After a respite, COVID-19 sickens hundreds more each day

Through the first half of June confirmed cases of COVID-19 in Wisconsin looked like they might be on their way down.

In the last two weeks that’s changed. Infections from the virus responsible for the illness have been rising, at times by record numbers each day. Deaths have been increasing as well, though more erratically.

So far, the increase has been mostly gradual, but unmistakable. And lately the largest number of cases are turning up among younger people, especially in their twenties.

The upswing doesn’t surprise health professionals.

“What’s really changed in the last four to six weeks is that, in Wisconsin, as in many states, we citizens are getting out and about more,” says Dr. Mark Kaufman, chief medical officer for the Wisconsin Hospital Association. “We’re having more person-to-person contact, and I think that’s probably a national phenomenon.”

A new webpage that the Wisconsin Department of Health Services (DHS) unveiled last week, mapping trends in individual counties, also shows something else: COVID-19 infections, once concentrated in some of the more densely populated parts of the state, are now rising elsewhere. The DHS map shows a band of counties across Wisconsin’s midsection where the illness hadn’t been as widespread before.

“None of this is really surprising,” says Stephanie Smiley, interim administrator of the Division of Public Health at DHS. “If you’re going to reopen and folks are going to be out and about, we anticipated that we would see an increased number of cases in areas that perhaps weren’t dealing with as much transmission when everything was sort of closed.”

Things aren’t out of control. Hospitals still have the capacity for a sudden surge in cases, should it come along. But there’s also no sign that the virus is going to go away soon. Until there’s a vaccine, “it’s not like it’s just going to be over one day in November,” Kaufman says.

Community spread increases

The greater number of cases and the more pervasive presence of the illness are signs of community transmission, when scientists tracking the disease aren’t able to pinpoint a specific infection source.

When the state’s Safer at Home order was in effect, from March 25 until May 13, “the areas where we were seeing the most transmission were in outbreak situations, either in long-term care facilities, workplaces, those types of things,” Smiley tells the Wisconsin Examiner. “Now what we’re seeing is back to what we had been seeing before the order went in place, which is community spread. It’s not surprising that we would see increases in community transmission once we open up a little bit.”

The Evers administration’s March 25 Safer at Home  order — which instructed everyone in Wisconsin to avoid unnecessary travel, required that all “non-essential” businesses stop receiving customers in person and barred gatherings beyond immediate households — abruptly ended May 13 when a divided  state Supreme Court threw out the order’s extension after Republican legislative leaders sued to block it.

In their lawsuit, Assembly Speaker Robin Vos (R-Rochester) and Senate Majority Leader Scott Fitzgerald (R-Juneau) maintained that the order should have been treated as an administrative rule, requiring it to go through the Legislature, although the state law authorizing DHS to impose orders to contain communicable disease says nothing about that. The suit also asked the court to delay the effective date of its ruling by six days to allow time for the governor’s office and the Legislature to come up with an alternative plan.

But the 4-3 ruling cut short the extension immediately, and when Evers, Vos and Fitzgerald met afterward, the Legislature’s leaders rejected any new statewide order or rule.

With the order thrown out, its provisions requiring affected businesses to limit customer contact — for example, by providing service via curbside pickup rather than on the premises — became voluntary. Many businesses, including bars and restaurants, have continued to follow those rules; others, however, have not.

Trends the wrong way

On May 13, the order’s last day, Wisconsin reported a total of 10,902 people had tested positive for COVID-19 since testing began, and 421 people had died.

Six and a half weeks later, as of Sunday, June 28, DHS reported that 27,743 people have now tested positive for the disease, and 777 have died.

Statewide “gating criteria” also show four out of six trendlines going in the wrong direction — increasing when health experts want to see them decreasing: reports of flu-like illness symptoms, specific COVID-19 symptoms, the percentage of COVID-19 tests that are positive and the number of COVID-19 cases among healthcare workers.

“As cases increase in the community, there’s also an increase in cases in healthcare workers,” says Dr. Nasia Safdar, medical director of infection control and prevention at UW Hospitals and Clinics (UW Health). “That concerns us from the staffing perspective and the spread [of the virus] perspective.”

The DHS originally posted the gating criteria as guidance for easing the Safer At Home order; although that purpose is now moot, the agency continues to track the information as a measure of the state’s battle against the spread of the disease.

Smiley says positive COVID-19 tests have been rising particularly among people 20 to 29. 

La Crosse, Eau Claire and Winnebago counties are among “those areas where we’re really starting to see community transmission occurring,” says Smiley. And there’s been a noticeable increase in positive tests for COVID-19 among people 20 to 29 years old.

“That is really due to people going out and about more,” she adds. “It’s summertime in Wisconsin — there’s lots of fun things to do.”

Healthy young adults might assume they can more easily withstand the worst outcomes of COVID-19. That may be true for some: Although hospitalizations have increased along with the number of cases, hospitals haven’t been straining resources.

“I think the reason that that has not happened thus far is because a lot of the infections that are happening are in  younger adults, who may have a better immune system, less illness, and who might not need the hospital care that older adults do,” Safdar of UW Health tells the Wisconsin Examiner. “But eventually it will spread to that [older] group as well,” she warns.

“One of the things that’s concerning to us,” says Smiley of DHS, “is that, because [younger people are] a more out and about group of folks, they may be  carriers of the virus to people who otherwise would not be able to fend off the illness as easily” — older people and people with other illnesses or whose immune systems are compromised.

Deaths among people 60 and older totaled 679 as of Sunday, June 28, but youth is no guarantee against severe illness or death from the infection: Eight state residents in their 20s and eight in their 30s have died from the illness, and 364 people in those two age groups have been hospitalized.

Government action

With the state Supreme Court ruling and subsequent vows by Republican legislators to block any statewide restrictions, local governments have stepped into the breach in some places.

In Dane County alone, half of 279 new COVID-19 cases over a five-day period ending June 25 were among people ages 20-29, according to Public Health Madison & Dane County (PHMDC), and 45% of all the people who tested positive “stated that they had attended a gathering, party or meeting with people from  outside their household,” according to a PHMDC statement. “

In response, the city-county health department — which had implemented its own order similar to the Safer At Home restrictions after the state Supreme Court tossed Wisconsin’s order — tightened up provisions it had recently relaxed. The department reinstated a limit on private gatherings to 10 or fewer people and ordered bars and restaurants, which were already limited to no more than 50% of capacity, to require all patrons to stay seated except when using the restroom, to ensure at least 6 feet of distance between parties and to seat customers “only … with members of their own household.”

La Crosse County, meanwhile, has published the names of bars, restaurants and other locations that have been associated with patrons or employees who have become infected. The establishments are rated as high, medium or low risk, and the dates during which people with COVID-19 infections were known to have frequented them are listed.

A county web page advises people who were at a location on the high-risk list during specific time periods to complete a risk screening form online and to get referred for COVID-19 testing and quarantine at home.

“The  bigger our social network gets, the harder it becomes to contain it,” says Safdar. “So I think it’s a reason for people to take a step back and try to keep their world a little bit shrunk at the moment, so that the spread can be contained.”

Hospital capacity

In addition to just stopping the spread of COVID-19, one reason for the original Safer at Home order was to keep hospitals from being overwhelmed with patients. It worked.

“In March to May, in anticipation of the initial surge, health systems and hospitals postponed or canceled elective surgeries,” says Kaufman of the WHA, which has published daily web updates on the use of medical resources. “Citizens really took seriously Safer at Home and physical distancing.” And because of that, “we never came close to outstripping hospital resources due to an influx of very sick patients with COVID-19.”

A month later, even with the rise in confirmed cases, hospitals still have an ample supply of unused intensive care unit beds and available ventilators, which have been needed for some of the sickest patients.

“There’s still enormous hospital resource capacity to care for critically ill COVID patients as well as other patients,” Kaufman tells the Wisconsin Examiner.  That’s just as true in outlying parts of the state where resources may be less prevalent than in metro Milwaukee or Madison, “even though cases are increasing in different regions.”

Kaufman says he’s confident that hospital resources won’t hit the wall without “an enormous, enormous surge,” beyond the current pace at which infections are increasing.

Hospitalization is a lagging indicator, however; given the seven- to 14-day time period it can take for COVID-19 to show symptoms after a person has been exposed, it could still be another week or more before the full extent of the current spike in infections is known, especially if people are hospitalized who haven’t previously been tested.

What’s next could depend on whether people are able to follow widely recommended public health guidelines — and whether their employers, businesses or other organizations they’re involved with make it possible for them to do so.

For the public, “the general recommendation from the state remains the same,” says Smiley, starting with frequent hand-washing. “Please wear a cloth face covering when you can,” she continues. “When you are out in public, please maintain physical distancing” — remaining at least 6 feet apart — “and limit your interactions with people that are outside of your normal group. That is really the most effective way to prevent the spread.”

At some point, says Kaufman, the current increase in cases could reach a peak, but danger from the pandemic won’t end until there is a vaccine. The next change of seasons will almost certainly increase the risk.

“The virus is much easier to catch indoors than outdoors, so in a sense we’re in a good period, because more people are out of doors,” he says. “But come fall and early winter, when everybody’s inside in Wisconsin with the cold weather,” the number of cases will likely rise again.

“I think this gradual up and down is going to continue, and it’s going to depend upon physical  distancing and wearing masks, and what kinds of facilities and businesses reopen and which don’t,” says Kaufman.

“As we’ve seen across states, across the country, the behavior of all of us really does impact what happens,” he continues. “Obviously there’s a lag time between  our behaviors and cases showing up and people being in the hospital and ultimately deaths, but they all contribute to the curves that we follow.”