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New models show social distancing measures could help COVID-19 cases in Vermont peak as early as this month. But officials and experts warn that those restrictions will need to stay in place long after the worst has passed.
“We’re not out of the woods yet,” Financial Regulation Commissioner Mike Pieciak said during a presentation on the state’s coronavirus forecasts Thursday. “The worst is ahead of us.”
Pieciak said the current caseload puts Vermont in an even better position than the “likely scenario” charted by the state’s analysts. But those trends could still lead hospitals to max out their supplies of ventilators and ICU beds. The state is working to expand its capacity using “surge” facilities and emergency orders of equipment.
Officials emphasized that the slowing growth of new cases would not indicate that it’s time to lift Gov. Phil Scott’s “stay home” order — instead, Pieciak said, Vermonters should “double down” on their social distancing efforts in order to avoid overloading hospitals in the coming weeks.
Dr. Jan Carney, the associate dean for public health at UVM, said looking to lift restrictions in the near future would be premature. Social distancing measures should stay in effect “for as long as practically possible,” Carney said in an interview this week. “Because if we open up everything we did too quickly, is there a worry that we could see some more disease coming back? I think we have to wait and see.”
On this week’s podcast, VTDigger data reporter Erin Petenko talks about what the state’s projections do and don’t tell us about the trajectory of the virus. Plus, Jan Carney discusses the science behind social distancing.
**Podcast transcript**
This week: New models show social distancing measures could help COVID-19 cases in Vermont peak as early as this month. But officials and experts warn that those restrictions will need to stay in place long after the worst has passed.
Our data reporter Erin Petenko has been watching the numbers.
We were on this briefing call, where a number of state officials ran through a whole series of statistical protections and models of what the next several weeks of this outbreak might look like here in Vermont, what was your overall takeaway from that conversation?
Erin Petenko: I took away that if this doesn’t get very bad, that will be very good. And if this gets very bad, this will be very bad.
What do you mean?
Erin Petenko: Well, almost always in these projections, they say, ‘under a best case scenario, there will be X number of cases. Under a worst case scenario, there will be Y number of cases.’ And Y is usually bigger. Obviously, the worst case scenario always looks really bad in terms of, you know, ‘we’re going to overrun our hospitals and so many people are going to die. But don’t worry, because we don’t know that the worst case scenario is going to happen and it’s probably not going to happen.’ So I could definitely see why an average person would look at these things because I do and go, ‘Well, what does this mean about what is going to happen?’ What if the ‘coulds’ and ‘shoulds’ turn into the ‘will’ and ‘won’t.’
Mike Pieciak: The situation that we are all dealing with is obviously a very fluid one. And the projections that we have run, the projections that we were reviewing a week ago, or even just a few days ago, are looking very differently than they do today.
At least according to what state officials told us, where does it seem like we are in terms of a best case scenario versus a worst case scenario?
Erin Petenko: This model also was kind of time traveling. Because they presented yesterday, but they put it together last week. So last week, based on the data they had, they created a likely scenario that will occur in Vermont based on the current data now. Just since that time, so much of the data has changed that even state officials are saying: ‘We think we’re going to do better than our likely scenario.’ Which is good news.
Mike Pieciak: We are seeing an — again, really good change impacting is being magnified, we start to fall off track and see even greater reduction in the weeks ahead. So that is the message. We want to make sure people drive home that there is an improvement, but that improvement, however, can change considerably if people change their habits. We’re not out of the woods yet. The worst is ahead of us.
We anticipate a peak sometime in the middle to late April or early May time period. So we really need people to be vigilant and to carry through with the social distancing that has shown some early glimmers of hope.
Erin Petenko: So what does that translate to in terms of all those bad things I talked about, about hospitals and capacity and things? Well, they admitted that under that likely case scenario, we will have too many patients in our ICUs. And we will probably have too many patients on ventilators.
Mike Schirling (Public Safety Commissioner): With the current healthcare capacity we have, if we keep on the current projection, we’ll be close. But right now we’re projecting there’s the possibility that there will outstrip our ventilator capacity. That’s why we have 452 that have been ordered, plus a FEMA request for ventilators.
Erin Petenko: But a whole nother variable in here is how can we as a state, increase our capacity and get more space in our ICU, get more ventilators, get more staff, more PPE, and get prepared for this virus and then raise that capacity so we never have to worry about going over it.
You’re saying that the likely scenario is kind of in line with this slowing growth that we’re already starting to see. But that still means that we have some potential shortages on the horizon.
Erin Petenko: Yeah. We are doing everything we can to increase our hospital resources. But we really need people to continue to do their social distancing habits. The best case scenario, which they say we could even still hit, we would never hit the limits of our hospital capacity. So that’s good news. They really do think it’s feasible that none of this bad stuff will happen, although unfortunately, people will still get sick even under a best case scenario.
Sure.
Erin Petenko: And then under the likely scenario, which is still preliminary and slightly out of date, we would be somewhat over hospital capacity at the very peak of the virus.
Got it. One thing I’m curious about is testing. We’ve reported just in the past couple of weeks that based on what epidemiologists know about how this spreads, and how limited the testing has been so far, that there’s a lot more people out there who are infected than we even really know about, more than just those confirmed cases. How are we able to use the data that we have to extrapolate these kinds of protections, knowing that there may be an unknown number of people out there that actually are infected?
Erin Petenko: Yeah, it’s kind of a strange way of estimating cases. Because they’re saying, well, we don’t know the total number of cases. But we think we know how much we don’t know. We know how much we’re testing compared to other states. And we know how many of those tests test positive. So we kind of have an idea of how many more cases are out there compared to our testing levels.
Mark Levine (Health Commissioner): As you know, all week since the end of last week, I’ve been advocating for as much testing as possible in symptomatic individuals. And we’ve seen a nice response to that, although I think it could be even more exuberant, to be honest.
Erin Petenko: They also say that their testing rate is relatively steady and relatively high. They do have one of the highest testing rates in the nation. I do also wonder, though, what that testing divide breaks down into by region of the state, which could, of course — if there’s under-testing going on in one particular county or one particular city, it could be harder to miss the beginnings of an outbreak in that particular area.
Are there other big unknowns here? Are there other things that the data that we do have might not really be able to tell us?
Erin Petenko: Absolutely. I mean, a lot of what this model is based on is research coming out about how the coronavirus spreads. You know, ‘if one person gets it, this is how many people that pass it to. If this person gets it, this is the chance they’ll get hospitalized.’ And they said they pulled that data from different countries across the world: China, Italy. And probably some preliminary U.S. data, I don’t remember if they mentioned that. But even that research is early. Even that research is changing. There’s still research coming out about what the death rate could be or how much transmission is going on. So those changes in the numbers could have an effect on how effective this model is.
The other unknown here — and we do have the beginnings of some of this data — is how well Vermonters comply with social distancing rules. Because if they comply with them really well, it will slow down how much a positive case can infect other people. But if they don’t, it’ll spread far more.
We have some early data that I’ve pulled and that the state has pulled, showing that this seems to be working pretty well. The state acted early, and they believe that Vermonters are traveling a lot less than they were. But we aren’t going to see the full effects of the social distancing rules for a couple of weeks, because it takes time for cases to appear. It takes time for people to become symptomatic. And it takes time for people to get tested and get the results back. So we’re also on a little bit of a time delay.
Got it.
[break]
Jan Carney (UVM Larner School of Medicine): Hi!
Can you hear me okay?
Jan Carney: I can hear you.
Great.
This week I caught up with Dr. Jan Carney. She’s the associate dean for public health at UVM, and she was Vermont’s health commissioner throughout the 1990s. In other words, she teaches epidemiology.
Jan Carney: We’re hearing those two words — “public health” — almost every day now.
The language of public health is really epidemiology. But the work of epidemiologists day to day, in every community in America and across the globe, is something that remains often invisible until something happens. Then you sort of see a little bit more behind the scenes about what they’re doing and how they’re doing it and why they’re doing it. That’s very much in the forefront today.
In terms of where we are right now — when you look at those trends, what are you seeing?
I see here in the state of Vermont, across our entire country, growing numbers. And they’re growing at different rates. For example, the situation in New York, right next to us, is extraordinarily serious. We’re also seeing high rates in Washington, and we’ve been hearing about that. And California and also the South. You look at the trend and the trend is up, right? And likewise, the state of Vermont.
So what do we know? What do we do? Who do we work with? And what can individuals do?
One of the things I’ve been talking about on a daily basis has been the science behind these social distancing recommendations. You know, do they really work? And is that our best protection? I think the science of social distancing is really compelling. And I can tell you a little bit about why I think that works.
Some of the lessons are from a different infection — one that we have a lot of evidence about what happened, which was the pandemic flu of 1918 and 1919. There’s a couple of studies that I talk about. One was, they did a study of that pandemic, and they looked at different mortality rates in United States cities. They looked at more than 20% of U.S. cities. And they found that there were differences in those actions that were taken.
The ones that did what we call social distancing — they closed the schools, they stopped public events, they isolated people who were ill from other people — it really separated people from each other. The ones that did the school closures, the isolation, and that also did that stopping of public events, had a reduction in deaths and serious outcomes from that pandemic that was different from the ones that didn’t. I think that’s a lesson that lasts over 100 years.
Wow. So you’re saying what we’re doing right now is directly related to evidence based on what happened back in 1918?
Yeah. And there’s more evidence from this current COVID-19 pandemic we know from over 100 years ago — that those strategies were very effective in reducing the most serious outcomes, deaths, from that pandemic.
Now, everything’s relative. So I’m not saying that the time and place from 100 years ago are 100% directly relevant right now. But the principle, I think, is the same. They were able to do that social distancing over a period of — in that study, it was about 10 weeks. And that showed a dramatic difference.
So what does that mean right now? Some of the recent papers that are coming out, and also the modeling that’s coming out, is from the countries who have already experienced it or passed the peak of this. As an example, there was an article from the CDC that looked at Singapore and showed the impact of their disease surveillance. They did more testing, and that enabled them to quickly isolate people who are sick. And they also did those same kinds of social distancing things that were done in 1918 here in the United States, and those were effective.
And it’s not just the government, what the government is saying. It’s what individuals do. To me, it’s kind of common sense, right? If you are staying apart from other people, and you might be coming down with a viral illness, well, you’re not going to spread it to somebody else. Or if you’re already sick, and you’re here apart from other people, that reduces the number of people you spread that infection to. So these kind of social distancing principles that we’re doing, like right now here in Vermont, they protect ourselves, protect our families. They protect our friends, they protect the people we work with, and they have a huge impact on disease rates in the community.
I’m curious, how do you know when to put these social distancing restrictions in place? How do you know when on that curve is kind of the sweet spot for when you can really make the most impact?
My short answer to that is, the sooner the better, and keep them in place as long as practically possible. No one knows exactly how long that is.
The value of doing it early is that you’re in a position where you know that things are getting far worse in other areas — to stop that from happening. So it gives you the potential for prevention.
As an example, what we did here in the state of Vermont, I thought was really, really good. It was strong, it was expansive, it was across the board. It was those exact same kind of social distancing strategies that we know work, all the way from that 1918 pandemic. And we continue to repeat them. People seem to be listening. If you go out, many places are far less crowded, and we’re telling people to do their best to stay at home.
You’ve talked a lot about what it’s like to look at this data and look at the trends. Are there things that the data doesn’t show?
Let me talk about that in a general way. Sometimes when this happens, it happens really, really fast. For example, they had to first sequence the genome of the virus, then they develop the test. You’re just going really, really fast while you’re trying to understand who’s getting sick, how to prevent that, do the public messaging, trace who exposed whom, and try to isolate them and just use the basic strategies.
I think in this case, we don’t necessarily have the luxury of having widespread data about: what is this infection rate truly across the board in the community? First, tests had to roll out. Then, the kinds of studies that can be done — in terms of really looking at the specifics of household spread and community spread — it was just moving too quickly. And you have to spend your time trying to prevent it any way you can and take care of people who are sick.
I think that moving forward, some of these studies that are going on now will help elucidate that in hindsight, but there’s never a perfect world in the time of a pandemic.
In terms of where we are right now, it does feel like we’ve entered a new phase of this crisis, where the restrictions have been put in place, everyone has at least started to adjust to them. We’ve gotten used to social distancing — it’s kind of entered everyone’s vocabulary at this point. What is the next shift on the horizon? What is the next phase of what this crisis looks like here in Vermont and in the U.S.?
I think it’s really hard on a personal, individual, family, community level to see what’s happening across the country, and things getting worse, and to remain confident and rest assured that what they’re doing, they need to keep doing that. Staying the course — you know, everybody all in on this — and reassuring each other and supporting each other, to staying physically apart from other people for a little longer than we might have thought we were going to have to do it when we started.
Some of the public message is to say: keep staying distant, keep staying apart from other people. But keep connecting with people. Make sure you remember the rest of your health. You can still go outside when the weather gets nice — that’s something that’s a real positive. We’re finding ways to connect with people, keeping up with school, depending on your age. Those kinds of things. I think staying the course, and being comfortable with it, and sort of knowing deep inside that this is absolutely going to help us.
But you’re saying we might not see some kind of major turning point in the way that this is developing for quite a while.
I can’t predict that. I don’t think anybody can predict that. I think we’ve seen the trends, and nobody knows when that’s going to be. I think what we can be confident in — if everyone in their respective roles is part of being physically apart, but socially connected to people — if we’re able to maintain that for the long term, we will watch, and there will be serious outcomes, but we’ll have spared thousands and thousands of people from those.
When do you start to get signals that this might be coming to an end? What kind of things do you look for?
I’m looking at the major sources of literature. We’re looking at the World Health Organization, the Centers for Disease Control and Prevention, and the Department of Health of course, as the major sources. The New England Journal of Medicine puts out regular articles that are publishing results of what’s happening in other countries who have already gone past the peak.
I think everyone’s looking at those and their experience. How fast is that happening? What did they do? And is there anything we can learn from them? And I think you watch that for certain countries in Europe as an example, that are doing more poorly than others, and everybody is following that sequence here in our country. You know, when something peaks, what are people doing? How are they doing it? What can we learn so that we can end it right here in our own state, our own community?
It sounds like you’re saying it’s a little bit too early to even know what those signals are going to be.
We can look at the data from the CDC website and look at their maps. And I have great confidence in how they do their jobs. And we can look at similar findings here in the Department of Health. When we start to see there’s a peak, and now the serious outcomes or the people testing positive are starting to go down. That’s what people are looking for.
The other thing is that even when we watch this curve, and we might see them start to come down and we relax a little bit, we still may need to maintain the social distancing for a while longer. Some of the newer data that’s coming out is saying, we’re going to have to be really careful to make sure things are really at a low level.
Once we start to see a small decline, everyone wants to go outside. But just pause for a minute and wait for those recommendations. Because if we open up everything we did too quickly, is there a worry that we could see some more disease coming back? I think we have to wait and see.
We’ll have plenty of information from the CDC and our own health department. We’re learning more and more every day about experiences from other countries and what people are doing in our state. I think you do have to be patient and wait to see.
Mike Smith (Human Services Secretary): You know, we’ll start adjusting our timeframe based on upon what we’re seeing on the ground. We’re not going to ease up if there are indications that we need to keep the restrictions on at the same time. Believe me, as soon as we’re confident that we can start releasing some of these restrictions, we will. But I can’t put a timeframe on that right now.
One thing I heard officials really stress yesterday was how new this problem is. How they’ve really never seen anything like this, both in state government and just in general.
Mike Smith: I just want to reframe everybody. Because we tend to think of this as a hurricane or natural disaster, like an earthquake or something like that, where you can set up triage sites for the injured. This planning is very, very different. This is a very complex a medical emergency, where some patients will need days of care, including in the ICU, and with ventilators — and some may not.
The hospitals are, like I said, our front line of defense, and the state is working hand in hand with our hospitals and our healthcare system to support them and add capacity.
Erin, I wonder, why should people trust these types of statistical models, when it feels like this is something that none of us have ever really had the opportunity to analyze before? Why does it seem like these numbers are really going to be able to indicate what happens next?
Erin Petenko: Well, I think that when it comes to trusting the models, it kind of depends on what you should trust the models for. If you’re trusting the models to say for certain what date you can go back to being in business, or for certain exactly how many cases there will be, or how much staff you will need, you’ll probably be wrong. Because again, this is completely unprecedented, and there is so much we don’t know.
I can’t blame the state for trying, though, because one thing that we can use these models for is to plan. We can’t say for certain, ‘we will have this many cases.’ But we can plan to have that many cases, just in case it comes true. We can plan to take action to prevent the spread of the virus based on those different scenarios. And hey, maybe we’ll take those actions and we’ll do a really good job and everyone will say, ‘Wow, why did you say there’d be so many cases? That didn’t happen at all.’ But that’s better than the alternative of being a lot worse than we expected. So it is good that they are putting those worst case scenarios out there and planning for them.
Michael Schirling: And we are preparing for the worst modeling that we have done, so the worst case scenario. We are buying hundreds of ventilators and millions of pieces of personal protective equipment, in case the models go in a different direction than they’re going now.
Erin Petenko: I will say this. If you’re listening right now, and you find that reading about these models and looking at these models and talking about them makes you feel really anxious, I am there with you. Sometimes I am crunching the numbers and I get really into it. And then I step back and I feel, like, a chill come over me of, you know, I feel like I signed the death warrant of the people that are written into this model. It’s like, all of our uncertainty and fear about the future for our entire lives compressed into this one three-week time span. Don’t feel bad for wanting to step back from all this science-y talk and think about, you know, there are real people and lives affected. And that’s really hard.
Thanks, Erin, for your time. I really appreciate it.
Erin Petenko: Thank you.
