'About Two Weeks Behind New York': D.C. Is On Track To Become A Coronavirus Hotspot

With nearly 9,000 confirmed positive cases and 188 deaths from the coronavirus reported in D.C., Maryland, and Virginia combined, local and national officials warn that the region could become one of the country's next "hot spots."

As of Tuesday, April 7, there were 114 new confirmed positive coronavirus cases in D.C., 326 new cases in Maryland, and 455 in Virginia. The District's number of fatalities from coronavirus now totals 22, and Virginia 63. On Monday alone, Maryland recorded its deadliest day yet, with more than 24 deaths, bringing the state's total to 103.

Last week, Maryland Governor Larry Hogan told CBS that the region was on its way to becoming "the next hot spot," estimating that the area's outbreak was "about two weeks behind New York." New York and New Jersey combined have a total of nearly 180,000 confirmed positive cases, and more than 6,000 reported deaths. For weeks, hospitalizations in New York grew by nearly 20 percent every day.

While national attention has zoned in coverage on the crisis occurring in New York, and tracking the spread in emerging hot spots like Louisiana, and Detroit, the White House coronavirus response coordinator Dr. Deborah Birx said over the weekend that other regions, including Colorado, Pennsylvania, and Washington, D.C., are emerging areas of concern as well.

When asked about Birx's comments in a briefing on Monday, D.C. Mayor Muriel Bowser said that she has been in communication with the White House, and had informed the federal coronavirus task force about her concern for a potential surge in the District.

"I told the president that, and Dr. Birx that, that we are concerned of the next wave. If you consider New York City the first wave, and other cities that we've heard about, that D.C. will be considered in the second wave," Bowser said during Monday's briefing. "I've been solidly mentioning in all of my communications with the White House and the federal staff our concern for the District, and their responsibilities in the District, so I hope that message is going through."

D.C. reported its first confirmed case of coronavirus on March 7, and its first death on March 20. As numbers of confirmed cases and deaths jumped throughout the following weeks, local leaders issued stay-at-home orders for D.C., Maryland, and Virginia in attempts to slow the spread of the virus, shutting down nonessential businesses and stressing the importance of social distancing. Now, with the data showing large jumps in just 24 hours, the concerns are mounting around the possibility of an overwhelming amount of infected and sick residents.

Surge predictions are largely based off of how quickly case numbers increase over time, and a region's bandwidth to handle a rapid influx of patients hospitalized from the virus, according to Amanda Castel, a George Washington University medical epidemiologist.

"If you follow the curve of positive cases, we're really seeing an exponential increase in the number of cases," Castel says. "I think two weeks ago, we had less than 200 cases. If you fast forward to some of the most recent data, we're seeing over 1,000 cases and over 20 deaths. If you just look at the rate of increase over time, that can be very concerning that we're going to see this rapid uptick."

William Borden, the chief quality and population health officer with GW Medical Faculty Associates, says a region's number of hospitalizations from coronavirus is a determining factor in tracking the trajectory of a city's outbreak.

"The measure of how many people are hospitalized and how many people are in intensive care is a really key measure to look at," Borden says. "That's really an indicator of how many people in the community are getting very sick, and it indicates how much health care resources are going into caring for those people."

As of April 6, there were 104 intensive care unit beds available in the District's hospitals, and 255 ventilators not in use. But following last week's newest models, which predicted a D.C. virus peak as late as July, the city would need an additional 2,972 ICU beds, and 1,030 ventilators to accommodate a cumulative total upwards 93,000 positive cases.

Virginia has seen 563 hospitalizations due to coronavirus, and Maryland nearly doubles that number, with 1,106, and a climb of 24 new patients since Monday.

Both Castel and Borden attribute the jumps in confirmed cases to both an increase in infected residents, as well as broader testing measures. Since mid-March, D.C. has upped its testing from 300 tests per one million people to 4,000, but the scope and availability of the testing remains limited throughout the area as a whole.

According to Borden, because of the delay between testing and results, the recent spikes in confirmed cases could refer to people tested days ago, perhaps those who had not yet developed severe symptoms requiring intensive care. That means the D.C. region could be on the verge of seeing an influx of critically ill patients, as the curve of confirmed cases continues to shoot upwards.

"In some ways, the data that we're looking at now is a snapshot in time from a week ago," Borden says. "At any point, the number of really sick residents in the D.C. community could increase dramatically."

Local jurisdictions have been slow to indicate which communities are most impacted by the spread of coronavirus. D.C. began releasing a racial breakdown for its data on on Monday, which showed that more than twice as many black residents of D.C. have tested positive for coronavirus than white residents, and that 14 of the 24 recorded deaths were African Americans. In Virginia, which began releasing some demographic data in late-March, black residents represent 13.5 percent of the confirmed cases, while white residents make up about 26 percent (the commonwealth does not provide a racial breakdown for deaths). Maryland has yet to release racial breakdowns in its data, but Hogan says the state will do so this week.

Castel says it's difficult to predict the trajectory of the D.C. area's pandemic, or how long a peak could last, based off the curves in other hot spots. But the following weeks will be the most critical period in blunting the scope and length of a coronavirus peak in the region.

"This is where the whole concept of slowing the spread becomes extremely critical," says Castel. "It's an indication that this is when we really have to double down, we really do need people at this point in time to stay at home. [This is also] where we need to make sure that we have available personal protective equipment, that we have a healthy health care work force, and we have access to hospital beds and ventilators. The general public can do their part, and then we have to make sure that we have the health care systems in place to respond appropriately."