Coronavirus overtook Oregon. Who should have made ‘tough decisions’?


As the contagious delta variant fueled an unprecedented spike in COVID-19 cases and hospitalization during the past month, Oregon Gov. Kate Brown and her health advisers repeated the same mantra: no more state mandates, let local leaders take action.

But virtually no one did. Weeks went by, and local officials publicly acknowledged a lack of political will for renewed safeguards absent a directive from Brown.

When Brown finally spoke to top officials for Oregon’s 36 counties Aug. 6, during a regularly scheduled meeting, some expected she might deliver a stern warning: Enough is enough, bring back mask mandates or other measures now, or I’ll do it.

But she didn’t say that. In fact, she made no specific request for action by counties, people on the call told The Oregonian/OregonLive. Brown explained that the coronavirus was now out of control and threatening to overwhelm the state’s hospital capacity, then asked: “What are you going to do about it?”

The answer, in all but a few cases, was very little. Eventually the conversation ended with no clear picture of what would come next.

“It was odd,” said Lane County Commission Chair Joe Berney, who was on the call. “There was a total lack of direction and leadership from her.”

Brown now paints that call as a pivotal moment in her controversial decision to renew the statewide mask mandate, which she announced Tuesday and that took effect Friday. She’s indicated that only during that meeting did it become clear local officials “were not willing to make the tough decisions.”

But that blame-shifting narrative during Oregon’s record-breaking summer surge ignores weeks of evidence that many local leaders across the state never had any intention of acting – weeks where Brown herself delayed a difficult decision as cases soared and hospitalizations climbed faster than ever before.

It also leaves out the fact that on July 27, the Oregon Health Authority gave Brown a detailed briefing on Oregon’s rising coronavirus case load, the prevalence of the delta variant and slowing vaccination rates. As part of that presentation, state epidemiologist Dr. Dean Sidelinger said that universal indoor mask usage would help control the delta variant’s spread, although he stopped short of calling for a mandate.

Brown that day issued a public recommendation for indoor masking, citing guidance from the Centers for Disease Control and Prevention. But she and state health officials decided against a requirement.

Brown’s finger-pointing at counties also ignores the reality that asking 36 jurisdictions to adopt their own public health edicts in a checkerboard fashion was both impractical and ineffective. The virus knows no borders, and county officials say they lack a mechanism to enforce local mandates. Meanwhile, many county commissioners had already expressed opposition to public health requirements, while others represent constituents who are outright hostile to them.

The governor’s office and state health officials did begin shifting their tone as the surge worsened. In public statements, they strongly recommended on July 22 that local officials consider masking, emphasized Aug. 3 that local action was expected in hard-hit areas, declared Aug. 6 that local inaction was unacceptable, and expressly called for local officials to set mask requirements to set mask mandates on Aug. 9.

Brown, with the power to reinstate a statewide mask mandate all along, announced her plan the following day.

The widespread inaction over those crucial weeks helps explain how Oregon now finds itself a national outlier, one of only five states whose summer surge has outpaced previous pandemic peaks. Oregon set new records Friday, averaging 1,652 cases a day in the past week, with 733 people hospitalized with COVID-19, including 185 people requiring intensive care.

And the numbers are projected to get worse. Much worse.

With hospitals around the state already operating at or near full capacity, researchers at Oregon Health & Science University forecast this week that the state could expect about 1,100 people with COVID-19 hospitalized by Sept. 7 -- a surge health care providers say they don’t have the beds or staff to accommodate. Brown on Friday activated the Oregon National Guard to help.

The governor declined to be interviewed for this story. Since hosting a reopening celebration June 30 to suggest the pandemic’s worst days had passed, she held no official news conference specifically to address the quickly deteriorating coronavirus situation until appearing Wednesday to explain the mask mandate as a necessary measure that “can save lives right now.”

In response to written questions, her office did not point to any specific instances this summer where state officials directly asked county leaders to take specific action to slow the spread, although they said communications about the pandemic occur regularly.

“Local leaders shouldn’t need an invitation to take action to protect the lives of their constituents,” Charles Boyle, a spokesperson for Brown, said in an email. “Throughout the pandemic, county leaders have asked for local control to make health and safety decisions for their counties. When informed about the rapid spread of the delta variant, most county leaders did nothing.”

Some of those same counties remain resistant. Dan DeYoung, chair of Josephine County, said he still prefers local control and is skeptical the mask mandate will be met with broad compliance.

Only 43% of Josephine County residents are vaccinated, well below the 60% rate statewide among people of all ages. Josephine County recorded Oregon’s highest coronavirus case rate this week, and the area’s hospitals have more than twice as many people hospitalized with COVID-19 than in earlier waves.

“There’s just a lot of people who are philosophically against them,” DeYoung said of state edicts.

To be sure, the delta variant is ravaging the entire country and the governor is in a no-win political situation. Her every decision during the pandemic to implement safeguards has been second guessed and loudly criticized by political opponents, local elected officials and average citizens, who have decried her as a tyrant and even burned her in effigy in front of the Capitol. A month ago, University of Oregon researchers, citing poll results, suggested the governor stop acting as a vaccine spokesperson because she was deeply unpopular among vaccine-hesitant Oregonians.

Advocates want Brown to get credit for becoming just the third governor to reinstate a statewide mask mandate. But that’s in part a necessity: the other state leaders who have done so, in Louisiana and Hawaii, are also experiencing their worst outbreaks of the pandemic.

Because Oregon had done so well preventing coronavirus spread until now, with some of the nation’s very lowest case and death rates, that’s left more people without natural immunity from previous infections. Even with the 18th highest vaccination rate, Oregon finds itself with the 16th highest case rate in the last week, according to federal data.

Resurrecting the mask mandate a few weeks ago -- even just one week ago -- could have headed off many cases, hospitalizations and ultimately deaths, one expert said.

“It could have made a huge difference ... more lives could have been saved. No doubt about it,” said Ali Mokdad, an epidemiologist with the University of Washington’s COVID-19 forecasting arm, the Institute for Health Metrics and Evaluation. The institute on July 22 projected that Oregon could set hospitalizations records, albeit not until this fall.

Mokdad said Brown’s decision to require masks is “a smart move.” He said masks, which reduce aerosol spray and limit coronavirus spread, are needed coast to coast.

“Every state should have had it,” he said, “and every state should have had it a long time ago.”

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The mood was jovial June 30 as Brown announced the state’s official reopening after more than a year of pandemic restrictions. Standing on a stage at Providence Park for a “Reopening Oregon” celebration, Brown declared: “We celebrate brighter days ahead. And, today, we celebrate that Oregon is 100% open for business.”

Those brighter days lasted about a week.

Oregon soon saw its lowest numbers in months, bottoming out at 150 cases a day and 99 people hospitalized with COVID-19. And the Oregon Health Authority, which since February 2020 had led the state’s public health pandemic response, made clear local health authorities would now be responsible for managing outbreaks going forward.

But the delta variant had other plans.

By July 12, the state’s case and hospitalization numbers were clearly climbing once again. Ten days later, on July 22, with cases and hospitalizations still rising, the Oregon Health Authority doubled down on its hands-off approach.

“A localized pandemic demands effective localized public health interventions, not a statewide response,” Patrick Allen, the agency’s director, said at the time.

Only Oregon’s largest county, heavily vaccinated Multnomah, prepared to heed that guidance.

County Chair Deborah Kafoury said her public health team began warning her around July 25 that a local mask mandate likely would be necessary. Input from local hospitals and the department’s own data modeling forecast a spike in cases driven by the delta variant.

But, Kafoury said, issuing a mandate too early might erode public confidence because the numbers didn’t yet reflect the dire predictions. So the county decided to issue a public health advisory July 26 recommending everyone over the age of five wear masks in all indoor public spaces, regardless of whether they had been vaccinated.

“We thought if we were to do a mandate closer to school opening, we could frame it around keeping business open and getting kids back in school,” she said.

Officials at the Oregon Health Authority were coming to similar conclusions. The Centers for Disease Control and Prevention on July 27 formally recommended indoor masking, and the state followed suit that same day.

Sidelinger, the state epidemiologist, updated Brown and public health officials in a biweekly meeting on the state’s vaccination progress, the prevalence of the delta variant and the early uptick in hospitalized COVID patients, including those in intensive care units. Sidelinger noted that although vaccines were still preventing serious illness among people sickened by the delta variant, it was much more contagious and research in Israel showed the variant spread among vaccinated, unmasked people.

Sidelinger listed “universal mask use in indoor public places” as one of the state’s available “tools to combat rising infections,” according to records of the presentation, but he stopped short of advising Brown to issue a mandate.

Officials had “a vigorous discussion of an indoor mask mandate in public settings,” Robb Cowie, a spokesperson for the health authority, said in an email answering questions about the meeting.

Brown and state public health officials ultimately “recognized that broad buy-in and adherence were just as important to the success of a mask mandate as issuing the actual requirement,” Cowie said.

“State policy-makers decided to give local leaders another opportunity to take action,” he added, “and state officials continued their discussions with local commissioners, public health officials and hospitals.”

*

The situation spiraled out of control in the following weeks, particularly in southern and eastern Oregon, two areas most resistant to restrictions.

By Aug. 2, Oregon was averaging more cases a day than in the spring peak, and hospitalizations were about to pass that similar crest.

Brown did not spend the week working the phones with county officials to convince them to issue mask mandates. Instead, she met with representatives of at least 10 major employers or industry groups, including Intel and the bankers’ and grocers’ associations, to ask if they were going to require their employees to get vaccinated.

Brown implied the state was preparing to mandate its employees get vaccinated and she would appreciate it if other major employers did the same, perhaps hoping it would lead to action among even smaller companies.

Sandra McDonough, president of Oregon Business & Industry, which is the state’s largest business lobbying group, said she spoke with Brown several times in recent weeks. As hospitals struggled with an influx of mostly unvaccinated COVID patients, McDonough said, she told “the governor’s team and others that they need to do a better job of helping the public understand what’s going on in the health system right now.”

Meanwhile, two days before Brown’s Aug. 6 meeting with county officials, Multnomah County health experts came back to Kafoury.

They were “strongly recommending a mask mandate right now,” Kafoury said. “We had another discussion and decided we’d announce it” the following week.

“We needed to have it done at a statewide level but when we saw that wasn’t going to happen we needed to move,” said Kafoury, who added that she was glad Brown acted but wished it happened sooner.

Officials in Lane County expressed similar frustration. Four days after Brown’s Aug. 6 call with county chairs across the state, County Administrator Steve Mokrohisky told commissioners there was no mechanism to enforce a local mandate and no staff available to follow up on complaints. They planned to issue a recommendation.

“Without the state taking action we have to do what we can locally,” Mokrohisky said, adding that businesses and organizations were crying out for clear guidance. They “just want someone to tell (them) what to do.”

The governor’s call with county leaders seemingly helped convince only one person, Washington County Chair Kathryn Harrington, that more action was needed. Harrington also knew Multnomah County was planning to enact a mask mandate.

Harrington made an impassioned plea to her fellow commissioners to protect children by adopting a mask mandate in Washington County. Four of the five expressed support during a meeting Tuesday, and county staff were instructed to draft the legislation for a vote at a special meeting.

Harrington said she isn’t critical of the governor’s timing. But she is concerned that rural counties with low and slowing vaccination numbers are exporting their problems to the metro area, where vaccination rates are among the highest in the state.

“In Josephine and Jackson counties, 20% of people that go to hospitals get transferred up to our metro area hospitals,” she said. “We’re having to bear the burden of other counties not being successful in their vaccination efforts. That’s a real problem.”

Don Russell, chair of the Morrow County board in eastern Oregon, said he doesn’t understand vaccine resistance in his community, where only 38% of the population among all ages is vaccinated.

“But the reasons to them are real and you can’t convince them,” he said.

Russell, like other county officials interviewed for this story, said he’s unaware of any specific requests that the governor or the Oregon Health Authority made to counties regarding local public health mandates.

“It almost has to come from the governor,” he said. “We don’t have any hammer. How would we enforce it? ... Maybe I should look at (the mask mandate) as a bonus. She took that rotten egg out of our pocket.”

Ultimately, any deeper reasons behind the timing of Brown’s decision to renew the mask mandate remain opaque. While she declined an interview request from The Oregonian/OregonLive, Brown made time for a national television appearance Thursday.

“The timing was right to take action and that’s what it’s taken during the pandemic, quick and decisive action, and that’s what I’m taking,” Brown told a national ABC News host.

Asked by The Oregonian/OregonLive why Brown ever thought local leaders in certain communities would renew restrictions, the governor’s spokesperson reiterated that those officials shouldn’t need an invitation to save lives.

“Local leaders in counties with low vaccination rates were in a unique position to help convince their constituents about the effectiveness of vaccines and masks,” Boyle wrote. “It’s unfortunate that hospitals in those regions are now facing the sharpest increases in COVID-19 hospitalizations, and those same local leaders are requesting help from the state and federal governments.”

Oregon now heads forward with 1.7 million Oregonians, including all children under the age of 12, unvaccinated and delta running rampant.

Schools plan to open full-time next month.

In California, Gov. Gavin Newsom recently announced he would require teachers to get vaccinated or take weekly COVID tests.

Brown, in her news conference Wednesday, said she plans to issue no such state mandate, leaving any action to local superintendents and school boards.

“That,” she said, “is in their very capable hands.”

To see more data and trends, visit https://projects.oregonlive.com/coronavirus/

-- Staff writer Aimee Green contributed to this story

-- Ted Sickinger; [email protected]; 503-221-8505; @tedsickinger