What would trigger a second lockdown in Mass.? The state still hasn’t laid out clear guidelines

Massachusetts Governor Charlie Baker on Tuesday warned that rising infections and troubling public health metrics could stall reopening efforts.David L. Ryan/Globe Staff

As concern mounts over the possibility of a new surge of COVID-19 cases in Massachusetts, Governor Charlie Baker on Tuesday warned that rising infections and troubling public health metrics could stall reopening efforts.

But as epidemiologists and doctors continued to sound alarms — some urging a return to more restrictive state guidelines on gatherings and businesses — Baker resisted laying out the state’s standards for reversing course on reopening. The state plan released in May identifies six key indicators guiding reopening, but it does not describe what specific set of conditions would trigger a reversal.

Statistics released Tuesday included 438 new confirmed cases — the highest single-day count in two months. For 10 of the past 14 days, new cases exceeded 200. And another key indicator — the average rate of COVID-19 tests that come back positive — has climbed to 2.2 percent, up from July lows of 1.7 percent.

At a press conference, which took place before the Department of Health released data on new cases, Baker acknowledged the possibility of renewed restrictions in the event of a surge, but pushed back against the notion that current data suggests now is the time to roll back reopening.

“We’ve only had a slight uptick from a low of 1.7 percent, to 2 percent, but we’ll be forced to adjust our plans if the data warrants it,” Baker said. “That could mean gathering sizes could be reduced, or we could make some of our business regulations more strict. Reopening and staying open is a big part of the goal, but obviously we can’t do that if we don’t have everybody’s help to continue to move forward.”

When pressed for details on how the state would determine whether to impose such restrictions, Baker noted that Massachusetts has reached its goal of attaining and staying below a 5 percent test positivity rate — the threshold the World Health Organization recommended in May that governments reach before loosening strict springtime lockdowns. Baker did not cite other specific standards that might be earlier indicators of a need for new restrictions.

But public health experts say the lack of clarity on reopening standards makes returning to an earlier shutdown phase — already a politically difficult decision — even more of an uphill battle.

“If you had clear rules, then everybody would be on the same page on what would happen if the indicators reached a certain point. In the absence of those clear guidelines, it becomes much more of an ad hoc judgement call,” said Caroline Buckee, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health.

Setting and publicly communicating clear standards for health decisions is key to the success of any public health effort, Dr. Leana Wen, Baltimore’s former health commissioner, said in June.

“Decisions should be based on science and evidence, and having those metrics in advance ensures that those are the reasons, as opposed to political considerations,” said Wen, an emergency physician and public health professor at George Washington University.

“[Other countries] were very clear at the beginning that reopening was not an on and off switch, it was a dial. . . . I do not believe that this has been done well in the US. The American people have gotten the message instead that this is a one-way street.”

Now, some Massachusetts epidemiologists say, the state appears to be headed the wrong way.

“Things are getting worse. Slowly,” Ashish Jha, the director of the Harvard Global Health Institute, tweeted Tuesday, citing the gradual growth of the the number of new cases and positivity rate. “We can choose not to act right now. We’ve all seen that movie before. It doesn’t end well.”

Others said the state must be prepared to act soon to prevent a second surge and ensure schools can safely open in the fall, even if that means returning to Phase 2 of the state’s reopening plan, when most indoor entertainment venues remained shut. Phase 3, which began on July 6 in most of the state, loosened restrictions on the sizes of gatherings, and opened gyms and fitness centers, movie theaters, museums, and more.

Baker focused Tuesday on the state’s initiatives designed to control the virus’s spread, including mandatory quarantines for most out-of-state travelers, free testing sites in higher-risk cities, and plans to expand rapid testing options.

Massachusetts has ramped up efforts to track COVID-19′s spread, including joining a new initiative meant to shorten the turnaround time on test results and enable the state to better track the spread. Baker, along with five other governors, signed a first-of-its-kind purchasing compact meant to pressure companies that make rapid-detection tests to quickly ramp up production.

The governors, three Republicans and three Democrats, say that other states and cities may join them and that talks have already begun with one of the two companies approved by the FDA to sell point-of-care antigen tests that can detect the virus in less than 30 minutes.

Each state — Virginia, Louisiana, Maryland, Michigan, and Ohio, in addition to Massachusetts — would request 500,000 rapid tests, for a total of 3 million that could be deployed to address outbreaks. Testing in Massachusetts has increased in recent weeks, data show, and on Tuesday the state reported an additional 15,316 new tests.

The state announced Tuesday that most travelers entering Massachusetts from Rhode Island will soon be ordered to quarantine for two weeks upon arrival unless they recently tested negative for COVID-19. The state Department of Public Health tweeted that, starting on Friday, Rhode Island will be removed from a list of eight low-risk states exempt from the travel order, citing “increases in both RI’s positive test rate and cases per 100,000.”

Baker said continued testing and analysis of the settings and behaviors resulting in new cases will be crucial to the state’s ability to prevent a resurgence of infections.

“Over the past several days, we’ve seen a modest uptick in the percentage of new positive cases, and we continue to closely monitor and analyze the data to determine the factors that are driving that,” he said. “If the data doesn’t support moving forward, as we have said many times, we won’t.”

Buckee, who first voiced concern over the lack of clear standards and protocols for a return to lockdown soon after Baker released his plan, said she believes it is already time to reverse reopening and return to Phase 2.

“Of course, nobody wants to go backwards. And politically, it’s challenging to ask people to return to a tighter lockdown,” she said Tuesday. “But I do think the absence of clear guidelines mean it’s even more politically difficult to make that decision.”

But she said she is still optimistic that if Baker clearly states his thresholds for reopening, he can rally the public to act now and prevent further increases in transmission.

“Massachusetts has done a good job. People have taken responsibility . . . and I think most people would agree that we should be prioritizing safe school opening in the fall,” she said. “Most people would be amenable to going back to Phase 2, with the understanding that we’re doing this in a targeted way with a specific goal.”

Material from The Washington Post and State House News Service was used in this report.