After Baker relaxes some pandemic restrictions, epidemiologists urge caution

A nurse instructed parents waiting for coronavirus tests at a post-holiday test site for Salem Public Schools.David L. Ryan/Globe Staff

The day after Governor Charlie Baker relaxed some coronavirus restrictions, epidemiologists warned that the state still must remain cautious — especially with a highly transmissible new variant in our midst.

Baker cited an improvement in some public health statistics in announcing he would lift a restriction adopted in November that had required restaurants, bars, and many other businesses to close at 9:30 p.m. He also will end an advisory that residents remain at home between 10 p.m. and 5 a.m.

But the decision set off a round of questions in the medical community: Does Baker’s announcement mean that we have passed the peak of the state’s second surge? Is now the right time to roll back restrictions, even modestly?

“No,” said Dr. Alysse Wurcel, an infectious disease physician at Tufts Medical Center, in a phone interview Friday.

Not all specialists are as certain, but most expressed caution. Wurcel stressed that she’s not privy to all the data the Baker administration has and acknowledged there are economic and psychological factors to consider when it comes to assessing restrictions.

However, she said, easing them now “is a little bit of signal to the community that the end is closer than it really is.”

Wurcel compared the restriction rollback to a radio broadcaster telling the public that roads are clear during a snowstorm.

“The roads are really not safe for driving yet,” she said. “This is a blizzard. People are still dying.”

She said the list of businesses that can now remain open longer — like arcades, restaurants, and retail outlets — is less important than “what it says to people about what could happen afterwards. We know transmission is happening in small gatherings at home. It seems too early.”

Wurcel added that she’d be willing to endure continued restrictions in January and February “even though it stinks, in order to have a better May, June, and July.”

Samuel Scarpino, an epidemiologist at Northeastern University, also expressed concerns about the restriction rollback.

“Although I agree with the [governor] that the indicators are headed in a better direction, we are in a really precarious situation with respect to hospitalizations,” Scarpino wrote in an e-mail, adding that Baker’s move “to relax measures sends the wrong message. It communicates that things are safer, which is not the case. Things are finally headed in a safer direction, but we need to stay on this trajectory for a few weeks until the hospitalization numbers come way down.”

He also noted that the state and the medical community need to be ready to respond quickly if the virus variant “show[s] up and start[s] altering the trajectory.”

Other specialists believe the curfew rollbacks announced by Baker on Thursday will not prompt numbers to climb.

Dr. Ranu Dhillon, an epidemic response specialist at Brigham and Women’s Hospital and Harvard Medical School, said he doesn’t think lifting the restrictions will cause a spike in virus transmission, which continues to be driven mainly by indoor and large outdoor gatherings.

The capacity restrictions that remain in place at stores and restaurants, he said, are “critical factors” that would appear to make lifting the curfew relatively safe.

He emphasized, however, that indoor dining remains a “high-risk activity,” and that state officials should continue to monitor public health data when considering the impact of lifting the curfew.

“It will be important to see how transmission goes in the next few weeks,” Dhillon said. “There can be an uptick for reasons that have nothing to do with the curfew — colder weather, people staying indoors more. It’s important to see this as a step-wise process.”

Before further steps are taken in the direction of reopening, he said, the state must see “sustained improvement in reducing transmission, especially with the variants in place,” which should prompt people to remain “extra cautious.”

In light of the variant, he said, the public should stay “cognizant of the risks of gathering indoors, especially with people outside your household and social bubble.”

The death toll from confirmed cases in Massachusetts has increased by 80 to 13,702, the Department of Public Health reported Friday. In recent weeks, daily fatalities peaked at 118 on Dec. 30.

The number of recent hospitalizations appeared to peak on Jan. 4, when 2,428 COVID-19 patients were hospitalized statewide. That’s below the one-day highwater mark of nearly 4,000 in April. The number has also dipped steadily since Jan. 4.

Nationwide, new coronavirus cases have fallen 21 percent in the last two weeks, according to a New York Times database. But, the Times reported, public health experts likened the situation to a race between vaccination and the virus’s new variants.

“We’re definitely on a downward slope, but I’m worried that the new variants will throw us a curveball in late February or March,” said Caitlin M. Rivers, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Asked Friday if he felt lifting the restrictions was a wise move, Dr. Abraar Karan, a global health and internal medicine physician at Brigham and Women’s Hospital, said via e-mail that people should continue to proceed cautiously.

“While the downward trend in cases, hospitalizations [and] deaths is encouraging, we need to have two main focus points right now — vaccinations [and] slowing the spread,” wrote Karan, who also conducts COVID-19 research for the Independent Panel for Pandemic Preparedness and Response. “In terms of the latter, we must discourage people from high risk scenarios — indoor dining is one of those because masks are off [and] there is close face to face contact.”

There has been criticism in Massachusetts, and around the US, over the slow rollout of the vaccine, even as President Biden has vowed to administer 100 million vaccine shots in his first 100 days in office.

Baker announced Thursday that everyone eligible for the vaccine under Phase 1 of the state’s rollout program can now book an appointment to get a shot.

That now includes home-based health care workers and health care workers who don’t interact with COVID-19 patients, as well as workers and residents of congregate care settings such as shelters and prisons. The vaccine has already been available to “COVID-facing” health care workers, staff, and residents of long-term care facilities, and first responders such as police, firefighters, and paramedics.

Massachusetts health officials notified hospitals on Wednesday that they were free to vaccinate all paid employees, “including non-patient-facing workers such as back-office administrative and remotely working staff,” according to an e-mail from Kerin Milesky, director of the Office of Preparedness and Emergency Management at the Department of Public Health.

Hospitals were also authorized to use vaccine doses on hand “to vaccinate selected high-risk patients (for example immune compromised individuals, dialysis patients, solid organ and bone marrow transplant patients; specific patient groups are to be determined at the hospital level).”

Mass General Brigham, the state’s largest hospital system, notified employees Thursday afternoon that it would use existing supply to vaccinate everyone, and invited them to schedule an appointment. Board members are not eligible, according to spokesman Rich Copp.

By Friday morning, Mass General Brigham had administered more than 52,000 first doses and about 11,000 second doses to its employees. But unvaccinated workers still seeking a shot are getting harder to find, and hospital administrators say they are striving for a more consistent and timely process for using every drop of vaccines.

Mass General Brigham is even reaching beyond its employee base to make sure no vaccines get wasted, according to Dr. Paul Biddinger, medical director for emergency preparedness. Hospice workers, first responders, and others in the community can put their names on an on-call list, to be summoned when spare doses are available.

“Because they are not officially associated with hospitals, it is difficult for these workers to find a way to get vaccinated,” Biddinger said.

Here’s a set of charts that show how we’re doing right now:

Cases

Deaths

Massachusetts has eclipsed 13,500 confirmed COVID-19 deaths since the start of the pandemic, and in recent weeks daily fatalities peaked at 118 on Dec. 30, with 75 reported Jan. 21.

“While attention understandably focuses on deaths, we must not forget the problem of long covid,” tweeted Bill Hanage, an associate professor at the Harvard T. H. Chan School of Public Health. “While the exact proportion suffering it is unclear, it’s plain that is is high enough to take very seriously indeed.”

Hospitalizations

They appeared to peak in recent weeks on Jan. 4, when 2,428 COVID-19 patients were hospitalized statewide. That’s below the one-day highwater mark of nearly 4,000 in April. The number has also dipped steadily since Jan. 4, with the one-day tally of patients hitting 2,152 on Jan. 20.

Case positivity

The road ahead

The state is monitoring the wastewater at the Massachusetts Water Resources Authority’s Deer Island treatment plant for traces of the coronavirus, hoping to use the results as an early-warning system of future case trends. The numbers have fallen steadily since hitting a high on Jan. 11.

A national tragedy

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Felice Freyer and Kay Lazar of the Globe staff contributed to this report.