Is Oregon Ready for What’s Next? We Made a Covid-19 Progress Tracker to Find Out

This post is being updated to reflect the latest public health recommendations and statewide data.

The governor of Illinois gave us an idea last month when he tweeted out a graphic showing the state’s progress on coronavirus testing and setting clear goals and targets for the next 10 days.

Why not do that for Oregon? And why stop at testing? Now that public health experts have identified a series of benchmarks that states need to hit before easing social distancing, why not pull those metrics into a single report card and update them each week?

We hope the Oregon Health Authority will eventually take this task over and make our tracker redundant. But until then, you can find our weekly progress reports by subscribing to our newsletter or following us on Twitter.

Note: The original version of this post used letter grades (A, B, C, D, F) to measure Oregon’s progress toward key metrics. We decided to replace that with a progress meter to better reflect what we’re tracking progress toward a goal as opposed to grades for completed work.

Goal #1: Ramp up testing capacity

Why it matters: A system of reliable mass testing would allow states like Oregon to identify hotspots and isolate people who are infected with the virus, including people who aren’t showing symptoms. Until then, it will be nearly impossible to know when and where stay-at-home orders can be loosened safely.

What we’re measuring: The number of completed tests per day, as reported by the Oregon Health Authority.[1]

The scale: Most health experts agree that the testing goal in the U.S. should be between 150,000 and 250,000[2] tests per day nationally, which equates to between 1,900 and 3,200 tests a day for a state the size of Oregon. 

  • Unprepared: <1000 tests per day
  • Poorly prepared: 1000-1899 tests per day
  • Quite prepared: 1900-2799 tests per day
  • Very prepared: 2800-3200+ tests per day

 

Goal #2: Reduce number of new cases

Why it matters: As long as the number of new cases per day is going up, health experts say the only safe option is to continue social distancing — or make it even stricter. Once that number starts coming down consistently, we can start thinking about what comes next.

What we’re measuring: The rate of new confirmed cases, as reported by the Oregon Health Authority.[3]

The scale: The latest IHME epidemiological model projects that new cases will peak by mid-April in Oregon and then begin to decline.[4] Here’s how we’ll measure the progress:

  • Unprepared: The number of new cases in Oregon is still increasing.
  • Poorly prepared: The number of new cases in Oregon has dropped 0-60% from its peak.[5]
  • Quite prepared: The number of new cases in Oregon has dropped 60-90% from its peak.
  • Very prepared: The number of new cases in Oregon has dropped 90-100% from its peak.

 

Goal #3: Increase hospital capacity

Why it matters: The goal of social distancing isn’t just to “flatten the curve” and slow the spread of the disease. It’s also to buy ourselves time to “raise the roof” — or in other words, to increase the number of COVID-19 patients that our health system can treat at one time. The more we do to expand hospital capacity, the more likely it is that all patients will be able to receive appropriate care, which dramatically reduces the fatality rate.

What we’re measuring: The number of available ventilators and the supply of personal protective equipment (PPE) for healthcare workers, as reported by the Oregon Health Authority and the news media.[6][7]

  • Unprepared: Oregon has fewer than 600 ventilators, and shortages of PPE are widespread.
  • Poorly prepared: Oregon has fewer than 1,600 ventilators and no plan to rapidly obtain them if cases spike, and shortages of PPE are widespread.
  • Quite prepared: Oregon has at least 1,600 ventilators (or a plan to rapidly obtain them if cases spike), and shortages of PPE are isolated.
  • Very prepared: Oregon has at least 2,200 ventilators (or a plan to rapidly obtain them if cases spike), and the supply chain for PPE is stable.

 

4. Improve containment strategy

Why it matters: A mass testing program won’t mean much if we don’t also have an effective strategy for isolating and monitoring people who do test positive, and for containing any additional spread of the disease.

What we’re measuring: The state’s progress toward four measures of an effective containment strategy:

  1. A plan for widespread serological testing to identify people who were previously infected and are now immune
  2. A network of comfortable, free quarantine facilities where people who test positive can voluntarily isolate away from their families
  3. A scalable process for monitoring patients who quarantine at home and tracing their contacts
  4. A public health advisory about the responsible use of face masks

The scale: The Oregon Health Authority doesn’t provide daily updates on these metrics, so we’ll be using news reports and our own reporting to track the state’s progress:

  • Unprepared: Oregon hasn’t met any of these conditions.
  • Poorly prepared: Oregon has met one or two of these conditions.
  • Quite prepared: Oregon has met three of these conditions.
  • Very prepared: Oregon has met all four of these conditions.

 

Footnotes

1. To minimize the effect of any outliers, we’re calculating the number of tests per day by taking a seven-day average. Note: We released our first progress report using a three-day average, before noticing a consistent trend of mid-week lags in testing that were skewing those numbers.  

2. This number is based on the estimate that Illinois needs to be testing 10,000 people a day “to get a truly holistic understanding of the virus in each of our 102 counties.” Illinois is home to about 4 percent of the U.S. population, so 10,000 tests a day in Illinois translates to about 250,000 tests a day nationally. This is consistent with the high-end estimates being floated publicly by experts, which range from 1 million to 2 million per week — or about 143,000 to 285,000 per day.

3. To minimize the effect of any outliers, we’re calculating the peak number of cases and the current number of cases by taking seven-day averages. Note: We released our first progress report using three-day averages, before noticing a consistent trend of mid-week lags in testing that were skewing those numbers.  

4. Technically, the IHME model is projecting when states will hit their peak hospital resource use, not their peak number of new confirmed cases. That means it’s possible that new confirmed cases will peak earlier in April — before hospital resource use peaks — because of the typical lag between getting diagnosed with COVID-19 and being hospitalized.

5. As Nate Silver has pointed out, it doesn’t make sense to track the trajectory of new confirmed cases without also considering the trajectory of testing. And that’s especially important in Oregon, where the rate of testing scaled up dramatically in April. How does that affect the numbers? Take our May 7 report: The raw data that week showed only a 16 percent drop in confirmed cases since the peak in early April. But Oregon’s testing rate in early April was about 32 percent lower than its testing rate in early May — and if you apply that same adjustment to the number of confirmed cases, you see a 46 percent drop in confirmed cases from the peak. That’s probably still underestimating the percent change (because there were so many cases that went unconfirmed in early April), but for the purposes of these updates, it at least helps create an apples-to-apples comparison that reflects the realities of the outbreak.

6. The Oregon Health Authority provides daily updates on the number of available ventilators in the state, but we actually care less about the supply of ventilators now than about the ability to acquire more ventilators in the future if Oregon’s caseload spikes. That’s why Governor Brown’s decision to send 140 ventilators to New York was actually good news. Yes, it means that we have 140 fewer ventilators, but because it secured a commitment from Gov. Andrew Cuomo to “repay the favor when Oregon needs it,” that move almost certainly improved our hospital capacity in the long run.

7. We originally included the number of available ICU beds as an additional metric, but that measure tracks closely enough with the number of ventilators that we decided to keep things simple and just track ventilators.