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Does Uptick In COVID-19 Transmission Rate Mean Murphy Will Slow Down Recovery?


Answering that question means assessing how closely residents are still following social-distancing policies, viral visitors from other states and the ‘knucklehead’ factor

This story was written and produced by NJ Spotlight. It is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. To read more, visit njspotlight.com.

Full story link – HERE.

By Lilo H. Stainton

New Jersey’s pandemic recovery process may have hit a speed bump, after a rise in the COVID-19 transmission rate led Gov. Phil Murphy to warn that additional public-health restrictions may be necessary to control the spread of the coronavirus.

On Monday, Murphy announced that the COVID-19 reproduction rate, or Rt, had ticked above 1 for two days, the first time it had been over this key threshold in 10 weeks. A value above 1 indicates the virus is spreading more efficiently, with each infected person giving it to more than one other individual.

While Rt is among an array of data Murphy’s team says it monitors closely, along with the positivity rate, hospitalization rate and other indicators, the governor suggested the rising reproduction rate had forced his administration to consider an outdoor mask policy for the public. Murphy also warned that people who ignore current mask or social-distancing guidelines are putting New Jersey’s economic reopening at risk.

“I want us to be able to deliberately and responsibly continue down our road back,” Murphy said at his media briefing Monday. (He is now hosting these sessions three times a week, on Monday, Wednesday and Friday, instead of daily.) “I do not want to have to hit another pause on our restart because a small number of New Jerseyans are being irresponsible in spreading COVID-19, while the rest of us continue to work hard to stop it, but we all need to be traveling down this road together.”

Rt rate — missing in action?

While the state posts a wealth of data related to the pandemic, Rt rate is not on the administration’s dashboard and details on how Murphy’s team calculates it have not been made public previously. Administration officials said Tuesday the calculation is based on a model developed by Imperial College London and considers the number of new cases over time and  how quickly such cases develop. Generally speaking, Rt depends on factors like new case data, the population’s vulnerability to infection, how long people carry a disease and how many recover or die — but the methods and models vary.

“It all depends on what the epidemiologist or modeler assumes or has belief in being the best indicators of this number,” said Henry F. Raymond, an associate professor with Rutgers School of Public Health and expert in epidemiological models. “There’s no gold standard in how to do these things.”

Another “pause” on New Jersey’s reopening would likely be unpopular. Murphy has faced a barrage of criticism over his decision, announced last Monday, to postpone the planned reopening of indoor dinning, initially scheduled for Thursday, July 2. But Murphy said  that sitting in proximity to others without a mask poses too much risk; he has also raised concerns about photos of young people packed into outdoor bars at the Jersey Shore and elsewhere, without masks or distance between them.

“We are continuing down our road back. However, today we are seeing a sign that we all need to take with the utmost seriousness, and which we all need to work together to reverse,” Murphy said Monday in announcing the Rt rate had reached 1.03 over the past two days. “This means that for every new case of COVID, we are seeing that case is leading to at least one other new case. This means increasing rate of spread statewide. This is an early warning sign that quite frankly, we need to do more.”

Beyond the possibility of an outdoor mask policy — which Murphy conceded would not be easy to enforce — it’s not clear what adjustments the state is considering. Outside dining has been open since mid-June, beaches since late May and arcades and other boardwalk entertainment sites began welcoming guests last weekend.

The unknowable ‘knucklehead’ factor

Murphy said Monday it was not clear how much of the Rt uptick reflected the state’s businesses reopening, the behavior of “knuckleheads” who ignore public-health recommendations or infections connected to out-of-state visitors. But the governor noted two Garden State case clusters were tied to travel, one of which involved a wedding in South Carolina, a coronavirus hotspot.

“We knew when we opened up the state again, we said this, we’re taking on more risk and that’s going to lead to more transmission, but we felt was responsible and manageable,” Murphy said. “I don’t know that a month ago, anyone — anyone — would have anticipated that Florida would be printing 10,000 or 11,000 positives a day, or Texas, Arizona, parts of California,” he added, “so I think it’s a mix.”

Seeking to prevent against a spike in cases here, in late June Murphy announced a mandatory 14-day quarantine for people traveling from — or returning home to New Jersey from — states that met certain criteria indicating high viral activity. With limited enforcement options, the policy essentially depends on personal responsibility for compliance. There were 19 states on the list Tuesday. While hospitalizations and new case counts have declined significantly since peaking in April, nearly 174,000 New Jerseyans have been diagnosed with COVID-19 and more than 1,800 have died since March.

A state Department of Health spokesperson said Tuesday the model New Jersey is using considers the number of new cases over 10 days and various “standard interval parameters” to determine how quickly new infections develop. This factor ranges from 4.5 to 6.5 days, according to assumptions culled from a global literature review of work published by epidemiological experts, administration officials said. The outcome can fluctuate depending on many factors, according to the DOH, including the number of tests involved, the amount of physical contact between residents and a region’s population.

Raymond, with Rutgers, noted that whatever data is being used in the calculation is subject to limitations as well. New case numbers depend on testing, for example, and if that isn’t widespread, then it may not reflect the true spread of the disease. (New Jersey has now tested more than 1.5 million people, according to state tracking.) In addition, the vulnerability of a population is impacted by how willing people are to adopt public-health protections like rigorous mask use, hand washing and isolating when sick — factors that are hard to measure.

“This is not a moon launch where we have everything down to who urinates when and what they eat when,” Raymond explained. “We’re dealing with human behavior,” he said. “But the point is, what’s a good number to guide public policy,” Raymond added, noting public health officials, “do the best with the numbers we have.”

 

Header: Photo by Tai’s Captures on Unsplash

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Will Summer Crowds at the Jersey Shore Unleash a New Wave of COVID-19?


Beachgoers seek normalcy after long lockdown, but not without misgivings about pandemic

This story was written and produced by NJ Spotlight. It is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. To read more, visit njspotlight.com.

Full story link – HERE.

By Jon Hurdle

On a warm afternoon at Seaside Heights, Nick Amoresano allowed himself a trip to the beach for the first time in about three months of pandemic-related confinement, but said he wasn’t completely confident that mingling with hundreds of others was the safe thing to do.

“You obviously take a risk when you come out here,” said Amoresano, 21, a college student. “I feel like now, we’re at a point where the total number of cases has dropped enough where we can feel safe going out, for the time being at least.”

On Saturday, Amoresano sat close with friends and shared the beach with others, some of whom were practicing social distancing and others who appeared to be ignoring it, as they tried to shrug off months of stay-at-home orders and state-ordered business shutdowns, and revert to some semblance of normalcy.

He expressed confidence that Gov. Phil Murphy has done the right thing by imposing stringent lockdown orders since mid-March. By comparison with states like Texas and Florida, where a resurgent virus has recently forced the reimposition of some closures, New Jersey set the right policies, whereas those that didn’t act with such force now appear to be paying the price, he said.

“I feel like our government has done a good job so far in keeping everything low-key and closed down for as long as they possibly could, and now the cases are on the way down,” he said. “We were able to flatten the curve.”

But his confidence didn’t extend as far as the Seaside Heights boardwalk about 100 yards away where a throng of visitors, most not wearing masks, were mingling, strolling, and queuing for hot dogs, and women in the long line for the ladies’ room were a lot less than 6 feet apart.

“When you’re walking up there, you are taking a little bit more of a risk but you are passing by these people; you are not really staying in an enclosed area,” Amoresano said. “You hear about these hotspots.”

Renewed concern among doctors

The gathering of large numbers of people in Shore towns as the summer season gets underway has renewed concern among doctors, local officials and even some beachgoers about a possible resurgence in the virus after a significant decline in infections thanks to three months of stay-at-home orders and state-mandated business shutdowns.

As of June 30, the number of new hospitalizations for the virus was down 95% from its peak, while the number of patients in intensive care was down 89%, Murphy said Wednesday.

Towns up and down the Shore are hoping that their businesses can salvage a successful summer season after an economically disastrous shutdown lasting three months in some cases. Local officials are urging visitors to continue to wear masks and stay away from others who are not in their immediate family.

But the Shore’s hopes for a full return to normal activity were dashed on Monday when Gov. Murphy postponed plans to allow indoor dining, which had been scheduled to resume on Thursday, July 2 but have now been put off indefinitely because of the recent surge in infections in many other states and the violation of social-distancing rules by a few New Jersey restaurants and bars.

“Given the current situation in numerous other states, we do not believe it is prudent at this time to push forward with what is, in effect, a sedentary indoor activity, especially when we know that this virus moves differently indoors than out, making it even more deadly,” Murphy said at his daily briefing on Monday.

He said the infection spikes in other states were caused in part by indoor dining by people who weren’t wearing masks.

“We do not wish to see New Jersey experience a similar spike,” he said. “We have been cautious throughout every step of our restart, and have always said that we would not hesitate to hit pause if needed to safeguard public health.”

While most bars and restaurants, and their customers, have complied with social-distancing rules, a few have not, and that risks reversing the state’s progress in curbing the virus, Murphy said.

“It only takes one,” he said. “The careless of one establishment can completely undo the good work of the others. We will not tolerate outlier bars and restaurants and, frankly, patrons who think the rules don’t apply to them. Compliance is not a polite suggestion; it is required.”

Asked at his briefing on Wednesday whether people should stay home or limit gatherings to prevent any COVID-19 spread over the holiday weekend, Murphy urged people to wear masks and celebrate outside rather than inside if they could. But if there’s no option of gathering outside, “I think you’ve got to limit” the number of people, he said.

Photo by Ethan Hoover on Unsplash

Murphy urged New Jerseyans to continue to follow social distancing guidelines so that the state doesn’t experience a spike like those in California and Arizona. “We pray for them, we wish them nothing but a speedy resolution but we can’t let that happen to us, we can’t go through hell again.”

Meanwhile, the mayor of Seaside Heights, Tony Vaz, said his administration hired about 15 “social-distancing monitors” starting at the end of June, to “courteously” remind people on the beach and the boardwalk that they must stay at least 6 feet apart from anyone who is not a household member.

Operators of restaurants and amusement arcades, which can reopen starting this Thursday, July 2, will be responsible for complying with the rules, and will risk ticketing or even the loss of their licenses if they are over-occupied, Vaz said.

The July 4 weekend will be a big test for people’s observation of social distancing because the crowds are expected to be a lot bigger than anything seen since the Shore started to reopen, swelled by the many house rentals that start from July 1, Vaz said.

Unable to enforce mask wearing

He acknowledged that many people on the boardwalk lack masks but said mask wearing is an “individual choice” that he can’t enforce.

“Everybody’s got their own opinions,” Vaz said. “There are people who believe that this is very frightening, and there are people that believe this is a hoax. I don’t like trying to convince somebody that this is not a hoax. I don’t think it’s a hoax at all; we have a problem and it’s gotten better in New Jersey.”

Asked whether the summer rush to Shore resorts like Seaside Heights could undo all the good work that New Jersey has done to curb the virus, Vaz said it will depend on the willingness of businesses and individual visitors to do the right thing.

“We are all going to watch,” he said. “Not only Seaside Heights, every beach community is going to watch. We don’t want 25 percent to become 50 percent. We don’t want to violate anything; once you start violating, you have problems.”

For Dr. Judith Lightfoot, chief of infectious disease at Rowan University’s School of Osteopathic Medicine, beach crowds at the Jersey Shore can’t realistically be expected to practice social distancing because they are too tightly packed, and so represent the start of a potential new wave of infections.

In addition to possible new community spread, the Shore also risks exposure from the virus being brought in from out of state, despite the recent order from the governors of New Jersey, New York and Connecticut that anyone coming from at least 16 states where infections are newly surging should quarantine for two weeks upon entering the tri-state area, she said.

Who’s going to monitor?

“People are migrating into New Jersey, and if they don’t quarantine for two weeks, they are going to be out and about, and who’s going to monitor that?” she asked. “Were they practicing social distancing wherever they came from, even if it was in the tri-state area? Are they going to wear masks?”

Larger groups of extended family visiting the Shore should not assume that they won’t be exposed to COVID-19, Lightfoot warned, because the more people, the greater the likelihood that some of them will bring in infection from outside the group.

And if someone gets infected over the holiday weekend, it won’t take long for it to show up. “If somebody had active Covid over the July 4 weekend, that individual will probably show symptoms within 72 hours to a week,” she said.

At Longport, there are no restrictions on the number of beach badges the town is selling because the beach is wide enough to take the expected number of people this weekend, while not violating social-distancing practices, said the mayor, Nick Russo.

So far this summer, there have been no complaints about social-distancing violations, Russo said. But he said that could become more challenging as rising temperatures draw more people to the water’s edge to cool off, making it more likely that they will move off other areas of the beach, and come within 6 feet of each other.

“It would not surprise me if our police officers remind people: ‘We realize it’s hot, but we still have to do what’s right and try to keep six feet apart,’” he said.

Recognizing the risk

On the beach at Seaside Heights, Aileen Narfolejos, 29, an accountant from Piscataway, had come for a day out with her husband, her parents and her sister. She said they always wore masks on the boardwalk and kept the appropriate distance from others on the beach, but nevertheless recognized that their outing was not without risk.

“We don’t see many people wearing masks, which is worrisome but we can only do what we can do,” she said. “We’re all working from home so we feel safe enough that we can be together without exposing ourselves to the virus.”

Colin Baldwin, 23, a recent college graduate, said he wasn’t so worried about getting the virus because he is young, but is more concerned about giving it to others, and so has given up going to bars and restaurants, even for outdoor dining, which is now allowed by the state.

“It’s something I try to be good about,” he said. “I might grab a water bottle but that would be the extent of it.”

Despite the attempts by town officials to enforce social distancing, and the threat of penalties for bars and restaurants that break the reopening rules, the success or otherwise of Jersey Shore towns in preventing a COVID-19 resurgence this summer will in the end come down to individual action, argued Mayor Russo of Longport.

“We as a government cannot legislate common sense,” he said. “It’s absolutely impossible.”

 

Header: Ocean City, NJ. Photo by Jesse Gardner on Unsplash

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Guidance to Reopen Schools


Governor Phil Murphy and Department of Education Commissioner Lamont O. Repollet announced on June 26 the release of “The Road Back: Restart and Recovery Plan for Education,” which provides guidance to reopen schools this fall.

The plan announces that, absent a change in public health data, public schools will open for in-person instruction and in some capacity at the beginning of the 2020-2021 school year. Individual school districts together with community stakeholders will be expected to develop plans that best fits their own district’s needs.

The guidance sets the minimum standards for returning to school and describes several health and safety standards to be prioritized in school reopening:

  1. Social distancing: Schools and districts must allow for social distancing within the classroom. This can be achieved by ensuring students are seated at least six feet apart. If schools are not able to maintain this physical distance, additional modifications should be considered. These include physical barriers between desks and turning desks to face the same direction (rather than facing each other)or having students sit on only one side of a table and spaced apart.
  2. Face coverings: School staff and visitors are required to wear face coverings unless doing so would inhibit the individual’s health or the individual is under two years of age. Students are strongly encouraged to wear face coverings and are required to do so when social distancing cannot be maintained, unless doing so would inhibit the student’s health. It is necessary to acknowledge that enforcing the use of face coverings may be impractical for young children or certain individuals with disabilities.
  3. Limited capacity: It is recommended that students and staff be seated at least six feet apart in class when practicable. When weather allows, windows should be opened to allow for greater air circulation.
  4. Cleaning/disinfecting: Procedures must be implemented by each school district for the sanitization of school buildings and school buses. Increased hand washing measures are also important for students and staff.

These provisions are informed by Centers for Disease Control (CDC) guidelines, which call for protecting staff and students who are at higher risk for severe illness, such as providing options for telework and virtual learning; providing reasonable accommodations for older adults (65 years and older) and individuals with serious underlying medical conditions; and, when possible, keeping early childhood students apart during naptime and avoiding close-group activities like reading circles.

Other provisions in the guidance include:

  1. Cafeteria directors should consider staggering meal times to allow for social distancing; discontinuing self-serve or buffet lines; having students eat meals outside or in their classrooms; and requiring staff to disinfect eating areas between groups.
  2. Recess should also be held in staggered shifts, with efforts to promote social distancing and hygiene protocols.
  3. Cohorting: Schools may wish to identify small groups of students and keep them together (cohorting) to ensure that student and staff groupings are as static as possible, thereby limiting exposure to large groups of students.
  4. School bus operators should encourage social distancing. CDC guidelines recommend seating on a school bus such that there is one student seated per row, skipping a row between each child, if possible. Barriers separating rows of bus seats may also be considered. If social distancing is not feasible, face coverings must be worn by students who are able to do so. Increased ventilation (i.e. opening windows) is also recommended in the guidelines.

As being able to reopen schools is dependent upon health data and informed by experts in the health field, districts will need to be prepared to switch to remote instruction at any time during the 2020-2021 school year should circumstances change. The guidance stresses that each school district should be working to ensure every student has a device and internet connectivity available, and it identifies funding streams available to school districts to ensure students have access to technology.

Districts should strive to share preliminary scheduling plans to reopen schools with staff, families, and students at least four weeks before the start of the school year in order to allow families to plan childcare and work arrangements.

Click here for a summary of the guidance.

Click here for the full guidance.

For more on the Jersey City School Board’s plans to reopen schools, please see Sally Deering’s coverage J.C. School Board prepares for September reopening.

 

Header: Dickinson High School, Jersey City Times file photo

 

 

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CDC Contract Tracing

Contact Tracing Plan for NJ: What We Know Now


Contact Tracing Plan for NJ: What We Know Now

This story was written and produced by NJ Spotlight. It is being republished under a special NJ News Commons content-sharing agreement related to COVID-19 coverage. To read more, visit njspotlight.com.

Full story link – HERE.

Lilo H. Stainton

It’s seen as a critical pillar in plans to reopen New Jersey and could involve hiring at least 5,000 people at costs that could top $5 million a week, but significant details about the status of a contact-tracing program are still at least a week away.

Gov. Phil Murphy on Monday urged patience about plans to establish a contact-tracing corps and said his administration expected to provide additional details on the initiative in seven to 10 days.

Contact tracing is critical as the state moves into Stage Two of its reopening strategy in the weeks to come, with restaurants offering outdoor dining, hair salons welcoming customers, and a quarantine-weary public flocking to parks and beaches, amid worries among experts that the virus could flare up once again.

The contact-tracing process involves identifying and tracking down all those who have come in contact with someone diagnosed with COVID-19, informing them of the risks and connecting them with a safe place to be isolated, if needed, to help cut down on the spread of the virus.

Murphy stressed its importance when he first outlined a broad strategy for reopening New Jersey’s businesses and public spaces in late April. The work requires individuals who can connect culturally with the people they call, and the governor has underscored the need to hire tracers from local communities.

Contact-tracing workforce

Two weeks later, in mid-May, the state released limited details about its plans for expanded COVID-19 testing, contact tracing and follow-up services, which Murphy said would cost “hundreds of millions of dollars.” They included a proposal to hire a company to create and oversee the contact-tracing workforce, which would be deployed to supplement the 800 to 900 contact tracers now at work on behalf of local or county health departments. The draft included a pay scale for these workers ranging from $25 an hour for tracers to $30 an hour for 21 county coordinators.

In the May announcement, Murphy stressed testing was just part of the solution. “We also have to have the infrastructure in place to fully follow up on those tests, and to reach out to those who may have been exposed to COVID-19 by someone who tests positive in the future,” he said.

As of Tuesday, COVID-19 had been detected in nearly 162,000 New Jerseyans, including nearly 11,800 who have died.

“In fact, contact tracing has not only been going on throughout this emergency, it is a practice that has been employed in other efforts to fight communicable diseases. The only thing that differs from those instances and today is the scope and the scale,” Murphy said. “In other words, we’re going to have to use contact tracing unlike it’s ever been deployed before.”

New details

Here’s a look, then, at what’s now known about the contact-tracing effort:

It will build on existing work: Contact tracing is a longstanding practice that epidemiologists use to control the spread of contagious conditions like HIV/AIDS and sexually transmitted diseases and has traditionally been handled exclusively at the local or county level, according to the draft guidelines for potential contractors. But some local health offices — which typically handle issues ranging from restaurant inspections to local flu outbreaks and have limited staff and financial resources — have been overwhelmed by added workload created by the pandemic.

State officials signed an agreement with the Rutgers School of Public Health to use recent graduates as part of this tracing corps. They have also consulted leaders at the four regional health hubs, coalitions that have evolved out of data-sharing projects designed to improve care for individuals in Camden, Trenton, Newark and Paterson.

It will tap tracers who reflect the community: While it is not clear if and how these hubs will be used, those involved said they feature deeply rooted community partnerships that could enable the state to find contact tracers who share the culture and background of those they need to reach.

“You have to be able to find (contact tracers) who can gain the trust of the community,” said Gregory Paulson, president and CEO of the Trenton Health Team, the hub based in Mercer County. “We look forward to working with the state as they roll out this process.”

It could require thousands of people and tens of millions of dollars: Estimates range greatly and depend on the number of individuals who test positive, but Murphy first suggested the state might need to hire as many as 7,000 additional contact tracers. When the draft guidelines came out in May, the anticipated need had been reduced to between 1,000 and 5,000 tracers.

The draft proposal also envisions hiring from 50 to 250 supervisors, depending on staff levels, as well as at least one data manager, social support coordinators and program coordinator in each of the state’s 21 counties.

Wages could run between $1.13 million and $5.37 million each week, if paid on the scale envisioned.

It will require outside help: The plan also calls for the state to hire a firm, or joint venture, that would recruit tracers and other staff, working with local nonprofits and other groups to ensure they represent local communities. The entity would then train these workers, provide technology if needed, dispatch them to support local departments as needed, oversee and administer benefits for the workers, and ensure that all data is properly entered into a shared system.

Murphy also signed an executive order requiring all tracers to be using the same web-based platform and the state has contracted with two firms to create a centralized database and uniform reporting system.

It’s going to matter more as New Jersey reopens: The rate of new cases in New Jersey has generally trended downward since April 22, but hundreds of additional COVID-19 cases are still being discovered every day. Plus, testing capacity continues to expand, meaning more people will be diagnosed with the virus.

“Implementing a robust contact tracing program is a key mechanism to break the chain of transmission and slow community spread for individuals who have come into contact with those infected by COVID-19,” the state said in the May 12 press release that outlined its intentions.

 

Header: Photo by CDC on Unsplash

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