Two Boston researchers propose ‘circuit breakers’ to stem spread of COVID-19

Ambulances outside of Massachusetts General Hospital.Stan Grossfeld/Globe Staff/file

Two Boston researchers are calling on the United States to implement a system that would urge local officials to consider a temporary pause in activities like indoor dining or large gatherings in order to prevent hospitals from becoming overwhelmed amid a rise in COVID-19 cases fueled by the Omicron variant.

In a memo to Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, the two researchers propose the use of “circuit breakers,” which are temporary, local restrictions on “high-risk” activities like indoor dining, performances, or non-essential work outside of homes.

“Because many regions are entering this wave with higher hospital censuses (both due to COVID-19 and other conditions) than in previous waves, it is possible that uncontrolled spread of Omicron could quickly overwhelm hospital capacity, despite the existing immunity of the population,” wrote Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital and instructor at Harvard Medical School, and William Hanage, an epidemiology professor at the Harvard T. H. Chan School of Public Health, in the memo.

As hospitals fill up and new COVID-19 cases shatter records in Massachusetts, some experts are calling for stricter measures on “high-risk” activities or adjustments to hospital policies and staffing if the data warrant additional action.

But nearly two years into the pandemic and with the widespread availability of vaccines and developments in testing and treatments, the specter of a return to some of the restrictions enacted in the early months of the crisis alarmed at least one expert, who said it’s time to find a new way to address rising COVID cases that doesn’t include resorting to business closures, remote learning, and other measures that can have negative outcomes.

The so-called circuit breakers would be triggered once individual regions have met or are approaching certain thresholds of COVID-19 cases and hospitalizations, Faust and Hanage said, and might last about five to seven days “but would be unlikely to be necessary for longer than 14 days in order to achieve the stated objective.”

“As the risks of Omicron are acute, we fear that any delayed action may be of substantial consequence,” Faust and Hanage said.

In an interview Monday, Faust stressed that the framework isn’t dependent solely on COVID-19 cases, but it also factors in the rate of hospitalizations per infection, which indirectly considers a region’s vaccination rate. The “circuit breakers” are meant to be specific, Faust said, in cases where the data demonstrate they could help thwart the risk of hospitals not being able to provide life-saving care in an emergency situation.

The idea is being introduced as Massachusetts enters another COVID-19 wave while hospitals in the state are already full, mostly with patients being treated for non-COVID ailments, Faust said.

“If you have a wave of COVID, you double or triple the amount of COVID, even though the COVID care is a minority of the hospitalizations, a doubling or tripling would tip us over, so that’s what we’re worried about,” Faust said.

It also comes as the workforce is exhausted, with health care workers who contract COVID sidelined for several days at a time, and as Omicron spreads rapidly in what Faust described as “the opposite of flattening the curve.”

On Saturday, Faust wrote on Twitter that “several Massachusetts counties are at risk or likely to have already exceeded normal hospital capacity.”

Boston was designated as “unsustainable,” according to the measure Hanage and Faust are using, “meaning that given current hospital capacity and new daily COVID, there could be a problem soon,” Faust said in the tweet.

🚨Update

Several Massachusetts counties at risk or likely to have already exceeded normal hospital capacity.

Boston in “unsustainable” category, meaning that given current hospital capacity and new daily Covid, there could be a problem soon.

@MayorWu https://t.co/0dXy6kGxGB pic.twitter.com/kAYiiiKvF4

— Jeremy Faust MD MS (ER physician) (@jeremyfaust) December 25, 2021

A City of Boston spokesperson said officials are closely monitoring COVID-19 cases and have “implemented a comprehensive public health approach to combat the spread of COVID-19 that prioritizes the health and safety of Boston residents.”

“We are focused on getting vaccines and boosters to residents across our neighborhoods, requiring proof of vaccination in select indoor spaces and masks in all public indoor spaces, and working to ensure that every Bostonian has easier access to vaccines, boosters, and testing across the city,” the spokesperson said in a statement.

Faust and Hanage wrote in the letter to Walensky that although they recognize Americans don’t want to “disrupt their lives” to mitigate the spread of COVID-19, they believe the population would be willing to and should be asked to, “with the narrow goal of avoiding catastrophic hospital overload and the avoidable deaths and suffering that would otherwise ensue.”

Individual jurisdictions can take a number of actions when confronted with the prospect of overrun hospitals, Faust said in the interview, and local officials can choose measures their residents would be most likely to adopt. If officials aren’t willing to introduce new measures on everyday life, hospitals are also able to implement new policies, Faust said.

Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center, said she disagreed with the approach Faust and Hanage have proposed, arguing that economic restrictions put in place to stem the rise in COVID-19 cases can also be harmful.

“Those are things that will cause people to lose their livelihoods, and in some cases permanently,” Doron said in an interview Thursday.

Doron said she is “slowly and reluctantly becoming convinced” that the number of cases that result in hospitalizations and the number of hospitalizations that result in deaths are lower with the Omicron variant than Delta. Early data also support that Omicron is less likely to result in severe clinical outcomes, whether that’s because of characteristics of the variant itself or because people are more immune, Doron said.

However, even if the variant causes more mild illness, a significant volume of COVID cases could still counteract the benefit that comes from Omicron potentially being less lethal.

Massachusetts and the country cannot return to the first few months of the pandemic, Doron said, adding that although she is concerned with rising COVID-19 cases, she is simultaneously worried about officials’ “knee-jerk response” to the increase in infections and the potential implementation of restrictions that can be detrimental to the population’s health and well-being. She cited colleges closing and schools returning to remote learning as examples.

“We can’t go back to March of 2020,” Doron said of the proposal submitted by Faust and Hanage. “There are certain things that we did then that we can’t do again, so we have to figure out a new way that we deal with rising cases.”

Governor Charlie Baker has implemented a number of measures to relieve the strain from COVID-19 patients and staff shortages. Last week, Baker directed hospitals to cancel all non-essential surgeries that require patients to stay overnight, in order to make beds available for patients with urgent medical needs. He also deployed the National Guard to help hospitals fill gaps in staffing.