With a much-anticipated report set to be released Monday that will outline the ground rules for a four-phase reopening of Massachusetts, Governor Charlie Baker says he’s looking at a number of public health statistics to guide him going forward.
Depending on how you look at the data, the state may have met some of the thresholds laid out in mid-April in the White House guidelines for “Opening Up America Again."
The non-binding document calls for, among other things, a “two-week downward trajectory of documented cases or positives as a percent of total tests.”
When it comes to the daily numbers, the state has not met those criteria. The numbers in both categories, total cases and percentage of people tested who turn out to be positive, have bounced around even as they have appeared to get lower.
A trend downward can be seen in the seven-day averages, however. The seven-day average of positive cases has dropped steadily from 2,016 on April 30 to 1,210 on May 13, even as the seven-day average of tests administered has remained above 10,000.
The seven-day average of positive tests dropped from 20 percent on April 30 to 12 percent on May 13. For both measures, there was one day when the numbers ticked upward slightly.
Dr. Thomas Tsai, a surgeon and health policy researcher at the Harvard T.H. Chan School of Public Health, said Thursday he had noted the declines and they were a “good thing,” but he noted that there were a few more days of data that will come in before Monday, the day the governor’s reopening roadmap is to be released.
The White House document also calls for 14-day “downward trajectories” in flu-like illnesses and “covid-like syndromic cases.” The state does not publish data on that in its daily dashboard, but Tsai said public health officials collect that information and it would serve as a “complement” to coronavirus testing data.
The White House plan also calls for treating “all patients without crisis care” and for a state to have a “robust testing program in place for at-risk healthcare workers, including emerging antibody testing.”
The plan notes, “State and local officials may need to tailor the application of these criteria to local circumstances.”
The White House plan has been criticized for being vague, including the use of the undefined phrase “downward trajectory.” Some experts also say looking to a downward trend, rather than a fixed number, is meaningless when a state may still be seeing large numbers of cases.
Ezekiel Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, told NPR in April, “We need to be close to zero new cases — like a threshold of 20 new cases per 1 million population." That would be about 140 new cases in Massachusetts per day, rather than the current 1,210 seven-day average.
“The directional numbers tell you where the pandemic curve is heading, but you obviously want the lowest absolute number” of cases, Tsai said.
Experts also say that the percentage of positive coronavirus cases should be 10 percent or lower, with strong testing, before reopening is considered.
“We would really want to see that below 10 percent,” Tsai said. "The notion there is that you want to be casting a wide-enough net, and the way you know that is if the test-positive rate is down and continues to go down.”
The much-anticipated report Monday by the state’s Reopening Advisory Board, which is chaired by Lieutenant Governor Karyn Polito and includes representatives from the business community, public health officials, and municipal leaders from across the Commonwealth is expected to lay out “the public health metrics that would indicate it is safe to move from one phase to the next” in reopening.
While the report hasn’t been issued, Baker has been telegraphing a focus on several measures at his daily news briefings.
He’s spoken about tracking the percentage of positive tests, one of the White House metrics, as well as the number of hospitalizations due to the disease, ICU usage, and fatalities. He has also said that the state looks at two- or three- or five-day rolling averages of various statistics because the reporting can be a “little lumpy.”
At his daily news briefing Thursday, Baker said the key metrics would be “a lot of the ones that I talk about here every day.”
He noted the data released on the state’s daily dashboard website is the data officials track and said “it’s pretty comprehensive.”
“If you were to say to me, ‘Is there one magic thing?’, the answer to that is ‘no.’ If the question is, ‘Do we pay attention to a lot of different metrics to draw conclusions about how we‘re doing?’ The answer to that is ‘yes,’” he said.
He said he would like to see more improvement in all the measures, saying that ICU usage is “particularly important to us because it’s a really important element in helping people get better, especially people who get really sick.”
“Massachusetts still remains one of the hardest-hit states. While many data points have been declining... we’re watching these numbers very closely, because they do move from day to day," he said.
“While we’ve seen declining rates of positive tests results and while we’ve seen declining rates of COVID hospitalizations and ICU bed days over the course of the past few weeks, we continue to be a state that has a significant number of people who test positive every day ... and our health care system continues to carry a fairly significant load on this,” he said.
Tsai said Massachusetts was a place where “for the most part our policymakers really rely on data” and the state was already on its way to doing a better job than the federal guidelines.
“In the absence of federal leadership, states should lead the way," he said. The guidelines are important as a roadmap, but “you can do better, you should do better.”
New York state offers a dashboard detailing, report card-style, how the state’s counties are doing in terms of a number of the metrics, including hospitalizations, deaths, and ICU bed availability, as well as testing and contact tracing capabilities.
Tsai said in an interview last week that decisions about easing up on business closures and other social-distancing restrictions “need to be based on the data.”
But it’s also important to have “transparent metrics” that the public can follow on which officials are basing decisions to phase-out — or back in — restrictions. He pointed to New Zealand as an example of a place that has done this well, creating a color-coded alert system that communicates to the public how serious the current virus threat is and what restrictions are in place given the threat.
He said the Massachusetts dashboard was “very transparent ... and I think that’s a good template” for how a similar dashboard could inform how we phase in reopening.
The clarity around the metrics guiding the decisionmaking process is important because restrictions are going to have to be tightened again at times as flare-ups in the virus occur, he said. Clear communication is necessary to avoid confusion, to ensure the public trusts that any changes are being driven by the data, not arbitrary decision-making or a sign government officials are changing their minds.
“This is going to be a very dynamic process. There may be peaks and valleys in terms of the pandemic. The big question is, how will the state respond to that? If we see cases rise” in two weeks, or four weeks, after the economy starts opening up, “what should people expect?” he said.
CLARIFICATION: This story has been amended to include the single slight uptick in daily the number of positive cases during the April 30 to May 13 period.
John Hilliard of the Globe staff contributed to this report. Material from Globe wire services was used in this report.