It’s OK for Connecticut to fully reopen, but individuals must make their own safety judgments, public health experts say

Hartford Courant - 5/18/2021

This week, Connecticut is embarking on an expansive reopening — Gov. Ned Lamont will lift social distancing requirements and capacity limits, allow bars to reopen and stadiums to fill up. And, for vaccinated people, the governor will only mandate masks in the riskiest of indoor spaces.

The reopening, scheduled for May 19, comes as the state’s coronavirus metrics show steady improvement. But still, the pandemic is not over and Connecticut continues to report hundreds of new cases and at least a handful of new deaths each day.

Medical and public health experts say that there is still some risk in reopening. But at the same time, with vaccinations on the rise, they add that it’s probably reasonable to move toward a form of normal.

“You can probably expect to see a bit of an increase in cases as you undergo this reopening,” said Cindy Prins, an epidemiology professor at the University of Florida. But “with good vaccine coverage, you can expect to see that go away.”

Connecticut is far from the first state to begin reopening. Florida lifted virtually all of its state-wide coronavirus restrictions in September. Texas lifted its mask mandate in March. Other states have been taking a slower approach, more similar to Connecticut. In Massachusetts, for instance, plans to lift the majority of restrictions at the end of May, about a week and a half after Connecticut’s reopening.

So as Connecticut prepares for a significant reopening, here’s what experts from inside and outside the state are celebrating and fretting.

Is this the right time?

When officials are deciding whether it’s time to start reopening, public health experts say it’s crucial to look at the metrics.

Dr. Jan Carney, the associate dean for public health and health policy at the University of Vermont and a former health commissioner for the state of Vermont, said she understands that officials are balancing public health considerations with economic considerations.

But if she was advising a governor or other state official on reopening, she would point to coronavirus case rates, hospitalizations and deaths.

“There’s no magic line, but the things that I would be looking at is the rates of community spread and the trend,” Carney said. The question would be, “what’s the burden of illness in the community that you’re looking at?”

Prins listed several prerequisites for a safe reopening: a low or manageable case rate, a low positivity rate and widespread access to vaccines. Connecticut means some, but not all, of those criteria.

The average case rate, however, is still higher than Prins recommends. While she said she’s seen benchmarks set at five new daily cases per 100,000 residents, Connecticut currently averages more than nine new daily cases per 100,000 residents.

As of last Thursday, Connecticut has a fairly low positivity rate, with the weekly average rate sitting at 1.5%. And Connecticut’s vaccination rate continues to rank among the highest in the country, although experts and officials have said herd immunity is likely not attainable.

“It’s not herd immunity necessarily, but there’s still an effect of interrupting that chain of transmission if you’ve got some proportion of people vaccinated,” Prins said.

Overall, Prins said it seems to her that Connecticut is in a place where it can safely move toward reopening, especially with the mask requirement still in place. (Lamont announced on Thursday that, in alignment with guidance from the U.S. Centers for Disease Control and Prevention, unvaccinated people will still be required to wear masks indoors, but vaccinated people will only be required to wear masks in the riskiest of indoor spaces, such as nursing homes and schools.)

But public health experts say that it’s crucial for any reopening decision to be reversible. If the metrics begin to turn around, if case counts and hospitalizations start rising, officials must be ready to respond even before the metrics turn completely sour.

“You have to monitor those trend lines like a hawk,” said Dr. Phil Landrigan, a pediatrician and epidemiologist at Boston College. “If you start to see an uptick, you have to understand that there’s probably a lot more cases around that uptick that haven’t yet become manifest.”

Landrigan likened it to when he was a hospital intern, before CT scans were widely available, and a sick child would come into the hospital in the middle of the night with appendicitis symptoms. The doctors would have to decide whether to remove the child’s appendix or not — even though they couldn’t be completely sure that it was indeed appendicitis.

“You never had all the information you wanted. But if you waited too long for all the data, you could lose the child,” he said. “It was important to be wiling to make prudent decisions on the basis of incomplete data.”

What are the concerns?

Unless COVID-19 has been entirely eradicated — which medical experts say is not a realistic possibility — there are some risks inherent in reopening.

For instance, Prins said that Connecticut can expect to see an increase in cases a few weeks after reopening. If that increase stabilizes a few weeks after that, she said, it’s likely nothing to be overly concerned about. But if the first round of new cases leads to a second round about six weeks after reopening, that would be cause for concern.

“You’re going to see some cases go among folks who are not vaccinated ... but you shouldn’t see continued spread in the community if you’ve got a good vaccine rate,” she said.

Local medical experts also worry about how residents will interpret the reopening.

Dr. James Cardon, Hartford HealthCare’s chief integration officer, said earlier this week that the reopening may be a signal to some, especially those who are vaccine hesitant, that they don’t really need to get vaccinated.

“Due to the signal [that] it’s less of a threat, the less impetus to do what you need to do to really protect yourself,” Cardon said, adding that the state and the country is still raising to vaccinate residents before new variants develop.

Keith Grant, senior system director for infection prevention at Hartford HealthCare, added that it won’t be possible to tell who is vaccinated — meaning that unvaccinated residents could take advantage of the reopening even though it’s not as safe for them.

“Although the data says it’s individuals within this group who are vaccinated that should enjoy the privileges of taking your mask off ... you’re not going to be able to know who is vaccinated and who is not vaccinated,” Grant said.

Grant’s comments came before the governor announced on Thursday that vaccinated residents will soon not be required to wear masks even in most indoors places. But when asked how the bifurcated rules would be enforced, Lamont said it will be up to individuals to follow the rules that apply to them.

Carney emphasized that people still need to make their own decisions based on their risk and comfort levels. Crowded spaces and indoor events may not be for everyone.

Landrigan took it one step further and noted that even residents who feel comfortable with riskier behaviors should remember that they likely come in contact with more vulnerable people — including some who are not vaccinated.

“Just because businesses are going to reopen, it isn’t a license for people to stop being kind to each other and to stop being considerate of each other,” he said.

Emily Brindley can be reached at ebrindley@courant.com.