Western New York now has the highest numbers of daily confirmed Covid-19 cases than at any point since the local health crisis began.
County and health officials are bracing for the ripple effects.
"First, you get the cases, then you get the hospitalizations," said Erie County Executive Mark Poloncarz. "And then, a couple of weeks after that, you get the deaths. This is serious."
The stark upward trendline of positive tests since mid-October has put the county and the rest of the Western New York region in the sightlines of the governor for potential targeted shutdowns and has led to grim conversations among health experts.
They have long expected that fall and winter would yield a resurgence in Covid-19 rates. Poloncarz even warned his emergency and health response administrators to take their vacations during the summer because they wouldn't be able to take time off in the fall.
The past month's numbers crush any wishful thinking that the region's low summer Covid-19 numbers would be a lasting pattern.
"That was delusional," said Dr. John Sellick, an infectious disease specialist with the University at Buffalo's Jacobs School of Medicine and Biomedical Sciences. "There was no way this virus was going to go away."
Sellick and national health experts have pointed to the higher viral concentration as people move indoors as the weather gets colder, as social distancing and mask-wearing fatigue set in and as cases rise among grade school and college-age students and young adults.
"I think it’s going to get worse before it gets better," added Dr. Peter Winkelstein, executive director of UB's Institute for Healthcare Informatics, who has been working with his team to determine the impact of higher cases on area hospital admissions.
Hospitals are preparing to see more Covid-19 patients and have reactivated emergency management teams. Winkelstein pointed out that the last time Erie County saw a short-lived swell in cases in August, a surge in Covid-19 related hospitalization admissions followed a few weeks later.
There's no reason to think that won't happen again, he said.
"The answer is yes," Sellick said. "We’re being philosophical for this, hoping for the best but planning for the worst."
Already, Western New York deaths have been elevated over the past four weeks.
If there is any silver lining, it's that the exceptional hospitalization and mortality rates that were seen in the early months of the crisis aren't repeating themselves, Winkelstein said. In March and April, concerns about having adequate hospital capacity were much greater than they are now.
More young adults are getting infected with the virus than older adults, who are taking more precautionary measures. Younger people are less likely to suffer serious illness and require hospitalization, Winkelstein said. In addition, doctors have become better at treating the virus, so those who do get admitted are more likely to recover and be hospitalized for a shorter period of time.
Access to testing has also improved. Masks, required by the state, have become more the norm. Even though the percentage of people testing positive for the virus has grown, the community has more tools to fight the coronavirus spread.
While the number of people hospitalized with Covid-19 in Western New York is higher than over the summer, the increase hasn't mirrored the increases in confirmed cases. So even if things get worse as winter approaches, Winkelstein said, there's a much lower chance that hospitals will be overrun.
"I’m cautiously optimistic we won’t have hospital capacity problems," he said.
That doesn't mean there won't be other consequences, however. As the infection rate climbs, so does the likelihood that the state will target parts of this region for "focus zones" where schools, restaurants and nonessential businesses could see new restrictions or once again be shut down.
Gov. Andrew M. Cuomo on Friday said his administration would talk with local officials Saturday and Sunday about the possibility of targeted shutdowns to reduce positivity rates in some areas.
"As you have more and more cases in the community, you have to take bolder and bolder action to reduce the transmission rate," Winkelstein said.
The holiday season, a prime gathering season for family and friends, is also likely to exacerbate the viral spread.
"Between Thanksgiving and New Year’s, normally, we’re going from one meal, one buffet, one party to another," Sellick said.
Residents are not helpless in the face of dire predictions about the viral spread. Adherence to mask and social distancing requirements will still make the biggest difference in how high the infection rate climbs, health experts say.
"We’re hoping that if people get their act together and understand that this is pretty serious, we’re not going to see the peaks we saw in April, May, June, July," Sellick said.