Amid a Historic Pandemic, Public Health Must Take the Lead Even With Other Concurrent Disasters

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By George W. Contreras

As we continue into mid-2020 and several months into this historic COVID-19 pandemic, Memorial Day 2020 marked an important milestone as the death toll in the United States surpassed 100,000 deaths, and many states started to reopen even while cases are still rising in their respective areas. As of June 25th, the United States now has over 2.3 million cases and 122,000 deaths. In the Northeast where the initial wave seems to have passed, New York State is finally experiencing a steady decline in cases and deaths.    From a public health perspective, however, a  looming threat remains—a resurgence of virus transmission based on recent warmer weather, mass gatherings and more people going back to work causing an increase of people in parks and beaches, some with  disregard to physical distancing and wearing face coverings.

In light of the lengthy incubation period associated with this virus and the growing disregard for precautionary measures throughout the nation, I am deeply concerned with the real possibility that we may be facing a second peak as part of initial wave in a matter of weeks—jeopardizing the significant progress that we have made in flattening the COVID-19 curve over these past months. 

There is no easy answer. No quick and painless fix. I acknowledge the almost fifty million people are currently unemployed in the United States, many who are struggling to survive, unsure of what their next day will bring.  Will they have enough money to feed their family, pay their rent and other needed expenses? 

As an assistant professor at the Institute of Public Health in the School of Health Sciences and Practice and assistant director at the Center for Disaster Medicine at New York Medical College, I am fortunate to be able to remotely continue my duties. As a New York City paramedic, working in the trenches I continue to see the realities of our current situation.  From this perspective, I see that, just because the number of cases and deaths are declining so far, it by no means indicates that this pandemic is behind us.  Rather from my vantage point, I see that we are clearly still in the middle of this historic pandemic. 

As a paramedic, it’s impossible to forget  that each new COVID-19 case, each additional death is not simply a number. The numbers are real people who are fathers, mothers, brothers, sisters, aunts, uncles, grandparents, sons and daughters.  They are healthcare workers and first responders and even colleagues. Above all, they are all human beings who died unexpectedly and too soon. New York City (NYC) contributed to more than fifty percent of New York State’s cases and deaths. The extreme circumstances were so severe, they required: convention centers to be retrofitted and converted into hospitals, refrigerated trucks to serve as temporary hospital morgues, the USNS Comfort to dock in Manhattan, more than 400 out-of-state ambulances and 1,600 personnel who came to assist with emergency medical services (EMS) during its darkest hour. 

Some may assume that working nearly three decades as a NYC paramedic should have prepared me for what I saw during this pandemic. But it didn’t. Being an EMS instructor and professor of public health and emergency management should have prepared me. But it didn’t.  In these past few months, I have witnessed so many people die during a single shift, week after week. It was certainly an eye-opening and disheartening experience. It reminded me how important it was to keep the human aspect even during these unchartered times because each death that gets reported or published is a human being and someone’s loved one.

As of today all regions in New York State have reopened in a staggered manner which allows for close monitoring of established indicators. Some regions are even set to enter Phase 4 by this June 26th.  After being closed since March 23, New York State Governor Andrew M. Cuomo rang the opening bell at the New York Stock Exchange on May 26 to emphasize that we are moving towards a new normal. New York City started Phase 1 on June 8th, entered Phase 2 on June 22nd  and Mayor DeBlasio announced today that NYC is on track to open by July 6th

With the recent tragedy involving the deaths of George Floyd and Rayshard Brooks and the subsequent national protests, I am even more concerned about a resurgence of COVID-19. I worry about the short-term consequences of these protests which consisted of hundreds (sometimes thousands) of people, many without face coverings, gathering in small areas. The long-term consequences can be even more daunting as additional people may die from COVID-19 infection. Mass gatherings are definitely one venue that can promote virus transmission. During the protests and other mass gatherings it is clearly hard to maintain the six-foot distance, especially when the numbers were large and encounters became confrontational.  I also worry about the possible increase of cases in the context of the recent Centers for Disease Control and Prevention (CDC) report, which stated that 35 percent of infectious people may be asymptomatic but still infectious. Compounded to this is that fact that COVID-19 has disproportionately affected minority communities.  These protests are creating mass gatherings which can present ideal situations for increased virus transmissions. As we reopen many more cities, we need to continue our vigilance and follow established guidelines and public health strategies which will work only if you actually implement them.

In the midst of ongoing events, I am not even sure that the public realizes that June 1 also marks the official beginning of the hurricane season.  Hurricanes do not care if there is a pandemic or if communities are engaging in protests.  The landfall of a hurricane during these times will only make matters worse.  These weeks should serve to remind us that we need to all do our part to keep this pandemic at bay.  We cannot lower our guard now or become complacent.  We stand to lose too much.

Even in the face of national turmoil, in the midst of economic distress and potential natural disaster, we must not forget that we are still in the middle of pandemic that currently has no treatment and no vaccine.  During these times, frequent hand washing or using sanitizer, wearing a face covering, keeping a physical distance and avoiding mass gatherings must continue.  It would be an absolute shame to see an increase in cases due to recent infections who can then transmit to other vulnerable populations.  As a result, the governors of New York, New Jersey and Connecticut recently announced that starting June 25th, anyone traveling from eight states (North and South Carolina, Florida, Alabama, Arizona, Arkansas, Utah and Texas) that are current hotspots will be subject to a 14-day quarantine. The progress made up to this point can be easily lost unless we make an effort to keep the public health above water and not overwhelm the healthcare system as the ultimate goal. We all need to continue to do our individual part in order to achieve a collective good for the public.

George W. Contreras, DrPH(c), MEP, MPH, MS, CEM, currently serves as Assistant Director of the Center for Disaster Medicine and Assistant Professor, Institute of Public Health, at New York Medical College in Valhalla, NY. He also works as a Paramedic in New York City.

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