3D rendering, coronavirus cells covid-19 influenza flowing on grey gradient background as dangerous flu strain cases as a pandemic medical health risk

3-D rendering of the novel coronavirus

Longer-lasting severe infections and public weariness in maintaining pandemic safeguards will delay the end of the record-shattering COVID-19 spike from Halloween to Christmas, a new state forecast predicts.

'We’re in a moment right now where we’re going to see what happens as fatigue sets in,” said Dr. Peter Graven, the lead data scientist on a new forecast released Thursday evening by Oregon Health and Science University.

The forecast, which is revised weekly, had correctly predicted that skyrocketing hospitalization rates would peak at just under 1,200 cases around Sept. 1.

But a mid-August projection that the numbers would fall just as precipitously proved to be too optimistic.

Graven and the team of OHSU researchers and statisticians pointed to medical, social and psychological factors pushing the timeline for a full rebound into March 2022.

The delta variant is requiring hospital stays twice as long as required for severe infections of the original virus that hit Oregon in February 2020.

Rates of inoculation in parts of the state where vaccine hesitancy and outright opposition are especially high has slowed again after an uptick early in the spike. Nine months after vaccines first became available, nearly one million eligible adults have not had even one dose injected.

Even in areas that have largely supported public health measures, a growing weariness with pandemic safeguards has shown-up as a decline in mask-wearing and increase in contagious social activity.

For not the first and possibly not the last time, the virus that has dominated public life and death has shown to be resilient and adaptive.

COVID-19 will mark two years as a worldwide scourge just before New Year's Eve.

Oregon had seen a steady if at times bumpy decline in cases after COVID-19 vaccines first became available at the end of December. By late June, less than 200 people were in hospitals due to COVID-19.

Scientific and government experts talked seriously about a possible beginning of the end of the pandemic in much of the United States.

Gov. Kate Brown ordered most state restrictions dropped on June 30. For two weeks, Oregonians had a taste of a return to "normal."

The delta variant had been discovered in India in May. By June, the first cases were reported in the United States. But by mid-July, it was causing only 5% of new infections in Oregon.

By the end of the month, infections began an almost vertical trajectory fueled by the delta variant. Less than a month after talk of the pandemic's end, it had flared hotter than ever before. Daily hospitalizations blew past the previous high records set in December 2020.

It would double again by Labor Day.

One of the few bits of optimism as infections were growing ten times faster than just six weeks before was the weekly forecast from OHSU. Their model showed hospitalizations reaching record-breaking highs.

But it was also narrow - with the forecast estimating the infection rate would reverse course around Sept. 1 and fall as precipitously as it had risen.

The mid-August forecast showed daily COVID-19 hospitalizations dipping below 200 by the end of October just as many children would be out trick-or-treating for Halloween.

By Thanksgiving in late November, infection rates would crash so low that daily hospitalizations would be counted in the dozens instead of thousands.

In the forecast released on Thursday, pre-spike hospitalization levels won't be reached until the last half of December. Case levels will remain elevated throughout the holiday season, with 600 hospitalizations per day forecast on Nov. 1.

Rates below 50 cases per day wouldn't be realized until mid-March 2022.

OHSU researchers underline that each forecast is just that  — a model based on data. Each week's forecast includes a graph overlaying prior forecasts.

Graven said the model was at a "tipping point" driven by both the resilience of the virus and weariness of the population. Oregon is wobbling in a "fright and fatigue" cycle in the pandemic.

When the delta variant skyrocketed in July, many parts of the state returned to masking and limiting contacts. The slow growth in immunization rates started to increase in July and August, even in counties where vaccine hesitancy or resistance was widespread.

OHSU said that "breakthrough" cases of infection in people who had been vaccinated has risen to 20% of new cases. But the worst outcomes have remained steady, with stark differences for the vaccinated and those who are not. OHSU said unvaccinated people accounted for 95.5% of severe cases and over 99% of deaths.

Those numbers hold up as September's 498 COVID-19 deaths statewide make it the second most deadly month in the 19-month pandemic. 

While hospitalizations have taken a steep dive, it is from the highest point in the COVID-19 crisis. If this forecast holds up, it will take over a month just to get below the peak of the 584 hospitalizations a day during last winter's surge.

The OHSU forecast this week pointed to some troubling areas. Estimated mask usage dropped from 84% to 81%. Based on an analysis of social media traffic, people are becoming more active and getting together in larger groups. With the colder weather starting to take hold, researchers worry that will drive activity indoors, where the virus can spread more rapidly.

Vaccinations have also slowed their pace of growth. A quarter of all adult Oregonians — just under 1 million people — remain unvaccinated more than nine months after COVID-19 vaccines first became available. 

The state is seeing a drop in infections and hospitalizations overall. But parts of Eastern Oregon are seeing an increase in infections, which some local health authorities have tied to outbreaks from the Pendleton Round-Up in mid-September.

An exception to the drop in hospitalizations is Region 7, which includes Deschutes, Crook, Jefferson, Grant, Harney, Klamath, Lake and Wheeler counties. After showing a decline along with the rest of the state, hospitalizations this week edged upward in Region 7 while declines continued in other regions. 

Part of the region has some of the lowest rates of vaccination in the state. Lake has the second lowest percentage of eligible adults who have been vaccinated, 41.7% as of Thursday, according to Oregon Health Authority reports.

Grant is one of the four counties in the state where less than half of eligible adults have been vaccinated. It's currently at 47.1%. Harney, at 50.3%, just crossed the threshold this week, nine months after vaccines first became publicly available.

After seeing two consecutive weeks of a decline in cases, Grant County quadrupled in cases from 30 to 116 between the weeks ending Sept. 15 and Sept. 22, the latest data available. The case rate per 100,000 people — a way to measure the level of infection between areas with different population sizes — was 1,596. The percentage of tests that were positive tripled from 5% to 14.6%

The highest infection rate in the state is in Harney County, where one out of every four tests was positive. Harney's infection rates have remained high for the past month and the most recent survey showed it with a state-leading 1,675.8 cases per 100,000 people.

Deschutes County has the fifth highest vaccination rate in the state at 77% of eligible adults. Jefferson is at 62%, while Crook is 58%. The positive infection rates continue to be high in all three, according to the OHA's most recent County Covid-19 Community Transmission Report. Crook is at 15.1 %, Jefferson at 12.1% Deschutes at 10.8%. The statewide average is 8.9% and OHA has said throughout the pandemic that any positive test rate above 5% allows for significant growth in cases. 

The statewide impact of the Pendleton Round-Up outbreak that began last month is still not completely known, state officials said this week. While many of the Eastern Oregon counties have low populations, they can be a harbinger of new statewide spikes because of the large percentage of unvaccinated residents.

That's what happened with the WhiskeyFest outbreak in July.

With infection rates at a low point in early summer and the statewide adult vaccination level near 70%, Gov. Kate Brown on June 30 lifted most restrictions on businesses and events across the state.

The move came despite wildly different levels of vaccination and infection among the 32 counties at a time when the highly contagious delta variant had swept across the country and into Oregon.

The WhiskeyFest, an outdoor country music event on July 16, attracted up to 12,000 people to Umatilla County. The county's vaccination rate was under 50% at the time (it's now 51.5%). An outbreak of cases after the WhiskeyFest swamped hospitals in Eastern Oregon and spread to the rest of the state. 

Each rise in infections targets the most vulnerable, those who have neither vaccination or exposure. 

OSHU puts out an "Immunity Index," which combines the number of people vaccinated, exposed to the virus, or both.

Some level of immunity occurs when a person is infected with COVID-19.  Of the 4.24 million Oregonians of all ages, OHSU currently estimates that 44% of the population is vaccinated, 23% have been infected at some point, and 11% have been vaccinated and infected.

The biggest concern is the 23% of the population who are neither vaccinated or had natural exposure. These "susceptible" residents are the ones that the delta variant will continue to hit the hardest.

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