Monday marked a noteworthy day in the arc of the coronavirus pandemic in Nebraska, as Gov. Pete Ricketts began to allow restaurant dining rooms, salons and other businesses in some parts of the state to reopen.
But the state also saw another milestone that day: Counties collectively reported more than 500 new cases of COVID-19, a new daily high for the state in figures compiled by the COVID Tracking Project. And the state, Douglas County and Lancaster County each set all-time highs for cases in several preceding days, too.
While projections had long suggested that the pandemic would peak at the end of April in Nebraska, it appears that cases have only plateaued at best — and at much higher levels than had been seen just weeks earlier, said Dr. Mark Rupp, chief of the division of infectious diseases at the University of Nebraska Medical Center.
That’s concerning, he said, as the recent surge is coming at a time when businesses are starting to open and people are becoming fatigued with social distancing measures.
“I think it’s too early to say we have peaked in our community, particularly Douglas County,” Rupp said. “We are not out of the woods by any means.”
Ricketts on Friday declined to say whether he thinks the state has peaked. He noted that the University of Washington model that once had Nebraska cases peaking in late April now has moved the peak into early May.
But he said he’s not so much focused on the current case numbers as he is on whether Nebraska’s hospitals are being overwhelmed with COVID-19 patients, and they’re not. That shows the social distancing restrictions Nebraska put in place have worked, he said.
“We slowed down the spread of the virus, we flattened the curve, so that peak did not overwhelm our health care system,” he said.
There’s no doubt the measures the state and its businesses and citizens have taken in the two months since Nebraska saw its first coronavirus case have made the state’s infection curve flatter than it would have been — preventing infections and saving lives. But it would be a stretch to call Nebraska’s current curve flat.
Because of huge outbreaks in a number of meatpacking counties, Nebraska leads the nation in percentage growth in new confirmed cases. That’s true over the past week, the past two weeks and the past month, according to a World-Herald analysis of national data.
Nebraska, which a month earlier was averaging 44 new cases a day, during the past week was adding about 440 a day.
Since the start of the pandemic, Nebraska now ranks 13th among the states in cases per capita. At the same time, the virus has not been as deadly here, with Nebraska’s 86 deaths as of Friday morning ranking the state 37th in per capita deaths.
Dr. Daniel Brailita, an infectious disease specialist with Mary Lanning Healthcare in Hastings, said the models for the pandemic showing an April peak clearly did not anticipate how explosively the virus would spread within meatpacking communities like Nebraska’s Hall, Dawson and Dakota Counties.
“They started like a burning fire,” Brailita said. “West of Lincoln and Omaha, we had some very scary spikes in hospital admissions and (ventilator patients).”
The trend was seen in other states, too, including Iowa, Kansas and Minnesota. All have found it difficult to contain the spread within meatpacking facilities, where thousands of people can work shoulder to shoulder in jobs that can’t be performed from home.
“No health department in the country was prepared to deal with this,” Brailita said. “It’s just a hard situation.”
In recent days, there have been some hopeful signs that Hall County and the surrounding region in central Nebraska are now on a downward slope, Brailita said. Not only are new cases trending down, but there have also been fewer people needing acute care.
But the flattening in central Nebraska comes as new cases in Douglas and Lancaster Counties have been rocketing up.
Douglas County, which was rarely topping 10 new cases a day as recently as two or three weeks ago, has been averaging 84 new cases daily since April 30. Lancaster County, which only once before April 26 exceeded 10 cases in a day, since then has topped that number every day but one, with a single-day high of 64 on Monday.
It appears that the Douglas and Lancaster spikes also have ties to meatpacking. Douglas County health officials say there have been outbreaks associated with a number of food-processing facilities in the county. Lancaster has seen cases related to a meatpacking facility in nearby Crete.
Brailita said the social distancing measures put in place in Nebraska’s most populous counties did appear to be effective — “until the fire found the target” in the meatpacking plants.
The increases in testing across the state no doubt have played some role in the recent increase in cases. Daily testing in Nebraska is more than triple what it was in mid-April.
But daily cases are up much more in that time — about eight-fold. And the percentage of people testing positive has also shot up, from 10% to 25%.
“That indicates to me, not only are we finding more cases because we’re testing more, but we’re finding more because it’s penetrating into the community,” said UNMC’s Rupp. “I salute the folks who have worked to get tests out in the community. But that is not the only explanation for the numbers we are seeing.”
Regardless of whether Nebraska has peaked, no one is saying the state has seen a sustained reduction in cases — something public health officials have recommended as a condition for states to lift restrictions.
President Donald Trump’s guidelines to states suggested that they should have 14 days of reductions before starting to reopen, though he made it clear the ultimate decision was up to individual governors.
“Clearly we are not seeing the declining rates that would make us all breathe a lot easier and say now is the time to relax things,” Rupp said.
But at the same time, Rupp said he’s not faulting Ricketts or local public health officials for decisions to loosen restrictions. The impact on the economy is real. And some degree of “quarantine fatigue” is settling in among the public, he said.
“These decisions are extremely complex and very difficult,” Rupp said.
Nebraska isn’t the only state that’s starting to reopen or making plans for it while falling short of that 14-day standard.
While 32 states have made plans to reopen to some degree, only eight of them have seen two straight weeks of reductions in average daily cases. In fact, Nebraska and neighboring Iowa, Kansas and Missouri have all seen daily averages continue to rise for each of the past two weeks or more.
“I think in an ideal world, you would have to wait and prove the decrease and start slowly,” Brailita said. “But the effect on the economy is pretty tough right now.”
Ricketts lifted some restrictions in Douglas County beginning this past Monday, among them allowing restaurants to open at half capacity. Those same provisions will take effect in Lancaster County on Monday. Restrictions have also been lifted on worship services.
Ricketts again used a speed limit analogy Friday when asked why Nebraska is moving ahead now. He said the state could eliminate nearly all traffic fatalities on the Interstate if it was willing to reduce the speed limit to 5 mph. Now that it’s clear the virus is not overwhelming the capacity of the health care system, he said, it’s time to ease up on the economic brakes.
“We’re trying to figure out what is the right speed to be able to allow people to return to a more normal life,” he said.
Both Brailita and Rupp said that because the state is starting to reopen before it’s clear that cases have peaked, it’s all the more important for people to be vigilant in following all the guidance and restrictions that remain in place.
“If we ignore the social distancing, if we stop wearing masks and don’t pay attention to hygiene, we will see a surge in cases,” Rupp said. “People have to understand they can’t let down their guard at this point.”