Pandemic may end soon, but keep your mask

“Although we’ve experienced large declines in cases and hospital admissions over the last six weeks, these declines follow the highest peak we’ve experienced. We may be done with the virus, but clearly the virus is not done with us.” Rochelle Walensky, CDC director

COVID-19 cases, hospitalizations and deaths in Maryland have plunged in the past month. Vaccinations against the virus are ramping up.

A year after the first cases of the coronavirus were reported in the state, public health officials say they feel optimistic that the pandemic and most of its restrictions could be behind us this summer if trends continue and people behave.

“Keep in mind there is probably not going to be a point where things are just normal,” said Justin Lessler, an infectious disease epidemiologist at Johns Hopkins University whose team has been modeling possible virus trajectories. “This will be a gradual process where eventually we wake up and say

COVID is not that big of a deal anymore.”

But the expressions of hope come with concerns from public health and government officials that some state leaders will drop restrictions too soon and the public will relax too much.

Indeed, Texas and Mississippi became the latest of several states to abandon a mask mandate in recent days, drawing a rebuke from President Joe Biden.

Officials also worry about more contagious virus strains gaining a larger foothold around the country. A variant first discovered in the United Kingdom is expected to be the dominant strain in the United States by the end of March.

That means the situation still could worsen before it gets better, officials contend.

State health officials have counted more than 383,000 infections in Maryland from the coronavirus, though the actual number is estimated to be several times higher. More than 35,000 people in the state have been hospitalized and more than 7,700 have died, state figures show.

But the number of new daily cases has dropped by about three quarters since the record highs in mid-January to around 800, and the number of people hospitalized has dropped by more than half to under 900.

Officials say the drop is likely due to increasing vaccinations and adherence to preventive measures such as masking and distancing.

Lessler said it is also likely due to the high number of people already infected, whether they knew they had COVID-19 or not. Lessler estimates the number ever infected likely approaches a third of the population.

But he and others warn that the public needs to remain vigilant.

Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, said during a recent White House briefing that declines in cases already may be slowing down and leveling out at an elevated level.

“Things are tenuous,” Walensky said. “Now is not the time to relax restrictions. Although we’ve experienced large declines in cases and hospital admissions over the last six weeks, these declines follow the highest peak we’ve experienced in the pandemic. We may be done with the virus, but clearly the virus is not done with us.”

Biden echoed those concerns, adding that more vaccine is on the way — enough for every U.S. adult by the end of May.

That doesn’t mean every adult will get a vaccination by then. The rollout nationwide and in Maryland has been slow. About 950,000 people in the state have gotten at least one dose of vaccine. Both the Pfizer and Moderna vaccines require two doses. The newly authorized Johnson & Johnson vaccine requires one.

The question is whether the vaccine gets out in time to stem another wave of cases, potentially fueled by more contagious forms of the virus. Already Maryland officials have identified three potentially dangerous variants in samples taken from infected residents.

Maryland providers have administered more than 1 million total doses of COVID-19 vaccines, officials said last week. The state is averaging 35,065 shots per day. Slightly more than 40% of all Marylanders 65 and over, the most at-risk population, have been vaccinated.

As of Tuesday, CDC data shows Maryland labs had identified 100 COVID-19 cases caused by variants. Of those, 89 were the U.K. variant, 10 were a variant first found in South Africa and one was traced to Brazil.

Public health officials expect those numbers to rise as the state bolsters its capacity for genomic sequencing, the testing necessary to differentiate between coronavirus strains. Most cases caused by variants, officials say, are not linked to specific travel but viruses found circulating in the community.

Variants have been found all around the country, with the most cases reported in Florida, Michigan and California.

Already, the U.K. variant, known as B.1.1.7, has been associated with a spike in cases in European countries where it’s become dominant, said Dr. Leana Wen, a George Washington University professor of public health and a former Baltimore health commissioner.

Italy, for example, has experienced a resurgence of cases driven by the U.K. strain. The variant is prevalent among schoolchildren who’ve been infected, and more young people are now contracting the disease than older residents. Local leaders in the country have begun to reinstitute lockdowns.

Following a recent study, scientists say that variant is likely more lethal, and Wen said it was associated with an increase in deaths in the European countries where it’s prevalent. How it and other variants affect the United States is “anyone’s guess,” she said.

That’s because there are too many unknowns about the mutations and their prevalence here due to the lack of genomic sequencing, a reflection of persistent underfunding of public health, said Dr. Brian Castrucci, president and CEO of the Bethesda-based de Beaumont Foundation, a public health-focused charitable organization.

Variants weren’t found in Maryland until January when that testing began ramping up.

Now policy decisions to ease restrictions could compound the variants’ effects before more people are vaccinated, Wen and Castrucci said.

“You don’t drop the ball on the 1-yard line,” said Castrucci, adding that impatience with restrictions “could stop us from punching the ball into the end zone and eliminating COVID.”

Added Wen: “We could avoid a fourth surge, but we could have one coming.”

The variants and other variables make mapping the ultimate trajectory of the pandemic tougher.

Modelers at the University of Washington’s Institute for Health Metrics and Evaluation project that infections, estimated now at about 2,000 a day, could drop below 500 by June. But cases could go even lower if everyone continues to adhere to masking and other precautions. However, they also could balloon if people let down their guard and variants cause more infections or even reinfection.

“The one thing making me lose sleep is our behaviors,” said Dr. Ali Mokdad, a professor of health metrics sciences at the institute.

“We’re seeing Americans increasing their mobility and decreasing their level of mask-wearing,” he said. “We’ve seen this before. Last Memorial Day we saw people celebrating prematurely as a country and we had a surge.”

Mokdad said the institute’s surveys show 25% of people plan to stop wearing a mask after they are vaccinated, though studies don’t yet prove people won’t still transmit any virus. Research also shows the vaccines are somewhat less effective against some variants.

Maryland, he said, may fare better. About 84% of people report wearing a mask outside, above the national average of 77%. Just over 81% also say they are willing to be vaccinated, exceeding the national average of about 74%.

But other models, such as one computed by researchers at the Children’s Hospital of Philadelphia’s PolicyLab, show Baltimore and other metropolitan areas facing possible surges in disease transmission, making the next several weeks, and months, more unpredictable.

Masks, other precautions and vaccinations will be crucial to continue driving down cases, said Dr. David Marcozzi, COVID19 incident commander for the University of Maryland Medical System. There’s also hope that continuing to vaccinate people, especially adults 65 and older and those with certain medical conditions, will help case, hospitalization and mortality rates remain low.

“We should be feeling some optimism at where we are, but we should not be comfortable at accepting our current phase,” Marcozzi said.

He said the state should be closely monitoring the positivity rate, which is the percentage of people who test positive for the virus. In Maryland, the rate dipped last month below 5%, the level the World Health Organization says is needed before governments should relax any restrictions.

The average of the 821 counties nationwide included in the Children’s Hospital of Philadelphia team’s model is closer to 7.5%.

Marcozzi said a positivity rate of 1% or lower would be an ideal goal to strive for, so as to not become complacent.

He said hospital workers are better equipped now to treat infections and better protected through their own vaccinations, but they don’t want to see another upswing in serious cases.

“They are seeing less COVID-related illness and death,” he said, “and they are finding that heartening.”

About 15% of hospital beds are currently filled with COVID-19 patients, according to the Maryland Hospital Association. With extra capacity, they are encouraging people to come get care they weren’t permitted to get or avoided during the pandemic.

But hospitals have no plans yet to dismantle the 6,000 beds added to prepare for the pandemic statewide, said Bob Atlas, the association’s president and CEO.

“We agree with concerns that it’s not time to let our guard down,” Atlas said. “It’s too soon to start celebrating and going back to what we recall as normal times.”

Normal times, however, may not be exactly as we knew it, Hopkins’ Lessler and others say. People may need to be vaccinated annually, as they do for the flu. They also may need to wear masks at times when infections crop up in the community or they feel sick.

But the worst of the pandemic could be over soon if cases continue to decline, said Jennifer Nuzzo, an epidemiologist and senior scholar at Hopkins’ Center for Health Security.

“It’s important to realize that some things can change,” she said. “It’s still a critical time for people to adhere to the protections that we have been doing for the last year. I’m hopeful, though, that they won’t be forever and we could see big changes in the months to come.”