The State Of Reopening: An Update From Vermont Health Commissioner Mark Levine

As Vermont continues to reopen its economy, states like Arizona and Texas are pumping the brakes due to surges in COVID-19. This hour: it's our weekly check-in with the Vermont Health Department. We get the latest COVID-19 case numbers for Vermont, as well as an update on out-of-state travel restrictions, mask guidance, and much more.

Our guest is:

• Dr. Mark Levine, commissioner for the Vermont Department of Health

Broadcast live after Gov. Phil Scott's 11:00 a.m. press conference; rebroadcast at 7:00 p.m.

The following has been edited and condensed for clarity.

Bob Kinzel: You've said in many cases that the virus is pretty much going to go wherever it wants to go and that it's not going to stop at the state line. As we've seen this surge of cases in about a dozen southern and western states, what concerns you the most?

Dr. Mark Levine: Clearly, I think we need to learn lessons from wherever we can. One of the things we're beginning to learn for some of the states is that they may have reopened a bit too quickly. And not only quickly, but extensively. But having said that, there are some other states that may have done the same and haven't seen the surge in cases. That’s one lesson we could potentially learn. And clearly, we have not done the reopening in Vermont in that way, and that's paid off in terms of dividends.

Another thing we can learn is that a significant percentage of the cases in these states have been in the 18- to 44-year age demographic. That's typically a demographic that may be more willing to take risks, may not be as prone to adhering to some of the precautions that we tell all people to adhere to, to protect us all. And it may be combined with some of the openings in settings that age demographic might frequent more, such as bars, beaches and other social locations.

I think we do have a lot to learn about this virus and how to coexist with it during this period where we don't have adequate number of therapeutics or vaccines to work with. We do need to live in a coexisting relationship where hopefully our behaviors prevail, and the virus does not.

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Do you look at the surge in those states and think it's just a matter of time before these cases find their way back to Vermont? Or do you think that the state, by maintaining its current policies, can be somewhat resistant to that surge?

We have to focus back a few months and remember that we were not among the best states in the Northeast a long time ago. The Northeast was where actually some of the worst experiences in the country were happening. And some of that was attributed to travelers coming in from foreign lands who would land in New York City, and then the virus would disseminate out through the region. So, this region has been through its share of unfortunate times, if you will, exemplified, of course, by Boston and New York City. And so, we were once there and now we're doing better, and these other states are not. So hopefully they could learn some lessons from what we did.

You look at a country like Italy and the worst part of Italy was in the very north. It didn't mean the rest of the country was unaffected, but it was almost like it was two different countries because one was very severely affected. There was a surge on the entire health care system. They were in very dire straits, whereas other parts of the country further south were doing much, much better. And there were gradations in between. So, within a country, one can see this. And just because an area becomes the hotspot so to speak, the behaviors in the surrounding areas can change in real time and hopefully prevent those areas from becoming as hot as the original hotspot.

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We often hear some public health officials saying, is this the second surge? And some people saying, "No, it's not the second surge, it's the tail end of the first surge." Does it make a difference if this is the beginning of a second surge or the end of the first? Or is it more just terminology?

This is probably not the second surge, but still just the ongoing initial experience with the virus in the country. In terms of how it impacts policy, we're really addressing this virus in two dramatically different ways. In the beginning we saw the exponential growth of the virus that had gone from just something that was transmitted from foreign travelers to now community transmission. And that happened very, very quickly. That happened at a time when we had little in the way of testing capability, never mind capacity, and we could not practice the so-called containment strategy because the first pillar of containment is being able to test and find cases. So, we quickly went into the non-pharmaceutical intervention realm with the various mitigation strategies that everybody's aware of, including reducing mass gatherings, closing various establishments, closing schools eventually, and eventually getting to the point of [saying] "stay at home." That's a very, very drastic approach towards any disease. Yet that's what was required at that point in time.

Now we're looking at this virus as something that when we find a bunch of cases, we don't immediately turn the faucet back all the way to where it started. We contact trace and isolate to contain the virus where it is. That's a very different strategy. What we're looking at in some of the rest of the country now is actually a return to those original mitigation strategies. So, thegovernor of Texasasked the population to stay home again. That's serious business.

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I saw a report over the weekend from the CDC that said perhaps there are many, many more people carrying this virus than we think right now. That there are lots of asymptomatic people, so the number of carriers could be 40%, 50%, 60% higher than the known cases that we have. What's the significance of that development?

Yes, and I believe the director of the CDC commented that at least in some parts of this country, the number of actual cases is probably 10 times the number of reported cases. That's huge. Now, it's not all that surprising. The fact of the matter is we know from experience in the U.S. and other countries, that there are lots of asymptomatic people who test positive for the coronavirus. Some of those people are pre symptomatic, meaning they're in the 48-hour period where they can infect someone else actively before they actually become ill themselves.

We know from our recent outbreak in Burlington and in Winooski that actually being asymptomatic was much more common than being symptomatic. So, I have no doubt that the ability of people to harbor the virus in an asymptomatic state is real. Somewhat more reassuring, though, is the fact that we have been doing aggressive testing in the state of Vermont.

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Do you think if we have this conversation three or four months from now, we're still talking about masks and social distancing?

I do think so, unless some of the zeal and enthusiasm regarding vaccines has come true. We do know that the vaccine trials are at a way more advanced stage than anyone ever imagined they would be. There's a lot of healthy competition going on, but there are multiple platforms that are being tested and are evolving into what we call phase three trials, which are the more advanced vaccine trials, which will look at not only how much can this vaccine help in terms of preventing the virus, but how safe it is as well.

So, we'll have some sense of security around the fact that it was tested well and that we don't have anything to worry about. So, people are talking literally November at the earliest. But that's a very, very optimistic on the timeline. Considering when it first started, people were saying we never see a vaccine until a year and a half at the earliest. And here we're talking November for something that began earlier in this calendar year. So, I'm not making promises to anyone, but that would change our tone in terms of how we have to behave in the future if we could deliver enough vaccines to the population and if enough of the population accepted it.

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