The director of the Oregon Health Authority, Patrick Allen, told OPB a fourth wave of COVID-19 infections could cause “upwards of 1000 cases a day” within the next month if people don’t alter their behavior.The spread of contagious variants and the easing of restrictions on businesses and social gatherings have already led to an increase in COVID-19 cases locally and nationwide. Now, those rising case counts have triggered a return to tighter indoor dining capacity limits and restrictions on other businesses and personal gatherings in several of Oregon’s most populous counties.The state moved six counties into its “high risk” category Tuesday, triggering stricter capacity limits on restaurants, bars, gyms, shops, and limiting private social gatherings to 8 people.The affected counties include Multnomah and Clackamas in the Portland metro area, as well as the more rural counties of Deschutes (home to Bend), Klamath, Linn and Tillamook, expanding Oregon’s list of “high risk” counties to 14.Gov. Kate Brown also announced a major change to the metrics the state uses to determine when to judge counties at “extreme risk,” which triggers an outright ban on indoor dining, among other restrictions.That risk level will only be triggered in limited circumstances that indicate the state could be at risk of running short on hospital capacity: COVID-19 positive patients occupying 300 hospital beds or more, and a 15% increase in the seven-day average over the past week.Three counties, Josephine, Klamath, and Tillamook, meet the state’s case and positivity rate threshold for being designated “extreme risk” but will be considered high risk instead, under the new guidelines.The governor has described the current situation as a race between the vaccination effort and the spread of more transmissible variants of COVID-19 that have been detected across the state.Two states with high enough case numbers to be considered “extreme risk” — Josephine and Tillamook — have among the lowest vaccination rates in the state.Overall, Oregon’s vaccination rates aren’t yet high enough to stop the spread of COVID-19: only about one-third of Oregonians have received at least one dose of the vaccine, and 19% are fully vaccinated. Statewide, 76% of seniors 65 and over have received at least one dose of the COVID-19 vaccine and 57% are fully vaccinated, but rates vary widely across the state.Allen warned that seniors in rural parts of Oregon where vaccination rates lag behind are particularly vulnerable as case counts, test positivity rates and hospitalizations all continue to rise.Grant County has the lowest rate of vaccinated seniors, with just 23.6 % fully vaccinated, while the highest is Baker County at 87.7 % fully vaccinated seniors, according to the CDC.Allen fears rates for seniors are leveling off at 50% or less in some rural areas.“I think that there are a lot of factors, and it is a little hard to get to the bottom of that. I don’t think it’s because of the lack of access to vaccine. I think it’s a lack of concern about the disease in some cases, a perception that a lot of us have that we’re healthy and strong,” Allen said.Oregon was among the last states in the nation to open up vaccine eligibility broadly for people 65 and up, and in many counties, a fragmented, largely online system for signing up for appointments has been difficult for older adults to navigate.Allen says that while the demand for vaccines still outstrips the supply in the Portland metro area, that’s no longer true in parts of rural Oregon, where it takes longer for vaccination appointments to get booked up.Statewide, the pace of vaccinations has ramped up significantly, a factor in the governor’s decision to open up vaccine eligibility to all Oregonians 16 and older on April 19, in keeping with a new deadline set by President Joe Biden.“Our daily average seven days a week is closing in on 35,000 people. While you still get a traffic jam when you make a new group eligible, we’re powering through those traffic jams faster,” Allen said.