At a press conference in early February, Dean Sidelinger, state epidemiologist for the Oregon Health Authority (OHA), had an announcement: if the state’s respiratory illness trends continue to improve, it will likely lift its mask mandate for healthcare settings.
The lifting of the mandate for healthcare settings would be another milestone in the state’s rollback of its pandemic-era public health measures—a signal that, while COVID-19 remains an active threat, it is no longer one worth taking specific precautions to combat.
“We recognize that we are entering yet another important, more sustainable phase of the pandemic,” Sidelinger said during the press conference.
The announcement rankled a number of Oregonians who see masking, particularly in hospitals and clinics, as a simple and effective way to combat the spread of the virus. But Hazel Wheeler, Director of Patient Support Services and Safety at the Virginia Garcia Memorial Health Center and Foundation, said the state masking requirement in healthcare settings is always going to have a limited level of efficacy if patients and staff members alike are going about the rest of their lives maskless.
“It’s hard to tell people, ‘Hey, you should wear a mask when you’re in public if it’s a crowd or if you’re at risk,’ if they don’t see that same modeled behavior anywhere except in a health clinic,” Wheeler said.
Wheeler acknowledged that the US and the world at large is in an odd place regarding COVID: the virus is still killing and hospitalizing thousands of Americans every week, but the public appetite for measures to contain its spread are all but gone. The state and federal government’s COVID emergency declarations are scheduled to expire later this year.
“If we had these numbers three years ago at this time, it would have been insanity,” Wheeler said. “And now it’s just, ‘Eh, I’m vaccinated. I’m fine.’ It’s a weird paradox.”
Not everyone feels that way. Nelly, who runs a mutual aid group called Mask Bloc PDX and declined to give their full name out of concern for their privacy, said that the potential end of the mask mandate for healthcare settings signals the extent to which people have been left isolated in their attempts to protect themselves from the virus.
“I just think that it is… an abandonment of the protective duty of the Oregon Health Authority to ensure the safety of all Oregonians,” Nelly said. “Anyone who’s had a casual look at CDC information on who’s at higher risk for severe outcomes from COVID, it’s way more people than even is generally understood or even talked about.”
In the winter of 2020, Oregon recorded as many as 10,000-plus cases per week. As of last week, the state recorded just 1,069 cases—which officials acknowledge is an undercount due to at-home tests and mild cases going unreported.
The country’s vulnerability to COVID has, of course, changed dramatically in the last three years. Vaccinations and immunity from prior infections means that the majority of people who get the virus do not end up in the hospital. Antiviral medications like Paxlovid provide another layer of protection against serious illness for people who can access them.
“At some point, you have to be honest,” former Multnomah County Health Officer Jennifer Vines said. “If you’re going to continue to influence people’s behaviors, you have to provide a really solid rationale for why you’re continuing to consider it an emergency or continue to require masking.”
The patient population at Virginia Garcia, which was founded to support migrant and seasonal farmworkers and serves a number of patients on the Oregon Health Plan and Medicaid, is comprised of a number of essential workers who have been particularly vulnerable to COVID.
But even though the COVID test positivity rate at Virginia Garcia continues to hold at around 20 percent—well above the state average—Wheeler said that many patients are simply done worrying about the virus.
Nowhere is that mindset more apparent than in Oregonians’ ambivalence towards the bivalent booster shot made available last fall. While 86 percent of Oregonians have received at least one dose of a COVID vaccine, just a quarter have gotten the latest booster, which protects against the current strain of COVID.
“The demand, in general, has pretty much fallen off a cliff,” Wheeler said. “So many people emotionally or conceptually have come to terms with the idea that the pandemic is over—it definitely isn’t, but there isn’t that appreciation of it still being with us.”
Vines said that she feels that the government has a “responsibility” to dial back emergency measures when public health situations improve to maintain the public’s trust for when it next needs to sound the alarm.
The concern, Vines said, is that it can be hard for the government to reverse course once it starts signaling to the public that a health crisis is abating. In other words, if a new COVID variant begins threatening to overwhelm the hospital system, will people respond to new mask mandates?
“There’s a worry in public health circles that if you dial back the last remnant of a mask requirement, that’s it—there’s no going back,” Vines said.
Given the fact that thousands of people are still being infected by COVID each week, the current conversation around COVID precautions has left a segment of Oregonians like Nelly deeply alienated. Not only is the virus still causing serious illnesses and deaths, but the long-term effects of repeated infections and conditions like Long COVID are not well understood.
“There are those people who have immunocompromised situations or a variety of other disabilities, and there will be literally no safe space left in our society for those people,” Nelly said of a future without the mask mandate.
Finding the right balance regarding COVID precautions is particularly important given the precarious state of Oregon’s hospitals. In December, a number of hospitals in the Portland area were overwhelmed by a surge in COVID, flu, and RSV cases—enacting crisis standards of care for the first time since the pandemic began in 2020.
Health officials are hoping the surge in serious RSV cases was a one-off. But Matt Calzia, a registered nurse and Director of Nursing Practice and Professional Development at the Oregon Nurses Association, said the strains of the pandemic have left hospitals short-staffed and newly vulnerable to quality of care issues.
“Our healthcare system is very tenuous,” Calzia said. “It is not well-functioning. So we always need to be considering, what are mitigation factors to prevent large influxes of patients going into our hospitals? Because our hospitals are severely broken in this state… it was in bad shape before the pandemic, and now it’s just totally dysfunctional.”
Calzia noted that there is still a lengthy backlog of medical procedures that were postponed during the early phase of the pandemic and that Oregon already has one of the lowest numbers of beds per capita of any state in the country.
That set of issues, combined with hospitals’ desire to make up profits lost during the pandemic, has contributed to what Calzia said are sicker patients and worse working conditions for frontline caregivers.
Nurse burnout has been a major issue since the start of the pandemic, and Oregon is struggling with staffing shortages to the extent that it has kept its late-2022 declaration of emergency in place to make it easier for retired and out-of-state practitioners to provide care in the state’s hospitals.
ONA is currently pushing a bill in the state legislature that would address that issue by guaranteeing hospital staffing levels, but hospitals generally oppose the measure. Debbie Karman, a Portland-based spokesperson for Kaiser Permanente, said that the hospital has hired temporary staff to fill shifts in the area as it works to increase its full-time staff.
“The hospitals trying to race back to the pre-pandemic status quo of unprecedented profitability is scary,” Calzia said. “Because they didn’t do well then. That is why things collapsed during the pandemic.”
Whatever the future of the mask mandate, COVID’s impact on both individuals and the health system as a whole is likely to be felt for a long time to come.
“I worry that we’re years if not a generation from a kind of recovery that would staff hospitals, clinics, all those caregiving responsibilities,” Vines said. “I genuinely worry that it’s going to be difficult for many more years.”