Health officers from Maryland’s five largest counties and Baltimore City sent a letter Monday afternoon to the state health department asking for renewed restrictions on bars, restaurants and other establishments to curb the recent spike in coronavirus cases.
The letter, the text of which was obtained by The Baltimore Sun, was sent to Fran Phillips, a deputy health secretary, and puts the local officials in league with other public health experts seeking statewide action before the recent resurgence of cases grows worse.
“We are writing to share our concerns regarding the recent increase in daily cases across the state and impact of the virus over the past week,” said the letter signed by the health officers from Baltimore City and the counties of Anne Arundel, Baltimore, Howard, Montgomery and Prince George’s.
“This has been evidenced throughout many of our jurisdictions by increased daily case totals, increased rates of transmission and increasing Covid related hospitalizations and critical care usage,” it says. “We are writing to ask that the state take action to curb these trends, including revisiting the activities allowed under the current Phase 2 executive orders.”
Those orders, given last month by Gov. Larry Hogan, eased restrictions on gatherings and indoor activities such as eating in restaurants and visiting malls and recreational establishments. The orders came with limits, such as the number of people served at a time and a requirement for masking indoors.
The letter said local jurisdictions were “prepared to act quickly” on their own but would “prefer for the state to take action to create a unified, standardized approach to address this resurgence of cases.”
Mike Ricci, a spokesman for Hogan, said “local leaders continue to have the flexibility to make those decisions as they see fit,” under the state’s recovery plan.
He also emphasized that “every day, whether the numbers tick up or down, we have talked to Marylanders about the importance of caution and vigilance, stressing face coverings, testing, and physical distancing.”
In response to the rise in cases among young adults, Hogan called last week for a crackdown on bars and restaurants flouting distancing and masking orders but stopped short of ordering them to close. In a Monday evening appearance on PBS NewsHour, the Republican governor said state officials continued to watch the data.
“If we have to roll things back, then we definitely will take those actions,” Hogan said.
Cases of COVID-19, the disease caused by the virus, have been on the rise this month after a sustained period of falling infections. The positive cases reached their highest number in almost two months Sunday, with 925 infections — about 3½ times as high as they were when Hogan more fully reopened the state. There were 554 new cases reported Monday.
The move to more fully reopen was called premature by some public health experts at the time, including one of the governor’s chief advisers at Johns Hopkins University, Dr. Tom Inglesby, director of the Center for Health Security. He and others later said Hogan should consider reversing course and close bars and restaurants.
The infections, which initially had been driven by those on cruises and in places such as nursing homes and prisons, now have shifted somewhat to younger adults. People of all ages are being infected, but those in their 20s and 30s are now disproportionately represented in the data, fueling the belief among many experts and political leaders that they are not practicing social distancing and masking in public.
Some observers say the order to lift restrictions may have sent a message that people no longer have to be as guarded.
“States like Maryland were pretty good in the initial actions, but I don’t know of messaging that prepared people for a long, sustained effort,” said John M. Barry, author of “The Great Influenza: The Story of the Deadliest Pandemic in History” and a professor at the Tulane University School of Public Health and Tropical Medicine.
“Even the best messaging concentrated on getting people to do the right thing now, without explaining how long the effort had to be,” he said. “So my guess is that when reopening occurred people felt like they had been let out of prison, or should reward themselves for having behaved properly. They let their guard down.”
Hogan and other leaders repeatedly said the pandemic that has infected nearly 78,700 Marylanders and killed more than 3,200 so far wasn’t over.
Barry said messages about staying vigilant could have been lost; compliance with orders eroded over time during the 1918 Spanish flu pandemic, too.
“Mixed messaging,” whether it be overt messages by President Donald Trump that the virus would disappear or more subtle ones showing leaders wearing or not wearing masks, can have an impact, Barry and others said.
Other states such as Florida, Georgia and Texas, which have exploding numbers of cases, never controlled the virus the way Maryland did to begin with. And Georgia Gov. Brian Kemp explicitly banned the state’s cities and counties from ordering people to wear masks in public places.
The uptick in some places surely is because of more testing, but there are more cases, said Justin Lessler, an infectious disease epidemiologist at Johns Hopkins Bloomberg School of Public Health, whose team produces “planning scenarios” with various outcomes rather than one model to guide decision-making.
Testing is more widely available now. When Maryland reported 925 new infections Sunday, it also reported that a record 28,899 new coronavirus tests were processed, compared with the previous high of 24,171 on Friday.
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The positivity rate, which shows the percent of tests that come back positive, dropped and remains below 5%. That’s the threshold set by the World Health Organization showing that significant numbers of new cases are being found.
Lessler said the models did show an uptick in cases when restrictions were eased in Maryland because the so-called reproduction number, a measure of transmission from each infected person, hovered around one. If the number is above one, cases are spreading.
The climb in infections has not been as steep as in other states, he said, but something still could “spark” a much larger uptick.
Lessler also noted there is a delay in reporting because it takes time for people to show symptoms and get tested. Further, as more people have gotten tested, there have been significant delays reported in the results. This could mean people are spreading disease because they are unaware they are infected.
More new cases, and additional hospitalizations and deaths, are likely to follow in coming weeks, he said. The numbers will be worse if the public and state leaders don’t take action to stem infections now.
“There is a lag from when infections actually occur,” he said. “Caution is warranted. You don’t want to wait until you see deaths or hospitalizations to spike to act. By that point, it’s already too late.”
Baltimore Sun reporter Lillian Reed contributed to this article.