As Mass. COVID-19 metrics rise, state officials avoid defining how bad is too bad

Haley Harrison of Boston stepped into a protective tent for her COVID-19 test set up inside the NEW Health Charlestown in the Crossroads Resource Center.David L. Ryan/Globe Staff

The numbers are clear: COVID-19 hospitalizations, daily case counts, and the percentage of people testing positive are all higher in Massachusetts now than they were a month ago. Less clear is what will happen next.

Even with statistics that track the pandemic’s spread on the rise, the state continues to move forward with reopening plans. And public health officials have not clearly explained what would signal the beginning of an unmanageable new wave of COVID-19.

But Massachusetts is already failing to meet the standards it has set for other states when determining whether they are low risk. And some medical and public health officials say they are concerned that current metrics will only worsen as reopening continues, cold weather and flu season approach, and public patience for prevention wanes.

On Tuesday, the Department of Public Health reported 21 new hospitalizations and 454 new cases, marking the 14th consecutive day that reported cases have exceeded 300. Though daily counts have fluctuated, on average, cases are rising steadily.

The state’s seven-day average for new cases per 100,000 residents on Oct. 4 was 8.20, meaning Massachusetts does not meet the criteria it uses to set interstate travel restrictions. Other states must have both a rate of positive tests below 5 percent and daily cases per 100,000 residents below 6, both averaged across seven days, for travelers from those states to visit Massachusetts without quarantining or testing negative.

Massachusetts last met the second standard on Sept. 24. And the state appears dangerously close to falling behind on test positivity. DPH reported that the percentage of tested individuals who were positive for COVID-19 on Oct. 4 was 4.4 percent — nearly five times a low of 0.9 percent from just over a month ago.

Case tallies and positive test rate metrics have in the past two weeks reached their highest levels since at least June, when the state was still on the descent from April’s harrowing peaks. Over the summer, the metrics had mostly stabilized, making current increases an anomaly that several experts called concerning.

Governor Baker’s multiphase reopening plan, released in May, allowed for the possibility that the state would pause or revert to an earlier lockdown phase if necessary. But officials have avoided outlining specific thresholds that would prompt such a reversal.

On Tuesday, Baker attributed the upward trends to increased testing and the onset of autumn. “We expected and anticipated that there would be an increase in the fall," he said in Salem. Baker also reaffirmed the state’s goal of keeping the rate of positive tests below 5 percent — the only concrete statistic tied to reopening so far disclosed publicly. But Baker clarified that he meant for that standard to apply to a different measure of the state’s two positivity metrics — one that includes tests repeated, sometimes again and again, on the same people.

“When you get to a point where fully a third of your population has been tested at least once, and you’ve done 4½ million tests overall, which means a whole bunch of people have been tested more than once . . . those people absolutely belong in the denominator,” Baker said.

Public health experts have disagreed, saying a positivity rate that measures individual people, not tests, better reflects the reality of community spread. And with Massachusetts regularly performing as many as 70,000 tests per day — the vast majority of which are repeat tests on people required to be tested again and again for things like work or college — the state would not reach 5 percent positivity until as many as 3,500 new cases were being reported daily. Such a figure would have been staggering even in April.

This is not the first time that concerns over rising pandemic indicators have increased pressure on the governor to say how much COVID-19 is too much COVID-19. In August, a number of prominent doctors and epidemiologists called for Baker to roll back his reopening plan — then at the start of Phase 3 — following a moderate increase in case numbers and positivity rates.

At that time, Baker avoided returning to an earlier phase but did impose new restrictions on crowd gathering size in the days that followed. The uptick then did not translate into an overwhelming surge of cases or hospitalizations, and spikes leveled out in a matter of weeks.

But experts said early August’s relatively short-lived spike does not ease their concerns about current metrics.

“This really is quite a different time for a couple of reasons," said Dr. David Rosman, president of the Massachusetts Medical Society, who was a vocal proponent of reversing reopening in August. “We’re seeing more than a doubling of what already had us concerned back then.” Case counts in the first week of August remained just below 300 on average. Average test positivity, which the state still measured based on tested individuals rather than total tests, barely exceeded 2 percent.

Rosman also cited cooler weather, which will draw more people into higher-risk indoor settings, and flu season, which increases burdens on hospitals.

But Rosman is no longer an advocate for reversing reopening plans.

“I appreciate the way the governor has been very data-driven in the way that he has approached this . . . so ultimately, those decisions are up to the governor," he said.

Others called on Baker to roll back some potentially hazardous reopening decisions. Dr. Ashish Jha, dean of the Brown University School of Public Health, urged the governor to consider restricting some indoor venues in light of current trends and in anticipation of wintertime increases. “What we’re seeing across the country is as people have let their foot off the brakes, then cases have started climbing," he said.

Experts noted that the concerning trends do not necessarily mean the state should return to the all-encompassing shutdown measures it issued in the spring.

“It’s a blunt [instrument] because we can’t really say everything is shut down for two weeks,” said Dr. Natalia Linos, executive director of the FXB Center for Health and Human Rights at Harvard University. Relying on broad shutdowns ignores that even under the strictest orders, some people still have to go to work, a fact Linos said means lockdowns “exacerbate existing inequalities” for Black and brown communities disproportionately home to essential workers.

Rather than an economy-wide shutdown, Linos recommended a more targeted approach that weighed the risks of various settings. In such a calculation, reopening schools might take precedence over indoor dining or bars, she said.

“We definitely should not move forward [with reopening]. I’m not sure we need to move backwards yet," said Dr. David Hamer, an infectious disease expert at Boston University and a physician at Boston Medical Center. “If the next week shows a similar [positivity rate], we need to be concerned."