After getting vaccinated earlier this year, Brenda Richard felt the threat of contracting COVID-19 ease. Activities she put off out of caution during the pandemic — meeting with friends, carpooling and going out to eat — became routine again. She made appearances at social gatherings and celebrated milestones in person with loved ones.
At one such family party last week, Richard, a Baltimore County woman who lives close to the city’s Erdman Shopping Center, interacted with a young child who tested positive this week for the coronavirus. So, in accordance with the latest public health guidance, she lined up Thursday to get tested for the virus near her house and told her close contacts to do the same.
Richard’s experience mirrors so many others’ nationwide as COVID-19 infections surge and hospitalizations spike. In the months since she got vaccinated, new variants of the virus have circulated, ones that are likely more contagious and more adept at evading vaccines’ protections — making those seasonal cold and flu-like symptoms and COVID-19 exposures all the more troubling, even for those who are fully vaccinated.
But Richard said the latest scare won’t keep her from continuing the pre-pandemic habits she picked back up.
“I have a lot planned for the holiday, so I’m just going to pray about it and take that risk,” Richard said. “We got vaccinated, so we should be OK.”
Mathematical models constructed by public health researchers suggest that the latest jump in COVID-19 infections and hospitalizations could be blunted if the public adheres to such precautions as getting vaccinated, wearing face masks indoors and social distancing. But changing certain behaviors may be out of the question now, especially for those who consider themselves pandemic-fatigued or willing to accept the health risks in exchange for more freedoms.
That weariness may be responsible for the current wave of sick people being admitted to Maryland hospitals, said Eili Klein, an associate professor in the department of emergency medicine at Johns Hopkins who studies how individual behaviors contribute to the spread of infectious diseases.
Newly reported COVID-19 hospitalizations
The number of people hospitalized in Maryland for COVID-19 has more than doubled in a month, according to state data. While several other key surveillance metrics remain unknown in the wake of a crippling cyberattack earlier this month at the Maryland Department of Health, the state has maintained its bed occupancy reporting. On Thursday, some 1,167 people were getting treated for COVID-19 in state hospitals.
Klein said the lifting of virus-related restrictions and increased “movement” generally correlate with spikes in cases. For example, infections spiked over the summer months when limits on indoor capacity levels and masking requirements eased. Meanwhile, the newly vaccinated took advantage of their high antibody levels to congregate, vacation and return to places like summer camps, houses of worship and indoor restaurants.
After Thanksgiving and ahead of Christmas and New Year’s, the numbers are jumping again.
“Movement patterns tend to follow what’s happening with cases. What we see is that cases go down and then people relax more, and then they meet up with grandma, and then cases go up again, and grandma dies,” Klein said. “People do tend to change their behavior when they think they’re at higher risk.”
Even though Maryland’s data is incomplete in the wake of the network breach, Klein said he and other researchers can look at data in states and countries with similar hospitalization data and fill in the gaps. There tends to be a correlation between high cases and high bed occupancy rates, he said.
“The picture will be a little less clear in Maryland because of that [breach], but it’s not unclear,” Klein said.
The dual threats of the still prevalent delta variant and the rapidly spreading omicron strain of the coronavirus already is pushing some people and government leaders to recalculate how much risk they are willing to assume.
In Howard County, the school district suspended after-school activities this week until some time in January, including athletic practices and games, theater rehearsals, performances and field trips to mitigate a rise of cases among students and faculty members. More than 3,700 students in the 57,000-student system and 146 staff members were in quarantine this week, according to the system’s dashboard. In Prince George’s County, officials canceled in-person classes for public school students until January following a surge in the infection rate.
In Annapolis, Maryland Gov. Larry Hogan ordered skilled nursing homes this week to offer residents therapeutics such as the lifesaving monoclonal antibody therapy upon detection of COVID-19. The state also launched a vaccine incentive program for Medicaid recipients who get vaccinated and called on hospitals to update their surge plans.
For Baltimore City resident Sue Colley, the new variant means getting tested for the coronavirus at the first signs of a cold and reconsidering plans with friends in jurisdictions that don’t require masks indoors.
But Colley, who is retired and lives in Butchers Hill, said there are limits as to how much scaling back people can reasonably do.
“When we used to grocery shop, we would wash our hands after and wash the bags and even get groceries delivered,” Colley said. “That’s just not how we do business anymore.”
To understand people’s behaviors throughout the pandemic, the Johns Hopkins Center for Communication Programs launched a COVID Behaviors Dashboard that regularly conducts surveys to give national and global policymakers and public health workers real-time information.
The latest survey was conducted in the last two weeks of November, and the findings still can defy expectations, said Marla Shaivitz, the center’s director of digital strategy.
For example, on a national level, scientists at the U.S. Centers for Disease Control and Prevention and health care workers were far more trusted to relay information than religious leaders, according to the data. And those who are disinclined to get vaccinated are more likely to cite the fear of side effects and doubts about the vaccines’ safety or effectiveness than the belief that vaccines don’t work.
Disinformation and misinformation also play a role in shaping behaviors, Shaivitz said. For instance, some people still think they are ineligible for vaccines, though everyone older than age 5 now qualifies.
“That tells me we still need to give people time,” Shaivitz said. “We’re asking an entire population of people to change their behavior in short order. We shouldn’t give up on them. And even if they say ‘never’ now, that might not mean never going forward.”
Shifts in behavior might come easier and more quickly if directed by governments or employers who can mandate immunizations or testing and masking requirements, said Christopher Thompson, associate professor of biology and immunology at Loyola University Maryland.
He said data indicates that mandates work better than choice in getting people vaccinated.
“When you have mandates, compliance is higher; when you don’t, compliance is lower, and that is not a political statement: it’s data,” he said. “That said, I don’t know if we need them. I hope people realize the importance of vaccinations and masking and other measures for their community. You don’t know who you are standing next to in the grocery. Maybe they are in chemo for cancer.”
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He understands the fatigue and the discomforts of vaccination, masking and testing, but they are far less uncomfortable and way safer than getting COVID-19, he said.
Public support for certain measures, such as masking on public transit, requiring employees of large companies to get inoculated against the coronavirus, and asking children to get immunized to attend school or colleges, has risen over time across nearly all states, according to researchers from The COVID States Project, composed of researchers from Northeastern, Northwestern, Rutgers and Harvard universities and Harvard Medical School.
The team found strong support as recently as September among survey respondents in mandating vaccinations for all, with more than six out of every 10 individuals indicating their approval. Support for narrower restrictions, such as vaccinations before riding airplanes, is even higher.
In Maryland, Hogan has indicated a reluctance to issue statewide masking or vaccination mandates, instead leaving those calls up to business leaders and county executives.
But even without federal, state or local requirements, the public should recognize that this moment calls for more vigilance, said Dr. David Marcozzi, an associate professor in the department of emergency medicine at the University of Maryland School of Medicine and COVID-19 incident commander for the University of Maryland Medical System.
Marcozzi, who previously commented publicly on the pandemic’s emotional toll on isolated individuals, said staying connected to others should remain a priority, even and especially during another surge. But people still should take steps to protect themselves, he said, such as masking, getting tested regularly and getting all recommended doses of COVID-19 vaccine as soon as possible.
“If we’re smart, we can all stay protected, and do it in a protected, thoughtful, follow-the-science way,” Marcozzi said. “I hope folks start to realize that this is changing, there’s no question about it, and we’re on a trajectory right now that is very concerning. And as more people understand that, I hope Marylanders say, ‘I’m going to do the same things as before to protect myself.’”