Oregon reaches dire stage in pandemic as state issues guidelines for rationing care

A rising number of patients will need emergency and critical care in the days ahead, officials said Friday. (Oregon Health & Science University)

The Covid-19 pandemic in Oregon has reached a dire stage, with the Oregon Health Authority advising hospitals how to ration care when they run out of beds, and officials warning the public that widespread infections will disrupt everyone’s life.

During a news conference on Friday, Dr. Dean Sidelinger, Oregon’s state epidemiologist, said the highly infectious omicron variant will sicken more people much more quickly than other variants, causing a steep rise in hospitalizations.

More than 10,000 people added in one day to the rolls of those infected, and hospital admissions for Covid continued to climb around the state.

Sidelinger said the thousands of unvaccinated Oregonians should consider the developments a “red alert.”

“It will overburden our already exhausted health care workers and oversaturate our health care system,” Sidelinger said. “It will disrupt lives and livelihoods.”

Schools have already been affected, with some returning temporarily to online learning just days after returning to the classroom from the holiday break. So have airlines, which were forced to cancel thousands of flights during the holiday season. But many other labor sectors in Oregon will be affected because infected people will have to stay home for at least five days, officials warned. 

Chunhuei Chi, director of the Center for Global Health at Oregon State University, told the Capital Chronicle Friday that any workplace with large numbers of people working indoors will be impacted, including factories, entertainment venues and churches.

He said companies need to have contingency plans to prepare for staff who call in sick or need to quarantine if they become infected even if they don’t suffer symptoms. Others will have to stay home to care for a child back at home temporarily for online classes as schools struggle with sick staff and students. 

“Many people will have to miss work,” Sidelinger said. “We will see disruptions in the services that we are used to.”

Peter Graven, the assistant professor at Oregon Health & Science University who’s shaped the forecasts that have driven state policy on the pandemic, said he expects those needing a hospital bed to peak at about 1,650 cases by the end of January. That’s 30% higher than the September peak for the delta variant when some hospitals in Oregon ran out of beds.

Oregon has about 4,700 adult beds available, including nearly 650 in intensive care units, according to Friday’s tally. State hospitals have about 300 pediatric beds, including 40 in intensive care, with another 280 dedicated to neonatal intensive care units.

As of Thursday, only 6.5% of adult intensive care beds statewide were available and only 5% of regular adult beds were open. Hospitals in eastern and north-central Oregon had almost no intensive care beds available on Thursday; north-central Oregon also lacked regular adult beds as did hospitals in Benton, Lincoln, Linn, Marion, Polk and Yamhill counties.

Right now Graven estimates that only 4% of Oregonians have the virus.

“That’s going to grow throughout January,” Graven said.

The lack of existing beds now is likely to be compounded by hospital staff getting sick or becoming infected and having to quarantine.

“It’s spreading among vaccinated people, including staff,” Graven told the Capital Chronicle before the news conference. “We’re going to have shortages of staff.”

He said even booster doses, which are the most protective, only thwart about 50% of cases.

“That’s not super great considering how quickly it spreads,” he said.

The data shared during the news conference was dire: Every day, Oregon sets a new record on the number of people infected, with nearly 10,500 reported on Friday. And that’s only a partial count. The state can’t track people who test positive with a rapid test at home. 

Right now about 20% of tests are positive.

Sidelinger said the latest seven-day running average of cases had risen more than 70% over the last month, pushing hospital numbers up.  

The virus is likely to infect everyone who’s unvaccinated, officials said.

They make up the majority of people needing hospitalization. About 30% of cases are in fully vaccinated people, but getting a booster dose helps prevent severe disease.

Sidelinger indicated, however, that the state is unlikely to meet its goal of getting 1 million more people boosted by the end of January – the state’s primary strategy to head off a catastrophic impact of omicron.

A large segment of the population – about 65% according to Graven – no longer is immune to infection either through a past illness or vaccine.

State adds resources

The Oregon Health Authority is hiring another 1,000 critical care staff to support nursing teams around the state, and on Friday, Gov. Kate Brown announced that up to 500 Oregon National Guard troops will be deployed to help hospitals. The first 125 will start next week providing logistical support and assisting Covid-19 testing sites.

Tests are in short supply, forcing long lines for clients in some places, and they’re difficult to find in pharmacies. The state ordered 12 million more rapid tests that take 15 minutes to achieve results. The first 1 million arrived this week. Five truckloads of about 1.9 million tests will arrive next week with successive shipments until the order is filled. The tests are being stored at a warehouse in Wilsonville. 

The health authority has not dispatched any yet.

“Allocations are still being finalized,” health authority spokesman Rudy Owens, said in an email to the Capital Chronicle. The “initial distribution will be to hospitals and health systems for their frontline health care workers, K-12 schools to facilitate test to stay, community-based organizations, homeless service sites, Head Start programs, local public health authorities and tribal partners.”

He said the state still does not know what criteria it will use to determine who gets tests and how many. 

“That is still under development,” Owens said.

The state will contract with delivery services to distribute them, and they will be free. 

Rapid tests are key to preventing the spread of the virus, officials said. Anyone who tests positive should stay home for five days and then wear a mask when venturing out in the next five days.

State officials also urge that people use high-grade, tight-fitting masks. They stopped short of recommending medical masks, like N95s, saying multilayered cloth masks with a good fit.

Potential for rationing care

In anticipation of a lack of hospital beds, the Oregon Health Authority has given hospitals general guidelines for rationing care when they have no more beds or other resources available for those requiring hospitalization.

The guidelines are voluntary and hospitals can adopt their own principles. 

Rationing care, considered an extraordinary measure in modern medical times, should be based on the patient’s likely “survivability” to the point of discharge, according to the state guidelines. In other words, give preference to patients likely to get better and be discharged.

The guidelines do not map out when hospitals should turn people away or whether they should bump patients from critical care when their outlook is dire. Instead, they urge hospital staff to not discriminate based on age, disabilities or other factors.

“No one will be denied care based on stereotypes, assumptions about any individual’s quality of life, or judgment about an individual’s ‘worth’ based on the presence or absence of disabilities,” the health authority said in a news release. “Care decisions should be based on the likelihood of survival to hospital discharge.”

Dr. Dana Hargunani, the health authority’s chief medical officer, said hospitals will evaluate everyone who needs critical care and take their prognosis into account if they have to ration services.

Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems, called the guidelines “a good first step.”

“As the omicron variant puts even more pressure on hospital capacity and the health care workforce, it’s important for clinicians to have a tool to guide very difficult decisions about how to allocate resources in a time of scarcity. We appreciate that OHA has committed to convening clinicians and other stakeholders to further develop a tool, and hospitals look forward to participating in that process.”

That sentiment was echoed by Dr. Seth Podolsky, senior vice president and chief medical officer of Legacy Health, who said in a statement to the Capital Chronicle: “We look forward to a more detailed plan to be developed in the coming months and would be honored to participate in the process.”

The Capital Chronicle asked several hospital systems for their internal guidelines on rationing care. Providence Health & Services and Salem Health responded in emails saying they have contingency plans in place. Neither hospital systems provided any guidelines, and Oregon Health & Science University and Kaiser Permanente didn’t respond. 

Safety regulations in schools

Despite the growing number of Covid-19 cases keeping teachers and students out of classrooms, the Oregon Department of Education and the Oregon Health Authority have not issued any new regulations or contingency plans should caseloads require mass quarantines.

On Friday, the federal Centers for Disease Control and Prevention issued guidelines for K-12 schools that allow for isolating for five days instead of 10 those a positive test or symptoms. 

Colt Gill, director of the Oregon Education Department, said his agency would continue to do whatever it takes to keep kids in school, and would leave it to districts to decide if remote learning was needed for a classroom or an entire building if caseloads and exposures are high.

On Friday, Portland Public Schools announced Cleveland and McDaniel high schools would go remote until at least Jan. 14 due to staff shortages and student absences related to Covid-19. Extracurricular activities have also been postponed.

The Beaverton School District announced it would temporarily pause all school assemblies and after-school social events beginning Friday, including school dances. 

Clubs, athletics, theater, band and choir are allowed to continue, though the district has limited the number of spectators who are able to attend. The Bethel, Eugene and Springfield school districts also announced on Friday that they would make similar restrictions on the number of spectators who can come to their after-school events.

Shellie Bailey-Shah, communications officer for Beaverton Public Schools, said there are contingency plans being developed should an entire school in the district need to go into quarantine.

She said their biggest challenge will be staff absences, but districts so far have covered them with substitutes or moving other district employees into teaching roles. 

Oregon Capital Chronicle is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Oregon Capital Chronicle maintains editorial independence. Contact Editor Les Zaitz for questions: [email protected]. Follow Oregon Capital Chronicle on Facebook and Twitter.