After a staff member at CCS tested positive for the Coronavirus a week before school started, the Chronicle thought it might be especially fruitful to interview Cornwall resident Denis Nash, Distinguished Professor of Epidemiology and Executive Director of Institute for Implementation Science in Population Health at the City University of New York, about how Covid-19 might affect Cornwall this coming fall and winter.
Chronicle: Are full-time residents of Cornwall right to think themselves relatively unexposed and thus “safe” from infection by the virus?
D.N.: It does appear that there’s very little transmission going on in Cornwall right now, but the positive case at the school reminds us that this place is not isolated; there are going to be cases. We have to take precautions. The fall is a special time; people are moving around, kids are coming back together at school so I expect to see a slight increase in cases everywhere but it could be both because people will be mixing more, and also testing more. The more testing the more likely you’re going to find cases, and that’s good, because once you know about cases you can get out in front of the virus.
Chronicle: You helped develop the protocol for COVID protection at the Cream Hill Lake Association. Any lessons from that?
D.N.: We started talking about it in May and early June. We decided to close the lake house because we didn’t want to worry about indoor transmission. That way most of the activities would be outside. Our biggest concern was how closely people would adhere to the guidelines we set out: wearing a mask when within six feet of someone not in your family or household; keeping distance whenever around others or moving around from Point A to Point B. Wearing masks reduces the risk outdoors and also makes people feel comfortable, knowing others that people are taking precautions. We increased communications to make expectations very clear and developed a set of frequently asked questions for members. We were very happy to see that over the course of the summer the rules became part of the lake culture. So, Lesson #1 is it’s possible to create a culture change without too much disruption in people’s experience. And Lesson #2 is that we should not expect there to be 100% compliance with protocols, that it’s better not to point fingers, to be punitive, chastising, or shaming but instead to model the behavior, communicate what’s expected, and remind people of the behavior gently if they’re having trouble adhering to it.
Chronicle: We were all relieved when summer came and we could be outdoors where it was safer and we could socialize more, if at a distance. Any ideas about how Cornwallians might continue limited social interactions as the weather cools, including for upcoming holidays like Thanksgiving?
D.N.: It’s still important to be cautious. Try to keep social activities as much outdoors as you can; if you’re indoors, use masks; keeping windows open is always a good thing. I also encourage people to think about safely forming “quarantine pods,” a small group of people outside your family that you want to socialize with safely. Have conversations with each other and agree on a certain set of rules and expectations so that you’re comfortable that everyone can keep the group safe. If it’s really important for people to be together on Thanksgiving, it’s not impossible, but it takes planning. Everyone would need to do two weeks of quarantine in advance, and the process of getting to wherever you’re going also has to be safe. Drive from New York City to Connecticut, but do not fly from Birmingham to Hartford, unless you are planning to quarantine in Connecticut for two weeks prior to Thanksgiving dinner!
Chronicle: Can you say a few words about the ISPH?
DN: The vision of the CUNY Institute for Implementation Science in Population Health (ISPH) is to achieve population health gains through better implementation of proven strategies that promote or protect health. We study how to translate and scale-up evidence-based interventions and policies within clinical and community settings in order to improve health and reduce health disparities.
Chronicle: Your “CHASING COVID” was one of the first research projects about the pandemic. Can you tell us what you hope to learn from it and when?
D.N.: We have two big COVID studies right now. The first is the CHASING COVID study which we launched back in March, when things were surging in NYC and our research institute — we were all quarantined, working from home — wanted to step up and do something related to this problem which we saw as very problematic for New York but that other jurisdictions around the country would also be dealing with eventually. So we decided to do a national cohort study. At the time a lot of people were mobilizing to do one-off surveys where they would get blood specimens from everyone going to a grocery store or a drive-thru testing site and estimate the SARS-CoV-2 prevalence. What we’re doing that’s different is we’re following the same people forward in time. We’ve enrolled about 6000 people from across the US into longitudinal follow up. We got a blood specimen from them at baseline which we have tested for antibodies and we will test folks again over time and follow which people go from being antibody negative (seronegative) to antibody positive (seropositive) for COVID-19. A longitudinal approach allows us to do a few things: without blood specimens we can see how people are changing their behaviors in response to different factors related to the pandemic such as mask usage, large gatherings, testing, and contact tracing. We’re asking our participants about all these different things over time, and since we’re looking all over the U.S., we can see where things are changing and where they’ve stabilized. One of the things we hope to learn is the extent to which having antibodies to coronavirus protects you from subsequent infection. This is a big unanswered question right now, though we are beginning to see some small studies or single instances of people who have been infected twice. But there are no large epidemiological studies of the issue. Are people who have antibodies protected? If we knew that they were that could change a lot about how we move forward and open up society.
Chronicle: Are all these 6000 people who have had COVID or not?
D.N.: No. The only criterion for them to join the study was to be an adult over 18 residing in the 50 U.S. states, D.C., Puerto Rico, or Guam. We’ve tested about 4000 of the first specimens so far, we started early in late March and early April. A lot of our participants were negative; somewhere between 2 and 3 percent were positive, and we’re following them over time and when we test again, probably be in October or November I expect that number to be quite a bit higher. Right now we’re rushing to compare the rate of developing new Covid-like illness among those who had positive antibodies to those who were seronegative. We want to be able to say something about this question as soon as possible.
The other study we’re launching as we speak is a cohort of K–12 teachers and educators. We see the teachers in the U.S. as what health care workers were back in the early days of the pandemic, often having to work in conditions that are not necessarily safe and often not having access to personal protective equipment or testing. States and cities are taking many different paths in opening up schools this fall: in-person, remote, or a hybrid; some in areas with a lot of cases, others with few, some schools with testing protocols, others without. So with this cohort we will try to understand the impact of these different strategies through the lens of the teachers. One of the key questions we hope to answer is the extent to which different school reopening strategies drive bumps or surges in Covid-19 transmission in the surrounding communities.
Chronicle: Is that also across the country?
Yes, that will be national. We won’t offer testing immediately, I would love it if we could, but similar to the CHASING COVID Cohort study, we launched this with limited funds but then we applied for a grant from the NIH to pay for the testing and that’s how we got the CHASING COVID study funded and were able to pay for the testing. So we don’t know if we can offer testing to our teachers for a little while yet. This new study is called the ‘The Educators of America COVID CoHort Study’, or TEACCH Study. If you know someone working in education right now who might be interested in participating, please tell them about it! For more information go to https://cunyisph.org/teacch-study/.
Chronicle: Do you have any thoughts about more extensive testing and prospects for a vaccine?
D.N.: I’m very hopeful. Everyone always talks about game changers like a vaccine or a treatment, but my hope is that a game changer much sooner lies in the arena of testing. If people had access to the more rapid antigen tests that can be done frequently and without a health care provider or laboratory, it would contribute as much to curtail transmission as a vaccine would in the short term. And we could have it as soon as September or October.
Chronicle: When a vaccine comes won’t it take time to roll out?
D.N.: Yes, and there are not going to be enough doses to vaccinate everyone immediately so there have to be priority levels with health care workers and first responders at the top of the list. Then there’s a whole lot of other groups according to their risk of having a bad outcome, people with co-morbidities or live in congregate settings like nursing homes.
Chronicle: What if it’s a relatively untested vaccine?
D.N.: I agree we’d have to be convinced that the vaccine was safe before we roll it out widely. But in the context of widespread transmission, people in these nursing homes where there is transmission in the community are like sitting ducks. There may be some risk associated with the vaccine, but there’s a real risk of death if the virus is introduced into a nursing home.
—Paul De Angelis
📸: Denis Nash (photo submitted).