With 77% of adults at least partially vaccinated in Schenectady County, local officials hopeful worst is over

Keith Brown, interim director of Schenectady Health Public Service, is pictured on Thursday outside the Schenectady Inner City Mission, where weekly COVID-19 vaccinations are held.

Keith Brown, interim director of Schenectady Health Public Service, is pictured on Thursday outside the Schenectady Inner City Mission, where weekly COVID-19 vaccinations are held.

SCHENECTADY — With just a handful of new infections reported each day in late May and early June, Schenectady County is bottoming out for the fourth time in the COVID-19 pandemic.

And with nearly 77% of adult residents now at least partially vaccinated, the pandemic may finally be at a point where it can’t bounce back.

Every county in the state has had its ups and downs with the virus that has surged and ebbed in waves over the last 15 months, infecting more than 2 million New Yorkers and killing more than 42,000. But Schenectady County’s path has seemed particularly bumpy at times:

  • Two major and two minor surges in positive test rates, in April, July, August and December 2020;
  • Decreases to 1% or lower after each surge;
  • Early frustration getting vaccine allocations;
  • Recently, the highest adult vaccination rate of any county in the state.

Schenectady County officials and medical personnel last week discussed the recent past and likely future of public health efforts with The Daily Gazette.

They all are cautiously optimistic that this may be the last lap in the pandemic, or that future laps will be much less painful and costly than previous phases.

Barring the spread of some new variant of the coronavirus that the current array of authorized vaccines aren’t as effective at treating, the pandemic may be subsiding for the last time.

“It’s a really different feeling to be heading into this summer,” said Keith Brown, interim director of public health.

“It feels like we’re on the tail end,” said County Legislator Michelle Ostrelich, chair of the Legislature’s Health & Human Service Committee.

“Cautiously optimistic” is a good way to describe the current situation, said Dr. David Liebers, a veteran infectious disease specialist and chief medical officer of the only Schenectady County hospital that admits COVID patients.

People are still getting infected with COVID every day and Ellis Hospital admitted a new COVID patient each day last week. But the numbers are a fraction of what they were at the start of 2021, and the new variants of the COVID virus have not yet proved a serious threat.

ROUGH START

Schenectady County made preparations for the arrival of COVID-19, which was first confirmed in the state on March 1, 2020, and first confirmed in a county resident 12 days later.

The preparations proved to be incomplete and inadequate here and in thousands of communities nationwide — too little was known about COVID and its impacts to effectively prepare.

As of June 1, the 15-month mark, 13,167 of the county’s 156,000 residents had been confirmed infected and 44,078 quarantines or isolations had been ordered.

Supervising Public Health Nurse Claire Proffitt said that Schenectady and other counties had long rehearsed their response to an outbreak of a serious disease. But since Sept. 11, 2001, the preparations had been more focused on a possible bioterror agent such as anthrax, which would be an intense, short-term effort.

Instead, they got a long-term crisis requiring a sustained campaign of infection prevention, public education, tracing paths of transmission and vaccination. 

Even a month before COVID arrived, the county was still girding for that short, intense effort.

“Feb. 4 was kind of like a defining day for me,” Proffitt said. That was the day they printed out the badges — which were never used — that would be issued to people allowed to be out in public while everyone else stayed home.

“Early on we had a good MRC, medical reserve corps, but it wasn’t enough for contact tracing,” said County Manager Rory Fluman.

One of the defining early days for Fluman came in mid-March, when a cafeteria worker at a Niskayuna school came down with COVID, potentially exposing 200 children to the virus.

“We were one of the first counties to have a super-spreader event,” he said. “So we were, early in the pandemic, understanding how powerful the virus was in transmission.”

The county built a contact-tracing team before such efforts were in wide use, he added.

And that tracing started before the state rolled out computer software for the task, Proffitt said: “We were literally making paper sheets to track people.”

SHIFTING DETAILS

Shortages of face masks and test kits were an obstacle early on, as was the frequently changing guidance: Children aren’t vulnerable, or they are; wear a mask, masks are ineffective, wear two masks; patients without symptoms cannot spread the virus, oh yes they can.

The shortage of masks and test kits was eliminated but the evolving science created doubts that still reverberate today.

This sort of learning curve is inevitable with a new disease, Brown said. “It’s crucial in understanding what happens in a public health crisis and it also explains a lot of why we’re struggling with misinformation now.”

The state shutdown and widespread unemployment gave people an abundance of free time to fret over these details and share their thoughts on social media, Proffitt said. “I think we were often playing catchup with messaging that was wrong or deliberately false.”

That’s a key takeaway from 2020, she said — the need to look at “how we’re giving information to people as it’s changing.”

Guidance needs to be clear, honest and explained, she said, and public health departments in too many instances failed on all three levels.

COVID is the third public health crisis Brown has experienced in his career, after HIV/AIDS and opioid overdoses. He sees similarities between the myths about COVID and the idea that mosquitoes could transmit HIV.

“Once people have misinformation, it’s way harder to correct that.”

WHAT WENT WELL

Ostrelich said a key factor in Schenectady County’s pandemic response was the inclusion of community organizations in partnerships. This approach evolved from the aftermath of Tropical Storm Irene in 2011, she said, and gave the Public Health Services department a reach far exceeding what it would have on its own.

These partnerships exist in normal times, such as with Code Blue efforts to keep homeless people safe in winter, “But this really was an opportunity for everyone to come to the table and that collaboration really was an opportunity for success,” Ostrelich said.

Planning was important but she gives full credit to the people on the ground: County employees involved in public health have been going nonstop, she said, and those with non-health jobs stepped up for food delivery or other tasks.

Proffitt said efforts to diversify the public health workforce while expanding it paid off. “I think that really is a big part of what has helped us be so successful in our vaccination rates,” she said.

And hundreds of volunteers have joined the effort, mostly at vaccination sites but also in contact tracing, Proffitt said.

“People really stepped up,” she said. “It was a really beautiful example of the community.”

Health workers’ willingness to work for public good at the risk of their own safety — especially at the beginning, when not enough was known about the disease, and masks were in short supply — is also cited repeatedly on lists of what went right in the last 15 months.

“I’m not saying this surprises me, but it was very satisfying to see the courage and work ethic of everyone on the front lines,” Liebers said. “It was amazing — no refuseniks. Everyone who was asked to jump into the front line did so.”

Brown said that today, with the virus on the wane, public health workers are subject less to potential infection than to ridicule as they try to reach the doubters within the community.

He recalled being out in the Becker Street/Brandywine Avenue area one evening in late May with some of his staff members conducting public education. They took some guff from people in the area and they kept right on going.

Public health nurses and outreach workers also deal with people who are more polite but just as skeptical. They continue to try, one dose at a time, to get the county closer to the point of herd immunity, where enough people are vaccinated that the disease can’t easily spread.

“It’s hard to put into words how the actions of each person have impacted our community,” Brown said.

NOT DONE YET

Schenectady County has had the highest per-capita rate of COVID-related deaths among the four large Capital Region counties, though the rates in four of its smaller neighbors are significantly higher.

Liebers cautioned that it’s too soon to dismiss the pandemic as a threat.

Just 46% of New Yorkers were fully vaccinated as of June 1, he said, and new variants of the virus pose a potential future threat — if not to people who are vaccinated then to those who are not. A more rapidly spreading variant, for example, could hit a subpopulation or cohort with a particularly low vaccination rate, such as teenagers and young adults, Liebers said.

Brown said the continuing low vaccination rate in some minority communities reflects inequities that predate COVID-19 and will remain after COVID is vanquished.

“One of the things we’ve learned in this pandemic is our societal safety nets are not enough to be a protective net in a situation like this,” he said.

Brown believes putting community organizations front and center in the partnership with the county made a difference in reducing the disparity.

“The only successful way is to have the people closest to the issue driving the effort to address the issue,” he said.

LESSONS LEARNED

When the pandemic is over, whenever that is, its lessons will be incorporated into a new normal for public health efforts.

Ostrelich said the list of successes, failures and gaps needs to be gathered from all who were involved and then systematically examined not just from a public health perspective but for contributing factors such as housing needs and the business community.

“We are in a unique position to bring the community’s needs back,” she said, and she encouraged people to tell their legislator about programs and initiatives that have succeeded in the last 15 months, or that went awry.

Proffitt said all the other functions Public Health Services performs — lead poisoning prevention, rabies clinics, advice for breastfeeding mothers, overdose treatment training, combatting other communicable diseases — haven’t paused during the pandemic, they’ve just been overshadowed.

They’ll return to the fore, she said.

Liebers said Ellis will make changes in its day-to-day operations.

“I think we have seen so little influenza [in 2021] that we may be looking for the foreseeable future at wearing masks in patient areas,” he said.
Also, visitation policies will be reviewed with an eye toward limiting disease transmission.

And seeing the doctor via a smartphone or computer is likely to endure, he said: “Honestly, I think that using the modality of remote telemedicine was a necessity and now we see a role for it going forward in certain circumstances.”

But discussions about these changes won’t begin formally until the pandemic is over in name and effect, Liebers said.

“I think we’ve all learned the lesson not to write the book yet.”

Brown said one lesson is that public health departments have been underfunded for the last decade. Another takeaway is that they were fundamentally not structured for the best response to the crisis.

“This has exposed that we’re not able to do the mitigation strategies that would have prevented a lot of deaths,” he said.

Looking at the COVID, opioid and HIV/AIDS crises, he finds the same broad groups of people disproportionately affected in each.

“A lot of it is eerily similar,” Brown said, pointing to a need for public health workers to deepen their relationships with the communities most often impacted.

“We take that moving forward for the next crisis,” he said.

BY THE NUMBERS

Here are some COVID-19 statistics for Schenectady County as of June 1:

  • 1.0% of tests positive on a seven-day average
  • 4 COVID-positive inpatients at Ellis Hospital and 1 suspected
  • 67 active resident infections
  • 76.5% of adult residents at least partially vaccinated, highest in the state
  • 63.1% of all residents at least partially vaccinated, third-highest in the state.

And here are some statistics from March 1, 2020, to June 1, 2021:

  • 13,167 positives out of 414,182 tests administered
  • 44,078 quarantines or isolations
  • 203 resident deaths
  • 32 nursing home resident deaths, second lowest per-capita in the region
  • 22 assisted living facility deaths, highest per capita in the region and one of the highest in the state.

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