A stark choice: COVID-19 fall forecasts show deaths increase, but toll depends on path taken – The Boston Globe

But the extremity of the COVID surge’s high-water mark, and how quickly Massachusetts turns the tide, depends on choices about wearing masks and getting vaccinated that can mean the difference between life and death, several disease trackers said.

One respected disease modeler from the University of Washington said that simply adopting universal mask mandates now could avoid roughly 1,300 deaths in Massachusetts by Dec. 1 and 50,000 deaths nationwide.

“I am concerned. Delta is causing a lot of increases in cases and in our hospitals,” said Ali Mokdad, a professor who has projected COVID cases, hospitalizations, and deaths throughout the pandemic at the Institute for Health Metrics and Evaluation at the University of Washington.

“We have underestimated this virus and celebrated prematurely,” he said.

These harsh predictions come as Massachusetts and the nation grapple with whether to adopt new restrictions in hopes of slowing COVID’s renewed spread. This week, Governor Charlie Baker enacted one of the nation’s strictest vaccination requirements for state employees, while Acting Mayor Kim Janey on Friday announced a mask mandate for indoor public places in Boston, a measure that takes effect at 8 a.m. on Aug. 27 as the city continues to battle the virus.

But there’s been pushback, too. The National Association of Government Employees, which represents 12,000 Massachusetts executive branch employees and thousands more in the state, said it would go to court, if necessary, to fight for workers who refuse shots.

COVID has humbled many who have tried to predict its path over the past 17 months, surging again after springtime levels so low that governments dropped many mandated social precautions. Now, the emergence of the wildly contagious Delta strain as the dominant source of infections, coupled with conflicting but worrisome studies about waning immunity from vaccines, has only made predictions more difficult.

Scientists also say that the piecemeal approach to renewed mask rules and vaccine requirements in Massachusetts and nationwide have made the job of predicting the pandemic’s course even tougher. Currently, some parts of the South are experiencing the most COVID cases yet, at rates far higher than in the Northeast where more people are vaccinated.

Still, two separate modeling teams are delivering similarly dark messages: The mounting hospitalizations and deaths from COVID in Massachusetts will continue into the fall.

The Washington University model projects that Massachusetts will see more than 1,900 additional COVID deaths by Dec. 1 if the state doesn’t appreciably change course on mask mandates, considered by many health experts to be the most efficient way to prevent transmission of the virus. If universal masking is adopted, indoors and outside when social distancing isn’t possible, the model shows that deaths still rise but much more slowly — an increase of 652 deaths instead of 1,309 by Dec. 1. So far, Massachusetts has lost just over 17,800 people to COVID during the pandemic.

The latest projections from a team of Massachusetts scientists, in a study last week that has not been peer-reviewed, concludes that the proliferation of the Delta variant, combined with low vaccination coverage in several regions across the country, and more relaxed attitudes toward social distancing, will likely lead to a surge in COVID-19-related deaths in at least 40 states.

An additional 157,000 COVID-19-related deaths could occur across the United States between Aug. 1 and Dec. 31, with the largest surges in Texas, California, Florida, North Carolina, and Georgia, according to the team’s COVID-19 Simulator.

But the team’s lead author acknowledges that their projection for Massachusetts — fewer than 300 additional COVID deaths by the end of the year — already appears to be too low. The state is already more than a quarter of the way there, recording an additional 91 deaths just in the first 19 days of August.

The model also predicts at least 1,000 additional new infections reported each day in Massachusetts through September. On Friday, state officials reported 1,459 new cases.

“It’s not the waning immunity [from vaccines] causing a rise in cases. It’s people having stopped social distancing and masking,” said the study’s lead author, Jagpreet Chhatwal, an associate director of Massachusetts General Hospital’s Institute for Technology Assessment and an assistant professor at Harvard Medical School.

“If you look at downtown Boston, the bars and restaurants, they’re filled like pre-COVID days,” he said.

A third projection, from a consortium of researchers affiliated with 10 academic centers, the COVID-19 Scenario Modeling Hub, also projected a steep autumn rise in COVID cases and deaths nationally. But working with data from early July, just as the Delta variant was taking off, their model had significantly underestimated the size and timing of the surge, and the number of cases and deaths had already surpassed the projections by the end of July.

“We had no sense things would get as bad as they got,” said Justin Lessler, an epidemiologist at the University of North Carolina, who helps calculate the data.

The consortium uses mathematical models from the 10 teams to come up with an “ensemble” projection, and it anticipates releasing a fresh outlook in September. But whether the new projection will be any more encouraging depends partly on decisions about masks, vaccines, and social distancing that are being made right now across the country.

“Delta isn’t the only thing driving the pandemic. It’s not like this is a magical strain we are helpless to do anything against,” Lessler said. “It’s also behavior and mitigation measures.”

Lessler said he believes that a steep rise in new cases now may mean infections will level off earlier in the fall, because people, alarmed by the trend, may start to take more precautions, masking up and getting vaccinated, and also because the virus, like a forest fire, will burn through those who aren’t immune, and then slow down.

The University of Washington model indicates new infections have recently peaked in several hot spot states such as Florida, Mississippi, and Texas, but won’t slow down in a number of Northern ones until weeks later. New cases are expected to peak in Massachusetts in late September, Maine in early October, and Vermont in November.

“I think it’s unlikely we will see cases go up all the way into the new year, but the virus has surprised us before,” he said.

Despite the public controversy over whether to require masks in schools and other settings, a new poll suggests most Americans support such requirements. Yet, few say such measures are being enacted in their workplace or by their local government.

The Aug. 17 Axios/Ipsos poll found roughly two-thirds of those surveyed support their state or local government requiring masks to be worn in all public places. But only a third say that their state or local government currently requires masks to be worn in public places.

“We just need to move on these things that we know will have an effect. How much do masks costs?” said Robert Hecht, an epidemiology professor at Yale University’s School of Public Health and president of Pharos Global Health Advisors, a Boston nonprofit focused on global health matters.

Hecht said that, given how contagious the Delta virus is, he has been advising people to upgrade the quality of their masks to KF94 or KN95 level.

The COVID vaccines were intended to protect against serious illness and death, and disease trackers say even with some indication of waning immunity after six to eight months, the shots still confer remarkable protection against COVID’s worst ravages. A study this week from the Centers for Disease Control and Prevention of adults in New York this summer found that even though vaccine effectiveness against infections fell from about 92 to 80 percent, its protection against hospitalization remained relatively stable, between 92 and 95 percent.

But in many southern states, where vaccination rates are low and masking relatively rare, hospitals are overwhelmed with COVID patients, and the outlook is not encouraging if nothing changes, disease experts say.

In Massachusetts, where the vaccination rate is among the highest nationwide, hospitalizations are also climbing, but, by comparison, less alarmingly. In early July, the seven-day average of hospitalized COVID patients in Massachusetts had dipped to 85. By August 19, the state average reached 412.

But hospitals are beset on another front. Many hospitals here are bulging with patients who deferred care for other problems during the pandemic and are now seriously ill.

At Tufts Medical Center, Dr. Shira Doron, the hospital’s epidemiologist, said the 11 COVID patients they’re caring for this week are a fraction of the 90-plus they had during last winter’s surge.

“We are fuller [with other patients] and with a higher acuity than we have seen, and COVID cases are still climbing,” Doron said.

“We are short staffed and we are tired,” she added. “We are hoping for the best and preparing for the worst.”


Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.