BRATTLEBORO — Vermonters have heard the admonitions for months now - wear a mask, wash your hands, keep your distance, avoid crowds, stay home if you're sick.
And, for the most part, this advice from state officials has been heeded by Vermonters, whose state has consistently had the lowest number of COVID-19 infections per capita in the United States.
But what happens if the advice is not followed?
According to health officials, the consequence is a COVID-19 outbreak that can spread far beyond the initial point of infection.
At a news briefing in Montpelier on Oct. 30, state officials offered a glimpse into how a coronavirus outbreak associated with the hockey and broomball leagues at the Central Vermont Memorial Civic Center in Montpelier grew from two cases to 87 cases in just 22 days.
Mike Pieciak, commissioner of the Department of Financial Regulation, reported 87 COVID-19 cases in 18 towns in four counties in central Vermont.
The first two cases were reported on Oct. 7, Pieciak said. By Oct. 12, 13 cases were linked to the hockey and broomball leagues.
In turn, Pieciak said, that initial outbreak led to four additional outbreaks, including one at Saint Michael's College in Winooski. That cluster has grown to 41 cases, with six more confirmed cases there on Oct. 29.
The original outbreak was “not something that was localized to a particular geographic area like we experienced with the Winooski outbreak, but spread quickly to other communities throughout the state, and even within smaller communities in certain particular locations as well,” he said.
Now, Pieciak said, the central Vermont outbreak has spread to 17 other locations, including worksites and schools, with 473 people identified as having been in close contact with people who carried the virus.
Pieciak said the central Vermont outbreak parallels one that took place in Maine in August, where a wedding with unmasked family members led to 108 cases and eight deaths.
All of the Maine deaths were people who did not attend the event but who either came in contact with someone who attended the wedding or with someone else who was exposed to a carrier who was there.
The cost of carelessness
One reason for the spread in the Central Vermont outbreak, Pieciak said, appears to be the increasing number of Vermonters who are not practicing social distancing the way they were when the pandemic began in March.
“We have noticed in our own mobility data that individuals are spending more time not just outside of their home, but further away from their home, since the spring,” he said.
Health Department data seems to support that conclusion. Their contact tracers have found that the number of close contacts for each COVID-19 case has risen in recent weeks.
Nearly 26 percent of all new infections in Vermont between Oct. 7 and Oct. 29 stemmed from the central Vermont outbreak, Pieciak said. However, there have so far been no deaths, and many of those infected are younger.
State Epidemiologist Patsy Kelso said contact tracers found some themes that contributed to the spread, including people gathering without wearing masks and people failing to quarantine - after they had been identified as a close contact, they had returned from travel, or they had experienced COVID-like symptoms.
Some people continued their daily activities while they were still waiting for COVID-19 test results, and some denied experiencing symptoms when asked during health screenings, she added.
“We know that not everybody with COVID-19 has symptoms, but if you do have symptoms that could be due to COVID-19, it's important to pay attention to those yourselves so you can be monitoring your own health,” Kelso said. “But also, report if you have symptoms. Don't go to venues or events.”
Kelso said in many cases, people with the COVID-19 virus might not show symptoms right away. That makes wearing masks, washing hands, and social distancing critically important to controlling the spread of the virus, she said.
Health Commissioner Dr. Mark Levine said of the information presented by Kelso and Pieciak that there were “abundant lessons we should all be instructed by.”
While there have been no deaths from COVID-19 in Vermont for nearly three months, and Vermont continues to lead the nation in every metric, Levine said the central Vermont outbreak showed everyone “what can happen when we let our guard down just a little bit.”
Levine reminded Vermonters to keep social circles small and agree on the ground rules for any interaction.
He also urged Vermonters to consider forgoing travel - “a hard holiday message to deliver, but it just may not be worth the risk.” If you do travel or have people visiting you, know the quarantine rules, he warned.
“And we can choose activities with the lowest risk possible,” Levine said.
“I'll repeat this simple guide again: keep 6-foot spaces, [use] masks on faces, and avoid crowded places,” he continued. “The more of these things you can do, the less risky it will be. And the less risk we take on, the more we can protect our classmates, coworkers, and our own families.”
Are hospitals prepared?
Vermont is just beginning to see an increase of people needing hospitalization for COVID-19. Four people were hospitalized for COVID-19 as of Oct. 30, two of whom are in the ICU, according to the health department.
With the virus spreading rapidly once more around the nation, and with the U.S. surpassing the 9 million mark for people testing positive for the virus, Levine said now “is the worst time to let 'COVID fatigue' set in.”
“We are seeing cases go up here in Vermont,” Levine said, “but there's still time to double down on our prevention efforts. And we can still be proud of what we've done and what we still have left to do.”
But with more cases popping up, hospitals are getting ready. In the case of Brattleboro Memorial Hospital, personnel there have been ready for a surge since March.
According to Eilidh Pederson, BMH's chief operations officer, the hospital set an incident command structure in March and made many operational adjustments.
These measures, still in place, include educating staff about screening for, testing, and treating COVID-19; increased cleaning and disinfecting protocols; creating informational signage for patients and visitors; updating the visitor policy to limit the number of people in the hospital; limiting the number of access points into the hospital; requiring health screenings at all open entrances; installing additional hand-hygiene stations throughout the campus; and providing masks.
BMH was also included in the state's surge plan and was prepared to set up an overflow space in the hospital's parking area to handle a sudden increase in COVID-19 cases.
In an email to The Commons, Pederson said the hospital is “continuing to review and update our surge plan to be certain we are prepared in the event of an influx of COVID patients. If we see an increase in COVID-19 patients who require admission, we have set up a five-bed negative pressure unit.”
A negative-pressure unit creates lower air pressure inside a room to prevent contaminated air or particulates from drifting elsewhere to non-contaminated areas.
“This unit is in addition to the negative pressure areas we already have in our ED and inpatient areas,” Pederson continued.
She also wrote that BMH is working on winterizing its screening process to include an awning with heat at the Richards Building entrance and is constantly monitoring its supply of personal protective equipment (PPE).
“At this time, we feel we have adequate amounts of PPE but continue to purchase supplies as they are available,” she wrote. “With all of the new processes and procedures we have in place, we are confident that BMH is prepared to care for our community in the event of a COVID-19 surge.”
“We do still have the cots from the National Guard and are prepared to set them up if there is a surge,” Pederson also noted.
Grace Cottage Hospital in Townshend has been similarly vigilant. According to Andrea Seaton, the hospital's chief development officer, “we've done almost 1,500 tests with only 17 positives in our drive-up testing facility and in our outpatient respiratory clinic.”
Seaton said the hospital is preparing for the anticipated surge “by carefully monitoring our supplies of personal protective equipment, continuing to train staff, and acquiring new equipment - including a nasal cannula [used to deliver supplemental oxygen or increased airflow to a patient in need of respiratory help] for the ER and an ultra-cold freezer for potential vaccine storage.”
The hospital is also constructing a new drive-up testing booth with a canopy that should be ready by the end of this month “so that our employees can stay warm as they're conducting the tests while people stay in their cars,” Seaton said.