Arizona, Florida and many other states across the South are reporting record spikes in COVID-19 cases, while cases continue to drop in Maryland and other northeastern states.
Maryland took steps to control cases so the state’s outbreak never reached the peaks seen in places like New York and Massachusetts before beginning a downward trend in April.
“I think Maryland stands out among states in terms of the best responses,” said Dr. Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security and a pandemic preparedness expert.
“It’s because of good leadership, and the people of Maryland have largely been following the guidelines, with the exception of the big crowds without masks that we saw Memorial Day in Ocean City and some other instances.”
Several scientists who follow the data echoed the assessment of Maryland’s actions to control cases. They give the state good grades compared to other states. But they also warn it’s more of a mid-term assessment than a final report card.
Maryland’s testing continues to expand and the state has launched a large tracing effort. It maintains hospital space. But Gov. Larry Hogan has faced some criticism by health experts for reopening too much too quickly, and some local leaders waited before following his lead.
Trend lines in cases, deaths and hospitalizations are sure to be affected as the state continues to reopen, people take summer vacations and others protest, public health experts said. Some people may become more lax in following guidance to wear masks and keep their distance.
“Everyone needs to understand that when you reopen you will have more cases,” said Julie Swann, a researcher at North Carolina State University. “How many is up to us.”
And no one is totally confident in all the numbers because testing got off to a slow start nationally and states continue to report different information.
The final result will be unknown until the pandemic ends and researchers piece together the whole picture, Toner said.
People’s behavior in each state will matter, as will the actions of their state governments, which so far have been uneven. That’s the case with the level of testing for infections and tracing potential cases. Some states also have more systemic issues, such as lacking hospital bed capacity and equipment such as ventilators for the severely ill.
A separate and unknown factor is what the fall flu season will look like and how that will exacerbate another expected wave of the coronavirus.
For now, a good way to look at cases is on a population basis, Toner said.
By that measure, Maryland still looks worse than other parts of the country.
Texas, for example, has had about a third of the cases per capita as Maryland, though that state has more than double the number of new cases in the last three weeks. Arizona has less than half the cases per capita as Maryland, but seen a 500% increase in the last three weeks.
“We had an early peak relative to those states,” Toner said. “The Northeast states got hardest hit early on, but the virus will continue to spread and get to every location eventually.”
A strict apples-to-apples comparison is difficult because states aren’t all reporting the same data or testing at the same rate. Some aren’t reporting probable cases when there was no COVID-19 test, for example. But scientists still have been able to gain some perspective and estimate the impacts, Toner said.
Maryland has had a cumulative 1,000 cases per 100,000 people, or 1% of the population. Massachusetts has about 1,500. New York has had about 2,000, about the worst rate in the pandemic.
In states reporting spikes in cases now, Texas and Florida have about 300 cases per 100,000 population. Arizona has about 500.
To illustrate how things can change over time, the University of Washington’s Institute for Health Metrics and Evaluation projects infections on a daily basis for the the next four months.
Maryland showed about 11 cases per 100,000 people in mid-June. The institute projects the cases will go down through summer and then rise again in the fall during a second wave. On Oct. 1, the model projects the state will have 74 cases per 100,000.
That’s just above the projected national rate of about 67 per 100,000 people.
States on the upswing now will look comparatively worse in the fall, including Arizona, with 143 cases, and Florida with 257 on Oct. 1.
Both of those states are likely to have higher rates of infection during the summer, “seeding” them to have higher rates in the projected second wave in the fall, said Dr. Ali Mokdad, a professor of health metrics sciences at the University of Washington institute. Mokdad notes that the institute updates its projections regularly and things could change.
He said people who are refusing to wear masks may have a change of heart, for example.
He cited New York, where people saw a lot of hospitalizations and deaths and began to take the virus seriously. The government and the people of Maryland also appear to have taken virus guidelines seriously, he said.
But in rural areas, where there have been fewer cases so far, they may “feel like it’s only a big city problem” and resist taking steps to protect themselves and others. In some of those states the spikes in cases could be compounded by lack of access to hospital beds and life-saving ventilators.
“The sad part is we now know how to control this,” Mokdad said. “This is a chapter, but not the final chapter.”
One thing the experts say is certain: All states are likely to continue recording at least some cases until there is a vaccine or they reach so-called herd immunity, when enough people are already infected that the virus stops transmitting.
The former is far more likely than the latter, even if it takes until next year to develop and manufacture large amounts of vaccine, said North Carolina State’s Swann. She is a professor and department head at the university’s Edward P. Fitts Department of Industrial and Systems Engineering.
Swann studies herd immunity and said in this case few people would likely support allowing the virus to infect people unabated if they understood the toll.
Swann estimates that 5% to 10% of Marylanders have been infected, including those tested and not tested. New York’s infection rate is likely higher and states including Arizona and Texas are certainly still lower, she said.
Herd immunity would mean 50% to 80% of the U.S. population would contract the virus. She estimated that would mean at least 3 million would die from COVID-19, including tens of thousands of Marylanders.
That’s many times the current death toll from the disease. State health figures show there have been more than 2,937 deaths in Maryland so far. There have been nearly 120,000 across the country, according to data collected by Johns Hopkins University.
A better tactic, Swann said, is to live with some restrictions and brace for more cases by maintaining beds and equipment in the health system.