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Follow the data: COVID trends point to more restrictions, perhaps a lockdown, by Jan. 1

Many are wondering if Governor Charlie Baker will issue more stringent lockdown rules.
Many are wondering if Governor Charlie Baker will issue more stringent lockdown rules.Nancy Lane/Associated Press

Governor Charlie Baker likes to rely on data to make decisions, especially when it comes to managing the COVID-19 crisis. So what does the data say?

Let’s look at just one number: 20 percent. That’s the rate of positive diagnoses among those who got tested for the first time over the past seven days, according to an analysis of state data by Sam Scarpino, director of Northeastern’s Emergent Epidemics Lab.

Scarpino zeroes in on this data point, instead of the more typical positivity rate among all those tested, because it’s especially important: It is a leading predictor of hospitalizations. These are the people who got tests because they have symptoms or were exposed.

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This number has been on the rise, but over the past two weeks jumped from 10 percent to 20 percent. By Scarpino’s estimate, a 20 percent positivity rate could translate into an increase of hospitalizations as high as 50 percent over the next two weeks.

That will compound an already troubling trend: COVID hospitalizations in Massachusetts increased 158 percent in recent weeks, according to state data.

Add all that up, and it almost certainly means one thing: More drastic restrictions, if not a shutdown, are coming, or should be, by the end of December, according to hospital leaders and epidemiologists.

“I would be very shocked if there are not more significant rollbacks or closures of the state by Jan. 1,” said Eric Dickson, chief executive of UMass Memorial Health Care in Worcester.

Baker has made one thing clear throughout the pandemic: He will not allow the hospital system in Massachusetts to be overwhelmed by COVID-19 patients. He hops on a call twice a week with hospital chief executives to get updates on positivity rates, COVID hospitalizations, ventilator capacity, and more. He’s versed in their data and is in his element, as a former health care executive and health secretary in the Weld administration.

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With the health care system under strain, Baker has made adjustments: On Monday, he ordered hospitals to cancel some elective surgeries to free up beds. On Tuesday, he tightened a few restrictions, which will force some businesses to close and others to reduce capacity.

Baker and health care leaders are seeing the torrent of cases related to Thanksgiving gatherings, as it can take two weeks before an infected person becomes sick enough to need hospitalization. The fear is that gatherings around Christmas will spur another surge.

Some prominent public health experts, mayors, and legislators have been urging Baker to implement more restrictions, such as temporarily closing indoor dining, casinos, and gyms altogether. On Friday, New York Governor Andrew Cuomo once again banned indoor dining in New York City, effective Monday, as COVID infections escalate there.

Not acting now, says Boston state Representative Jon Santiago, could result in a more stringent lockdown, with more business closures than would have been necessary. “The longer you wait, the worse off you’ll be at the end,” said Santiago, who is also a practicing emergency room physician.

Baker spokeswoman Lizzy Guyton said the governor is always looking to slow the spread of the virus. In addition to recent restrictions, in November he ordered early closing times for restaurants and urged people to stay home at night.

“The administration constantly analyzes public health data,” she said. “All options are on the table for future action if necessary.”

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The timing of a second shutdown, however, couldn’t be worse. Drastic rollbacks right before Christmas could hurt the critical holiday season for retailers and restaurants. Meanwhile, unemployment benefits for some people are due to run out at the end of the month, and small business owners have likely spent the federal aid from the first stimulus package, and Congress has been unable to agree on a deal for another round of aid.

Like the rest of the country, Massachusetts is caught in a second wave of the virus. One forecast by the University of Washington indicates infections here will be on an upward trajectory through mid-January, and that daily deaths will climb through the end of January. The leading cause of death in Massachusetts last week, COVID-19 is on track to claim an additional 4,000 lives by April, according to this model.

The vaccine, the first doses of which will be administered to health care workers within days, is not expected to markedly curb the infection rate until late spring, after it becomes available to the broader population. Meanwhile, while they focus on different data points than Scarpino, hospital leaders say they, too, are seeing positivity rates coming in at the high end of their estimates.

In a note to staff Tuesday, Kevin Tabb, chief executive of Beth Israel Lahey Health, noted the dramatic increase in COVID-19 patients at the state’s second largest hospital system.

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“We have entered a more urgent stage of firefighting,” Tabb wrote. “Although we are at less than half of our April high-water mark, the trend is alarming in that we have seen a near doubling in our number of [COVID-19] inpatients over the past 14 days.”

Dickson, the UMass Memorial CEO, is worried about handling this second wave based on the current rate of hospitalizations. Before Thanksgiving, the number of hospitalized COVID-19 patients increased about 10 percent a month; now it is about 20 percent.

“Boy, if we grow 20 percent a week between now and February 1, that is the brink,” said Dickson. “I don’t know if we can manage that.”

UMass Memorial helped set up a 220-bed field hospital at the DCU Center in Worcester and has put a call out for retirees and health care workers to staff it.

Like other hospital executives, Dickson is less worried about having enough beds, and more about having enough staff to support COVID-19 treatment. His workforce is exhausted and stretched thin, some redeployed to virus testing or vaccine distribution. And, not everyone is trained or able to work in a COVID unit. Of a staff of about 8,000 doing clinical work, about 200 cannot work either because they have the virus or are in quarantine due to an exposure, he added.

Dickson said Baker is in a no-win situation over further restrictions — balancing saving jobs with saving lives.

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“The governor has done an amazing job,” he said. “I wouldn’t want to have that man’s job right now for all the money in the world.”

Compared to other states, hospitals in Massachusetts are in better shape to handle the second wave, said Ali Mokdad, chief strategy officer for Population Health at the University of Washington, who helps lead its COVID-19 modeling.

Mokdad, who advises governors on the pandemic, said despite high mask compliance of about 80 percent and a restricted economy, the onset of winter in Massachusetts is responsible for the growing number of cases; people are spending more time indoors, which drives up the risk of close contact that could transmit the virus.

“All of us moved indoors,” Mokdad said. “The seasonality is increasing the cases.”

Scarpino, the Northeastern professor, is worried the state may have no choice left but a total shutdown.

“The real concern is there might not be any options left except for a lockdown,” said Scarpino.

Victoria McGrane of the Globe staff contributed to this report.


Shirley Leung is a Business columnist. She can be reached at shirley.leung@globe.com.