‘Still in a purgatory.’ COVID numbers have risen in Mass. ahead of holidays and winter weather

Few believe the virus will be eradicated so the focus is learning how to live with risk of infections for the foreseeable future.

COVID-19 cases in Massachusetts have risen to levels not seen since last winter.Craig F. Walker/Globe Staff

The numbers are ominous. And they’re coming just as families prepare to gather for what they hoped would be a return to more normal Thanksgiving traditions.

Yet in the last week, COVID-19 cases in Massachusetts have risen to levels not seen since last February. Hospitalizations have edged up, too. In European countries such as Austria — with higher vaccination rates than the United States — soaring infection rates have led to nationwide lockdowns and vaccination mandates.

How should Massachusetts residents, who have adhered better than most of their fellow citizens to public health recommendations, react to these new numbers?

“We are still in a purgatory, unfortunately, and no one wants to hear it, but we have to double down on our public health commitment,” said Dr. Howard Koh, a former Massachusetts health commissioner and now a professor at the Harvard T.H. Chan School of Public Health.

The latest state data show the seven-day average of new COVID cases has shot up 78 percent since Nov. 1, from 1,187 to 2,114. Hospitalizations have risen more slowly. They were up 26 percent during that same time period, to 663 on Friday.

The highest rates of infection now are among children 5 to 9 years old, the group most recently eligible for COVID shots. They account for 17 percent of cases in the past two weeks but make up just 5 percent of the population.

Still, there is one fact that brings hope: We are in a much safer place than a year ago now that we have vaccines, booster shots, and treatments to stave off the virus’s most powerful punch, say many public health experts.

National COVID-19 forecasts, including the widely followed University of Washington’s Institute for Health Metrics and Evaluation model, project fewer cases, deaths, and hospitalizations in Massachusetts this winter than last winter.

As more Americans have gained protection against COVID-19, public health recommendations have loosened. A year ago, the message was clear: To flatten the rise in deadly cases, stay home. If you must go out, wear a mask. Today, medical specialists are no longer advising people to hunker down and avoid travel or family over the holidays, but rather to take reasonable precautions, get vaccinated, and consider infection rates in the community where they might be headed.

“This is a global public health issue but it’s also very local, so when people are making decisions for themselves and their family it’s important to look at the local levels of disease and vaccination rates,” said Dr. Helen Boucher, an infectious disease physician and interim dean of the Tufts University School of Medicine.

Others suggest using over-the-counter rapid antigen tests to check whether family members are infected in the days before gathering.

“The testing piece is something we have to do a better job on, especially as we are getting into the holidays,” said Samuel Scarpino, managing director of pathogen surveillance at the Rockefeller Foundation’s Pandemic Prevention Institute. “Layering in masking and testing is going to be essential.”

The latest spike in COVID cases comes just as people were hoping to let their guard down.

“We have been in this long enough,” said Robyn McNair, a dog groomer in her 50s who is fully vaccinated, as she headed into a Gloucester Market Basket last week.

A sign on the entrance to the store asked all customers to wear masks. Yet easily half of those who hustled through the doors on a recent Friday morning wore none, including McNair.

“It’s not that I don’t think about it,” she said. “I am choosing not to.”

Robyn McNair left a Gloucester Market Basket after shopping maskless, despite a sign urging face coverings. “We have been in this long enough,” she said.John Tlumacki/Globe Staff

While it remains above the national average, mask use in Massachusetts has fallen since last spring, in one of many signs of pronounced COVID fatigue. Just before the CDC lifted its indoor mask recommendation in May, around 88 percent of state residents reported having worn a mask in public most or all of the time in the past seven days, according to survey data from Carnegie Mellon University and a consortium of health groups. As of mid-November, mask use sat at 65 percent, even though the CDC continues to recommend wearing them indoors in areas of high transmission, which applies to nearly all of Massachusetts.

Increasingly, public health experts are tailoring their recommendations to the risk levels they perceive the public will tolerate.

“We need to realize what people are willing to do and figure out within that how to help them do things more safely,” said Dr. Ashish Jha, dean of the Brown University School of Public Health. At his 9-year-old son’s recent indoor basketball tournament in Stoughton, there were hundreds of kids and parents, but Jha said he was in the minority, among perhaps only 5 percent who were masked.

Jha equates the current situation to the early days of the HIV crisis four decades ago.

“The initial public health message was, people should do abstinence. Well, sure, but that’s not what people were willing to do,” Jha said. “Then, part of the messaging became, ‘How do we make sex safer?’ I feel like it’s the same thing here.”

A hallmark of the pandemic has been a fixation with numbers, particularly with daily case counts. That’s because, before vaccines became available, many people who were infected got seriously ill. But vaccinations and effective therapeutics changed that. Today, most vaccinated people who do not have underlying health conditions generally have mild symptoms if infected, though they can still infect others.

“A case today is not what a case was a year ago,” said Dr. Sandro Galea, dean of Boston University’s School of Public Health.

“I am not sure case numbers matter anymore in general,” Galea said. “I think ... hospitalizations and deaths matter.”

Moving forward, a blueprint for safely living with COVID in an increasingly vaccinated world will mean making actions that at first seemed extraordinary appear ordinary, said Koh, the former state health commissioner.

“We never used to have bike helmets, and now it’s the ordinary thing. Same thing with seat belts when they were first introduced,” Koh said. “Can we see a time when wearing a mask in the face of an infectious disease threat will be seen as ordinary and not controversial? I sure hope so.”

Galea, the BU dean, predicts that society will find a mask compromise.

“We will get accustomed, when people feel a little bit sick, when they have sniffles, they will wear a mask when coming to work,” Galea said. “That is a middle ground I can see us settling on comfortably.”

Mask fatigue is rising, and customers at Market Basket have mixed feelings. A sign on the door to the entrance. John Tlumacki/Globe Staff