New York City was America’s first coronavirus epicenter. Then rural communities became the hub, the virus jumping from one region to another as months passed.
The D.C. area was generally low on the U.S. list of most-covid-burdened places — partly because of high levels of mask-wearing and social distancing, and partly through just plain luck.
FAQ: What to know about the omicron variant of the coronavirus ArrowRight
Until the omicron variant came along.
Suddenly, the District is one of the country’s worst coronavirus hot spots, with a significantly higher rate of cases per capita than any state, and a sharper increase in hospitalizations, too.
The city’s leaders are flummoxed by the turn of events. Mayor Muriel E. Bowser (D) was plain-spoken this week about the reasons behind the rise: “I don’t know.”
Tracking coronavirus deaths, cases and vaccinations in D.C., Maryland and Virginia
Everyone from epidemiologists to political leaders to residents stuck at home missing holiday parties because of the sudden flood of contagion has a theory. But there is no consensus on the answer to why the D.C. region is omicron’s leading hot spot.
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Some hypothesized that the lack of a mask mandate in the city for a month — particularly at a time when the new variant was beginning to take hold — allowed the virus’s spread to accelerate.
“You get lucky sometimes, but you can’t stay lucky,” University of Maryland public health professor Donald K. Milton said. “You need to be out ahead of the conditions, not lagging behind them, and we are constantly lagging behind them. We relaxed mask mandates. People were starting to go out to restaurants, going home, and going to Christmas parties. This is what is generating these waves.”
Of course, people all over the country were going to Thanksgiving dinners and holiday parties, not just in the nation’s capital. Many states and cities long ago stopped requiring masks; Bowser rescinded the D.C. mask mandate just before Thanksgiving, but many in the city continued to use masks in public settings.
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Milton’s research has shown that many more people infected with the omicron variant — even vaccinated people — are shedding virus particles when they exhale than people infected with other variants. With such an infectious strain, he said, any region that hosts a small number of patients will soon have many more.
They were so careful, for so long. They got covid anyway.
Neil Sehgal, another University of Maryland public health professor, said he also thinks Bowser’s decision to end the mask mandate was a factor.
He pointed to additional features that set the capital region apart: First, the area has more young adults than many parts of the country — the demographic that is most socially mobile and thus spreads the virus most quickly. Second, omicron hit D.C. harder than other variants because the Washington region was protected from the delta variant by its relatively high vaccination rate, and omicron has proved more adept at overcoming the vaccine and infecting patients anyway.
“In previous waves DC’s relatively high vaccination rate was helpful in curbing infection and transmission,” Sehgal wrote in an email. “DC dropped its mask policy at very much the wrong time, just before Thanksgiving when we’d expect an increase in transmission without Omicron looming, but of course we know now that Omicron was circulating alongside Delta at the time.”
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Bowser has said that she has made the best decisions for the time at each stage of the pandemic. November was different from December, and ending the mask mandate was warranted then just as bringing it back was later, she said. Asked about the city’s high case rate on Wednesday, she also pointed to the District’s leading status in testing and vaccination.
Part of the reason that the D.C. area seems to have the most cases may simply be that more people are getting tested here. One out of every 50 D.C. residents tested positive in the past week alone. It is clear that the virus is more prevalent in the region than it ever has been before — test positivity is exceptionally high, at 19 percent in D.C. and Virginia, and 14 percent in Maryland in the past week — but positivity is similarly high in several other states where fewer people are getting tested.
In both Maryland and Virginia, the worst of the omicron wave is in the D.C. suburbs. Virginia is reporting record infection rates across the state, but the steepest increase is playing out in Northern Virginia as well as the state’s Northwest health district, which spans the Shenandoah Valley, including Charlottesville. The current wave seems to be spreading from north to south, following the initially high numbers in Maryland and D.C. into Virginia, state epidemiologist Lilian Peake said.
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In past waves, rural areas such as southwestern Virginia have experienced high rates of infection, but that region of the state has some of the lowest rates at the moment, Peake said. Weather and population density do not appear to be factors, she said.
She blamed indoor holiday gatherings combined with omicron for much of the surge. “Many people came together with family and friends for the holidays. Unfortunately, the virus was spread through these get-togethers,” she said, calling for people to get vaccinated. “I don’t like to see the cases go up. It’s heartbreaking. Everyone’s tired. But we have to continue to do the things we know protect ourselves and other people.”
Before Thanksgiving, Maryland had one of the rosiest pandemic outlooks in the country. It was ranking consistently in the top quarter of states in terms of population vaccinated; new coronavirus infections were plateauing and hospitalizations were far from hitting capacity. Then in early December, a cyberattack hampered the state’s covid-19 data reporting system, causing health officials to fly blind for nearly a month.
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By the time the data system was restored in late December, Maryland was recording some of the biggest leaps in cases and hospitalizations in the country despite having a vaccination rate of nearly 70 percent. In Montgomery County, the state’s most populous and most vaccinated jurisdiction, new infections multiplied eightfold over four weeks.
Local health officials are puzzled by the recent surge in cases and hospitalizations as they continue to validate data that was only recently restored. With vaccinations, boosters and multiple coronavirus variants, it’s more challenging now than last winter to “look at a slide deck and get a complete picture” of what’s happening, said Montgomery County’s assistant chief administrative officer, Earl Stoddard.
While total covid-related hospitalizations have soared to record highs in Maryland, the number of patients requiring intensive care has yet to hit the peaks recorded in May 2020 or January 2021. One reason is that hospital patients are regularly tested for the virus, Stoddard said. People in the hospital for other reasons might be adding to the total hospitalization rate, he said. This makes him hopeful that the current surge in hospitalizations may not result in as many deaths as expected.
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That’s not to say that hospitals are equipped to handle the situation. The Maryland Hospital Association pleaded with Gov. Larry Hogan (R) this week to reinstate a partial state of emergency as hospitals began declaring “crisis levels of care” — a measure that they had not used in previous waves of the virus.
“We’re presently in a perfect storm,” said David Marcozzi, a professor and physician who is leading the covid-19 response for the University of Maryland Medical System.
While most people testing positive in recent weeks have been infected by the highly transmissible omicron variant, many of the those winding up in the hospital have the delta variant, Marcozzi said. Droves of vaccinated individuals have found themselves isolating after positive test results, but across the state, three-quarters of those hospitalized for covid-19 have been unvaccinated, according to the hospital association.
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“The challenge here is that you have a virus that still transmits whether or not you’re vaccinated,” Marcozzi said. So even though a majority of Marylanders are immunized against the virus, he said, they’re able to carry and spread highly transmissible variants of the coronavirus that sicken those who aren’t adequately protected. Densely populated counties closer to Washington and Baltimore have reported the most dramatic increases in new infections, but even in rural Allegany and Washington counties, new infections have skyrocketed.
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The strain on hospitals has also been intensified by staff shortages and the increased demand for acute health services from non-covid patients who delayed care until after they were vaccinated, Marcozzi and hospital association chief Bob Atlas said. Many hospital workers in the state who were of retirement age left their jobs earlier than expected after serving on the front lines of the pandemic; others quit because of a sense of “moral exhaustion” — a feeling, Atlas said, “that people don’t understand what they do and aren’t taking the precautions to prevent this situation.”
None of the factors, individually, may have pushed hospitals to declare the need for crisis levels of care, but together they’ve caused intense strain, Atlas said.
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Some local officials wonder whether residents let their guard down because the region is so highly vaccinated.
“I honestly feel like the fact that we’re a fairly vaccinated state has played a role,” Baltimore City Health Commissioner Letitia Dzirasa said. “I wonder if folks, given our vaccination rates, thought, ‘Hey, I can return back to normal.’ ”
About 60 percent of Baltimore’s majority-Black population is fully vaccinated, lower than the statewide average of 70 percent. Dzirasa said she’s concerned that the recent wave in cases might make it even more challenging for officials to persuade people to get the shots.
“We’re seeing case rates soar and we’ve got the most people vaccinated than we’ve ever had,” Dzirasa said. “I think for some people, this raises the question of ‘Why [get the shot]?' ”
Public health officials in communities with lower vaccination rates may soon be confronting the same question. “I worry that DC isn’t an anomaly, but simply a few weeks ahead of the rest of the U.S.,” Sehgal wrote.
Milton said the region’s time as a covid hot spot might not last long.
“This week it’s D.C. There are a bunch of places that are in the running to catch up and overtake us,” he said. “A tsunami doesn’t hit every island at the same time. That’s what we have: We have a tsunami coming.”