Why are COVID-19 cases rising again in Massachusetts?

Massachusetts may have taken two steps forward in its reopening process this month, but Gov. Charlie Baker says the state still has among the toughest COVID-19 rules in the country.

As a small but growing number of states completely repeal mask mandates against the advice of national health officials, Baker has stood by his order requiring people to wear face coverings at all times in public (even when they can keep a distance from others). Massachusetts has continued to tightly limit private gatherings to 10 people inside and 25 people outside. And while the Republican governor did loosen capacity limits for many businesses earlier this month, they’re still capped at 50 percent maximum occupancy and subject to sector-specific safety standards. Likewise, stadiums like Fenway Park and TD Garden, which were allowed to welcome back fans last week, are limited to 12 percent capacity.

In other words, Massachusetts is a far cry from states like Texas, which repealed its mask mandate and allowed businesses to open 100 percent earlier this month — or even Connecticut, which has completely lifted capacity limits on everything from gyms to churches and plans to allow amusement parks to reopen Friday.

“Massachusetts has some of the strictest COVID-19 protocols in place,” Baker said during a press conference Tuesday at the Hynes Convention Center vaccination site. “And they’re there for a reason, and we need everyone to continue to follow them, and embrace them.”

And yet, those restrictions haven’t spared the state from the national uptick in COVID-19 infections. In fact, Massachusetts was flagged this week as one of the areas of “greatest concern” by former Food and Drug Administration commissioner Scott Gottlieb.

Following a dramatic drop in cases since the peak of the second surge in January, coronavirus cases in Massachusetts have increased by more than 35 percent over the past two weeks to a seven-day average of 1,543 cases a day. The state’s positive test rate has crept up from less than 1.8 percent to 2.55 percent over the past three weeks. After leveling off, hospitalizations due to COVID-19 have also again begun to rise.

Acknowledging the uptick, Baker said Tuesday that residents should not have a “false sense of security about the fight against COVID being over.”

However, even if Massachusetts isn’t reopening as fast as other states, some experts say the relaxed rules could contribute to that false sense of security.

Dr. Cassandra Pierre, the acting hospital epidemiologist at Boston Medical Center, told GBH News last week that the relaxed restrictions contribute to a sense of confidence among residents that was partly to blame for the changing trends.

“It’s the thought that if something is open, then it must be safe,” Pierre said.

In reality, experts say those activities could be riskier than they seem due to the rise of the more contagious variants of COVID-19. According to the Centers for Disease Control and Prevention, there have been 441 confirmed cases of the B.1.1.7 variant, which originated in the United Kingdom, in Massachusetts. Baker has suggested that the official numbers are likely an undercount, due to limited viral sequencing; he said Tuesday that one local hospital found that the B.1.1.7 variant accounted for 55 percent of the infections that they tested.

“That is very much present here,” the governor said.

Dr. Abraar Karan, an internal medicine doctor at Brigham and Women’s Hospital, attributed the recent increase in cases to a combination of more contagious variants, policy changes that allow higher-risk activities, and people “feeling like we are out of the woods.” However, he noted that it’s difficult to say to what extent any particular factor is to blame.

According to state data, more than half of the COVID-19 cases reported in Massachusetts over the past two week have been among people under the age of 30, who are less likely to suffer from complications due to the disease. Massachusetts has also administered at least one vaccine dose to 80 percent of residents above the age of 75, according to Baker.

“That helps drive down hospitalizations and cases for this particularly vulnerable group,” he said Tuesday.

But as Karan noted, the vast majority of the state — including many frontline workers — remain unvaccinated. While Baker has repeatedly noted that that the Massachusetts vaccine rollout is now outperforming national averages in reaching its most vulnerable residents, the state is still averaging several dozen deaths due to COVID-19 each day. Hospitalization have also increased from a 2021 low of 580 on March 20 to 711 as of Tuesday.

“I treated multiple cases this month– unsurprisingly, they were a mix of frontline workers; people who had no choice but to go into crowded spaces to do essential activities (and reported wearing a mask the whole time); and people who don’t know quite how they were infected,” Karan said in an email. “I saw mild cases; I also treated severe cases.”

For his part, Baker has tried to counter any suggestion that easing restrictions means that residents can “let their guard down.”

“It’s still far too early to declare victory,” he said. “And we have more progress to be made, especially with respect to vaccinations.”

Baker noted that his administration will continue to review the data and “update and adjust our restrictions accordingly.” For now, the governor is urging residents to continue wearing masks and keep their distance from others, arguing that informal gatherings where “people let their guard down” is the main driver of the uptick.

“It’s not when they’re in formal situations, like this, where everybody’s wearing a mask and everybody’s distancing and everybody’s playing by the rules,” he said. “It’s exactly when you’re not doing any of those things.”

CDC Director Dr. Rochelle Walensky, who joined Baker and other Massachusetts officials at the Hynes vaccination site Tuesday, also put the focus on mask-wearing and social distancing. While she urged states against reopening earlier this month, Walensky declined to comment on whether Massachusetts should reverse its recent moves.

“What I will say is I’m really pleased to see that everybody here is masked, everybody outside is masked, and people are doing their part to try and contain the virus here in Massachusetts,” she said.

After the dramatic decline in COVID-19 rates, Walensky also said she thinks people now “understand that cases are rising” and that they “know what we need to do to stop the surge.”

“We would ask everybody to go ahead and do that,” she said.


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