By late last week, there had been 438,371 confirmed cases of COVID-19 in Massachusetts and more than 13,000 deaths. Those numbers are sure to grow significantly worse before things get better. How much better and how soon remain the questions of the day.
“There are two sets of competing forces. This is true both for Massachusetts and the country,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health. “I don’t know, to be perfectly honest, which one is going to win.”
A new variant of the coronavirus, first detected in the United Kingdom and now identified in several places in the United States, spreads more quickly and easily than the old variant. It is almost surely present in Massachusetts.
On Friday, federal officials warned that the new variant could accelerate outbreaks and may become the main source of infections by March. Although more easily transmissible, the variant doesn’t appear to cause more severe disease, but its spread could result in more deaths if hospitals are overwhelmed.
“There is every reason to believe it is going to cause a huge spike in cases,” Jha said.
The countervailing force is the vaccine. “If we can start vaccinating people in a serious way,” Jha said, “that will blunt things a lot.”
No one in public health is looking at the data and saying, “Oh, thank God,” Jha said. “We’re looking at the next four to six weeks and thinking, ‘Please, please, get the vaccine into people.’ We are in for such a hard six to eight weeks.”
Samuel V. Scarpino, director of Northeastern University’s Emergent Epidemics Lab, said he’s getting mixed signals in tracking COVID-19 in Massachusetts. “Some signs are pointing to a peak coming imminently and things improving. And others are pointing in a more concerning direction,” he said.
The proportion of COVID-19 tests that are positive has been declining, which would suggest relief is coming for busy hospitals.
But people are moving about more, leaving their homes to shop and go to restaurants, according to data from a company that tracks people’s movements, Scarpino said. This kind of mobility “correlates with increased cases,” he said.
Massachusetts faces a rare moment of opportunity right now, in Scarpino’s view. Infections are going down, people are getting vaccinated, and federal relief money has arrived. Strong action could quickly end the surge, he said.
If the state were to tighten restrictions now, while people have aid money to hold them over, the disease could be stopped in its tracks, he said. A few weeks of sacrifice, he said, would enable life to quickly return to normal. Otherwise, he believes, it could take six to eight months.
With the new variant likely already present in state, but not yet prevalent, Scarpino said, “We have an opportunity to get out in front of this thing.”
Currently, COVID-19 rules in Massachusetts allow businesses such as restaurants and movie theaters to stay open, but they must operate at 25 percent of capacity. Gatherings, both in private homes and at public venues, are limited to 10 people indoors and 25 outdoors.
Marc Lipsitch, director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health, said the lower number of new infections in recent days may merely result from the testing centers being overwhelmed. He said he has heard of people with symptoms unable to get tested.
The vaccine rollout is happening too slowly to make a difference before the spring, Lipsitch said. But the availability of federal relief money might make it easier to impose restrictions that will reduce transmission. ”Politics could change things in that way as well as by improving the response,” he said.
Lipsitch identified four critical needs: more vaccinators, more vaccine supplies, more certainty about the availability of vaccines, and greater vaccine acceptance. But he can’t say which of these would make the biggest difference.
“I’m not trying to project the next month or two,” he said. “I’m not sure it can be done.”
One scientific organization that is willing to make projections is the University of Washington’s Institute for Health Metrics and Evaluation. The institute has been criticized for inaccurate predictions in the past, but its projections for Massachusetts could provide a straw of optimism to grasp at.
Based on calculations last updated Dec. 23, IHME foresees daily deaths, new infections, and hospital use hitting the downslope right about now — unless the state eases its restrictions on social gatherings and businesses. If mandates are eased, infections and deaths will continue to rise steadily into March, according to the model.
The institute forecasts similar patterns nationwide.
“We have peaked right now in January, or we will peak next week in January, and then it’s going to start coming down slowly, and April and May are going to be very slow months in terms of mortality,” said Ali Mokdad, IMHE’s chief strategy officer of population health. Vaccine uptake and warmer weather will drive the improvements, he said.
“The only two things that will deter us from going back to normal,” Mokdad added, “is this new variant of the virus and if the vaccine is becoming less effective because of the new mutations that we are seeing.”
So far, scientists believe the vaccines will probably be effective against this latest variant, but it’s not known what will happen if there are additional mutations.
Still, Mokdad said, the new variant won’t be a big factor if people avoid getting infected by wearing masks.
“In the coming months we’re going to be in a better position,” Mokdad said. “So that’s the good news. But we need to be extra vigilant until we reach herd immunity through vaccination.”
Jha, the Brown public health dean, finds cause for optimism in another place — the change of leadership in Washington, D.C.
In his view, President-elect Joe Biden’s team is on the right track with its proposal for a massive vaccine push. “They are laying out a set of plans that are exactly what I would do if I could wave a magic wand,” Jha said. “That gives me a lot of hope.”
Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.
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