Could Virginia be heading for a new COVID-19 case peak?

Though a University of Virginia model now projects a potential new peak in Virginia COVID-19 cases in November, a top state health official says it’s too soon to tell whether an uptick in cases over the past few weeks is indicative of a bigger trend.

“It’s premature to say now things are increasing,” said Dr. Lilian Peake, Virginia’s state epidemiologist. “We really have had quite a bit of increase over the summer. And that’s been generally going down. Now we are seeing a little bit of increase but it’s small and we need to see what happens with that.”

A model released last week by UVA’s Biocomplexity Institute projects that confirmed COVID-19 cases will peak in Virginia during the week ending Nov. 22 with 8,394 weekly cases and a total of 202,040 confirmed cases by Thanksgiving, though the institute cautioned that model isn’t necessarily a crystal ball. (As of Tuesday there were 167,754 confirmed and probable cases in Virginia.)

“Models are designed to project what could happen based on current trends but do not forecast what will happen. Behavioral responses drive changes in current trends,” the Oct. 16 report says. Previous reports by the institute indicated Virginia hit its weekly peak the week of Aug. 9, when there were 7,581 weekly cases. Incidence of COVID-19 in Virginia remains below the national average, Peake said, with 88 new cases per 100,000 last week compared to the national average of 117 per 100,000.

The model says five Virginia health districts have entered “surge trajectories” (defined as 2.5 or more confirmed cases per 100,000 people per week) and the “reproduction rate,” the number of cases expected to be generated by one case, is above 1.0 statewide and in all but one region.

Bryan Lewis, a computational epidemiologist and a research professor at UVA, said the institute’s latest projection was also informed by increasing transmission rates in cooler states like Wisconsin, North Dakota and South Dakota and previous research on how respiratory viruses spread, particularly when cold weather forces more people inside.

“We’ve been seeing increased rates up there,” he said.

That onset of colder weather, combined with schools across Virginia resuming in-person instruction, school-related virus transmission data from other states as well as the increased cases in college towns when universities brought students back, augurs an increase in virus cases into the late fall and early winter.

“While early, national and global trends suggest concerns about winter case growth and schools reopening may be founded,” the institute wrote in its most recent update.

But it’s not carved in stone. Human behavior can make all the difference, both Lewis and Peake said. And after more than eight months of grappling with a pandemic virus that’s infected millions of Americans and killed almost 221,000 people (including nearly 3,500 in Virginia) now isn’t the time to let “COVID fatigue” set in, especially as Thanksgiving approaches and many people are considering how to approach large family gatherings, they said.

“Outbreaks are occurring when people let their guard down,” Peake said, citing recent examples of workplace breakrooms and lunch rooms when masks come off and social distancing isn’t observed. “One thing that we have learned is there is a lot of asymptomatic transmission.”

Peake said state officials are monitoring mounting case numbers in southwest, central, and southern Virginia and have rapid-response teams to help curb rising transmission, similar to the approach the state took with surges in eastern Virginia over the summer. The teams combine workers focused on testing strategies, containment of outbreaks, communications and making recommendations for isolation and quarantine, she said.

“Each region is doing that to really look at the data and understand what can we do differently,” Peake said.

The prescription for Halloween and the coming holiday season is more of the same: masks, social distancing and avoiding large gatherings.

“It’s been hard but it has kept a lot of people well,” Peake said.

“Virginians have done a really good job of taking this seriously and putting preventative measures in place,” she added. “Transmission is continuing. In some areas it is quite high. So it’s important for all Virginians to continue to take this seriously and practice preventive measures that we know are working. … There has been some good news about potential vaccines. So if we continue to take this seriously and practice safe measures, hopefully in the future we’ll have a vaccine and have better treatment.”

From a policy standpoint, Virginia has done a good job of managing the pandemic, Lewis said. Some of the commonwealth’s residents, however, don’t get as high marks for their compliance, in his view.

“There’s guidelines, mandates, etc. …  But adherence is what drives reduction of the disease,” he said.

Virginia, and much of the rest of the country, he noted, are entering a potential high transmission season not having knocked down prevalence of the virus enough to relax any restrictions.

“We’re heading into the winter with a higher number of cases than we would have preferred,” he said, likening the situation to a speeding car coming to a bend in the road. “We’re going into this curve a little too fast.”