With the second wave of Covid-19 already worse than the first, state and local officials are working to limit the spread of the virus and prepare to treat the sick while putting into practice lessons learned from the first wave to limit the negative consequences of across-the-board lockdowns.
In October, Governor Andrew Cuomo announced a new cluster-based system for applying restrictions to businesses, gatherings and schools, based primarily on the metrics of new cases per capita, testing positivity rate and hospital capacity.
On November 30, Cuomo tweaked some of this guidance as part of a five-point plan to combat Covid this winter, which includes: (1.) Manage hospital capacity to enhance and equalize care; (2.) Increase and balance testing resources and availability; (3.) Keep schools open safely; (4.) Prevent viral spread from small gatherings; (5.) Operationalize an equitable and safe vaccination program.
“While the holiday season often brings joy to many, the increase in social activity and mobility will also bring an increase of viral transmission,” said Cuomo. “We understand the cause and effect, and the effect is dramatic. We must adapt to this reality and have a plan in place that specifically addresses the challenges that come with it. We’ve been through the worst, and while we’re not done yet, we are moving forward with the lessons we learned in the spring to come through this together.”
The clusters are color-coded based on severity, from yellow, which include some limits on capacity but otherwise keeps all schools and businesses open, to orange and red, which would close non-essential businesses and sharply limit in-person gatherings.
“We have not been designated in any of those yet,” said Ulster County Executive Pat Ryan. “But, if our numbers stay where they are, it’s possible that we will enter the yellow zone, which will start to restrict business activity somewhat and have an impact on our school Covid testing.”
Ryan said the window to close the trajectory of the impending yellow zone for Ulster County is almost closed. As of Tuesday, December 8, the county had 4114 total confirmed cases since the pandemic began, with 1476 active cases, and 107 deaths. Two requirements to enter the yellow zone are a seven-day average of more than 15 new cases per day per 100,000 residents for 10 straight days and a positivity rate of more than 3 percent, also as a seven-day average for 10 or more consecutive days. Ulster’s numbers, according to our calculations based on the data on the county’s Covid-19 site, have the county well above 15 new cases per day per 100,000 residents (that would be around 27 new cases per day; Ulster has ranged from 48 to 70 for its seven-day average over the last 10 days). The county has also had a positive test rate of more than 3 percent for 12 days as of the data for December 7, and above 4 percent for seven straight days. If the county isn’t officially in the yellow zone by the time you read this, it will likely be soon.
“What’s clear now, in Ulster County and at the state level, we are entering a new, and unprecedented, phase of Covid,” said Ryan. “It’s clear now that it’s an even worse second phase than the first. We are in uncharted territory. It makes sense heading into the winter that we have a plan statewide that incorporates the lessons learned from the earlier part of the pandemic period.”
What does the governor’s five-point plan mean for Ulster? We asked local officials, point-by-point.
Strategy 1: Manage hospital capacity to enhance and equalize care
The idea behind flattening the curve is to prevent hospitals from being overwhelmed, which would mean some stricken with Covid-19 would die who could otherwise be saved due to lack of resources. Cuomo’s winter plan includes some changes to the cluster-based system based on hospital metrics, including regional hospital bed capacity, intensive care unit capacity, staffing ratios, and daily hospital admissions.
In addition to looking closer at the hospitals, the New York State Department of Health began to prepare for an expected surge and asked hospital systems to identify retired nurses and and doctors, balance patient loads across facilities, prepare to use emergency field hospitals, increase bed capacity to 50 percent and confirm availability of resources in existing stockpiles- all similar measures to what was implemented in the spring.
“In the last few days I have now spoken extensively and directly to the CEOs of our major hospitals – Ellenville, HealthAlliance and Nuvance,” said Ryan. “We’re coordinating really closely with them and they feel ready … People should feel confident that our health care systems are ready to meet the growing need.”
Ulster has seen an increase in hospitalizations, with 15 as of Tuesday, December 8, nearly doubling the 8 that were hospitalized six days before.
“We’re seeing that go up and we anticipate it will go up even more,” said Ryan. “We’re working to be ready for that.”
Michael Doyle, executive director and chief medical officer of HealthAlliance of the Hudson Valley, said that they are “well positioned” at this point in time. They have a stockpile of personal protective equipment, have created a plan on how to increase bed capacity to 50 percent and also are ready to meet staffing needs to meet the demand that is expected. At this time, they test all patients who come in and have worked closely with Ryan to ramp up testing for the entire community.
“We’re trying to stay ahead of this wave that is coming,” said Doyle. “We’re set well for the coming weeks and won’t have to degrade other clinical operations while managing what may come.”
HealthAlliance is a part of WMCHealth, which allows for an entire network that can share staff, equipment, and most importantly, transport patients if needed. The network stretches from Margaretville to Westchester, which allows hospitals in areas with less of a surge to assist where it is needed.
Strategy 2: Increase and balance testing resources and availability
The governor has said that not only those who work in nursing homes, schools and essential workers receive frequent tests, but business professionals, returning students, travelers and the general population are as well.
Locally, County Executive Ryan has vowed to do what’s possible to increase the availability of tests, including asking health-care providers to increase hours, and to use the limited number of rapid tests in key areas like schools and nursing homes. The county is currently doing nearly 2000 tests a day, up significantly from the spring, when only a few hundred tests were done each day. However, as the second wave is hitting most parts of the country, and every place is trying to increase testing simultaneously, inevitably demand will outstrip supply.
HealthAllliance has been considering how to prepare its 27 Grand Street pop-up testing facility for the winter months. They are working with the county to transition the site from tented to something warmer so that healthcare workers can use it throughout the winter.
Strategy 3: Keep schools open safely
Whether to open or close schools has been a source of controversy since the spring. New data gathered since the spring seems to favor keeping them open for in-person learning, particularly for elementary age children. Cuomo’s winter plan includes modifications to previous guidance that would keep schools open where previously the metrics would have closed them.
But that relates only to whether the state will order schools to close for in-person learning; it doesn’t require schools to stay open, and locally, several school districts have opted to go remote-only recently following reports of cases among students or staff, or due to caution over increased caseload in the community generally. The Kingston School District recently decided to go fully remote from December 4-11; Rondout Valley from November 30 to December 4; Marlboro from December 1-4; and Onteora from November 30 to December 11. In the New Paltz School District, the middle school and Duzine Elementary went remote December 3 and will remain so until December 11. Meanwhile, the Saugerties, Highland and Ellenville school districts are continuing in a hybrid format.
“Experts from around the globe have determined that as long as a school’s infection rate is under control and remains under the infection rate of the community at large, schools should remain open, particularly for students in K-8,” stated a release from the governor. “Not only does school provide parents with support in terms of childcare, it provides a regularity to life which has been missing for so many children throughout this pandemic.”
As caseloads increase in an area, the state requires more testing in schools. Districts in orange zones will have to test 20 percent of in-person students, faculty and staff over the course of a month while the red zones will have to test 30 percent. This is significantly different from the earlier guidance in October, that stated all schools would be remote-only if an area enters the orange zone.
“It will be a heavy lift for our districts,” said Ryan about the potential additional testing required. “We had a call with all of the districts and we are taking a series of steps to help them. We are training their nurses and medical staff within each school to be prepared.”
Additionally, Ulster is rolling out an increased number of rapid testing specifically for the school districts. The county has received over 5,000 rapid tests for the school and they are working to get more.
“If and when we hit those zones, they will be ready to meet those requirements,” said Ryan. “I know they’re feeling a lot of pressure and they’re already juggling a lot of challenges just making the school run.”
Strategy 4: Prevent viral spread from small gatherings
Sixty-five percent of all cases have been identified as coming from small gatherings. Before Thanksgiving, Governor Cuomo mandated a limit of 10 people for all in-person gatherings. Other states, like Kentucky, have moved to gathering limits of eight people, which might be in New York’s future.
“We’re still concerned on what the impact of Thanksgiving will be,” said Ryan. “We were just starting to see the impact in our numbers, but given the time it takes for transmission and for symptoms to present, plus testing, we’re probably more likely to see that at the end of [this] week.”
Ryan hopes to be able to better understand the impact of holiday gatherings once it is clear the impact that Thanksgiving had and to use that information to plan for December.
“We’re headed toward a long, dark winter, unless we dramatically change our behavior,” said Ryan.”
Strategy 5: Operationalize an equitable and safe vaccination program
With news on a vaccine planning to be released in the coming weeks, Governor Cuomo has made it clear that, “it will be months before a critical mass of available vaccinations for the general public will be available.”
Right now, the state is working on building a plan to distribute vaccinations that will consider fairness, equity and safety.
In Ulster County, Ryan has begun preliminary discussions with the three main hospital systems regarding how they will handle distribution of the Covid-19 vaccine.
“It is very good news,” said Ryan about the vaccine. “We know it’s coming but it’s going to be three-, four-plus months before we have widespread availability in Ulster County.”
“It’s bittersweet to know it’s out there but we’re a ways from it,” said Ryan.
Distributing the vaccine isn’t going to be easy, especially considering different factors like the temperature it needs to be kept at to remain effective. On top of that, Ryan said his concern is to ensure everyone has access to the vaccine and that no one gets “left out or left behind.”
“I have made clear to our team that this is the most single important thing we are going to do this year, through the pandemic and for a long period of time,” said Ryan. “We have spent time working through every detail and aspect of how we’re going to do this.”
The takeaway
“I think it’s easy to feel like this is out of individual’s control,” said Ryan. “But I think it is very important to remember we can control our fate here through collective action. We did that exact thing in April and May and have an entire summer and early fall period that we were under a one percent infection rate. I know we can control it.”
Ryan fears that people might not be taking the second wave as seriously as the first, despite the seriousness of it.
“That could literally cost other people their lives – people with health risks, seniors, vulnerable,” said Ryan. “To be blunt, we need people to not be selfish and we need people to think about others, especially during the holidays.”
Ryan has been holding frequent press conferences on Facebook Live regarding the Covid-19 pandemic and the county’s updates.
“All the decisions and recommendations we’re making are coming from a place of now even more data and understanding and from the health experts,” said Ryan. “If there’s one thing we’ve learned from the pandemic is that the health experts have been right.
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