As virus rates rise, state’s precautions considered
As coronavirus cases rise, medical experts say the state is better prepared to avoid a lockdown like in the spring, but fatigue with virus precautions and other challenges could set Connecticut back.
“We’re in a better position in a lot of ways compared to where we were in the spring, but we still need to be cautious,” said Dr. David Banach, hospital epidemiologist and infectious diseases expert with UConn Health.
The state’s positivity rate, which measures the number of positive cases per test taken, was 2.9 percent Friday. Although below the national rate of higher than 5 percent, the state’s rate shows much higher rate than experienced over the summer which was consistently below 1 percent.
“Our infection rate was the lowest in the country over the last few months, and like the rest of the country we’ve been ticking up,” Lamont said at a news conference Friday. “[ Friday], the United States of America announced more infections than ever before, and while Connecticut has gone from a 1 percent infection rate to a 2 percent infection rate, we’re now about 2.3 [ percent] over the last seven days and 2.9 percent today. And that’s not a trend I like to see.”
Lamont hasn’t called for widespread scaling back business operations, schools being opened or full- on cancellation of all public events. Instead, he has identified towns by a color- coded system and issued recommendations based on the color. The red towns, which average 15 or more confirmed coronavirus cases per day over a week, are recommended to revert to the state’s rules for the second phase of business reopenings. Residents in those towns, including Danbury, Norwalk and Fairfield, are advised to limit trips outside their homes and to avoid gatherings with non- family members.
The restrictions come as state and public health officials see a trend of COVID- 19 fatigue, where people are letting their guard down with decreased mask wearing and increased gatherings. Officials believe the fatigue is among the primary reasons for recent increased cases.
“Everyone is just getting tired of having to avoid social gatherings and not traveling,” said Summer McGee, dean of University of New Haven’s School of Health Sciences. said.
Majid Sadigh, an infectious disease physician and director of global health for Danbury- based Nuvance Health, said the state’s outlook depends on how the public acts.
“The virus behavior depends on the human behavior,” he said. “And it is good news. You can modify the virus behavior by your behavior. Many other viruses, we have no control over.”
Cold weather could also help the virus spread, pushing people indoors, Sadigh said .
“Everything would suggest that this virus is going to get worse during the wintertime, but to be honest, we don’t know,” he said.
How it could get worse
The weather is sending more people inside and with it, have come increased cases of COVID- 19 which does not suprise Banach.
“The real question is whether we see a slow creep up in rates or whether we see a more rapid increase,” he said.
That depends on factors like holiday gatherings and obedience to mask and social distancing guidelines, Banach said.
Cases spread rapidly in congregate settings, such as nursing homes and correctional facilities, so outbreaks there could drive up rates, too, Banach added.
Facilities like these were huge problems early into the pandemic, but methods such as frequent testing and contact tracing have been effective at preventing cases recently.
“They’ve incorporated these kind of measures in their routine of care of patients and their routine practices, which I think is a good thing,” Banach said. “They are more prepared than they were in the spring in order to prevent rapid transmission in the facilities.”
Spread among high- risk populations, such as the elderly, could lead to an increase in hospitalizations, he said.
Travel restrictions on drivers coming from other states is hard to enforce, Sadigh said.
“I don’t think they have very careful protocols for them,” he said.
Stricter guidelines?
While cases remain relatively low, McGee backs the state’s approach permitting so- called “red- alert” communities with higher rates to return to the restrictions under the phase two reopening plan. This allows local health authorities to target their responses, she said.
“What’s happening in Hartford is not the same as what’s happening in New Haven, as what’s happening in Fairfield,” she said. “That’s a really smart move.”
So far, only Windham has rolled back to Phase 2.
Regions should work together otherwise residents in a “red” community could drive to a neighboring town where restrictions are loosened, McGee said.
“The virus doesn’t recognize city boundaries, so they have to be in communication and make decisions together,” she said.
But as rates increase, McGee said Connecticut should reconsider scaling back capacity at bars and restaurants at a statewide level.
“A lot of these smaller gatherings are happening in those establishments,” she said. “We need to look very carefully at some precise rollbacks where people have to engage in activities with their masks off.”
She said it is hard to say what rate the state would have to hit to reach that point.
“If we begin to see we’re crossing that 5 percent positivity threshold, certainly as we get closer to 10 ( percent), there’s a real concern,” she said.
In other parts of the country, the virus has spread rapidly when officials fail to quickly put restrictions in place, she said.
“They have to make those sacrifices,” McGee said. ‘ It’s really difficult to tell your local businesses that they have to reduce their capacity, but the consequences of not doing that are much worse than doing that for a brief period of time.”
Banach hopes a lockdown will not be needed. Experts know more about the virus and how it spreads than they did in the spring, he said.
“A severe lockdown is really the response to uncontrolled spread, widespread infection,” Banach said. “Right now, Connecticut is not in that kind of position.”
But a strict two- week lockdown — like the one the state was under in March through May — might be necessary to quell a larger increase, McGee said.
“As painful as it may be to be to have to do another lockdown, it would be brief and probably less painful than if we didn’t respond,” she said.
This would be part of focused effort to test residents and identify and isolate positive cases, she said.
“It’s better than not taking those decisive actions and ending up having incredibly high positivy rates and taxing our health care system as a result,” McGee said.
Sadigh said he feared another lockdown would cause people not to go to the hospital for other illnesses and emergencies, which was a problem in the spring. It could also worsen mental health, he said.
“I worry about the psychological aspect of the confinement,” he said.
How it could improve
The state has contained the virus by encouraging testing and conducting contact tracing, which will be key this winter, Banach said.
“We have to think about how we can support those measures in a way that allows them to be done aggressively moving forward,” he said.
Sadigh said these efforts should be intensified in “red” communities.
“We have to go where the fire is,” he said.
Doctors have gotten better at treating the virus and getting patients home sooner, experts said. Far fewer patients are in the hospital than they were in April because high- risk groups have stayed home.
“The virus is not as severe as it used to be because of the human change or the significant change in human behavior,” Sadighn said.
Educating the community and getting the public on board with precautions will be important, experts said.
Officials initially concentrated on urging people not to throw large events, such as weddings. But the focus should turn to promoting staying in one’s “bubble” and deterring smaller gatherings, where much of the spread originates, McGee said.
“There’s a real significant amount of risk from a lot of these smaller, sequential gatherings,” she said.
But there is little the state can do other than explaining why people shouldn’t gather, Banach said.
“People have the liberty to act as they please within the confines of their own home,” he said.
But Sadigh said he fears the “pandemic of misinformation” and people refusing to listen to scientists will be major obstacles.
“The most disturbing element that makes the virus extremely happy is mistrust of the public to the science,” Sadigh said. “I have no solution to that.”