What to know about rules and risks
State mostly open, but we aren’t clear
With the state Supreme Court overturning Gov. Tony Evers’ stay-home order, many restrictions that have been in place for two months are off.
In some parts of the state — those where local officials haven’t instituted their own orders — the doors are wide open. Even before the ruling, the state was on the verge of meeting benchmarks for reopening. And other states have relaxed their orders, despite scientists and health officials urging caution and warning of more outbreaks and flareups.
At times, the information seems contradictory and foggy. There is a lot we don’t know about the coronavirus, but we know more about it than we did when it emerged. We seek to answer your questions from our collective reporting since March, interviews with experts and review of dozens of studies.
Here are some things to know and consider:
Wisconsin — and lots of other states — are reopening. Does that mean we’re in the clear?
No. The virus remains highly contagious, there is no vaccine, and while some treatments have shown promise, there is no clarity on what works best. Scientists and doctors have been in a race to catch up, accelerating research and sharing data.
One thing that seems clear: Different people are affected differently.
Some patients have breathing problems, others have circulation problems and blood clotting, others have very low levels of oxygen in their blood and mental fogginess. Some have loss of smell.
Indications are that even without symptoms, people may be contagious.
Older people with underlying health conditions are at most risk from COVID, according to health officials and death statistics. Experts note that more than half of the population has some type of condition that puts them at risk, such as hypertension and diabetes.
The concern, health officials say, is that things could flare up and we may see new surges of cases.
Weren’t some of these experts wrong with their projections of overloaded hospitals and a surge in COVID cases and deaths?
Many experts warned of widespread COVID-19 outbreaks, high numbers of deaths, and overwhelmed health care systems, with the possibility of excruciating decisions needing to be made about who lives and who is allowed to die.
So far, these dire projections have not materialized in Wisconsin. In fact, hospitals and ambulance systems are, at times, reporting lower-than-usual volume as people with other conditions appear to be staying away from health systems, even when they may need medical attention.
There has been considerable focus on models. A model is simply a range of future possibilities meant to inform decision-making. Some models change a lot based on the underlying data and assumptions being used. Others rely on a static vision of the future: best, middle and worst-case scenarios.
If the model seems to be “wrong,” it may be that people behaved differently than anticipated. For instance, more people may have stayed at home. Or actions ordered by the government may have been more stronger and more restrictive than anticipated.
In addition, as doctors and researchers learn more about the unpredictable disease that is COVID-19, they are adapting how they treat patients and trying things in real time, such as putting patients on their stomachs, which has led to less use of ventilators.
Many experts say that social distancing and stay-at-home orders have helped prevent the spread and avoided overloaded hospitals, but we may never know all the reasons why the grim forecasts did not materialize in the early weeks of the pandemic.
If there was no spike from the in-person election, why should we be worried about one now?
Experts feared a spike in cases, based on what they knew about the disease and how it had been found to spread in mass gatherings.
It’s hard to say why the predictions didn’t materialize. There are many possible factors at play — from a heightened awareness of risk to added precautions at polling locations to how much people were moving around during that period.
The election also was focused on specific locations, so officials could put precautions in effect and assure rules were being followed.
Under the Supreme Court order, it may be left largely to individual business owners to determine precautions in their establishments — such as requiring masks, or setting limits on people allowed inside. What happens next could also depend on the choices people make as they shop, go to bars and restaurants — in short, how they live their lives.
Wait, but aren’t some people are more at risk than others?
Everyone is at risk of exposure, but the consequences are more serious for some people.
A Milwaukee Journal Sentinel analysis of deaths in Wisconsin showed the typical victim was a man, in his mid-70s, with at least one underlying health problem who, in at least four out of 10 cases, lived in a nursing home. The most common conditions were diabetes, high blood pressure, heart problems, lung diseases, and obesity, the analysis showed.
Those findings match what the Centers for Disease Control and Prevention reports about those most at risk from COVID. Other conditions include compromised immune systems, liver disease, and asthma. Confusing matters, there was a study out of UW-Madison that indicated asthma may actually offer some protection from COVID-19.
People outside the risk group have gotten seriously ill and died, but those numbers are small, nationally and in Wisconsin.
From the early data, it appears the chance of dying from COVID-19 is low. But how low remains unclear because we don’t know how many people actually have the virus, in part, due to limits on widespread testing. The number of positive cases is key in determining the death rate. If the number of positive cases rises and deaths hold steady, the death rate drops.
So far, experts don’t see COVID-19 as being as deadly as Ebola or SARS, though it appears more contagious.
If I’m not in at-risk group, can’t I behave differently?
If you do not have underlying health conditions, you are less at risk if you go into situations where you may be exposed to the virus. The concern is that then you might spread it to someone with an underlying health condition.
Consider that six in 10 Americans have a chronic disease, the “underlying condition” that you hear about when people discuss who’s most at risk for serious illness due to COVID-19.
If you’re interacting with five people during the pandemic — say your spouse or roommate, your children or parents, your elderly neighbor or your friend across the street, for example — three of them are likely to have such an underlying condition and are at risk.
The more you are out and about, the more people you interact with, the more chances of exposure.
So what behaviors are most risky? Going to the grocery store is different than hanging out at a club, or attending a sports event, right?
Here is one example: Early data about how the virus moves says you’d be at higher risk getting together for a two-hour choir practice than going to the grocery store.
Why? The goal is to limit the “dose” of the virus you could catch, as well as the length of time you’re exposed, according to Erin Bromage, a professor at the University of Massachusetts-Dartmouth.
An event such as a choir practice poses two problems. Singing sends respiratory droplets into the air at a greater degree than just talking, meaning you’re getting a higher “dose” of the virus. And it unfolds over two hours, giving the virus more time to get out into the air and possibly into your lungs. At the grocery store, you’re likely in and out and not speaking much at all, unless you’re an employee, which puts you at a greater risk.
So the grocery store doesn’t appear to be as much of a problem as was once feared, but any activity that would increase your “dose” of the virus or time spent exposed, like a restaurant or attending church or sitting next to someone at a sporting event or getting a haircut — especially when it’s in an enclosed space — is going to increase your risk.
New research and recommendations from some public health officials is to utilize outside space more, being careful to continue distancing as a way to to gradually reopen.
So, what have we learned about mitigating risk? Doesn’t a mask and hand washing do the trick? What about gloves?
The topic of masks has scientists and public health experts divided. The CDC currently recommends that people, even those without symptoms, should wear facemasks in public to prevent the spread of respiratory droplets when talking, sneezing or coughing.
But the World Health Organization has taken the stance that there “is not enough evidence for or against the use of masks” for healthy individuals in public.
Why haven’t scientists been able to come up with a definitive answer?
For one, the COVID-19 virus spreads primarily through airborne droplets, but scientists don’t know how small the droplets are or whether they travel in masses or groups, which affects whether the droplets can pass through a mask.
And we don’t have a lot of previous research to draw on. Few of the major studies done on facemasks were conducted during a highly contagious epidemic, and very few have been done specifically on SARS-CoV-2, the virus that causes COVID-19.
Additionally, scientists are also
unsure whether masks may cause unintended consequences such as increased face-touching and increased moisture that could turn masks into an additional source of contamination.
Since scientists can’t state with confidence that wearing masks will produce a desired effect, that means public health officials are left to weigh whether the potential benefits outweigh the potential harms.
Despite the uncertainty, many public health experts continue to advocate mask-wearing, while emphasizing that the best defense is still to wash your hands regularly and maintain distance.
Side note: wearing gloves is not recommended, except in rare cases. Wearing them can actually spread the virus, experts say.
OK, if I’m not in an at-risk group, don’t engage in risky behaviors and live in an area with few cases, what’s the big concern?
The concern is that an area where there are not a lot of cases can see a spike. That happened in Brown County, where an outbreak at meatpacking plants turned a county with few cases and almost no deaths into a hot-spot for several weeks.
Even smaller communities that have not seen many cases so far have to consider the impact low-risk groups can have in spreading the disease.
Universities are a good example of this. Young healthy students interacting in dorms, classrooms, and social events may not have much to worry about, but their older professors, the grandparents they interact with on visits home, and the vulnerable people living and working in the surrounding communities could.
That’s why universities are delaying final decisions about fall classes, as they try to figure out how they would sanitize everything, frequently test people on campus and respond when someone does get sick to prevent further spread.
UW-Platteville Chancellor Dennis Shields summed up the risks this way at a recent public meeting:
“We have a hospital here in Platteville; there’s 25 beds. If they expand and use all the emergency room beds, it’s 45 beds. So, I bring 7,000 people back into close contact on a daily basis and there’s an outbreak — it can overwhelm that facility and put all of Grant County in danger. So we’ve got to be really careful about how we proceed.”
If I do go out and take precautions, what happens when others don’t?
As many businesses re-open in light of the high court ruling, some are taking a go-slow approach, others are not. Prior to the ruling, guidance was coming out from Evers’ administration for businesses, for instance, about how many people could be in a business at a time but that is no longer in effect, except in those counties continuing orders.
The use of masks has varied around the country, in Wisconsin, and even within communities. In some grocery stores, nearly everyone — employees and customers — are masked, while at other businesses, say a hardware store or pet store, far fewer masks are seen.
As this world opens, we will need to find new ways to operate in it.
Raquel Rutledge, Mark Johnson and Erin Caughey of the Journal Sentinel staff contributed to this report.
Contact John Diedrich at (414) 2242408 or jdiedrich@journalsentinel.com. Follow him on Twitter at @john_diedrich, Instagram at @john_diedrich, LinkedIn or Facebook.