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Dartmouth-Hitchcock Doctor: N.H. Seeing COVID-19 Surge (As Expected)

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COVID-19 is spreading faster now than it has in any point during this pandemic. And this is not a surprise to infectious disease experts who warned earlier this year that the worst was yet to come.

Among those was Dr. Michael Calderwood, associate chief quality officer at Dartmouth-Hitchcock.

He specializes in infectious disease and hospital epidemiology. He joined All Things Considered Host Peter Biello to discuss the pandemic.

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Below is a lightly edited computer transcript of the interview.

So is what we're seeing now with COVID-19, this rapid rate of virus transmission, high numbers of deaths better or worse than what you might have expected earlier this year?

So compared to where we were in August and September, we are in a much worse state now in the months of November into December, then maybe we would have expected. I think that there were some that we're projecting that we would have a false surge. We initially thought it would occur around schools reopening and colleges going back into session. And we didn't see that after that. And I think we began to let out our breath and think maybe we had missed some of that surge. But now, as we model this, we are following the trend as projected. And so if you look over the last month, we on a daily basis are following our projections pretty closely. And so we can predict pretty well into December what we're expected to see.

So what does the rate of infection look like? I don't know if you know these numbers, but are there numbers that could help us understand how many new infections a given infected person could cause?

So there are. And so we'll get to that in a minute. Maybe what I'd like to start with is where we are on the numbers. Sure. So I think as folks have seen on the state reporting pages, we're now seeing at least diagnosed about seven hundred new cases per day on average. We know that there are individuals out in the community either who are asymptomatic or have mild illness, who are not getting tested. And so it is expected that the number of true new infections on a given day is well above that 700. If we look at the test positivity rate we have seen well in the past, we were in that 1 percent to 2 percent range. We now have areas of the state that are above 10 percent. And on any given day there are certain communities and some of our population centers in New Hampshire where that's getting as high as 25 percent, meaning that one out of every four people you're testing is actually testing positive. In terms of where we are, if you are infected, how many people you're going to transmit to on average right now, one person will transmit to one other person, but that's not the case. What it really is, is that it tends to be one individual that transmits to a whole number of people and another individual that transmits to no one. And so it averages out. But we know that the increasing social networks, when there have been investigations through the course of the fall, the number of contacts with exposure has been on the rise.

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Do you think it's time for the the governor to impose another safer at home order or something similar, something that would stop the spread?

You know, I think that we've learned a lot since last spring and there there were harms from shutting everything down. First one I will highlight is actually the harm to children and shutting down the schools very much impacted education and kind of social interaction of the children and to the pediatricians have been very clearly highlighting the long-term implications of the changes in education. So I think that's number one. If we're to think about what we shut down, there's been a lot of discussion about what we shut down. And it may be that we don't shut everything down, but do we focus on things like shutting down bars while trying to keep things like schools open? And I think these are the choices that we need to make as a community in thinking about what is important for our long-term health.

Is that something you would recommend, shutting down bars and restaurants, going back to take out only as they did in the spring when they were far fewer cases?

I think that we do need to move towards fewer in-person visits to bars and restaurants. Why I say that recognizing that these are important institutions in our communities. And so we need to find other ways to support restaurants, for instance, with takeout. And so I was just having a conversation with a friend around the frequency that you're taking out, which may be more than prior, but really thinking about the long-term economic survivability, because once we come out of this, we don't want our communities decimated. We want to look at our main streets and still see things that are open.

People are looking forward to vaccines. The UK's already begun to administer them. They'll come to New Hampshire soon. How long do you think it will be until we see the impact of vaccines in New Hampshire?

I think that we're going to get through kind of phase one of the vaccine delivery by about April or May. And there is a projection that if everything goes as expected, we could reach the point where we would have a population herd immunity in the United States, which means that we would have vaccinated over two hundred and thirty million people by late next summer. It really does mean that all of the logistics have to go as planned, but also that people come out and agree to be vaccinated.

Dr. Michael Calderwood, associate chief quality officer at Dartmouth Hitchcock, thank you very much for speaking with me. And you can find all of NHPR's coronavirus coverage at and let us know how the pandemic has affected your life.

Peter Biello is the host of All Things Considered and Writers on a New England Stage at New Hampshire Public Radio. He has served as a producer/announcer/host of Weekend Edition Saturday at Vermont Public Radio and as a reporter/host of Morning Edition at WHQR in Wilmington, North Carolina.
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