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The coronavirus might not be the worst of it
The Washington PostDemocracy Dies in Darkness

Coronavirus cases have sharply declined in the D.C. region. But as the area reopens, officials expect a surge.

People in Arlington, Va., take advantage of a mild summer day to dine outside earlier this month. (Jahi Chikwendiu/The Washington Post)
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correction

Earlier versions of this article misstated the number of coronavirus patients at Children’s Hospital who exhibited signs of multisystem inflammatory syndrome. About 40 patients fall into that category.

In coming days, more Washingtonians will be chatting over a meal inside restaurants, huffing through a workout in a neighborhood gym or settling into a barber’s chair for an overdue haircut.

Along for the ride, in many instances, will be the novel coronavirus.

The District, Maryland and Virginia are not yet seeing the spikes underway in some southern and western states that reopened faster, and with fewer restrictions, than states on the East Coast. But as Virginia prepares to enter a Stage 3 reopening on July 1, with Maryland and the District likely to follow soon after, experts say there is little doubt that some kind of surge will happen soon.

“There’s nothing that’s changed about the virus,” said Joshua Sharfstein, vice dean for public health practice and community engagement at Johns Hopkins Bloomberg School of Public Health. “We’re the ones changing. As we’re reopening, it’s just so important to be vigilant.”

The trajectory for covid-19, the disease caused by the coronavirus, has followed the same downward curve in the Washington region as in other hard-hit areas of the country that used aggressive shutdown restrictions before gradually reopening, including New York, Connecticut and New Jersey.

In Maryland, the seven-day average of daily reported covid-19 fatalities has fallen from 56 in late April to 16 as of Friday, while the average number of hospitalized patients dropped to 565 from a peak of 1,674 in early May, according to a Washington Post analysis of state data.

Virginia’s seven-day average for daily reported deaths had fallen to nine as of June 20, down from 32 last month, but it had crept up to 14 by Friday. The state’s seven-day average for current hospitalizations has fallen to 861, just over half of what it was in early May.

In the District, the average number of newly reported deaths was two on Friday, down from a peak of 12 in late April. The District’s average number of hospitalized patients has steadily dropped, to 163 on Friday from 437 in early May.

Those numbers — plus the percentages of positive coronavirus test results, which have fallen into single digits in all three jurisdictions — show that the shutdown restrictions that went into effect in late March have worked, local officials say.

But with rising infections in Florida, California and about 20 other states, leading to record-high increases for the country last week, officials in the Washington area warn that the gains made here can easily evaporate.

“Everyone should continue to take this pandemic very seriously,” Virginia Gov. Ralph Northam said, urging residents to wear masks after announcing plans to move to Phase 3 of his reopening plan on July 1. Among other things, the new phase allows groups of as many as 250 people to gather and public pools to be used at 75 percent capacity.

“Cases are on the rise in many other states,” Northam (D) said. “I do not want to see that happen in our commonwealth.”

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Hospitals in the area say the load of covid-19 patients has lightened, but still not in a consistent way.

At Children’s National Hospital in Washington, the number of children testing positive for the coronavirus each day drifted down in mid-June before climbing back up again.

“We were hopeful for a day, but that hasn’t held, and the cases have continued coming in,” said Roberta DeBiasi, the hospital’s infectious-disease division chief.

DeBiasi said the hospital is still seeing cases of the multisystem inflammatory syndrome, the mysterious Kawasaki-like condition that has appeared in some children who have tested positive for the coronavirus. Of the nearly 500 coronavirus cases Children’s has treated, about 40 have shown signs of the syndrome, two-thirds of them boys.

“We’ve seen about six in just the last week, so that isn’t slowing down,” DeBiasi said.

In Maryland, Prince George’s Hospital Center in Cheverly had 26 covid-19 patients on Thursday, compared with more than 100 three weeks ago, said Joseph Wright, chief medical officer at Capital Region Health, which oversees the hospital.

But, Wright said, the severity of the cases has not diminished, with 40 percent of those patients requiring critical care.

“It’s all relative,” he said. “We’re breathing a sigh of relief because we only have 26 covid patients in the hospital — but that is still a significant burden.”

Reopenings, record cases and full hospitals. America’s dissonant response to the pandemic

Adventist HealthCare system’s three hospitals in Maryland are also seeing fewer patients but a consistent level of severity, officials there said.

Fourteen percent of patients at Fort Washington Medical Center have covid-19, down from a peak of 60 percent in May. The massive medical-surgical tents that state health officials erected in the hospital parking lot in April are no longer needed, said Chief Medical Officer Griffin Davis.

But the mortality rate for covid-19 patients there and at the hospitals in White Oak and Shady Grove has held steady at a “discouraging” 20 percent, he said.

“We are cautiously optimistic,” Davis said. “But I do think we will see a second wave. I just don’t know when — and if this current wave is over.”

Eric Houpt, head of the Division of Infectious Diseases and International Health at the University of Virginia Health System, said it could take another month to fully understand the effects of the loosened restrictions in Virginia, Maryland and the District — and the mass street protests and demonstrations this month in the nation’s capital, Richmond and elsewhere.

When someone becomes infected, it can take as many as two weeks for that person to infect one or two others, then another two weeks for those people to pass on the illness to a third group of people, Houpt said.

“It may be hard to see the impact unless it’s a massive number — and we hope that’s not the case,” he said.

Signs of a significant resurgence could prompt local officials to keep current restrictions in place, or possibly reinstate shutdown orders, as in Texas, Florida and Arizona, which paused their reopening plans last week after the rate new cases skyrocketed in their states.

‘That’s when it’s time to stop and reflect and say: ‘Do we need to step backwards?’ ” said Amanda Castel, an epidemiologist specializing in infectious diseases at George Washington University.

Eric Toner, a pandemic preparedness expert at Johns Hopkins Bloomberg School of Public Health, said government officials should be more aggressive about preventing such a spike. For one, the turnaround time on covid-19 tests needs to be faster, so people can more quickly avoid the possibility of infecting others, Toner said.

“For much of these tests, the results don’t come back for three to five days,” Toner said. “They have relatively little value by the time you get the results back.”

Toner also said the warnings to wear a mask in public, and to avoid close contact with others whenever possible, should be repeatedly drilled into people’s heads.

“We should have country music stars and rap stars and movie stars . . . talking about the importance of these public health measures, if we want to avoid shutting down the economy again,” he said.

Currently, mask usage in the national capital region is fairly high compared to other parts of the country, according to the University of Washington’s Institute for Health Metrics and Evaluation, which has been tracking responses to the pandemic and currently projects that the virus will be mostly contained in the District, Maryland and Virginia throughout the summer.

But as more businesses reopen, attitudes have grown more relaxed about the risks of exposure, particularly among young adults, said Ali H. Mokdad, a professor of health metrics sciences at the University of Washington.

“They used to go out to dinner in couples; now 15 of them are out partying,” Mokdad said. He predicted that this exposure, combined with family gatherings last weekend for Father’s Day will lead to more reports of infections among elderly parents in coming weeks.

The prospect of large gatherings for next weekend’s Fourth of July holiday — when President Trump plans to host a fireworks-filled “2020 Salute to America” on the South Lawn of the White House and the Ellipse — prompted D.C. Mayor Muriel E. Bowser (D) to urge residents to instead stay home.

“Large gatherings are still a high-risk activity,” Bowser said during a briefing Thursday at which city health officials reported there are still signs of community spread of the virus.

“You’ve asked me: ‘Are you concerned about it as we go through reopening?’ ” Bowser told reporters. “And the answer is a resounding ‘Yes.’ ”

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