller: The Health Authority and the Oregon Department of Education are both saying they strongly advise continued use of masks in K-12 schools even after March 31st. Where is the line for you between strongly advising something as a state epidemiologist and requiring it?

Sidelinger: What we know about masks at school is that they are a key part of a multi-layered strategy to prevent transmission at school. We know that being up to date with vaccinations provides great protection for the students, teachers, and staff in those settings. We know that universal masking where everyone is wearing a mask so that if someone is sick, they have a mask that helps keep the folks around them safe and then the folks around them are also wearing a mask to keep them safe. But we know schools have taken other measures such as improving ventilation, increasing air filtration, keeping kids spread out a little more than they had in the past, having testing programs that are available to test individuals who get sick, and other things to identify cases early. With multiple measures in place, by removing the mask requirement and going to recommendations, local communities and local school boards can make decisions. Do they have enough of those layered mitigation strategies in place in light of their community vaccination rates, vaccination rates of children in their community, disease spread in their community, to think about lifting that mask requirement and relying on some of those other safety measures. But for now, based on the types of spread we’re seeing in communities, those masks remain an incredibly important tool to help reduce the risk of transmission in schools.

Miller: Are you going to wear a mask if you go grocery shopping on April 1st?

Sidelinger: I’m struggling with the same decisions that many others are. I am up to date on my vaccinations and I’m a relatively healthy middle-aged man. But I do live with a relative who’s older and has underlying conditions. While she’s up to date on her vaccinations, if she gets sick with COVID-19 she could have more complications. So, I will likely continue to be cautious and wear a mask at least initially when I’m out in the grocery store and likely won’t be in large, crowded, indoor settings until I see case rates go down even more. But that’s a decision I’ll make based on my own household and personal situation. I’ll also look at what disease and vaccination rates are like in my community. Living in the Portland Metro area vaccination rates are higher here than they are in some parts of the state and that helps provide some level of protection for the community.