The biggest question in slowing the spread of the coronavirus is whether the recent surge will prod people to change their behavior.
The recent signs have not been encouraging.
“It is very difficult to sustain behavior change of the kind that we need,” said Nasia Safdar, an infectious disease physician and professor at the University of Wisconsin School of Medicine and Public Health.
“It is not unique to a particular group of people,” Safdar said. “Health care workers are also finding it difficult to sustain those very same behaviors that we are asking others to do. That’s understandable. It’s not ideal, but it’s understandable.”
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What has been called pandemic fatigue is widely acknowledged. But the recent surge also has hit at a time when many people have simply become less fearful of COVID-19.
In contrast, when the virus first spread to Wisconsin in March, less was known about the disease.
“It led to a lot of fear and people changed their behavior in response to that,” said Safdar, who also is the medical director of infection control at UW Health.
Now, many people — particularly those who are younger or without medical conditions that make them more susceptible to severe complications — expect to experience only mild symptoms if they become infected.
The result has been a certain amount of acceptance, even fatalism, about the pandemic — and that, too, has made it harder to change people’s behavior.
Yet Safdar warns that much still is unknown about the virus.
“We are only now starting to learn of these long-term consequences of even mild infection,” she said.
What is known is that the virus is extremely efficient in how it is transmitted — and now is well-established in the state’s population.
The numbers — with more than 7,000 people testing positive for the disease on some days — make that clear.
But that is only one measure. The incubation period for the virus can be up to 14 days. And people can be contagious before they show symptoms, potentially infecting other people unawares.
“We don’t really know always who has it and doesn’t,” said Laura Cassidy, an epidemiologist at the Medical College of Wisconsin. “And often it is most contagious right before people show symptoms.”
In short, an unknown number of people have been infected by the people who test positive for COVID-19 on any given day.
There’s another challenge: As many as 40% of the people infected with the virus may never show symptoms but still be contagious, said Jeffrey Engel, a physician and senior advisor for the Council of State and Territorial Epidemiologists.
These people tend to have a lower “viral load,” which can lessen the severity of the illness in people they infect.
Further, colder weather has brought more gatherings indoors, where the virus is more easily spread. The most recent surge has been attributed partly to small gatherings of friends and families. And the Thanksgiving holiday is only a couple of weeks away.
None of this bodes well for the weeks and even months ahead.
Public health officials, physicians and health systems have pleaded with people daily to take basic steps, such as wearing a mask and social distancing, to help slow the spread of the virus. And on Tuesday, Gov. Tony Evers urged people to stay home and to take the pandemic seriously.
“It is in our power to do it,” Cassidy said. “It is our responsibility to do it. And we can do it.”
The numbers don’t suggest that message is taking. Nor do other signs. People not wearing masks or wearing them under their chins or below their noses can be seen at supermarkets and other businesses around the state.
“It is very difficult to get people to comply that haven’t complied,” Amesh Adalja, a senior scholar and infectious disease physician at Johns Hopkins Center for Health Security, said in a recent interview with Bloomberg. “I really fear for the worse in some places where their hospitals already are under stress.”
“Now there is a lot of complacency in the public,” he added, “and people in the community don’t seem to care what’s happening in their own hospitals.”
Hospitals straining to keep up
Hospitals in Wisconsin already are straining to provide care, and the coming weeks and possibly months could be much worse.
The hospitals in Eau Claire are at capacity. And Marshfield Clinic Health System is exceeding its bed capacity at Marshfield Medical Center.
Its eight other hospitals in north-central Wisconsin are in a similar situation, the health system said. And it has begun putting two patients in a room in some parts of its hospitals.
ProHealth Care’s hospitals in Waukesha and Oconomowoc are essentially full, said Ken Price, chief operating officer of the health system.
“We have not been turning patients away at this point, but we have not had any spare beds to put people in,” Price said. “We are managing it well, but it’s not a point you want to stay at for a long period of time.”
ProHealth reduced the number of inpatient elective procedures by 50% last week.
“That helped but it hasn’t helped enough,” Price said. The health system now is adjusting its surgical schedule daily. “We don’t see this pressure easing any time soon,” he said.
Other health systems and hospitals also have taken steps to limit the number of elective procedures. They include Aurora Health Care, Ascension Wisconsin, Aspirus and UW Health. And Froedtert Health said it is considering limiting elective procedures.
One concern is that people who need emergency care will delay treatment.
“Ascension Wisconsin hospitals and emergency rooms are well prepared to safely care for people with symptoms of heart attack, stroke and other serious conditions,” Greg Brusko, chief medical officer of Ascension Wisconsin, said in a statement.
Other health systems have said the same.
Staffing challenges increasing
Hospitals also are struggling with staffing shortages as workers become infected or need to quarantine because they have been exposed to someone who is. For example, ProHealth had about 120 people out, up from roughly 90 the previous week.
Intensive care units at many hospitals are at or near capacity. Hospitals can add ICU beds quickly. But the challenge is staffing them. Further, other patients, such as those who had heart attacks and strokes, still require ICU care.
Health systems are moving staff. But staffs already are struggling.
“Health care workers are experiencing a level of exhaustion, fatigue and fear that they haven’t thus far,” said Safdar of UW Health. “People have been working extremely long hours, putting in double shifts, being called in on their time off.”
They also don’t know whether the surge will last for two weeks or two months.
No health system, Safdar said, is exempt from feeling overwhelmed or close to overwhelmed.
“The mission is pretty clear, right?” she said. “You take care of sick people, no matter what else is happening around you.”
But this week public health officials and health systems warned that the state is close to a tipping point.
“This could get much worse quickly and that tipping point is when we stop being able to save everyone who gets severely ill,” Ryan Westergaard, state Department of Health Services chief medical officer, said during an event hosted by Wisconsin Health News.
Roughly 3.5% of COVID-19 patients are hospitalized, and about one in four of those patients will need to be treated in an intensive care unit.
Based on those estimates, 1,521 people would need to be hospitalized — and 380 would need ICU care — out of the 43,463 people in Wisconsin who tested positive for COVID-19 over the previous seven days as of Thursday. And some of those patients could be in ICUs for weeks.
“In day-to-day operations, we continue to focus on what they need to do as an organization to take care of the patients,” said Price of ProHealth. “We are managing through it at this point.”
But he also said, “We are not seeing anything but continued growth in the patients we are seeing.”
What happens if that continues for weeks or months is the fear.
Cassidy, the Medical College epidemiologist, said the current trajectory can be checked.
“We just need to work together,” she said. “The trajectory and future depend on how we behave now.”
Whether that message finally takes and whether people begin to change their behavior won’t be known for several weeks.