A second wave? Seven months into pandemic, Anne Arundel coronavirus cases on the rise again

Seven months after contracting coronavirus from her son in March, Dennis can finally talk without having to pause for breath after COVID-19, the disease caused by the virus, left scars on her lungs.

At the start of 2020, COVID-19 had yet to upend the lives of billions of people. In March, COVID-19 tests were hard to come by, personal protective equipment was undersupplied and hospitals were fighting a virus they didn't yet understand. The virus spread, and the lockdowns began.

As the year nears an end, life is different. Masks are required to slow the spread of the virus, restaurants still have to limit capacity and close by 11 p.m., and movie theaters are slowly opening with restrictions.

Despite these efforts, coronavirus cases are on the rise again in the county, state, across the nation and in many parts of the world. As Anne Arundel County debates how to return children to classrooms and prop up a battered economy, residents struggle to pay their bills as federal aid dries up. For some, going out in public could get them killed.

Public health officials warned from almost the start of the pandemic that the virus would be part of normal life until an effective vaccine is available.

"This is not a joke. This is not something that should be politicized. This is people's lives, and it impacts people in so many ways," said Dennis, who experienced blood clots, inflamed organs and lung damage from her three-month stint with the virus.

Until a vaccine is widely distributed, officials leverage now-familiar tools to push back the virus: hand washing, mask-wearing and distancing. These measures prevent transmission and protect residents, especially people with preexisting health conditions at greater risk of death.

"There are two ways to approach it. One is: if you're not part of the higher risk group, you could say, 'That's their problem.' Or you could say 'This is our problem, and we need to help those who are at higher risk,'" said Dr. Nilesh Kalyanaraman, county health officer.

There is no standardized or FDA approved treatment to cure COVID-19. Several potential treatments are under review, including antiviral drugs and convalescent plasma therapies in clinical trials.

Dr. Anthony Fauci, the government's top infectious disease expert, said Wednesday a vaccine could be available in April. But the World Health Organization predicted that won't happen until the middle of next year.

Coronavirus in

Anne Arundel

Government and health officials look at several metrics over time to base decisions on reopening or imposing restrictions. Those metrics include rate of community spread, hospital and testing capacity, contact tracing efficiency and health equity.

These benchmarks are looked at all together, rather than individually or in a one-day time frame.

There are roughly 579,000 residents in Anne Arundel County. Virus testing has identified 11,222 people infected with the virus, and 251 have died from COVID-19 as of Saturday. The county averaged 70 new coronavirus cases a day over the past week.

Anne Arundel County recorded 11.9 cases per 100,000 people on Wednesday, the fifth-highest case rate in Maryland's 24 jurisdictions.

Maryland has confirmed 134,329 cases and 3,887 deaths since state officials began tracking the spread of the virus in March.

Forty-two people have died of COVID-19 since June. Of those deaths, 23 were white, 18 were Black and one was Asian. All were older than 40.

"Pretty striking, that disparity," Kalyanaraman said. "Because Blacks only make up about 16% of the population but are making up almost double that in terms of deaths."

Black people are 1.5% more likely to have the disease and die from it, Kalyanaraman said. Hispanics are 3% to 4% more likely to get COVID-19 based on demographics but less likely to die from it since most positive cases are among younger residents. The positivity rate among Hispanics fell to 5.5% for the first time last week.

Health officials knew relaxing business restrictions in June would increase coronavirus cases as people interacted. The idea was to decrease the case rate as low as possible before reopening so the virus would spread slowly. Slower growth allows contact tracers to keep up, inform sick residents to isolate, and track close contacts for emerging symptoms to stop the spread.

"If you don't push it down far enough, it's easier for it to spread because there's more people (infected)," Kalyanaraman said. "We didn't get it down that low, and that's why we're struggling right now."

County Executive Steuart Pittman eased restrictions in Phase 1 of reopening on June 1. The lowest case rates the county reached was 3.5 cases per 100,000 on June 25, a seven-day average of 20 infections per day.

Cases have steadily increased since then, spiking in mid-July and early August. Pittman ordered residents to wear masks in public on July 9. Cases continued rising, so he ordered restaurants and bars to close at 10 p.m. and malls to scale back seating in food courts on July 23.

Almost two weeks later, cases began to decline and continued to drop for more than two weeks. But after reaching 7 cases per 100,000, on Aug. 18, the case rate is steadily on the rise again.

Where are we now?

In September, Gov. Larry Hogan announced Maryland could move into Stage Three, expanding indoor dining, retail and religious facilities to 75% capacity. Gatherings can be up to 250 people at outdoor venues.

Hogan empowered local jurisdictions to pace their reopenings. Anne Arundel County is still in Stage Two of recovery except for open movie theaters and stadiums that must limit capacity at 50%. Gatherings are capped at 25 people indoors and 50 people outdoors. Restaurants, bars, retail stores, entertainment venues, and other businesses are allowed 50% normal capacity inside, a significant range depending on the space's size.

Since June, the rate of positive tests in Maryland has been 5% or below, meeting the World Health Organization recommendation. Since July, the county tests about 2% of its population each week.

Hospitalizations have been slowly increasing in Maryland and Anne Arundel County. Most hospitalizations happen a few weeks after initial exposure. Health officials want to see a 14-day decline in ICU an acute hospitalization. Anne Arundel County does not currently meet that metric.

There are currently 55 contact tracers in the health department who have been able to keep up with the caseload that 90 tracers were initially tracking down, in part because of the state's call center. Positive cases and close contacts get called by caller ID "MD COVID" and tracers follow up by text message, increasing efficiency.

The push for schools

In late August, Hogan laid out benchmarks public schools must meet to reopen.

Those guidelines permit some in-person instruction if jurisdictions can enforce mask use, social distancing, keep their positivity rate under 5%, and their case rate less than 15 per 100,000 people.

Anne Arundel County tailored the state's guidelines for reopening schools based on classroom size, student age, and community transmission level, among other metrics. American Academy of Pediatrics strongly encourages school districts to bring students back to the classroom. AAP recently said more research into the transmissibility of COVID-19 in children is needed.

Health department guidance says elementary school students, the oldest are 11 or 10 years old, can return to some in-person learning when the case rate is between 5 and 10 cases per 100,000.

Even if infections rise to 15 cases per 100,000 people, elementary students can remain physically in school because students' cohorts are smaller at the elementary level, and classes do not rotate like in middle and high school.

Older students, particularly in high school, can transmit the virus similarly to adults, Kalyanaraman said. The health department recommends middle and high schools return to some in-person learning when the case rate is five cases per 100,000 or less - and after elementary schools have successfully returned.

Private schools with smaller middle and high school class sizes reopened with hybrid in-person and online learning this September.

The health department wants to lower the case rate as much as possible before sending students back to school. Like reopening bars and restaurants, the idea is the virus will spread slower and not reach a case rate that shuts school doors again.

State benchmarks say schools would have to revert to more online instruction if the positivity rate were to rise by 1.5 percentage points within two weeks.

Caption: Aimee Willard, seated, Patrice Smith, from left, Julia Verhoef, Vivian Foster and Holly Shontz from the Anne Arundel County Health Department administer coronavirus tests at O'Malley Senior Center in Odenton.

Virus testing has identified 11,222 people infected with COVID-19 in Anne Arundel County, and 251 have died from the virus as of Saturday. The county recorded 11.9 cases per 100,000 people on Wednesday, the fifth-highest case rate in Maryland's 24 jurisdictions.

Jeffrey F. Bill/Capital Gazette

Jeffrey F. Bill/Capital Gazette