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Science Behind Public Health Decision Making

The COVID case rate has been increasing steadily for two months with the case rate at 47 cases per 100,000 residents on December 11. Hospitalizations in the county are growing and the state reached a new high in hospitalizations on December 11 as well. The COVID vaccines are our way forward; to take the greatest advantage of them, everyone needs to be healthy and alive so that they can get the available vaccine.

The hospitals will continue to care for everyone that comes through their doors. But, as more people are hospitalized, the stress on their system is increasing each day. At this rate, in the next one to two months, the hospitals will be overwhelmed. This is happening in other states and the modeling shows that it is happening here in Maryland. That’s why action needs to be taken now.

Contact tracing information provides a good sense of where people have been during the time period in which they were exposed to COVID-19, but it can’t identify clear causes in the majority of cases. The drivers of spread are:

  • activities which bring groups of people together for prolonged periods of time
  • inability to mask or distance
  • indoor spaces

Decreasing the number of contacts individuals have during their infectious period will slow the exponential spread of COVID-19. Focusing actions on the highest risk activities and venues will produce the biggest reduction in high risk contacts while minimizing the economic impact of these actions. Based on this, the following were the highest risk locations based on contact tracing data:

  • Food service establishments: Indoor dining and outdoor dining are both consistently ranked between the second to fourth most likely place where people who are positive had been in the 2 weeks before diagnosis. Indoor dining combines all three of the main drivers of spread. Outdoor dining in the best weather combines two of the three main drivers, but during the cold winter months it essentially turns into indoor dining.
  • Retail: This consistently ranked between the second to third most likely place where people who are positive had been in the 2 weeks before diagnosis. It combines two of the three main drivers for spread.

At the same time the people and communities hardest hit by COVID-19 are more likely to be lower wage workers, racial and ethnic minorities, and small businesses. That’s why financial, food, and housing support are critical to support all those who need it.

These actions will be in place for four weeks at which time they will be reassessed. This gives enough time to see the effects of these actions and make a decision on if further actions are needed. Critically, the holidays are a time when people get together and the more people stay within their households during the holidays, the lower the spread will be.

The goal of these actions is to avoid overwhelming the hospitals. Success means that the case rate will go down and the hospitalizations will go down before the hospitals are overwhelmed. Averting the worst case scenario will be because of these actions, not despite them.

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