The novel coronavirus COVID-19 could peak here in Delaware soon--sooner than expected, according to a University of Delaware epidemiologist.
"I think next week we're really going to see the worst of this," said Jennifer Horney, founding director and professor of the epidemiology program at the University of Delaware.
About a week from now, Delaware is predicted to see a surge demand on health care resources with hospitals likely reaching capacity, according to models from the Institute for Health Metrics and Evaluation (IHME) out of the University of Washington.
"Between April 7th and April 15th is when we're really going to be in the top of our epidemic curve here in Delaware," said Horney. "It's really important for people to continue to stay home as much as possible and to take seriously the concerns and the emergency order updates that has been issued by the governor," she said. "That will really be our big test to see if we can maintain our strictest social distancing through April 15th, when we're hopefully well on the other side of our peak."
That surge will happen on Saturday, April 11, 2020, and according to IHME, what's needed to meet it -- 777 hospital beds. IHME data showed just 696 are available. Delaware also lacks enough intensive care unit beds for a surge. The IHME forecast noted Delaware has 124 beds--41 shy of what it needs at the peak, nine days from now. The institute noted Delaware would need 99 ventilators. It currently has 400 and is working to refurbish another 200 with help from Bloom Energy on UD's STAR campus.
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Horney said since we're behind on testing, we don't have a great picture of exact case counts. That's why epidemiologists are forced to rely on models like IHME to determine how many infections may come in the next few weeks and how much those infections could cause surge capacity at hospitals and health care systems to be inadequate.
She pointed to Singapore and Hong Kong, as models, for conducting rapid testing and taking swift action to isolate anyone who tested positive. But here, in the United States, public health is too decentralized.
"Each state health department is responsible for that jurisdiction," she said. "Even if we had the tests available at the time, I think it would have been difficult to stand up testing at a scale that we've seen in some other places."
The IHME model doesn't predict how many cases are part of the state's peak. The Delaware Division of Public Health said it also could not predict a peak or end date to the COVID-19 crisis nor could it give figures on just how many cases a peak might bring.
"The public should be prepared to see an increase in cases and deaths for at least the next two weeks. This is to be expected--not only because we anticipated to see evidence of spread of the disease--but also because we expected to see additional cases detected as a result of expanded statewide testing," said Stacey Hofmann in the DPH Joint Information Center.
Horney said Delaware's COVID-19 peak coming sooner than previously predicted brings both good and bad news.
"The good side of that is if we keep on April 11th, we're going to have fewer total cases on the backside of that curve. The bad side of that is that only gives us 10 more days to get ready, so hospitals are trying to acquire more medical material, so ordering more masks and ventilators, and so that only gives them a shorter time to get ready. But hopefully, they're getting ready for a smaller surge."
But the models have uncertainty tied to them, cautions Horney. The IHME model assumes full social distancing is in effect through May.
Once Delaware reaches its peak, the Delaware Division of Public Health, and in turn, the media will still report new cases of COVID-19, but we should see fewer each day.
"Hopefully, some models, we get down to early May, mid-May, basically not adding any additional cases at that time."
As we get on the other side of the curve, Horney said it's important to maintain social distancing practices.
"The last thing that we want to see is we get on the downside...when our number of cases are actually decreasing each day, and then we have a second wave because we released those restrictions too soon," she said.
Initially, Horney feared it would take a few weeks to see the benefits of social distancing and that might cause Delawareans to question the motivation behind it.
"Part of my concern about the social distancing is that at the same time we were asking people to do this, we were also ramping up testing, so we knew we were going to see a lot more cases as we were asking everyone to stay home, and we're generally impatient. We live in a society, where we want to see the results happen quickly, so I was concerned that as we ask people to social distance, and we begin to do more testing, they would see those numbers rise and think social distancing wasn't being effective."
But she's encouraged by new data that shows social distancing is working on a national scale.
"In some of the models, we're seeing an increase in the amount of days that it takes for the number of cases to double. So that was two or three days a week ago, and now we're up to probably somewhere between four and five days, on a national level."
Here in Delaware though cases are still more than doubling every three days as we approach that predicted peak. Dr. Karyl Rattay, who directs the Delaware Division of Public Health, said Wednesday the state saw a 260 percent increase in recent days, leading to further restrictions by the governor on gatherings and a crackdown on businesses about social distancing practices.
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Horney predicted a lifting of restrictions could happen around the governor's declared May 15th time-frame, but some of those decisions could change, based on what we learn about the novel virus.
"It seems to be fairly reasonable given the models. Hopefully, we'll continue to move in the right direction on the model," she said. "Depending on the availability and reliability of testing as we continue to move forward with that, could something happen such as if people were tested and shown to have already recovered from COVID, and then perhaps be immune from being infected again, could those people, somehow, be released to go back to work or to do other essential or non-essential work in our communities? I think all of that remains to be seen once we get on the other side."
How COVID-19 differs from H1N1
"Initially, we saw [H1N1] cases come out the spring of 2009, which is remarkable because we're usually seeing the number of influenza cases go down by March or April--so that sort of put everyone on alert that we are dealing with something different."
But in most people, Horney said the H1N1 infection while a novel pandemic strain at the time, was far more mild than COVID-19. Medications Tamiflu and antivirals were also effective in shortening the duration of the symptoms and reducing the severity of symptoms from H1N1.
Right now, there's no evidence that COVID-19 infections will drop with the change of the season.
"We do usually see seasonal fluctuations in influenza because it moves down to the southern hemisphere as we move into our spring and summer here in North America, and they move into their winter. And that actually factors into the development of the vaccine for the following winter in the northern hemisphere because we're able to see, sort of get a preview of the virus in the southern hemisphere, a few months before we begin to see a case this year in the U.S."
Horney, who's studied various emergency situations, said we've identified and still face communication and coordination issues that began with the 2001 anthrax attacks and the 9/11 terrorist attacks. But what she said what makes the coronavirus so devastating on a large scale is the lack of available mutual aid.
"If Hurricane Sandy really devastated New York and New Jersey, they can call on emergency managers, or nurses, or other people from other states to come in and provide surge capacity. Or when wildfires devastate northern California, they can send fire crews from other states. This is unique in the sense that we're having a global pandemic, so there's no one that's untouched and able to say with certainty, 'Yes, I will send my supplies or I will send my personnel because I don't expect to impacted by this.'"
Check out the full projections of the Institute for Health Metrics and Evaluation at the University of Washington clicking here.