A person skates while wearing a mask at Oaks Park in Portland, April 13, 2021.

A person skates while wearing a mask at Oaks Park in Portland, April 13, 2021.

Kristyna Wentz-Graff / OPB

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Last week, Multnomah County health officials recommended people start wearing masks inside again. This week, 15 Oregon counties have reached medium risk levels, triggering the Centers for Disease Control and Prevention’s indoor masking recommendation. Case counts are on the rise, though hospitalization rates are still fairly low. Multnomah County Health Department’s Jennifer Vines joins us for an update.

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

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller, COVID-19 cases in Oregon have more than doubled over the last month. Now six of Oregon’s most populous counties have hit the threshold where the CDC recommends people wear masks indoors. Meanwhile, unlike earlier spikes in cases, a relatively small number of Oregonians have been hospitalized with COVID-19. Jennifer Vines is the lead health officer for Portland’s tri-county region and she joins us now with more details. Welcome back to Think Out Loud.

Jennifer Vines: Hello. Thanks for having me back.

Miller: Thanks for joining us once again. Can you give us your big picture? What does the pandemic look like to you right now?

Vines: I think the pandemic is still very much with us, and we can talk about what’s happening now. But I think my big picture is thinking about how different things are now compared to 2020. The virus has changed. We have safe and effective vaccines and a lot of people vaccinated. We’ve been through several variants now. We actually have built up a level of population immunity that is somewhat reliable, obviously not completely, given the wave that we’re heading into. But things are definitely better than they were. As with all things COVID, I can look out two to three months ahead, and beyond that it gets a bit fuzzy. So these sort of two to three month cycles that we’ve been through I think are going to continue for the next bit.

Miller: What does the modeling look like right now – the short term as you’re saying, two to three months? [What does] that modeling look like to you in terms of cases and hospitalizations?

Vines: We’re expecting a wave that we can attribute to the BA.2 variant. This is the very close cousin to omicron that is even more contagious and is quickly finding people to infect who either have not encountered the virus or whose immunity has worn off. It’s giving us this late spring wave, and it’s expected to peak sometime in early June with hospitalizations statewide forecast around 300. That’s total people in the hospital testing positive for COVID, so some might be there for COVID, some with COVID. That number is nowhere near what we’ve seen with the prior omicron and delta peaks, so this is expected to be a relatively small wave. But no question that it’s causing disruptions – with people ill, with outbreaks, that schools have been hit hard – so it is unfortunately another reminder that we are still in a global pandemic.

Miller: Can you just remind us– Around 300 is what the models are predicting right now in terms of hospitalizations at the peak; you said that’s way below. What were the hospitalization peaks before?

Vines: Omicron peaked at about 1000. The delta peak last fall was similar. And omicron is different; remember omicron on the whole causes less severe disease on average. So, as we look at people hospitalized and testing positive for COVID, it can be difficult to say exactly but some of them will be there with COVID – they’ll be hospitalized for another reason, but COVID is so common in the community, they’ll test positive and be reported as such – and some will be there for complications of COVID. The estimates vary, but it’s possible that, of that 300 hospitalized, maybe only half or 200 or some number like that will be there for complications of COVID. So that really pales in comparison to the delta wave which was a much more severe version of the virus.

Miller: At this point, how accurate do you think the state’s or the county’s accounting for case numbers are? I’m asking this because what I’ve read is that, if people are testing at home, finding out that they’re positive without some kind of PCR test that would be reported, it’s likely that there are a good number of people who are simply not being counted.

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Vines: I think that’s definitely the case. We try to be really clear that what public health reports as case counts is not the entire universe of testing. A lot of testing happens at home and does not get reported. A lot of people simply don’t test. We think that, for every case that we in public health know about, there could be four, maybe as high as 10, cases that we don’t. What we do look at, though, are different things that all tell us the same thing. We look at cases that we do know about. We look at hospitalizations, which are pretty reliably reported. We can look at emergency department visits for COVID. And we can look at the number of outbreaks that our communicable disease teams are working on. All of those point in the same direction of a wave that we’re headed into. Then we look to the OHSU forecast to give us a rough idea of when that peak might be and what it might look like. The last step is to convey all of that to the public and make sure they know what’s going on and how to protect themselves.

Miller: A listener on Twitter asked: ‘Why is hospitalization the only benchmark for COVID risk? Try losing 10 days of work, as I recently did, and the income because you don’t have sick day coverage. Those of us who got vaxed and wear masks are still at risk of poverty.’ How do you think broadly about this question of risk right now, separate from the question of hospitalizations?

Vines: I think it’s a great comment and a great thought. I think that the disruption that COVID can cause is real. I think this listener is saying things that I completely agree with in terms of just going through an illness, risking long COVID – which we’re still learning about – losing days at work. I hear from parents whose child care has been disrupted, schools worried that they’re not going to be able to have events that so many people are looking forward to. I think it’s true that we have to look beyond hospitalizations to the disruptions that COVID causes. That’s why Multnomah County made the recommendation for masking as we go through this wave. Clackamas and Washington counties, certainly in support of masking in general as a way to lower your risk of infection. But then I also look even more broadly at COVID. COVID risk is also not the only lens through which to look. I think people do need to gather. I think they need to socialize. So I’ve tried to be really clear that no one in local public health wants to see gatherings restricted or businesses closed. Those things all need to continue. As long as we’re vaccinated and masking and staying home when we’re sick, we need those other economic engines, those social engines. We need those to keep going for other aspects of our health, definitely.

Miller: When I talked to the state epidemiologist Dean Sidelinger a few months ago now, the sense I got was – at the state level, the Oregon Health Authority or the governor – they have very little to no appetite to go back to statewide mandates. The sense I got was those were being pulled away and they don’t want to go back to that. Does that mean that it’s really up to individual counties to make these tough decisions now?

Vines: That’s exactly what we at the county level have heard from the state. We think that it is at the individual county level to make these decisions. I think the important thing for people to know about mandates is that – they send a clear signal about risk, there’s no question – but they’re only as good as the public buy in to actually do the behavior. We could create a mandate, but at the end of the day, public health can’t enforce our way to COVID prevention, if that makes sense. So I do think it’s a local decision. I think it’s something that, at least for Multnomah County, it’s something that we’re saving for a really big change in the virus or when we need to send a really clear signal of danger to the community. I don’t think this spring wave, while it’s concerning and disruptive, I don’t think that’s a circumstance that calls for a mandate.

Miller: Many families with young children have been wondering for a long time now, more than a year, about when a vaccine will be approved for kids under the age of 5. Month after month after month, we see a report that a drug maker is going to send an application to the FDA, and then it just doesn’t happen. It gets pushed back and then we wait again. Do you have a sense right now for whether a vaccine is ever going to be approved?

Vines: I don’t have a read on the exact timeline. I completely understand why parents of young children want this information and many want access to a vaccine. The good news for these parents is that children in that age group rarely get severe COVID. It happens, but it’s rare. So this is an age group that we actually have to be careful with and ask for good information about the vaccine in terms of how effective it is and how safe it is. Because overall this is a group that does well and that doesn’t suffer severe disease. As much as I feel the frustration of parents, I think it’s worth waiting for good information for this particular age group because the risk-benefit calculus for them is a bit different. Thankfully it’s because we rarely see severe COVID in this age group.

Miller: Sticking with vaccines for a second, I remember being told early on, after the MRNA vaccines were released, that because of this new vaccine technology, it might be easier for vaccine makers to create new variants of the vaccine for new virus variants that are circulating. But it doesn’t seem like that’s happened yet. Why not?

Vines: I don’t have a line of sight on the long-term plans for vaccine development for this virus. What I can share as an observation is just how quickly variants have emerged and the fact that vaccine technology– it’s wonderful that it exists, these vaccines are safe and effective. But it doesn’t turn on a dime. If you compare it to influenza, we settle into a yearly cycle with influenza where there’s time to look at different strains. You have to look a year ahead of time at what you think the strains are going to be to create a vaccine that matches, hopefully, a particular flu season. There just hasn’t been that kind of time with this virus. That’s my educated guess on that, but I don’t have a line of sight onto the long term vaccine planning or the immunology and virology that goes into those types of strategic plans.

Miller: But in other words– I appreciate your willingness to engage with these questions even though you’re not a vaccine maker. But, if I understand correctly, one possibility is that vaccine makers, say, could have focused on the delta variant. And then by the time it was almost ready to push that out, then omicron comes along, and then the same thing could keep happening. It’s possible that the pulses here of these changes just haven’t really meshed with the vaccine-makers’ ability to catch up.

Vines: Yeah. Just from my experience on the ground, it took several months to roll out the COVID vaccine that we’re still trying to promote among people who have yet to be vaccinated. So again, the pandemic has evolved so quickly, the variants have come around so quickly, that I think this notion of keeping up with variants as they’ve evolved in real time, I think that’s a difficult one. I would look to the vaccine experts to figure out, what does a longer-term strategy look like in terms of COVID vaccine.

Miller: One of the things that we’ve learned recently is that people can be reinfected with omicron in seemingly relatively quick succession. The New York Times reported this week that researchers now think people could get sick three or four times in one year. What does that mean to you in terms of the future course of this pandemic?

Vines: I think it speaks to omicron’s very special power of getting into our nose and throats really easily and sometimes causing illness, sometimes not and fortunately, rarely causing severe illness, although that can certainly happen. I think it starts to beg the question of how do we live with COVID: ideally keep people out of the hospital but also keep our lives running and keep our kids in school and our basic services functioning without the disruptions of outbreaks and people just out sick and unable to perform essential functions. I think these are all questions that we’re going to have to continue to wrestle with. And it’s going to have to be in tandem with however the virus evolves. If it stays mild, I think that’s a different set of planning assumptions versus if we get another variant that looks really different. As much as I hate to say it, one that causes more severe disease or completely gets around our vaccines, unfortunately, would be a big setback.

Miller: But does it follow, then, from what you were just saying that, absent a major change, which is a big assumption because there have been a lot of changes in the last two-plus years. But [does it follow] that if something similar to what we’ve been experiencing for the last five months continues for the next year, that it could simply become the norm, say, for many people to keep doing what they’ve been doing: to wear masks whenever they’re in public, for a lot of people to not be going into workplaces where they used to if that kind of thing is possible in their workplaces? In other words, whatever people have been experiencing for the last half year could go on indefinitely?

Vines: I’m not sure I’m ready to say it could go on indefinitely. I think the notion that we ramp up masks when there’s more disease activity, we can pull them back when there’s less, we track long-term strategy around vaccine, we all make sure that we’ve gotten at least the first two doses of the Pfizer or Moderna vaccine. I think those are all things that allow us to return to some kind of normal life. It’s our job in public health to look at, how many days do you need to stay home? When do you need to stay home or stay home from work or keep your child out? How do we balance that with the risk and people’s expectations of risk management versus getting back to our day-to-day activities, making sure that childcare is running, schools are running, and that we are learning to live with this virus, which hopefully will stay on on the milder end of the spectrum?

Miller: Jennifer Vines, thanks very much.

Vines: Thanks for having me.

Miller: Jennifer Vines is the lead health officer for Portland’s tri-county region.

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