Volunteers wait for patients at a walk-up COVID-19 testing site set up by the health department in Richmond. (Ned Oliver/Virginia Mercury)
Data from the University of Virginia’s Biocomplexity Institute show that roughly a third of the commonwealth’s health districts are showing “sustained growth” in COVID-19 cases — what computational epidemiologist Bryan Lewis said could be described as a surge.
“What it basically means is over the past couple of weeks, there has been a very steep incline that has been sustained,” Lewis said. So far, Virginia has avoided the kind of headline-grabbing case growth that’s occurred in states such as Texas, Florida and Louisiana as safety restrictions across the country have almost universally been loosened or lifted (though many states are now reimposing rules to mitigate the spread). But public health experts are sounding the alarm over recent increases in Virginia, fearing that the trend will continue to worsen in the coming weeks.
“We are not out of the woods yet,” said Madhav Marathe, director of the institute’s Network Systems Science and Advanced Computing Division. “That’s the key message I would like to pass on. In fact, we have a few dark clouds on the horizon that we have to manage. Otherwise, all the good work we’ve done for the past few months could be lost.”
Some of the most recent messaging from state officials has focused on a regional growth in case numbers. Earlier this month, Gov. Ralph Northam held a news briefing that largely focused on a spike in cases in the Hampton Roads area, where daily case counts have risen from a low of less than 10 to the triple digits in mid- and late July. Northam, attributing many of the new cases to crowded bars, directed state agencies to crack down on businesses that weren’t complying with safety measures and said he’d consider a regional rollback of Virginia’s reopening plan.
And he said this past weekend that he’s considering taking “additional steps to blunt the spread of this virus” if numbers don’t come down.
But experts said recent increases should still be viewed from a statewide lens. Lewis said significant surges in certain areas of the state have been followed by an increase of cases in surrounding localities. Dr. Thomas Yackel, the president of MCV Physicians at Virginia Commonwealth University, pointed out that the total number of cases in Virginia — more than 83,600, as of Saturday — is now slightly higher than the surge scenario predicted by UVA’s COVID-19 model for Virginia.
“The trend is toward increases now, and there’s not something that we believe is going to intervene to prevent that,” he said. “Early cases can be a big concern for an exponential spike coming in the future. So, that’s my sense of why this concern is really coming to the forefront.”
According to modeling estimates, ongoing mitigation efforts — including policy interventions and weeks of good compliance with guidelines to stay at home — have averted more than 772,000 cases in Virginia. But recent projections show the possibility of a sharp spike in COVID-19 cases that begins in early August and continues through September.
Marathe emphasized that modeling can change drastically through “micro-changes” that can be difficult to anticipate. One of the biggest factors is compliance with recommendations to avoid stay socially distant and wear masks (an intervention that Christopher Barrett, the executive director of the Biocomplexity Institute, said is no longer debatable as an effective intervention by the vast majority of scientists).
But public health experts are concerned that multiple factors will continue to drive a rise in cases. Seasonal effects on COVID-19 are largely uncertain, and as the weather gets colder, Barrett said there’s concern that transmissions will rise — especially if more gatherings occur indoors. There are ongoing worries that flu season will further strain hospital capacity and make coronavirus more difficult to diagnose. And most significantly, schools are scheduled to reopen, which could further drive the spread.
“It’s hard to overestimate what it means to reopen the schools,” Barrett added. While many of the state’s largest public school districts have announced plans to reopen remotely in response to rising case numbers, in-person learning could drive mobility of the virus. Colleges and universities also remain a big concern. Many of the state’s largest universities, including UVA, have debuted plans to bring students back to campus in the fall. Barrett said that equates to more than 300,000 people from across Virginia — and, in some cases, the country and the world —migrating back to college towns.
“A lot of them are smaller than the places that people are coming from,” he added. And there’s ongoing uncertainty over how well schools can effectively mitigate spread between students and staff.
Much of the hope hinges on compliance. Lewis said that recent mobility data shows some activities, such as shopping, have returned to pre-pandemic levels. But it’s not clear that new transmissions are stemming from places like grocery stores, where customers may be mitigating the risk by wearing masks and staying six feet apart.
Those same safety measures might not be universally applied. Marathe said fatigue with the restrictions has a real effect on case numbers, and some of Virginia’s biggest increases have occurred among residents between the ages of 20 and 29. Some local health districts have traced outbreaks to small gatherings and events.
“We reviewed case investigations and observed a pattern of increased socialization with extended (non-household) family and friends, such as birthdays, Father’s Day, backyard barbecues and other celebrations and gathering among friends,” wrote Lindsay Demetria, director of the Norfolk and Virginia Beach Departments of Health, in an email on Friday. Kathryn Goodman, spokeswoman for the Thomas Jefferson Health District, said several new cases in the area had been traced to neighborhood block parties. Summer travel could compound the problem, especially as schools and businesses continue to reopen.
“That’s what I thought when I saw pictures of young adults at Virginia Beach who weren’t practicing social distancing,” said Dr. Taison Bell, an infectious disease specialist at UVA. “Some of them are UVA students or people who live in different areas who could be circulating [the virus] around the state.”
Rising cases could also have ripple effects across Virginia. Yackel said there’s been an increase in the average amount of time between a patient contracting COVID-19 and learning about the infection. Turnaround times for test results have increased in Virginia as cases surge nationally — Yackel said he’s heard of patients waiting a week or longer — which increases the risk of transmission and could get worse if new infections burden the state’s network of labs. Martha Jefferson Hospital in Albemarle County discontinued its community testing events on Thursday due to a “recent surge in community transmission” and an increase in hospitalized patients, according to spokeswoman Jenn Downs, which reduced its laboratory capacity. Elsewhere, testing turnaround times have been as long as two weeks.
Statewide, hospital capacity is at 77 percent (not including surge beds created during the pandemic), according to data from the Virginia Hospital and Healthcare Association. Experts said that if cases continue to rise, it could have a cascading effect on the Virginia’s health care infrastructure.
Bell said the state’s initial goal of 10,000 tests a day was widely regarded as too low by public health experts, and even as the numbers have risen — with a recent high of 18,043 new results recorded on Friday — Virginia remains below its testing target for fully suppressing or even mitigating the spread of the virus, according to estimates from the Harvard Global Health Institute. If hospitals in certain areas are overwhelmed with patients, Lewis pointed out they would be transferred to other areas, which would further reduce the statewide safety net.
“We aren’t quite there yet, but the model is showing we’re on that trajectory,” Lewis said. Data from the Virginia Department of Health also shows that Virginia’s percentage of positive tests is also rising, which Bell said is an indicator that new infections are outpacing the state’s growth in testing. In a worst-case scenario, Lewis added, transmissions would spike even more rapidly, further straining efforts to contain the virus.
“You can think about it sort of like bailing water out of a boat,” he said. “You’ve got this leak and you’ve got a bucket, so you can bail it out at a certain rate. But if all of a sudden, there’s three or four more leaks and the boat’s filling up three times as fast, it’s really hard to scale up your response.”
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