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COVID-19 in Maryland Health Care Working & the Economy

One by One, County Leaders Put Brakes on Hogan’s Reopening

The crowds in Ocean City are expected to grow now that the mayor has lifted restrictions on hotel bookings and short-term rentals, effective immediately. Photo by Hannah Gaskill

Three weeks ago, Gov. Lawrence J. Hogan Jr. (R) said a regional reopening of the state’s economy risked a spike in Maryland’s COVID-19 caseload.

“You could possibly do things in different regions or different parts of the state,” he told reporters at an April 20 news conference. “But what we don’t want is to have one place open, everybody rushes over there and then infects that county.”

With several of Maryland’s largest counties and the City of Baltimore declining to embrace the governor’s move to Stage 1 of the “Roadmap to Recovery” Friday, the state is — for all intents and purposes — moving into the sort of regional reopening that Hogan warned against.

A public health expert said on Thursday that the state will discover in roughly two weeks (COVID-19’s incubation period) whether the move was wise.

Pushback from local leaders on Hogan’s decision to replace Maryland’s “stay-at-home” order with a “safer-at-home” guideline began within hours of his announcement on Wednesday — and it accelerated on Thursday, as local leaders from Maryland’s largest counties and Baltimore City declared, one after another, that they will keep in place restrictions on commerce and social interaction.

Hogan’s order, which takes effect Friday evening, effectively shifts responsibility for managing the crisis to local leaders, many of whom lack the staff resources and access to experts that the governor enjoys, political leaders and health experts said.

There were also questions about whether Maryland has met the health criteria Hogan has for weeks said were essential to loosening restrictions.

(See more detailed COVID-19 data for Maryland here.)

“It’s the put the ‘Big 7’ or the ‘Big 8’ in a tough spot, to have to make their own decisions,” said a Democratic official, referring to the large county executives and the mayor of Baltimore.

“The local governments, the county executives have the least amount of staff to be able to figure out the health implications and everything else,” said the official, who would speak candidly only on the condition of anonymity. “Honestly, a countywide basis is kind of silly.”

Montgomery County Executive Marc B. Elrich (D) was one of several local leaders to keep existing restrictions on social interaction and business activity in place.

Montgomery’s coronavirus case load — the second highest in the state — and other key metrics “have not changed enough” to reopen on Hogan’s timeline, he told reporters outside the county administration building in Rockville Thursday.

Elrich also cast doubt on the wisdom of Hogan’s decision.

“I think he went farther than he probably should have right now,” he said. “I think he should have waited until the cases were at least on a downturn for some period of time, so that you knew that you had more control over the virus than we have right now.”

Prince George’s County Executive Angela D. Alsobrooks (D) is also keeping current restrictions.

She said Prince George’s, which has the highest caseload in Maryland, has been hampered by a lack of support from the state.

“We need the state to do its part,” she told reporters. “At this point, we do not have it. We do not have gowns that we have needed. We do not have enough PPE. We don’t have enough tests to expand the capacity for what we need. We don’t have enough contact tracers. And these are metrics that were set out by the governor.”

Mayor Bernard C. “Jack” Young (D) announced an extension of Baltimore City’s “stay-at-home” order on Thursday, saying it would be “irresponsible” to allow more commerce and interaction until the crisis subsides and testing increases.

“As I have said from the beginning of this state of emergency, we are going to follow the data and listen to what our public health experts are telling us – and right now, they are saying it is still too soon to reopen,” Young said in statement.

Currently the city is able to test 570 residents per day, he said. Under World Health Organization guidelines, the city should test approximately 2,700 residents.

“Without more testing capacity, it would be irresponsible to begin the reopening process,” the mayor said.

Baltimore County Executive John A. Olszewski Jr. (D) declared on Thursday that most restrictions will remain in effect.

“After examining the available data and consulting with our public health team, it’s clear that we are not yet in a position to safely move toward a significant reopening,” he said.

Gatherings of 10 people or more are prohibited, malls must remain closed, and churches and beauty salons remain off-limits. Retail stores can utilize curbside pickup, he said, and the “vast majority” of manufacturing firms can reopen as long as they follow guidelines to protect workers.

Anne Arundel County Executive Steuart Pittman (D) and Howard County Executive Calvin Ball (D) made announcements in line with Olszewski’s.

Frederick County Executive Jan Gardner (D) opted for “a phase-in of the phase-in.”

All retailers in Frederick will be allowed to use curbside pickup, manufacturing plants can open, and small retail shops can open at 50% capacity as long as an employee is stationed at the door and customers wear masks.

In addition, pet adoption, car washes and pet grooming can resume.

She noted that many Frederick residents work outside the county and expressed a concern about increased movement.

In Ocean City, Maryland’s top tourist town, Mayor Richard W. Meehan took a different approach, lifting the town’s restriction on hotel bookings and short-term rentals, effective immediately.

“We encourage residents and visitors to follow health and safety guidelines, including physical distancing and gathering limits,” he said.

“Personal responsibility and individual comfort levels are incredibly important to exercise during each phase of recovery.”

Moving the goalposts?

For weeks leading up to Wednesday’s announcement, Hogan described the foundation that Maryland would need to see before it could safely start to reopen, and on Thursday there are questions about whether the state had hit those targets.

As recently as late April, Hogan said the state needed to see a two-week decline in hospitalizations and ICU use before Phase 1 could be considered.

“The federal guidelines issued by the president last week call for states to meet specific gating metrics before considering lifting restrictions. That includes a 14-day downward trend in key numbers,” Hogan told reporters on April 24.

“We’ve had a couple of days of things that look better, but a couple of days, three days does not make a trend. Right? We need like 14 days,” he added.

At the same press event, Dr. Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health and a top Hogan adviser, offered reinforcement.

“At this point, for the state to move forward in easing social distancing in a lower risk way, there needs to be a period of declining hospitalization and ICU stays and deaths from COVID in Maryland,” he said.

But the latest numbers — including an analysis shared with Maryland Matters — show little evidence of a sustained decline.

The data do show a leveling off. And in recent days, Hogan has spoken less of a need for a steady “decline” and more of a “plateauing.”

  • New hospitalizations averaged 158 for the week ending May 7, higher than the week before, when there were, on average, 155 per day. For the most recent seven-day period, the state averaged 127 new hospitalizations per day.
  • ICU utilization has remained in a narrow band over the last two weeks — between 563 and 611 beds. On the day Hogan announced the start of reopening, there were 569 ICU beds in use.
  • As Hogan spoke Wednesday, Maryland was seeing a spike in new cases, 1,091, up from 751 and 688 the two days prior.
  • Also on Wednesday, the state saw a spike in its “positivity rate,” 22.4%, up from 16.2%, 14.6% and 18.4% the three days prior.

“Because we’ve plateaued doesn’t mean we’ve started on a downward curve,” said Elrich.

A noted public health expert who declined to be quoted by name said “there has been a moving of goal posts.”

Hogan “set some very high standards originally — declining hospitalizations, declining number of cases, declining infections,” the expert said. “I don’t think we’ve met all that. It’s kind of been shaded. ‘It’s generally gone down.’”

In a letter to Hogan Thursday, the presiding officers of the General Assembly, House Speaker Adrienne A. Jones (D-Baltimore County) and Senate President Bill Ferguson (D-Baltimore City), asked Hogan to provide more data to justify his decision for partially reopening the state.

“Many of the actions you have taken throughout the COVID-19 public health emergency undoubtedly have saved the lives of countless Marylanders, and we appreciate your efforts,” the lawmakers wrote. “While your early actions should be applauded, we have concerns about your plan to reopen Maryland without first understanding and having access to the data guiding those decision points.”

Ferguson and Jones went on to ask 15 specific questions of the governor, requesting a response by May 20.

Hogan has been under pressure for weeks from business groups, Republicans in the General Assembly and U.S. Rep. Andrew P. Harris (R) to ease back on social and business restrictions. The group Reopen Maryland formed several weeks ago, held one protest in Annapolis and has another planned for Friday.

“The problem is, all these indicators are lagging indicators,” said the public health official. “There’s a two- to three-week lag between when you open things up and when you’re going to see cases go back up.”

‘Open’ counties may be a temptation

Elrich said counties that follow the governor’s guidance can expect to see lots of visitors from neighboring jurisdictions that keep current restrictions in place.

“I do worry about things opening up in other jurisdictions and people going there because they can do things,” he said. “If you think about some of the rates in the D.C. metropolitan area, I frankly don’t think you want residents from here going to places where there aren’t restrictions.”

Elrich said Maryland’s big-county executives intend to act in unison. But a municipal official wondered how long that unity can withstand pressure from business owners and groups like Reopen Maryland.

“It’s a massive shift in responsibility to the locals,” said the official. That includes the responsibility not only for decision-making but communicating effectively with the public without the media platform the governor can command, the person said.

Supplies lacking in Prince George’s 

Michael Ricci, a spokesman for the governor, told Maryland Matters the state has never received a request for PPE from Prince George’s County.

But Alsobrooks’ aides quickly produced an April 26 letter from the executive to Steve Schuh, Hogan’s liaison with local governments during the COVID-19 crisis, making the case for additional hospital capacity, testing, contact tracing and PPE.

“I appreciate the fact that the State has many requests for support, but since we continue to lead the State in the number of positive cases and hospitalizations, we ask that our requests be prioritized,” Alsobrooks wrote to Schuh, a former Anne Arundel County executive.

“These requests are critical to stopping the spread of the virus in our County, flattening the curve in our State and successfully navigating through the Maryland Strong: Roadmap to Recovery plan proposed by the Governor.”

Speaking at the Alsobrooks’ news conference in Hyattsville Thursday, U.S. Rep. Anthony G. Brown (D) said Maryland has “fallen behind” in testing and he called on Hogan to “quickly” deploy needed test kits to Prince George’s County.

“This is a commitment the governor has made repeatedly and now he needs to deliver,” Brown said.

“We rank 27th in the country for per capita testing, and the positive daily infection rate is still in the double digits,” he added. On Wednesday, “Maryland was second highest in the nation. Scientists say this simply means we are not testing enough.”

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One by One, County Leaders Put Brakes on Hogan’s Reopening