City emerges as virus hot spot

Vigilance urged amid ‘deeply concerning’ spike in cases, deaths

Cases of COVID-19 in Baltimore City have spiked in recent weeks, outpacing every county in Maryland and rivaling an infection level not recorded since the winter peak.

The reasons aren’t entirely clear, but state and local data suggest the pandemic could worsen still in the city before it gets better this summer as vaccinations against the disease continue.

Cases and hospitalizations are rising in the state generally, though remain well below their mid-January peak, and state and local health officials are cautioning people to wear masks, practice social distancing and get tested after traveling or if they think they’ve been exposed.

The city’s caseload started to rise again weeks after restaurants and bars reopened in late January and were already on the upswing as elementary school students started going back to classrooms in March. The latest seven-day average of new cases in Baltimore, reported daily, hit 244, a level last seen in early January and early December

right after major holidays.

“The recent rise in new COVID-19 cases and fatalities in Baltimore City is deeply concerning, particularly among residents under 70,” said a joint statement from the Baltimore City Health Department and the office of Mayor Brandon Scott.

“With a COVID-19 positivity rate above 5 percent, we have reached widespread community transmission, and are currently unable to pinpoint a specific driver for the rapid rise in cases,” it read. “The presence of new COVID-19 variants, increased city resident mobility approaching pre-pandemic times, and less vigilance around social distancing and mask wearing all appear to be contributing factors. The pandemic is far from over.”

Nationally, many cities and states are reporting upticks as others are showing declines, and there is likely more than one reason.

In addition to the city’s dense population, more contagious variants and people relaxing their guard, the city also has targeted its vaccination efforts on its most at-risk to serious disease, which includes seniors and minorities. Officials have said that makes vaccination efforts more labor-intensive and slower overall.

About 32% of the city’s population has been at least partially vaccinated, compared with close to 40% statewide.

Officials from the Maryland Department of Health specifically traced the rise in cases in Baltimore and other counties to the B.1.1.7 variant first found in the United Kingdom, which is also prevalent in neighboring states Pennsylvania, New Jersey and Delaware.

The state agency is “aggressively” promoting monoclonal antibodies as a treatment for people in the early stages of infection and closely coordinating with hospitals, epidemiologists and public health professionals to track and trace where variant strains are originating and how they are spreading, according to the department.

For now, the city is a hot spot rivaling some of the most affected states, with an average daily infection rate in the past week of about 43 per 100,000 residents, according to a Baltimore Sun analysis of state data. Baltimore County had the state’s next highest rate at about 35 per 100,000.

Jennifer Nuzzo, lead epidemiologist for Hopkins’ coronavirus resource center’s Testing Insights Initiative, said not enough of the state or national population is fully vaccinated yet to keep the virus from spreading.

“It’s not surprising that when you have young people take their finger off the pause button, the virus is going to increase the number of people it infects,” she said.

In counties elsewhere in the Baltimore region, case rates per 100,000 residents in the past week were: 32 in Harford; 24 in Anne Arundel; and 19 in Carroll and Howard.

Maryland overall had a rate of about 23 per 100,000 people.

Cases have been rising in many states, with Maryland in the middle of the pack. An analysis by The New York Times shows in the past week that the state infection rate was worst in Michigan with 79 per 100,000 people, followed by 44 in Rhode Island and 41 in New Jersey.

“Maryland is somewhere in the middle with cases going up and not where we want, but not as severe as other places,” said Caitlin Rivers, an epidemiologist and senior scholar in the Johns Hopkins Bloomberg School of Public Health’s Center for Health Security.

“I expect there will be somewhat of a bumpy period, but we will get beyond it as the vaccine rolls out,” she said. “It takes a few weeks for immunity to kick in, and many people have had only one dose. But after that we should enjoy more flexibility this summer.”

Most of the vaccines administered have been those from Pfizer/BioNTech and Moderna, both of which require two doses. Far fewer have had the one-dose Johnson & Johnson vaccine, now mostly on hold as regulators investigate extremely rare blood clots.

Rivers speculated that the city’s dense population was contributing to the rise in cases. She said young adults who just recently became eligible for vaccination could be contributing as they go to recently reopened bars and restaurants.

“Last summer, they were quicker to get back into the community when they perceived the risk was lower,” said Rivers, adding that may be “a durable pattern.”

City leaders did not say whether they would consider reimposing restrictions, but that likely would face considerable resistance from businesses and the public. There are alternatives, said Dr. Leana Wen, a former city health commissioner and professor of public health at George Washington University.

“It will be very difficult to have businesses that have been hurt so much by the pandemic to close again,” she said. “One thing they could consider doing is to ask for proof of vaccination status. For example, restaurants and bars can be safely at full capacity if everyone there is fully vaccinated. This helps to reduce COVID-19 spread, improve economy recovery, and incentivize vaccination.”

If nothing changes, one projection from the PolicyLab at the Children’s Hospital of Philadelphia shows the city’s high rate of infections continuing through May. It also projects Baltimore, Harford and Cecil counties’ rates to rise, though not to the worst peak over winter.

PolicyLab researchers cited Maryland’s rising hospitalization rate in a recent blog post, up 50% since mid-March.

State health data shows there were 1,244 people hospitalized Thursday, up eight from the day before, but below the peak in mid-January of 1,952.

The PolicyLab researchers wrote, however, “because of steep declines in test positivity rates, our models forecast that Maryland counties are nearing their spring peaks and case incidence may soon decline.”