Things have changed a lot in Oregon in the last two weeks. We went from one confirmed case to 32. Schools and large events are closed or canceled. Doctors and nurses are sounding the alarm about Oregon hospitals' state of readiness in the face of an expected surge of coronavirus patients. It’s been declared a global pandemic and a national emergency.
After the first local case, we put together an FAQ. Now we're following up with the latest information.
How bad will it get?
Dr. Dean Sidelinger, the state epidemiologist, thinks there are far more actual cases than the number that has been confirmed — possibly between 150 and 250 cases in Oregon as of Saturday.
Experts have looked at data on how fast the disease might spread and estimated that there could be as many as 75,000 cases in Oregon by mid-May if we don’t slow down the coronavirus spread.
It’s important to remember that over 4.2 million people live in Oregon so it’s only going to make a relatively small percentage of people sick. But 75,000 is still a lot of people and it’s going to be really rough, especially for the elderly and others whose compromised health makes them especially vulnerable to coronavirus. It will also be a burden for the health care workers caring for them.
How did it get this bad if we’ve been tracking it for weeks?
Public health officials were trying to track the virus, but it didn’t really work. Testing has been slow to roll out across the country. The World Health Organization has testing kits available, but the Trump administration decided that the Centers for Disease Control and Prevention should create its own test, which isn’t unheard of or very unusual.
But there were problems with the kits the CDC made and possible contamination at the lab site. So test kits were delayed for weeks. The CDC finally sent some out to states and that’s how we confirmed our first few cases. But supplies are still really limited and it isn’t clear when more test kits will arrive.
In the meantime, some states started rolling out their own tests, but in some places the Food and Drug Administration and the CDC shut them down or told them to stop testing. Some hospitals developed their own tests for internal use but they aren’t official so those numbers aren’t reported.
Are there any plans to change that?
Hopefully. On Friday President Trump vowed to overhaul the testing process with drive-through testing options in some parts of the country.
And before that, the CDC decided to allow two commercial centers, Quest Diagnostics and LabCorp, to develop tests. Right now their testing is also pretty limited but they hope to ramp up to a few thousand tests a week or more pretty soon.
What about here in Oregon?
Under Oregon Gov. Kate Brown’s new rules announced Thursday, doctors won’t need to get permission from the Oregon Health Authority before contacting a commercial lab for testing. So now, if you think you have coronavirus, you can call your doctor from home and they can arrange for you to get tested.
The Oregon government is also partnering with five major hospital systems throughout the state to develop their own testing, which should be up and running in about a week. But even with those changes, Brown said she’s worried about Oregon’s testing capacity. She also said that the only way really widespread testing will be available is if the federal government steps in to help.
Are hospitals ready for coronavirus?
That depends on the hospital. The Oregon Nurses Association has been keeping an eye on hospital protocol across the state. They say that preparedness in all the hospitals is improving but that some still have a long way to go. And all of them are short on personal protective equipment to some extent. There's a global shortage of masks and other items right now. The big concern right now is how hospitals will handle it if they get an overwhelming surge in coronavirus cases.
What happens then?
If we get a really big, fast surge like the ones that happened in Italy, South Korea and Wuhan, China, where the novel coronavirus originated, it doesn’t really matter how prepared hospitals are. We have a real capacity issue in Oregon.
Take that potential spread estimate of 75,000 infected people. Keeping in mind that’s a rough estimate, probably a worst-case scenario, it’s still a huge number.
Studies from China give us some formulas to work with. And when you consider the percentages — that perhaps 15% of infected people will need hospitalization — you come out with over 11,000 people who could need hospital beds. But Oregon only has 6,601 staffed hospital beds in the entire state.
And of course some proportion of those beds will already be full — on average in 2018 they were 64% full — because hospitals still need to treat people with conditions that are unrelated to coronavirus.
And what does that look like?
Best-case scenario, hospitals are crowded. Staff have to put patients in hallways, cafeterias, meeting rooms — places that really aren’t designed to house people who need to be monitored regularly. The hospitals will also be short-staffed, so they won’t be able to provide care that meets their usual standards.
Doctors are worried that as emergency departments and intensive care units flood with coronavirus patients, other people won’t be able to get the life-saving care they need. It’s possible people could die who never caught the virus. But because hospitals couldn’t support them, coronavirus would still be responsible.
Another big issue is ventilators, which many COVID-19 patients suffering respiratory ailments will need to help keep them breathing. Per OHA, there are only 688 ventilators in Oregon, and that’s definitely not enough to support a huge influx of patients.
What’s a worst-case scenario look like?
Again, we can look to Italy. Instead of treating everyone, they've had to focus on saving as many people as they can.
In Italy, doctors have found themselves making really hard decisions — like who qualifies for care. Italian doctors published guidelines saying that very old patients who are unlikely to recover, and have fewer years left to live shouldn’t get lifesaving care if someone else needs it. It’s awful, but that’s the only way to make sure that people who have a better chance at survival live. It’s basically combat triage, but these aren’t military doctors — these are normal doctors who never thought they’d have to make decisions like these.
Is there anything to feel good about?
OPB reporters have been hearing from doctors and nurses all week. And one thing is clear: Even though they know they’ll be facing an uphill battle, they’re willing to do it. Medical clinicians don’t want to be doing their jobs under less-than-ideal conditions so it’s really important we do what we can to stop the spread of the disease.
What can we can do to help?
The best thing to do is to “flatten the curve.” We’re hearing this expression a lot from public health experts and basically, it means trying to slow down the rate of infections so that they’re spread out over a longer period of time, instead of coming all at once.
The same number of people overall might get sick, but more will survive. That’s why events are being canceled and schools are closed. Social distancing can’t stop the virus, but it can slow it down enough to make it manageable. If we can successfully flatten the curve we might be able to stop hospitals from being overwhelmed.
And what, exactly, is social distancing? Is it how far we are from each other?
Social distancing can mean different things for different people. At its most basic it means limiting up-close, in-person contact. It means not shaking hands when we meet new people (now's a good time to bust out your best Live-Long-And-Prosper or go with the elbow bump). Try to stand about 6 feet away from people. That can be weird for Americans; we're pretty touchy and in-your-face when it comes to personal space. But you'll get used to it.
Social distancing also means avoiding large gatherings (in Oregon the standard is 250 or more people) and smaller gatherings in tight spaces and canceling big trips. Call people or video chat instead of speaking to them in person. It means working from home whenever possible. It means skipping the gym and maybe getting a home-workout app or watching yoga videos on YouTube.
By expanding your personal bubble, you can do a lot to stop the spread of the virus. Remember: A sniffle for you could be a serious illness for someone else.
There are a number of other preventive steps that have been promoted for weeks as the coronavirus arrived in the United States: Keep washing your hands, using hand sanitizer if soap and water aren't available, and avoid touching surfaces that may not have been sanitized since other people contacted it.
Who needs to worry about this virus?
People who are elderly or immune-compromised should be extra cautious and self-isolate as much as possible. Underlying conditions that can make a coronavirus infection much worse include heart disease, diabetes and lung and respiratory diseases.
Is this virus like the flu?
Yes and no. It spreads like the flu and has symptoms like the flu but it's more contagious than the flu and it's deadlier, too. According to the World Health Organization, here's where things stood as of March 5:
In Wuhan, because hospitals were so overcrowded, mortality was as high as 5.8%. For China as a whole it was about 3.8%. It was .7% in other parts of China — that could be due to increased testing or it could be because people who just tested positive for the virus hadn’t gotten very sick yet.
In South Korea they implemented widespread testing and are likely documenting mild cases. Their mortality rate is .85%. But the outbreak is also newer there, so just like some areas of China, the virus might not have had enough time to progress.
The average fatality rate for the flu globally is .1%. In the US, it’s .05% for this season. So in a best-case scenario, this is seven to eight times deadlier than the flu and possibly much worse.
Is the virus going to go away over the summer like the flu does?
We all hope so, but that doesn't seem likely. Other coronaviruses circulate seasonally but most of us are immune to those viruses. When a new flu strain emerges the flu season can last a month or two longer than normal, stretching into May and June and coming back a few months earlier, too. We saw that happen with H1N1.
Even though a virus doesn’t like summer and may not do well in summer temperatures there are so many people to infect that the odds are in the disease’s favor. And even then we don’t know if it will go away; that’s just an assumption.
This coronavirus has infected people in a lot of different types of environments in China and around the world: dry places, cold places, warm places, humid places. There’s no guarantee it’ll stop. It’s a definite possibility but we shouldn’t put all of our hopes on the virus burning out.
What about a vaccine or treatments?
Vaccines are, at best, a year away. They might be two years away. And while there are hopes some antiviral treatments will work to cure or lessen the severity of COVID-19 in patients, trials are still in very early stages. Again, it’s a possibility but we can’t count on it.
Is it OK to go buy a shopping cart full of toilet paper?
You shouldn’t hoard. You shouldn’t panic buy. You shouldn’t buy all the hand sanitizer or all the toilet paper. Make a list of things you need so you don’t impulse-purchase too much.
Just buy a few more things than you normally would on your next grocery trip. That’s important for a few reasons: It gives stores time to restock and it helps ensure there’s enough for everyone. It’s also important to remember that some people can’t afford to buy a ton of food like they’re preparing for the apocalypse. If you buy all the food, toilet paper and cleaning and sanitizing goods, those people are stuck.
What should I do if I need those things, and stores are out?
Try non-traditional stores. Fancier stores seem to be selling out of foods and toiletries more slowly than big-box stores like Target, Walmart and Fred Meyer. Office supply stores and hardware stores usually have some cleaning agents and toiletries, too. Give those a try.
Can I get coronavirus from my dog? Or give it to my pet?
Maybe. Early on, a Pomeranian in China tested positive for the virus but never experienced symptoms. Health authorities think it's possible the dog had a low-level infection and the WHO updated its statement on pets to reflect that. But there's no evidence that that infected pets can transmit the virus to humans. If you have contracted the coronavirus, the WHO advises you to be cautious around animals.
Can I get coronavirus from a package?
Almost certainly not. A study out this week concluded the virus can survive on cardboard for up to 24 hours. In the real world, there are variables like exposure to the sun's ultraviolet light, which is a disinfectant. So the odds are extremely low that a package would get contaminated with the virus and it survives up to the moment you pick it up on your porch.
What role do kids play in transmitting the virus?
The good news: Kids don’t seem to get very sick from this virus.
The bad news: That makes them really good at spreading it. That’s why closing schools and day-care facilities can be so effective at slowing the transmission of coronavirus.
As all teachers know, kids are sneaky, walking germ-bombs, so if you live with at-risk people it’s a good idea to make sure your child is healthy and isn’t going on play-dates with sick kids.
Any tips to stay sane while we’re practicing social distancing?
The goal here is limiting contact and potential spread. And sure, maybe you shouldn’t meet your friends at a restaurant or coffee shop, but dinner for two is OK if you’re both asymptomatic and wash your hands a lot. Try cooking at home where you can clean everything.
Going outside is safe as long as you aren’t up in someone else’s personal space. If you need in-person contact, call a friend and go for a walk with them.
Finally, we’re pretty lucky: There are so many ways to stay in touch with people who live close to you — or thousands of miles away. Do some group video chats. Watch streaming movies with your friends long-distance and text each other.