COVID-19 cases are climbing again in Pennsylvania and nationally. And so are hospitalizations. Matthew Ferrari, director of Penn State’s Center for Infectious Disease Dynamics, is also part of the research project Data4Action, which has been measuring the impact of the pandemic on the local community for the last two years. WPSU's Anne Danahy spoke with Ferrari about the current upswing in COVID cases, how to understand the data and steps that can be taken in response.
Here's their conversation.
Anne Danahy
Welcome to Take Note on WPSU. I'm Anne Danahy. COVID cases are climbing again in Pennsylvania and nationally, and so are hospitalizations. The White House is warning about the potential for a surge in cases this fall. Joining us to better understand the numbers and what they might mean is Matthew Ferrari, director of Penn State's Center for Infectious Disease Dynamics. Ferrari is also part of the research project Data4Action, which has been measuring the impact of the pandemic on the local community for the last two years. Matt Ferrari, thank you for talking with us.
Matthew Ferrari
Not at all. I'm glad to be here. Thank you.
Anne Danahy
On the one hand, COVID cases and hospitalizations are going up in Centre County and in Pennsylvania. But on the other hand, it's not as bad as it was in January. When you look at the case numbers and the maps of where the increases are happening, what do the numbers mean?
Matthew Ferrari
Boy, that is a tough question that because because "what do the numbers mean" is constantly changing. You know, a really important shift that we've seen from last year to January to now has been a change in how people are diagnosing and testing COVID cases. And increasingly, people are using at home rapid tests, which is great. That's actually been, I think, a really powerful and important intervention in helping to control this pandemic, as people can more rapidly detect whether or not they're infected and stay home from work, stay home from school. And so I think it's been a really powerful tool in preventing the spread of infection. But it also means that not as many of those cases are then going to be seen in a formalized healthcare setting, and not necessarily recorded and imported to the Department of Health or what have you. So what do the numbers mean? I mean, I think, you know, I think it's more important for us to be focusing on trends here than in terms of absolute numbers, right, because the absolute number of people that are testing or reporting tests or getting tested in formalized setting might be constantly changing. But what we are seeing is an increasing trend. And that's a concern. We've seen a number of waves and increases in the past, some of them have been bigger than others. And you know, and so we're watching the one that we're seeing right now, and trying to take appropriate precautions to get ahead of what we're seeing out there in the world.
Anne Danahy
And part of that is that the hospitalizations are going up. So people are doing, as you said, people are doing at-home testing, more are testing in different ways. But the hospitalization numbers are — they've doubled from mid April to mid May. But on the other hand, it's again, it's not nearly as bad as what we were seeing in January. I guess for for like a regular person who thought, "Hey, by now, maybe the pandemic wouldn't be over over. But we would at least be like, kind of headed that way." What advice would you have for kind of navigating this information?
Matthew Ferrari
So things like hospitalizations are, I think, probably a more robust indicator than absolute cases. When somebody gets sick, they might go to their health care provider and have a test that has to be reported to the Department of Health versus staying at home with a test with a test positive, that doesn't have to get recorded. So there's going to be some uncertainty over time about that. And you know, seeing hospitalizations go up, that's, you know, the number of severe cases that require hospitalization. And that's going to get seen by the system at about the same rate no matter what, right. If you need to go to hospital, you need to go to the hospital, whether you tested at home or tested in a clinic. So I think it's bound to be a little bit more of a robust indicator. It's a really important thing to note is that what we've seen throughout this pandemic is that hospitalizations tend to be a lagging indicator. So there's all, because not everybody has severe disease outcomes. And because the hospitalization tends to occur late in your illness, you go through a period, usually you go through a period of being sick for a while, and it's not that bad. And it's kind of fluey, and then it gets a little bit worse, and it gets a little bit worse, and then you go to the hospital. So you know, hospitalizations tend to lag infections by one to two weeks. Which means that by the time you're starting to see those numbers go up, there's already been a pretty substantial increase in rates of transmission in the community. So that means that if we're starting to see that increase now then, you know, the overall risk in the community is, is much higher than it was two, three, four weeks ago. And it's against that background that individuals should be taking, or should be assessing their activities and taking on the mitigations that are necessary for themselves and hopefully, you know, the mitigations that are going to be helpful to their neighbors and community members to reduce risks to them as well.
Anne Danahy
Right and we are heading into the warmer weather. So hopefully that makes it a little bit easier to kind of navigate because it's easier to do things outside than in the winter.
Matthew Ferrari
Certainly. I mean, I know that's what we do around my house is you know. I mean unfortunately this is the third COVID summer that we're heading into. And in each of them, we sort of look forward to the warmer weather because it means that we can do a little bit more a little bit safer because of that, and you know, so I think that's something for us to be looking forward to as we as we each, you know, assess the activities and the plans. I think the other important thing is that a lot of people plan for big important events in the summer, right, people plan for vacations, there's school graduations that are coming up. There are these big, important events that are very meaningful to us. And, you know, as we're looking at increasing cases and increasing hospitalizations, that means that the trend is conceivably going to increase for, at this point, an indeterminate amount of time. And risk may be higher in the future when those events that we really value come around on the calendar. So, again, we need to be thinking, I think a little bit about what's important now versus what's important in two to three weeks. And if it's those things that we've been pining for, are coming up in two to three weeks, or four weeks or five weeks, right? Then we can take steps now to manage our own risk, right to ensure that we're in a healthy spot for when that event that we've been planning for comes up, right when that vacation comes up, or that family reunion or that graduation or whatever, right, that thing that we've been hoping for, right? Well, managing our risk now is part of that planning, you know, not doing a couple of risky things. So in the next couple of weeks, limiting some activities that are maybe not necessary. You know, I personally still wear masks when I go into big public spaces. And I know that maybe, maybe if it's not that big of a reduction in risk, it's a reduction in risk that has almost no cost to me. Whereas the cost of not being able to go and do the activities that I want to do in the future. That's a big cost. And I want to and I want to hedge against that.
Anne Danahy
Pennsylvania's Department of Health switched from daily reporting to weekly reporting of the case numbers and the latest numbers. From the day we were recording, this interview shows cases climbing in the past week, an average of 4,000 a day. Hospitalizations are up to more than 1,100. I guess it sounds like you're saying that people need to take kind of the long term big picture view.
Matthew Ferrari
Yeah, again, I think, you know, the risk that we're facing is twofold. It's the absolute number of cases that are out there. That's sort of if you think about that, in terms of, you know, if I go and I meett 10 people today, what are the chances that one of them is going to be infectious, right? hat's a function of the absolute risk. Right? So that's piece one. The other is the trend, right, which is, you know, Where where are things headed for the future things that I'm planning for. And if if the future is heading up, then the more I do now to to manage my own risk, the more likely I am to be healthy when the future gets here, a rapid increase when absolute numbers are small. That's concerning, but not horrible, right? A rapid increase when absolute numbers are high. That's that's the really severe case. And we've been through those in the past. And we've taken on severe measures when that happens. I said this before, and I think this was was an important lesson from the Omicron wave in January, was when we started seeing things increase. We didn't know at that point, didn't know how bad it was going to get. But we did know how bad it could get. We had a sense of worst case, because we had seen these waves come through before. And now we've seen Omicron. And we don't know if this increase now is going to lead to another big giant wave. But we know that it could. So we need to use that news that experience both for ourselves and within our communities to assess how we're going to, you know, each contribute to mitigation of risk.
Anne Danahy
Yeah. Can you talk about what factors will go into whether this does become another really big surge? Or no, it just the numbers go up a little and then they come back down? I mean, does it depend on whether there's new variants and sub variants and how easily they transmit? Or is it some of it's just kind of unknown?
Matthew Ferrari
Yeah, it's a little bit of everything. We can sort of step through what the major contributing factors that we would think are to the increasing trends right now. One is that we're getting to probably about six, between six and eight months out from when the last round of adult boosters were really taking off. So individual immunity levels for lots of people are sort of waning. And so that means that more people are going to be susceptible to getting infected regardless, right. So that's piece one, so more people are probably at risk of getting infected with any variant that's around. We also are seeing a switch in the relative proportion of what's circulating to this new sub variant of Omicron, which we've already identified does seem to evade the immune system a little bit better than the last Omicron variant. We're noticing some, you know, again, points that are sort of that are intellectually very interesting, you know, but hard to translate into practical experience. But these Omicron variants seem to be less sort of broad scale in their, in their immunogenicity, what we call, like how protective they are, that they're very, they generate a protective immune response to themselves, but not so much to the next to the to the next variant that's coming along. And so it seems that we're starting to see cases where it's much more likely that even small shifts in these variants are likely to move us into a place where people can get infected with the new variant. And so this new is BA, dot 2.1 2.1. Right? The the numbers are getting very long, right? This one, even though it's not, it doesn't have a full new name, as we're still calling it Omicron. Right, we are seeing higher rates of infection of people with this, even if they got infected with Omicron in January, or some of the some of the previous variants, right. So, overall boosters are getting to, you know, are getting far enough away in in the past. So more people are susceptible, we're seeing shifts in some of these variants. And so now those variants are probably more likely to be able to infect people. So that's what the virus and that immunity is doing. But then we're also seeing, we just went through a period of time where cases were really low. And whenever cases are really low, we say great, we're almost out of this. And now we can start doing our activities again. And so activity levels increase, people start taking on more risky activities, right, which is not an unreasonable thing to do, when cases are low. But it's probably now causing a feedback where we have, you know, lots of people in more high density settings, more people return to school, and to work and all these places. And so now we've got that activity level coming back up, which is mixing people around and increasing the chances that we're that we're going to see transmission. So now we have these three factors all together. And in some combination, those factors are probably what's driving this increase. And what we don't know and what we unfortunately never know until, you know, after the fact is how big that increase is going to be, how fast it's going to escalate and where the peak is going to be.
Anne Danahy
One other question with that is because something is a new variant, or sub variant, or sub sub variant, that doesn't necessarily mean it's milder, right. Is that something you have to also wait and find out?
Matthew Ferrari
So it absolutely doesn't mean it's milder, and in an absolute sense, pretty much every variant that we've seen from the original Wuhan strains, but we first saw in spring of 2020, pretty much every strain that we've seen, or variant seen, since then has been at least as severe as the variant before. So in an absolute sense, this virus has been at least staying the same, if not getting worse. If you were to expose a person that had never been vaccinated and never been infected before, they would, on average, have more severe disease outcome with each new emerging variant as time goes on. Now, what we have seen is that the people that are getting infected now are disproportionately more likely to have been infected in the past or vaccinated at least with you know, with one with one series and possibly a booster. Right now, your severity of disease if you've been previously immunized, right, either with infection or with a vaccine is likely to be lower. So we're seeing on average, less severe disease now, but that's not because of the properties of the virus, that's because of the properties of the people that are getting infected, right, they're more likely to have been immunized either by past infection or vaccination. So that's great. And that's great for us, and it's great for the health system. I think that's why a lot of the discussion now has shifted in some sense to individual and mitigation of risk, right, rather than large scale, you know, community wide concerns about you know, overflowing health systems, etc, is because right now, much smaller fraction of cases that are occuring are ending up in the hospital, and we're much less likely to be taxing resources and our health systems, you know, needing to close down schools because of absenteeism of teachers, I mean, all those kinds of things. Again, the fact that more people are immune, or have some immunity, rather, is is the primary explanation for the lower severity of disease that we're seeing now.
Anne Danahy
If you're just joining us, this is WPSU's Take Note. I'm Anne Danahy. And we're talking with Matt Ferrari, the director of Penn State's Center for Infectious Disease Dynamics. What happens if there is a pretty big surge this summer or fall and you hear people say, "You know, businesses were closed down before. Schools were remote. Everybody was wearing masks, and it still spread. It's still bad." So a lot of people, I think there would be opposition to it. I think that's fair to say that there'd be opposition if there were more restrictions imposed at the state level and nationally. What are your thoughts on that? Do you is it now more just individual behavior choices?
Matthew Ferrari
There's no easy way to to address this question. And there's really no easy way to answer this question. And one of the conundrums that we often face in public health is that if we're successful at preventing something, right, then we will almost universally be accused of overreacting, right, because we prevented the severe outcome, and then you didn't see that the severe outcome occurred. That's this problem that we're faced with now, where absolutely lots of people are tired of, of, you know, two and a half years of pandemic and restrictions and missed events and missed opportunities and developmental events for their kids. All that kind of stuff. I get it. I've missed all those things, right? And so I'm, and I'm also tired and don't want to, you know, don't want to take on large scale restrictions. And so the push back against, you know, against those mitigation efforts, you know, is palpable. And I think that what it means is that, in order to take a step towards increasing, you know, severe restrictions, community wide restrictions, I think we unfortunately need, you know, pretty strong and convincing evidence that, you know, we're headed on a dangerous path. And we need to, and we need to put something important in front of it. Hopefully, two and a half years of evidence, and, you know, that we have now will, will allow us to make those make those decisions if they occur. I'm personally, I don't think that we're there yet. I think that again, because we have, because there's lots of immunity in the population, lots of individuals have some level of immunity, they have some level of circulating antibodies because of either vaccination or prior infection, then that has greatly reduced the potential, the potential individual level severity. And so I think that we can probably be much more targeted in our controls and interventions. And individual level is one way, that's, that's the most targeted, we could let everybody do their own thing. Right. But I think that, you know, there are other, less severe systemic, you know, system wide interventions that we can use, such as increasing access and opportunity to testing services, you know, maintaining opportunities for for paid leave from work so that people when they get sick can stay at home. And when you think about that, those are meaningful cultural changes from where we were two years ago, right, the idea that we would, you know, as a community support, increases in paid sick leave, right, that needs to be that was like a theoretical discussion about is this the right thing to do? Now, we're talking about it, as you know, this is an important public health intervention, right, so that people when they're sick, can stay away from the office and keep their office mates healthy. So again, I think that there are, you know, there are these sort of intermediate community wide types of interventions that we can try and take on that are that are still very powerful, and are a step in between, let everybody adjust their their own risk individually, or, you know, or shut everything down for everybody.
Anne Danahy
Right, and some of the schools are actually taking kind of those intermediary steps right now. As you know, cases are going up in children. And the State College Area School District, for example, just this week reported seeing a rise in cases to the point where they have masking for some of the grades — it's a limited masking. And another charter school in Centre County, they went remote briefly. Reports are that most children do OK when they get COVID. But parents are still going to be concerned about how to know like, is that going to continue? Or do we expect that children will still be able to do OK as the new variants emerge?
Matthew Ferrari
I can't predict the future and can't say, you know, what, what's going to happen with new variants. All evidence has at this point been that kids have thankfully been spared the most severe outcomes throughout all of these throughout all these variants. So it would be quite a significant change relative to what we've seen before that would if we saw something that all of a sudden started impacting children more severely. One of my concerns always with with infection and kids, especially as schools are returning more to sort of conventional levels of operation and interaction, is the potential for spread then to family members and you know, high risk folks at home. We're talking about families managing their risk, and that risk is not just, "Is my kid gonna get sick?" But is my kid gonna get sick have to stay home and I have to take time away from work, which maybe I can't afford to do. And so that collective impact is going to be important. Or my kid gets sick comes home brings that in and affects you know, grandma or grandpa who's you know, who's older and more likely to have severe disease. So again, assessing risk of a family scale is much more complicated than just this sort of simple discussion of is disease severe in kids or not? My raising that isn't to be alarmist, I think that, you know, it's really important that kids be in the schools. And I think it's fantastic that we've been able to shift back to, you know, almost complete, you know, in person enrollment in schools and back to sports and activities, and all these important developmental milestones for kids. So I'm enormously supportive of that. But I think the way that we support each other, and support individual families to make the decisions that are necessary to them, right, we need to consider that, you know, they're probably doing a calculus that is not just is my is my 12 year old gonna get, you know, get end up in the hospital? They're doing a calculus that is, what does my 12 year old's illness mean, for my family and other family members? Right, it's a much more complicated thing. So reducing it only to "Do kids get very sick," I think is I think it's probably underselling the, the challenging decisions that families have to make in the face of this.
Anne Danahy
I just want to go back to one thing you had mentioned, one of the steps that can be taken to help respond to the COVID increase is more testing. But a lot of universities including Penn State, they're closing down their testing sites. Do you think that needs to change? Do you think the state should be stepping in and opening up more testing sites or no is it OK that people are doing it at home?
Matthew Ferrari
It's a great question. But I'm going to qualify my answer, right, because I've been involved with Penn State and helping Penn State planning. And so what I want to do is I'm going to take off my Penn State hat, and I'm only wearing my Matt Ferrari hat at this point, right? I think that one of the things that we've learned throughout the course of this pandemic is that testing and diagnostics, identifying who's sick, where, you know, when which people are at risk, is both a powerful tool for getting those individuals into care and getting taken care of well, and for, you know, assessing overall population risk and minimizing the risks to others allocating resources appropriately. Right. And so it's in that case that I think I think that testing has really shown that it is cost beneficial at the community level, right, for individuals to be able to test that is that provides a demonstrable benefit to the community. And so therefore, that suggests to me that it is a service that the community should be providing and investing in. Now, I've used community as an abstract construct. What does that mean? Is that community, Penn State University, because they're a big part of our community? Or is that, you know, State College borough? Or is that the Pennsylvania state Department of Health? That's a, you know, that's a higher level discussion about, you know, how you provide public services. But I do think that the case has been demonstrably made, that allowing people to test in a, in a setting where it can be well monitored, and, you know, the data and information can be accessed and acted upon, I think that has been shown to be cost beneficial. And, you know, and so therefore, I think there's a really strong argument for investing in that, you know, at whatever administrative level, we're talking about the university, the town that state, what have you.
Anne Danahy
One of the projects you've been involved with is Date4Action. And it's this two year project that surveyed community members in Centre County and did antibody testing on volunteers. And the idea was to get an understanding of the impact of the virus on the community. Can you share some of the findings and insights so far?
Matthew Ferrari
Sure. We've done our most detailed analysis of the first year of the pandemic. So that was last academic year, was some of the things that we found are admittedly not going to shock that many people. But there was a very, it was a significantly large fraction of Penn State students that they got infected, we saw, you know, upwards of 30 to 35% of the students that were involved in our study had antibodies to COVID by the end of the fall term and in fall 2020, right. That's a pretty you know, that's a meaningfully high number of students that were likely to have been exposed. By comparison, interestingly, the the community members that were involved in our study only, you know, somewhere around nine to 10% of them, right? So despite the fact that we were all co-located, we're in this you know, we're in the same area where we normally think about high levels of interaction and circulation between you know, Town and Gown there, you know, those two portions of the community really experienced, very different pandemics and In terms of individual levels of risk, and then when we dug into, you know, we did all these surveys of folks and how they were behaving and what they were doing and how they were mitigating risks. We saw, you know, really strong differences between community members that disproportionately were working from home, you know, avoiding lots of large group activities, and the students who, even those that were taking most of the mitigation activities, right, we're still disproportionately more likely to, you know, attend the occasional large gathering, right? Even those sort of rare, you know, comparatively rare interactions relative to relative to the average yield, were still enough to meaningfully elevate risk in students.
Anne Danahy
In an interview you did you said that one of your biggest concerns about preparing for the next pandemic is that we'll still be playing catch up, and that we're not going to be getting ready for that next pandemic. I mean, I can see that right, once it's out of sight out of mind. What type of work do you think needs to be happening at the state or federal level to be prepared?
Matthew Ferrari
I fundamentally think that routine health services for everyday things are probably it's probably the best way to prepare for uncertain things in the future. One of the biggest things that I've noticed has been concerned with getting information from new sources, new experts, all this information about the pandemic. Who do I trust, where am I going to go? Right, and lots of people indicated that they that they tended to trust, you know, their routine health care provider, right? If that's somebody I know, I've got, I've had years of experience with that person, and I trust what they're going to say. So building, you know, increasing access to routine care, routine health services, preventative, preventative measures, things, you know, having people having positive health care encounters, you know, on a regular basis throughout their lives, I think is going to increase the probability that when something new comes and people like me have to say, Hey, listen, something dangerous is coming down the pike, we need to take steps to do so right, there that will already have those relationships. Existing right there will already have a level of trust built up. So it won't sound like you know, I'm coming out of the blue and I'm some stranger, you know, raising a set of alarms for nefarious purposes. So again, I think that providing increased access to routine preventative health care services. When that happens, everybody knows where to go. Everybody knows who their doctor is. Everybody knows where they can get drugs, everybody's had good positive experiences with a health system, and they're much more likely to trust them in the future. And to me, I think that that is, you know, that's an investment that, even if I'm wrong, even if that doesn't help against the next pandemic, it actually did a good job keeping people healthy until that pandemic happened, right. So I think the downside of making that recommendation is still pretty small.
Anne Danahy
Matt Ferrari, thank you so much for talking with us.
Matthew Ferrari
You're very welcome.
Anne Danahy
We've been talking with Matt Ferrari, director of Penn State Center for Infectious Disease Dynamics. To listen to this and other episodes of Take Note, go to wpsu.org/takenote. I'm Anne Danahy. WPSU.
