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Vermont mostly passes the test, but we’re not perfect yet.
At a presentation of Covid-19 projections Friday, state officials said Vermont is ready to reopen without a surge in cases — as long as it holds up its current pace of testing, tracing and social distancing.
Michael Pieciak, commissioner of the Department of Financial Regulation, who has developed hospital preparedness modeling for the state, said Vermont is meeting its own criteria for reopening the economy, noting the drop in cases over the past month as the state plans to ramp up testing.
“One of our modelers told us this week that Vermont is actually in a good position to reopen compared to the many other states that modeler is working with, including the federal government,” he said.
One research preprint ranks Vermont among the best in its response to the virus, ranking well both for its social distancing guidelines and its decline in cases since March 24.
But does Vermont meet other experts’ criteria for relaxing lockdown rules? VTDigger examined six criteria cited by government bodies and academics that have guided countries and states on reopening decisions.
Vermont meets many of the criteria, but there are caveats with each metric. And with so much uncertainty around the actual number of cases and the lack of understanding regarding how Covid-19 spreads exactly, there is still plenty of uncertainty about the right way forward.
Pieciak said the state needs to continue to keep a close eye on the metrics and stay vigilant to prevent a second wave.
“We got here by being smart and being safe, by following scientific evidence and public health guidelines,” he said. “And we intend to keep doing this, as we keep a close eye on our public metrics.”
1. Vermont meets testing capacity per person
VTDigger’s finding: Pass, with some lingering reasons for concern.
Experts have given estimates for how many tests are needed to reopen the United States, but Vermont seems to meet most researchers’ standards for how many tests per person are needed to reopen the state.
The Harvard Global Health Institute, for example, estimates that Vermont needs to conduct about 166 tests per day based on its population to be ready to reopen. Vermont has performed about 463 on average per day since the beginning of the month.
However, Vermont is still below its own goal of performing 1,000 tests per day with ramped-up testing capacity. At a press conference last week, Department of Health Commissioner Mark Levine said the state is working to meet that goal with new pop-up testing sites and broader testing of the population.
“This is really a time to capitalize on our ability, which we have now, to contain the virus if it should flare up in any particular part of the state or community,” Levine said. “It will require us all to exercise our new opportunities to socially connect while physically distanced, but to also keep up a high testing schedule.”
While testing seems to be generally increasing, there are still broad swings from day to day, from over 600 on May 12 to just over 300 the next day.
2. Hospital bed and ICU utilization
Our finding: Pass with flying colors.
Federal agencies have said states should have excess hospital capacity before reopening, but there are no specific standards. The University of Maryland analyzed hospital data with a 90% standard — that is, hospitals needed to be lower than 90% capacity to pass.
Vermont had more than 700 staffed hospital beds as of April 24, according to the Department of Financial Regulation projections.
As of May 13, Vermont reports five people in the hospital with Covid-19 and another 12 people who are hospitalized under investigation for Covid-19, meaning that they are waiting to get tested or get test results. That’s less than 10% of Vermont’s hospital capacity.
While the state doesn’t report ICU capacity every day, the latest model also shows ICU numbers are well below the capacity of the hospital system, too, even when including non-Covid patients who are expected to take up a certain number of beds.
3. 14 days of declining cases
Our finding: Fail … but is that fair?
A key metric issued by the White House in guiding states on reopening is based on their case trajectory: A state should have a 14-day decline in cases before considering making changes.
Technically, Vermont does not meet that criteria. While the state has seen an overall decline in new cases per day since mid-April, there has not been a 14-day period in which cases have continuously declined.
Easton White, a researcher at the University of Vermont, says there may be some reason to add nuance to that criteria.
“I think it should be a continuous decline or constant low number,” he said in an email. “For instance, 14 days of zero cases would not qualify in their example.”
At the same time, Vermont does occasionally see small surges in case numbers. For example, the state had six cases connected to a single testing site at the Vermont School for Girls on May 11.
4. Lowering positivity rate
Our finding: Pass.
The White House also recommends a low or lowering percent of tests that come back positive — a sign that the state is testing enough people and catching a lot of cases.
Vermont has one of the lowest cumulative positivity rate in the nation, with only 4% of tests coming back positive since the start of the crisis. The positivity rate of tests has also declined over time, according to the latest state model presentation.
5. Declining influenza-like illness cases
Our finding: Pass.
In a typical flu season, one of the ways that public health officials track the spread of the flu virus is tracking who shows up to doctor’s offices with ILI (influenza-like illness), or symptoms of influenza.
As concerns about Covid testing arise, the state has begun tracking those with ILI and reported Covid-like illnesses as they appear. Pieciak said their data shows that the number of people cropping up with each has declined.
6. Number of contact tracers
Our finding: Fail.
Vermont has promised in recent weeks to step up contact tracing efforts. On Wednesday, Levine said the new enhanced contact tracing the state is conducting allows them to track a person’s history through their entire 14-day incubation period and inform those who may have had extensive exposure to the infected individual.
“So that context they may have had in settings, they may have been in can be ascertained as to where their symptoms might have originated from, to really again help with what we call containment of the virus,” Levine said.
The National Association of County and City Health Officials estimates that each state should have about 30 contact tracers per 100,000 people to truly meet pandemic needs.
Vermont is still falling short on that metric. The state has 53 contact tracers, or an estimated 8.49 contact tracers per 100,000 people.Â
That shortage is not just a Vermont problem. NPR estimated there are about 66,000 contact tracers across the country as of May 7, compared to a goal of 100,000 to 300,000.
Other states have announced massive hiring efforts and volunteer recruitment, but Vermont has not yet committed to stepping up the total number. To be fair, Vermont’s outbreak did not reach crisis proportions like the pandemic did in Massachusetts or New York, which have each promised an army of 1,000 contact tracers.
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