COLUMBUS, Ohio – As several states start to see a surge in COVID-19 cases since reopening, Ohio has not.
Ohio has gradually lifted its stay-at-home order over the past six weeks. The result: a plateau in newly reported cases and a decline in hospitalizations, both reported and estimates of people currently hospitalized.
Since May 1:The 7-day rolling average number of newly reported cases per day has dropped from 476 to 391. The number of weekly cases for the week ending Monday was the lowest since the second week of April. The number of currently hospitalized patients went from an estimated 1,067 to 513. The percent of tests returning positive results each day has dropped from 10.7% to 3.2%. A smaller percentage of people who have tested positive for the virus (not antibodies) have been hospitalized.
"We're not seeing any significant increase or reestablishment of a wave or a peak in Ohio and that’s great," said Mark Cameron, an infectious disease researcher and professor in the school of medicine at Case Western Reserve University. "What that could mean is that people are still generally following the guidelines."
But Cameron, echoing epidemiologists and public health officials, says that good news doesn't mean Ohioans should stop taking precautions such as social distancing and wearing a mask.
It's impossible to say for sure now what's contributing to Ohio's plateau or dip in coronavirus metrics. There have been multiple factors in the state and local response and there's no hard data on, say, how many Ohioans are wearing masks or staying home.
Here are three possible reasons why Ohio hasn't had a surge in cases:
1. Testing is catching more cases, earlier
Testing is up and cases are up but hospitalizations haven't trended up, which experts say is a good sign. The number of viral tests administered more than doubled from April to May, from 104,247 to 255,030. In the first two weeks of June, 154,792 tests have been administered.
Cameron said increased testing is likely catching people earlier in the illness so they can be treated at home. It's also probably catching asymptomatic or pre-symptomatic people before they unknowingly pass the virus on to others.
Not only does that keep people out of hospitals, it also breaks the chain of transmission that could have continued undetected.
Testing, combined with contact tracing to identify others who might be infected, prevents hotspots from merging to become a surge, said Dr. Michael Oglesbee, director of the Ohio State University's Infectious Diseases Institute.
Ohio is still far from the daily testing levels epidemiologists recommend to safely reopen, but that's improving. Ohio recently began an effort to test all nursing home staff members, who could bring the virus in or out of the facilities. And Ohio Gov. Mike DeWine announced last week that testing would be available to anyone who wants a test, including at "pop-up" testing sites around the state.
2. Not everything is open
Ohio didn't fling the doors open for everything on the same day. Instead, business sectors and activities have been OK'd to open on a rolling basis, with many medical and dental procedures resuming May 1, bars and restaurants allowing indoor service May 21 and gyms and low-contact sports starting May 26.
Zoos, museums and water parks have reopened in the past week. Spaces where large numbers of people gather, such as concert halls and professional sports, remain closed.
Even when businesses and activities were allowed to resume, not all did or they opened at a fraction of their pre-coronavirus level. And everyone had to follow new safety rules: keep 6 feet between people, require face coverings for employees and clean high-touch surfaces frequently.
"Ohio officials have done a good job at getting the point across that we are going back to some sort of normalcy but that doesn’t mean you can go back to normal," Cameron said.
Oglesbee said several states with rising cases – such as Arizona, Texas and Mississippi – didn't really get a first wave.
"Our phased reopening is strategic and it’s effective and it's effective based on what we’re seeing because we’re not seeing this secondary peak," Oglesbee said.
Cases can take weeks to appear from an event – cases emerging now in Alabama have been pegged to Memorial Day. Although two weeks is the oft-cited incubation period for COVID-19, Cameron said it can take three weeks to see infections from exposure at an event appear in reported numbers and even longer to see secondary infections.
3. Promising mobility data
Ohioans haven’t totally resumed pre-coronavirus activities, mobility data shows.
People spent about 40% less time at the office during May, compared to January and February, according to cellphone location data analyzed by Google.
Traffic on Ohio roads was down 46% in the first week of Ohio’s stay-at-home order compared to the same period in 2019, according to the Ohio Department of Transportation. Last week, traffic was still 22% below 2019 levels.
Restaurants opened for dine-in service May 21 and there hasn’t been a mad rush back, according to data from OpenTable, a restaurant reservation app. In the first week of dine-in service, reservations were down 71.6%, on average, compared to the same time last year. In the last week, that has improved to 58% on average compared to last year.
"The data indicate, on whole, people were taking this very seriously," Oglesbee said.
Oglesbee said Ohioans complied with social distancing and stay-at-home orders about 75% to 80% of the time in late March – much higher than modelers in his department expected.
A recent University of California-Berkeley study of mobility data in four large states found people had reduced human-to-human contact by 76% and nonessential outings by 52% before stay-at-home orders went into effect. Stay-at-home orders, they found, accounted for an additional 5% reduction in person-to-person contact.
"I think we’ve probably underestimated the behavior change that’s taken place and is going to persist," Oglesbee said.