Coronavirus: Public Enemy No. 1
Pandemic challenges Essex County Health Department workers in 2020 and beyond
ELIZABETHTOWN — For a moment, her office was quiet.
With just one full day left before the start of the New Year, Essex County Health Department Director Linda Beers sat down in her Elizabethtown office and looked at a timeline of the county’s coronavirus pandemic laid out before her. This timeline, full of challenges the department has fought to overcome throughout the last year, was prepared by Andrea Whitmarsh, one of her colleagues and the county’s senior public health educator.
Temporarily set apart from the rush of activity outside her door, Beers reflected on everything that’s happened this year — and what it took for a small rural health department to respond to the challenges 2020 brought.
At the start of 2020, the Essex County Health Department was gearing up for a collaboration with Essex County Mental Health Services and St. Joseph’s Addiction Treatment and Recovery Centers. Officials planned to go full-throttle on a campaign to address substance abuse throughout the county, on top of other work related to maternal health, obesity and food insecurity, tick-borne illnesses and lime disease.
Staff met to discuss the novel coronavirus for the first time on Jan. 27. That day is also the first time the department shared information related to the coronavirus on social media. The post reached 305 people, according to Beers. No cases of COVID-19 had been discovered in the county yet, nor in New York state — though it’s known now that by the time the first case was discovered in New York City on March 1, the virus had already spread undetected to thousands of people. For many, the threat of COVID-19 — the disease caused by the novel coronavrius — seemed far away at the time.
“To date, no one has been diagnosed with this virus in New York State, and the risk of becoming sick from coronavirus is still considered low,” the department wrote on Jan. 27. “Coronavirus can lead to fever, cough and shortness of breath. There is no specific treatment available, but everyday preventive actions can stop the spread of germs.”
In a matter of weeks — March 11 — the coronavirus crisis was declared a pandemic by the World Health Organization, and it became the department’s primary focus. Other functions of the department — such as its role in the anti-substance abuse campaign — were shifted to other departments.
The pandemic didn’t come as a surprise. By the time Essex County saw its first confirmed case of COVID-19 on March 17, the department had long ago put together plans for how to proceed.
“Public health departments have planned for this all of our lives,” Beers said. “It’s public health 101 — you all take pandemic courses.”
Throughout the years, there’s always been something.
“We weren’t sure how far Ebola would spread. We trained, did unbelievable measures,” she said. But Ebola is more difficult to spread than the coronavirus. It was contained.
“I don’t think we were surprised that something happened. We’d had H1N1, flu variants. These are deliverables from us. If there’s ever a pandemic, it’s A, B, C. We’ve been working with our partners in the health care field on how we’d distribute a vaccine. Did I know it would be COVID? No. Did I expect this in my lifetime and while I was here? Yes.”
On March 10, the Essex County Board of Supervisors issued a proclamation declaring a state of emergency. Seven days later, the first case of COVID-19 was discovered here. Two days after that, Gov. Andrew Cuomo signed the New York State on PAUSE executive order, mandating the closure of non-essential businesses in an effort to curb the spread of the virus. Hospitals were ordered to cancel elective surgeries to free up hospital beds in the event of a COVID-positive patient surge, and were then asked to put together a plan to expand bed capacity if needed.
By the end of April, the county had reported 31 test-confirmed cases of COVID-19 and 16 suspected cases.
“We thought that was mind-blowing,” Beers said.
On Tuesday, Dec. 29, Essex County reported 84 active cases of COVID-19, 25 of them new since Monday.
All hands on deck
In May, the eight-person health department began searching for help from anyone available around the county complex in Elizabethtown.
“Anytime anyone had any availability, we trained them to do COVID contact tracing,” Beers said.
For some time, public health officials had a small amount of data at their disposal. The full scope of the virus’ spread was unknown. Testing in the North Country region was severely limited for weeks, even as the state became the COVID-19 epicenter of the country. At Adirondack Medical Center in Saranac Lake, Alice Hyde Medical Center in Malone, Elizabethtown Community Hospital and ECH’s Ticonderoga Campus, COVID-19 testing was available only to hospital inpatients and health care workers for weeks in an effort to conserve testing materials amid a nationwide shortage. The capacity of labs across the state to process all of the samples being sent in for testing was also limited.
Up until May, the department kept track of its COVID cases by hand, on spreadsheets. It was a labor-intensive process, but it worked, according to Beers. In May, the department became one of the first in the state to sign on to CommCare, the state’s Communicable Disease Management System. CommCare streamlined the data reporting process.
“It runs numbers for us and the data is there,” Beers said.
In May, the state set seven benchmarks that needed to be met to trigger the first phase of industry reopening. For the North Country region, widespread COVID-19 testing was the last hurdle to overcome before businesses could begin opening doors again. The state delivered testing supplies to local hospitals, and a testing surge in the first two weeks of May pushed the region forward. On May 15, Cuomo announced that the North Country region had met all of the benchmarks to kick start Phase 1 reopening.
But as the region reopened, the county health department faced even more work. Travel advisories were put in place by the state, and every day, the department’s staff arrived to new lists of travelers who needed to be contacted for quarantine.
It wasn’t until July that the department was able to switch gears and start to put together more plans preemtively, according to Beers. That period was short-lived.
“Aug. 18 happened,” she said.
That’s the day that the health department realized there was an outbreak at the Essex Center nursing home and rehabilitation facility in Elizabethtown.
On Aug. 17, several things happened in quick succession that kick-started a mass-testing effort that began to unveil the full scope of the outbreak. Judy Frennier-Ryan, a 65-year old woman who had been staying at the Essex Center since February for rehabilitation services, became the first person in the county to die after contracting COVID-19. After she died, nursing home administrators discovered that her roommate had symptoms of COVID-19. That same day, routine COVID-19 tests for three staff members without symptoms — which had been sent to a lab to be processed 19 days prior — came back positive.
Subsequent testing revealed that Essex Center had more than a few cases. Altogether, 109 residents and staff were infected. Sixteen residents died.
“For us, that will not be forgotten,” Beers said. “It was devastating to everybody, every day that someone passed away.”
The fall brought an uptick in COVID-19 cases, but a bright spot came in December when two coronavirus vaccines received emergency authorization from the U.S. Food and Drug Administration. On Dec. 15, Chazy nurse Karen O’Connor became the first person in the North Country region to be vaccinated.
The number of COVID-19 cases, now, is rising to levels not seen here before.
“We’re rising. We are,” Beers said. “Our cases are soaring.”
On Dec. 29, the county posted its highest number of cases ever. By 11:30 a.m. on Wednesday, the county had received reports of 17 more new cases.
“I think the virus is prevalent,” she said. “It’s in community spread now.”
Throughout 2020, the department’s staff have practically been living at the office.
“I cannot ever describe what I like to call my work family,” Beers said. “We have lived here. There is not a lot of us. We are strong, we have North Country grit, and we know we have the support of our community and the (county) Board of Supervisors.”
This year hasn’t been all bad. In this pandemic, partnerships have been forged between the health department and a variety of community organizations, plus the county’s school superintendents, who meet with Beers over the phone every week.
“That type of collaboration will last forever,” Beers said.
This year has been challenging at times, but Beers said she knows the department has the community’s support.
“After working every holiday and every weekend, sometimes it gets daunting,” Beers said. “Then these crazy packages come. Some coconut cream pie that the attorney’s office brought us, just because, moved us forward another week.”
The health department has received gifts from school districts, church groups and members of the community. Residents even sent the department Christmas cards.
“It really sustains us,” she said. “It makes us feel valued in our community. This isn’t a hardship to us, we feel really … like everybody in health care, it’s our destiny and our responsibility to move forward.”
In 2021, the health department’s role in the fight against COVID-19 will be changing. While the department will continue to work with county residents who test positive for COVID-19, the state will take on more of the contact tracing duties, freeing the county up to work on vaccinations.
“We have plans, we’ve been drilling this,” Beers said. “Essex County is working to do mass vaccinations. There is a plan to vaccinate everybody. It’s a staggered, thoughtful distribution of this vaccine. There’s really an emphasis on equity.”
That means the county will identify the populations hardest hit by COVID and ensure they have access to vaccines, and working with pharmacies and health care agencies such as the Hudson Headwaters Health Network to get the vaccine out quickly.
“The majority of vaccines will stay in hospital centers, but moving forward, more will move to health departments,” Beers said. “The Essex County Health Department will set up points of distribution throughout the county, and they will be well advertised. It will not be a one-and-done. We will do this every day, every week.”
In this state, the general public won’t be eligible for vaccines until late January at the earliest, according to Cuomo.
A return to normalcy will take some time. Asked how much time, Beers said it will depend on a large portion of the population getting vaccinated.
“We need herd immunity,” she said. “We get out of this when enough people have the vaccine.”