Physicians with the Carilion Clinic in Roanoke wear enhanced personal protective equipment inside the health system's facilities (Photo courtesy of the Carilion Clinic).

In early January, Gov. Ralph Northam warned that the worst of Virginia’s winter surge may not have happened yet. 

“The virus is worse now than it’s ever been,” he said at a news briefing. At the time, the state had reached an all-time high in daily new cases and hospitalizations — a trend that threatened to overwhelm some hospital systems. Many local health departments were forced to suspend contact tracing programs amid the spike, warning residents that winter travel and holiday gatherings had made it impossible to keep up with cases.

“Case numbers are about four times higher than they were last spring, and we can expect them to go higher,” Northam continued. “In fact, the [University of Virginia] model shows cases could keep rising until Valentine’s Day or even later.”

That didn’t happen. According to data from the state Department of Health, cases in Virginia crested at nearly 6,200 a day on Jan. 18 and have been on a downward trend ever since. Bryan Lewis, a computational epidemiologist who works on the model from UVA’s Biocomplexity Institute, said the plummeting numbers were a surprise to scientists analyzing the data.

“There are about 30 or 40-odd academic groups participating in the CDC’s forecasting hub, and I don’t think any of them predicted the cliff we fell off there,” Lewis said, adding that cases dropped dramatically not just in Virginia but across the country. “We went into this declining phase, and honestly, it’s declined much more rapidly than our model predicted.”

Figuring out why the state’s numbers improved so rapidly is a more difficult question. Respiratory viruses thrive in cold weather, and Lewis said it’s likely that the precipitous growth in infections was tied to specific circumstances — namely, holiday travel and gatherings — that also stopped suddenly after the start of the new year.

“It hopped once or twice through those social networks, and once it got to mid-January, there just weren’t any more people within those initial circles for it to transmit to,” he said. The improving metrics have been another ray of optimism for Virginians as access to vaccines also continues to expand. 

On Tuesday, VDH announced that three local health districts — Eastern Shore, Southside and Pittsylvania/Danville — would move into Phase 1c of the state’s vaccine rollout, a broad category that includes restaurant workers, university faculty, energy, construction, transportation and sanitation workers, lawyers, media and a range of other professions. 

Other districts are expected to make the shift “within weeks,” according to VDH. Dr. Danny Avula, the state’s vaccine coordinator, said the current progress put Virginia on track to provide vaccines to all adults on or even before President Joe Biden’s May 1 deadline — offering what Northam has described as a “ray of light at the end of a long, dark tunnel.” 

Nurse Lisa Bastek gives the Moderna COVID-19 vaccine to 100-year-old Annie Laura Downing during an event at Richmond Raceway in Richmond, Va., Feb. 2, 2021. (Parker Michels-Boyce/ For the Virginia Mercury)

For public health experts, though, there’s also some fear about what might happen in the spring. Lewis said mobility data has ticked up over the last three weeks, indicating a rise in restaurant visits and other pre-pandemic activities that could spur the spread of disease. If Virginians let their guards down before most of the population is vaccinated, there’s concern that the state could see another spike of cases in the spring.

“That’s a nightmare for me,” said Dr. Taison Bell, an infectious disease specialist at UVA. “And it’s a predictable one.” Like other experts, he’s particularly worried that COVID-19 variants could complicate efforts to keep the virus under control. 

Virginia has already reported multiple cases of both the B.1.1.7 and B.1.351 variants — forms of the virus first discovered in the United Kingdom and South Africa. While there’s no evidence that either can cause more severe COVID-19, there are indications that they’re more infectious than other versions of the virus.

It’s currently estimated that variants make up about 20 percent of the virus circulating in Virginia — a smaller percentage than initially modelled, Lewis said (though surveillance of new cases is spotty and reports are on a time lag). 

But other states, including California and Florida, have more variants circulating than expected, he said. For public health experts, there’s concern that Virginians could travel to those areas, especially over spring break, and bring new cases back home, spurring another surge in infections.

Right now, Bell said he’s encouraged by the state’s more conservative approach to restrictions. In late February, Northam relaxed a few guidelines, including raising the attendance cap on outdoor gatherings from 10 to 25 people. But he’s taking a much more moderate approach than other state leaders, including Gov. Larry Hogan in neighboring Maryland, who lifted capacity limits on restaurants, stores and entertainment venues last week.  

That, combined with Virginia’s improving metrics, made Bell “guardedly optimistic,” he said. COVID-19 hospitalizations in Virginia have plunged from an average of nearly 3,330 a day in mid-January to a little over 1,000 as of Tuesday. The statistic suggests that overall infections are declining, given that only a relatively small percentage of coronavirus patients need to be hospitalized.

“So, if you have an increase in hospitalizations, it almost always means there’s more virus in your community,” Bell said. The state’s percentage of positive tests also declined to 5.2 percent as of Tuesday. At the same time, the state’s daily number of tests administered has also declined. Bell said it’s an indicator that fewer people are presenting with symptoms of the virus and fewer cases are spreading throughout the community.

For Lewis, of greatest concern is vaccinating as many Virginians as quickly as possible. After a rocky start to the state’s rollout, just over 21 percent of the population has now received at least one dose of vaccine. As of Tuesday, Virginia ranked 23rd out of all 50 states and Washington, D.C. when it came to the number of vaccines administered per 100,000 people.

As the state’s pace improves, Lewis said he’s more concerned that some areas might see high rates of refusal, giving the virus a “Petri dish” where it can continue to circulate.

A Kaiser Family Foundation report published late last month found that “Black and Hispanic adults continue to be more likely than White adults to say they will ‘wait and see’ before getting vaccinated” and that “nearly four in 10 Republicans and three in 10 rural residents say they will either ‘definitely not’ get vaccinated or will do so ‘only if required.'” In Virginia, Avula said concern over potential vaccine hesitancy has shifted from Black and Latino residents to those in more rural areas of the state, where there’s often been more resistance to masks and other statewide safety orders.

Most health experts estimate that at least 70 percent of the population needs to have acquired resistance to the virus in order to reach herd immunity. But in some areas, there could be pockets where only 20 to 30 percent of people are vaccinated. 

“That’s what we really don’t want — for that virus to continue to evolve and interact with people who have been vaccinated and figure out ways to get around that vaccine,” Lewis said. “So it’s being kept alive by those folks who are maybe more hesitant and less willing.”

“In my mind, this is a race between variants and the vaccine,” he added.