Tuesday, August 04, 2020

D.C., Maryland, Virginia will rely on similar data to decide when to end shutdowns

May 04. 2020
Photo by: The Washington Post — The Washington Post
Photo by: The Washington Post — The Washington Post
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By The Washington Post · Antonio Olivo, Erin Cox, Rebecca Tan · NATIONAL 

The number of people hospitalized in Maryland for covid-19 was down for the third consecutive day on Sunday, and new admissions were mostly stable in Virginia.

The daily increases in deaths across the greater Washington region - meaning the total in the District of Columbia, Maryland and Virginia - has roughly plateaued for the last week.

And the governments of those jurisdictions have made progress in expanding testing, hiring contact tracers and stockpiling personal protecting equipment.

Still, the number of people dying of complications from the novel coronavirus remains high, and it spiked on Saturday and Sunday in Virginia.

Government leaders say any easing of the widespread social distancing measures that have been in place since mid-March will be gradual and will not start until at least later this month.

On Friday, Virginia Gov. Ralph Northam, a Democrat, said he'd announce this week whether he plans to extend his ban on nonessential businesses when it expires May 8. Maryland Gov. Larry Hogan, a Republican, has suggested that a phased reopening can begin early this month, while D.C. Mayor Muriel Bowser, a Democrat, said the surge in covid-19 deaths in the city on Wednesday and Thursday "highlights for everybody that we are not done with this virus."

While their routes to reopening are different, they're all based on similar benchmarks: a sustained decline in the levels of devastation caused by a novel coronavirus that leads to the covid-19 disease that had killed 2,192 people in the region as of Sunday, with the number of known infections approaching 50,000.

Here is where each jurisdiction stands with respect to the metrics that Hogan, Bowser and Northam are monitoring.

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Infections, hospitalizations and deaths

Each of the three leaders initially based their blueprints for relaunching the local economy on White House guidelines that say there should be first 14 consecutive days of declining trends in new covid-19 cases or infection rates.

But Hogan has also talked about wanting to see a "plateau."

His "Roadmap for Recovery" doesn't focus on overall covid-19 cases because, his administration says, there hasn't been enough testing to know whether that metric is accurate.

Hogan said on April 17 that the state would closely watch deaths. But the governor's written reopening plan, released a week later, called the death toll a "lagging indicator" of the state of the pandemic, and said hospitalizations were a more useful measure.

"The rate of COVID patients occupying beds is currently our most accurate measure of our ability to slow the spread of this deadly disease in Maryland," his plan said.

Like Virginia and D.C., Maryland is focused on the daily influx of hospitalizations and intensive care unit patients.

"When we start seeing a downward trajectory, or a consistent plateauing of those metrics, that can put us in a position to consider lifting the stay-at-home order," Hogan said last week.

The number of new daily hospitalizations seesawed from 132 to 192 and back to 142 over the five days ending Sunday, while the number of ICU beds in use inched down from 585 to 565.

The state's rate of positive test results was steady at 19% last week.

In Virginia, a spokeswoman for Northam clarified that the governor will not necessarily need 14 consecutive days of declining trends, as long as the general trajectory shows a decline.

"One spike upward won't reset the counter if the overall trend is down," spokeswoman Alena Yarmosky said last week.

Northam, who is also a pediatric neurologist, is focusing on rates of infection and hospital admissions. Authorities are also looking at whether the percentage of positive test results is rising or falling, Yarmosky said. 

The rate slowly dipped last week, to 15.6% on Sunday.

The state reported 94 new hospital admissions a day on Wednesday, Thursday and Friday, but that number climbed to 103 and 108, respectively, on Saturday and Sunday.

In D.C., Bowser's administration says an initial phase of reopening would occur only after 14 days of sustained declines of new daily cases, reported flu-like illnesses and new cases inside nursing homes.

On Sunday, D.C. reported 219 additional cases, up from 137 on Saturday, but down from 335 on Friday. Officials did not share the city's data for other flu-like illnesses or nursing homes, but said they are nowhere near meeting their benchmarks.

D.C. health officials initially said they want to see the rate of positive tests fall below 10% for 14 straight days.

As of Saturday, the infection rate was 22 percent, up from early last week.

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Tracing and handling infections

Another factor in lifting restrictions is the capacity each jurisdiction has to handle existing covid-19 patients and absorb spikes in infections, which experts say will come as the shutdown eases.

That fortification process involves ramping up testing, increasing the numbers of contact tracers who can identify and isolate new patients, adding more hospital beds and stocking up on personal protective gear for medical workers.

Maryland officials say they're on track to meet all of those goals.

The state has met its target for another 6,700 hospital beds, Hogan said, by freeing up beds normally used for elective procedures, erecting treatment tents in hospital parking lots, reopening a shuttered hospital in Laurel and converting the Baltimore Convention Center into a 250-bed field hospital.

The governor's acquisition of 500,000 coronavirus test kits from South Korea is a step toward reaching his goal of testing 10,000 people per day. But the state has been slow to use the tests and still lacks critical swabs used to collect samples and chemical reagents needed to detect the virus.

Last week, Maryland signed a contract with the National Opinion Research Center (NORC) at the University of Chicago to hire 1,000 contact tracers, which will bring its workforce for that effort to 1,250 such workers.

Efforts to collect enough personal protective equipment suffered a setback Saturday, when the state canceled a $12.5 million contract with a company started by a Republican political operative because the company had not delivered on its promise to import masks from China.

Virginia officials have said there are enough hospital beds to handle new admissions through mid-June, with about 5,100 still available, according to the Virginia Hospital and Healthcare Association.

Northam announced Friday that the state has significantly expanded testing, with about 5,800 tests conducted Thursday. Virginia had been averaging about 2,600 tests a day, far behind most other states, but hopes to get to 10,000 tests per day before restrictions are eased.

Virginia officials say they are also working to increase their ranks of contact tracers, but have not offered details.

Late last month, Virginia officials said they ordered 17.4 million respirator masks, 1 million face shields and 17 million pairs of gloves.

D.C. says that, to reopen, its hospitals have to be less than 80% full for seven consecutive days. The city in general has met that benchmark. As of mid-April, D.C. hospitals were at 65% capacity, according to the city's most recent data.

D.C. officials also said Friday that hundreds applied for new contact tracing jobs on the first day they were posted. But getting enough protective equipment and contact tracers remains a challenge.

Bowser has said the city needs about 600,000 N95 masks, 5.6 million surgical masks, 1.4 million gowns, 350,000 face shields and 40 million gloves to get through August. Last month, the city had about 7.6% of the N95 masks it needs and about 12% of the its needed surgical masks, officials said.

The city had enough test kits to diagnose patients exhibiting flu-like symptoms, officials said, and is working to expand the number of people who are tested. D.C. officials said they want to have enough test kits to also diagnose all essential workers and close contacts of infected patients - even those who are not showing symptoms - before the restrictions are lifted.

D.C. officials say their public health lab plans to double its capacity to 1,000 a day but currently does not get more than 500 requests per day.

On Friday, Howard University announced plans to open a testing site for up to 200 residents per week.

"We need to screen everybody," said Hugh Mighty, dean of Howard University's college of medicine and vice president of clinical affairs. "You want to know the negative as well as you want to know the positive. Unless we blanket the whole region with screening, we're not going to know what we're dealing with in terms of who is positive."

 

 

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