As COVID-19′s winter peak subsided and vaccinations accelerated in the spring, Gov. Kate Brown offered a clear roadmap: The economy would reopen and mask mandates would end once 70% of adults got the jab.
Oregon achieved that data-driven goal in late June. Brown ceremoniously proclaimed Oregon to be re-open, only to quickly reverse course in August amid a worsening delta variant surge.
This time around, with case counts and hospitalizations again declining, and vaccinations underway for more than 300,000 eligible children age 5 to 11, Oregon has no clear triggers for lifting mask rules that could be in place until February if not longer.
That wait-and-see approach is a mistake, three leading public health experts told The Oregonian/OregonLive.
“I firmly believe that we need clear metrics to release mask mandates or public health officials will lose trust with the population,” said Dr. Monica Gandhi, an infectious disease specialist and professor of medicine at University of California, San Francisco.
While wearing a mask is still prudent indoors, the experts said, the state should clearly tell Oregonians what it will take to end the practice. All three said Oregon could already safely loosen or eliminate outdoor mask requirements.
Oregon today stands alone in the nation with its outdoor mask rules, established in anticipation of college football games and the Pendleton Round-Up. Oregonians are required to wear masks outside not only at football games but also in parks, rooftop terraces and outdoor sporting fields when distancing isn’t possible. Washington, the only other state requiring outdoor masking, applies the rule solely to outdoor gatherings above 500 people.
Oregon no longer needs those outdoor mandates, even with college football games remaining, said Dr. Bob Wachter, chair of the Department of Medicine at University of California, San Francisco.
“The risk is low enough in moderately vaccinated communities with moderate COVID transmission that we can be liberated from outdoor mask mandates now,” Wachter said.
Vulnerable people — unvaccinated, those who haven’t gotten boosters, the immunocompromised and the elderly — should still be encouraged to wear masks at outdoor gatherings, he said.
Gandhi said she sees no evidence supporting outdoor masking, even during the delta surge, given the profound benefits of ventilation.
“There have been multiple unmasked large football events around the country outside and they have not been superspreader events,” Gandhi said. “No study during delta has shown a high risk of outside spread.”
Linsey Marr, a Virginia Tech environmental engineering professor specializing in airborne virus transmission, also said a general mask mandate outdoors isn’t necessary. She said masks are useful during standing-room-only outdoor concerts, where people are even more jammed together than at football games.
Chicago health officials traced 203 cases back to a summer Lollapalooza festival attended by more than 300,000 people who had to provide proof of vaccination or a negative test.
Marr called mask requirements at football games “a gray area” but said she’s feeling better about lifting them as cases drop.
“There is so much dilution outdoors that, in almost all situations, the virus can’t build up in the air and pose a threat,” she said.
Oregon’s brief flirtation with a return to pre-COVID times has left public health officials cautious about their messaging as they navigate the country’s poorly defined transition from uncontrolled pandemic to endemic disease. While Brown has not pursued capacity restrictions on businesses during the delta wave, her masking requirements are becoming more of a flashpoint as cases drop.
Dr. Jennifer Vines, the Multnomah County health officer, called the summer surge humbling and said she is optimistic that mask mandates can be lifted by spring 2022, after Oregon gets through winter, the traditional time when respiratory diseases spread. Multnomah County’s stance was previously reported by Portland Monthly.
“There’s a strong sense that we’re on a one-way street out of this pandemic,” Vines said. “We owe it to the public to not go back and forth. We don’t want to do that.”
Multnomah County is actively working to determine what metrics should be used to make that decision, she said, including test positivity rates. “We are very interested in setting expectations for the public,” Vines said.
At the state level, however, Brown and state health officials would not offer clear benchmarks for what it will take to lift the mask mandates they set.
Asked what metrics the governor will use, her spokesperson provided no specifics, saying state health and workplace safety officials “will continue to monitor Oregon’s COVID-19 metrics in assessing Oregon’s mask requirements in the coming weeks and months.”
Dr. Dean Sidelinger, the state epidemiologist, said hospitalizations and case counts need to drop before mask mandates are lifted. How low? Sidelinger wouldn’t say.
Sidelinger said the state’s health care system must be able to provide care without the assistance of the National Guard. Brown authorized the deployment of 1,500 troops in late August to help create capacity during the delta surge. Sidelinger said he hopes to see the strain on the state’s system alleviated by spring.
“We need to see cases going down and no resurgence of disease,” Sidelinger said. “We’re not there.”
Oregon is now averaging slightly fewer than 1,000 coronavirus cases a day, its lowest mark since early August and nearly 60% below the summer record. Just over 500 Oregonians are hospitalized with COVID-19, down 57% from its apex.
But cases and hospitalizations remain higher today than in all but the two worst peaks of the pandemic. Hospitalizations aren’t projected to recede to pre-delta levels until around February, according to modeling by Oregon Health & Science University.
Wachter, the UCSF doctor, said indoor mandates are still prudent but could be lifted when:
More than 75% of the whole population is fully vaccinated. Oregon is at 63%.
Case counts are below 10 cases per 100,000 a day. Oregon is at an average of 23 daily cases per 100,000 in the last week.
Test positivity rates are below 2% to 3%. Oregon was at 6.4% in the last week.
“None of these are magic on-off switches,” Wachter said, “but meeting them would indicate an environment in which even being in the presence of unvaccinated people indoors would be relatively low risk.”
Gandhi, the UCSF infectious disease specialist, cautioned against basing mask decisions on the federal Centers for Disease Control and Prevention’s community transmission rates.
The CDC used to recommend mass testing of asymptomatic people but now discourages it unless someone’s been exposed. The result, she said, is a skewed view of transmission since testing is zeroing in on people more likely to have COVID. All but two Oregon counties (Clatsop and Curry) are in the CDC’s highest risk category.
Instead, Gandhi said, Oregon should tie indoor mask mandates to two key targets:
A vaccination rate above 80% of eligible people. Oregon today is at 73% fully vaccinated for those 12 and up. That doesn’t include inoculations that began last week for the estimated 330,000 5- to 11-year-olds in the state.
A COVID hospitalization rate between 5 and 10 people in every 100,000. Oregon is at 12 per 100,000 today.
Gandhi pointed to Marin County in the Bay Area as an example: It dropped indoor mask requirements Nov. 1 after hitting an 80% overall vaccination rate combined with declining hospitalizations and 21 consecutive days in the CDC’s “moderate” transmission risk level.
Alternately, Gandhi said, mask mandates could be lifted eight to 12 weeks after the 5- to 11-year-old vaccination rollout — between New Year’s Eve and the end of January.
Oregon’s mandates are due to expire Feb. 8, 2022.
