Six months ago this Friday, the governor announced reality had finally hit Oregon: After months of the epidemic raging in China, the first person in the state had tested positive for COVID-19.
Since then, Oregon public health officials have reported more than 25,000 known cases and more than 400 coronavirus deaths, marking a grim and ongoing chapter in the state’s history.
But Oregon has fared far better than many others -- ranking 45th in the number of overall infections per capita and 43rd in the number of deaths per capita since the pandemic began.
Why?
Public health experts credit a mixture of geography, demographics, public health orders, the willingness of a substantial number of Oregonians to abide by them and even a bit of luck. The state was the seventh in the nation on Feb. 28 to announce its first case of COVID-19, and that might have helped shift Oregon into high gear earlier than many others.
“Overall, we have done really well,” said Dr. Renee Edwards, chief medical officer at Oregon Health & Science University. “An important piece is we had some time to prepare and in large measure we’ve treated this like a public health emergency.”
To be sure, Oregon is not Texas, Florida or Arizona – three of the states hit especially hard by the disease. Oregon also doesn’t have the international connections and population density of New York or New Jersey, where the virus flew in with travelers from Europe early in the pandemic and spread rampantly among the crowds, killing close to 50,000 in that region so far.
Conversely, Oregon has a lot more in common with sparsely populated places like Montana and Wyoming than neighboring states, which have all been hit much harder by the coronavirus.
Washington has seen 66% more per capita cases and two and a half times the rate of deaths than in Oregon.
Idaho has reported nearly triple the cases per capita and 60% more deaths per capita than in Oregon.
“Idaho is kind of on fire right now, from a case standpoint,” Pat Allen, director of the Oregon Health Authority, said earlier this month.
But Oregon is performing well only relative to the rest of the United States, which overall has floundered in its response. The country accounts for about 25% of cases and 22% of deaths in the world, but only about 4% of the world’s population.
Oregon, for example, has seen more cases and deaths than the entire country of South Korea, which is 12 times more populous.
So it comes as no surprise the pandemic still holds a tight grip over Oregon as well as the rest of the nation -- shuttering schools and businesses, forcing millions into unemployment or to work from home and altering nearly every other facet of daily life.
William Lapschies, who recovered from COVID-19, celebrates his 104th birthday with a small group of family, at the Edward C. Allworth Veterans’ Home in Lebanon, Oregon, on April 1, 2020.Brooke Herbert/The Oregonian/OregonLive
Roughly half of all fatalities have been linked to vulnerable Oregonians living in nursing homes and other long-term care facilities. Oregon’s Latino population, too, has been hit hard and now accounts for nearly 40% of the state’s known cases.
Some analysts, however, suspect the state’s overall case numbers and deaths might not be as high as in other parts of the country because Oregon is mostly white. One nationwide analysis found Latinos and African Americans are three times more likely to become infected and twice as likely to die as whites -- the likely result of jobs that don’t allow these groups to work from home, longstanding disparities in access to health care and living in more crowded or multigenerational households.
Experts caution there’s a long slog ahead -- and there’s still much Oregon, let alone the country, can do to improve until there’s a widely accessible vaccine.
“This is really a fragile state of affairs,” said Carlos Crespo, director of Portland State University’s School of Community Health. “We can be the next Idaho, California or Washington.”
Early interventions
Oregon adopted several early interventions that appear to have helped slow the coronavirus, providing a leg up over other states.
Just over two weeks after Oregon identified its first coronavirus case, Gov. Kate Brown closed K-12 schools statewide March 16.
That placed Brown among the first wave of governors nationwide to shutter classrooms.
A study published in the Journal of the American Medical Association later found that states requiring every school to close saw a drop in new infections and deaths.
Later that month, Brown announced Oregon’s stay-home order – an aggressive move that made it more difficult for coronavirus to spread.
She took heat from local leaders, including Portland Mayor Ted Wheeler, for not acting sooner. But Brown implemented her March 23 order earlier than most others.
Before that, only four states – including California – had ordered residents to stay home, except for essential needs, and certain businesses to shut down.
Brown’s order came on the same day Washington Gov. Jay Inslee handed down a similar mandate. Washington’s order failed to have as much impact, despite the fact that Inslee lifted it more than two weeks after Brown lifted hers.
Some experts suspect that’s because COVID-19 had been circulating in Washington far longer, with the first case in the U.S. detected there Jan. 21. Seattle’s many international connections to Asia likely meant the virus was able to widely seed itself in the region before the true extent of the public health crisis was identified.
According to the National Institutes of Health, the timing of public health interventions is crucial. Each day that passes without them can dramatically change the trajectory of the disease because the coronavirus spreads exponentially.
Oregon’s eastern neighbor, meanwhile, issued its stay-home order two days after Brown, on March 25. Gov. Brad Little lifted that order May 1, two weeks before Brown.
Cases surged in both states a short while later. Brown issued a statewide mask order effective July 1. Little has shunned one – and he’s received praise for it.
Among Little’s supporters? Ammon Bundy, an Idaho resident who is best known for helping lead the 2016 occupation of the Malheur National Wildlife Refuge in eastern Oregon.
Research shows masks make a difference. Data modelers at the University of Washington determined this month that if 95% of Americans start wearing masks whenever they go out, they’d prevent 66,000 people from becoming ill and ultimately dying coast to coast by December.
Roy St. Warren of Red Rainbow PDX holds a sign asking for "free masks for all" on May 1, 2020, during a May Day car caravan in Portland. Brooke Herbert/The Oregonian/OregonLive
In Idaho, 58% of Boise residents said they always wear masks when out in in public, according to a nationwide analysis published by The New York Times from July.
In Portland, it was roughly 75% to 85%.
“Idaho – being a more politically conservative state than Oregon – may have a much higher proportion of ‘pandemic deniers’ among its population,” speculated Chunhuei Chi, director of the Center for Global Health at Oregon State University.
“If people don’t believe there is a pandemic,” he added, “they will not take up any preventive measures.”
Hindsight is 2020
For all of Oregon’s good fortune, however, the state might have missed several opportunities to tamp down spread further.
It’s become clear Oregon, like much of the country, reopened too early under tremendous economic pressure to do so, experts say.
The governor gave the green light May 15 for most counties to reopen barber shops, beauty salons, gyms, malls and restaurants and bars for in-person dining as part of her Phase 1 reopening plan.
Within two weeks, new infections in the state began to surge, from 35 new known cases a day in May to about 350 a day by late July.
Several experts told The Oregonian/OregonLive that the state reopened even though it lacked, and still lacks, testing capacity to identify new infections; a robust contact tracing system to track down people who might have been exposed; and quarantine and isolation policies to ensure that people who’ve been exposed and infected by the virus don’t spread it to the general population.
The state also has fallen short in supplying a place for people who’ve been infected to stay so they don’t infect other members of their households, experts say.
“This is why we have an uncontrollable pandemic,” said Chi, the Oregon State public health professor.
Brown also has been criticized for waiting too long to mandate masks statewide. She first ordered face coverings in seven highly populated counties in the last week of June.
A cyclist travels over the Hawthorne Bridge wearing a mask amid the coronavirus (COVID-19) outbreak in Portland April 10, 2020. Mark Graves/StaffMark Graves
That was about 12 weeks after the federal Centers for Disease Control and Prevention recommended all Americans over the age of 2 wear face coverings in public, indoors or out.
Brown extended her mask order to the entire state July 1, but only in indoor public spaces and for children 12 and older. By mid-July, Brown again expanded her mask orders to also include outdoor public spaces and later to children ages 5 and older.
Brown has acknowledged that, in hindsight, she wishes she implemented masking requirements earlier.
“Do I wish I had implemented face coverings earlier, when we started the reopening? Yes. The answer is yes,” Brown said this month. “The science wasn’t as clear. We didn’t have the extensive evidence at that point from other countries, and honestly there’s the issue of community acceptance.”
Experts believe masks appear to be having some impact. New infections statewide have dropped from a high of about 350 a day in late July to about 240 a day in late August.
This past week, Brown again amended her order to apply to office workers when they can’t maintain at least six feet of distance from their co-workers.
Some public health experts say standing steadfast by the six-foot standard disregards the latest scientific evidence that the virus can travel much farther indoors. One study found the virus traveled 16 feet across a hospital room and still remained infectious.
“Masks should be worn in all indoor environments other than your own home at all times if there are other people present, period,” said Richard Corsi, a Portland State University dean who has studied the airborne transmission of COVID-19. “I am not sure why we continue to even have this discussion.”
But Oregon, like every state in the nation, has been slow to accept that the virus can spread in tiny airborne particles that can travel more than six feet and stay suspended in indoor spaces for hours, Corsi said.
“This has been a big mistake that has cost our country dearly,” Corsi said.
What the future holds
Oregon’s biggest challenge has been testing, although there’s optimism more residents will be screened in the months ahead.
Oregon ranks 47th in the nation in per capita testing, according to Johns Hopkins University & Medicine.
The state has been testing only two-thirds of the people it should be to stop people with symptoms from spreading the disease, according to the Harvard Global Health Institute.
At the current rate, the institute determined Oregon will come nowhere close to stamping out COVID-19 because doing so requires testing people without symptoms, too.
A biomedical engineering graduate student holds a swab and specimen vial in a COVID-19 testing lab. (AP Photo/Charles Krupa) AP
The governor’s office has faulted the federal government for neglecting Oregon while sending the vast majority of its testing kits and supplies to other states with higher infections.
Spokesman Charles Boyle said “the Trump administration’s refusal to take this disease seriously” and ramp up resources for testing and contact tracing has been “one of the biggest barriers we have faced.”
“Had the full resources of the federal government been devoted to this crisis early, it is possible that we would be in a better position now to lessen restrictions on businesses or reopen schools for in-person instruction this fall,” Boyle wrote in an email to The Oregonian/OregonLive.
The Oregon Health Authority last week announced significant progress on the testing front. Allen, the agency’s director, said Oregon has reached an agreement with Thermo Fisher Scientific that would add 20,000 tests to the state’s weekly capacity through December, or about 400,000 tests in all.
Oregon has tested some 500,000 residents six months into the pandemic.
Crespo, the community health professor at Portland State, predicts Oregon will be stuck in a holding pattern possibly for the next year despite its overall efforts.
“I think where we are now is easily where we’re going to be until we get a vaccine,” Crespo said. “The virus hasn’t gone anywhere.”
He said the public knows what it takes to stamp out the disease – keeping physical distance from others, wearing masks and handwashing – “but as human beings, we have shown we are very bad at that.”
Crespo thinks that means schools won’t open for in-person classes until there’s a vaccine. Watching schools in other parts of the country open and then close days or a few weeks into their reopenings is a good indication of what’s to come for Oregon if it tries to go that route, Crespo said.
“Kids are extremely bad at wearing masks,” Crespo said. “High school kids in crowded spaces? It’s a recipe for disaster in terms of spreading the virus to teachers and spreading the virus to family members.”
Medical staff also are bracing themselves for the fall, when the warm weather disappears, Oregonians start spending more time indoors, and COVID-19 could once again surge. If the flu hits hard, hospitals could be overwhelmed as they struggle to treat COVID-19 and influenza patients at the same time.
State officials are privately looking to the fall with worry, as well. Although cases in recent weeks have slowly declined, Brown said Friday the progress isn’t fast enough and that at this rate it will take more than 200 days for transmission rates to drop to the point she’ll allow schools to reopen statewide.
She warned that Oregonians need to fully embrace her public health orders to do that.
That means wearing masks and forgoing weddings, parties and social gatherings larger than 10 people, where the virus has persistently been spreading.
Brown said it’s either that or she’ll consider closing down businesses such as restaurants and bars to slow the spread.
As she’s done so often, Brown said it’s up to each one of us to decide Oregon’s future.
“I’m laying it out very, very clearly for Oregonians,” Brown said. “We have a choice.”
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-- Aimee Green; agreen@oregonian.com; @o_aimee
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