Local COVID-19 updates

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As of 4PM today, the Commonwealth of Massachusetts is reporting 21 newly reported confirmed deaths (9 less than yesterday - down 30.0%) for a total of 9,503 deaths, 550 newly reported confirmed cases (152 less than yesterday - down 21.7%) for a total of 139,903 cases, and 12,395 new patients tested by molecular tests (2,567 less than yesterday - down 17.2%) for a total of 2,499,045 individuals tested. There were 75,834 new molecular tests reported (18,193 more than yesterday - up 31.6%) with a total of 5,088,797 molecular tests administered to date. The ratio of newly confirmed cases to individuals tested by molecular test is 4.4%, compared to 4.7% yesterday. The state also reported zero newly reported probable deaths (same as yesterday) for a total of 220 deaths, and 34 newly reported probable cases (31 less than yesterday - down 47.7%) for a total of 3,027 cases. The state also reported 75 patients tested by antibody tests (246 less than yesterday - down 76.6%) for a total of 123,968 patients, and 1,741 patients tested by antigen tests (1,298 less than yesterday - down 42.7%) for a total of 161,945 patients. Combining the confirmed and probable numbers gives 21 new deaths for a total of 9,723 and 584 new cases for a total of 142,930.

The seven day average number of newly confirmed cases per day is 615.0 compared to 540.6 last week (up 13.8%) and 568.9 two weeks ago (up 8.1%). The seven day average number of newly confirmed deaths per day is 18.7 compared to 11.4 last week (up 63.7%) and 16.3 two weeks ago (up 14.9%). The seven day average number of newly tested individuals per day is 14,784.7 compared to 15,418.1 last week (down 4.1%) and 16,152.1 two weeks ago (down 8.5%). The seven day average percentage of individuals coming back confirmed positive per day is 4.2% compared to 3.5% last week and 3.5% two weeks ago. (The above averages are calculated from today's raw data download.)

Of the Commonwealth's four "key metrics" listed on page 2 of the report, the seven-day weighted average positive test rate is 1.3%, 63% above the lowest observed value of 0.8% on September 21. The three-day average number of COVID-19 patients in hospital is 505, 67% above the lowest observed value of 302 on August 29. The number of hospitals using surge capacity is 1, 1 above the lowest observed value of 0 on September 5. The three-day average number of COVID-19 deaths is 21, 125% above the lowest observed value of 9 on September 7.

Okay news day-to-day, tempered by the knowledge that today's a Saturday and Saturdays tend to be better on the day-to-day front. Cases, deaths and ratio of new cases to newly tested people all down compared to yesterday - but still way higher than, say, the third Saturday in August, when the daily dashboard showed 14 confirmed deaths and 366 confirmed cases. The seven-day averages, on the other hand, flat-out suck, with cases and deaths both up over the last two weeks.

What to do as cases rise? Maybe, with more effective and targeted interventions, we can avoid broad-based lockdowns:

As COVID-19 cases have risen in Massachusetts and around the country, a public still hearing the echo of "flatten the curve" has begun bracing for — and dreading — a potential wintertime shutdown.

So far, though, elected officials, including Governor Charlie Baker, have largely resisted saying if they would issue a new round of stay-at-home orders. And, increasingly, public health experts say they might not need to.

"Lockdown is a blunt measure that impacts the whole population," said Natalia Linos, executive director of the FXB Center for Health and Human Rights at Harvard University. "We know that we will have pockets of outbreaks, and if we are able to quickly identify those pockets and shut them down, then we can prevent the situation where we have widespread exposure" that leads to wider lockdowns.

Avoiding that scenario is fairly straightforward: Test as many people as possible; locate the source of outbreaks and trace and quarantine those who have been exposed to the virus; target high-risk settings with public health restrictions and prioritize keeping open settings that serve public interest, such as schools.

In Massachusetts, even as many in the scientific community expresse concern about rising numbers of infections and hospitalizations, few call for a return to spring or summer restrictions. But, experts warned, a lighter-touch approach will only be effective if Baker and other officials work hard to keep the public informed, united, and compliant.

"Communication is an important part of showing people that the governor is looking at the numbers and responding to them," said Dr. Sarah Fortune, chair of the department of immunology and infectious diseases at Harvard T.H. Chan School of Public Health. "There's a huge tension between giving people so much information that it compromises others' privacy and giving them enough information that they are able to feel safe."

[ ... ]

"In the spring, we just didn't even know what was going on. . . . You really have no other option at that point other than to just shut everything down," said Helen Jenkins, a Boston University epidemiologist. "You then use that time while you're shut down," Jenkins said, to learn more about how a new virus spreads and then get to work tracking and containing it.

"We've learned a lot since March when we implemented these shutdowns," said Dr. Leana Wen, an emergency physician and visiting professor at the George Washington University's Milken School of Public Health, "including about what are the targeted measures that we can apply that would have less of an impact on the economy and still have a significant impact on reducing infections."

Experts said we have also learned that shutdowns carry significant consequences of their own — not only for the economy, but also for public health. Many people suffer from isolation, and those who have health care needs unrelated to COVID-19 may be afraid of going to the doctor or unable to access their usual services.

Shutdowns remain an important tool if COVID-19 spread becomes rampant and hospitals risk being overrun, but scientists say we need not reach that point again.

Public adherence to behaviors that minimize risk can help contain outbreaks, said Wen, who prior to her post at George Washington served as Baltimore's city health commissioner. She noted that some reports suggest that private gatherings of friends and family, not unsafe workplaces or public settings, are primarily driving the current surge in COVID-19 cases across the United States.

"Policy interventions can only go so far. At some point, we need individuals to do their part," she said.

While public health strategies that avoid economy-wide shutdowns have their merits, they are not a guaranteed solution, experts said. Just as shutdowns did not entirely prevent community spread or deaths, neither would more targeted containment strategies.

And Shawnita Sealy-Jefferson, a social epidemiologist at Ohio State University, said the movement toward targeted closures continues to disenfranchise high-risk communities.

"Large numbers of people have died, and the majority of people who have died have been people of color. I see this push against shutdowns as being an economic one, and it's not really thinking about the potential cost in terms of lives that are lost," said Sealy-Jefferson, the incoming chair of the American Public Health Association's epidemiology group. "The people who are dying most are not being centered in the decisions about how we address spikes in the number of cases."

"If every segment of our population had a similar rate of deaths, we would not even be having this conversation. Everything would be shut down," she said.

Some experts were less certain that avoiding lockdowns would result in public health disparities.

"For the lockdowns, we know that there's a variability in individuals that can work from home and those that can't," said Sam Scarpino, a Northeastern University epidemiologist. That variability, he explained, leaves people of color and essential workers more exposed to the virus. Moreover, the economic costs of shutting down are felt most deeply by those already facing financial precarity.

At the same time, Scarpino said that keeping businesses open heightens the risk of exposure for workers such as restaurant employees. "With outdoor dining, I can't get these images out of my head of people not putting their mask on when the server comes to the table," he said.

Ultimately, Scarpino said, a pandemic response that avoids shutdowns must grapple just as seriously with inequality issues as heavy-handed measures.

Experts also said an effective containment strategy will require officials to work harder than ever to build public trust and awareness — an area where some said Massachusetts leaders have room for improvement.

"We're still not hearing specific information from the governor's office on where cases are coming from," Scarpino said. "Either [contact tracing] is not happening well enough, or we're not being told enough about them."

Of course, that's assuming effective and targeted interventions. Charlie Baker hasn't demonstrated any appetite for those yet.

The town of Acton has yet to post an update today. As of the most recent report at 9:15PM on October 14, the town of Acton reported 217 cumulative cases of COVID-19 in town with 5 individuals in isolation, 191 recovered and 21 fatalities.