You Do Not Need a Mandate to Use Common Sense and Do the Right Thing


By George W. Contreras


As we start a new year with widespread transmission of COVID-19, we need to carefully assess our surroundings, situations and do a personalized risk assessment to do what is right based on what we know. With the arrival of the Delta and Omicron variants of the virus, we know that these variants are easier to transmit and may not elicit the usual debilitating and severe symptoms. We need to continue advocating for complete vaccinations and boosters, if eligible, for as many persons as possible. The public also needs to realize that even with vaccinations and boosters, people can get infected although their symptoms might be very mild or nonexistent. 

It is important that elected leaders are transparent and consistent in their messaging, actions, and strategies in response to COVID-19 transmission. For example, providing free N95 respirators to the public is of little value because N95 respirators are most effective only when they are properly fit tested for the user. Fit testing is critical and specific to the brand, make, model and size. Having an improperly fitted N95 respirator may provide a false sense of security. Creating guidelines that are constantly changing unfortunately confuses the public and private sector.

The Centers for Disease Control and Prevention (CDC) recently reduced isolation and quarantine guidelines from ten to five days and later admitted that it was driven by the staffing crisis and potential economic consequences if businesses could not meet staffing numbers. We have seen the consequences of staffing shortages in various sectors such as aviation—where thousands of flights have been delayed or cancelled in recent weeks—and even the Fire Department of New York Bureau of Emergency Medical Services who recently reported 30 percent of its personnel were out sick– resulting in increased response times. I can attest to the increase in response times in recent weeks.

In addition to staffing shortages, an increase in calls to emergency services is also exacerbating stress on hospitals and first responders.  On December 31, 2021, due to the current surge of 9-1-1 calls and hospital emergency room visits, temporary protocols were implemented in New York City.  Some of these protocols address the surge of emergency calls and non-emergency reasons for which some people are calling 9-1-1.  NYC is even publishing public service announcements to implore the public to not call 9-1-1 unless it is a true medical emergency.

To be clear, wanting a COVID-19 test is not a medical emergency, although some people may think otherwise and call 9-1-1. Until further notice, after being evaluated by emergency medical technicians (EMTs) or paramedics, certain persons who are not critically ill will be advised to stay at home.  Those persons who are in fact critically will then be transported to the closest hospital. These temporary protocols highlight the fact that hospital emergency rooms are once again being overwhelmed with patients, although the patients may not be as severely ill as the initial wave of COVID-19 patients in 2020. In early January, FEMA sent additional ambulances and personnel to struggling cities such as Rochester and NYC. Although NYC received 50 FEMA ambulances in January 2022 (a far cry from the 400 ambulances NYC received in March 2020), it still highlights the fact that NYC EMS was overburdened over this holiday season

We need to continue practicing sound public health measures such as getting vaccinated and booster shots, wearing masks, good hand hygiene, keeping your physical distance and avoiding gatherings, because people can be infected and asymptomatic. Due to the recent holidays and increased availability of testing, it should not be surprising that positivity rates will continue to increase throughout January. Positivity rates in the tri-state area continue to increase, with New Jersey at 32 percent, New York at 23 percent and Connecticut at 22 percent. According to public health experts including Dr. Fauci, these rates will continue to rise in January and hopefully then start to decline.  As of January 20th, we are, in fact, starting to see the decline of cases throughout the country and NYC.  Unfortunately, hospitals are still dealing with a surge of persons visiting the emergency rooms and struggling to manage amidst staffing shortages.

As guidelines and policies constantly change, we need to do our part to protect ourselves, our families, our co-workers to keep our communities safe and healthy. We can still practice good public health without the need for mandates telling us to do so.  This past season, we saw a low number of persons getting infected with the flu because we were adhering to public health measures—and it worked. Deep down, we know what the right thing is to do. We just need to make sure that we do it so that we can avoid potential lockdowns which have additional mental health and economic consequences.

George W. Contreras, DrPH(c), MEP, MPH, MS, CEM, FAcEM, EMTP, is assistant director, Center for Disaster Medicine, and assistant professor, Institute of Public Health, at New York Medical College. He is adjunct faculty at Metropolitan College of New York and John Jay College of Criminal Justice.  He is also a frontline healthcare provider as a New York City paramedic.

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