Social distancing has been a key strategy in New York's fight against the coronavirus. The threat of a second wave highlights its continued need
Once the epicenter of the coronavirus outbreak in the nation, New York has seen its infection rate drop to one of the lowest in the last month.
Gov. Andrew Cuomo has said the rate, which hovers around about 1% of those tested, easily could jump up if residents are not diligent with safety precautions such as social distancing.
While public health experts have praised the state’s strict social distancing guidelines, they believe mixed signals and public confusion could dampen its effect going forward.
Improving safe social distancing measures for the elderly and prompt action at the first signs of a second outbreak also will be key to stemming the tide in the state.
How social distancing succeeded in New York
In March, the number of coronavirus cases in New York swelled to 15,000 in three weeks, and officials took drastic measures to slow the spread.
Schools closed March 16, all but essential businesses shut down on March 22 and gatherings of any size were banned. With Cuomo's "New York State on PAUSE" executive order, residents were told to stay home and, if they couldn't remain there, at least keep their distance from other people.
"The best way to prevent the spread of disease is to avoid being exposed," explained Bonnie Litvack, president of the Medical Society of the State of New York.
But for some, that was easier said than done.
At 7 p.m. each day, Robyn Gershon, DrPH, applauded and cheered along with her neighbors in New York City, extending a daily "thank you" to the essential workers still heading out to do their jobs during the first outbreak.
A clinical professor of epidemiology at NYU School of Global Public Health, Gershon believes most New Yorkers recognized the severity of the situation in those early weeks.
"In the beginning, it was a sense of community," she said. "We knew it was something to be taken seriously."
Isaac Weisfuse, MD, an adjunct professor at Cornell University MPH Program, says overall the effort to stop the spread by social distancing worked.
"The people taking seriously the quarantine…really did flatten the curve and put it way down," he said. "So I think it was a success from that perspective."
"Flattening the curve" refers to spreading out the number of coronavirus cases over a longer period in an attempt to avoid a rapid spike of cases that could overwhelm the health care system.
At its peak, New York saw 11,186 cases on April 8 and 11,434 on April 15.
There were 2,762 new cases on May 15, the day five regions of the state — Finger Lakes, Southern Tier, Mohawk Valley, Central New York and North Country — entered the first of a four-phase reopening plan, having reached a list of benchmarks including a 14-day decline in COVID-19 hospitalizations and death, at least 30% of hospital and ICU beds available and 30 contract tracers for every 100,000 residents available.
"We know that Cuomo’s phased opening was very successful," Gershon said. "How do we know that? We see our cases, all of our metrics met. He didn’t rush to reopen before we met the metrics. I felt very confident about it."
How social distancing failed in New York
Where the state may have fallen short is timing.
"We were sort of ignoring (the outbreak) and we paid the price for it," Weisfuse said. "I think we learned a bitter lesson about things."
A Columbia University study in May contended that New York may have been able to save as many as 17,000 lives if it shut the state down two weeks earlier.
And when the stay-at-home orders did arrive, the shift was abrupt.
Parents who were able to work from home were thrust into new roles juggling their children's home school work. Older adults living alone were further isolated and those suddenly unemployed waited months for a backlogged system to provide monetary relief.
Cornell University professor emeritus Elaine Wethington, whose research includes the role stressful life events play in mental and physical health, said the shock of the stay-at-home orders was particularly detrimental to those who lived alone or had few social contacts. They became lonelier, she said, and their levels of depression and anxiety went up.
"The only way to have really mitigated the negative effects of that kind of abrupt social distancing and lockdown would have been to have started much earlier preparing people for what was going to happen," Wethington said. "All the advice of how to cope with it came well after."
In protecting the elderly from the virus, Weisfuse says, "We got a D."
State data shows 67% of the 25,014 deaths in New York were those 70 years old and older — with the most among those aged 70 and 79, followed closely by those aged 80 and 89.
A May investigation by the USA TODAY Network Atlantic Group, a consortium of 37 Gannett-owned newspapers, also revealed long-term care facilities were unprepared for the pandemic, citing records of infection-related control violations.
"We didn’t do a great job in the issue of elderly people and people in nursing homes," Weisfuse said, "and we need to tighten that up tremendously."
In New York's four-phase reopening plan, industries began to slowly reopen, with strict rules regarding physical separation of six feet between people and masks being worn any time that separation cannot be maintained.
Across the nation, rules and regulations were proposed en masse and the inconsistency, Wethington says, generated confusion and mistrust.
"There’s just been this overwhelming confusion which has led to a very inconsistent application of the principles epidemiologists know should be carried out," Wethington said. "There needed to be more coordinated communication from the very beginning … we just didn’t have that."
How New York needs to prepare
Looking ahead, the state has imposed restrictions on travelers from states with high infection rates to help prevent another wave of infection in New York.
In addition to a policy requiring a two-week quarantine period for all travelers entering New York from those states, travelers must provide information about their local accommodations or face a penalty of up to $2,000.
"While New York has flattened the curve … we continue to carefully monitor the data and manage our phased approach to reopening," the New York State Department of Health said in an email statement July 10.
If there is a "significant" increase in the number of COVID-19 cases in New York, the health department said it will "take appropriate action, as we have done since the first case was detected here."
Another wave would mean another test of the state's long-term care facilities, as well as its contact tracing and testing systems. Screening those who visit the elderly at their homes, assisted living or nursing homes will be key, Weisfuse said, as well as ensuring infection control and social distancing.
"I don’t think the government wants to reinstate quarantine unless they have to, but I think that means they really need to reemphasize the social distancing aspects," Weisfuse said. "That may or may not fend off a second wave, but they should be starting that now essentially to try to mitigate an extra impact."
For medical professionals, Litvack says telehealth has become "a very important tool in our toolbox" to provide care while ensuring social distancing. Protecting that system under insurance coverage will be crucial to keeping traffic low in local doctor's offices, protecting healthcare workers and patients.
Additionally, Litvack cautioned New Yorkers not to lose sight of the importance of social distancing.
"If we let our guard down and think, 'Well it’s over,' and go back to life as it was, we’re going to be in a bad position," she said. "We need to be ready and prepared to keep reinforcing this."
For opened industries, Weisfuse stressed the importance of strict social distancing policies, including making sure sick employees stay home, swift testing and contact tracing and socially distanced workspaces.
As of Friday July 17, 776 new positive COVID-19 cases were recorded. All New York regions were in Phase 4, except New York City, which entered Phase 4 on July 20.
"We just have to be extra, extra cautious at this very critical moment," Gershon said.