Oregon Gov. Kate Brown is expected to reimpose a statewide facemask requirement in an effort to slow the rampant spread of the delta variant of the coronavirus. State executive branch employees will also be required to get the COVID-19 vaccine.

The mandate, which Brown is announcing on Wednesday, comes at a time when 151 COVID-19 patients are in Oregon hospitals’ intensive care unit beds — more than at any other point in the pandemic, including the peak last December. And hospitalizations are rising faster than they ever had, according to data from the Oregon Health & Science University.

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“The situation is dire and is only going to get worse,” said Dr. Renee Edwards, chief medical officer at OHSU, in a press conference on Tuesday. “There has been a drastic increase in patients hospitalized due to COVID-19.”

Hospitals are increasingly overwhelmed. St. Charles Health System in Central Oregon has canceled elective procedures again, and a massive outbreak associated with Asante Rogue Regional Medical Center in Southern Oregon has sent dozens of infected or exposed health care workers home.

The decision to issue a new mask mandate is an about-face for Brown. On Monday, Multnomah County Chair Deborah Kafoury announced that a new mask mandate would be in place in the county. She was joined by officials from hospitals around the region, who asked the state to issue a mandate, and if not, asked that individual county leaders do so.

In response, Gov. Brown issued a statement in support of Multnomah County’s decision, and added that city and county leaders had asked, “for local control and the ability to make local public health decisions when it comes to COVID-19.” She asked local leaders to make those health decisions quickly and said that if leaders did not act quickly, “we will continue to explore statewide health measures necessary to stop the delta variant from stretching Oregon hospitals beyond their full capacity.

Just 24 hours later, Brown announced a new mandate. The reason? New modeling from the Oregon Health Authority and OHSU projects Oregon could exceed its health system capacity by 500 staffed hospital beds if interventions are not taken.

The worst we’ve seen

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“We’re in crisis,” OHSU’s Edwards said. She asked unvaccinated individuals to limit interactions and lock themselves down “like they did in spring of 2020.” Cases are rising so quickly, it’s hard to see where the surge could end. Dr. Peter Graven, a data scientist at OHSU, said that cases are rising faster than ever. ”We are in our fifth wave, and that red line is going up,” Graven said. The number of new daily COVID-19 cases is approaching record highs set in December of 2020. He pointed out how by this point in previous waves, mitigation measures were already in place and the curve was beginning to flatten.

That is not the case today. When the mask mandate was lifted on June 30, mask use plummeted in Oregon and has hovered in the 30% to 40% range. When the Centers for Disease Control and Prevention and OHA issued mask recommendations, it rose to 44%. According to Graven, that number is not high enough. ”The recommendations haven’t changed mask mandates enough to impact this surge,” Graven said. That puts precariously full hospitals in a dangerous position.”The actions we take today do not impact the rise [of cases] for two weeks,” Edwards said. And it will take up to 3 weeks before any impacts are seen in hospitals.

Without any interventions, Oregon could find its hospitals literally overflowing, with 500 more staffed beds needed, and not enough healthcare workers to reach that point. ”We do a very good job of maintaining our health and wellness in Oregon, so we have fewer beds than other states,” Edwards said. Even with the new mask mandate the governor issued, a good portion of those cases are already baked in. Since it takes time for measures to take effect, Graven estimated that even if new stay-home orders and masking measures were put in place, the state would still be about 300 beds overcapacity in two weeks.

A hospital system in crisis: At St. Charles Health System in Bend, doctors and nursing staff are already overwhelmed.

“I know you all keep hearing the word ‘crisis,” Dr. Doug Merrill, the system’s chief medical officer, said in a press conference on Tuesday. “We’ll try to dive in and give you an idea of what that means.”

The picture Merrill painted was bleak. In the last week, St. Charles had seen a 20% increase in visits to the emergency department, some COVID-19-related, some not - a high enough number that 3% to 10% of patients left without being seen by a clinician. And there weren’t enough beds available in the hospital, so at one point 20 patients were boarded overnight in the emergency department.

To keep up with the challenges presented by COVID-19, staff at the understaffed hospital have been working extended hours month in and month out. Requests were made for state assistance, but there aren’t enough healthcare workers available to fill in the gaps.

“It’s not sustainable,” Merrill said. “Folks have been heroic in the way that they’ve responded, the way that they’ve continued to rally, and the way that they continue to come and care for patients. But it’s not something we can rely on to keep going in the future.”

And the hospital is just about full. “We start days at somewhere between 90-95% occupancy,’ Merrill said.

That’s led the hospital to once again cancel elective surgeries, sometimes at great cost to patients. At St. Charles alone, 257 surgeries have been canceled since April. All told, the hospital system has a backlog of 2,500 patients waiting to be seen.”Although we sometimes refer to this as elective surgery, we are now talking about folks who’ve been waiting for surgery for well over a year, and in some cases, face rather dire medical consequences,” Merrill said.

St. Charles Health asked the Deschutes County commissioners to consider implementing a mask mandate, but that did not happen.

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