CHARLESTON — Echoes of “Let them play” greeted West Virginia Gov. Jim Justice as his black Suburban eased onto the state Capitol grounds on the morning of Sept. 14. Hundreds of student-athletes, parents and supporters chanted and toted signs, calling on the governor to loosen restrictions instituted amid the novel coronavirus pandemic.
Justice paid no heed to the crowds gathered outside the Capitol, making his way inside for the first of the week’s three updates on the state’s pandemic response. He began with a familiar refrain, recounting the deaths of 12 more West Virginians from COVID-19.
That day’s virus transmission rate in West Virginia topped the country, meaning COVID-19 was spreading faster here than in any other state. Three days earlier, West Virginia recorded 325 new cases, its highest number for a single day.
“I can tell you this,” the governor declared during his briefing, “I am trying with all my soul to continue to change and adapt this system to where it works the very best for all of us, where it keeps us safest and where it works for a better way for all of us.”
During an emergency meeting later that afternoon, Justice discussed changes to the color-coded map the state uses to determine when to tighten public school restrictions. The following day, state officials released a revised map complete with a new color, easing rather than tightening the threshold for restrictions and clearing the path back on to the field for student-athletes.
“It would be plain stupid to be stubborn and not change and adapt as we go forward,” Justice said at a news conference announcing the new map.
Two months later, the governor ordered additional restrictions, marking the most significant tightening of COVID-19 requirements since he rolled up to the Capitol that September day. By Friday, when Justice announced the moves, the number of new cases and deaths had soared, more than doubling the total from Sept. 14.
In the past week, West Virginia reached new highs for the number of hospitalizations (339), patients in intensive care (104), daily new cases (885) and seven-day average of new cases (650).
The cumulative positivity rate began climbing the first week of September and hasn’t gone down since. As of Friday, it stood at 4.06%, well past Justice’s earlier 3% threshold to trigger shutdowns.
“We are all very hopeful that, as it’s done in the past, it will peak and then it will go the other way,” Justice said Wednesday. “But right now, we’re still going up.”
Like the rest of America, West Virginia has confronted two waves of the pandemic, the first in the spring, when the governor issued a series of executive orders to help mitigate spread. Restrictions ranged from mandating masks in public places to closing restaurants to banning visitation at nursing homes. The spread ebbed and the curve flattened.
Then West Virginia reopened.
Summer came. People traveled and dined, drank and celebrated together as they had before the pandemic.
And the virus came back.
Across the country with the start of a new academic year approaching, officials weighed whether to resume restrictions to slow the second wave. In West Virginia, they changed the map.
State officials touted a school reopening map inspired by the Harvard Global Health Institute’s COVID-19 risk map, compiled by a consortium of leading scientists, epidemiologists and public health officials from throughout the U.S.
West Virginia’s map only applied to schools. The distinctions didn’t end there. If a county is coded orange on Harvard’s map, a stay-at-home order is advised. If a county is coded orange on West Virginia’s map, students may practice sports but not play games.
Justice bristled at criticism of the state map. Had he followed Harvard’s parameters, he said, “we’d have a third to half of our state shut down.” He accused critics of playing politics.
“In a lot of these situations, it’s politics, politics, politics, and it just always stinks,” he said.
Indeed, the specter of politics loomed as the number of cases rose. After easily winning the Republican gubernatorial primary in the spring, Justice shifted into the second wave of his re-election bid. During virus briefings held three times a week, Justice frequently drifted from the topic of COVID-19 to other subjects such as revenue, agency accomplishments, tourism and trout stocking.
His focus in virus response largely centered on staying open and keeping the games going.
In September, the governor unveiled a plan for aggressive testing and he revealed an addition to the state map, a gold category in which counties coded in that color could move to in-person instruction in grades 3-12, with masks required at all times and extracurricular activities permitted.
Asymptomatic people needed an incentive to get tested, Justice said, and the map’s gold category, with its pathway for a return to sports, offered that.
“If it takes additional measures to keep our people safe, we’re here to do them,” Justice said. “But I strongly believe that what we needed to do was tweak our color-code system and add another bracket to be able to give a lot of our kids the opportunity to get back in school.”
As testing became more readily available, West Virginians took advantage. In Kanawha County, some drive-thru testing drew thousands of people.
“As we keep testing and testing, we might identify a few people who didn’t know they had it and stop it from spreading,” Justice said in September after committing CARES Act money to a new testing initiative. “But more often than not, we’re going to get good results. You’ll see the numbers in your county go down and we’ll begin to move in a way to where our kids can go to school, play sports and do all kinds of other things safely.”
Testing rates have increased in West Virginia over the past three months. COVID-19 incident rates also increased. Justice last week attributed the spike to more testing. Health officials disagreed.
“It’s not just a proportional more tests, more positive cases. There’s actually more disease in West Virginia,” said West Virginia University’s Dr. Clay Marsh, the state’s virus czar.
Both Marsh and Justice acknowledged the onset of fatigue among West Virginians weary of following safety protocols.
“I absolutely understand with all in me that people are tired and frustrated. Today we have become lackadaisical to some degree,” Justice said. “Everyone is tired. Everyone is frustrated, but let me say this: You’re not really tired. You’ve made yourself mentally tired, but if the threat … was an enemy at our border threatening our lives, we would pick it up like you can’t imagine. That’s exactly what we’ve got to do.”
By mid-October, the state’s death toll was approaching 400. By late in the month, virus rates were soaring again. Marsh cited complacency.
“I think the data is telling us that, in fact — as we saw during the 1918 (flu) pandemic, as well — that, as this thing continues to go on, people are getting very fatigued,” Marsh said.
Slowing the spread requires convincing people to change their behavior, said Dr. Cathy Slemp, who served as state health officer until Justice forced her to resign in June.
“Masking and physical distancing and ventilation and hygiene, those are things we can all do individually to slow the virus, then there are policy things that you can look at to bolster those individual actions,” Slemp said. “It’s not all-or-nothing, shut down everything or nothing. There are targeted interventions that can be helpful. It’s harder, though, to play catch-up than it is to take some actions, and you have to think about long term, too, not just the short term.”
Fatigue isn’t unique to West Virginia. Dr. Dave Rubin, director of PolicyLab at the Children’s Hospital of Philadelphia, wrote in a blog post last week that, nationwide, spread is happening more often in smaller, intimate settings, where people frequently abandon protocols.
“As the weather becomes colder, these gatherings are taking place indoors, often in the absence of strict mask use, creating the perfect conditions for a virus that can spread among people who are crowded into a poorly ventilated space,” Rubin wrote. “These events are a sign that pandemic fatigue has set in, beset with mixed messages from political leaders on the value of masking and distancing to contain the resurgence this winter.”
For months, health officials have warned winter will worsen the danger. COVID-19 will be compounded by flu season, and cold weather means more time inside, where spread is easier.
Justice urged people to remain vigilant but did little to force matters. Last week, as Ohio and Maryland officials tightened restrictions, Justice declared, “I don’t know what else I can do.”
By Friday, after reading the names, ages, genders and home counties of another 63 West Virginians claimed by COVID-19 over the past week, Justice was ready to act.
He issued a series of executive orders requiring masks to be worn at all times inside businesses, delaying the start of winter sports and extending Thanksgiving vacation for schools. If people defy the mandate, Justice said, businesses should call police. Businesses that fail to enforce it could risk losing their licenses, he said.
“Too many of our neighbors are getting sick, going to the ICU and dying,” Justice said. “At the end of the day, the responsible thing to do is to stand up and take bold, strong action.”