Despite signs that the number of new COVID-19 cases and hospitalizations may be plateauing, experts warn the long-term trajectory of the disease is still unclear, and a relaxation of business closures and social-distancing guidelines too soon “would be a catastrophe.”
Gov. Andrew M. Cuomo on Tuesday said there were indications that the spread of COVID-19 was leveling out. New hospitalizations and admissions into intensive care units are dropping, he said.
If new hospitalizations continue falling, “in a broad sense, that should be showing that social distancing is working,” said Henry Raymond, an associate professor of biostatistics and epidemiology at the Rutgers School of Public Health in New Jersey.
On Long Island, the number of new hospitalizations fell from a peak of 619 on Friday to 113 on Monday.
The number of new cases on the Island also is falling, from the largest one-day increase in confirmed coronavirus cases, 2,845 on April 2, to four straight days of the number of new cases falling below that number — the first time this has happened since the outbreak began.
The drop in new cases is not particularly meaningful because confirmed cases are tied to the number of tests done, and many New Yorkers even with COVID-19 symptoms cannot get tested, said Robyn Gershon, a clinical professor of epidemiology at the New York University School of Global Public Health. While the number of new cases on Long Island has fallen since April 2, so has the number of tests, data show.
“Much better is the fact that the hospitalizations seem to be going down,” Gershon said.
People who are hospitalized may not see symptoms for up to two weeks, and often they don’t go to the hospital until days after their illness begins, after symptoms worsen, so many of those newly hospitalized may have been infected two or three weeks ago, she said. That is when social-distancing guidelines were imposed and nonessential businesses began closing.
Summer Johnson McGee, the dean of the school of health sciences at the University of New Haven in West Haven, Connecticut, said “only in hindsight will you know that we’ve seen a peak. Once those numbers start to fall, we will know."
She defined the peak as the high point after which the number of new cases and deaths go down.
"The hope is that after the sharp rise, we see a sharp decline, and we don't have much of a plateau, where it stays in one place for a while," because the longer the plateau, the greater the strain on the health care system, she said.
It is difficult to entirely eliminate new infections, because grocery stores and other businesses considered essential are still open, Raymond said.
“That means there is still potential virus spread, but hopefully it’s minimized,” he said.
Limiting the number of visits to stores and wearing masks are ways to reduce the chance of contracting the virus and of spreading it if you are unknowingly infected, he said. Walking outside is much less risky than being in an enclosed space if your contact with others is fleeting, in part because wind can disperse aerosolized particles of the virus, he said.
Projections on the trajectory of the disease are “best guesses based on data” that make assumptions on people’s behavior, including adherence to social-distancing guidelines, said Anthony Santella, an associate professor of public health at Hofstra University who specializes in infectious disease prevention and control.
Santella worried that signs of a flattening curve may send the wrong message.
“That’s what most people are waiting to hear: ‘Oh, things are getting better. My kids can have their friends over,’ ” he said. “Or 'I can make that unnecessary trip to x y or z location.’ Then we’re just going to see a resurgence.”
Dr. David Battinelli, senior vice president and chief medical officer at Northwell Health, said that "if we didn't follow social distancing, this would have been 10 times worse than it is right now.”
It appears that only a vaccine will substantively control the spread of the virus, and it will take at least a year and a half before one is widely available, Santella said.
“The big question is what do you do for the next year and a half when we don’t have a vaccine but also know realistically you can’t keep people in their homes for a year and a half” and maintain huge levels of unemployment, he said.
One option could be allowing a limited number of businesses to reopen, some with restrictions, such as allowing restaurants to open if they only use every other table, he said.
Battinelli said mass testing of people for antibodies to COVID-19 could lead to a partial reopening.
"If you already have the antibody, the assumption is you're now immune," he said. "Theoretically, then you'll be able to tell who can and can't go back out there."
Santella is skeptical of mass antibody testing in the United States, pointing to how “we’ve already failed at doing mass COVID testing” and how hospitals and public health departments are already overwhelmed.
“To implement that is a nightmare,” he said.