When Maryland officials lifted statewide mask mandates and other COVID-19 restrictions July 1, it looked like the pandemic might be, well, maybe not over, but at least suppressed by widespread vaccination.
Infection, hospitalization and death rates were down substantially across Maryland and the nation. Offices, restaurants, bars and gyms started welcoming back those who had stayed away for so long. Older adults and people with certain medical conditions got the green light from federal and state agencies to break out of isolation and hug their loved ones.
But a month later, the situation has taken a turn due to a much more contagious COVID-19 mutation, called the delta variant, now circulating widely in the United States. For public health experts, delta represents the next grave chapter of the global health crisis, a wrench in the progress made toward returning to pre-pandemic life that could devastate the communities most resistant to getting inoculated against COVID-19.
Already, cases, positivity rates and hospitalizations are rising again across Maryland and elsewhere, particularly in places with low vaccination rates such as Cecil County in northeast Maryland and St. Mary’s County in the south.
The situation became dire enough that the U.S. Centers for Disease Control and Prevention reinstated its indoor mask-wearing guidance Tuesday for areas with “substantial or high” transmission, even for people who are fully vaccinated. This applies to about 70% of all U.S. counties.
For now, all but one of Maryland’s 24 jurisdictions are classified as areas with “moderate” transmission, according to the latest CDC data, with the exception of St. Mary’s, which has “substantial” transmission. But the state is showing troubling trends elsewhere, as well.
As of Friday, state data shows the statewide average positivity rate had risen to 2.73% from under 1% for much of late June and early July. The number of people hospitalized has more than doubled since July 1 to 222. New cases numbers, which had been under 100 a month ago, jumped all week, topping 300 Tuesday, 400 Wednesday and 500 Thursday and Friday.
“It was intermission, and now Act III is starting,” said Brian Castrucci, a public health researcher and president and CEO of the de Beaumont Foundation, a public health-minded charitable organization based in Bethesda. “There was tremendous COVID fatigue and that factored into wanting to get back to normal and wanting to get back outside. But the virus doesn’t get fatigued.”
In many Maryland counties, the average testing positivity rate exceeds the state’s. Some jurisdictions also surpassed the 5% threshold cited by the World Health Organization and others as indicating uncontrolled community spread. Among them were Cecil (5.80%), St. Mary’s (6.11%), Talbot (5.59%) and Wicomico (5.65%) counties.
The numbers point to a growing disparity in who continues to contract COVID-19. And it’s not exclusive to rural areas: It’s more connected to an area’s vaccination coverage.
“I’m worried about the disparate impacts that the delta variant could have on some parts of the city compared to others,” said Baltimore City Health Commissioner Dr. Letitia Dzirasa during a Monday news conference where she highlighted city ZIP codes with as many as 70% of residents unvaccinated. “If you’re unvaccinated, I implore you take the steps to get your questions answered this week before it’s too late.”
Those ZIP codes include 21223, 21216 and 21207 in West Baltimore; 21213 in Northeast Baltimore; and 21225 in Cherry Hill and Brooklyn.
In Cecil County, nine cases of the delta variant have been confirmed through genomic sequencing, said Lauren Levy, the county’s health officer. There are likely more given delta’s transmissible nature and the lack of sequencing capacity available nationwide, she said.
Cecil County’s case rate Wednesday stood at 8.89 cases per 100,000 people, the highest point in several months, Levy said. After recording no hospitalizations in May and most of June, hospitals have started filling with sick people again, she said, with some patients on ventilators and generally skewing younger.
“We’ve been watching with significant concern,” Levy said. “The introduction of delta, which we know is highly transmissible, and the lifting of so many of the restrictions, are contributing to what we’re seeing.”
Newly reported cases per 100K 7-day average
Cecil’s vaccination coverage is not where Levy and her team would like it to be. Slightly more than 41% of the eligible population has been fully immunized, county data shows, though the rates significantly improve among adults, with more than 76% of the 65 and older population fully vaccinated.
Still, it’s well below the vaccination rate of other counties, such as Howard, where 80% of the eligible population is fully immunized, according to county officials. The state immunization rate is about 60%.
The Cecil County health department issued a public health advisory last week recommending that people start wearing face coverings in indoor public settings again. There are ongoing efforts aimed at getting more people vaccinated, Levy said, with teams setting up a vaccination station at the county fair, outside of libraries and at other public settings.
On Tuesday, the St. Mary’s County Health Department issued similar guidance, recommending people, regardless of vaccination status, wear masks indoors when in the presence of those they don’t live with. About 46% of its eligible population is fully vaccinated, data shows.
The county also has identified cases of the delta variant through genomic analysis, and there have been at least 19 so-called breakthrough cases, when a vaccinated person becomes infected anyway, in the past week, according to the department.
“It’s escalating very rapidly, and when it’s escalating and there are high rates of transmission, you’re going to see more breakthrough cases,” said Dr. Meena Brewster, the county health officer. “This is where we as a community need to come together again. We would love for everyone who’s medically able to get vaccinated.”
Trusted messengers seem to be key in convincing many of those on fence to roll up their sleeves.
At the Cecil County Fair, Republican Gov. Larry Hogan made the rounds Tuesday morning as the county health department tried to corral visitors into getting vaccinated on site.
Cole Stafford, supporting his brother that day at the fair’s livestock sale, still hasn’t been vaccinated, he said, partly because of the conflicting opinions expressed by those around him.
“Some of them did it because it’s a requirement at the college, some of them didn’t because they’re worried, some of them are really against it,” said Stafford, 20, about his inner circle. “You hear different things from everybody.”
But he’s more open to the idea now and said his girlfriend, who works in health care, may help him schedule an appointment. He’s also more motivated by the delta variant.
“With an infant son, it has crossed my mind to get one,” Stafford said. “Just to make sure he’s safe.”
Parkes Williams, a fully vaccinated Marine Corps veteran from Elkton also attending Tuesday’s livestock sale, said he listened to a trusted source, too.
“I give all the credit for the vaccinations to President Trump,” Williams, 69, said.
Opposing and blatantly false messages about the coronavirus and about vaccinations have been swirling from officials at the highest levels of government since the coronavirus pandemic reached the U.S. in March 2020, causing trust in government, media and medical institutions to plummet.
Trump initially downplayed the severity of COVID-19, saying he wanted to avoid inciting panic. He later contracted COVID-19 and was hospitalized. Federal officials also flip-flopped on the importance of masking.
Several Trump-branded Republicans and cable talk show hosts have since called the science behind the vaccines into question, with some publicly refusing to get immunized and others spreading falsehoods about its safety. There has been progress in recent weeks, however, with U.S. Senate Minority Leader Mitch McConnell and the No. 2 House Republican, Rep. Steve Scalise, endorsing the vaccines.
Castrucci said the pandemic was exacerbated and unnecessarily prolonged by misinformation.
“We have not necessarily gone through a pandemic where misinformation is so easily spread or accessible and for which there’s no accountability,” he said. “We know you can’t yell ‘fire’ in a movie theater. Can you yell ‘vaccines aren’t safe’ in the middle of a pandemic, when they are?”
Some people likely will never get vaccinated in Maryland or elsewhere due to medical conditions, religious or personal beliefs. But a large swath of the unvaccinated population remains movable, said Caitlin Rivers, an public health researcher and senior scholar at the Johns Hopkins Center for Health Security.
Rivers said local governments, health departments and health care providers should concentrate on incentivizing vaccinations when possible and providing high-quality answers to questions.
“It’s a ground game at this point,” Rivers said. “Targeted messaging to different age groups is helpful.”
Time, place and circumstance also are attracting some “holdouts” to vaccination clinics.
In Baltimore’s Brooklyn neighborhood, a vaccination clinic hosted Wednesday by the Baltimore City Health Department and MedStar Health provided first and second doses of the Moderna vaccine to adults over 18. About 20 people signed up ahead of time, said Megan Berry, a community health coordinator for the medical system. At their peak, the clinics usually drew 100 people at a time, she said.
Some who arrived for vaccinations that day said they had been enticed by the clinic’s morning hours, location and small crowd size.
Justin Jordan, a restaurant manager who lives near Towson, said he had been unable to get vaccinated given the challenges posed by his work schedule. A friend in the city health department helped him find a time that fit into his day, he said.
“It was hard to find a convenient time to go,” Jordan said. “There’s more convenient ways to get it [now].”
Others signed up that day after they walked by and saw the health department giving away free diapers, baby formula and fresh produce. At least one young woman opted to head into the clinic after picking up a box of vegetables.
For Anita Phillips, another factor drove her to the Brooklyn clinic for her second vaccine dose: Most companies she wants to work for are requiring COVID-19 immunization as a condition of employment.
“I really was not going to get it,” Phillips, a bookkeeper, said. “Then I decided I’m bored and could use the money. You do what is necessary in life sometimes.”
Baltimore Sun reporter Lizzy Lawrence contributed to this article.