Why an ER doctor at Brigham and Womens is calling for a halt to indoor dining in Mass. – Boston.com

A Boston emergency room doctor is urging state officials to halt indoor dining and make other adjustments to the state’s reopening, raising concerns about where Massachusetts is heading with controlling the coronavirus through the fall and winter months.

Beginning Monday, Gov. Charlie Baker allowed cities and towns classified as “lower risk” for COVID-19 transmission to enter step two of Phase 3 of the state’s reopening plan, which includes upping the limit on public, outdoor gatherings from 50 to 100 people and loosening capacity limits for gyms, museums, and libraries. The change followed after Baker eased seating limits for restaurants.

Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in the division of health policy and public health, urged Baker to roll back some of the reopening measures on Twitter last week, pointing to the state seeing daily new positive case numbers above 400.

Last month, a study from the CDC found that adults who tested positive for COVID-19 were about twice as likely to report that they had dined at a restaurant in the 14 days prior to their diagnoses than individuals who tested negative. In addition, researchers at Massachusetts General Hospital found in a study released Monday that the relaxation of statewide social distancing measures aimed at controlling the spread of COVID-19 “frequently” led to an immediate reversal in the control of the virus those measures had gained.

In addressing concerns about the reopening, Baker has repeatedly emphasized that based on information from local boards of health and the state’s contact tracing initiative, the continued spread of the virus is largely not occurring in workplaces or businesses.

“The biggest concern we’ve had — and other states have experienced this as well — has much more to do with those informal, no-rules, no-guidance gatherings, that are usually a part of daily life for most people, but it’s something we’ve had to step back from,” Baker said last Thursday. “Virtually everything we talked about with respect to a reopening, step two, as part of lower-risk communities, are things that have been going on in other states for a long period of time at this point — months — without any evidence in those states that those are the things that drive spread.”

Faust stressed in an interview with Boston.com that the state needs to take action to prevent the rate of COVID-19 transmission from further increasing and argued that contact tracing hasn’t been adequate enough to say “with any certainty” the role of indoor dining’s role, or lack of role, in the spread of the virus.

“If you want an example for what can go wrong if we’re not careful and if we leave it to chance, look no further than the White House,” he told Boston.com.

So far, Massachusetts is not seeing more deaths than what is typically seen at this time of year, but Faust is watching the data to monitor for those “excess deaths,” he said.

“We know things are out of control when we’re having more deaths than usual from all causes, which is called excess deaths,” he said. “We know that those correlate with coronavirus case numbers, and so we know that it’s caused by coronavirus.”

At the height of the pandemic in Massachusetts — in March, April, and May — the state was well “well above” the seasonal norm for deaths from all causes, Faust said.

“We’re nowhere near as bad off as we were obviously in April, but I’m worried that we’re sort of creeping up towards that pattern,” he said. “And it reminds me of what was going on in early March, and I’m hoping that we don’t have what we had in April.”

Rolling back or at least returning some restrictions to indoor activities in particular should be prioritized, Faust said.

“Over and over again we see that super-spreader events and that case counts are associated with indoor activities in which people are close together for long periods of time,” he said. “So indoor dining is just one of the big ones. … But the real issue is why do any of this until the case counts are low enough that every single school could be opened, in-person? Because I think everyone can agree that the priority is to have our schools be in-person as soon as it’s safe. And in my view, if any schools are closed, we haven’t yet achieved our goal.”

Achieving that goal means making “tough calls” about what the state should roll back, the emergency room doctor said.

Faust said he believes that taking those steps to prevent the spread of COVID-19 doesn’t necessarily mean the economy would suffer. He said officials should continue to invest in creative solutions, including heat lamps and expanding tents and opportunities for outdoor dining.

“I’ll just say there shouldn’t be indoor dining, but at least say 10, 20 percent [capacity] at most or 25 percent indoors at most, with lots of space and really good filtration,” he said. “That would be one thing at the very most, and then you could really augment a lot of your business with outdoor heat lamps and that kind of thing. It might take a little bit of financial support to business to get them over the top, but we won’t have to bail them out entirely. We can keep them open and the public can feel safe about going and we’ve basically accomplished two things. We’ve kept the economy open without actually feeding into a brewing crisis.”

As it is, Faust said, with case counts going up, people get scared of going out, even as those who aren’t worried continue and up the risk of creating or being exposed to a super-spreader event.

“There’s no reason to be reassured that the worst case scenario couldn’t happen,” the doctor said of heading into the winter months. “And there’s very little to be lost by taking precautions that are reasonable. … There are things that we can and should do that could very well save a lot of lives without imposing a great deal of economic or personal burden. And the reason that I think that that’s wise is we don’t know what the next few months will bring.”

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