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Oregon lifts many COVID-19 restrictions, but concerns remain

Most COVID-19 restrictions have been lifted in Oregon. But should Oregonians still be worried about the delta variant? And what vaccination disparities remain in the state? Kim Repp, chief epidemiologist for Washington County, joins us to discuss what to keep in mind as restrictions ease.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave miller. Last week, Oregon Governor Kate Brown lifted Covid-19 restrictions on public life in Oregon. It means no more mask mandates in most indoor public spaces and no more limits on public gatherings. At the same time, though, the most infectious variant of the virus that has been identified so far, the Delta variant, has been spreading relentlessly around the world. According to the CDC, it now accounts for more than half of new cases in the US. The Delta variant has led some countries to reimpose restrictions. So far, federal and state governments in the US have not followed suit. For more on what the Delta variant could mean in Oregon, we’re joined, once again by Kim Repp. She is the Chief Epidemiologist for Washington County. Kim, welcome back to Think Out Loud.

Kim Repp: Thanks Dave, awesome to be here again.

Miller: Do you have a sense for how prevalent the Delta Variant is in Oregon right now?

Repp: Yes. The Oregon Health Authority has been watching this very closely and Oregon has some of the best sequencing rates in the country, in terms of looking at our Covid cases, and we have seen the Delta Variant inside Oregon, inside Washington County, and it is here, it is not the most common variant yet, but it is definitely here on our soil.

Miller: It’s striking that it’s not the most common because I’ve seen in some states that 70% of new cases, for example, are the Delta Variant. But here it’s not above 50%, you’re saying.

Repp: That is correct.

Miller: Do you have a sense for why that is?

Repp: Yes. So what is the one thing that stops COVID?

Miller: Well, it’s inability to actually get in from one person and go to another one... Have I answered the question or have I just received a question?

Repp: That’s exactly right. So vaccination. The more vaccinated a population is, the less hosts, as you just said, are able to be infected with the variant. And as we know, not all populations are vaccinated equally. For example, we know in Oregon we have pockets of populations that are not vaccinated at all. Right? So it’s not like everyone is evenly vaccinated. So what happens is the Delta Variant will get into one of those communities and it will spread like wildfire, through all of the people who are not vaccinated. And then once it bumps up against people who are vaccinated, it shifts and then looks for the next group of people to infect that are not vaccinated. So it has to do with how close people are together and the percentage of those people that are vaccinated.

Miller: Do we know why this particular variant is so much more transmissible, than even the one which I guess was called Alpha that originally came from the UK. Which, before this was known as the most transmissible of the identified variants. What makes Delta special?

Repp: Nature is amazing, right? We can go the philosophical angle on this and every time a virus reproduces it has sort of errors built into that reproduction. Sometimes those errors out of billions and billions and billions and billions of tries, develop into something that’s more effective for the virus to more easily transmit. Every time this virus is in someone’s body that’s happening, every new infection every moment of every day. This virus is replicating and testing sort of new evolutions of the virus. Well, India had the first round of the Delta Virus so the mutation took there, and the strain spread and because it is the most successful right now, out of all the streams because of its contagiousness and transmissibility, that’s why we’re seeing it. Now, is it possible that there will be, you know, they stopped using Greek letters now, for some reason, but could there be something stronger than Delta? Of course there could be that this is how nature works every single moment of every day. It’s trying to make something better and stronger than what’s out there, right now.

Miller: The World Health Organization is recommending that everyone continue to wear masks inside because of the Delta Variant, even if they are vaccinated. The CDC so far is not making that recommendation. They’re sticking with their announcement from May that if you’re vaccinated you can go maskless inside. What do you make of this disagreement from these two public health bodies? Obviously one of them is looking globally, which overall has a significantly lower vaccination rate than the US does and the other, you know the U. S. Public health body.

Repp: Yes and as an Epidemiologist, it’s the most exciting drama when the World Health Organization, the CDC don’t agree on something, which happens all the time. So they have different political pressures, right? Our CDC has to answer to the President. The World Health Organization does not, right? So like you said, they have to do something one size fits all for the world. The CDC is thinking about the United States. It’s a different risk tolerance. So in America we are more tolerant of risk. Hence, the ‘you don’t need to wear masks.’ The World Health Organization thinking across the globe, it would be best practice to wear a mask. I mean the CDC isn’t going to say that’s not a good idea, because of course it will be more protective. They’re just not going to require people to do it. Does that make sense?

Miller: I’m curious about one of the phrases you mentioned that the US is more tolerant of risk. As an Epidemiologist, do you see that as synonymous with the phrase that in the US we are more tolerant of people dying?

Repp: I mean that’s the consequence of that right? That is absolutely the consequence. We often value our individual freedoms over the lives of others and that’s just something that is unique to our country.

Miller: To go back to the way you parsed this, obviously the CDC is not requiring that people wear masks inside. But what about simply recommending them, saying this is probably a good idea?

Repp: I think they’re leaving that to the States, which in turn is leading the locals to do that. I don’t think that’s a confusing recommendation. It’s basically, if you want to protect yourself to the most amount possible, wear your mask, if you don’t want to wear your mask and you’re vaccinated, okay. If you’re unvaccinated and not wearing a mask, then you’re in a serious, serious risk category. But again, masks are best practice. That’s not really something profound that they would need to come out and say, honestly.

Miller: Let’s dig deeper into the question of the extra level of protection provided to fully vaccinated people by wearing a mask. We asked folks on Facebook if they had questions about the Delta variant, and a listener wrote, ‘Dr. Fauci said over 99% of the people who died of COVID in June were unvaccinated.’ She asks, is that true for the Delta variant as well?

Repp: We don’t have everything sequenced yet enough to be able to answer that. We will be able to answer that soon, but the results take time. Sometimes it takes weeks to get the results back. I cannot speak of the people who have died from Covid-19, what percent had Delta versus the fatality rate for Delta virus alone? The Delta Variant alone. I’m not sure on that.

Miller: It has been reported though that for the three vaccines that have gotten approval in the US, when people have received the full course of those vaccines, the two shot regimens for the mRNA one or the single dose Johnson and Johnson, that they seem highly effective in preventing serious disease, hospitalization and death. That’s what has been reported recently. So how much extra value is there for the mask wearer in wearing a mask, if you’re fully vaccinated?

Repp: That’s pretty hard to put an exact number on. The studies that I have read have shown anywhere between a 5 to 12% increase in protection, depending on whether you’re in a room full of coughing Covid people versus the general population outdoors, that’s going to give you a very different protection level. In the worst case scenario, you’re in a COVID ward where everyone’s coughing and you’re fully vaccinated and you have a mask on, it can give you up to 10% more protection, which maybe some people think that’s not a lot. But hey, if that’s something you’re interested in, its available.

Miller: That scenario seems different than going into a grocery store for 10 minutes, right, and picking up some tomatoes.

Repp: Yes, Absolutely. If you’re outdoors, there’s a lower risk, we know this. If you’re in a not very densely populated area, but if you’re going into a mosh pit at Coachella, a mask might be a reasonable option.

Miller: How are you feeling when you look statewide about how we’re doing in terms of vaccinations?

Repp: I think Oregon is doing pretty well. I will be happy if we ever hit 80% because that is a really pretty number for herd immunity that protects you... Not a lot of diseases where you need more than 80% herd immunity to protect yourself. So we’re getting there. I know the vaccination rates are declining in terms of people wanting to get vaccinated. So we’re really hoping to get those last people who have changed their mind or haven’t had access for any reason and get them in to get vaccinated because every little bit that we do right now is going to help us keep the Delta variant away.

Miller: That decline is really striking. When you look at the graph that shows the seven day rolling average of vaccinations per day going into Oregonians’ arms in early April, the average was around 45,000 people a day. As of today it’s under 5,000 a day. So, 1/9 of what it was at the peak. What does that mean in terms of getting to that 80% number that you’re hoping for?

Repp: One thing that’s going to help is once the vaccines are available for the younger members of our population. That will help take a large chunk of the available people to infect out of the system. So that will be good. It appears from those numbers that everyone who has wanted to be vaccinated had access, mostly speaking. Now we have left the people that are either vaccine hesitant, don’t want to get vaccinated, or can’t get vaccinated. That’s a very different body of work than the people that have been crawling over each other to get the vaccine. It’s just focusing on a different population

Miller: Washington County, the last I looked, actually has the highest vaccination rate as a county in the state, but there are some counties in southeastern Oregon that are less than half of Washington County’s rate. Is it fair to say that we’re looking at a case of two Oregons, when it comes to the future of this pandemic?

Repp: Oh, absolutely. You can look at the vaccination by county and see where Delta variant is going to start. The math is very, very simple there. Where are the most people to infect? You only have to introduce one person into that population and it’s sure everyone will get infected. So basically, the people that are not getting vaccinated for whatever reason, they may be experiencing the Delta variant as their introduction to Covid instead of the vaccine.

Miller: Even if Washington County has the state’s highest overall rate, there are still disparities in Washington County and in every county within different demographic groups. How are you thinking about addressing those disparities in Washington County?

Repp: Actually, we have been working on this for quite a while. We have many community organizations that we are working with to provide culturally competent access to the vaccine. We are going to where people are at, meeting them in their communities, meeting them at specific areas that the community has requested with people who speak their language, who are part of that community. And the county has been funding and providing all of this to have very targeted outreach to our most vulnerable populations, like Native Hawaiian Pacific Islander, or Hispanic/Latinx. We know that’s been a huge disparity, and we have taken active steps. And actually, if you look at our numbers, we have significantly increased the percentage vaccinated within each of those communities because of the efforts we have taken.

Miller: Are you seeing disparities in terms of who’s getting infected that tie directly to the vaccination rates of different groups?

Repp: Can you say that a different way?

Miller: Well, I’m wondering if, for example, Latinos and Hispanic Oregonians in Washington County have one of the lower rates of vaccination in the county. Are you still seeing higher rates of infections among those groups?

Repp: Yes. Yes, we are, of course. Until that percentage vaccinated bumps up to 70 or 80%, you are still going to see a disproportionate amount of the disease burden within that community. So yes, we are still seeing a disproportionate amount of cases who identify as Hispanic/Latinx.

Miller: Kim Repp. Thanks very much, once again, for giving us some of your time.

Repp: Thank you.

Miller: Kim Rap is a Chief Epidemiologist for Washington County, joining us to talk about the Delta variant in Oregon and around the world.

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Copyright 2021 Oregon Public Broadcasting

Elizabeth Castillo