The Next COVID Challenge

UPDATED on Wednesday, Sept. 9, 2020

New York has used up the margin of safety it built this spring to contain the coronavirus. That is a blunt way to describe the situation the city and state are in right now as the virus blazes across other parts of the country.

New Yorkers know how it feels to be inside this wildfire. Locking down our lives brought the disease under control. By early May, the number of new cases each day in New York City, which peaked at 6,378 on April 6, had been driven well below the number of existing cases. The epidemic subsided, although the virus was never fully extinguished from the community.

Which is the challenge now.

Because by last week the rate at which each infected person transmits the virus to others, the Rt, climbed above 1 in both the city and the state for the first time since the first half of April, according to two widely followed monitoring groups. That means new cases will start increasing again, absent steps to contain it.

This is particularly treacherous as New York City, with the green light from Governor Cuomo, proceeds on Monday to a modified version of the last phase of the four step reopening process the state created. Outdoor activities, like visiting the Bronx Zoo or Botanic Gardens, can resume, but indoor activities, like shopping in malls, are still restricted.

This is based on the scientific guidance that being outside is far safer than being inside. What we still don’t have, however, is a solid way to be sure the choices are working.

Corralling a pandemic demands two simple things. Real-time data on viral spread and the ability and will to then act swiftly to stop it. At the moment we still lack the first, in New York and nationally. Which means we don’t know how far behind we are on the second.

The heart of this problem is the ever-spreading debacle around testing and contact tracing.

“A Data Flow Problem”

Testing for coronavirus is not an end in itself. It is a tool to find the virus in its human carriers and then stop it from spreading. “It’s a data problem,” explained Mark Siddall, formerly of the American Museum of Natural History. “It is a data flow problem.”

The needed data comes from the test results. At first, New York and the country had too few tests. We probably still don’t have enough tests. But more urgently, results from the tests we do have are taking so long that by the time they are received they are describing history.

It is as if those radar systems set up in the arctic to spot Russian bombers sent their warnings back by mail. Or like what pilots say about flying in bad weather without adequate radar. You don’t know you are in trouble until you hit a cloud full of rocks.

In 2015, Siddall curated an exhibition at the museum on the work of President Carter and his Carter Center to eradicate the parasite, guinea worm.

“We did this against guinea worm, driving it down from 3.5 million cases to 20. No drug. No vaccine,” said Siddall, an expert on parasites. “Nigeria did it in Lagos during the recent West African Ebola outbreak. We know exactly what to do and if we had given the Carter Center a billion dollars in January or February and the authority to do domestically what they have done internationally for decades we probably would have gotten it right. Like New Zealand, Taiwan, etc.”

New Numbers

Mayor Bill de Blasio announced on May 8 a new Test and Trace Corps in the city’s Health + Hospital corporation. The work got underway on June 1. Based on their own numbers, the city so far has been only partially successful in tracing and isolating cases.

After releasing new numbers each week at first, the city has not updated the figures since July 4. An H+H spokesman said the Mayor would release new figures this week.

In any case, the Test and Trace numbers only start when the test results arrive. Since many test results are taking a week or more to arrive back from the labs, even a 100% successful tracing system would be of limited overall effectiveness at stopping the spread.

The mayor said last week that only the Federal government has the power to fix the testing delays.

“Whether there is a vaccine or not, whether there is a drug or not, we have known for a very long time how to do this,” Siddall said. “’We did this with smallpox in West Africa and in Bangladesh right on the heels of its war of independence against Pakistan in the 70s (a war that decimated infrastructure and the professional class). We did this with polio in the Western Hemisphere in 5 short years (85 to 90) and during Reagan/Bush no less.”

The question now is whether we can do it here in New York.