Has the ‘coming’ winter COVID-19 wave arrived?

BOSTON — It may be autumn, but in the public health world it’s beginning to look a lot like spring in Massachusetts -- and that is not good.

New Covid-19 cases topped 1,000 Saturday -- for the first time in five months -- then exceeded 1,000 Sunday and Monday, as well.

“Clearly, there are more cases now than there were in the summertime,” said Paul Sax, MD, Clinical Director of the Division of Infectious Disease at Boston’s Brigham and Women’s Hospital. “Quite a few more. It’s tempting to say we are in the midst of a surge. We are still nowhere near where we were in April, fortunately.”

Eight days in April, case counts topped 2,000 -- with the highest counts of the pandemic occurring on the 23rd and 24th, when new cases came in at 3,079 and 4,946 respectively, according to data from the Massachusetts Department of Public Health. Three other days, cases topped 1,900.

By mid-May, new case counts had dropped considerably. Between May 18th and the 31st, only four dates saw new cases top 1,000: the 18th, the 20th, the 21st and the 24th.

That Covid-19 cases finally topped 1,000 in October seemed inevitable -- as the month has seen a steady rise in positive numbers followed, this week, by a sharp jump up to 986 new cases last Thursday and 968 on Friday.

“The winter is going to be worse than the summer,” Sax said. “I think there’s no doubt about that.”

How much worse depends on which pandemic model you trust.

“We are at the beginning of the third wave. And it’s going to be a big wave,” said Qi-Jun Hong, PhD, a senior research scientist at Brown University, who correctly predicted through his Covid-19 model, the massive summer wave of infections that swept across the U.S. west and south.

“At this moment I have no idea how big this wave will be because the curve is still increasing and there’s no sign of the curve flattening,” Hong said.

One characteristic of this wave that differs from the spring and summer ones, he said, is that it is less regional and not selective in the areas it’s hitting -- with rural and urban areas sharing in the pain. It’s also not rising as sharply -- which could indicate a broad and prolonged period of rising infections. In fact, Hong is now projecting more than 100,000 Covid-19 infections per day in the U.S. by the end of the year and 1,400 deaths.

Certainly, the virus has plenty of hosts left to infect. Another model, Covid-19 Simulator, estimates just five states -- Massachusetts, Connecticut, New York, New Jersey and Louisiana -- have had infectivity rates 15 percent or higher.

What’s behind the latest wave?

Hong said colder weather is definitely a factor. But it’s also virus fatigue -- with the previous two waves showing a distinct pattern of cessation once social distancing and mask-wearing went up.

The problem, Hong said, is that Americans give up on those measures too quickly.

“My biggest concern is the country is getting used to this situation,” he said.

In many respects, the latest surge in Covid-19 infections couldn’t come at a worse time -- with some families still planning to get together for the holidays, despite public health advice to the contrary.

Sax said any Thanksgiving dinner gatherings should be kept small and immediate -- and, if possible, should exclude vulnerable populations, such as the immunocompromised or those over age 65 with health problems.

“What ultimately has to happen if the cases go up enough then we’d have to implement the kind of strict shutdown measures that we did in the spring time,” Sax said. “Which do work but they’re really rather extreme.”

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