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A deadly spike in COVID-19 infections that began just before Independence Day should near its end around Christmas, a new state forecast said Thursday.But with more than two months to go to reach the projected end point, about 177,000 more infections are expected in the state, according to the Oregon Health & Science University weekly forecast released late Thursday.The Oregon Health Authority said Friday that hospitalizations for COVID-19 continue a steady decline in Oregon, with 563 infected patients hospitalized on Friday, less than half the 1,178 recorded Sept. 1Hospital Region 7, which covers eight central Oregon counties and includes Bend and Klamath Falls. Rates of hospitalizations and deaths remain "stubbornly high" in the region.St. Charles Bend had 70 COVID-19 patients according to a Friday OHA tabulation, the most in the state. It reported 11 COVID-19 patients in its intensive care unit, the second highest in the state.Sky Lakes Medical Center in Klamath Falls had 25 COVID-19 patients, the fifth most in the state.The statewide spike in infections, which began in the first week of July and peaked just after Labor Day, has steadily tracked downward since, the report said. The spike was driven by the highly contagious delta variant.However, the forecast projects that the state still has 2.5 months until it might reach "herd immunity" for the delta variant. OHSU says that is when 85% of the population is either vaccinated or has been exposed to the virus.The university's virus modeling projects that Oregon will arrive at that point around Dec. 26.Over that time, the forecast estimates there will be another 177,000 infections in Oregon – enough to fill Autzen Stadium at the University of Oregon three times.The number of "breakthrough" cases of infections in people who have been vaccinated has risen, accounting for 27.2% of new infections in OHA's weekly report released Wednesday. It's one of the reasons that federal and state health officials have moved to approve booster shots of vaccine for those already inoculated. But throughout the spike, severe cases requiring hospitalization and deaths have remained low among vaccinated people compared to those who are unvaccinated.Vaccinated patients account for less than 5% of hospitalizations and less than 1% of deaths.“There’s still time for people to take action to prevent transmissions and to get vaccinated, but we’re projecting that a whole bunch more people are going to get infected in the next month," said Peter Graven, director of the OHSU Office of Advanced Analytics. Oregon recorded 610 deaths in September, the highest monthly total since the pandemic arrived in the state in late February 2020. OHSU said the drop is being aided by an increase in vaccinations, including those motivated by the deadlines for state and federal employee mandates. The state's "immunity index" shows that 22% of Oregonians remain vulnerable to the virus, having neither been vaccinated or exposed to the virus by others.“A lot of people have gotten infected over the past three months, and it’s become harder for the virus to find susceptible people,” Graven said.Graven said that though there remains a large pool of unvaccinated Oregonians who could end up in the hospital. But the worst is likely over."The severe strain on hospitals should ease as the virus finds an ever-shrinking pool of susceptible hosts," Graven said. “It’s going to be increasingly difficult to generate a new surge in hospitalizations."Patients with COVID-19 accounted for 24% of all cases in intensive care units statewide as of Oct. 12. At the peak of the spike, they took up more than 50% of ICU capacity.The OHSU report said the timeline could be slowed by the trend of Oregonians tiring of preventative measures such as wearing masks and avoiding gathering indoors with those outside of their household or outside in large groups. While a high number of deaths have been reported recently, deaths are the last indicator to rise or fall in a spike. The current numbers are projected to decrease, as hospitalizations and infections already have gone down.Test positivity continues to slowly decline. OHA reported the statewide rate at 7.3% on Friday. OHA officials say a rate below 5% is when the number of new infections is within manageable limits.

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Recipients of the Johnson & Johnson coronavirus vaccine may need a booster shot - and while they could benefit from a second dose of the original vaccine, they may derive even greater protection if the boost comes from a different vaccine technology, according to data that emerged Wednesday.

The documents include an FDA review of Johnson & Johnson's tests of a second dose of its own vaccine and a separate preprint study that tested mixing booster doses from different companies. The data could provide a road map for the 15 million people who received the Johnson & Johnson vaccine in the United States, many of whom have felt left out because the vast majority of U.S. vaccine recipients received messenger RNA vaccines from Pfizer-BioNTech or Moderna.

The Food and Drug Administration review of company data appeared to acknowledge the potential benefit of a booster dose of the Johnson & Johnson vaccine, although the agency did not have time to complete an independent analysis of the company's data as it typically does.

An expert advisory panel will meet Friday to consider the Johnson & Johnson booster and a National Institutes of Health study in which recipients of all three coronavirus vaccines received boosters from different companies.

That preprint study found that a second shot using a messenger RNA vaccine - Moderna - triggered the biggest boost of virus-neutralizing antibodies in Johnson & Johnson recipients, resulting in a 76-fold increase in antibody levels. A Pfizer booster increased antibody levels 35-fold. A matching Johnson & Johnson booster triggered only a fourfold increase.

From the dawn of the vaccine campaign, many experts said they believed the one-shot Johnson & Johnson regimen would ultimately require a second shot, and the documents released Wednesday pave the way for a panel of experts who advise the FDA to discuss Friday the timing, necessity and safety of a booster dose - and whether they should stick to the same shot.

There are limitations to the NIH study, which was small, with short-term follow-up. The study measured antibody levels, which are easier to evaluate than other parts of the immune system, but did not review whether someone got infected. The Moderna dose tested in the trial was twice what Moderna is seeking authorization for as a booster.

"This is a small piece of the big picture," said John Beigel, associate director for clinical research in the Division of Microbiology and Infectious Diseases at the National Institute of Allergy and Infectious Diseases, who worked on the study. Beigel said the main finding is that it appears booster doses can be used interchangeably and safely, regardless of what the primary vaccination was.

Beigel said there are other parts of the immune response that have yet to be measured after the boost, and recipients need to be followed to see what happens to those antibody levels.

"I would be hesitant to say one is better than the other. Our study was never designed to do that," Beigel said.

The data will leave the FDA's advisory committee with a bigger question: What is the role of a booster of Johnson & Johnson's vaccine in a country with enough supply of messenger RNA vaccines?

"If there's one [booster] dose, should you get the one with the highest antibody? I'd probably say either of the two mRNA vaccines," said Kathryn M. Edwards, professor of pediatrics in the division of infectious diseases at Vanderbilt University School of Medicine. "I think many people may choose to get the immunogenic booster."

Johnson & Johnson's initial advantage was largely logistical - the potential for a speedy vaccination campaign that could help end the pandemic, even though a single shot offered slightly less individual protection than the messenger RNA vaccines. It offered particularly strong protection against severe disease.

In a statement, Johnson & Johnson spokesman Jake Sargent said the results "complement" the other data "confirming the strong and long-lasting protection of the Johnson & Johnson single-shot COVID-19 vaccine, as well as Phase 3 data showing protection against COVID-19 increases when a booster shot of the vaccine is administered."

The FDA review focused only on data submitted by the company, which exclusively tested a second shot of its own vaccine.

"Although not independently confirmed by FDA from datasets, summaries of the data suggest there may be a benefit in a second dose administered approximately 2 months after the primary dose," FDA staff wrote in assessing data of a second dose of Johnson & Johnson.

There were shortcomings of the agency's review of the Johnson & Johnson booster data. Typically, agency scientists do their own independent review of data, but much of the data was not submitted in time, meaning large parts depend on the company's analysis.

Johnson & Johnson is seeking authorization of a booster dose at six months or later after the initial shot for people 18 and older. The company says the extra dose could be given as early as two months after the first shot.

The safety and efficacy of a booster are reviewed in the documents Johnson & Johnson submitted to the FDA. The submission includes results from four clinical trials that tested booster doses two to three months after the first dose or six months after the initial shot.

Longer follow-up of the initial 40,000-person trial that showed the vaccine was effective found that it was 56% effective overall against illness, including moderate and severe disease - lower than the initial estimate.

One study that tested two doses 56 days apart found that two doses were 75% effective against illness, and 100% effective against severe disease.

Two other studies measured the immune response after a booster. Those studies suggested that giving a booster after six months drove antibody levels higher than if given at a shorter interval. But limitations in the test used to do the analysis mean FDA staff deemed that the immune responses shouldn't be directly compared.

One of the discussion questions the FDA has laid out for the expert panel is whether a second shot should be authorized at two months, or with at least a six-month gap.

The FDA's reviews of booster doses of messenger RNA vaccines have not taken a position on whether boosters were needed. A Pfizer-BioNTech booster dose was authorized for a select population despite that. The expert committee is expected to vote on Moderna's booster Thursday.

In contrast, the review of the Johnson & Johnson vaccine suggests the agency sees a clearer need for another dose, even as data remain limited.

The agency noted that overall, the data suggest the Johnson & Johnson vaccine still protects against the worst outcomes - severe disease or death - but pointed out that the initial protection was less than other available vaccines in the United States.

"The highest effectiveness estimates (including for more severe COVID-19 disease) across clinical trials and real-world effectiveness studies . . . are consistently less than the highest effectiveness estimates for the mRNA COVID-19 vaccines," reviewers wrote.

Kathleen M. Neuzil, director of the Center for Vaccine Development at the University of Maryland School of Medicine, said all the vaccines are protective against severe illness and death, and the Johnson & Johnson vaccine's protection has held up well, suggesting that parts of the immune system other than antibodies are contributing to its protection.

"This is a small study, it absolutely points in the direction of . . . saying the mRNA boosts are better," Neuzil said. "We're going to learn a lot more in the next two days."

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ALTAMONT, Tenn. — Sarah Rymer suspects her 11-year-old son was infected with the coronavirus, and she knows her husband was. He coaches Pee We…

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Gov. Kate Brown said Tuesday that she was "gravely concerned" about an alarming spike in COVID-19 cases across Eastern Oregon with a common factor  — the Pendleton Round-Up. During a morning press call, Brown and state health officials gave an upbeat update on the state's efforts against the highly contagious delta variant of COVID-19.Statewide, the COVID-19 surge of late summer and early fall “appears to have reached its peak,” said Deputy State Epidemiologist Dr. Tom Jeanne.Brown hailed the state’s efforts in curbing new infections and hospitalizations as the state appeared to descend from a two-month spike in cases that set new pandemic records in Oregon.It was only during a question and answer period at the end of the presentation that the Pendleton Round-Up spike was addressed as a sour point in the state's progress.The East Oregonian newspaper was the first to report Monday that the spike in COVID-19 cases in Umatilla County had been tied by local health officials to the annual rodeo event held Sept. 15-18.The East Oregonian reported Tuesday that at least 68 COVID-19 cases have been traced back to the event and all its venues, up from 49 Monday. Health officials across Eastern Oregon reported spikes in new cases, as did some in eastern Washington and Idaho.“That was a very large outdoor event,” Dr. Tom Jeanne, deputy state epidemiologist, said of the Round-Up. “And there may not have been great compliance with masking there. We do expect to see some impact on cases from that, but it’s still too early to know the full extent of that.” When pressed for her level of alarm amid the outbreak, Brown said first and foremost that she did not attend the Pendleton Round-Up because she was concerned about community spread.Brown said she was well aware of the regional case spike “as a result of the Pendleton Round-Up,” but she still said “it’s a little early,” noting that the Round-Up only ended a few weeks ago.But the state's own numbers, along with those from federal and non-government groups, painted a darker picture.There were 424 COVID-19 deaths in Oregon in September as of Monday, making September the third deadliest month of the pandemic.September has already surpassed August's death toll and could exceed the January total of 476 by the end of the month on Thursday.Oregon's Hospital Capacity Web System (HOSCAP), which tracks availability of hospital beds in the state, reported Monday that only 6 of 89 staffed adult Intensive Care Unit beds located east of the Cascades were available.The Pendleton Round-Up was canceled in 2020 amid COVID-19 concerns, but plans moved forward in early summer as Brown had dropped many restrictions on activities when COVID-19 cases appeared to bottom out at the end of June.The event went off as scheduled despite a steep wave of cases linked to the the highly contagious delta variant that swept across Oregon and filled state hospitals to capacity.It’s still too early to say if cases foreshadow a new spike statewide and health officials are watching closely for that possibility, Jeanne said.Brown did not voice any regret in not overriding local officials' decision to go ahead with the event. The Round-Up brought tens of thousands of people into an area with high infection rates and where just 51% of eligible adults were vaccinated. Many of the visitors came from areas in neighboring states where vaccination rates were also low.Brown said the state had pressed officials across Oregon to encourage safety protocols like mask mandates. She pointed to other states where people are gathering en masse without a mandate. “If you watch an Ohio football game in Ohio, those stadiums filled with 100,000 people, there is hardly a mask there,” Brown said. “That is very different here in Oregon.”Prior to the mid-September event in Pendleton, Brown had said it was up to local officials to ensure the safety of the crowd. As for those who attended, she said they should mask up, follow social distancing guidelines, but otherwise "let 'er buck," the Round-Up's slogan.But masks were few and far between throughout the Round-Up, even though organizers were offering thousands of them and had posted signs encouraging masking and distancing. Umatilla County Public Health Director Joe Fiumara has said the number of COVID-19 cases tied to the Round-Up is an undercount, as many people who have tested positive, and are aware of others who have, are not cooperating with health officials. The reported cases include people who had COVID-19 symptoms prior to the event and yet still chose to come, officials have said. “When so many people come together in one location, it is inevitable,” Umatilla County Commissioner George Murdock said in an email. “The same thing has happened each time restrictions in Oregon have been lifted.”No county or state officials voiced any interest publicly in stopping the Pendleton Round-Up from happening. Until this past week, COVID-19 cases had declined statewide for three consecutive weeks.But state officials acknowledged in the press conference that cases had flat-lined over the previous week. They cited the Pendleton Round-Up outbreak specifically as one of several factors contributing to this trend. Last week, Umatilla County reported 505 new COVID-19 cases, the county’s second-highest total since the pandemic started.On Tuesday, the county’s average daily cases reached a new pandemic high, topping its previous record set in August, a month when more county residents died with COVID-19 than any other month — 22. But public health directors in Umatilla County and the Umatilla Indian Reservation have voiced alarm in recent days about the speed with which the outbreak has unfolded.Umatilla County officials have said they are preparing for the surge to continue for several weeks. In response, tribal officials quickly reinstated pandemic restrictions that hearken back to those from the pandemic’s early stages, including limited social gatherings. Brown said she was “very, very concerned,” adding that rural communities generally have less access to health care than counties in Western Oregon.“Honestly, I’m very concerned about the capacity of health care workers themselves,” Brown said. “They have been working day in and day out for the last several weeks providing incredibly valuable patient care, life-saving care. And to have an additional surge on top of it is incredibly frustrating, I’m sure, for them after they have worked so hard.” In August, Brown announced a COVID-19 vaccine mandate for teachers and health care workers with an Oct. 18 deadline, citing the alarming rise in cases driven by the delta variant.Besides Wheeler County, more than a quarter of health care workers in every county in Eastern Oregon county are unvaccinated, according to state data. All would be fired or forced to resign under Brown’s current mandate. Last week, Umatilla County’s public health officer, Dr. Jon Hitzman, said if a COVID-19 surge were to follow the Pendleton Round-Up, its peak would occur right around the mandate’s deadline, placing a greater strain on hospitals that are already short-staffed. In the press conference, Brown said she was “pushing forward on our vaccine requirement for health care workers because we have a really stark choice right now: a vaccinated workforce that can continue to work through our COVID surges like the one we’re likely to see again from the Pendleton Round-Up, or an unvaccinated workforce that’s depleted by quarantines and illness.”Much of the briefing was taken up with mostly upbeat news of overall drop of statewide cases, approval of booster shots for some Pfizer vaccine recipients, and the usual requests for continued voluntary masking and social distancing.The rising numbers in Umatilla County led the independent pandemic monitoring group COVID Act Now to raise the county's risk rating to its highest level: Extreme.Since first appearing in Wuhan, China at the very end of 2019, COVID-19 has infected 232.6 million people worldwide and killed 4.76 million, according to the Johns Hopkins Coronavirus Resource Center. In the United States, 43.2 million cases have been reported and 692,058 have died.Bryce Dole is a reporter with the East Oregonian. Gary A. Warner is a statehouse reporter for the Oregon Capital Bureau.