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With hospital beds filling, Oregon devises triage rules

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Linn Fairgrounds Vaccine Clinic 11

Laura Ziburske from the medical reserve corps in Corvallis fills Pfizer doses at the Linn County Fairgrounds on Thursday, Jan. 6.

Facing the likely scenario of too many patients and not enough hospital beds amid surging COVID-19 cases, the Oregon Health Authority released on Friday, Jan. 7, an interim system of triage to prioritize who receives health care.

Oregon is on a "red alert" after the omicron variant pushed the daily new COVID-19 case count to 10,451 Friday, eclipsing the records set the past four days.

"Once again, COVID-19 has regrouped and is marching across Oregon," Dr. Dean Sidelinger, the state chief epidemiologist, said in a Friday press call.

With the new wave forecast to peak on Jan. 27 with 1,650 people in the hospital, the Oregon Health Authority issued a "crisis care" protocol to guide doctors on prioritizing possibly life-or-death care.

Based on a model already used by Washington and other states, patients who would not survive if discharged have top priority. Patients already under care take precedence over newly arriving cases of the same level. If a choice needs to be made between two patients in identical medical situations, the choice will be made at random using a system on OHA's website.

"This is a very difficult topic to consider and work on," Dana Hargunani, Oregon Health Authority chief medical officer, said.

Omicron spreads twice as fast as the delta variant that swamped Oregon hospitals, peaking in September.

Early studies show omicron more easily infects fully vaccinated people compared to earlier versions of COVID-19. But people who have received the two-shot Pfizer or Moderna vaccine and also had the recently added booster shot are unlikely to suffer the worst outcomes.

In so-called "breakthrough" cases, people who have had the maximum number of shots make up about 4% of those needing hospital care and 1% of deaths. The average age of death for that group is 81.

Sidelinger said omicron was a "red alert" for unvaccinated people, who make up the vast majority of severe cases requiring hospitalization, intensive care unit beds, ventilators and whose infections prove fatal.

But the severity of omicron will be largely offset by the sheer number of people who will be infected.

"That doesn't help with the kind of all-at-once impact on hospital capacity that we're going to see here, and hopefully prevent," said Peter Graven, the chief medical forecaster for Oregon Health & Science University.

The unvaccinated who fall severely ill will require high levels of care that will make it more difficult for already overstretched and exhausted medical personnel to care for people with heart attacks, strokes, and injuries from vehicle accidents. 

National Guard called

Gov. Kate Brown also ordered the Oregon National Guard to deploy what Sidelinger called 500 "non-clinically trained" members to help relieve hospital staff around the state whose staff are depleted by infections among their own ranks.

Which hospitals will receive aid from the National Guard is under consideration and won't likely be announced until Monday, according to Brown Press Secretary Liz Merah.

Under recent state guidelines following recommendations by the Centers for Disease Control and Prevention, anyone vaccinated who tests positive for COVID-19 should isolate for five days, then wear a mask in all places for another five days.

The Oregon officials said they were monitoring states to the east, where the omicron spike arrived earlier. The ability of omicron to infect vaccinated people has led to staff shortages in medical emergency responders, schools, law enforcement, public transit, private businesses and government agencies.

COVID-19 will take its toll on the schools, Colt Gill, director of the Oregon Department of Education, said.

Keeping children in classrooms was the "north star" that the state was following as closely as possible.

But the virus is having an impact on schools that is likely to rise in coming weeks.

"I'm not saying students and staff won't be exposed," Gill said

Graven said the forecast will peak with hospitalizations 30% higher than the peak of the delta variant at the beginning of September.

Sidelinger said that he understood people are fatigued by what are now six waves of the virus since the pandemic reached Oregon in February 2020. But dropping masking, social distancing or not getting as many vaccinations are recommended will only extend the time before new infections get low enough for a return to some pre-COVID-19 conditions.

"We're all tired of the virus, but the virus is not tired of us," he said.

 

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