Rewind the clock a month, to late March, as nonessential businesses were closing and Governor Charlie Baker asked us to stay home to reduce the spread of coronavirus. Where did we imagine we would be as a state by the start of May?
A lot further along than we are now.
It’s maddening: More than six weeks after statewide social distancing measures began to take effect, the number of hospitalizations for COVID-19 infections is stuck in a stubbornly high place — about 3,800 — a figure that has barely budged in two weeks, dropping 1 percent on Thursday. And the daily death toll is at once tragic and numbing. On Wednesday, Massachusetts officials reported another 252 COVID-19 deaths, the state’s largest single-day increase since the outbreak began. On Thursday, officials reported 157 more, which brought the total to 3,562.
The disease models of late March suggested we would be well on our way down the backside of the pandemic by now, but given the depressing numbers, it is hard not to feel spirits dipping, while progress feels illusive.
“A lot of the models were a little bit misleading in terms of suggesting that there would be these nice, perfect bell curves,” said Thomas Tsai, a professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and a surgeon at Brigham and Women’s Hospital. “And what we are seeing is that, realistically, instead of a peak and then a rapid climb down the mountain, so to speak, there’s more of a plateau, especially when it comes to hospitalizations and deaths, because those are lagged behind development of new cases by a few weeks.”
The climb down from the coronavirus plateau is probably going to be a lot slower and more gradual than the climb up, and along the way we can expect some frustrating stops and starts.
Early disease models published in March had predicted that the peak of the outbreak in Massachusetts would be in mid-April; the real peak was probably closer to the week of April 20, Tsai said. “What is encouraging, though, is that if you think about two weeks ago, three weeks ago, the case counts were rapidly rising and the hospitalizations were rapidly rising,” he said. “It’s a silver lining in the sense that the curve does seem to have flattened and the hospitals in Boston and Massachusetts have been able to create the capacity to be able to take care of the surge of COVID-19 patients.”
That is: If the outbreak raced off in the beginning like a car with the accelerator stuck to the floor, we have managed to stop it from going any faster and hold at a roughly steady speed. Stopping the acceleration prevented the state’s hospital system from being overwhelmed.
The next step is “slowing down or decelerating because the idea is to bring that car to a stop,” Tsai said. “You want to be actively stepping on the brakes and seeing the speed come down every single day. I think that analogy is helpful for thinking about our case-positivity rate as well.”
The daily number of new confirmed coronavirus cases has dropped over the past week, though the lines of the “curve” are painfully jagged.
“We still have a long ways to go,” Tsai said, not offering a timetable. “I think that's why the governor and a lot of municipalities are doing the right thing by still being cautious.”
The persistently high numbers of coronavirus deaths and hospitalizations have dispelled the idea that if we just stayed away from each other for a few weeks through social distancing, the virus would have no place to go and would fade out. A problem with that thinking is that we are not entirely separate from each other, not all of us. About 40 percent of the US workforce “is currently in essential services” and therefore on the job, according to an April 20 report from the Edmond J. Safra Center for Ethics at Harvard University.
Researchers at the University of Maryland have rated Massachusetts among the better states for maintaining social distancing over the past two weeks, though still behind New York, New Jersey, and Hawaii. Yet as recently as a few weeks ago, many of us shopped without masks at grocery stores, handing money and accepting sales receipts from checkout clerks who were not protected by plastic shields.
Given the virus’s incubation time, the time required for symptoms to develop, and the lag before sick people get tested and get results, identifying the disease can happen along “a pretty long window,” said Summer Johnson McGee, dean of the School of Health Sciences at the University of New Haven.
“Increasing numbers of new cases could mean that we may not be as good at social distancing as we think, but it is just as likely that existing cases are just now being captured in test results,” McGee said by e-mail.
Driving around, though, it is not hard even now to spot people gathering. Suburban parks and Home Depot stores are crowded on weekends. Boston Mayor Martin J. Walsh complained on CNN after a spot of nice weather 10 days ago: “There were people out golfing. There were people playing soccer. There were people gathering — I think, right now — not understanding the severity of what’s happening here in this country and in Boston, in Massachusetts. It’s just wrong.”
Dr. James Baker, and epidemiologist and a Boston-area hospice specialist, said social distancing must be faithfully practiced to be effective — and even then: “It is not possible in America to have people totally quarantine and social distance, not to the degree that happens in a country like China where people can be forcibly locked in their homes or taken off the street.” Baker said, though, that he thinks we could do more and do better. “With interactivity, all it takes is one person in the group to infect all the others.”
Which means that as much as we like to talk about “opening” the state, social distancing is probably going to be part of our lives for a long time, experts said.
“Social distancing is not an on/off switch,” said Tsai, from Harvard Chan School. “We need to think about this as a dial. We may have to dial it up, or dial it down depending on what the case counts are, what the hospitalization rates are, what the fatality rates are.”