People are getting tired of following precautions, said Dan Suffoletto, spokesman for Public Health-Dayton & Montgomery County.
"When you’re around familiar people, you tend to think, ‘Oh, I know that person, they’re not going to give me COVID,’ but in reality they can,” Suffoletto said.
The climb in cases this past spring flattened during the lockdown, and a July surge was knocked down after a statewide mask order for public spaces. Now public officials say social gatherings have fueled much of the spread, which then extends into the community, schools and nursing homes.
The record number of hospitalizations has local health care leaders concerned about staff shortages. The flood of sick people has stretched contact tracers' ability to alert people who have been exposed.
Halloween parties contributed to some of the recent surge, so Thanksgiving — and its indoor gatherings of extended family and friends — worries local experts.
“There is an enormous concern about Thanksgiving, family gatherings, bringing multiple generations together where people are going to be eating and talking and aerosolizing viruses. So there’s no question that this is going to be a challenging time,” Dr. Glen Solomon, professor and chairman of internal medicine and neurology at Wright State University.
Are more regulations needed?
It is difficult to regulate what people do in their homes. Public health officials won’t “violate the sanctity of their home,” Patterson said. So health department employees and Gov. Mike DeWine said they can only encourage Ohioans to do the right thing to save lives.
With lots of spread from social gatherings, from a policy standpoint, Solomon said limited options exist, other than trying to limit people’s use of indoor restaurants and bars, and large gatherings.
DeWine is weighing new mandates like closing indoor dining, bars and gyms to curb spread and protect the health care system, and he issued stricter masking requirements last week with new penalties.
“It’s easy for us to become complacent because we’re out in public, we see people healthy moving around and not having problems,” said Dr. Don Brannen, an epidemiologist at Greene County Public Health. “You never see those sick people at home who are struggling to breathe or having high fever, don’t feel like doing anything … And now we’re seeing the results of that … People are suffering, even though people suffer in private.”
In the U.S., significant behavior changes don’t seem to happen without policy changes, said John Corlett, executive director of the Center for Community Solutions, a health and human services think tank.
“The virus is just going to continue to affect and kill people, it’s just going to keep going higher. And the only thing that can interrupt that or change that is a combination of policy change and personal behavior change,” Corlett said.
What policy changes might make a difference?
Better coordination of testing and tracing could help with responding to the surging cases, experts told the this newspaper.
DeWine announced last week the state is setting aside $30 million to assist the 113 local health departments. Each department will receive $200,000 to use as needed and the remaining money will be used to hire contact tracers. President-elect Joe Biden’s coronavirus plan also proposes a more robust approach to testing and tracing.
“We’ve definitely improved our testing numbers. But we could be doing even more testing and then looking at what happens when someone has a positive test result. What kind of support is provided?” Amy Bush Stevens, vice president at Health Policy Institute of Ohio, said.
Corlett noted there are also gaps in who gets access to paid sick leave. The Families First Coronavirus Response Act expanded federally funded paid sick leave, but it has exemptions for companies with 500 or more workers.
Workers in a situation where they can’t afford not to go to work can mean more coronavirus spread, Corlett said.
“We need to protect employees against discrimination and retaliation that they raised concerns about workplace safety,” Corlett said.
Corlett, also the former Ohio Medicaid director, said it could be helpful to send every household masks, saying it could be reminiscent of when the Reagan administration sent a letter to every household in the U.S. about how to prevent HIV/AIDS.
“I like this notion of sending masks to every household just to convey the seriousness of it,” Corlett said.
Addressing the pandemic will mean addressing the troubling disparities linked to race and ethnicity, Bush Stevens said. Black Ohioans have disproportionately been hospitalized and died during the pandemic, state data shows.
She said a response should include making sure Ohio policy follows the recommendations laid out by the Ohio Minority Health Strike Force.
“Those reports kind of stretched the gamut from the short term things that we need to do, like making sure that there’s access to testing in communities of color and low income communities, all the way to the more longer term things that we need to do to dismantle racism,” Bush Stevens said.
The reasons for the disparities range by context and population. Essential workers with more exposure are more likely to be people of color. Minorities are more likely to live in crowded housing or multi-generational homes.
Reem Aly, also with Health Policy Institute of Ohio, said people have had a flood of information and alerts about positive cases in the community, workplaces and schools but don’t always have enough specifics and context on what to do with that information and how and when to quarantine.
“The guidance that people are receiving from their school, from their child’s school, versus their employer might be very different,” Aly said.
Bush Stevens highlighted an article published Tuesday in Nature, which using mobile phone data from 1 in 3 Americans, suggested restaurants, cafes and gyms account for many of the U.S. infections clusters earlier in the pandemic. The paper suggested reducing occupancy in venues cuts infections. The paper also found that higher income white people are more likely to visit places that are less crowded, and thus lower risk.
She said more stringent occupancy caps could help.
“Because what they were finding is that in low income communities, there was just more density of people in stores and restaurants. And that was driving some of the disparities in transmission,” Bush Stevens said.
She also pointed to the policy of some other countries to close down and financially support higher risk venues like indoor dining and bars in order to reduce spread that could affect schools' ability to stay open.
Would better education help?
Another challenge is that the specifics of good hand hygiene and infection control are not widely understood, according to Shanina Knighton, PhD, RN, and instructor with the Frances Payne Bolton School of Nursingbett at Case Western.
America was given a crash course in infection prevention when the pandemic hit, Knighton said, and some of the widespread pandemic communications like “wear a mask” are missing important details. She recalled being at the grocery store and seeing a person wearing gloves but handling objects in a way that could spread germs.
Knighton has been creating shareable graphics that detail how to safely navigate activities, like the importance of washing your hands after handling your mask and how to store it in a paper bag marking which side faced out toward potential germs. As we move more inside for the winter, she said people could also benefit from more clear information on ventilation and inside environments.
“Are people getting their HVAC systems maintained the way that they need to? Are they allowing for proper ventilation of air? And are they cleaning their hands? And even when we talk about the masks, are they lowering masks to be able to talk or not using cough and sneeze etiquette? These are common issues that we’re seeing in the reason why the numbers are going up,” Knighton said.
