This is the first article in a three-part series on the COVID-19 response from Oregon as we enter the second year of the pandemic.
One year after the coronavirus pandemic, it became clear that Oregon had succeeded in curbing the spread of COVID-19 in a way that was virtually unheard of in most other states across the country.
In mid-March, 3.8% of Oregon’s population tested positive for COVID-19. Only Vermont, Maine and Hawaii had a lower percentage. Washington ranks fifth, just behind Oregon.
This is an achievement that can be attributed in part to the willingness of Oregonians to be vigilant with social distance and to wear masks, but also to government and health officials who often impose unpopular social restrictions to protect public health.
Although, in a way, comparing Oregon to other states, it’s like saying it’s one of the best players in the worst team in the league. The coronavirus response in the United States was about the worst in the world.
“What I have done throughout the pandemic is not only to see how we are doing compared to other states, but also to other states,” said Patrick Allen, director of the Oregon Health Authority. “As things have played out, flowed and flowed, we actually compare quite favorably with most European countries.”
Among countries with more than a million people, the American case falls in third place the worst in number of cases according to the population.
On the scale, Oregon would have ranked 45th worst – it fared better with cases than countries like Ireland, Lebanon and Spain, but fared worse than Germany, Canada and Mexico.
Oregon to the world
What percentage of a country or state’s population is infected with COVID-19?
Although the United States had one of the worst COVID-19 reactions in the world (third worst in countries with more than a million people behind the Czech Republic and Slovenia), Oregon and Washington fared much better. If the states are also ranked on the world stage, they will achieve the 36th and 46th worst place respectively. Graphic: Jes Burns / OPB Data source: Our World in Data / University of Oxford, CDC 3-15-21
Double-edged sword
Recent case scores are commendable, but the success has put Oregon and Washington in an unusual position: we may be more difficult to achieve herd immunity to COVID-19.
Herd immunity is the gold standard for disease control; therefore, we do not have massive outbreaks of measles every year. We get herd immunity when enough people in a population become immune to a contagious disease that is unlikely to continue.
Becoming immune to COVID-19 can leave you infected and then survive. A recent analysis suggests that this “natural” immunity increases during the first three months after recovery of COVID-19, and probably lasts for many months thereafter.
The other option is to develop immunity in response to a vaccine.
For COVID-19, more than 70% of the people will probably need to be vaccinated or previously infected to achieve herd immunity.
Because of our relatively low rate, the Oregon population has a lower percentage of immunity due to infection compared to people living in other states. And that means we do not have the natural immunity buffer that so many other states have. As a result, Oregon (and Washington) are going to be much more dependent on vaccinations to make up the difference and bring us to a herd immunity.
“I think it definitely plays a role. How much of our role, I think, is likely to come out in the coming months – it’s hard to know now, “said Dr. Sidelinger, a state epidemiologist in Oregon.
Related: Returning to ‘normal’ in Oregon means you need to get COVID-19 herd immunity
Because there are so many asymptomatic cases of COVID-19, the Centers for Disease Control & Prevention estimates that there are actually 4.6 times more coronavirus infections than have been reported nationwide. The use of this to calculate a near-realistic number of people with natural immunity shows clear differences between states and regions.
“The Midwest is actually building herd immunity,” said Mark Slifka, a professor at Oregon Health & Science University.
States like North Dakota and South Dakota, which have had massive and uncontrolled outbreaks, already have about 60% of their population naturally immune.
The number of cases in Oregon was low, so our immune population is naturally only about 17%. Washington’s is just over 21%.
This is unlikely to affect the early vaccination strategies. Without tests on the entire population, people who had no symptoms and had unreported cases of COVID-19 can be separated from the vaccine. Nevertheless, health officials know that a certain percentage of the non-vaccinated population is already protected against the virus to some degree. And the higher the number, the better our chance of ending the pandemic.
The two-edged sword of the case of COVID-19
States that have not kept things low are, of course, closer to reaching the 70% -75% herd immunity threshold
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Populations in countries that could not keep the number of cases low suffered more COVID-19 disease and deaths, but the number of people with natural immunity is higher. States that have managed to keep the number of cases low will consequently be more dependent on vaccines to achieve herd immunity. Oregon and Washington are two of the most vaccine-dependent states in the country. Here, the official number of cases is multiplied by 4.6 to estimate the natural immunity rates. The CDC estimates that there are 4.6 times as many cases of COVID-19 as have been confirmed nationwide. Graphic: Jes Burns / OPB Data source: CDC 3-15-21
Deaths
On March 15, 2324 Oregonians died of COVID-19. Each of those deaths is a tragedy. And the state’s response was not without obstacles.
But Oregon as a whole fared better than all other states except Hawaii, Vermont, Alaska and Maine – when it comes to deaths due to the disease. The state lost 5.5 people for every 10,000 inhabitants. Nationwide, 16 out of every 10,000 died of COVID-19.
“When we rural people die in Oregon, more than 4,000 people die in the state. Every time I think about it and think about how awful … the deaths we’ve had so far [are], imagine you triple that number, ”Allen said.
The low mortality rate is closely linked to the state’s low cases. Yet Oregon is also in the top third of states in COVID-19 deaths per number of cases. About 1.5% of Oregonians who tested positive for the disease died. Washington is there too.
Allen said looking at COVID-19 cases, death rates and positivity rates, Oregon’s response to the pandemic has prevented much suffering.
“What tells me is that the sacrifices (made by Oregon residents) worked,” he said.
Oregon vs. States
COVID-19 deaths per 10,000 population