In January, when my first article in the Rochester Beacon appeared, there were no confirmed cases of the new coronavirus in New York and only 10,000 worldwide. And yet, anticipating the inevitable spread, our community was asking itself: Is Rochester ready?
Now, nearly four grueling months later, the worldwide COVID-19 death toll exceeds 300,000, including more than 300 lives lost in the Finger Lakes area.
Sad as that is, it represents significant local success at flattening the epidemic curve, the number of COVID-19 patients needing health care. Without delving into the complexities and limitations of different modeling methodologies, I’ll summarize that our analysis had led us to predict an approximately 50 percent higher Monroe County hospitalization rate than we have so far experienced. Our hospital, ICU, and ventilator capacity have not been overwhelmed, thanks to our collaborative regional planning and this community’s embrace of protective measures, such as hand washing and social distancing.
So, the answer to our original question is yes, Rochester was as ready as possible for COVID-19.
Over these past months we have learned a lot about the virus itself. It seems to be more contagious than we originally thought, with each infected person potentially passing COVID-19 to a greater number of others. The disease manifests in a wider range of symptoms, including inflammatory complications in some children.
We’ve learned more about treatment options. Early on at Rochester Regional Health, we cautiously treated some patients with hydroxychloroquine. Since then, more-robust studies have shown the drug is not helpful, and possibly is harmful. Therefore, we almost never use hydroxychloroquine now. Promising treatments under study include the antiviral remdesivir and convalescent plasma, using protective properties from the blood of patients who have recovered from COVID-19. In addition, Rochester General Hospital is one of four sites in the country testing a new vaccine.
We’ve learned to rely more on our own local efforts and networks, and less on federal action, for supplies, testing, and equipment.
What we did right
At our local level, the response has been solidly evidence-based, well-articulated, and highly effective. A great portion of the population has respected the need for protective measures, including wearing masks to protect others. Several local manufacturers switched their production lines to making hand sanitizer, masks, and face shields. Donations poured in from citizens and businesses—of meals, funds, and PPE.
Our county and state health departments worked effectively with local governments and health care providers. Our health systems collaborated to ensure communitywide capacity, and they aligned for consistency on measures such as visitor restrictions. Within Rochester Regional, multidisciplinary teams sprang into action to accelerate adoption of telemedicine; procure and distribute PPE; establish hospital and drive-through COVID-19 testing; and train and redeploy staff to cover areas of need.
Statewide, the governor’s office led a data-driven charge for lockdowns, hospital capacity increases, and now for phased reopening.
Phase 1 reopening
On May 15, the Finger Lakes region began Phase 1 of reopening. This includes construction, agriculture, hunting, fishing, forestry, manufacturing, wholesale trade, and certain retailers with curbside pickup. The incremental release from lockdown restrictions depends on seven key COVID-19 metrics: hospitalization rates; deaths; new hospitalizations; hospital bed capacity; ICU bed capacity; testing capacity; and contact tracing. As long as these remain within defined parameters, the region can release the valve on restrictions in a controlled way that avoids a surge in COVID-19 spread. If the data head in the wrong direction, we return to greater restrictions to avoid overwhelming hospital capacity.
From an epidemiology standpoint, this is a good strategy. We must reopen with care—slowly, cautiously, with robust testing and contact tracing.
We will continue to see deaths, and we’re all worried about a second wave once people resume normal activities—particularly when flu season arrives in the fall. We’ve seen the potential danger of relaxed restrictions in places like South Korea, where a single person going to a nightclub infected perhaps 85 others. Rochester must continue to exercise discipline in social distancing, mask wearing, and hand washing.
Next steps: decisions on school reopening
Among the next big decisions we face locally, the question of school reopenings looms large. We know that schools can be hotbeds of disease transmission, as we’ve seen with measles. We don’t yet know what interventions are most effective in school settings. Again, we must proceed cautiously, test robustly, and be ready to respond quickly to evidence of spread.
What gives me hope—and what worries me
These days I spend about half my time answering questions from hospital executives, nurses, staff members, and colleagues about infection control—what measures are evidence-based and what are not—so we remain in compliance with guidance from the Centers for Disease Control and Prevention, and state and local health departments. The other half of my time, I treat patients hospitalized with COVID-19. We are constantly refining our treatment guidelines as more data become available.
What gives me hope is the high quality of our local response—among health care officials, elected representatives, businesses, and average citizens. Our testing and contact-tracing capacity are growing significantly. We’re learning more about treatment options. And, while we’re still using conservation measures in the use of PPE, production is ramping up, and our supply has improved.
What worries me is the risk of a secondary surge, particularly if people here and elsewhere relax precautions without adequate controls. This virus is a killer that does not respect borders.
My advice to readers today is: Obtain your information from reliable sources—including Monroe County Commissioner of Public Health Michael Mendoza, M.D., and Monroe County Executive Adam Bello. Continue practicing hand hygiene, sanitization, and social distancing. Wear a mask in public. Keep taking care of yourselves and one another.
Emil Patrick Lesho, DO, FACP, FIDSA, FSHEA, is a specialist in infectious disease and the health care epidemiologist at Rochester Regional Health. All Rochester Beacon coronavirus articles are collected here.