Epidemiology department chair Albert Ko spoke about handling the COVID-19 pandemic and reopening the state in a virtual talk on Sept. 22.
Ko first spoke broadly about influences on and challenges with the pandemic and then delivered a more detailed discussion on the specific steps taken in Connecticut to handle the crisis. He cited demographics and behavior, international traveling commerce, land use, presence of wild animals in domestic markets, crowded urban centers and the climate as having large influences on the development of pandemics. COVID-19 is no exception.
“A lot of the biology, the environmental features, the ecology and the social features really kind of shaped where we’re at right now with public health interventions,” Ko said.
Ko, along with former CEO of PepsiCo and Co-Chair of AdvanceCT Indra Nooyi ’80 SOM, co-chaired the Reopen Connecticut Advisory Group, created at the height of the pandemic to advise the Lamont administration on COVID-19 policies for the state. Ko stated that one of the group’s first priorities was to create a multidisciplinary team to advise the governor’s office about a plan to reopen Connecticut.
He listed points the group aimed to address: the need for science-driven policies, protecting citizens at higher risk and understanding risk stratification, ensuring that the health system was ready to handle the needs of patients with and without COVID-19, minimizing harm to the economy and laying the groundwork for future crisis responses.
“You couldn’t look at this epidemic and pandemic only through the lens of public health, given the increases we had in domestic violence and child abuse, the long term developmental effects it had on our children, as well as in terms of the economic effects of unemployment, especially for our most vulnerable population,” Ko said. “So this was really a multi-sectoral, interdisciplinary effort to come up with this plan.”
Another priority for Ko was testing. Ko said that many people with symptoms, such as headache or cough, stayed at home without knowing they had COVID-19. This issue resulted from a shortage in testing. He emphasized the importance of being aware of COVID-19 diagnoses, so that healthcare professionals could act in a timely manner and to ensure that transmission in hospitals is monitored.
To this end, testing in the state was increased from about 800-1,000 tests per week in April to about 100,000 tests per week currently. But even as testing capacity increased, people without cars were often rejected from testing centers.
“It was the wealthy, suburban populations who had cars that were able to go to the drive through centers, not the population that were most vulnerable,” Ko said. “That issue of access was so key in testing, in the issue of decentralization and democratization of testing and public health. And it was really kind of a theme that runs its course through COVID.”
Ko stated that the reopening advisory group looked at small businesses, restaurants, salons and museums, given that they comprised only 10-12 percent of the gross state GDP but accounted for 43 percent of unemployment claims. The group created a scoring system to measure the contact intensity of various businesses as well as how easily their venues could be modified to abide by public health guidelines.
They mapped out the economic benefit of reopening against public health risk to inform their decisions. The reopening plan was designed in phases and “baby steps,” with social distancing guidelines and face mask use emphasized, according to Ko.
He concluded by stating that a resurgence in COVID-19 will happen, but noted that the next wave could look a lot different from the first, given that social distancing measures and public health guidelines are already in place.
Dean of the Yale School of Public Health Sten Vermund echoed the need to follow current social distancing measures.
“In the absence of a vaccine and in the absence of better drugs for treatment we’re left with classic public health strategies for reducing transmission risk,” Vermund said. “You’ve memorized them by now — we all have — mask use, physical distancing, hand and surface hygiene, small groups and air quality. To some extent, even with reopening Connecticut, we’re still trying to maintain a lot of those principles.”
A main point that Ko emphasized during his talk was the extent to which COVID-19 impacted nursing homes in Connecticut, which was a “major disaster.” Over 4,000 deaths in the state were among nursing home residents, and 11 percent of all nursing home residents died due to this disease.
Sunil Parikh, associate professor of epidemiology and of medicine, cited the lack of attention on nursing homes and asymptomatic testing as primary reasons for the devastation.
“Now that testing is more available, there are new/evolving guidelines to do testing of all residents and staff at periodic intervals,” Parikh wrote in an email to the News. “This was not true in the early part of the pandemic, largely because testing was not widely available, and the financial logistics had not been worked out. This has to be continued in order to identify early outbreaks before they spread in homes.”
Parikh said that reopening visitation in nursing homes, while necessary for the emotional well-being of families, could increase the risk of outbreaks in these high-risk communities.
He, in addition to both Ko and Vermund, noted overall fatigue from COVID-19 social distancing restrictions as an additional concern. The labor-intensive and time-consuming nature of testing being placed on limited staff contributes to this fatigue and should be taken into consideration in the near future.
“We have seen that outbreaks can spread through homes within just a few weeks, so we need to continue with testing, maintain PPE supplies, and continue inspections and training,” Parikh wrote.
As of Wednesday afternoon, there have been 57,329 COVID-19 cases in Connecticut.
Maya Geradi | firstname.lastname@example.org