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Editor’s note: this article was updated at 5:00 p.m. on April 2.
The state’s modeling of the coronavirus caseload in Vermont shows that cases will peak in mid-April to early May, in a “likely scenario,” but that existing medical supplies and space may still be stretched beyond their current capacity.
An exponential increase in COVID-19 cases that began to appear last week has slowed amid severe social distancing measures.
However, modeling released by the Scott administration on Thursday shows that the caseload is still likely to overextend the hospital system, particularly when it comes to ventilators and intensive care beds.
The state’s “likely scenario” would require 211 ICU beds at its peak, well above the 135 beds that are currently available. It would also require 114 ventilators; the state currently has 93 available.
The state’s data shows that Vermont is in the middle of the pack in New England in terms of how quickly the virus is spreading.
Financial Regulation Commissioner Mike Pieciak presented the state’s modeling in a video conference with members of the media on Thursday.
Pieciak said that while the spread of the disease did seem to be slowing — even beating the “likely” scenario the state has developed, it was time to “double down” on social distancing measures, not back off them.
“We’re not out of the woods yet, the worst is ahead of us,” he said. “So we really need people to be vigilant and to carry through with the social distancing that have shown some early glimmers of hope.”
Pieciak said the situation is very fluid and the projections the state has developed are evolving and change “quite rapidly.”
Through March 26, Vermont had a daily growth rate in COVID-19 cases of 32%, doubling the number of people infected with the virus every three days, and ranked 13th in the nation. Now the state is ranked 46th and has a 12% growth rate, doubling the number of cases every 5.5 days.
That decline in the rate of case growth has only occurred in the past week, as a result of intensive social distancing policies instituted by the Scott administration, including a stay home mandate for everyone but personnel for essential businesses, a prohibition on gatherings, the closing of the state’s public schools and mandatory telecommuting for state workers.
Pieciak credits the slowing of the disease growth to the sacrifices Vermonters are making “personally and professionally and socially” by socially distancing themselves from their neighbors, friends and families.
It takes a period of 10 to 14 days of social distancing to be measurable and “fully effective,” he said.
Those sacrifices will need to continue for weeks to come, Pieciak said, in order for the state to continue to see incremental progress and avoid a situation in which the health system could be overwhelmed, resulting in an accelerating mortality rate.
Charts developed by Pieciak, based on models from Oliver Wyman and Helen Leis, Columbia University professor Jeffrey Shaman, and Northeastern University professor Alessandro Vespignani, show that these tactics have slowed the anticipated curve in peak cases.
In the worst case scenario, with no social distancing, the state would have experienced a peak number of 2,575 hospitalizations, which would have overwhelmed the system by a factor of five.
In the likely trajectory, which falls between the best and worst case scenarios, about 522 hospital beds would be needed — about 100 fewer than the maximum number available.
The peak could extend over a two to three week period, according to Mike Smith, the secretary of the Agency of Human Services.
The Scott administration is using worst case scenarios because the pandemic is an unprecedented event, he said, “and if you look at history … you will find that where there have been failures in major events like this, they did not plan for the worst case scenario.”
Smith said the governor’s mitigation strategies are “critical” to preventing the worst case scenario. “I can’t emphasize this enough,” he said. “They are critical to help us protect overwhelming, our health care system.”
“Lives are at stake,” Smith said if Vermonters don’t continue to adhere to the social distancing policies, hospitals will not have enough medical personal and equipment to treat COVID-19 patients.
The Scott administration is using the projections as a way to determine how many hospital resources would be needed — including ICU beds, ventilators and personal protective equipment.
“This is a very complex medical emergency where some patients will need days of care, including in the ICU and ventilators,” Smith said. “The hospitals are our front line of defense, and the state is working hand in hand with our hospitals and our health care system to support them in adding capacity.”
The state is currently standing up more than 800 beds in gymnasiums, auditoriums, fairgrounds and medical trailers in locations across the state. COVID-19 patients will be treated in hospitals, while non-COVID patients will receive care in the “surge” capacity facilities.
While the state will have just enough hospitalization capacity in the “likely” scenario, the conversion of dozens of regular hospital beds into intensive care units will be necessary.
Ventilators, which are a matter of life and death for seriously ill COVID-19 patients, could still be in short supply, however, given the variable amount of time — from days to three weeks — each patient could be expected to need the devices.
Michael Schirling, commissioner of the Vermont Department of Public Safety, said 452 ventilators are on order and about 15 will arrive by the end of the week. Hundreds of thousands of pieces of personal protective equipment have been acquired by the state, Schirling said.
The Scott administration refused to provide mortality rates, even though the state has one of the highest per capita fatality rates in the nation. The state has four refrigerated trucks on hand in the event there is a large number of deaths as a result of COVID-19.
“We are not projecting a fatality rate for Vermont,” Pieciak said.
Smith would not put a timeframe on when the stay home order might be lifted.
“It would be irresponsible of me to do that right now,” he said.
The Scott administration will share updates of the predictive COVID-19 model for Vermont on a regular basis.
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