Just a few weeks after Oregonians got used to going out without their facemasks, COVID-19 infections are once again soaring. The daily case count hit a new all-time high this week and intensive care units are filling up with sick patients. The sudden surge has prompted Oregon Gov. Kate Brown to issue a statewide mandate to wear facemasks while in public. And we’re all left with a lot of questions.

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How bad are things right now?

They’re not good. On Monday, Oregon recorded over 3,200 new confirmed or presumptive COVID-19 cases. It was the highest single-day number to date. And on Tuesday, Oregon had almost 2,400 new cases. One of the things that’s so notable is how fast new daily case counts are growing. Just two weeks ago, Oregon was only seeing 600 or so new cases a day. The virus has a lot of momentum, and people have been living summer to its fullest. Major venues are still open, for example, and there are no social distancing restrictions in place. The governor’s newly-announced mask mandate will slow that some, but it’s not clear if it will be enough.

There are also so many cases that test results have been slower to turn around, and contact tracers and case investigators are taking days — and sometimes over a week — to contact people who have tested positive to trace them to others who may have been exposed. That means it takes longer to tell people that they should quarantine.

I’m fully vaccinated. What should I do to stay safe?

The good news is, vaccinated people are a lot less likely to get sick and die from COVID-19. But the highly contagious delta variant of the coronavirus did make things worse. In addition to wearing a mask, even vaccinated people should limit contact with other people, try to be outdoors as much as possible, and limit trips to indoor public locations. Practice social distancing. And older people and people with pre-existing conditions are still more at risk, though much less at risk than unvaccinated people.

What about unvaccinated people?

Dr. Renee Edwards, the chief medical officer at Oregon Health & Science University, recommended that unvaccinated people lock down as they did in the spring of 2020. There is so much virus circulating right now and it’s so contagious that it really is risky, and there aren’t any hospital beds to spare (see below). If that isn’t possible, try to be as cautious as you can - double-mask, stay home, do all the things that have kept us safe so far.

And what about kids?

Although kids are still less likely to get seriously sick or die from COVID-19, the delta variant is so dangerous that it’s made things riskier for kids, too. Cases in children are on the rise. Just like adults, kids should wear masks, social distance, avoid indoor public spaces, and get vaccinated once it is approved for their age group.

But I thought we vaccinated enough people to stop this wave?

We vaccinated enough people to save lives — in July, only one in five cases of COVID-19 involved somebody who was already vaccinated. But the state also lifted mask mandates and ended social distancing restrictions, so the virus has been playing on easy mode for over a month, and it’s had a chance to spread.

Almost 57% of the state’s population has received two doses of a COVID-19 vaccine. That’s a far cry from the 70% threshold initially pegged for herd immunity, but it was enough to make a serious dent in the virus. Unfortunately, the delta variant has undone the progress vaccinations made towards slowing transmission. Because it is more transmissible, and because vaccinated people can transmit it, scientists now estimate that the threshold for herd immunity is around 85%.

Is that because vaccines aren’t effective, or aren’t effective anymore?

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No. These are still among the most effective vaccines ever made, even with the delta variant in play. Don’t let the higher number of breakthrough cases scare you. Well, let it scare you away from being reckless, not from the vaccines.

What’s the impact of this surge on Oregon hospitals?

It’s the worst it’s ever been. There are 170 people in intensive care units in Oregon hospitals right now who are thought to have COVID-19 and just 69 ICU beds are left available in the state. Some hospitals have already run out of beds, and have had to board patients in the emergency department overnight. People without COVID can’t get the care they need. A model by OHSU says we could be short 500 hospital beds by September if things don’t change.

Hospital staff has been warning county officials about the rise in cases for weeks. They report long wait times in their emergency departments and even longer wait times for hospital admissions. Some hospitals have canceled elective procedures — which can be really hard on people who have had their surgeries postponed more than 18 months.

It sort of seems like this surge came out of nowhere…?

It really does feel like it came out of nowhere: there have been fewer messages from the state with dire predictions. But there were warning signs. The delta variant had been circulating at low levels in Oregon for months. Other states and countries showed how easily this variant could overwhelm cities with high vaccination rates. Social distancing measures kept cases low, but after the last mask mandate was lifted at the end of June, cases started rising. And that gave delta the edge it needed to take over.

How did it get so bad, so fast?

There are three big factors here:

  • One is the delta variant itself: it’s very, very transmissible. Scientists measure how easily a virus spreads with a factor called R0. Previous variants of the coronavirus had an R0 of three or four, which means that without protective measures, each sick person will infect an average of three others. Depending on the source, the delta variant has an R0 between seven and eight. That makes it the most infectious respiratory virus ever seen.
  • This is our first wave without some kind of state-mandated social distancing requirements.
  • Oregon is one of the most vaccinated states, but it is also one of the least immune states. That’s because Oregonians have kept cases pretty low until now, so not a lot of unvaccinated people have pre-existing immunity, the kind you get after being sick. So when you add vaccinated people, and unvaccinated people who have been sick before together, Oregon has a lot of people who can be easily infected.

Besides being more contagious, how is delta different?

The delta variant also seems to cause more severe illness, more quickly, and in a younger population. For the first time in the pandemic, large numbers of children are ending up in the ICU with COVID-19. And unvaccinated people in their 20s and 30s are going on ventilators and even dying. In the past, COVID-19 was a slow disease and it could be weeks before a person needed to be hospitalized. Now it can be a matter of days.

With so many people infected, will a mask mandate be enough to stop our hospitals from being overrun?

Even in our best-case scenario, hospitals are likely to be overrun. Remember that the model out of OHSU expects Oregon hospitals to be short 500 beds by early September if steps are not taken to slow the spread of COVID-19. Some of that increase is already baked in. It takes a while for infected people to be diagnosed, counted, and be hospitalized. The rule of thumb for the pandemic is that it takes about two weeks to start seeing impacts from things like mask mandates at the hospital level. Peter Graven, a data scientist at OHSU, said on Tuesday that if the transmission were to drop sharply, right now, Oregon might still need between 200 and 300 more beds.

The Oregon Health Authority is optimistic that by moving some patients to long-term care beds, they can free up more hospital beds. OHA state epidemiologist Dr. Dean Sidelinger said there are plans to transfer patients from hospital to hospital to help manage the patient load.

But to get that best-case scenario, we’ll need to do more than just mask up. Gov. Brown asked people to social distance and avoid indoor public spaces, but has yet to issue any new social-distancing mandates.

Why didn’t the governor implement a mask mandate sooner?

During Wednesday’s press conference, Brown gave a few reasons for waiting until now. She said that counties have been asking for more local control over the pandemic for months, and she wanted to give it to them. OHA Director Pat Allen also suggested that if cases were lower, people would be more reluctant to accept a mandate.

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