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6 pressing questions you need answered as COVID-19 cases surge in Delaware

Brandon Holveck
Delaware News Journal

A record-breaking surge of COVID-19 infections is sweeping through Delaware and much of the nation as temperatures cool and the holidays near.

With case counts and hospitalizations rising in Delaware, Gov. John Carney and Dr. Karyl Rattay, the state's top public health official, have discussed the importance of slowing the spread before hospitals approach their capacity, but the state has yet to implement new restrictions.

Here are answers to some important questions to consider as residents decipher necessary and unnecessary risks while navigating their everyday lives. All numbers reflect the state of the virus as of 6 p.m. Saturday unless otherwise noted.

A woman is tested for the coronavirus in her car during a drive-thru testing event Tuesday, April 28, 2020, at the Route 9 Library near New Castle.

Where are we compared with spring and summer?

In several metrics state health officials consider key to monitoring the spread of COVID-19, Delaware is at levels unseen since late spring. Some figures have reached an all-time high.

Over the past week, Delaware has averaged 315 new cases per day, an all-time high. The state has set a new record for its seven-day average of new cases in 10 of the last 11 days.

At least one hospital did not report hospitalizations Sunday, leading to an inaccurate figure in Sunday's data. Delaware reported 132 hospitalizations on Saturday, roughly the amount in early June.

The seven-day average for the percent of tests that are positive is 5.3% as of Thursday. That's the highest it's been since July 11.

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Delaware on Thursday reported eight new deaths related to COVID-19, the most in a day since June 4. Of the 28,803 Delawareans who have tested positive, 736 have died.

One significant difference between earlier waves of the virus and today is that people ages 18 to 34 are now making up a higher percentage of the total cases. Earlier outbreaks centered in poultry plants and long-term care facilities.

The effects of COVID-19 are likely less severe in younger people.

Why are cases and hospitalizations spiking?

The best method the state has for determining why cases and hospitalizations are spiking is its "case investigations" performed by contact tracers. They ask people who have tested positive about where they visited in the two weeks prior and who they might have come in contact with.

Rattay said earlier this past week that some themes have become apparent through the feedback the state has received.

Unlike the summer months of the pandemic – when large gatherings garnered significant attention as "super-spreading" events, responsible for infecting dozens of people – the virus is now spreading in smaller and often more private settings where face coverings aren't worn, according to state officials.

Delaware Governor John Carney gives an update on the state's coronavirus response in Wilmington on Tuesday, Oct. 27, 2020 at the Carvel State Building.

"We need to make sure we’re particularly monitoring social environments where people not necessarily go out to a restaurant, but invite people over to watch a sporting event or a movie on TV and have drinks and cocktails and enjoy one another’s company without masks on," Carney said. "That’s where we’re seeing a lot of transmission."

"The bottom line is people should not be meeting, dining with other people outside of their household unless they're outside or more than 6 feet apart," Rattay said.

According to the most recent publicly available data, people who tested positive visited restaurants most frequently, followed by religious services, house parties and gyms.

However, the data only show part of the picture. 

Contact tracers have completed interviews with 69% of the cases reported since June 27, when the state launched its current contact tracing system – leaving about 5,500 known cases unaccounted for. 

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They've completed interviews with 40% of the contacts named (only 79% of cases who completed an interview named a contact). From June 27 through Tuesday, in only 28% of cases have contact tracers identified exposure to another known case.

It's also likely there are hundreds, if not thousands, of cases in the state that have gone undetected because people have not been tested.

As daily cases increase leading to further community spread, it will become more difficult for public health officials to deduce how the virus is making its way through the population.

How bad could the uptick get?

Scientific models predicting the spread of the virus indicate the recent surge could get significantly worse in the coming weeks.

The Children's Hospital of Philadelphia's PolicyLab has developed a model for projecting cases based on current case counts; county-level population density; average historical temperatures; testing capacity; and social distancing, which is measured as the percentage change in travel to nonessential businesses based on cellphone GPS data.

It projects the number of daily cases in Delaware to surpass 500 by early December under the current state guidelines.

A similar model from the Institute for Health Metrics and Evaluation, an independent research center at the University of Washington, places Delaware around 400 daily cases in early December. According to the forecast, the number of deaths will remain relatively steady – around two per day – in early December before spiking to more than five per day in January, if the state follows its current trajectory.

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The cooler, drier air of late fall and winter allows respiratory viruses of all types to spread more easily, especially with people spending more time indoors, said Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

"I think we're in for a rough few months," Offit said.

Some experts also expect "pandemic fatigue" to set in, especially around the holidays, leading to more indoor and mask-less gatherings where the virus could spread.

"Older individuals are getting to the point where they're willing to take certain chances because they're really desperate to see their kids and grandkids," said Dr. Daniel Griffin, head of infectious disease at ProHEALTH, an independent, physician-led health care organization.

Why isn’t the state shutting down again?

Carney and Rattay have been asked several times in recent weeks whether the state should prepare for new coronavirus-related restrictions or another shutdown, as states and municipalities in the region have started implementing new rules.

They've said a shutdown like the one this spring is untenable and most likely unnecessary, but they are considering restrictions targeted at smaller "unstructured" gatherings, which they believe are the main driver of the virus's spread.

Dr. Karyl Rattay, director of the Delaware Division of Public Health gives an update on the state's coronavirus response in Wilmington on Tuesday, Oct. 27, 2020 at the Carvel State Building.

As far as what new restrictions could entail, Carney said on Tuesday, he is monitoring what other states are doing and would like to be consistent to avoid "cross-border incentives."

In New Jersey and New York, bars, clubs and restaurants have been ordered to stop indoor dining from 10 p.m. to 5 a.m. In some counties, other essential businesses have been given earlier curfews and sports activities have been suspended.

And in New York, Baltimore City and some Maryland counties, indoor social gatherings are now limited to 10 people.

When pressed about what restrictions in Delaware might look like, Carney indicated the state will exhaust its ability to achieve voluntary compliance, which he says the state has relied on "almost exclusively" when implementing previous restrictions.

Carney likened possible limits on indoor environments to sending "a signal we need to be more careful."

"We might have to do something that gets the attention of folks so that it’s more top of mind," he said.

"We’re really trying to kind of hit a sweet spot or strike a balance that recognizes the needs of a healthy community and the needs of a strong economy. Right? And it’s a tough call."

SCHOOLS: The state changed its metrics for school reopening. Here’s what that means for students and teachers.

The state is not concerned about spread within schools, which are operating in hybrid formats across Delaware.

One of the state's three statistical indicators for school reopening has reached the "red zone." If another turns red, the state's guidance indicates schools will return to distance learning. Both criteria – average daily hospitalizations and percent of tests that are positive – are relatively far from reaching that point.

The state made a slight adjustment to the school reopening metrics in October. Had Delaware stuck with its original measures, schools would be completely remote this week.

"The spread is really occurring external to our schools, it’s happening outside the school building," Rattay said.

Was the initial stay-at-home order effective?

The Centers for Disease Control and Prevention has released a study noting a decline in Delaware's transmission, mortality rates and hospitalizations after the state implemented a stay-at-home order and mask mandate.

The study, which has since been widely cited, examined the state of the virus from March through June.

From late April – when the mask mandate went into effect – through June, cases declined by 82%, hospitalizations by 88% and mortality by 100%. The numbers continued to decline after May 12, when the state's contact tracing program began.

The study concluded Delaware's mitigation measures "likely contributed" to the subsequent decline in case totals and hospitalizations, but came with several shortcomings.

It did not include data on adherence to the stay-at-home order and use of masks and relied on self-reported information when discussing how many people self-quarantined after being exposed to the virus.

The slowdown of the virus's spread could be attributed to several other factors, including, most notably, higher temperatures in the late spring and summer months. 

One of the final takeaways presented by the study was that no single mitigation strategy is likely to be effective alone – strategies must be implemented in tandem with routine and timely case investigations and contact tracing to have a chance at reducing spread.

The trends have notably reversed since.

The CDC has also made changes to its mask guidance in the days since publishing the study. A growing body of science now suggests wearing a mask not only helps you prevent spreading the virus to other people, but serves as personal protection.

Should we really not have family holiday celebrations?

In accordance with CDC guidelines, the state is asking residents to limit the size of holiday gatherings and is encouraging virtual get-togethers.

"The safest thing would be to have a small dinner only with your household members," said Molly Magarik, secretary of the Department of Health and Social Services.

State officials said there was a bump in case numbers attributable to Halloween parties. Family gatherings for holidays like Thanksgiving pose an arguably greater risk, experts say, because they are more likely to involve vulnerable populations. 

"I know there will be plenty of families who mock this kind of advice and say, 'That’s ridiculous. We’re going to get together and enjoy Thanksgiving like it’s supposed to be, and no one’s going to tell us otherwise,'" said Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University, in an interview with USA TODAY.

"That may give them a sense of independence, but then the virus gets to Grandma, and she ends up in the hospital on a ventilator, and then you live with the guilt."

USA TODAY contributed.

Contact Brandon Holveck at bholveck@delawareonline.com. Follow on Twitter @holveck_brandon.