ALBANY — A second wave of coronavirus infections, hospitalizations and deaths is well on its way in the Capital Region. But will it be as bad as the first?
If there’s one thing public health experts and hospital leaders don’t like to do, it’s predict the future — especially when so much of it hangs on the behavior of a weary public and a virus we still don’t know enough about. But they have expressed hope that vigilance on the part of the public, combined with the region’s greatly expanded testing and tracing capabilities, will help shield us from the worst of what could come.
“I feel hopeful, frankly, about the next few months based on how we’ve responded to surges this past month,” said Eli Rosenberg, an associate professor of epidemiology and biostatistics at the University at Albany’s School of Public Health. “I think it’s truly about testing. In March, the virus took off on this scary exponential slope. Suddenly it was this runaway thing and it was so mysterious. Now that it’s less mysterious, now that we have testing and we have tracing, we can react in an intelligent way.”
Signs of a second wave
New daily cases across eight local counties have increased noticeably, coming just 17 cases shy recently of the region’s spring peak of 147 new cases recorded May 1, a Times Union analysis of local county data reveals. The region has topped 100 new daily cases only four times this year — three of which occurred this month.
The five-day rolling average of new daily cases in the region — a more forgiving metric that takes sporadic jumps and anomalies into account — reached its highest point since spring on Monday, with 78 average cases. That average peaked at 117 on May 2, and bottomed out at just 13 on June 17.
The percentage of positive tests performed on residents in the region has also climbed, from 0.5 on Sept. 26 to 1.3 on Oct. 26, according to the state’s COVID-19 dashboard. This metric can be a less reliable indicator, however, depending on testing capacity at any given time, as well as whether repeat testing of essential workers is taking place.
Most concerning to local officials is the recent rise in hospitalizations. Daily hospitalizations in the region have increased more than 400 percent over the past month alone, from 15 on Sept. 27 to 80 on Oct. 27, according to figures published by the state. Leaders from Capital Region hospitals gathered at Albany Medical Center on Wednesday to warn of the increase, and to urge the public to get vaccinated against flu and remain vigilant about mask use, distancing and hand hygiene.
“It seems as though for us, the next wave has started,” said Dr. Fred Venditti, hospital general director for Albany Medical Center.
There is a glimmer of good news. Venditti and other hospital officials say that while cases are rising, their severity is decreasing.
“What’s interesting is we’re seeing a very, very different outcome for patients being hospitalized now than we did in the spring,” Dr. Steven Hanks, chief clinical officer for St. Peter’s Health Partners, told the Times Union. “The mortality rate seems to be much lower. The number of hospitalized patients who go to the ICU is down compared with spring. The number of patients needing to be ventilated is down compared with spring. And the number of patients who are dying with COVID-19 who are hospitalized is down compared with spring.”
The reasons for this remain unclear, though officials have a few ideas. Doctors have learned when and in what combination to administer therapies to patients to produce the best outcomes, Hanks and Venditti said. There’s also a theory circulating that mask use may be shielding people who are exposed to the virus to smaller viral doses than they would have been otherwise.
“That’s all conjecture,” Hanks said. “But these are all things we’re giving consideration to, including possibly just changes in the virus as the virus mutates in the wild. So that’s the good news part of the story. The bad news is the virus continues to spread.”
While mortality appears to be falling, deaths have picked up pace in recent weeks. The region saw a wave of deaths in the first three months of the pandemic, and then sporadically over the summer. Some counties went months without seeing any. In recent weeks, however, those streaks have ended. As of Tuesday, at least 360 residents of the eight-county Capital Region were known to have died from the virus.
‘COVID fatigue is real’
From the beginning, public health experts and epidemiologists worldwide warned that much like the 1918 Spanish Flu, the coronavirus pandemic would occur in waves — hitting hard in the cold months and dying down in the summer. That has generally been true for New York and the Capital Region, though the United States experienced a second wave outside of the Northeast this summer and is now entering its third wave.
Part of the reason is that viruses just have an easier time circulating on dry, cold air. Another reason is that people tend to spend more time indoors when the weather gets cold, and virus from an infected person has fewer places to escape.
Unfortunately, officials fear a confluence of other factors will cause a surge this winter. People are exhausted by the stress and isolation the pandemic has caused, and a sort of “COVID fatigue” has set in that is leading to increased socialization and decreased vigilance, public health officials say.
“COVID fatigue is real,” Rosenberg said. “It’s fatigue at multiple levels — individuals letting their guard down, visiting family more, as the cold season approaches thinking, ‘Oh, I can’t eat outdoors at the restaurants I’ll just try indoors a few times.’ All of that is real.”
While they may have been able to count on people staying away from loved ones in the spring when the virus was new and lockdowns were novel, officials are now worried that the impending holiday season and return of college students from possible hot spots is going to fuel a new surge of cases at the worst possible time.
Albany County Health Commissioner Elizabeth Whalen said people were already associating the reopening of schools and businesses as a green light for pre-pandemic behaviors.
“People were taking that to mean they could be doing other things, like attending parties and socializing in groups and maybe letting their guard down in terms of wearing masks and keeping distance socially and avoiding large gatherings,” she said. “But those latter three strategies are more important than ever and what people need to understand is the ability for us to keep businesses functioning and schools open are entirely contingent on those behaviors.”
Whalen and other health officials who spoke to the Times Union agreed that people should try and avoid holiday gatherings with family and friends outside of their immediate household this year.
“I know it’s difficult,” she said. “But I think this is a different year and I think people need to take that into consideration in their planning. Because the last thing we want is for families to be brought together for a holiday that’s supposed to be about celebrating the things that we’re thankful for and for that to result in a case or sickness of a loved one.
Preparing for round two
While local health officials are hopeful a second wave won’t be as big as the first, they are preparing for possible contingencies in the coming months.
Hospital leaders on Wednesday urged the public to fight the fatigue and stay vigilant about basic precautions such as hand washing and masking while out in public. They also urged people to get vaccinated against influenza — a move that will help divert people from the hospital at a time when COVID-19 is surging. Local hospitals also announced that they will be mandating all staff, including those at private physician practices, to get vaccinated for flu, with exemptions for medical and religious reasons. That should impact roughly 35,000 health care workers in the region, they said.
“We don’t know where that curve is going to go,” said Dr. David Liebers, an infectious disease specialist at Ellis Medicine. “The more we do proactively, the better. It may be a tough winter but we can make it a better winter with sticking to everything we’ve been doing so far.”
Venditti noted that Albany Med spent the summer looking through its emergency response plan and adjusting where appropriate. Surge plans that hospitals developed in the spring remain on file with the state. And hospitals have built up a 90-day supply of PPE as mandated by Gov. Andrew M. Cuomo. They’ve also begun disinfecting single-use PPE for re-use — a practice used back in the spring to conserve supplies but which nurses have protested, arguing it puts them at risk.
“We’re definitely trying to be cautious with our use of PPE,” Venditti said. “Having said that, we are only doing what’s been sanctioned by the (Centers for Disease Control) or the Department of Health in terms of re-use … we’re trying to be careful anticipating that two months down the road, a month down the road, we could be in a different circumstance with limited supplies.”
As 2020 comes to a close, hospitals have also filed applications with the state to administer any COVID-19 vaccines that are expected to hit the market for essential workers in January 2021 and the rest of the population by spring.
Until then, individuals have an important role to play in keeping their communities safe, Whalen said.
“If people aren’t compliant and if people keep acting like it’s either a hoax or it doesn’t exist or they don’t like to wear masks, you know, yeah, we could be heading for (another shutdown),” she said. “I sincerely hope that doesn’t come to pass.”