Uptick seen in state’s future
Projections of virus in Maryland vary, change day to day
States across the country are beginning to reopen their businesses and public spaces, and public health experts expect the effects will show up in coming weeks in the number of coronavirus cases and deaths. Those who make projections about how the pandemic plays out already are thinking about that.
Announcements from states, including Georgia, Florida and Alabama, that they have or will ease restrictions have been worked into models and affected the number of cases in every state — even those such as Maryland that have taken a more cautious approach to reopening.
While the outbreak appeared to be plateauing nationwide, new models for Maryland created for The Baltimore Sun by Logecal Data Analytics now project more deaths in every region of the state, with the biggest upticks in the hard-hit Washington suburbs and on the Eastern Shore.
Some of those upticks are due to local factors, such as outbreaks in a poultry plant on the Eastern Shore and in several nursing homes. But whether revisions are due to hot spots or political decisions, changes to the models in Maryland and across the country illustrate the constantly changing dynamics of a pandemic.
“The models make various assumptions” said Dror Rom, president of the Pennsylvania-based health care consulting firm Prosoft Clinical, an affiliate of Logecal, “such as the state of social distancing, opening, businesses, adherence to wearing protective gear.”
How good are those assumptions? Rom said we’ll know in the next few weeks, though, he added, “you could really update the models daily.”
Anticipating human behavior is difficult in modeling, said Justin Lessler, an infectious disease epidemiologist at Johns Hopkins University, whose team produces “planning scenarios” with various outcomes rather than one model to guide decision-making.
The team factors in people tiring of distancing and wearing masks, for example.
Without immunity to the virus, such as from mass vaccination, any level of restarting businesses, schools and activities will come with risks, he said.
“Long-term models show us there is no free lunch,” he said. “At some point we have to think about reopening at least somewhat with the idea the disease will still be around until we have that immunity. How fast we do that depends on a lot of factors, a lot of judgment calls.”
Experts at Hopkins and elsewhere say risks can be mitigated by ensuring widespread testing and contact tracing are available before reopening so new and potential cases can be isolated. Absent those, the government leaders must be prepared to respond to spikes.
“The more extreme measures and the quicker they are implemented, the quicker it gets under control,” Rom said.
It’s important, Rom said, for the public to look beyond a nationwide or even statewide model for an idea of how well measures are working.
The nation’s cases appear to have more or less plateaued, he said. But that is because New York City is showing big declines after a massive surge, offsetting increases in other hot spots, such as towns with outbreaks in meatpacking plants, prisons and nursing homes.
The same is true in Maryland and the Baltimore region, which also appear to have plateaued. The increases in the Washington suburbs and Eastern Shore offset decreases in cases in Western and Southern Maryland.
Also, the curves down aren’t expected to be smooth, with some days logging more cases and deaths than the day before, experts say. Hogan said he wants a downward trend over 14 days in hospitalizations before he lifts stay-at-home orders, though there has not been more than a few such days in a row.
There have been more than 32,500 cases in Maryland and more than 1,500 deaths. Hospitalizations stood at 1,640 Sunday and have been hovering between about that many and around 1,700 for 12 days.
Logecal’s projections show by the end of June, there will be 2,645 deaths in the state.
That includes 1,521 deaths in the Washington suburbs, 868 in Central Maryland (including Baltimore), 96 in Southern Maryland, 128 on the Eastern Shore and 32 in Western Maryland.
Rom and others say many factors influence projections: distancing measures and how well they are followed; stay-at-home orders and restrictions on businesses, and how well they are followed; use of protective gear; and the increase in testing that identifies more cases. But studies also suggest there could be different strains or mutations of the virus on the horizon.
The models will help states plan, Rom said, by showing how well measures are working to reduce spread, also called the reproductive rate.
When that rate is above one, meaning a person infects two or more people, daily infections rise quickly. Rom said when they are controlled with “extreme measures,” such as stay-at-home orders, the rate drops below one and cases drop.
That leads to what is called the inflection point. Once the point was reached in South Korea and China cases dropped quickly, but not all states here have stuck to strict measures.
Maryland Gov. Larry Hogan, a Republican, has not lifted stay-at-home orders, but recently allowed beaches to open and other recreational activities to resume.
“The lesson from what I have seen to date is that we should be on alert and react quickly to signs of new outbreaks,” Rom said. “The quicker we react, the easier it is to bring it under control.”
Among the other models revised sharply upward recently include those from the University of Washington’s Institute for Health Metrics and Evaluation. Its projections for deaths have doubled since midApril. That model now projects there will be 2,190 deaths in Maryland by Aug. 4 and 134,475 in the United States.
Dr. Vin Gupta, affiliate assistant professor of health metrics sciences at the Institute for Health Metrics and Evaluation, agreed that models need constant updating. But they are useful for decision-makers and for the public to understand the implications of their actions.
“I would love to see the public look at the models and say, ‘Wow, all the models are conditional on a set of actions and we all have to play a role in making sure the American public is safe,’” he said. “The take-home doesn’t get clearly conveyed sometimes. When people don’t stay put, it affects the models.”
Though the majority of states appear to rely on statistics and modeling to aid decision-making, including Maryland, he said, “it doesn’t strike me as some governors, like [Republican] Gov. [Brian] Kemp in Georgia, are looking at models.”
Many experts have said premature lifting of restrictions will cause the case and death curves to rise swiftly. A draft report from the Federal Emergency Management Agency reported by The New York Times shows one worst-case scenario where deaths could jump to 3,000 a day from an average of 2,000 or so.
There have been more than 76,000 U.S. deaths so far, and President Donald Trump, a Republican, has said he believes there could be 100,000 or more from the pandemic.
Lessler, whose team has worked on many of the government’s scenarios, said as long as conditions change, so will the models.
“People ask me to read the leaves somewhat,” he said. “I can do that. But asking me to predict politicians and people’s behavior is not something I can do.”