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Late on a Thursday afternoon, Governor Charlie Baker is folded behind a table in his office, examining how often COVID-19 is showing up in people’s poop.
The wastewater data in front of him and several of his aides in the late-March meeting show COVID levels have crept up since mid-month, including in places such as Brockton and North Attleborough. But, one slide notes, the overall numbers are still below weekly averages from a year ago.
Mulling the data, Baker cuts in to ask what that means for daily case counts in the coming weeks. “Somewhere between 800 or 1,000?” he asks.
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More than two years into the coronavirus pandemic, this has become the routine. Every Tuesday and Thursday, Baker and staffers will gather, usually for an hour, to pore over data on booster shots, test distribution, hospitalizations, and more. Every other week, he’ll huddle with a six-person advisory board of doctors and public health experts; every other Wednesday at 7 a.m., Marylou Sudders, his health and human services secretary, talks with hospital leaders.
It’s fed into what Baker called the state’s “giant surveillance effort,” the largely behind-the-scenes work tracking COVID-19 that has trudged on after the daily press conferences and physical trappings of the administration’s pandemic response have steadily fallen away.
In their place, more typical gubernatorial scheduling demands have proliferated. Hours before that Thursday COVID meeting, Baker stood in the middle of a street in Boston’s Seaport, peering into a foot-long pothole crews were filling as a local TV station’s camera captured the scene. Later that morning, he shoveled a small scoop of dirt into the air to mark the groundbreaking of a building, smiling as cameras clicked.
“I think people have a perception that, at the federal and state level, COVID is being forgotten because there aren’t mandates,” said Dr. Shira Doron, an infectious disease physician and epidemiologist at Tufts Medical Center who sits on Baker’s advisory board.
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But the discussion about bolstering vaccine efforts, distributing protective gear, or tracking available treatments — “all of those things,” she said, “are still happening in full-force.”
State officials describe the shift from more public-facing policy-making to back-room data tracking as a reflection of the pandemic’s evolution. Once relied on to stand up vaccine efforts, the state has largely ceded that infrastructure to pharmacies, doctors, and local sites. Three-quarters of the state’s free COVID testing sites closed last month; meanwhile, state officials said they’ve so far overseen the distribution of nearly 10 million rapid at-home tests.
The state has continued to update its public COVID data dashboard five days a week, and Sudders said officials plan to keep the current reporting in place until at least the end of July. But she said it could “evolve” after that, depending on the track of the pandemic.
That has been difficult, if impossible, to predict. An Omicron subvariant that is believed to have driven a recent surge in Europe accounted for more than 80 percent of new cases in New England, according to federal estimates earlier this month. But how high it could send new infections here is unclear.
“It’s not that we stop [addressing COVID]. We become the backstop to more local-driven responses,” Sudders said of the state’s efforts. For example, she said, the state has kept “contingency contracts” in place, including for mobile vaccine clinics.
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“Within a week’s time, I can deploy more,” she said. “You wouldn’t see that. You wouldn’t know that existed. But rapid response teams, testing, and vaccines — we’ve kept in place.”
Some critics say that lack of public visibility into some of the current efforts is a problem. Public health advocates, for example, have repeatedly pushed Baker to set out metrics for making decisions in response to data, such as what Mayor Michelle Wu did when she set thresholds for lifting a proof-of-vaccination mandate. (Baker did not set such a requirement at the state level.)
State officials should continue to consider a wide breadth of data beyond how many are dying or are hospitalized from COVID, which can be lagging indicators, said Representative Jon Santiago, a South End Democrat.
“If we’re just looking at hospitalization and deaths, we’re behind the eight-ball here,” said Santiago, who also is an emergency room physician at Boston Medical Center.
Others want to see a more public analysis of what worked, and didn’t, at the state level. The administration should consider a public process, including listening sessions, to build an “after-action report” as a way to vet its own response to the pandemic so far, said Carlene Pavlos, executive director of the Massachusetts Public Health Association.
“Transparency is essential for accountability. And accountability is not always a negative word,” she said. “They should be accountable for the decisions they’re making and the policies they’re enacting.”
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During the throes of the initial Omicron surge that swept through the state this winter, Baker faced pressure from lawmakers who said he should have acted more swiftly, including by reinstating a mask mandate. (He didn’t). In a January oversight hearing, he also faced calls to communicate more regularly with the public, or as one senator put it, to “be more present.”
Baker said he views some of those differences as “good old-fashioned policy disputes” about the best way to respond.
During a Thursday COVID meeting on the final day of March, Baker and staff ran through sometimes granular data, including how many protective gear requests it had received. (There were 745 in total, including 60 in the past few days). A vaccination clinic Springfield held with the Department of Public Health at a Bounce Trampoline Park in late February, for example, made up more than half of the children vaccinations the city recorded that week.
With federal officials authorizing people 50 and older to get a second COVID-19 booster, Baker and his aides also discussed ways they could encourage people to seek out another jab.
“Send me or the LG to get a booster somewhere?” Baker, 65, wondered aloud to staff, referring to Lieutenant Governor Karyn Polito. The governor suggested he get his shot at a long-term care facility, saying he’s “a little more interested in those folks than anyone else.”
“I definitely view the surveillance and the continued effort around vaccines, and especially boosting vulnerable populations, as something we’re going to keep doing,” Baker later said in an interview in describing his administration’s role with nine months until he leaves office. “I just don’t see a scenario where we don’t.”
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There are still wider questions, however, of what role the state should take this year and beyond, including when Baker’s successor takes office.
Dr. Paul Biddinger, chief of emergency preparedness at Massachusetts General Hospital and an outside adviser to the Baker administration throughout most of the pandemic, said the state should continue to “beat the drum” on everything from vaccines and boosters to available testing and therapeutics. But he also didn’t rule out officials reconsidering steeper measures if a more deadly variant were to emerge.
“I can’t speak for the state, but I don’t know if it will be fair to say that none of the previous measures would be off the table if the situation were to change dramatically,” he said.
Kate Walsh, chief executive of Boston Medical Center, said the state should “stand in and be the voice of patients and the public at large.”
“Whether that’s resources, whether that’s public education. . . their job is to make sure that we, the health care sector, are as ready as we can be,” she said.
After two-plus years, addressing COVID — once measured in travel restrictions and mask rules — is baked into the state’s work in other ways, Baker said. When he speaks with other governors now, the focus of most conversations is not how to deal with the virus, but what “COVID left,” he said: behavioral health challenges, learning gaps in schools, distributing federal funds.
“I don’t think we think of it as kind of front-and-center stuff. We think of it as part of what we just do,” Baker said of navigating the virus. “It’s like following traffic and dealing with all the other issues that come with the job.”
Baker then paused. “Like filling potholes.”
Matt Stout can be reached at matt.stout@globe.com. Follow him on Twitter @mattpstout.