Coronavirus cases appear to be stabilizing in D.C., Maryland and Virginia, with early signs of decline in the D.C. metro region — giving health officials hope that the area’s vigorous vaccination campaign has paid off.
The District’s case rate showed slight declines this week after consistent increases through most of August and September. Montgomery County’s case rate per 100,000 people has hovered just over 10 since the start of the month while Fairfax County has averaged a case rate of 16 per 100,000 residents for nearly a week.
Public health officials and experts say they’re increasingly hopeful that the region will come down from this latest wave of the virus without the skyrocketing hospitalizations and deaths that plagued other parts of the country.
They warn it’s still too early to declare victory over the highly contagious delta variant, which has fueled the recent spike — especially while sizable pockets of the unvaccinated persist in rural parts of Maryland and Virginia. But it’s cause for optimism that the region’s twin strategies of vaccinations and encouraging masks appear to be holding the line against the surge.
Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security, said she doesn’t expect the region to experience another dramatic surge in infections heading into fall, especially if vaccine mandates and government campaigns continue to push the vaccination rate upward.
The region’s recent increase in cases, she noted, has not reached the its January peak of more than 8,500 new daily infections, even though communities have far fewer pandemic restrictions in place than nine months ago. Deaths and hospitalizations, which tend to lag changes in cases by a few weeks, have increased since mid-August, but at a slower rate than in previous waves.
“My hope is that the worst may be behind us,” Nuzzo said.
Anne Arundel County health officer Nilesh Kalyanaraman said that barring a new variant of the coronavirus that is resistant to the available vaccines, he thinks it’s unlikely that Anne Arundel or neighboring jurisdictions will need to return to major restrictions on social and commercial activities in the coming months.
“The main thing is that we now have the tools to deal with this,” said Kalyanaraman said. “This winter will be better than the last winter.”
Boris Lushniak, dean of the University of Maryland School of Public Health, said the delta variant’s course through the region so far shows that the vaccines work. While there were breakthrough infections among vaccinated residents, the shots largely protected the vulnerable from severe effects of the disease, such as those in nursing homes, who were among the first to be immunized.
In Maryland, about 80 nursing homes recently reported covid-19 outbreaks, compared to more than 200 in previous waves of the virus. Even in facilities with new cases, the outbreaks have been smaller and less severe, said Allison Ciborowski, chief executive at LeadingAge Maryland, which represents nonprofit operators of long-term-care facilities.
“The most anxiety-provoking issue of delta was the unknown. … People were having these flashbacks to the outbreaks that we had earlier in the pandemic,” said Ciborowski, noting that numerous facilities reinstituted restrictions of visitations when case rates picked up. “But these outbreaks have been different from what they were before.”
Joseph DeMattos, president of the Health Facilities Association of Maryland, said that while nursing homes have generally been “holding their own” against the delta surge, there are disparities across the state. Skilled nursing facilities in liberal, affluent Montgomery County, where 75 percent of all residents — and 96 percent of those above 65 — are vaccinated, have been better able to beat back the virus than facilities along the state’s rural eastern and western shores, where less than half of the total population has gotten their shots.
As cases ticked up in the late summer, Montgomery expanded its covid-19 surveillance, said acting health officer James Bridgers, going from conducting 1,000 coronavirus tests per week in July to 6,000 in September. Along with D.C., Baltimore City, and other more densely populated counties, it also reinstated its indoor mask mandate.
Bridgers said there could be bumps in case rates as cooler weather sends people indoors and more in-person activities return, but he doesn’t expect them to be drastic. “In the county, we’ll continue to maintain a steady course,” he said.
In this wave, cases and hospitalizations in Virginia have outpaced those in Maryland and D.C., probably because of the pockets of unvaccinated residents in the southwest parts of the state, experts say. In Carroll County, part of the Mount Rogers Health District, less than 35 percent of the population is fully vaccinated, compared to 63 percent in Fairfax. According to state data, the covid-19 case rate among unvaccinated residents in Virginia reached nearly 669 per 100,000 in mid-September, more than 12 times the rate among fully vaccinated residents.
“Our region is undervaccinated, and we have seen during this surge that this means many people are unnecessarily vulnerable to illness, hospitalization, and death,” said Breanne Forbes Hubbard, population health manager for Mount Rogers Health District. In recent weeks, Virginia’s coronavirus-related hospitalizations have climbed to two-thirds of its January peak; in Maryland, by comparison, hospitalizations have plateaued at less than half of its former peak.
Valley Health, which operates in rural Virginia and parts of West Virginia, said this week that it exceeded its previous record high of covid patients, taking in 175 in 24 hours. The overwhelmed health system has had to send patients as far as Pittsburgh and Philadelphia to receive care, the system’s quality and patient safety officer Nick Restrepo said.
The delta surge “has completely overwhelmed our hospital capacity,” said Beth O’Connor, executive director of the Virginia Rural Health Association. “The previous waves didn’t necessarily hurt rural communities as hard or as fast as delta has. … And it’s ongoing,” she added.
After an early lead, rural areas in April started lagging behind their urban counterparts in getting shots into arms. Efforts to increase vaccine access and counter misinformation has helped to steadily increase vaccinations, O’Connor said. But it’s slow work.
As the vaccination campaign marches on in the fall, elected officials will have to deftly manage the expectations of residents, said Lushniak. The delta variant has blunted the “sense of euphoria” from the start of the summer, he said, and served as a warning sign for communities to move more cautiously toward normalcy. Health care systems are still operating precariously, with exhausted hospital workers caring for unvaccinated covid-19 patients, absorbing a backlog of other medical cases, and facing an impending flu season.
“If we change our behavior … we could see another rise in cases. Nothing is inevitable,” said Nuzzo. “The decline in cases, it’s not like it’s a car without brakes. There’s no sustaining momentum — except us.”