@VALUEZTV AM EDITION
Lindsay Webar & Krys'tal Griffin
Twelve states are seeing record spikes in COVID-19 cases and 16 more are seeing enormous surges in hospitalizations. Delaware isn’t one of them.
Still, epidemiologists urge that even in states where cases continue to decline, now is not the time to ease precautions. On Tuesday, the governor ordered bars to close in beach towns over the Fourth of July holiday because of a resurgence of cases there.
It has left many questions in people’s minds:
Did we open up too soon?
Are economic factors overriding health factors?
Is this the second wave?
Why are numbers rising?
And most importantly, Am I more at risk now? What should I do?
All this is going on while some people refuse to wear masks in public spaces and fail to adhere to social distancing guidelines.
We talked to four experts in epidemiology about what the current coronavirus data means and how Delawareans should be interpreting what they see in these numbers.
Cindy Prins, Ph.D, is an associate professor of epidemiology at the University of Florida and specializes in biochemistry, microbiology, and molecular biology.
Ronald Fricker, Ph.D, is the associate dean of the college of sciences at Virginia Tech, and specializes in research on the performance of statistical methods for use in disease surveillance.
Laura Hungerford, Ph.D, is the head of the department of population sciences at the Virginia-Maryland college of veterinary medicine and holds a doctorate in veterinary epidemiology.
Lisa Lee, Ph.D, is the associate vice president for scholarly integrity and research compliance at Virginia Tech, and has worked in public health for over 25 years.
How bad is coronavirus in Delaware, and will it worsen here again like in other states?
Cases in Delaware are trending slightly upward as of the past few weeks. As of June 28, the average number of new cases a day was 111 compared to 58 the week prior. However, Delaware is not seeing the record high spikes and hospitalizations seen in mostly southern and western states like Arizona, Florida and Texas.
But Delaware is also not opening up fully. Gov. John Carney has pushed back phase 3 of reopening, which was slated to begin June 29, citing concerns about Delawareans not taking proper precautions.
"We’ve heard and seen concerns especially in our beach communities, in restaurants, in gyms, and at sporting events,” Carney said in a statement on June 25. “Now’s not the time to let up. You’re required to wear a mask in public settings. Keep your distance from those outside your household.”
Delaware may have managed to avoid a worst-case scenario like Florida and Arizona so far for a few reasons. Delaware had a more significant lockdown period: Carney enacted a stay-at-home order on March 24 and began phased reopening June 1. Florida and Arizona, two states seeing record high cases nearly every day, had shorter stay-at-home orders: April 3 to May 1 in Florida, and March 31 to May 15 in Arizona.
Furthermore, Delaware has mandated mask-wearing in public places where social distancing is not possible, like grocery stores and restaurants. Many states seeing spiking cases have no such mandates.
How worried should we be?
It depends on where you look.
The trend in cases is key to understanding the severity of the outbreak, according to Cindy Prins, associate professor of epidemiology at the University of Florida. If cases are increasing exponentially (as in states like Florida, Arizona and Texas) this indicates a growing number of unnoticed cases that perpetuate the spread.
“When you're seeing that trend go upward, I'm concerned that you also have an increase in the proportion of cases that are asymptomatic, and potentially transmitting because they don't even know to stay home,” Prins said.
In Delaware, data on case numbers is available on the state’s coronavirus website.
Another key metric in understanding the severity of the outbreak is the volume of hospitalizations and emergency room visitsfor COVID-19-like illnesses. While increases in new cases in some areas may be partly due to increased testing, increased COVID-19 hospitalizations tell us the severity of the outbreak is worsening.
“Increasing numbers of hospitalized cases and/or increases in the number of COVID-19-related deaths in the coming weeks will be indicators that it’s more than testing but also an increasing spread of the virus,” Fricker said.
However, the percentage of people testing positive out of the total tested is a less reliable indicator of an outbreak’s severity, several experts said. This is because the amount of testing varies wildly depending on where you are. Furthermore, only certain populations may seek out testing, giving an unrepresentative sample of the entire population.
“If every state did testing in the same way, we could compare them – but testing isn’t even the same in different parts of the same state,” Hungerford explained.
“Who's volunteering to get tested? It may be people who are high risk or it may be people who are worried about having it even if they're not likely to have it,” Prins said. “Long story short, it's difficult to interpret at this point.”
Particularly in Delaware, it’s hard to know how to interpret our percent positive rates. Between June 10 and June 23, the percentage of people testing positive has seen a slight upward trend but has fluctuated significantly between a high of 8% and a low of 2.5%.
“I think about the percent positive rate as saying more about the testing regimen than the state of the pandemic,” Fricker said.
Latest updates:Tracking coronavirus cases in Delaware
Is this the second wave?
The initial outbreak of the pandemic never actually ended, although some states had seen heartening declines.
"Many states are seeing increases," said Lee. "In some ways, we would expect cases to rise in places where people are beginning to move around again."
"This is not to say the increase is the natural way things are supposed to unfold."
She attributed the increases in cases appearing around the country to the lesser restrictions on public gatherings, increases in reopenings, and mask-wearing not being as enforced.
Why are numbers rising?
The United States is seeing record high numbers of COVID-19 cases. But numbers aren't rising everywhere in the country.
Ronald Fricker, associate dean of Virginia Tech’s college of sciences, highlighted the importance of looking at state data as opposed to national due to the disparities between certain states.
“Nationally the number of cases are going up,” Fricker said. But … this very much varies by location and so aggregating at the national level obscures local trends.”
Why are deaths trending down now, while cases continue to rise?
Experts speculate that deaths are now trending down because theaverage age of an infected person has begun to trend much younger, and young people are less likely to become severely ill or die from the virus. Many theorize that young people are increasingly getting infected because they are more likely to resume their normal routines as states reopen, while older people continue to take
“The theory is there are fewer people who are at risk that are going out now,” said Lisa Lee, associate vice president for research and innovation at Virginia Tech. “They are really heeding the advice of public health officials, that’s good news.
“The bad news is with young people who become more mobile, they are more likely to get infected and pass the infection on.”
And with hospitalizations on the rise in many states, more than just people with COVID-19 face health risks. Hospitals at or near capacity run the risk of not being able to provide patients with critical care they need.
“I think either way you have to take [rising hospitalizations] as a marker of, is there going to be care available if i get sick?” Prins said. “Am I gonna be able to have good access to health care if something happens?”
Furthermore, COVID-19 deaths may be trending down now because of the lag between infection, onset of symptoms and severe illness/death.
“The incubation period is about five days and people take another couple of days to realize that they are sick and get tested,” Hungerford said. “Then, for those who get very ill, the hospital admission may be around the time they were found to be a case, or even a week after this.”
“The average time of mortality is about two weeks after the person started showing signs – and the average time from when a person has died until their reason for death is confirmed and reported as from COVID can be another week. So, the deaths reflect people who were infected two and a half to four weeks ago.”
In other words, trends in coronavirus deaths lag behind trends in cases. And it may take some time before the trend in the number of deaths begins to mirror the trend in the number of cases.
Did Delaware open up too soon?
Recent outbreaks at Delaware's beaches are a cause for concern. Health officials identified more than 100 COVID-19 cases last week at resort towns and several bars shut to test employees for the virus.
Epidemiologists echo Gov. Carney’s concerns, and stress that now is not the time to let up for states like Delaware who are not seeing record high cases.
“I would look at some of these states as examples of where you could potentially wind up if you're not careful,” Prins said.
Am I more at risk now? What should I do?
Delaware must remain vigilant to avoid a larger outbreak, experts say.
“I think my take-home would be if you have that lower number of cases it is not time to drop those precautions,” Prins said. “I think what we're seeing is when those precautions start to lapse, those cases are gonna start going back up.”
She added that if states can keep encouraging people to routinely wear masks, it will be one of the most important ways to prevent people from getting infected.
In a similar fashion, Lee stresses that if the number of infections are going up, people need to make sure they continue to follow public health measures no matter where they are.
“We have to think of how to not only keep ourselves safe, but how to keep others from getting sick,” she said. “Nobody wants to be the person to infect somebody else.”
She has a simple reminder for everyone.
“The fundamental public health cautions remain the same here,” said Lee. “Make sure you remain physically six feet away from other people, wear a mask when you’re out in public, wash your hands and don’t touch your face."