The omicron variant could drive the largest ever wave of COVID-19 infections and hospitalizations since the beginning of the pandemic, public health officials warned Friday, and they are launching a campaign to get booster shots into 1 million additional Oregonians by the end of January to blunt its impact and preserve health care capacity.
An alarming but preliminary new forecast from Oregon Health & Science University predicts the state could see the number of Oregonians actively hospitalized with COVID-19 spike to more than 3,000 by early February.
That’s 2.5 times higher than the delta peak of 1,178 peak Sept. 1, a level that pushed Oregon hospitals to the brink and resulted in the highest concentrated number of deaths of the pandemic. Fewer than 400 people testing positive for coronavirus are currently hospitalized.
“There’s no way we could accommodate that many hospitalized people with the staff we have,” Dr. Dean Sidelinger, the state epidemiologist, said in an interview Friday.
OHSU’s sequencing of virus samples detected the first three cases of the omicron variant from patients in Washington and Multnomah counties earlier this week. Peter Graven, OHSU’s lead data scientist, said his model was based on the rapid spread of the new variant in Denmark, which has a similar immune profile to Oregon, as well as the rapid rate of omicron’s spread in Washington.
He acknowledged that the numbers were preliminary and would be updated as researchers learn more, and his past projections have not always been on the money. His high-end hospitalization estimate assumed there were no additional interventions, such as increased boosters and masking.
But even with the state’s expanded vaccine effort and assuming more masking by Oregonians, the forecast shows hospitalization peaking at over 2,000 by mid February – two thirds higher than the level that threw the state’s health care system into crisis in September.
Gov. Kate Brown joined public health officials at a news conference Friday to sound the alarm and encourage Oregonians to get vaccinated, get boosted and use masks and distancing to prevent infection.
“If you take one thing away from today’s press conference let it be this: Get your booster shot,” Brown said. “Boosters work, and are incredibly effective at continuing your protection against this virus and hospitalization. And if you aren’t yet vaccinated, now is the time.”
The projected omicron surge differs significantly from delta, not only in its scope but in the way state officials and residents may choose to prepare. The delta wave built steadily this summer among a wide-open economy with no restrictions, prompting Brown to reinstate a mask mandate only when cases and hospitalizations surpassed previous highs.
This time, the statewide mask mandate remains in effect and the forecast is far worse than previously envisioned, setting the stage for potentially difficult political and personal decisions for the governor and pandemic-weary public.
Brown said she was delaying the return-to-office date for state workers who are currently working remotely and was talking to members of the business and labor community, encouraging them to do the same, and if possible to incentivize workers to get vaccinated. She said she was not contemplating any further interventions at present and was committed to keeping schools open.
Brown said the state has a three-week window to act, and, as she’s said many times, “all options are on the table.”
Some public health experts worry Brown won’t act fast enough. Washington County’s chief epidemiologist, Kim Repp, said waiting weeks could be far too late.
“By the time our hospitalizations go up, the ship has sailed,” Repp said. “So the time for action is actually now, before our cases are completely out of control. Because everything past that is a Band-Aid.”
Immediately and dramatically limiting gathering sizes and capacity within indoor spaces such as restaurants – or even shutting down high-risk settings like gyms – would help, Repp said. If the worst comes true, Repp said she worries the state may be forced into a lockdown, with hospitalizations crippling the system as everyone from COVID-19 patients to car accident victims to cancer patients are unable to get swift and adequate treatment.
“I’d absolutely assume the hospital systems will be completely overwhelmed,” Repp said. " ... What’s going to happen is people are just going to start dying at home.”
Oregon’s alarming forecast comes as preliminary research in other countries has found the omicron variant is three to eight times more transmissible than delta and that it is more resistant to vaccines, causing more breakthrough cases. So far, disease severity looks to be lower than the delta variant, and deaths are not spiking, due in part to the high level of vaccinations.
But the sheer size of the projected omicron wave will still cause hospitalizations to surge, officials said, and more deaths can be expected.
As of Friday, nearly 700,000 adult Oregonians remain completely unvaccinated, with 2.7 million fully or partially vaccinated. But the number of Oregon adults fully vaccinated and boosted stands at just under 1 million, or less than a quarter of the state’s overall population – and that booster shot is becoming seen as a necessary precaution against the aggressive new variant.
Oregon Health Authority Director Patrick Allen described the potential for a major omicron wave as “deeply troubling and demoralizing.” But he said that shouldn’t make people feel powerless to fight it.
“Today’s forecast is a warning we can’t ignore,” Allen said. “Like a tsunami alert, the OHSU forecast is telling us that a big wave is coming and it threatens to be bigger than any wave we’ve seen before.”
Allen said that even if a vaccine doesn’t prevent an omicron infection, vaccinated individuals are less likely to become severely ill or require hospitalization. A booster dose further builds antibodies to fight against the virus, he said.
Referring to the delta surge, which took the lives of roughly half of Oregon’s 5,531 COVID fatalities, Allen said: “Approximately 9 in 10 of these lives could have been saved by vaccinations.”
Dr. Renee Edwards, OHSU’s chief medical officer, noted that the delta surge is ongoing. She said while Oregon has passed through the peak, it has turned into a “long shoulder” surge in which hospitalization have not declined to a level that gives the health care system and burned-out workers a chance to recover.
To that end, the state health authority has a five-point plan to prepare for the omicron surge. It will:
- Urge 1 million Oregonians to get boosters by the end of January. The state will add three new medium-capacity vaccination sites, in addition to the six currently operating statewide or set to come open, and resume mobile vaccination clinics. It will provide support to local health departments to double or triple their capacity, deploy contracted health care staff to vaccination clinics to expand appointments and clinic hours, and expand the supply of vaccine doses available with help from the federal government.
- Focus boosters on older adults and minority groups. That effort will include mobile vaccination teams at skilled nursing facilities and other long-term care facilities in the next two weeks and incentives to get more residents and staff vaccinated; more staffing at Federally Qualified Health Centers and other clinics to help them vaccinate approximately 800 to 1,000 people per day, and support for community-based organizations to host 35 vaccination events for communities of color around the state, with an additional 93 events scheduled in coming weeks.
- Deliver new COVID-19 treatments and expand testing. The state will develop a high-volume site in the Portland area to deliver monoclonal antibody therapy, open seven days a week, 11 hours a day, with the capacity to treat 350 people per week. The state also plans to register Oregon health care providers with federal agencies so they will be able to quickly receive newly approved antiviral drugs when they become available.
- Extend the health authority’s staffing contract to bring more health care workers from out of state. A regional hospital collaborative and an emergency management command center will coordinate available beds, ventilators and other resources. The state will work with long-term care facilities to provide alternative step-down beds to move patients who can be safely discharged. It also plans to provide hospitals with an interim crisis care tool they can use to equitably prioritize care if forced to ration.
- Shift the state’s outreach focus to connecting people to boosters. That will include everything from billboards to multi-lingual spots on social media.
Despite the looming threat, the state does not plan to reopen the high-volume vaccinations sites it previously established at the Oregon Convention Center and the state fairgrounds in Salem. Officials said there simply aren’t enough health care workers to administer shots. They did not immediately release the locations of the three planned new medium-capacity sites, nor did they say when those would open.
There are currently five state-supported clinics running: at Tektronix in Washington County, Jackson County Expo in Medford, the county fairgrounds in Redmond, K-Mart in Gresham, and a facility in Aumsville in Marion County. The state is looking to open a sixth site in Clackamas County soon.
The sites are designed to administer 1,000 shots per day, but not all of them are currently hitting that level. The one at Tektronix is administering 1,000 a day. The others are at a third of that, said Robb Cowie, an OHA spokesperson.
“We’re hoping with more demand we can get to a higher level,” he said, adding that they are only one piece of the expanded effort.
It’s unclear how successful the booster campaign will be. Oregonians seeking boosters even before the arrival of omicron have had trouble finding available shots, and meeting the goal of 1 million more people would require administering about 22,000 boosters a day.
The state’s daily report shows Oregon is averaging about 9,000 boosters a day over the last week among those 18 and older, though 16 and 17 year-olds are also eligible, so that may be an undercount. The state estimates that number is closer to 15,000, and the undercount is because of provider delays in reporting. Its target is to reach 30,000 a day.
“We do have confidence we can reach that goal,” Cowie said. “We’ve been talking to vaccination sites and asking them what it would take to get there. They’ve said more staff so that’s what we’re concentrating on.”
Graven’s forecast assumed that daily boosters were currently closer to 7,000, and could double to 14,000, though he said the discrepancy would not change his projected hospitalization numbers much.
“If they think they can get it to 30,000 that would have a positive impact, but them saying they want to get to 30K and getting to 30K are different,” Graven said Friday night. “If anything the model is being conservative.”
In a statement following the news conference, Becky Hultberg, chief executive of the Oregon Association of Hospitals and Health System, said hospital staffing and capacity are “overwhelmed from the delta surge, seasonal influenza, and patients needing urgent, delayed care.”
“The single best thing you can do is to get vaccinated and receive your booster shot if you haven’t already,” she added. “Please continue to wear a mask, physically distance, avoid large gatherings, and wash your hands regularly. It is not too late to protect yourself. The time to act is now.”
Aimee Green contributed to this report.
To see more data and trends, visit https://projects.oregonlive.com/coronavirus/
-- Ted Sickinger; tsickinger@oregonian.com; 503-221-8505; @tedsickinger