New cases of COVID-19 in Massachusetts and Rhode Island have been inching up over the past couple of weeks, increasing by as much 50 percent since the lows of early March. The seven-day average of reported cases in Massachusetts, which hovered at just over 1,300 a month ago, has now climbed to over 2,000. Hospitalizations, which tend to follow a surge in cases, have begun to tick up again.
All this is happening even as the vaccine rollout accelerates. What does it mean, and how worried should we be? The Globe asked an infectious disease specialist, a social epidemiologist, and an emergency room doctor what they make of this trend.
Does the rise in COVID cases portend a third surge?
It could go either way.
“It’s been described as being on the precipice,” said Dr. Helen W. Boucher, chief of the Division of Geographic Medicine and Infectious Diseases at Tufts Medical Center. Boucher said she found the numbers concerning but is holding onto hope that the upward trend won’t turn into a major surge.
Nancy Krieger, professor of social epidemiology at the Harvard T.H. Chan School of Public Health, put it this way: “We’re at a careful point where it could go in a new direction, or it could go very, very badly.”
“The ingredients are here for it to go well,” Krieger said. “The question is whether we will have the leadership and messaging” to ensure that people with public-facing jobs have adequate protection and that everyone wears masks and keeps their distance in public.
Dr. Megan Ranney, an emergency room doctor at Rhode Island Hospital, said she’s seen a marked increase in people with COVID-19 coming to the emergency room. “It’s not at the overwhelming levels of late fall or winter,” she said. “The thing that worries many of us is we know the disease spreads exponentially. This is the tip of the iceberg of what we’re going to see two weeks from now. … How big the iceberg is, honestly we don’t know. It depends on our actions.”
What is driving the increase in cases?
“It’s not entirely clear,” Boucher said. “We’re seeing infections among younger individuals,” as many older people have been vaccinated.
Governor Charlie Baker has been criticized for allowing restaurants and public venues to open up, and indeed dozens of clusters during March were linked to retail stores, restaurants and food courts, and athletic events. But the vast majority of clusters — nearly 7,000 outbreaks involving 18,000 people — occurred within households, according to state data.
“My recommendation to people is to avoid indoor gatherings unless you’re in your own little circle or among vaccinated individuals,” Boucher said.
“This is the dynamic thing about this virus,” Krieger said. “It doesn’t care if people are tired of taking precautions.” Once people start to intermingle, the virus will seize the opportunity to infect them. And with new variants that are even more transmissible, those infections will spread faster.
“We’re all sick of this,” Ranney said. “You feel the end is in sight. It’s human nature to let down our guard.“ But most people still have no immunity to COVID-19. “There’s an awful lot of people out there who can still be infected,” she said.
The increasing prevalence of the B.1.1.7 variant from the United Kingdom, which spreads more easily than the original coronavirus, could explain some of the growth in cases, Ranney said. The other variants, B.1.351, and P.1, which were discovered in South Africa and Brazil, have also been detected in Massachusetts, with P.1 rising rapidly in the past few weeks.
The vaccines do work against the variants, but not quite as well as against the original version of the coronavirus, suggesting that people may need to get booster shots, Ranney said.
With all adults eligible for a vaccine later this month, won’t vaccination solve the problem pretty soon?
That depends on how many people take the vaccine and how fast. In Massachusetts, just a third of the population — or about 2.3 million — has received one dose of a vaccine, and half that number are fully vaccinated.
“It’s really a race to get as many vaccinated as quickly and safely as we can,” said Boucher, of Tufts.
What percentage of the population needs to be vaccinated for things to return to normal? “We don’t know what the magic number is,” she said. Estimates range from 65 to 90 percent.
“There is reason for hope,” Boucher said. “We are getting there with the vaccination and our state is doing very well with vaccinations. … The trend tells us that we just need to hang in there a little longer with masks and mitigation.”
Krieger, the Harvard epidemiologist, added a note of caution. “Where things have gone badly,” she said, “it’s when we open up too quickly.”
While the pandemic seemed to start waning a month or so ago, the case counts plateaued at a level that is still much higher than last summer. And now they’re moving back up. “That means more infections and more deaths, and that’s completely preventable,” Krieger said.
Even as vaccine distribution speeds up, for each person there’s a weeks-long lag from the first shot to full immunity. “The next two weeks are going to be really tough no matter what we do today,” said Ranney, of Rhode Island Hospital.
Meanwhile, though, with better weather prompting people to spend more time outdoors, infections may start to slow. “And if people can continue to wear masks and avoid socializing with others who are not part of their household, that would have a dramatic impact on future cases,” Ranney said.
When will it finally be over?
“There’s a lot of reason to be hopeful that we are getting there and that we are going to get to the point where we’re going to see the numbers go down and stay down,” Boucher said.
Ranney noted that COVID-19 will always be with us, but eventually at manageable levels as with other vaccine-preventable illnesses.
“I expect that by July we’re going to be able to be closer to normal,” Ranney said. “How close to normal we are depends on how many get the vaccine. ... These vaccines are amazingly effective. The end does not come until most of us get vaccinated.”
Martin Finucane of the Globe staff contributed to this report.