BRATTLEBORO — Every Tuesday, state Department of Financial Regulation Commissioner Michael Pieciak stands before the Vermont press corps and delivers the weekly COVID-19 modeling update.
Since a state of emergency was declared by Vermont Gov. Phil Scott on March 13, the Brattleboro native has been the numbers cruncher - the person leading the task force at his agency which charts the current state of the pandemic and forecasts its trends.
Since the summer months, Pieciak's briefings have been a compendium of good news as Vermont has led the nation in nearly every metric when it comes to controlling the spread of COVID-19.
While the tally kept by the Center for Systems Science and Engineering at Johns Hopkins University (coronavirus.jhu.edu) shows more than 225,000 Americans have died from COVID-19 since the first case of the virus was spotted in the U.S. in January, Vermont has seen just 58 deaths, with none coming since July 29.
But will the good news continue?
Many epidemiologists are predicting a resurgence of the virus in the United States in November and December, with the death toll rising as high as 400,000 by the end of 2020.
“The next six to 12 weeks are going to be the darkest of the entire pandemic,” Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said on NBC's Meet the Press on Oct. 18, adding that vaccines and treatments were “coming down the pike” but wouldn't arrive soon enough to affect that bleak prediction.
Dr. Scott Gottlieb, former commissioner of the federal Food and Drug Administration, told CNN last week that the United States is “about two or three weeks behind Europe,” which has seen a big increase in both COVID-19 cases and hospitalizations in October.”
He added that a rise is already underway in the U.S., with 42 states seeing an increase in hospitalizations and 45 states seeing an increase in COVID-19 cases last week.
And Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said last week that the United States may have a “very difficult fall and winter” because of the pandemic.
Vermont, according to state Health Commissioner Dr. Mark Levine, remains an island of low-case counts in a raging sea of rising COVID-19 cases and hospitalizations.
Should we be worried that Vermont's good fortune is coming to an end? It's worth taking a look at where we've been and seeing how that experience might indicate how things will be going forward.
Riding the waves
In March and April, the news was grim as Vermont and the Northeast saw a steady increase in COVID-19 cases. Unlike the rest of the Northeast, the death toll in Vermont was a fraction of what was seen in southern New England.
Part of that can be attributed to the shutdown of all schools and non-essential businesses in Vermont, and the sharp curtailment of all public gatherings that began in mid-March.
The high acceptance of Vermonters following the now-familiar protocols - wearing a mask, washing your hands, social distancing, and avoiding crowds and unnecessary travel - also played a role.
By late April, according to data from John Hopkins University, the United States had passed 1 million total cases of COVID-19, and about 30,000 new cases were reported daily.
Epidemiologists consider April 10 as the end point of the first wave of COVID-19 infections in the U.S. After that time, the number of new cases started to decline and the first tentative steps at reopening the Vermont economy began to unfold.
Health officials at the time warned that there would be an increase in COVID-19 cases as this happened. The 2 million mark was reached in the U.S. by mid June, and 3 million cases were reported by early July.
By July 19, there were nearly 70,000 new cases reported daily in the U.S., and the nation passed the 5 million mark. This second peak coincided with increased travel and more states around the country lifting many of their COVID-19 restrictions - restrictions that were only slightly loosened in Vermont.
Soon, the South and the West surpassed the Northeast as the region that was most hard-hit by the pandemic.
From that point, there was another decline from the second peak. Still, the 5 millionth case was identified in mid-August, and the 6 millionth case was reported at the end of that month. However, new cases had dropped to 40,000 per day at the end of August and about 35,000 per day by mid-September.
As public schools and colleges reopened and many travel restrictions were lifted, cases have risen again with the Plains states, the Midwest, and the South particularly hard hit. The nation's 7 millionth case was reported at the end of September and the 8 million mark - the most of any nation in the world - was surpassed by mid-October.
A fall resurgence
In Vermont, the peak for new COVID-19 cases arrived on April 6, when 287 cases had been reported in the previous seven days. The following week, 211 cases were reported. But the numbers dropped to 63 on April 20, then to 38 on April 27.
With four exceptions, new weekly cases in the state have ranged between 20 and 50 between April 27 and Sept. 28. The outlier was the week ending June 8, when 88 new cases were reported.
The big drivers of increased COVID-19 infection seen elsewhere in the U.S. have not been a factor in Vermont.
Public schools, and colleges and universities reopened in September with few new cases reported. As of mid-October, 13 cases were reported in Vermont's public schools and 51 cases in Vermont colleges and universities.
As for travel, fewer visitors came to Vermont during the weeks between July and October, and with outdoor concerts, festivals, and fairs cancelled, far fewer opportunities have remained for mass gatherings where the virus can rapidly spread.
The low number of new cases between May and September came despite a sharp increase in testing. Early in the pandemic, the Scott administration set a goal of at least 1,000 people a week getting tested in Vermont. That rate was reached in early June and has since increased to about 4,000 people per week.
However, the weekly reports of low case counts came to an end in the first three weeks of October.
Vermont reported 72, 58, and 71 new cases in those respective weeks, the highest three-week total since April. And the past seven days have ushered in a series of double-digit increases in daily new cases, and the cumulative number of cases rose above 2,100 as of Oct. 27.
The good news for Vermont is that the fear of a “twindemic” of seasonal flu and COVID-19 might be averted.
According to Health Department data, more than 90,000 Vermonters got flu shots as of mid-October, or about 10,000 more than at the same point in 2019. The agency has set a goal of 325,000 Vermonters getting immunized for the flu this season.
The not-so-good news is that nearly everyone traveling to and from Vermont from other states must quarantine for 14 days. That is according to the standard that Vermont is using, where any county that reports more than 400 active cases per million of population is considered not safe.
According to Pieciak, about 95 percent of the nation currently would need to quarantine if they decided to visit Vermont. In New England, the number of people who live in “safe counties” is about 880,000, down from 7.1 million in mid-July.
Rural America had been particularly hard hit by COVID-19 in recent weeks, with nearly 70 percent of the nation's 1,976 non-metropolitan counties now in the “red zone” of at least 100 new infections per week per 100,000 in population.
Of the more than 8.5 million COVID-19 cases in the U.S. as of the end of last week, slightly more than 1 million of them are in rural counties.
While one of Vermont's counties - Chittenden County - is in red-zone status, 97 percent of Minnesota, 98 percent of South Dakota, and 100 percent of North Dakota, Iowa and Wisconsin's rural counties were as of Oct. 23.
Being prepared
The state of emergency that Vermont has been under since March 13 was extended by Scott for the seventh time on Oct. 15.
Scott has been clear that as long as the pandemic persists, the state of emergency will be in place. Under that policy, given the current outlook, when the order is set to expire on Nov. 15, the order will almost certainly be extended for another month.
“We've worked together to keep each other safe and prevent our health care system from being overwhelmed, allowing us to methodically reopen our economy and keep it open while many other states have had to take steps backward,” Scott said on Oct. 15. “But we cannot become complacent.”
That vigilance is reinforced by data from the Centers for Disease Control and Prevention which indicate that only a small number of people in the U.S. have been exposed to COVID-19.
How small? CDC director Robert Redfield testified to a U.S. Senate committee in September that “a majority of our nation, more than 90 percent of the population, remains susceptible.”
Keeping the emergency order in place helps Vermont manage the public health risks, Scott said, and that status also maintains numerous supports to ease the economic hardship resulting from the pandemic: expanded housing and meal delivery systems, expanded eligibility for unemployment insurance, and additional resources for businesses, and federal emergency funding, for example.
The early days of the pandemic saw a shortage of personal protective equipment (PPE) - masks, gowns, and gloves - in health care facilities around the nation. Vermont was no exception, and the state has since made it a priority to stockpile enough PPE gear - masks, gowns, and gloves - to have a 60-day supply and a 60-day reserve.
Aside from gloves, which have been in short supply around the world, Vermont has met this goal. State officials said earlier this month that about 3.4 million pieces of PPE have been delivered to Vermont so far, with more supplies on the way. The state says it also has an adequate supply of ventilators.
Vermont is already making plans for distributing a COVID-19 vaccine when it becomes available.
“With so many unknowns, this is difficult work,” said Scott at a Oct. 23 news briefing. “But we have a strong infrastructure in place, and we have been working with a talented team of world-class experts for months to learn from past experiences and to further strengthen our systems.”
“The bottom line is: We will be ready,” he said.
The federal government, which is responsible for nationwide distribution of vaccines, still needs to provide details on many logistics surrounding a potential vaccine, and this interim COVID-19 vaccination plan will evolve as new information comes forward.
According to Levine, a COVID-19 Vaccination Planning Team was convened in July to begin this process and is responsible for fully developing such a plan. This team includes experts from the Department of Health, Vermont Emergency Management, the University of Vermont Medical Center, and the Agency of Digital Services.
“Having a safe and effective vaccine is an essential tool to stop the virus from spreading. We see every day what it means to have a highly infectious disease spread without a vaccine available to keep it in check. I encourage everyone to get vaccinated when it's available to them,” said Levine. “We are all ready for this next step toward ending the pandemic.”
However, Levine made it clear that “safety comes first.”
“Any vaccine must meet all FDA safety standards and be recommended by the Advisory Committee on Immunization Practices, free from politics,” he said.
While representatives from the state agencies say their teams will be prepared for any amount of vaccine, they expect the initial supply of COVID-19 vaccine will be limited.
Accordingly, the first to get the vaccine will be groups that are most critical to the response, such as health care providers and first responders, as well as those at highest risk for developing severe illness from the coronavirus, such as long-term care facility residents and staff.
“This is an enormous undertaking with a number of crucial considerations,” said Levine. “But one thing is clear: In Vermont, we'll be ready for the vaccine before the vaccine is ready for us.”
Pandemic fatigue
Levine has been at nearly every one of Gov. Scott's COVID-19 briefings since the early days of the pandemic in March. As health commissioner, he has served as the calm voice of science and common sense in explaining what Vermonters need to do to stay healthy.
However, even Levine realizes that people are getting weary of dealing with COVID-19.
At the Oct. 20 briefing, Levine acknowledged Vermonters are all facing “pandemic fatigue - adjusting our routines, foregoing social and family activities, and being relentlessly reminded to wear a mask and keep a distance from one another. But we still have to wait a little longer for a COVID vaccine, and we are seeing cases increase - both nationwide and closer to home.”
He asked Vermonters not to give in now, especially heading into our first coronavirus winter.
“As we start to head into the holiday season, I am asking us all to join together, to take a moment to re-center, to step back from pandemic fatigue and rededicate to doing everything we can to keep the virus from spreading.
“Think carefully about travel and know that, if you do, you will most likely have to quarantine upon your return. And take a hard line if you are not feeling well. Even a headache or a runny nose - things you wouldn't think of as symptoms - could be a sign of the virus.”
The good news, Levine said, is that Vermonters “already know what we need to do” to get through the coming months.
“We just need to double down on prevention and not roll the dice on risk,” Levine said. “Because one thing we do know is that when gambling with health, the virus might really win. We have been a model for the nation and, if together we stay Vermont Strong, we can keep it that way.”