At 2:30 a.m. last Thursday, Dr. Maxine Dexter could not sleep. 

The critical care and lung physician at Kaiser Permanente in Portland—not coincidentally, the first hospital system in the region to cease accepting elective and non-emergency patients—got out of bed, found her computer, and wrote a long letter to Gov. Kate Brown, pointing out all the steps that Oregon needed to take to fight off the COVID-19 outbreak, including an immediate closure of schools, a step that the state had been holding off on to that point. 

By 6 a.m., Dexter had a draft to share with friends in the medical profession, including Dr. Sharon Meieran, an ER doctor and Multnomah County Commissioner, and Dr. Smitha Chadaga, an internal medicine doctor at Legacy Health Systems who has campaigned for universal health care. 

The letter went public that afternoon, and quickly gained steam. Ultimately, more than 400 Oregon doctors added their names. That evening, Brown announced a statewide school closure. 

“And we thought, well, that worked, we need to do it at the national level,” says Dexter. So Friday morning, at 6 a.m., she was back at her computer, this time working on a letter to Vice President Mike Pence, workshopping it with her colleagues, and then with staff at Sen. Ron Wyden’s office, who helped refine the message for a national platform.  

By 6 p.m. that night, the letter went live on Medium.com, and was reportedly passed around on the House floor, where debate over a coronavirus relief bill wrapped up at 1 a.m. Whether it ever made its way to Pence is an open question, but almost 5,000 physicians and counting from around the country have signed the letter. 

“It gives me hope that people in a time of crisis are still looking for leadership, and will lean into those people wherever they find them,” says Dexter. “The normal chains of command aren’t necessarily the right ones when things start going sideways.” 

Since then, Dexter has been urging follow-up on the state and national level—her call for statewide coordination between all Oregon hospitals, for example, was heeded this afternoon. She was displeased when Brown announced early Monday morning that bars and restaurants would be permitted to remain open, and relieved when the governor abruptly reversed course later in the day and announced that in fact, bars and restaurants needed to shutter, and no gatherings of more than 25 people would be permitted in the state for the next month. 

But so much more has yet to be addressed, she said. Oregon urgently needs more ventilators and oxygen tanks to prepare for the expected exponential growth of the virus. And, pragmatically if heartbreakingly, doctors need firm, overarching guidelines on who will get such life-saving resources if they get scarce, so that medical professionals can make tough calls without fear of future lawsuits. 

Dexter, who is running to replace retiring Rep. Mitch Greenlick in the Oregon House of Representatives, is leaving the campaign trail, and all fundraising events, to return to full-time medicine. Her family is hunkered down at home, she says, limiting trips to the grocery store and interaction with others, though she’ll be taking walks and bike rides in the sunshine for mental health breaks. 

“We have eight to 14 days before it starts to feel like a war zone at the hospital,” she says. “It’s hard to fathom the resources we will need. We are not ready. We will get as ready as we can. People are working hard to make that happen. It would have been more streamlined if our government had looked at the signs and had started leading earlier.”