The District of Columbia, Maryland and Virginia have been shut down for weeks, their economies in tatters. Large swaths of the population venture out only rarely, wrapped in masks and gloves.
But hundreds of new cases of COVID-19 are still reported each day, as the virus continues its devastating march through nursing homes, jails and other institutional settings. Doctors and public health officials said it increasingly is infecting people who can’t afford to miss work, or can’t telecommute — grocery store employees, delivery drivers and construction workers. Sometimes, they, in turn, infect their families.
On Thursday alone, there were nearly 2,000 new cases, and 92 deaths.
“It is community spread, then taking it home,” said Sonja Bachus, chief executive of Greater Baden Medical Services in Prince George’s County (Maryland), who has been fielding calls from relatives of essential workers. “It is disheartening.”
The decision to close schools and ban large gatherings in mid-March, and issue stay-home orders in the District, Maryland and Virginia two weeks later, have helped slow the spread of the virus, experts say. But that doesn’t mean no one is getting sick.
While some of the first known victims in the greater Washington area had traveled on international cruises and to professional conferences, it is now more common to hear about police officers, firefighters and health-care workers contracting the slowly incubating infection.
Medical technician Tiffany Smith had been running a fever for four days when she showed up for a free coronavirus test this week outside a dilapidated shopping center in Richmond. One of her co-workers at an assisted-living facility in Chesterfield County has the virus.
Smith’s five children, ages 14 to 28, have mostly felt fine, she said, and are “walking around like nothing’s wrong.”
“It’s easy for me to put on my public health hat and say everyone should stay in bubble wrap for the rest of their lives,” said Rebecca Katz, director of the Center for Global Health Science and Security at the Georgetown University Medical Center. “But when we look at the mobility data, we still have people who have to go to work. We still have people who are riding the Metro.”
Jeff Martin, a professor of epidemiology and biostatistics at the University of California at San Francisco’s School of Medicine, said some continued spread is inevitable, even seven weeks after schools closed and officials banned large gatherings, and four weeks after a broad stay-home order. On the West Coast, which began social distancing before the greater Washington, D.C., region, new cases only recently started to slow.
“I don’t know if there was ever the reasonable expectation that we would entirely bring down transmission to zero in a country this dynamic,” Martin said.
Government leaders say they won’t ease shutdown restrictions until the number of new hospitalizations starts to fall. And they warn that the continued spread of the disease illustrates that when businesses, schools and retail establishments are allowed to reopen, people may need to wear masks and avoid crowds for many months to come.
State and local health departments don’t publish the occupations and living conditions of everyone who tests positive, so there is no comprehensive analysis of who is getting sick. But interviews with doctors and public health officials, and data that has been made public, paint a portrait of a pandemic that increasingly is infecting those who have limited ability to socially distance.
“I had two people that work in a grocery store, one person that works in a day care and another person that works in housekeeping,” said Luis Nunez Gallegos, assistant medical director at Unity Health Care Upper Cardozo Health Center in the District’s Columbia Heights neighborhood. “They all had contact with a COVID-19 positive person at work.”
When he told patients to quarantine, many replied that it wasn’t that simple.
“They are afraid of losing their jobs,” Nunez said. “They are anxious their employers won’t respect the quarantine, or that two weeks seems too long, and they don’t always have the savings to get by.”
Sherrell Thompson, a community health worker in a Richmond, Virginia, public housing community, said residents working at fast-food chains and in grocery stores don’t have easy access to as many masks as they’d like for themselves and their families.
“But what can you do?” Thompson said. “You have to go to work and support your family. It’s your only means of income.”
The District updates the number of infected police officers and fire and EMS responders every day, and the number of infections keeps growing, albeit more slowly.
As of Tuesday, 88 members of the fire department had tested positive, up from 77 a week earlier, 67 on April 14 and 40 on April 7. The number of District police officers with confirmed infections grew during the same period, from 31 to 59 to 86 to 92.
Members of both the police and fire departments wear protective gear and have made other efforts to avoid getting infected. But they still at times come in close contact with one another and members of the public.
A Virginia man who works in public health in the region tested positive last week after spending days fitting N95 masks on health-care providers. He spoke on the condition of anonymity because his employer had not authorized him to be interviewed.
Although he washed his hands constantly, wore protective gear and kept a bottle of hand sanitizer on his desk, the man, who is now quarantined at home, said he knew he was at risk of contracting coronavirus.
“It was a job I had to do,” he said. “I’m a senior team lead in my organization, and it kind of fell upon me to be the one to go out and do it.”
Andrew Washington, executive director of the American Federation of State, County and Municipal Employees (AFSCME) District Council 20, has heard about infections among District sanitation workers, paramedics who work on private contracts, and city government employees who work with the poor and disabled.
“They all are considered first responders as well and should be getting the same kudos,” he said.
LaQuandra Nesbitt, the director of District Health, said last week that around 2 percent of the city’s confirmed cases involved travel, and about 5 percent involved health-care workers. Poorer neighborhoods account for an increasing share.
On March 31, wealthy Ward 3 had 70 cases, while Ward 8 — the city’s poorest — had 44. As of April 28, Ward 3 had 270 total cases, with 55 new patients over the previous week. Ward 8’s caseload had spiked nearly 14-fold to 597, with 139 added over the previous week.
Some of that shift may reflect the fact that wealthier people with better access to information and health care were quicker to get tested. But it also illustrates that those who can stay at home are now largely protected.
Increased testing also explains, to some extent, why the number of new daily cases continues to rise. “That is expected,” said Laurie Forlano, Virginia’s deputy commissioner of health. “Obviously we’ll detect more cases, and those cases will be counted.”
But health experts say the region is far from testing enough of the population to get a clear picture of who has the virus. And neither the District nor Maryland nor Virginia has enough contact-tracers in place to sketch a picture of how the coronavirus is passing through.
Each new positive patient represents a tangle of possible exposures … co-workers, family and random encounters. Tracking down those connections is the only way to isolate the spread and stop the danger, experts say.
It would help solve mysteries like that of Sharrane Morton, a Prince George’s resident who says she stayed at home and took precautions but still contracted the virus.
“The few times I did go out, I had a mask and gloves,” she said. “My daughters even bought me a hand sanitizer that you put on the key ring.”
Stella Jefferies, a nurse practitioner who runs a clinic in Silver Spring, Maryland, said she has personally tested a number of patients since March 23 who cannot account for their exposure. The infections seems to stem from the community, not through travel, she said, and the cases have steadily ticked upward.
“If I have the virus, but the department of health can’t contact-trace all the people who I have been in contact with and get them out of circulation, we will continue to have it in the community,” said Lynn Goldman, dean of George Washington University’s Milken Institute School of Public Health.
“We haven’t had the resources to do that yet.”
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The Washington Post’s Rachel Chason, Peter Hermann, Fenit Nirappil, Laura Vozzella and Ovetta Wiggins contributed to this report.