While Vermont's COVID-19 growth rate has slowed considerably, suggesting social distancing is having a positive impact, officials caution that the peak in cases is yet to come, and are urging Vermonters to double down on precautionary measures.
As of April 2, the Vermont Department of Health reported 338 positive cases and 17 deaths, with 17 cases in Bennington County and 18 in Windham County — well below a worst-case scenario model that had predicted the state could have had up to 1,000 COVID-19 cases by about this time.
"That should be a glimmer of hope to Vermonters, that their sacrifices are working," said Michael Pieciak, commissioner of the Department of Financial Regulation, at a press conference on Thursday.
It's a sign that Vermonters need to continue stringent social distancing as well — as the worst is still ahead, and these new cases will require resources, he said.
In Vermont, where the average daily growth in COVID-19 cases had been 32 percent, the rate has fallen to 12 percent on a five-day rolling average, according to information provided at the press conference on Thursday. "Vermont is on a very different trajectory," Pieciak said.
Gov. Phil Scott has issued multiple social distancing requirements since declaring a state of emergency in regard to COVID-19, the disease caused by the new coronavirus, on March 13. Scott issued a "Stay Home, Stay Safe" on March 24 that directed non-essential businesses and nonprofits to stop in-person operations and residents to leave home only for essential reasons, and on March 26, he also directed schools to cease in-person instruction for the rest of the academic year.
Officials anticipate a peak in COVID-19 cases in mid-to-late April or early May, Pieciak said.
The state is planning for the worst-case scenario in predicting medical needs and planning surge capacity, per modeling scenarios provided by a consulting company, Oliver Wyman and professors from Northeastern University and Columbia University.
"We will always look at the data as it's coming in," Pieciak said. "These data points can change quite rapidly, and we need more data to confirm the exact trajectory that we're on."
It's important to have the appropriate perspective on the data, Pieciak said.
"We control the outcome by the measures that we implement and how closely we follow them, much more than a forecast does," he said.
The number of days it takes for confirmed COVID-19 cases to double in Vermont has also slowed from three days to 5.5 days, according to the information provided.
Modeling that was done when the state's rate of growth was much higher predicted worst-case scenarios in which the state maxed out available hospital beds by April 14 and ICU needs and ventilators by April 7.
Vermont is not trending in that direction, Pieciak said, but cautioned this drives home the importance of the state's efforts to increase its medical resources.
Increasing surge capacity
On Thursday, Gov. Phil Scott announced that the state has coordinated with communities and hospitals statewide, and with Dartmouth-Hitchcock Medical Center in New Hampshire, to increase capacity in the event of a surge of COVID-19 patients who require medical care.
In partnership with the Vermont National Guard, the state is also creating two additional high capacity surge sites: one in Essex Junction at the Champlain Valley Exposition, which will provide 400 beds staffed primarily by national guard personnel; and another in Rutland County, supported by the Rutland Regional Medical Center, which will provide 150 beds, according to a media release from the governor's office on Thursday.
These high-capacity surge sites are in addition to regionally deployed sites at the Collins Perley Sports and Fitness Center in St. Albans, Barre Civic Center in Barre, and at the University of Vermont, which will create available bed space as the COVID-19 response unfolds. These sites will be operated in close coordination with health care providers and will only be used if hospitals exceed their capacity, according to the release.
Additional medical surge trailers containing material for 50 additional beds have been pre-positioned across Vermont, including at Brattleboro Memorial Hospital in Brattleboro, and Mt. Ascutney Hospital and Health Center in Windsor.
More resources, including two state portable hospitals, will be staged, and the state is also working to increase capacity through partnerships with home health providers, designated agencies, federally qualified health centers (FQHCs) and more, according to the release.
It makes sense to plan for worst-case scenario, as the modeling isn't perfect, and when there have been failures in events like this in history, "the fact is — they did not plan for the worst-case scenario," Michael Smith, secretary of the Agency of Human Services, said at the press conference.
"I just want to say this is a very serious event," he said. "And I can't emphasize this enough. Lives are at stake. People must continue to conform to the mitigation efforts to prevent the healthcare system from becoming overwhelmed."
Under any scenario, the state needs to plan to increase capacity, he said. Hospitals are the first line of defense, and they have been asked to plan to surge "well beyond" their additional capacity, he said.
That planning is well underway.
Part of the planning also involves addressing COVID-19 care for special populations, like those with mental health needs, and isolation sites or facilities for vulnerable populations like those who are homeless or who don't have a safe place to remain isolated.
"We've concentrated on hospitals in the first part of this, but there are other populations that we really need to plan for," Smith said.
Plans are already underway for a site for hospitalized mental health patients who have COVID-19, he said.
The state is also working with municipalities and partners to decide the best options for isolation sites, according to information provided at the press conference.
People are also needed to help staff surge facilities, Smith said.
On Thursday, Scott also announced a call for volunteers for those with medical experience or a healthcare background to help the state in fighting COVID-19.
The Vermont Medical Reserve Corps is seeking licensed and certified health care professionals,
people with mental health, or other types of clinical or professional experience; health care administrative experience, such as with medical data entry or language translators; and people who have worked with displaced individuals, such as homeless shelter programs.
"The response has been encouraging, but we need more [people], quite frankly," Smith said. "The facilities are one thing. Finding the personnel are another, and we need to make a concerted effort over the next few days to find personnel to staff the facilities that we're putting into place."
In these unprecedented times, Smith said, he also wants to assure Vermonters that officials are attempting to deliver healthcare in the most compassionate way possible.
The state is also buying hundreds of ventilators and millions of pieces of personal protective equipment, along the same lines of planning for the worst-case scenario, said Michael Schirling, commissioner of the Department of Public Safety.
Scott and Schirling said earlier this week that six trucks from the federal government with PPE supplies arrived over the weekend, and additional trucks will be coming. The items received include surgical masks and face shields — "hundreds of thousands" of items, Scott said.
He emphasized that Vermont is not relying exclusively on the federal government for help.
"That is one avenue," he said. "It is not by any means the exclusive avenue."
Health Commissioner Dr. Mark Levine described at Thursday's press conference how the deceleration period of COVID-19 cases could last at worst case a month, or maybe three months in the "intermediate" case.
Everyone agrees there would be a rebound after that, where mitigation measures would once more have to be imposed — but hopefully on a faster, shorter timeline, he said..
"There is some science behind knowing that this virus will be with us," he said. "And even when we think it has quieted down, it will act up again."
Patricia LeBoeuf can be reached at email@example.com, at @BAN_pleboeuf on Twitter and 802-447-7567, ext. 118.