In mid-March, one statistic defined how ill-prepared Oregon was for the expected surge of coronavirus patients: It led all states with the lowest number of staffed hospital beds per thousand residents.
But after two convulsive weeks of preparation — by health care systems, shuttered businesses and staying-at-home citizens alike — state health officials now say they’re cautiously optimistic that Oregon may now have enough beds to avoid some of the worst repercussions of the pandemic.
“It appears that we will not see a dramatic spike in cases over the next month here in Oregon,” State Epidemiologist Dean Sidelinger said, citing the latest modeling data from the University of Washington, speaking to reporters on a teleconference.
If that is the case, it’s good news. An increase in patients could be managed by hospitals, if that increase is spread out over enough days and weeks that it doesn’t overwhelm the available number of staffed hospital beds, ventilators and medical clinicians on duty.
But there are a lot of things that still need to go right for that to happen.
“I think that’s an important distinction to make,” cautioned Andrew Phelps, director of the Oregon Office of Emergency Management, speaking on the same call. “This is not about predicting the future, it’s about identifying trends based on the most current data for the information that we have.”
Those trends can be used to help hospitals prepare.
The models assume that people are practicing social distancing, and that they will continue to do so. Sidelinger says that secondary data, like data from traffic cameras and cell phone GPS data, indicates many Oregonians are staying home. But whether they’re staying home enough, or practicing good social distancing protocols when they do go out remains to be seen.
It also depends on acquiring enough masks and other personal protective equipment (or PPE) to keep doctors from getting sick, too, and potentially spreading the virus to their families.
“If we can accomplish those things, we are cautiously optimistic that here in Oregon, the cases seem to be rising about a level that will be able to care for the people who need it most,” said Sidelinger, who chose his words carefully to include qualifiers like “if,” “cautiously,” and “seems.”
“What I’m hearing is that now is not the time to take the foot off the brake,” he elaborated.
“We can’t go back to business-as-usual like we had in February.”
He said Oregon needs to make sure the curve stays flat for the rest of the outbreak.
Sidelinger wasn’t ready to declare what kind of impact Oregon’s social distancing and stay-home policies have had on the spread of the coronavirus. That’s because once someone gets infected, it can take anywhere from a few days to two weeks for them to start showing symptoms.
From there, it’s usually a few days before they seek medical care, and a few more days before they get sick enough to qualify for testing. And once they’re tested, it can take a few days to more than a week for results to come back. Essentially, Sidelinger said, the numbers we see today reflect the state of Oregon two or even three weeks ago.
Data and case counts over the next week or so should help shed light on how well suppression efforts have worked. Just fourteen days ago, so many visitors flooded Oregon beaches and hiking trails that towns along the coast and in the Columbia Gorge responded by discouraging non-locals from visiting. Parks and public lands agencies restricted access.
“The actions we take have consequences two or three weeks later. We don’t want to be reacting, we’re trying to anticipate what’s happening,” Sidelinger said.
It’s also unclear how the spread of the virus will impact different regions, some of which are less equipped to handle a surge in patients than others. GPS data reported March 24 shows that in the largely rural stretches of Eastern Oregon, people were still traveling more than they were in the more densely-populated Western Oregon.
But they also have fewer hospital beds available for patients, and they generally don’t have the same financial resources hospitals in urban and suburban parts of the state have.
Hospitals are continuing to prepare for a potential surge in patients, said Becky Hultberg, the president and CEO of the Oregon Association of Hospitals and Health Systems. It’s more difficult now, because many of them are also treating COVID-19 patients.
“They’re looking into staffing, how and when to discharge patients, even what to wear,” she said.
In a statement provided to OPB, Oregon Health & Science University said, “While we are concerned that the number of patients with COVID-19 may increase significantly over the next several weeks, we are committed to doing everything we can to provide care to all those who need us.”
OHSU currently has 79 adult and 29 pediatric intensive care unit (ICU) beds. OHSU said measures like stopping elective procedures helped make more beds available.
OHSU also has 178 ventilators for severely ill patients who can’t breathe on their own. One-hundred are standard ventilators, and 19 of them were rented to help prepare for a surge. Thirty-eight are single-use ventilators, and 40 are anesthesia machines that can be converted to ventilators as needed. OHSU also said it currently has “adequate” staffing, but has plans in place should more be needed. OHSU did not say how many of those beds or ventilators were currently occupied.
OHSU is one of the better-resourced hospitals in the state, with a large campus in an urban area. According to Hultberg, hospital preparedness can vary dramatically from one hospital to another. Hultberg said many community hospitals in Eastern Oregon, for example, primarily serve as outpatient clinics. If someone is seriously ill, those hospitals have the resources to stabilize them until they can be moved elsewhere. Those community hospitals also have fewer medical clinicians on staff, and less money to hire more nurses and doctors in the event of a surge.
As one measure of hospitals’ improving state of readiness, there are currently 762 ventilators in the state, up from around 680 prior to the pandemic. Thirty-eight COVID-19 patients are currently on ventilators across Oregon.