The number of Oregonians hospitalized with COVID-19 has skyrocketed over the past month, rising faster than in previous waves and almost entirely among the unvaccinated.

Hospital leaders say COVID-positive patients requiring hospitalization are younger on average than ever before. With a quicker onset of symptoms, patients are more ill when admitted to hospitals and rapidly declining in health compared to previous surges.

On Friday, the number of people hospitalized with COVID-19 reached 496, including a record 135 in intensive care. At the current trajectory, Oregon is on pace to exceed its all-time high of 584 COVID-positive patients as soon as next week.

But hospital leaders and Gov. Kate Brown have not sounded the alarm, as they did during earlier waves. Brown warned in June 2020 – when 108 people were hospitalized with COVID-19 – that hospitals “could be overwhelmed” within weeks based on modeling. Brown renewed restrictions in November – when 285 people were hospitalized – saying that hospitals could withstand a surge but “that needs to be a last resort.” And in April – with 328 people hospitalized – Brown again restored some restraints because rising hospitalizations were “threatening to overwhelm doctors and nurses.”

The reasons such dire warnings and capacity concerns haven’t returned this summer appear three-fold: With vaccines readily available and known to dramatically reduce the need for hospitalization, healthcare providers have shifted their focus to pushing for more people to be vaccinated; the current hospital surge has largely spared the Portland area — where hospitals have developed ways to better manage hospital capacity — giving the state an extra buffer for more sick patients; the governor handed off COVID-19 safeguards to individual counties, where local leaders are reluctant to institute them for communities feeling worn-out after being given the green light just weeks ago.

“Three or four weeks down the line, there’s a concern here, but that’s also the point, which if somebody went out today and got vaccinated, they’re not going to be sick,” said Erik Robinson, a spokesperson for Oregon Health & Science University. “We need people vaccinated.”

Oregon’s governor has largely taken a hands-off approach to the current wave, deferring to county officials to implement restrictions to slow spread since she lifted statewide restrictions June 30. So far, no county has acted, although some hospital systems have voluntarily postponed non-emergency procedures to manage capacity.

Brown is “incredibly concerned about the increase in COVID-19 hospitalizations,” spokesperson Charles Boyle said in an email earlier this week.

“Local leaders asked for local control and therefore we expect local leaders in areas most impacted by COVID-19 to take action,” Boyle added. “All options remain on the table if hospitalizations continue to rise.”

The summer spike has left healthcare providers scratching their heads about vaccine hesitancy or resistance, but they have few options aside from continuing to push shots as the single most effective way to prevent hospitalization or death from COVID-19. Some 70% of eligible Oregonians are at least partially vaccinated, leaving more than 1 million people without shots.

“We are doing all we can … to promote vaccination for the community,” said Dr. Katie Sharff, an infectious disease doctor at Kaiser Permanente. “But if you don’t have any mitigation measures in place, you will continue to see community transmission, we will continue to see people get sick, we will continue to see people hospitalized. And so that just feeds into this problem of capacity.”

Meanwhile, the pool of unvaccinated people in the state tends to be younger, and the delta variant is more contagious and shows more severe effects, said Gary Walker, a spokesperson for Providence Health & Services.

“The difference is they’re younger, sicker, quicker,” Walker said of the people now being hospitalized.

Prior to the Fourth of July holiday Providence Portland Medical Center for a few days had zero patients in intensive care with COVID-19, said Sabra Bederka, an ICU nurse at the hospital. Encouraged by the decline in patients, Bederka and other medical staff she spoke with believed state plans to officially reopen were “a terrible idea,” she said, even though Oregon was among the last states nationally to do so. “And clearly we were right, unfortunately.”

“‘It’s OK to not take precautions,’ is basically what we heard from government,” she said. “‘Mask if you want to, mask if you haven’t gotten vaccinated.’ People aren’t going to pay attention to that. They have to be basically forced to do the right thing, and that’s heartbreaking. And they get mad when they’re told to do the right thing because it’s their right to not do the right thing.”

When Bederka was last at work a few days ago, she said, none of the COVID-positive patients in the ICU were vaccinated. “This is a surge of the unvaccinated,” she said.

“There is no 100% guarantee of anything, but wear a mask, get the vaccine, you have a very, very, very, very high chance of not getting sick at all,” she said. “Or if you, heaven forbid, do get sick, it’s very, very mild.”

As of Friday, the summer surge had officially pushed hospitalizations of COVID-positive patients in metro region past the spring peak, but they remain at just over half of what they were at the height of the fall.

Portland and its surrounding counties also have a considerably smaller share of COVID-positive hospitalizations than in the fall — previously claiming around half of the statewide total but now just over a third.

Meanwhile, the summer spike has been particularly acute in southern Oregon. The hospital region that covers Jackson and Josephine counties had a record 100 patients with COVID-19 as of Friday.

The Asante health system recorded about 80% of those patients across its three hospitals in Medford, Ashland and Grants Pass. “We have been operating at capacity for many weeks,” said spokesperson Lauren Van Sickle.

She added that 90% of Asante’s COVID-positive patients are not vaccinated.

Hospitals in the Portland region are often taking in the most seriously ill COVID-positive patients from across Oregon. The region on Friday recorded 47 people in intensive care, already above the spring peak, and 18 people short of the fall high.

As the state’s only academic medical center, OHSU is taking in the most critically ill and complex cases, said Dr. David Zonies, OHSU associate chief medical officer for critical care. Providence has also taken COVID-positive patients from southern Oregon, Washington, Idaho, California and Montana who were flown by helicopter to Portland, Bederka said.

As of Friday, Oregon reported that hospitals in the Portland region were operating at 95% capacity, with 89 available non-ICU beds. Capacity for intensive care stood at 87%, with 44 available beds.

The summer surge has increased anxiety among health care workers battered by 17 months of the pandemic. Hospitals nationwide continue to face staff shortages, with many leaving the profession during the pandemic.

“I don’t think anyone was truly anticipating a summer surge,” Zonies said. “We were all really focused on what happens when we go back indoors in the fall.”

Zonies said the most frustrating part of the hospitalization surge is that it was avoidable, had more people been vaccinated. He said the hospital is now seeing critically ill patients ages 20 to 40 who are unvaccinated, although state data show only about three dozen Oregonians in those age groups have died during the entire pandemic out of nearly 2,900 total deaths.

“The narrative that it doesn’t affect the young doesn’t jibe any longer, and that’s what makes it so scary,” he said.

“It’s not a scare tactic. It is just a stark, cold reality,” he added. “People need to just really understand that that’s where it is. We need to encourage, we need to be firm, and we need people to engage with their community and keep us all safe.”

— Ardeshir Tabrizian; atabrizian@oregonian.com; 503-221-8067; @ardytabrizian