Microcluster Strategy Begins to Fail – COVID-19 Update

microclusterThis is a roundup of coronavirus news and announcements from New York State and Hudson Valley and Catskills counties for Thursday, December 3 and Friday, December 4. Published in collaboration with The River Newsroom

NEW YORK STATE
11,271 new cases yesterday
208,297 tests yesterday
Positive test rate: 5.41%
62 deaths yesterday
4,222 hospitalizations
795 ICU admissions
New York State coronavirus page
New York State official pressroom
Hotline: (888) 364-3065

For months, Governor Andrew Cuomo has been talking about positivity rates in New York. The percent of COVID-19 tests coming back positive has been at the heart of state pandemic policy, and in the public spotlight as it dropped to reassuringly low levels, or spiked in local outbreaks. But the focus is shifting: In a Friday press briefing, Cuomo said that the state would move to focus instead on hospital data in the state’s 10 regions. “The infection rate is not that relevant anymore,” he said. “We’re really focusing on the hospitalization rate and hospitalization capacity.”

There’s no avoiding it: A state shift in focus from cases to hospitalizations is a more defensive position, signaling that efforts to keep the pandemic under control are falling short. That’s because hospitalizations lag behind case numbers: A predictable percentage of the cases reported today will be hospitalizations in a week or two, and deaths in three or four weeks. The goal of controlling case numbers is to keep them from surging high enough to threaten hospital capacity in the near future, a threshold New York may have already passed.

As of Thursday’s data on NY Forward, which tracks hospital capacity by seven-day rolling average, about 26 percent of hospital beds statewide were still available, with the least capacity still free in Long Island (21 percent) and New York City (22 percent). There was more capacity in ICUs, with 39 percent available statewide. Cuomo and state health officials have tasked hospitals recently with adding 50 percent capacity in case of surges, and planning to transfer patients between networks if hospitals get overloaded. In Erie County in Western New York, where some of the highest positivity rates have been seen in recent weeks, Cuomo ordered elective surgeries to be canceled this week.

If there’s a silver lining in the state’s grim preparations for hospital overload, it’s this: The death rate among the hospitalized is down. In March and April, Cuomo said, 23 percent of those hospitalized with COVID-19 died. In recent data, that figure is down to about 8 percent. The average length of a COVID-19 hospital stay has shortened also, from 11 days to five days, and the percentage of patients intubated has shrunk from 85 percent to 45 percent. Although there is no surefire cure for COVID-19, doctors and medical researchers have learned a lot over the course of the pandemic about how to treat patients so they have a better shot at recovery. The range of effective treatments runs the gamut from cheap steroids to recently developed monoclonal antibodies to practices like “proning”: flipping patients onto their stomachs so they can breathe better.

Nationwide, hospitals in many places have passed the breaking point, The Atlantic reports. “The pandemic nightmare scenario—the buckling of hospital and health-care systems nationwide—has arrived. Several lines of evidence are now sending us the same message: Hospitals are becoming overwhelmed, causing them to restrict whom they admit and leading more Americans to needlessly die,” write Robinson Meyer and Alexis Madrigal, two Atlantic writers who are also cofounders of the COVID Tracking Project.

With the state shifting its policy focus from case data to hospital data, what’s happening to New York’s microcluster strategy? We don’t know. Cuomo has said in recent briefings that the strategy would be revised to factor in hospital data, but offered no details. No changes have been made this week to focus zones, and no new focus zones have been added, despite surging cases in many areas across the state that have been under watch as potential zones.

The state’s microcluster strategy isn’t working, says Bill Hammond, senior health policy fellow at the Empire Center. More worrying still: Cuomo bent his own rules in downgrading a Brooklyn cluster zone, Hammond writes, allowing the neighborhood to move to a less-restrictive yellow designation before state case targets for downgrading were met. “If the governor was trying to head off an adverse ruling by the Supreme Court, his strategy did not work: In a 5-4 ruling on Thanksgiving eve, the justices struck down the cluster-zone limits on religious gatherings as a violation of the First Amendment’s protection of freedom of worship,” Hammond writes.

New York passed a milestone on Thursday: The number of COVID-19 tests that have been done since the beginning of the pandemic is now greater than the number of people who live in New York State.

New York State will join a federal program to vaccinate nursing home residents and staff, Cuomo said Friday. The move will free up more of the state’s allotment of vaccines for frontline healthcare workers: About a third of the state’s 700,000 healthcare workers are considered “high risk,” working in emergency rooms or other parts of the system where they are often in contact with COVID-19 patients, Cuomo said. New York State health officials expect to be able to vaccinate about a third of that third in the next two weeks.

This week’s best read on vaccines: STAT News has a deep dive on what the development of effective vaccines means for society, and how we can make the most of them. They’re not a silver bullet, writes Helen Branswell: “If we’re not careful, we could fail to take full advantage of the opportunity scientists and governments, pharmaceutical companies and philanthropic foundations have created for us.”

One topic touched on in STAT’s story, and an issue of growing urgency: When will pregnant people be able to get a vaccine? It’s not just a matter of priority and limited vaccine availability. The front-running vaccines haven’t been tested on pregnant people in clinical trials, and there is debate among experts about whether they should be recommended during pregnancy. Vaccines might pose different risks to pregnant people or developing fetuses—but COVID-19 infection poses heightened risks to both. And then there’s the matter of pregnant healthcare workers at risk: STAT reports that three-quarters of healthcare workers are women, and roughly 330,000 are either pregnant or breastfeeding.

The CDC issued new guidance this week on how to take community action to keep COVID-19 at bay. Much of it reads like old news to those who have been following pandemic developments closely, in particular the agency’s recommendation that all Americans wear masks anytime they are indoors with non-household members, or when a household member may be infected.

Cuomo said Friday that he will sign an executive order that changes the rent relief bill passed by the state legislature. Details are scarce at this point; the governor said only that the order will “reopen the application window [and] extend the eligibility requirements to help more New Yorkers.” That expanded eligibility should help with a core problem of the initial bill, which appropriated $100 million in rental assistance, but only allocated $40 million of that total due to the income-eligibility parameters of the law and technological and linguistic barriers to applying for aid. Back in July, Curbed did a deep dive into the problems with the program.

New test locations will soon be rolled out statewide, Cuomo announced Thursday. New York is partnering with Prescryptive Health to expand testing capacity in areas where testing is limited, and Prescryptive will deploy rapid test kits provided by New York State in those locations. One question we have at The River: How will the expanding role of rapid tests affect key COVID-19 data, like the positivity rate the state has been using as a rough guide to outbreak severity? Rapid tests are much more likely to return false negative results than PCR tests; in October, the state of Kentucky stopped counting them toward its calculation of positivity rates in order to standardize state data.

The federal CDC may have shortened quarantine requirements this week, but New York State has not followed suit, and county health departments are struggling to convey to frustrated local residents that they still must follow 14-day quarantine periods if exposed to COVID-19. “The New York State Department of Health has not adopted that,” said Orange County Executive Steve Neuhaus in his Friday video briefing. “We live in the state of New York. Elections have consequences.”

The New York Times conducted an informal survey of 700 epidemiologists, a redux of a similar survey done in the spring. The paper found epidemiologists were a cautious bunch, acting more carefully in their personal lives than most Americans. They have also modified precautions as more is learned about COVID-19. Some reported they now worry less about “socializing outdoors, touching surfaces or sending young children to school,” but are more worried about indoor air transmission and the dangers of not wearing masks. Only a small minority of the epidemiologists said normal life could restart in the summer; most said that even with the vaccine, it would be a year or more for many activities to safely restart.

The outbreak is getting worse in state prisons, too, reports Law.com. Some 20 state prisons currently have at least one active case among their inmate population. The Legal Aid Society is urging Governor Cuomo and the state prison department to release inmates who are vulnerable to the coronavirus.

The resurgence of the virus in correctional facilities has made the question of when the incarcerated will get vaccinated even more urgent. We still don’t know the answer. Inmates are not in the top tiers of federal vaccination criteria; the CDC has prioritized corrections officers in the first phase of immunizations, and the Associated Press reports that the federal prison system will set aside its initial allotment for prison employees as well. We still don’t have enough data on the vaccines to know if they will stop transmission. It’s possible they may stop people from becoming ill, but still allow them to become infected without symptoms—and if so, vaccinated guards could still bring COVID-19 into prisons and transmit it.

The US unemployment numbers for November were released Friday, showing hiring continued to slow from its rapid clip over the summer. The country added 245,000 jobs, far fewer than the 610,000 added in October, edging the unemployment rate down 0.2 percentage points to 6.7 percent. This is not necessarily bad news—the unemployment rate still fell, after all, and is dramatically lower than its peak of 14.9 percent in April—but other economic indicators show a worrying picture. The unemployment rate only counts people actively looking for jobs, missing out on most unemployed people: stay-at-home parents, people unable to work due to medical conditions, the incarcerated, most homeless people, and your friend Steve, who just lays on his parents’ couch all day and takes bong hits. The employment-population ratio captures these groups; it has recovered more slowly than the unemployment rate, and actually fell in November. Two possible explanations for people not seeking jobs: the fear of contracting COVID-19 and need to stay home with children due to school closures.

On Friday evening, Secretary of Education Betsy DeVos extended the “pause” on student loan repayment through January 31, an additional month of reprieve for borrowers. Interest rates will remain at zero during the freeze.

Long-term symptoms in those who have recovered from active COVID-19 infection is a growing problem in the US. Leading public health officials recently convened for the federal government’s first workshop on the issue, The New York Times reported Friday. “In an inadvertent but stark illustration of the difficulty of the recovery process, two of the four patients scheduled to speak at the meeting were unable to because they had recently been hospitalized,” the Times reports. Oof.

Bloomberg Law has a troubling report on COVID-19 survivors being denied new life insurance policies because they have previously tested positive for the virus. One former state insurance commissioner told the publication that he’s “not aware of any state regulations that stop insurance companies from underwriting against a disease like Covid-19.”

Quote of the week: Albany contact tracer Lara Madison, who regularly encounters incredibly hostile people in her efforts to reach out to COVID-19 patients and people who have been exposed. “Every single one of us contact tracers has that kind of story,” she told the Times Union. “That’s probably the hardest part for all of us.”

Microcluster Focus Zone Update

New York State’s current strategy for curbing infection assigns neighborhoods with outbreaks to “microcluster focus zones” that are coded red, orange, or yellow depending on severity. The NY Forward website has a guide to the restrictions on business, schools, worship, and gatherings, plus high-resolution maps of focus zones in the microclusters.

No changes have been made to New York State’s focus zones since our Wednesday roundup. The state currently has 26 microcluster focus zones, located in Erie, Niagara, Monroe, Onondaga, Rockland, Chemung, Tioga, Orange, Nassau, Suffolk, and Westchester counties, as well as in Queens, the Bronx, Brooklyn, Manhattan, and Staten Island. The positivity rate across New York State’s focus zones in Tuesday’s data was 7.35 percent. The positivity rate statewide with the focus zones excluded was 4.79 percent. Detailed information on recent positivity rates in each of the state’s focus zones is available in a press release on the state website.

 

LOWER HUDSON VALLEY
County coronavirus pages: Rockland, Westchester, Putnam
University coronavirus pages: Sarah Lawrence, Iona, SUNY Purchase, Manhattanville, Westchester Community College, Rockland Community College, Dominican, Mercy

Westchester County’s seven-day average positive test rate remained above 5 percent, County Executive George Latimer said in Friday’s coronavirus briefing. On Thursday, 768 people tested positive in the county, 6.7 percent of total persons tested. As of Wednesday, 292 residents were hospitalized with the virus, up from 47 one month ago. But Latimer said that the county has “not yet reached a point of crisis” in the availability of hospital beds, and expects there to be no changes to the county’s microclusters—one orange zone in Port Chester, and five yellow zones, including one in Peekskill, where the seven-day rolling average of those tested is 10.10 percent.

On Friday, the Putnam County Department of Health addressed a question that’s growing more saliently by the day: When you should seek treatment at a hospital? County Health Commissioner Dr. Michael J. Nesheiwat advises that over-the-counter medicines and rest can subdue mild COVID-19 symptoms, though it’s imperative to continue monitoring progress with a thermometer and a pulse oximeter, which measures a person’s blood-oxygen level and is available at most drugstores. Symptoms that demand immediate emergency attention include shortness of breath, persistent pain or pressure in the chest, bluish lips or face, the inability to wake or stay awake, and confusion. “People coping with or recovering from COVID-19 should pay attention to their respiratory strength,” Dr. Nesheiwat said. “Daily observation of personal breathing patterns such as rhythm, rate, and quality can help to determine when or if to seek medical care.”

Putnam also released an update to its coronavirus dashboard via Twitter on Friday. Some of the numbers beggar belief: for example, the county says there are only 153 active cases. But Putnam reported 442 positive test results over the past week, which raises the question: How is the county’s health department tracking active cases? By comparison, neighboring Westchester County is using all new cases in the past two weeks as a proxy for active infections. That leads to a current estimate of 6,746 active cases in the county, some of whom are probably no longer infectious. But it’s better to overestimate than underestimate, and it strains credulity that Putnam has just over 2 percent the number of “active cases” as the county bordering it to the south.

“Did Rockland see a post-Thanksgiving COVID spike?” asks a headline of an article LoHud.com that dives into the county’s troubling numbers. In the week since Thanksgiving, active cases jumped 32 percent, to 1,953, and 12 people have died. More troubling still is that if Rockland is seeing a surge of new cases as a result of Thanksgiving gatherings, we wouldn’t even be seeing it yet.

For the second day in a row, only a limited number of nurses at Montefiore New Rochelle Hospital were called into work. On Tuesday and Wednesday, some 200 nurses went on strike amid a labor dispute with the hospital, before seeking to return to work Thursday. But in the two days since the strike, only a small number have been called in by hospital administration, despite what the nurses union said was a typical patient workload. The union said that the move was retaliation for the strike.

MID-HUDSON VALLEY
County coronavirus pages: Orange, Dutchess, Ulster, Columbia
University coronavirus page: Bard, Vassar, Marist, SUNY New Paltz, SUNY Ulster, Columbia-Greene Community College, SUNY Orange

The coronavirus is continuing to spread rapidly in Ulster County, with 283 new cases reported in the last three days. Active cases set a new record Friday, with 1,212, double what it was 12 days ago. The previous peak of 1,009 was in the spring, though the positivity rate was likely higher then due to scarce testing. “If we don’t start to flatten the curve, this is going to be a very long and a very dark and a very difficult winter,” County Executive Pat Ryan said during a Thursday briefing. The county modeled how cases may rise in the following weeks, and “the best-case scenario still has us exceeding 5,000 cumulative cases by Christmas,” according to Ryan—nearly 1,200 new cases in 22 days.

Ryan also said that contact tracers in the county were being stretched thin, even with reinforcements from the state, and volunteers may once again be sought in the “near future.” He also warned of having unrealistic expectations for the first batch of vaccine doses, which will begin to be distributed in the state on December 15. The state will receive enough vaccines for 170,000 people, and some simple math suggests only about 1,600 people in the county of 180,000 will receive vaccinations from the initial batch.

Active cases in Ulster County are concentrated in New Paltz, which reported 165 on Thursday. Town supervisor Neil Bettez told The Daily Freeman that the recent end-of-semester testing at SUNY New Paltz could not account for the surge of new cases, and that he had not been informed of any super-spreader events, saying that the virus was “likely being spread by small gatherings.”

Ten deaths have been reported from COVID-19 in Orange County over the last four days as hospitalizations continue to slowly rise, reaching 102 on Friday, compared to 33 at the beginning of November.

Orange County Executive Steve Neuhaus got sassy at his Friday briefing with plans to hold a protest at the county Department of Health to rally against schools closing throughout the fall. “If you wanna to get out of the house and need a reason to do it, I have a ton of other things we could protest together but the school district and what they’re going through, what the health departments are going through, what first responders are going through, what hospitals are going through…give me a break. Some of these things I read boggle my mind.” Twelve of the 14 school districts in the county closed at least one of their schools at some point between September 15 and November 15, according to Neuhaus.

A business in Middletown was issued a warning for price gouging on disinfectants, Neuhaus also reported at the briefing, but he did not name the malefactor.

Fireworks planned for the kickoff of this year’s alternate Winter Walk in Hudson have been canceled, according to The Columbia Paper, after county Health Commissioner Jack Mabb said the event could be “a significant COVID-19 spreader.” The alternative Winter Walk (titled “Winter Walk: Hudson Safe Edition), a lower-key version of the annual event, will be spread out from Saturday until Christmas Eve.

Columbia County released its town-by-town breakdown of cumulative COVID-19 cases Friday. The Gossips of Rivertown noted there were no new cases reported in nursing homes since last week, and the highest number of new cases were in Greenport, with 12.

Two mobile testing clinics have been scheduled in rural Columbia County. This first will be held in New Lebanon’s Shatford Park, adjacent to the town hall, from 10am to noon on Tuesday, December 8. The second will be held the following Tuesday, December 15 at the AB Shaw Fire Company in Claverack from 9am-11am. A form of ID is needed, as the clinics are only open to county residents.

CATSKILLS
County coronavirus pages: Sullivan, Delaware, Greene, Schoharie
University coronavirus pages: SUNY Cobleskill, SUNY Delhi, SUNY Sullivan

Delaware County hit new records for both daily and active cases on Friday, with 17 new cases for the day and a total of 87 known active cases in the county. Six county residents are hospitalized. “Multiple cases today and this week are linked to ‘living room spread’ from Thanksgiving dinners and gatherings,” officials said in an email to local reporters.

A tale of two counties: Neighboring Delaware and Sullivan are both small, rural counties which residents often have to leave for medical care. Both counties publish a daily count of COVID-19 hospitalizations. It’s tempting to compare the two to see how each area is doing—but because the counties report data in different ways, those numbers mean very different things in each place. Sullivan County health officials say they are counting only people hospitalized in the county, which may mean the county’s number is substantially lower than the number of hospitalizations coming from local outbreaks. Delaware health officials say their daily count is the number of county residents who are in the hospital with COVID-19—most likely in other counties with larger urban centers. It’s a microcosm of the data problems we’re seeing everywhere, as there is no standard method that different health departments are using to track the pandemic.

Sullivan County officials issued possible exposure alerts for two Wurtsboro restaurants on Thursday and Friday. One person at La Mananitas has tested positive, and another suspected case is awaiting test results. Dates and times of possible exposure are November 27, 28, 29, and 30, and December 2, all between 11am and 10pm. The restaurant has closed, health officials say. Another alert was issued for the Wurtsboro Diner and Cafe, where an employee tested positive. Dates and times of possible exposure are November 15, 17, 18, 22, 24, and 25, all between 9am and 3pm. “We have identified a significant increase in cases in the Wurtsboro area in the past week,” said Sullivan County Health Director Nancy McGraw. “We want the public to be vigilant about following safety protocols.”

Active cases in Greene County jumped dramatically this week, reaching a high of 79 on Friday. Only one case is active in Greene Correctional Facility. In response to rising cases, the county announced in a press release on Friday that the in-person workforce at all county offices is being reduced to 50 percent, which may affect public access and department hours. County officials urge Greene County residents to check the website for the department they need to visit and call ahead before visiting any county office. “Active case rates are showing a significant spread of the virus as people move their activities indoors and gather for holiday events,” the release stated. “The Greene County Public Health Department has observed that the virus is now more widespread within the county workforce, school systems, and the general public.”

Unable to sing together for the holidays, the Schoharie Valley Singers are going virtual this year. Singers are participating from their individual living rooms in a concert to be held at 7pm on Friday, December 18 on the group’s YouTube channel.

On-the-ground local reporting and analysis has never been more important, and that’s what The River aims to provide. But we need your help to continue the work we’re doing. Will you support our journalism today?

OF INTEREST?
The River has a guide on where, how, and when to get tested for the coronavirus in the Hudson Valley and Catskills. To read more of our coronavirus coverage, visit our coronavirus page.

The River and The Other Hudson Valley are collaborating with WGXC to announce these updates over the air. To listen, tune in to 90.7 FM at midnight, 5am, 7am, or 9am, or visit the audio archive online.

La Voz, una revista de cultura y noticias del Valle de Hudson en español, está traduciendo estos resúmenes y co-publicandolos en su página web. Leyendo aqui. También puede escuchar actualizaciones diarias por audio en el show “La Voz con Mariel Fiori” en Radio Kingston.

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