Episode 36: Looking Back At Two Years

Additional resources

What we knew then and what we know now about COVID-19

Q1: When this started in March 2020, we heard a lot about “flattening the curve.” What does that mean?

“Flattening the curve” means slowing the spread of a virus so that fewer people need to seek treatment at any given time. We do this by doing things like hand washing, wearing masks and physically distancing, including staying at home. These types of measures are needed when a new virus emerges and we have no immunity from it.

The Centers for Disease Control and Prevention (CDC) first recommended these types of measures in 2007 to protect ourselves during future pandemics. In 2017, the CDC updated their recommendations to include other measures like masking and handwashing, and lessons learned from the 2009 H1N1 or “swine flu” pandemic. So this is not a new idea.

Q2: But COVID-19 is still here. Does that mean we didn’t flatten the curve?

No; in fact, these types of measures did flatten the curve and slow the spread of COVID-19. 

In Oregon, we started by staying at home. If you look at Oregon’s COVID-19 data for the first year of the pandemic, you can see Oregon’s curve is pretty flat. It doesn’t have the sharp rises that would cause strain on the health care system.

You can also look at “zero COVID” countries, like China and New Zealand. They put measures in place very early: In January 2020 for China, and March 2020 for New Zealand. Their measures included staying at home, mass testing and contact tracing. China first declared they were COVID-free in March 2020. New Zealand did the same in June 2020.

Studies have shown that what we went through in that first year, across the U.S., helped us avoid millions of COVID-19 cases, the United States and globally. 

Q3: So, what happened?

In April and May 2020, states began reopening. Oregon didn’t reopen as early or as fully as other states. So while there were states seeing big increases in COVID-19 cases as early as July, Oregon wasn’t among them. So staying at home, avoiding crowds, and the other precautions were still helping us. 

As we got into the fall and winter, we did experience another surge of COVID-19 as more activities had to be indoors, not outdoors, due to the weather.

But also, these measures could not protect everyone. Not everyone was able to work from home. Essential workers could not stay at home. If people could not afford the time, money, or other supports that could help them stay at home and avoid infection, they went to work. They were still at risk. 

Q4: Then the vaccines became available. How did that change things?

Supplies were limited in December. This meant that Oregon had to decide where these limited supplies would have the most benefit. So the vaccines first went to health care workers and patients in residential care. By April 2021, everyone over age 16 could get the vaccine. By May, everyone over age 12 could get the vaccine.

That spring, Oregon did have another COVID-19 surge. Most of the United States experienced a spring surge, for many reasons: Reopening, loosened COVID-19 restrictions, and there was more travel. Pandemic fatigue was setting in. The B.1.1.7 (or Alpha) variant also emerged, which was more transmittable than the original virus. 

But with the rising vaccination rates, Oregon still saw a decline in COVID-19 cases, hospitalizations and deaths when compared to the previous surge in November. Case rates decreased as vaccination rates increased, until Delta.

So we learned two things during this time: that vaccines worked. And how variants could drive up case rates. We were also reminded that the precautions we took at the beginning of the pandemic still work. 

Q5: Oregon reopened on June 30, and the Delta surge followed. What can we learn from this?

Oregon reopened because almost 70 percent of adults in Oregon had been vaccinated. The effectiveness of the COVID-19 vaccines was evident. Oregon turned to what worked in the past. That’s why masks were recommended in public indoor settings in response to the Delta surge and continued to promote vaccines.

The Delta variant is more than twice as transmissible than the original COVID-19 strain, and 50% more transmissible than Alpha. It is also associated with more severe cases of COVID-19, including hospitalizations and deaths. This, and low vaccination rates in many areas and groups, caused the surge we had in the summer of 2021.

But at the height of the surge, Oregon’s rate of COVID-19 cases among the unvaccinated was six times as high as the rate of COVID-19 cases among fully vaccinated people. 

It wasn’t until after the Delta surge that research suggested that Delta could evade vaccine immunity. COVID-19 is a novel coronavirus. It means it’s new, and our understanding changes as we learn more. Our understanding is changing as the virus changes. We need time to see how the virus, and the vaccines, affect the pandemic. We need to make decisions that are based in science and what the data tells us. Since the virus is new, it takes time to collect and understand the data.

Q6: Would COVID-19 boosters be an example of how health recommendations change over time, in response to what we learn about the virus and the vaccines?

Yes. We couldn’t see that we needed a booster dose of COVID-19 vaccine until there was enough data showing us that the vaccines became less effective over time. When that happened, booster doses were recommended.

Even so, researchers will continue to study the effectiveness of the vaccines and collect more data that may change those recommendations in the future. We have been using booster doses for a short time. But already Oregon’s report on COVID-19 breakthrough cases shows that booster doses do better protect us against COVID-19. The latest report shows that the rate of COVID-19 cases among unvaccinated individuals was almost twice the rate of COVID-19 cases among those who are fully vaccinated and 3.4 times the rate of COVID-19 cases among those who are fully vaccinated and boosted. 

Q7: What about Omicron and the plan to lift masking requirements by March 31? Are we still following what the science tells us?

Yes. Cases have been declining since Omicron’s peak in January. This is because we have continued to take the steps to protect each other such as wearing masks, getting a booster shot or vaccinating our children. This is why Oregon has the third lowest cumulative COVID-19 case rate in the nation and the eighth lowest COVID-19 death rate since the start of the pandemic. 

March 31 just means the statewide requirement is lifted. Counties and schools will decide whether to continue masking for their communities. Masking is still recommended for people who are:

Q8: Looking back at the changes we’ve experienced throughout the past two years, and entering our third year, what does the science tell us now about COVID-19?

It tells us that the precautions we have taken throughout the pandemic work. It confirms that getting vaccinated is the best protection against COVID-19. Getting fully vaccinated, and getting a booster dose if you are eligible, provides the best protection.

For people who are immunocompromised, the CDC now recommends a booster (fourth) dose of an mRNA vaccine (Moderna or Pfizer) three months after the third dose. For people who received the Johnson & Johnson vaccine, the CDC recommends an additional dose of an mRNA vaccine at least 28 days after the initial dose, then a booster dose two months later. 

If you have concerns about which vaccine you should get, ask your health care provider.