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Communities Perspectives Planning

Stay the Course

The following is a transcript of my remarks made during the weekly public address of the Office of the Mayor, Bayonne, NJ – May 28, 2020

My name is Michael Rosanoff and I am an epidemiologist and public health professional proudly serving as a member of the Bayonne COVID-19 taskforce, under the Office of Emergency Management and the leadership of Mayor Davis.

I would like to take this opportunity to briefly discuss the journey that we have all been on for the last 11 weeks, since the World Health Organization declared COVID-19 a global pandemic on March 11th, and since Bayonne began implementing efforts to mitigate the spread of the coronavirus in our City.

I would like to discuss where we began, how we got to where we are today, and what we might expect over the coming weeks to months as we continue to address the pandemic in our community.

Bayonne, NJ had its first confirmed COVID-19 case on March 18th. Nearly one week earlier, any parent of a school-age child in Bayonne will know, the decision was made to preemptively close schools. This was a critically important step taken to slow the spread of the virus and to protect our children and teachers.

Shortly thereafter, restaurants were restricted to take-out only, retail stores were closed to customers, and our state’s directives to stay at home began. Essential services like grocery stores remained open, but the number of customers were limited, senior shopping hours were added, and anyone out in public was asked to stay six feet apart. Our world of “social distancing” had begun.

Why did our City and our State take these measures? The purpose was to slow the spread of the virus and “flatten the curve.” This term was used to describe how reducing our exposure to one another could reduce the rate of new COVID-19 infections, and avoid a potential tidal wave of new cases in a short period of time.

The fear was that a rapid surge in cases could overwhelm our hospital system and limit our ability to treat patients, as beds, ventilators, and personal protective equipment were all in limited supply.

Fortunately, we never got to that point in Bayonne. We certainly came close, but our front-line healthcare workers remained strong. Our community remained strong. Because we listened, stayed at home, and followed the social distancing guidelines, we were able to flatten the curve and slow the spread.

This brings us to where we are today. We are at a place where we are seeing a consistent and steady decline in the number of new COVID-19 cases and new hospital admissions. We have met criteria to begin to reopen aspects of society, but will need to do so slowly and in stages.

We should be proud of our collective commitment to slowing the spread of the virus, and be hopeful that the worst is behind us. However, we should not mistake this moment as the end of the pandemic.

While our goal has always been to slow the spread of COVID-19, we also know that it will take more work to stop the spread altogether. What we know about infectious diseases is that a certain percentage of the population needs to have immunity to the virus before we can stop its spread.

Some scientists estimate that 60-80%, or up to 8 out of 10 people, need to have immunity to COVID-19 for new infections to stop. We do not know how many people have immunity to COVID-19 today, but it is likely well under that number.

It is still unclear whether recovering from COVID-19 and having antibodies to the virus is enough to be immune from re-infection. What we do know is that the preferred way of achieving that 60-80% immunity is by finding a COVID-19 vaccine. While there are some promising clinical trials taking place, and the studies are being accelerated, a vaccine is not expected to be available before the end of 2020.

What this means is that we are not out of the woods yet. We shouldn’t be fearful but we must be mindful that the virus is still out there, it is still highly contagious, and it can still cause very serious illness for some people.

As the weather is turning nicer and society begins to re-open, it might be more difficult to adhere to the social distancing guidelines, but we must continue to do so. Though we may no longer be told to stay at home, we are still safer at home.

We must continue to maintain six feet distance from others, not only in supermarkets but at the park, or walking the Bayonne bridge, or anytime we are out in public. And research has shown that wearing a face covering does significantly reduce the spread of respiratory droplets that carry the coronavirus – so continue to wear a face covering in public, and always wear one when you may not be able to maintain six feet distance from others.

Many of us will want to visit with family and friends that we haven’t seen in weeks. The best guidance is to continue to limit your exposure to others outside of perhaps a small and select circle of trusted family and friends. Choose your small circle and stick with it. This is not the time for large gatherings.

Most importantly, we must protect our family, friends, and members of the community at highest risk of severe illness from COVID-19, including our seniors and those with other health conditions.

If we remain vigilant, we will continue to see a steady decline and plateau of new COVID cases through the summer months. But we also must prepare ourselves and our community for the possibility of a resurgence of the virus and another wave of cases, particularly as we get into fall and winter, when we will start to see cases of seasonal flu as well.

While we continue to be hopeful, we must not let our guard down. And if we do start to see a resurgence, we will be ready. Bayonne has demonstrated that, as a community, over the last 11 weeks, we will do what it takes to protect our loved ones and neighbors.

Let’s all continue to recognize the incredible work and sacrifice of our front-line essential workers and emergency personnel. And let’ remember those in our community, and around the country and world, who have lost their lives or family members to this pandemic.

Thank you again for following the guidelines. Please continue to wear a mask, wash your hands, and practice social distancing. And to stay strong as we overcome the pandemic together.

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Communities Perspectives Response

A Practical Approach

We’ve all been racking our brains trying to figure out when and how it will be safe to relax the stay-at-home directives and begin our slow return to normal. In our city, it appears our COVID-19 infection rate and hospital admission rate has crested and now plateaued over the last 10 days. We came close, but never exceeded hospital capacity in terms of beds, ventilators, or personal protective equipment. Our social distancing measures did their job. The fear now is that relaxing those measures too soon could send the infection rate back up.

The problem in answering the question of when we can re-open is that there simply isn’t a clear answer. There is no quantitative measure of readiness. We’ve checked one box – the number of new infections are under control.

Maybe we need to turn the question around. When will we – you and I – feel safe going back work? Riding mass transit? Sending our kids to school? Eating at a restaurant? The answer to those questions different. It is when the risk of infection is slim to none. Fortunately, there are ways to quantitatively measure that and at least estimate the risk. But we first need to know who has had COVID-19.

In theory (but still a BIG question mark), people with COVID-19 antibodies should have immunity to the virus and should be free to roam about the world without fear of becoming infected or spreading it to anyone else. Unless you were tested, clinically diagnosed, and have recovered from COVID-19, there is no way of knowing if you have antibodies. That is unless you receive an antibody test.

Currently, there is no widespread access to these tests. Some community testing has taken place as part of research. One study, touted by the Governor of New York today, showed that as many as 14% of New York residents have COVID-19 antibodies. Until we know who and how many people in the wider community are immune, we can never truly gauge just how safe it is to return to the outside world.

This is where a practical approach is needed, and a practical solution may exist. There may be an opportunity for widespread antibody testing, by utilizing a network of blood testing sites that already exists in communities across the country right now. The American Red Cross.

You see, the Red Cross is the non-profit organization that provides disaster relief and coordinates blood donation campaigns across the country in preparation for those disaster situations. It provides US hospitals with about half of the nation’s blood supply. If you’ve ever seen a poster for a blood drive, the Red Cross was probably involved. The have staff, volunteers, and donation sites in every state if not every city.

The Red Cross is also the organization currently taking the lead in identifying donors as part of its COVID-19 convalescent plasma program. As I mentioned earlier, individuals who have recovered from COVID-19 have antibodies in their blood that not only make them resistant to future infections, but their blood can also be used as a treatment for other patients with severe COVID-19 symptoms. There is now a major campaign to recruit recovered COVID-19 patients (with a documented positive COVID-19 test) as plasma donors, with the potential to save many lives as the coronavirus crisis continues. The challenge has been identifying enough donors.

Another challenge being faced by the Red Cross, and by hospitals around the country, is a severe blood shortage caused by COVID-19. Many blood drives have been canceled and donors are canceling scheduled donations due to stay-at-home directives.

There is an opportunity to address three major issues by utilizing The American Red Cross: 1) identifying plasma donors for COVID-19 treatment; 2) increasing donations and the nation’s blood supply; and 3) widespread community testing for COVID-19 antibodies.

This would be a nationwide campaign by the American Red Cross – a national blood drive, so to speak – with the promise of testing never-diagnosed, even asymptomatic donors for active COVID-19 virus or COVID-19 antibodies. The Red Cross has to test these blood samples for pathogens anyway before they are made available to patients. In the process, we would also be identifying much needed convalescent plasma donors and providing a much needed boost to the US blood supply.

It’s a win-win-win-win. We get tested. The Red Cross gets blood. Hospitals get plasma. Public health officials get the elusive COVID-19 data we need to re-open the country.

The major question is capacity. Does the Red Cross have enough personnel, supplies, testing kits, donation sites, etc. to manage the donor “demand” while adhering to social distancing guidelines? By-appointment-only donation appointments could help mitiage this. Also, many community locations could be utilized or re-purposed for blood drives. If my old high school auditorium could handle it, then so can many other places. This makes the testing process more practical and way more scalable than if it required a doctors appointment and an in-office blood draw. (Don’t forget medical insurance).

The US is fortunate to have an organizational like The American Red Cross, with blood drawing and testing infrastructure in place in nearly every community in the country. This presents a unique opportunity to tap into this supply (no vampire pun intended) to help bring our country closer to re-opening, by generating real-world quantitative data on infection risk in our local communities. And along with blood type, the Red Cross could include COVID-19 antibody status right on our donor cards.

There is still a lot we don’t yet know about COVID-19 immunity, like whether the presence of antibodies means there is no longer a risk of re-infection. Or if there needs to be a certain amount of antibody to achieve immunity. Or how long immunity of any kind actually lasts. There are also questions about the reliability of antibody tests – like are they specific to COVID-19 and not capturing the presence of other coronovirus antibodies? Thus, at this moment in time, antibody test results are not informative for determining individual risk or for decision making on the scale of communities looking for indicators of when it will be safe to “reopen.”

For more on the subject of testing and its implications, see my post:

Is Testing Telling?
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Masking the Risk

We are approaching 400 identified cases here in our city, which may still only represent about 20% of the actual number. We may be nearing the peak of the COVID-19 crisis and, rightfully so, our stay-at-home directive remains in place. Yet, my household is out of goldfish crackers and I need to replenish supplies before my kids revolt. You may be in a similar predicament. So how do we stay safe while making that essential shopping run?

We lasted two weeks (which is pretty good in my opinion) but I had to leave the safety of home to restock on groceries over the weekend. A few days earlier, the CDC released new guidance on the public use of face coverings. The Governor of New Jersey followed suit, requiring all retail store customers to wear a face covering while shopping. So to keep myself safe – in addition to distancing from other shoppers and not touching my face – I donned a medical-grade face mask that I fortunately had at home.

Why face coverings?

Lets start with the why. Why should we wear a face covering? First, notice I am saying face covering and not mask. The CDC was intentional in saying this in its guidelines. The reason is because we are already experiencing a shortage of medical grade masks in many places around the country. And in the worst possible places – hospitals. Our front-line healthcare providers are the ones who need these masks the most. I am not just talking about the N95 mask, which is the “top-of-the-line” medical respirator used to filter 95% of all airborne particles. I am also talking about the “run-of-the-mill” surgical masks. The CDC recommends wearing face “coverings” as opposed to “masks” to keep the already limited supply from dwindling even further.

Wait, so any old scarf will do the job? These is where we need some science. Those run-of-the-mill surgical masks don’t filter airborne particles. Instead they keep fluid droplets from coming in, and more importantly, from coming out of the person wearing the mask. Because COVID-19 is transmitted by liquid droplets, wearing any fabric face covering – be it a surgical mask or a bandanna – will keep those fluid droplets from getting into – or out of – the nose and mouth. Many COVID-19 spreaders are either asymptomatic or pre-symptomatic, and those individuals can prevent spreading the virus by breathing through a face covering.

CDC: Understanding the difference between a surgical mask and an N95 respirator
This is a good thing, right?

Yes, and no. While wearing a face covering can reduce the likelihood of spreading the virus in public, it can also provide a false sense of security. In a way, wearing a mask can mask the true risk.

Masks do not replace social distancing. If you need to leave home, one of the best preventative measures is to stay away from people. It sounds rude, but its not. It’s rude to invade someone’s 6 foot force field. Just because you have a face mask does not mean you can relax the other social distancing measures.

Whats worse, I fear, is that the face covering recommendatios could actually backfire. What I saw at the grocery store was alarming. While it was great to see nearly everyone wearing a face covering, nearly everyone I saw was also constantly fidgeting with those face coverings.

The CDC is recommending that we make our own face covering. These homemade, make shift masks can be bulky, uncomfortable, and/or really hot, especially indoors, especially if you are using a scarf. Anyone not used to wearing a mask, even a medical-grade mask, might be tempted to adjust and play with the mask to get a better fit. Each time you touch your mask, you risk bringing the virus to your face from your hands, even if you are wearing gloves.

Unmasking the issues

The COVID-19 pandemic has unmasked a number of issues with regard to the use of face masks in the US. Ideally, everyone would already own a medical-grade mask, know how to use it, and be comfortable using it. Unfortunately, none of these are true for the average American.

Much of this stems from our fear of masks in public. Mask wearing is highly stigmatized in the US. Here, someone wearing a mask invokes fear. In many Asian cultures and countries, masks are worn regularly to prevent the spread of disease. A person who is ill wears a mask out of respect for others, as a precaution. If we had the same cultural understanding here, we would be more likely to own and be comfortable using masks. We might also be avoiding the current crushing demand for masks, weighing heavily on the healthcare system.

Instead, our fear of masks, our lack of understanding about masks, and our limited supply of masks have left us unprepared and scrambling. Not just individuals scrambling to create face coverings, but federal agencies scrambling to provide guidelines and hope that people will change their long-standing behaviors. Hopefully, now and after the COVID-19 crisis, masks are no longer seen as weird. They are seen as a courtesy. We should expect – and hope – that masks become a part of our new normal. They are already becoming the new must-post social media selfie. #covidmask

https://youtu.be/tPx1yqvJgf4
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Local Update

This post is an update on our local situation and some of the challenges we are experiencing as the number of COVID-19 cases climbs. Other communities around the country may be experiencing similar challenges now, or can anticipate and prepare for such challenges in the coming weeks. While our community had considered many of these issues, we also hoped that social distancing measures would have made a greater impact on slowing the rapidly approaching peak in new cases and new hospitalizations.

Our city now has 240 test-confirmed COVID-19 cases. Currently, only symptomatic individuals with at minimum a fever and cough are eligible for testing, as testing kits are limited. We are most certainly under-identifying COVID-19 cases. Yet, our hospital system is still quickly becoming overburdened with the cases we are identifying. Our hospitals are beginning to approach capacity.

The general escalation of the COVID-19 situation in our city, and in others around the country, has been as follows:

Hospital beds are filling up.
ICU beds are filling up even faster. They are far fewer in number and patients who need ICU attention are occupying those beds longer.
The main solution has been to re-purpose other areas of the hospital to serve as a temporary ICU. Entire floors of hospitals or entire hospitals themselves are being restricted to COVID-19 patients only as a way to reduce the chance of spread. Temporary non-COVID areas are being set up, in some cases as tents outside of hospitals. Temporary field hospitals are being set-up by the State or by FEMA as part of the federal response.

Hospital equipment and supplies are running low.
Ventilators, which serve as the primary treatment for the most severe cases of respiratory distress, are extremely limited. Personal protective equipment like masks and gowns that health care providers and hospital staff use to protect themselves and other patients are in limited supply. Testing kits are still in limited supply. Requests have been made to the State and Federal Government for additional supplies. Communities have been asked to support local hospitals through the donation of medical grade masks and gowns. The American Red Cross is requesting blood donors to address shortages (You can find out if you are eligible to donate here).

Healthcare workers themselves are in limited supply.
Long hours, a steady influx of admissions, a growing number of inpatients, and, sadly, a growing number of deaths from COVID-19 all weigh heavily on our front-line healthcare workers. In addition, should a healthcare practitioner experience symptoms and/or test positive for COVID-19, they are no longer able to treat patients and that creates a gap in staffing coverage at the hospital for an extended period of time. The shortage of providers presents one of the biggest challenges of this crisis. Cities and states are expediting the training and graduation of medical students and nursing students, allowing doctors to come out of retirement to practice, and requesting any that any licensed healthcare provider join the effort.

The same challenges extend to our first responders.
Police, fire, and EMS personnel are similarly experiencing shortages of supplies including personal protective equipment. The vast majority of reports are COVID-19 related and response to those requires proper precautions including the use of this protective gear. In addition, vehicles – police cars, fire trucks, and ambulances – and stations need to be properly cleaned at increased intervals, which requires resources and personnel. First responders, too, are falling ill with COVID-19, requiring time-off from work and creating additional stress on the emergency response system.

All of this takes a toll on our front-line workers.
This is, no doubt, a difficult time for everyone. A great amount of that burden is being carried by our healthcare workers and emergency services personnel. Lets make sure we take a moment to appreciate their selfless commitment to our health and safety. The best way we can do that is to continue to adhere to social distancing measures. Our stay-at-home directives are in place to protect them as much as they are to protect ourselves.

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