State officials on Thursday acknowledged they will likely fall far short of their goal to get vaccine boosters into the arms of 1 million Oregonians by month’s end, and rolled out new initiatives instead to stabilize a teetering health care system gripped by an unprecedented wave of coronavirus infections.
The announcement came on a day that the state reported 9,796 new cases and a moving average over the last week topping 7,900 daily confirmed or presumed infections – six times higher than two weeks ago.
The sheer volume of cases and staffing shortages caused by them rippled through the metro area, prompting a dizzying array of temporary school closures or moves to online learning. As of Thursday night, public schools and districts serving about 75,000 students had announced closures or online learning instruction – upending in-person learning for more than one in three students across Multnomah, Washington and Clackamas counties.
State officials Thursday said they are focusing most closely on keeping the health care system afloat. Oregon Health Authority Director Patrick Allen said that will include deploying 1,200 members of the Oregon National Guard to provide administrative and non-clinical support for hospitals; bringing in thousands of out-of-state health care workers under contract with staffing agencies to support hospitals and long term care facilities; adding testing services at its 10 high volume vaccine sites; and requesting that the federal government stand up three additional testing centers in the Willamette Valley.
While the spike in case numbers looks alarming, Oregon still has the 15th lowest case rate in the country, though most any measurement system at this point is proving no match for the highly transmissible omicron variant.
Allen told lawmakers in a hearing Thursday morning that the state may be capturing only one in every 10 cases because so many people are testing positive at home or have asymptomatic cases. For that reason, he said the agency is moving away from case counts as a primary metric in tracking the surge and will place more emphasis on hospitalizations and deaths. Infections have also outpaced the state’s ability to conduct investigations and contact tracing to the point they can’t effectively slow spread of the disease.
In response, OHA has launched a hotline (866-917-8881) to provide case support to infected individuals, and a website where they can complete an online survey programmed to report their positive case to public health officials. Allen said the agency would be including those self-reported infections in its daily case counts.
While the omicron variant is less virulent than previous strains of the virus, hospitalizations continued to climb. There were 777 people hospitalized Thursday who tested positive for the coronavirus, up 21 from the previous day. Allen said the rate of patients requiring intensive care beds or ventilators is increasing more slowly.
Hospitalizations among patients who test positive for coronavirus are still projected to set a record later this month, at about 1,650, according to new modeling by Oregon Health & Science University. But about 500 of those patients are projected to show up at the hospital for non-COVID reasons and test positive upon admission.
Officials nonetheless emphasized that with the health care system already under severe strain from heavy cases loads, testing demands, burned out employees, and infections among staff, it may still outstrip current capacity. They also said that while omicron infections may be less severe, that doesn’t mean “not severe,” and that many infected patients will still be clogging hospitals, and likely intensive care units.
Indeed, the head of trade associations for Oregon’s hospitals and long-term care facilities testified Thursday about swamped emergency departments, exhausted staff, and the inability to discharge patients because of a lack of staffed beds at step-down care facilities, many of which are already operating under executive orders that prohibit them from admitting more patients because of recent cases among staff and residents.
Becky Hultberg, president of the Oregon Association of Hospitals and Health Systems, said successive waves of the virus are fracturing the health system. She described workforce shortages, discharge delays, growing administrative and regulatory burdens and increasing costs that are causing financial instability for many organizations. She said hospitals had been forced to serve many roles they normally wouldn’t, including backstopping public health when other systems fail.
“The one door that’s always open is the hospital emergency department,” she said.
Libby Batlan, senior vice president at the Oregon Health Care Association, which represents long-term care organizations, said 427 out of 685 licensed facilities have positive cases among residents or staff, preventing them from taking on additional patients. That in turn clogs hospitals with patients who are healthy enough to be discharged but still need post-acute care.
To date, the state has deployed more than 600 clinicians from temporary staffing firms to help support hospitals. Allen said one of its main contractors, Jogan Health, had established a rapid relief pool of 200 clinicians and will augment that by another 300 in coming weeks. The state has signed another contract with Maxim Healthcare Group for another 700 traveling nurses, and it is finalizing another contract to bring in 600 temporary staff to support long-term care facilities. Separately, the Department of Human Services is preparing to bring in another 500 clinicians to support long-term care facilities and increase the number of staffed beds so hospitals can discharge more patients.
Meanwhile, the state’s campaign to get a million booster doses in Oregonians arms by the end of January is running well short of that pace. Some 330,000 Oregonians have received booster doses since Dec. 17, when the initiative was announced.
Officials for the Oregon Health Authority say they are now likely to hit just 650,000 by the end of the month.
Some 72% of Oregonians have received at least one dose of vaccine and 30% have been boosted after completing their two-shot series. Allen said the state has successfully closed the vaccination gap between whites and people of color, but there is still a major booster gap.
Treatments, meanwhile, are in short supply across the country, and Oregon is no exception. There are currently three monoclonal antibody treatments available, but two of them are ineffective against omicron, and Oregon is only receiving 300 doses of the third, which is effective, every two weeks. Antivirals can also be effective but need to be administered early in an infection – with infections becoming harder to quickly identify among a backlog of testing or insufficient supplies.
Allen said OHA is focusing distribution of those treatments to federal qualified health centers, which serve populations more likely to have negative outcomes.
The state so far received a million rapid antigen test kits out of the 6 million it ordered in December and expects to receive the rest by the end of January. Allen acknowledged the frustration that many Oregonians are facing in finding quick tests and prompt results, but said the state is conducting more testing than ever.
It will not be providing rapid tests to members of the general public, but sending them to hospitals, schools, Head Start programs and community organizations that target vulnerable populations such as the homeless, migrant workers and agricultural workers.
“We need to target testing resources in ways that are smart and fair,” Allen said.
To see more data and trends, visit https://projects.oregonlive.com/coronavirus/
— Ted Sickinger; firstname.lastname@example.org; 503-221-8505; @tedsickinger