Doctors behind a COVID-modeling study used by the president’s coronavirus task force are now warning that virus hot spots are beginning to converge and jump from county to county as people increase their travel for work and summer vacation.
According to doctors working on a study put together by PolicyLab at Children’s Hospital of Philadelphia, the virus is moving along major highways and interstates—such I-10 in California, I-85 in the south and I-95 on the East Coast—as states continue to reopen their economies. With an uptick of coronavirus cases taking place in states in the south and southwestern parts of the country, this new finding has raised fears that new outbreaks may soon move north to major metropolitan regions, reversing the progress already made in flattening the curve.
“There’s a convergence of metro areas that’s now leading to these larger epicenters of transmission. Places that were already in trouble … are the ones that are slipping out of control,” said Dr. David Rubin, the director of PolicyLab. “For example the southwest outbreak is moving right up the I-5. You can see the risk all the way up. We’re a week or two away from Sacramento and San Francisco.”
The findings from PolicyLab are the latest warning sign to emerge as the majority of states have now moved into the second phase of their reopening plans, with restaurants, religious communities and some places of work open for business. Rubin’s fear, as culled from the data, is that as individuals begin to relax their own social distancing measures they have begun to travel more within their communities and to other surrounding states, thereby spreading the disease.
The new analysis comes as President Donald Trump and his re-election campaign continue to move forward with plans to hold large rallies across the country, including in cities with increasing cases such as Tulsa, Oklahoma, and Phoenix, Arizona. The president is insistent on campaigning despite members of his own coronavirus task force sounding the alarm over the growth in cases where increased testing is not a dominant reason for the spike. Over the past several weeks task force coordinator Dr. Deborah Birx has told governors that she is concerned about the new outbreaks, especially in regions that were already struggling to flatten the curve before reopening. Birx also said she was worried about protests causing a spike in cases, but no evidence has emerged to confirm that fear.
And during a conference call with governors on Monday, Vice President Mike Pence highlighted increased cases in North Carolina, California and Arizona as a problematic sign. “They have seen some increase in cases that are not necessarily accounted for entirely via an increase in testing,” Pence said, according to a recording of the call obtained by The Daily Beast. “We are re-deploying [Centers for Disease Control and Prevention] personnel in those states and also we are sending additional personnel.”
The PolicyLab modeling raises questions about whether the U.S. will soon see another round of major outbreaks in counties and regions that have already seen coronavirus spikes recede and whether the Trump administration will issue new guidelines on reinstating some social distancing restrictions. A senior official familiar with conversations about the new outbreaks said top coronavirus task force members and within the Center for Disease Control have started discussing the parameters that would cause the federal government to step in and advise states to tighten social distancing guidelines. No final decisions have been made, that person said, and officials continue to monitor the situation.
“Only 11 counties out of over 3100 are seeing a true acceleration in new COVID cases, and less than 2 percent of counties show any significant increase in cases,” said Devin O’Malley, a spokesperson for the task force.
Doctors working on the data are already beginning to see patterns of the virus moving along major roads not only in California but on the East Coast as well. Rubin pointed to North Carolina and South Carolina as states of concern, saying the virus is moving along I-85 through Mecklenburg (a county Birx highlighted as problematic on Monday’s call), Durham and Randolph counties in North Carolina, and Greenville and Spartanburg in South Carolina.
“We could see the D.C. metro area start to increase, moving from the south to the north. I’m watching Richmond, Virginia, really closely,” Rubin said. “As these places open up, we’re now developing these zones of transmission that are more than just these metro areas because we’re moving around more. Your risk is going to go up because how are you going to contain the travelers?”
That is a question local and state officials in the hot spot regions are actively trying to answer.
In California, Imperial and Riverside counties have seen hundreds of new cases each day over the last week, according to their local health departments. Imperial, whose hospitals reached capacity last week, currently has the highest infection rate per capita in the state. The county has a population of about 180,000 and has seen close to 2,000 new cases since June 3. Hospitals are now having to transfer patients hundreds of miles away for treatment. According to The New York Times dataset, Imperial County ranks second in the country for metropolises with the highest number of cases per capita.
Outbreaks are taking form just north, too, in California’s Kern, King and Fresno counties, and PolicyLab’s data shows those communities seeing a significant spike in cases over the next three weeks. Rubin wanted that there’s a real chance Sacramento and San Francisco will also be impacted.
“Some places have more disease transmission than others, and when people travel, the risk that disease will move from high transmission areas to low transmission areas is increased,” said a spokesperson for the California Department of Health. “One of the key factors in disease risk is whether people have close contact with others outside their households.”
And in the southeastern region of the country, officials in South Carolina and North Carolina are working overtime to contain outbreaks along the I-85 corridor.
In South Carolina, Greenville County has reported more than 1,200 cases over the last two weeks, according to publicly released state data—more than half the county’s overall cases. Officials in the state have said they do not believe the uptick is because the state has expanded its testing capacity. PolicyLab’s most recent projections for Greenville County show it reporting 80 cases per day by July 4. But over the last several days the county has reported more than 100 cases each day. Lexington and Richland, neighboring counties in the state, counties are also seeing massive increases in coronavirus cases.
Last week one of South Carolina’s top epidemiologists, Dr. Linda Bell, said she was more concerned about the coronavirus in the state than she has “ever been before”.
“For the past two weeks, we’ve seen some of our highest daily numbers of cases since the start of this pandemic,” a spokesperson for the state’s emergency response team said. “Public health officials are concerned about the recent upward trends in South Carolina, and we can't stress enough how critical it is for each of us to wear a mask, avoid group gatherings and keep six feet between us.”
In North Carolina, the percentage of positive tests has increased in recent weeks as have hospitalizations.
“You hear a lot about a second wave. I think in North Carolina we’ve been in one big wave the whole time. We never ended the first wave before opening up,” said Kimberly Powers, an epidemiologist and professor at UNC’s Gillings School of Global Public Health. “Testing has increased recently but people are still getting sick and going to the hospital. To me, that suggests that it is not just about increased testing.”
Rubin said he is concerned about the virus continuing to spread from the Carolinas up into the metro D.C. area via Virginia, particularly to the Richmond region, which is currently experiencing a downward trend in cases and hospitalizations. Despite the recent good news, Dr. Danny Avula, the Richmond City Health District director, is still cautious in the way he speaks about the future for the community.
“The first phase of disease in Richmond was all about travelers and people moving around. I do think I-95 was a clear pathway of transmission,” Avula said. “Will that continue? I’m not sure yet. We’ve spent three months training on how to do social distance effectively. It’s curious how quickly we lose that. We hoped that as opening happens people would still do it in a distant way. But they’re not. I think we’re at something like 118,000 deaths and it seems like some people are just numb to that. Have people forgotten the insane scale of this?”