Health officials nervously eye emerging hot spots

Public health officials are nervously eyeing cities that may become the next epicenters of the coronavirus pandemic as new models point to increased rates of transmission.

The fact that restless Americans are now emerging from lockdowns to resume something approximating normal life is only exacerbating those concerns.

While the number of new coronavirus cases is declining in New York, Seattle and other focal points of the first wave of cases, models are predicting that cases could skyrocket in the next two weeks in cities like Houston, Dallas, Nashville, Tenn., and Memphis, Tenn., creating new epicenters.

Modelers are also watching suburban areas like Fairfax County in Virginia, and areas around Minneapolis, Phoenix and Omaha, Neb. 

“We think there's a storm out there, there's the potential for a storm. We're not sure if it's going to land on shore,” said David Rubin, director of the PolicyLab at the Children's Hospital of Philadelphia, whose models show the impending surges. “The next two to three weeks are going to be really important.”

Epidemiologists were alarmed over the Memorial Day weekend when big crowds showed up to stroll the boardwalk in Ocean City, Md., and when viral videos showed raucous pool parties at Lake of the Ozarks in Missouri. The social distancing habits that have had a measurable impact curbing the spread of the virus seemed to have been abandoned by tourists and partiers ready to let their guard down after two months of enforced lockdowns.

To public health experts, those large gatherings, with nary a mask in sight, have lit a fuse, but they say it will take a week or two to understand just how deadly a blast it ignites.

“We need to see what happened Memorial Day weekend,” said George Rutherford, an epidemiologist at the University of California-San Francisco. “We're certainly flirting at the edge, and it'd be great if we dodged a bullet, but I think we need to know that as a fact.” 

The potential for a second surge in urban and suburban areas is coming even before the first wave fully subsides. Twenty-six states reported higher case counts last week than in the week prior, according to The Hill's analysis. Case counts have declined for two consecutive weeks in only 13 states.

North Dakota, a sparsely populated state that has seen few cases so far, for the first time confirmed more than 100 new coronavirus cases on two separate days last week. Emergency rooms in Arizona reported their largest influx of coronavirus cases so far this weekend. In North Carolina, more than 700 people remain hospitalized, the highest tally that state has experienced so far.

“It feels like we're just sort of drifting. Like we’re drifting out at sea,” said Nita Bharti, a biologist at the Center for Disease Dynamics at Penn State University. “In some places we are seeing slowed growth in new cases, we're seeing a decline in the rate of new cases. The problem with that is that a lot of the other measures that we needed to build up during the time of extreme behavioral interventions are not getting better.”

The new potential hot spots forecast by the Philadelphia model are in some of the nation's largest cities. Rubin’s models show the number of new cases confirmed on a daily basis rising from about 300 today to about 500 by June 1 — and then doubling to more than 1,000 a day a week after that. The model shows Dallas County surpassing 500 new cases a day by this time next week.

In Nashville and Memphis, slackening social distancing practices are likely to mean those cities will experience more than 100 new cases a day by next week. Fairfax County, Va., already hard hit by the virus, is likely to see an average of 250 cases per day over the next four weeks, the model shows.

The number of confirmed coronavirus cases should rise, modelers and epidemiologists agree, as a state’s capacity to test residents expands. More testing would mean more low-symptomatic or asymptomatic carriers are identified, patients whose health outcomes are more likely to be positive than the more grievously ill. 

Rubin said he is closely watching emergency room visits as an early indication of a rebound in serious cases. Already, more than three-quarters of intensive care unit beds are occupied in states like Alabama, Georgia, Maryland, Massachusetts and Rhode Island. Only 12 states meet federal testing capacity guidelines, according to data maintained by a group of scientists who operate the Covid Exit Strategy website.

Rubin is also keeping an eye on weather reports, as summer temperatures send the mercury north. Little is known about how the coronavirus can survive in high temperatures and humid conditions — though some experts point to cities like Manaus, in Brazil, where the virus is raging even in muggy conditions.

“It's possible that at an extremely high temperature the floor drops out,” Rubin said. “If Houston flattens out as it continues to reopen, it would suggest to me that there is a threshold at which temperature and humidity does have an impact.”