"The numbers don't look good," says Sam Scarpino, who directs the Emerging Epidemics Lab at Northeastern University.
He's talking about the coronavirus statistics for Massachusetts, which have been looking increasingly ominous for weeks. The latest, out Thursday afternoon, report 986 new confirmed coronavirus cases — the highest one-day increase since May — and put nearly 80 cities and towns — about one-fifth of communities — into the high-risk red zone.
If you take a step back and look at the state numbers, you see a very sharp spike in the spring, then much lower levels in the summer, and more recently a slow, fairly steady rise in cases.
That rise is not nearly as dramatic as the spring spike, but it's sparking concerns about the outlook for this fall and winter, and whether the state is at the start of another surge.
To use a mountain analogy, the central question is whether the current rise will turn out to be a relatively gentle mound or the foothills of a much taller, steeper peak — the start of a second surge.
Dr. Benjamin Linas, an associate professor of medicine at Boston University, says we can’t know for sure right now, but he’s worried.
"There are obviously a lot of concerning signs," he says. "The test positivity rate is rising. There is data coming from the COVID viral load — how much COVID genetic material is in our wastewater — and that's spiked up recently as well, and in a shape that's quite concerning. So I can't answer definitively. No one can. But clearly, there are signs suggesting that we are at the beginning of a surge."
Dr. Linas points out that the curve is looking flatter than spring, and the state is clearly far better prepared now than it was back when Boston Medical Center — where he’s an infectious disease specialist — was filled with almost 90% COVID-19 patients.
"Surge doesn’t have to always be the same thing," he says, "and I’m hopeful that even if we are seeing cases come back up, we can prevent that sort of overwhelming surge that we had in April and May."
Linas is part of a COVID-19 simulator project that lets users plug in various scenarios and see their expected effects on coronavirus spread.
"The general shape of the curves now is that if we stay on the path that we’re on, our model is not currently projecting a rapid, dramatic rise but it is showing continuing, ongoing rise of infection, " he says. In contrast, if more active measures were taken now to stem the spread, "we could actually get it to come back down, get back down to the rates we were at over the summer."
Our entire model suggests that things are continuing to smolder, but not spin out of control at this point.Dr. Jennifer Stevens, Beth Israel Deaconess Medical Center
Modeling projections are always cloaked in uncertainty, but here’s a bit more cautiously optimistic news from Dr. Jennifer Stevens at Beth Israel Deaconess Medical Center, who works on COVID-19 forecasting to help hospitals prepare.
"Our entire model suggests that things are continuing to smolder, but not spin out of control at this point," she says.
The modeling her team uses includes looking at data on people’s movements — in particular, whether they’re going to different types of businesses, including non-essential ones. Since Labor Day, Massachusetts residents have been very restrained, she says.
"There’s not been a huge uptick in how people have been going out of their homes and how much they've been interacting in some of these businesses," Stevens says. "It's certainly more than it was during the shutdown. But we have not had some huge marker of pandemic fatigue in that respect. I take that to be an encouraging sign."
On the other hand, Boston has just reverted to all-remote schooling because its positive test rate went over 5%. City officials have been seeing a notable spike in recent days and weeks, and are concerned to the point that they’re now encouraging residents to get regularly tested, whether they have symptoms or not.
Add to the concerns: Transmission is expected to rise in the fall and winter as people head indoors, and the virus may spread more easily in cold, dry air.
All in all, Sam Scarpino of Northeastern sees multiple ill portents — in particular, the rise in both raw numbers of cases and the percentage of tests that are positive — meaning there really are more cases, it’s not just more testing.
"And then, of course, probably the most worrying is that the hospitalization numbers are already way up," he says. "They’ve stabilized over the past week, but we’re up almost 70% over the past four to six weeks. And so, those three together paint a very worrying picture."
It should be added, however, that hospital numbers remain far below the spring surge. At latest count, just four Massachusetts hospitals are using surge capacity.
Are you in your house? And if the answer is no, then you’re wearing a mask.Dr. Benjamin Linas, Boston University
Still, all these dread-inducing indicators raise the question of what can be done now to fend off worst-case scenarios in the future.
On a personal level, all the familiar public health recommendations, from social distance to hand-washing, remain in force and become all the more urgent.
Dr. Linas from BU is thinking in particular that "we might need to amp up the mask-wearing. I’ve said to friends for a while now, I think the right question is, 'Are you in your house? And if the answer is no, then you’re wearing a mask.' "
Public officials cite particular concerns about parties and other types of social get-togethers that can spread the virus. Scarpino says there’s growing evidence that indoor dining, including in restaurants and bars, poses significant risk.
He recommends "starting to look really hard at how do we support those sectors financially, ensure that they’re not bearing an undue burden as a result of the need to potentially close indoor dining. But that’s one of the measures that we should be really very strongly considering."
He also recommends more testing and more investigation of coronavirus cases, among other measures — and soon.
"I would love us to do something now that's a lot more palatable than if we find ourselves, two months from now, having to go back into another lockdown and wishing that we had taken more effective, more palatable measures while we still had an opportunity to do so," he says.
This segment aired on October 23, 2020.