Massachusetts officially surpassed 1 million cases of COVID-19 on Tuesday, a sobering milestone that would have seemed unimaginable in March 2020 but now strikes many experts as conservative in its scope.
The staggering number was reached as the state and nation prepare for a greater surge in cases fueled by the highly transmissible Omicron and Delta variants, which began to sweep across the United States just as holiday travel season got underway.
The lightning spread of the virus this fall and winter pushed Massachusetts to a total of 1,002,266 confirmed cases, the state reported Tuesday. Nationwide, the seven-day average of new daily COVID-19 cases reached 253,245 on Tuesday, The Washington Post reported, surpassing the previous high of 248,209 cases on Jan. 12, in the midst of last winter’s punishing surge.
“Did anybody think we would be here two years ago? I certainly didn’t,” said Jacob Lemieux, an infectious disease specialist at Massachusetts General Hospital and co-lead of the viral variants program for the Massachusetts Consortium on Pathogen Readiness. “The numbers themselves are really disheartening, especially if you think about the shattered and lost lives inherent in that statistic.”
Though staggering, the official numbers likely still vastly undercount the real reach of the virus, given the difficulty many Americans have faced in obtaining a test, and especially now with people using millions of at-home tests that have no mechanism for reporting a positive result to authorities.
The grim numbers came just after the Centers for Disease Control and Prevention on Monday evening reduced the number of days that infected patients should remain isolated — and for many workers, off the job — from 10 to five days. Anyone leaving isolation must be free of symptoms and should wear a mask when near others for the remaining five days, according to the new guideline.
Importantly, the CDC also said that infected people can leave isolation without first having to test negative for the virus.
The CDC’s move received a mixed response from infectious disease experts who noted that the shortened isolation timeline is supported by evidence that shows most people with the virus are most infectious two days before and three days after the onset of symptoms.
“I think it’s going to generate both more compliance, and also create a better incentive to get tested,” said Ashish Jha, dean of the Brown University School of Public Health. “One of the things that people forget about public health is that, yes, you have to follow the biological science, but you also have to follow the social science. People are complex, and you’ve got to make recommendations that people can live with.”
Despite his support, Jha said that he wished the CDC had also recommended that infected persons receive a negative antigen test before ending quarantine. That sentiment was shared by dozens of other infectious disease experts who took to social media to express their concern.
“On the one hand: I’m all for following the science for the vaccinated & asymptomatic. No reason to keep people home unnecessarily. Kudos to @CDCgov for recognizing that our knowledge has changed — and the virus has changed,” wrote Megan Ranney, an emergency room physician and associate dean at the Brown University School of Public Health, on Twitter.
“On the other hand: the data shows a RANGE of infectiousness. Requiring a rapid test before ending isolation (esp for folks like, say, healthcare workers) would be far, far, far safer,” she added as a caveat.
Michael Mina, one of the nation’s leading advocates for the at-home rapid antigen test, suggested that by omitting the testing requirement for those in quarantine, the CDC was acknowledging the nation did not have enough tests to make that recommendation practicable.
“Essentially the CDC cannot make policy that people can’t abide by,” said Mina. “The slow authorization of rapid antigen tests by Food and Drug Administration has led to this idea that they are scarce, which has led to an inability to create robust science-backed policy, such as guidelines that don’t include testing.”
This December, the demand for testing has far outstripped supply in Boston and around Massachusetts. Before the holiday weekend, Massachusetts residents staked out pharmacies in hopes of intercepting new shipments of at-home tests. This week, the tests remain out-of-stock at major online retailers such as Amazon, CVS, and Walmart. They also typically cost anywhere from $10 to $39 per a test kit, a cost barrier that favors the wealthy and makes regular use largely prohibitive. Local and state governments have distributed millions of free tests to some high-need communities, but the efforts have been limited and spotty.
Moreover, if someone were to test positive via a rapid antigen test they are not required to notify public health authorities.
Obtaining a PCR test ― lauded as the “gold standard” due to its high sensitivity, but panned for its slowness and inconvenience ― has proved similarly difficult. At just one location on Tuesday, for example, Beth Israel Urgent Care in Chelsea, testing was cut off after the line of waiting cars spilled onto Route 16 and disrupted traffic.
“Any increase in testing capacity that we’ve had in Massachusetts has been swamped by the need. And those that have been able to access rapid testing aren’t exactly required to report a positive to any state or federal agency,” said Asaf Bitton, associate professor of health care policy at Harvard University’s Chan School of Public Health. “All of this, paired with the fact that there are a lot of mild and asymptomatic cases, likely means we are way undercounting the actual number of people in the community with infection.”
In November, the CDC estimated that just one-quarter of all COVID-19 infections were officially recorded in the overall case total from February 2020 to September 2021, meaning that even before the Omicron surge, infection counts woefully underestimated the actual number of cumulative cases across the nation. As of Tuesday, the United States had officially recorded some 52.7 million cases since last spring. That number includes reinfections, which have been increasing as the highly mutated Omicron variant spreads.
The variant, which was first detected only five weeks ago, has swept around the globe so quickly that it has left experts scrambling to understand its transmissibility and severity.
On Tuesday, the CDC walked back its estimates on the prevalence of Omicron, stating it now accounts for roughly 59 percent of all COVID cases in the United States, a major decrease from the approximately 73 percent estimated the week of Dec. 18. (In its revision, the agency said the variant accounted for about 23 percent of cases that week.)
Meanwhile, the FDA warned Tuesday that “early data suggests” that antigen tests are not as sensitive in detecting Omicron as other variants. However, the agency did not provide context on exactly how much less effective antigen tests might be in flagging an Omicron infection.
Fears over Omicron’s seemingly unstoppable spread have been somewhat tempered by studies out of South Africa, Scotland, and England that suggest the new variant may cause less severe illness. But many experts have cautioned that the sheer number of people who are likely to be infected could create a flood of patients, overwhelming already stressed health care systems.
Still, 1 million cases later, the state is in a far better place than it was last spring.
“It is a very different pandemic right now than it used to be. We have reliable tests. We have vaccines that are outstandingly effective in preventing severe illness. We are starting to see the rollout of multiple therapies that are effective for both hospitalized and non-hospitalized patients,” said Lemieux.
“Is COVID-19 ever going to go away? No,” he added. “But are we going to get to a place where we can live with it? Yes. We’re not quite there yet. We have a rough patch ahead that will absolutely stress every aspect of society and the health care system. But we won’t be in this patch forever.”
Hanna Krueger can be reached at email@example.com. Follow her on Twitter @hannaskrueger.