Like much of the rest of the country, Central Oregon is in the midst of a surge in COVID-19 cases. On Sunday, Deschutes County reported 16 new cases, after reporting 15 new cases the day before. There were no new cases reported on Monday.

While the numbers are not big in comparison to major surges in other areas, they nevertheless represent a significant increase from the days when Deschutes County added a case or two — at most a handful — in a day. Some of that increase is due to ramped-up testing and contact tracing, but the surge also represents growing community spread.

St. Charles Health System reported peaking at 14 hospitalizations on April 5, in the midst of the initial pandemic shutdown. On Friday morning, the hospital reported 11 patients, one in the intensive care unit (ICU) on a ventilator.

On Monday, the overall count dropped to six, but three were in the ICU on ventilators.

“We’re definitely below our peak, but it’s ramping back up,” said Dr. Robert Pfister, chief safety and quality officer for St. Charles Health System. “We’re definitely seeing more cases than we did a few weeks ago.”

Sisters has recently recorded the first confirmed cases in the 97759 zip code since the pandemic began. The actual numbers are not reported until they exceed 10; currently Sisters is listed simply as one to nine cases.

Dr. Pfister notes that the St. Charles ICUs are at or near capacity due to standard medical and accident-related traffic. Bend was at 92 percent capacity as of Friday; Redmond was at 100 percent. Just a handful of critical COVID patients would severely strain the system.

Oregon at large has broken single-day reporting records several times over the past two weeks. On Sunday, Oregon Health Authority reported 332 new cases and two new deaths. As of Sunday’s reporting, Oregon has reported 12,170 cases and 234 deaths.

Spread of COVID-19

The increased community spread of COVID-19 was an inevitable — and expected — byproduct of “reopening” economic and social activity. The reopening seems to have led some to let down their guard.

Oregon Health Authority reported last week that, “Since Oregon began reopening, we have seen spread of COVID-19 when people get together to celebrate with family and friends.” Some examples include:

• Graduations.

• Birthdays.

• Weddings.

• Holidays.

“For sure a lot of the uptick we’ve been seeing has been from gatherings,” Dr. Pfister said. “If you just drive around…. You’ll see people in large groups…. I think people are trying to do the right thing in general terms, but it’s pretty hard to drink a beer through a mask.”

COVID-19 is spreading more through social activities involving groups of younger people, OHA reports. OHA has recorded outbreaks linked to:

• Exercise classes.

• A fraternity party.

• A bachelor party.

Citing rapid increase in COVID-19 cases, Governor Kate Brown announced on Monday a ban on indoor social gatherings of more than 10 people — which does not apply to churches or businesses.

The Governor also extended mask requirements to apply outdoors when people are unable to maintain six feet of physical distancing.

She left the door open to applying further restrictions.

“I hope I don’t have to go the route of Texas and California and close bars and restaurants, but nothing is off the table,” Brown said.

The spread among younger demographics may be behind the rapid increase in cases — and a reason why mortality has not climbed along with cases.

COVID-19 Mortality

Dr. Pfister noted that, nationwide, 85 percent of new cases have involved patients ages 20 to 40. That skew toward younger populations, Dr. Pfister believes, may in part explain why the death rate has not soared along with case increases.

Data shows that the death rate from COVID-19 has not been increasing apace with significantly increased caseloads. Data shows that the daily death toll from coronavirus — allowing for a couple of spikes well above 1,000/day — has hovered between 500 and 1,000 through most of June and into July, after peaking at 4,900 in a single day on April 16.

Dr. Pfister and other medical professionals posit several possible causes for the flat mortality curve in the face of a climbing case curve.

First, the virus has mutated, and it may be more contagious and less deadly. Dr. Pfister notes that the first element is certain — the second aspect is not yet established.

“We know that the virus has already mutated eight or nine times,” he said. “The virus we see now is definitely more contagious. We don’t know if it’s less deadly or not, but that’s a real possibility.”

Dr. Pfister notes that the mortality rate for COVID-19 is 0.3 percent — considerably less than what was experienced in severe, deadly outbreaks in Italy and Spain, where death rates were estimated at two percent or higher. However, he is not complacent about the lower number.

“I’m eternally grateful for that (0.3 percent number) — but that’s still pretty deadly,” he said.

Asked if treatment protocols have reduced mortality, Dr. Pfister demurred. While he is full of praise for the diligence and adaptivity of the front-line medical professionals dealing with the worst cases, he says that treatment protocols — “proning” (keeping a patient face down instead of on their back) and the use of less-invasive respiratory support; the use of anti-coagulants and corticosteroids; and the anti-viral treatment remdesivir — have been refined, but aren’t revolutionary.

“We were doing most of them in the first wave,” he said.

He doesn’t see improved treatment as having a big enough effect to significantly bend the mortality curve downward.

“My gut tells me that’s not it,” he said.

For Dr. Pfister, the key to the reduced rate may lie in who is currently getting sick — that younger demographic that makes up 85 percent of new cases. Though there have been terrible stories of death in young, apparently healthy patients, the vast majority of deaths have been recorded in older people with underlying medical conditions. Most of Oregon’s deaths have been in people in their 80s and 90s and almost all have had underlying problems.

“We know that the possibility of (younger patients) getting serious illness is far lower,” Dr. Pfister said.

However, Dr. Pfister offers two cautions: Young people can carry the virus to older, more vulnerable people, which could increase mortality. And mortality is a lagging indicator in a disease that often manifests its most deadly effects many days after contagion.

“This is a smoldering disease,” Dr. Pfister said.

Daily death tolls appear to be ticking upward in recent days. As of Friday, Dr. Pfister noted, “mortality has gone up every day for the last three days.”

Severity of COVID-19

Death is not the only severe impact of COVID-19. Recovery can be long and arduous for severe cases, and the disease can have lasting or possibly permanent effects.

It’s important to note that the vast majority of COVID-19 cases are not severe.

“Eighty percent of people who get it are either asymptomatic (they show no symptoms and may not notice any) or mildly symptomatic,” Dr. Pfister said.

But those who do get severe cases can really suffer.

“By far the biggest problem is respiratory failure,” Dr. Pfister said. “That respiratory failure shows up kind of late.”

A COVID patient can be sick — sometimes mildly sick — for several days, then suddenly develop acute and dangerous respiratory complications. The worst case is development of acute respiratory distress syndrome (ARDS), where fluid fills air sacks in the lungs and deprives the bloodstream of sufficient oxygen.

Heart tissue damage similar to heart attack has also been seen in COVID-19 patients.

“It looks like you can recover from it, but it’s scary, man,” Dr. Pfister said.

Clotting has been a problem, and has been seen in younger patients.

“We’re seeing that more than we do with most respiratory viruses,” Dr. Pfister said. “We also see that particular side-effect with people under 50 with no health conditions.”

Dr. Pfister noted that it is now part of the regular treatment protocol to screen for clotting and treat it with blood thinners.

The doctor acknowledged some of the recent concerns raised about lasting neurologic effects from COVID-19. He said it is hard to parse out what is an effect of the disease itself, and what is the result of being under intensive treatment.

“It’s very hard on you,” he said of being in the ICU.

Some COVID-19 patients are in for a long time, and that has always produced unpleasant mental side-effects.

“We sometimes refer to it as ICU delirium,” he said.

Masking up

Dr. Pfister supports the wearing of face coverings as an important tool in combatting the rapid spread of COVID-19.

“It’s a big part of getting back to normal,” he said.

He acknowledged that the messaging from health officials regarding the wearing of masks has changed, and that that has created doubt and confusion for some.

“As we’ve learned more about this virus, our recommendations have changed — and I think that’s uncomfortable for some people,” he said.

Dr. Pfister noted that constant reevaluation and reassessment are part of the scientific process.

“Science is a method; it’s not a basket of facts,” he said.

As of now, it seems evident that the main method of transmission for COVID-19 is through close contact with an infected person — who may not be showing symptoms.

“Community transmission of this virus transmits through pretty small droplets,” Dr. Pfister said. “It looks like the predominant method of spread is people talking, people coughing on each other.”

Masks won’t prevent the spread of the disease — but they can help limit the radius in which the droplets that carry the virus are exhaled. As an illustration, Dr. Pfister said, “Try to blow out a candle with a mask on.”

In combination with physical distancing and thorough and frequent hand-washing, mask-wearing as “a pragmatic tool” can diminish the community spread of COVID-19.

It requires widespread use for masks to be effective. Wearing a mask protects others; their wearing a mask protects you.

“It’s a team sport,” Dr. Pfister cautioned.

The doctor noted that the incremental effects of widespread precautions add up in a significant way.

“Just diminishing something like this, in aggregate… can have a massive benefit,” he said.

The road forward

Dr. Pfister noted that St. Charles Health Systems data modeling team has thus far been “spot on” in their work. Built on a complex model that accounts for a wide range of factors, including detection rates and numbers of tests administered, modeling indicates the local area is going to be dealing with a COVID-19 surge for a while.

“It predicts now that our peak is going to be in the first week of August,” Dr. Pfister said.

The doctor urges anyone who has a travel history or who has been exposed to someone with the coronavirus be tested. Anyone exhibiting the classic symptoms of fever, aches, persistent cough should be tested immediately “so they can really stay home and not spread the disease.”

He notes that the Red Cross has “a pretty well-validated test” that can determine if you have antibodies that would indicate that you have already had the coronavirus. He also says that it is very doubtful that anybody had the illness before March, though many people had respiratory illnesses.

The doctor sees a significant problem with some people’s encouragement to seek “herd immunity” as quickly as possible. With no vaccine available now, herd immunity would require at least 160 million people to get COVID-19.

“If 160 million people get this with a 0.3 percent mortality rate, that’s still (almost) 500,000 people (dying),” Dr. Pfister said. “I just can’t sign off on that.”

The doctor acknowledged that coronaviruses can be notoriously difficult to vaccinate for — but in this case accelerated efforts are showing promise. He said he is “cautiously optimistic that we’re going to get a vaccine.”

Until one is developed, mask wearing, physical distancing and restrictions on the size of gatherings will likely need to stay in place.

“Our best road forward,” Dr. Pfister said, “is to slow the roll of this disease … till we get a vaccine.”