“That is the hard thing to reconcile,” said Gabe Kelen, chair of the emergency medicine department at Johns Hopkins University. “I get it that people are willing to take a personal risk, but it is not a personal risk. There are a lot of people who are older, who are immunocompromised who can’t fully participate in society” because others “are not willing to do the right thing.”
“The country has moved so far to, ‘I’m only concerned about me,’” he added.
With AAA predicting more than 39 million people will travel over the Memorial Day weekend, local officials have opted not to reinstate mask mandates and are instead urging people to exercise caution in hopes of tamping down rising infection and hospitalization rates.
“As we approach the Memorial Day weekend, a lot of people will be traveling, so it is an important time to take precautions to protect yourself, friends, and family from COVID-19 as much as possible,” Montgomery County Executive Marc Elrich said in a statement Thursday. He encouraged travelers to wear masks on public transportation and indoors and when distancing is not possible, as recommended by the Centers for Disease Control.
A federal judge last month struck down a federal mask mandate on commercial flights, buses, ferries and subways, prompting several airlines to make face coverings optional on domestic flights. By that time, most local mandates had been lifted.
Baltimore City had recorded high levels of community spread by Thursday evening, federal data show. Arlington County officials reminded residents to social distance and wear masks as the positivity rate hit its highest level since January.
In the District, the average daily caseload was up to about 48 this week, nearly double the total from three weeks ago. Cases are also surging in Virginia. A a steady increase across the region followed a lag after record numbers associated with the omicron variant.
Kelen noted many people are simply not masking indoors now that it is not required and it appears that vaccinations and a past infection protect most against severe disease. “A lot of people psychologically said, ‘I can’t live the same way. If I get covid, hopefully I’ll do just fine and that is all there is to it,’” he said. “A lot of people decided to make the same calculation.”
Kelen said he understands that perspective but also sees the consequences of fewer regulations, as the number of deaths in the United States resulting from coronavirus cases surpassed 1 million this month. “Covid is on a pretty major uptick,” he said. “What is a little bit obscure is hospitalizations are also going up.” He added, “We’re seeing a lot more people both in the emergency department and being admitted. And not a trickle.”
The Hopkins emergency department at the flagship Baltimore hospital saw coronavirus patients dwindle to about one at a time but are back up to six to eight at once, not near the peak of 30 but is still elevated, Kelen said.
Hospitalizations, a lagging indicator after infections rise, have been up across the region for weeks, federal data show. Baltimore had more than 280 cases per 100,000 people over the last seven days, and hospitalizations grew to nearly 12 admissions per 100,000 cases, according to the city health department.
Starting more than two weeks ago, Baltimore Health Commissioner Letitia Dzirasa urged residents to wear masks indoors regardless of vaccination status, as the city moved from low to medium spread, and doubled down on the message as the city moved into the high category. Howard and Anne Arundel counties also recorded high levels of spread, according to the CDC.
“The most important thing to remember is that we have the tools to fight this,” Dzirasa said in a statement Friday. “Vaccines, tests, and masks coupled with a solid hygiene routine are enough to keep many healthy people out of the hospital as we work to determine whether we are at the end, middle, or launch point of this surge in cases.”
Part of the challenge of responding to coronavirus at this point in the pandemic is understanding the risk when public health agencies have moved to less frequent data reporting and people increasingly rely on home test kits to know their status but fail to report positive cases.
Public health officials are using wastewater surveillance to gauge coronavirus levels in a community days before people develop symptoms. In Maryland, the Department of the Environment is monitoring more than two dozen wastewater treatment sites for trace amounts of the virus and sharing the data online.
Virginia officials plan to launch a website by August and have applied for additional federal funding to expand 25 sites to 40, said Rekha Singh, a wastewater surveillance program manager for the state.
In the meantime, the data is available from the CDC, and it shows large concentrations of virus in populous Northern Virginia, mirroring testing data. “It can fill the gap and is a really promising public health tool,” Singh said, adding that plans are in the works to add more sites in Southwest Virginia.
Inova Health System recommends Paxlovid, an oral medication approved for people 12 and older, as a therapy for outpatients at high risk of developing severe covid cases, said John Paul Verderese, an Inova physician who said the latest surge is the first time the treatment is widely available.
Patients can start taking it within five days of symptom onset, after ruling out adverse drug interactions, and it is widely available for free at pharmacies across the region. The drug is easier to administer and can be more effective than intravenous monoclonal antibody treatments, even with reports that some have had a resurgence of symptoms, Verderese said.
“It is a good thing we have this available to us and hopefully there will be more therapeutics available to us as time goes on,” Verderese said. Although Inova is far below its peak covid patient count of more than 425, he said, there were 64 patients in the system on Thursday, about a third of that a month ago.
“I’ve seen folks get less vigilant,” Verderese said. “We’re humans, that’s human nature. There is a lot of fatigue that is setting in but at the same time we have to live our lives. People have to make their own decisions, and be better at protecting themselves, especially if they are high risk.”