The number of COVID-19 cases are on the rise here and around the world. That much is indisputable. The reason behind the increase, though, is open to debate.
It could be the expected, and feared, second wave of the pandemic, it could be from an increase in testing and finding more asymptomatic positive cases and those with less severe symptoms or it could be from a new phenomenon — COVID fatigue. Or it could be a combination of all three.
Over the past week, Albany County saw increases similar to those in April and May, when COVID-19 was just getting a foothold in upstate, including 53 new cases from Oct. 29 to Oct. 30, the single highest tally since May 20. As of Monday, Nov. 2, the five-day average for new daily positives in Albany County jumped to 28.4, up from single digits over the summer months.
Hospitalizations are also on the uptick. As of Friday, Oct. 30, there were 80 patients hospitalized in the eight-county Capital District region and statewide, there were 1,136 hospitalized. The number of Albany County residents hospitalized, jumped to 27 in Friday for a rate of .75 percent, the highest number since the beginning of June.
The severity of the cases, though, has lessened since the spring, an indication health care professionals are getting the cases earlier and are getting better at treating the symptoms.
“They seem to be a little less ill this go around compared to the spring as evidenced by fewer in the ICU and fewer on ventilators,” said Dr. Fred Venditti, executive vice president for system care delivery at Albany Medical Center Hospital.
Dr. Dennis McKenna, president and CEO of Albany Med, said the youngest of the COVID patients at his hospital was 28 years old but the majority are elderly and with underlying health issues like obesity, heart disease or hypertension. The most vulnerable population has not changed since the onset and the virus, by and large, is little more than a nuisance to the young and otherwise healthy.
“COVID fatigue. This is a term a lot of people are referring to as we see the numbers increase,” he said. “Our message is one of resilience not fatigue. One of cooperation not competition. And one of preparedness and not fear. If the numbers continue to go up we have a plan, we have executed that plan in the past and we would be happy to execute that plan again if we need to.”
It is nearly impossible to go even a few hours without some official somewhere issuing some sort of public service announcement reminding people to wear a mask, wash hands and avoid crowds.
In the spring, when everything was shut down, the universal goal was to “Flatten the Curve” and avoid overwhelming health care systems with COVID-19 patients. The curve, though, has been flat for months, particularly in New York state, which as of last week had the third lowest infection rate of any state in the nation, so people, naturally, are getting lax in their COVID-19 precautions and are gathering more and wearing masks less.
The fatigue comes at a particularly difficult time in upstate New York, as the temperatures dip, more people will stay inside for more hours of a day and while there is still much not known about COVID-19, it is widely believed it is more readily spread among people congregating inside versus when they do outside.
“I know people have COVID fatigue. People are tired. I’m tired. It’s OK to be tired but we have to stay vigilant,” said Albany County Executive Dan McCoy.
The fatigue can come out of a false sense of security after the numbers started bottoming out just a couple weeks ago or a sense of rebellion associated with the presidential election or in general. It can come in the form of people attending gatherings, not wearing masks or not following basic safety protocols like washing hands and paying attention to symptoms.
It comes at a difficult time, when flu season is just getting going in this country. There are, though, some positive indications regarding seasonal flu from other parts of the world. For example, according to the CDC, there was an extremely mild flu season in the Southern Hemisphere, which runs from May through September, and there is no reason to believe it won’t be the same here.
While there are indications that trend could carry over here thanks, in part, to the precautions undertaken to prevent the spread of COVID-19, health care professionals are still concerned about cases of the flu taxing health care systems.
“In the spring flu season was over and now we have to deal with two viruses that have similar symptoms,” Venditti said. “We encourage people to get a flu vaccine so if COVID does start to surge as we expect it might we don’t have to sort out what is really going on with those patients. It is not 100 percent but it will mitigate the symptoms.”
Just as a flu vaccine will not guarantee a person will not get the virus, wearing a mask and social distancing and doing all the “right things” will not guarantee immunity from COVID. Last week, four Albany County Health Department employees tested positive for COVID and the office is forced to work remotely for at least another week.
“There are no guarantees in medicine and what we can do for the public is advise people as we advise our own staff as we advise or own family based on evidence. And evidence suggests that mask wearing protects you,” said Dr. Elizabeth Whalen, head of the Health Department, in response to her employees testing positive.
There have been COVID-19 comparisons to the Spanish Flu of 1918 — the deadliest global pandemic of modern times that infected up to 500 million people and killed up to 50 million including 675,000 in the U.S. — since early this spring. The first wave hit the U.S. in March, 1918, and the second seven months later, according to the Center for Disease Control. In October of that year alone some 195,000 people died of the H1N1 virus.
“We are concerned over the last few weeks we are seeing an uptick in numbers and it could in fact be something we have been concerned with all along, the beginning of a second wave,” Whalen said. “The data will show if that is the case is in the coming days and weeks.”
While there is no immediate indication Gov. Andrew Cuomo will shut down businesses again, last week McCoy said he reverted back to Continuity of Operations Plan, or COOP, which includes staggered shifts and more employees working from home to reduce unnecessary contact between people.
As the number of tests increase, logically, the number of positive cases increases. The vast majority of people get a mild case of COVID, and the symptoms during any other time would lead to staying home from work for a couple days and recovering on the couch instead of getting a COVID test.
For example, in Albany County, during March and April just a few hundred tests were administered a day and only twice did the number of tests exceed 500. In October, there was not one day when less than 500 tests were administered and the majority of days saw 1,000 or more tests. Nationwide there are more than 1 million tests administered daily, according to Johns Hopkins University. All told, the U.S. has conducted more tests, 145.6 million, than any other country outside of China.
And, while the number of cases is going up, the number of deaths is not proportionately increasing and is nowhere near the numbers seen this spring. In New York, on Saturday, Oct. 31 there were 17 deaths while in April and May the death toll was topping 700 per day.
Regardless, Cuomo and other leaders are wary of what is happening in Europe and other parts of the country and with a widespread, effective vaccine still months away, have repeatedly said they will not hesitate to shut things again if the numbers get too high.
“With cases starting to surge again in the northeast and regionally, it is more important than ever to remember the importance of hand-washing, social distancing, and limiting the size of gatherings, even among families,” said Dr. Alan Sanders, chief medical officer for acute care at St. Peter’s Health Partners in a statement. “The reality is we are still going to be battling COVID into the holiday season, through Thanksgiving, through Hanukkah and Christmas, and well into the New Year.”