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COVID-19 cases could rise as Virginians move toward Phase 3 reopening

COVID-19 cases could rise as Virginians move toward Phase 3 reopening

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Gov. Ralph Northam is expected to announce next week that the state can enter Phase 3 as early as Friday.

This would remove restrictions for inside restaurants and stores, allow gatherings of up to 250 people, increase capacity in gyms, open swimming pools and allow up to 1,000 people to visit zoos and outdoor recreational spaces.

What it doesn’t do is remove the threat of the virus.

“I had somebody I met this weekend say, ‘Oh, we decided coronavirus was over in our family.’ I said, ‘That’s interesting,’ and somebody I was with pointed out what my job was. So my response was, certainly the coronavirus, the pandemic is not over,” said Dr. Molly O’Dell, who is leading the pandemic response for the Roanoke and Alleghany Health Districts. “As I told you before, it’s not over until there are no new cases for two incubation periods, and we are nowhere near that.”

While the state’s trend line shows fewer cases this week than last week, that is not the case in Southwest Virginia, where the numbers have climbed since Virginia moved into Phase 2 of reopening.

“While our data is good and our restrictions may ease, the virus has not gone anywhere,” Northam said. “We are adapting our lives around it, but it has not changed.”

The disease is still killing people and sending them to hospitals, although at a slower rate.

During the last week of May, more than 7,500 Virginians tested positive. This week, while testing numbers were at the same level, the number of positives dropped to 3,582 new cases.

Coronavirus hospital admissions, which were averaging about 500 a week in May, dropped below 400 this week.

Deaths were being recorded at a rate of about 200 a week during May. They dropped to 95 the first week of June and have continued to decrease to 59 new deaths this week.

The trend lines are looking good overall in Virginia, but as Northam added, they aren’t looking encouraging for states that have already relaxed restrictions. Cases are on the uptick in Texas, North Carolina, South Carolina and Florida.

So how should we behave? Is it safe to venture out?

O’Dell said you can just go ahead and figure on cases rising as more people move about, but that doesn’t mean you need to stay locked inside your home.

“There is a difference between going to the beach or going to a lake, basically sheltering in place and sticking with your own family or your own germ pool. That’s a different scenario than you go to the lake or you go to the beach and everyone runs in and plays with everybody else,” she said. “There are two ways to go to Claytor Lake, and we are just going to have to wait and see how people decided to behave.”

For her, “it’s all going to come down to social distancing and compassionate use of face coverings and appropriate hand washing like we’ve been saying since 88 days ago. It’s not going to change.”

Want to know how effective those things are? Modelers with the University of Virginia’s Biocomplexity Institute provide weekly projections for the Virginia Department of Health. Friday’s report factored in compliance with infection control. If everyone in the Roanoke metro area gave each other space, wore masks and washed their hands, the number of new cases each week would be just a handful until zeroing out in July and August.

If only some people complied, cases would steadily rise by 100 to 200 more each week during the summer in the best-case scenario, and anywhere from four to eight times that many in a worst-case scenario.

The modelers’ best scenarios also rely on robust contact tracing to isolate and quarantine people who have been exposed to the virus.

The department is still hiring the more than 1,000 tracers that it needs.

Dr. Costi Sifri, director of hospital epidemiology at UVa, and Dr. John Voss, who specializes in clinical epidemiology, follow the modelers. They also look closely at Virginia’s daily data and similar reports from other states to understand how the disease is spreading.

“We don’t have the epidemiology tools that we want. We don’t have the ability to do the experiments we’d want — to take a random sample of the population that is evenly distributed, test people on a repeated basis to know exactly what is occurring at any point in time,” Sifri said.

So they rely on case counts and the ratio of positive tests to the number administered. Hospital and death data lags a few weeks behind how the virus is behaving because it takes time to become sick after exposure and then more time to become very ill.

They said the state’s many reporting changes as to how it counts tests — which now include multiple tests of an individual, the mixing of different types of tests and other changes — have added noise to the data.

But all the data has limitations, they said.

“I don’t think people have a full appreciation of exactly how noisy data can be. If you look at a star, it flickers and yet the light that comes from that star is constant. I don’t know the physics of it, but there are variations that occurred over time,” Sifri said.

“What the VDH site does is show you what happened,” Voss said. “People want to know what happens in the future.”

That’s where the modeling comes in, they said, especially when it includes mobility data and drills down into smaller geographic areas.

“As we relax social distancing, we are going to see more infections. It’s just a matter of how many and how fast and whether we can control that,” Voss said. “Here at UVa, we have had about the same number of admissions and discharges as last month. I would expect as social distancing is relaxed, it is only natural we will see an uptick.”

Sirfi said the novel coronavirus spreads the same as other respiratory viruses through regions and hot spots.

He said while he hesitates to use the flu in an analogy, since the coronavirus seems to be more virulent and deadly, people understand when they hear the flu is bad in another part of the country.

“When it comes into your state you hear of certain places like, boy, it’s really bad in Richmond right now, but we aren’t seeing much here in Charlottesville. I’m not sure people have made that connection with COVID.”

The Health Department website includes data on how the disease is behaving in the health regions. The trend line for the state, which shows a deep drop in cases, follows that of heavily populated Northern Virginia, but looks much different in Southwest Virginia, where the line shows small, steady increases.

Jacob Shortt, a professor in Virginia Tech’s Pamplin College of Business, said students in his accounting analytics class used the Health Department data in the spring for year-end projects. The data was just coming onto the dashboard.

Now it is spread over multiple pages with multiple tabs to navigate.

“It’s a little information overload. It’s hard to know what are the salient points you should focus on,” he said.

He said the seven-day moving average that the health department uses is a good tool for looking at how numbers change over time, and that it’s encouraging that the department is using a platform that makes the data public and usable by others.

For the general public’s use, though, Shortt suggested they understand what’s happening in their locality and region and the demographics of who is affected.

“From a day-to-day standpoint, I’d look at my region. But at Virginia Tech, the majority of students come from Northern Virginia and Virginia Beach, so the thought going into the fall semester, as a professor, I would look at these as well because it is going to affect our community in a couple months,” he said.

Until then, as restrictions ease and the summer calls, how should people behave, knowing the virus is still there?

“As an infectious disease expert and hospital epidemiologist, I try to live the way I encourage people to behave,” Sifri said. “I do feel there are things I can do that don’t pose much risk to myself and my family.”

They recently spent a few days at Smith Mountain Lake.

“We didn’t go with other families. We spend time with ourselves outdoors,” he said. “There is evidence to show respiratory viruses, in general, are less when you are outside.”

“We should all put a plug in for national parks,” Voss said.

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