New York: New York City has kept its Covid-19 infection rates low, but the risk of a resurgence looms over the Big Apple as fall approaches.

The city has been a success story in combating Covid-19 since March and April, when the pandemic swept through its boroughs killing thousands of people. Yet the strategies that helped suppress the first surge — dropping the infection rate to just 1% statewide — will be tested as cooler weather pushes people together indoors.

Melbourne, Australia, with 5 million people, offers a case in point. With the Fahrenheit dropping into the 50s, Melbourne has seen an upswing in cases, a foreboding indicator of how tough it may be for cities like New York to control infections as the mercury drops. With fall and winter approaching, it’s “inevitable” Covid-19 cases will tick up, said Ashish Jha, director of Harvard University’s Global Health Institute.

“I am worried about complacency,” Jha said in an interview. “New York went through such a difficult few months, and I am worried that people are tired. A lot of people are looking at New York over the next six months and saying: ‘Could we possibly see a spike?’”

New York’s success is seen as somewhat of a beacon for the rest of the country. If the city can keep its rate low as it reopens through the fall and winter, then epidemiologists say its efforts can serve as a model for other big cities nationwide.

The city entered Phase 4 of the state’s reopening plan on July 20. Stores are open, though with capacity limited, and New Yorkers can enjoy outdoor dining at restaurants. However, indoor dining, bars and gyms remain closed while the wearing of masks, social distancing and aggressive hygiene practices are still being pushed as imperative.

When the U.S. passed a grim milestone with more than 150,000 Americans having died from the pandemic, New York reported just 59 new cases citywide on Tuesday. Meanwhile, on Thursday, Florida and Arizona reported record death tallies.

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State actions

The state is already taking steps to head off any uptick. On Thursday, Governor Andrew Cuomo said New York is making $30 million available to counties to increase contact tracing as well as testing for the coming flu season, which generally hits in the fall and winter.

Influenza will pose problems, he said, since symptoms will look like those of Covid-19. Tests must be done at the same lab facilities that already are busy conducting coronavirus testing, according to Cuomo. “That could affect the turnaround time on the Covid tests, so we want the counties to be ready,” he said.

The city has also developed a testing and contact-tracing initiative called NYC Test & Trace Corps. Contact tracing is key in finding suspected cases, identifying clusters and isolating the sick. Though it must be paired with a quick turnaround for test results.

“You’ve got to have testing in order to have contact tracing,” said Ted Long, executive director of NYC Test & Trace Corps. “Moving forward we’re going to watch like a hawk the turnaround times for each of the individual labs to figure out what we need to do to improve the turnaround times overall for the city.”

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Pooled testing

Taking advantage of available testing methods is a crucial strategy in containing the virus’ spread, said Lorna Thorpe, professor and director of the Division of Epidemiology in the Department of Population Health at NYU Langone.

For one, the city’s current infection rate of approximately 1%-to-2% is within the threshold for pooled testing, which is most effective in areas with very low infection rates. The strategy combines multiple tests together in a single batch. If the pool comes back negative every person in that pool is considered cleared. If the pool is positive, each sample will need to be tested individually.

“Pooled testing is critically important to have in New York City,” Thorpe said. “To have the ability to do it, and to have the systems well designed to do it so that we can increase our testing capacity in particular populations as needed to be on top of the spread of the virus.”

Quest Diagnostics Inc. was the first lab to gain emergency authorization for pooled testing this month. Laboratory Corp of America Holdings was approved for emergency use shortly after.

Mass use of point-of-care rapid tests will also prove useful in containing the virus. The tests which can be processed on site without needing to be sent to a lab can yield results within 15 minutes. However, scaling production to meet the needs of a pandemic have been difficult and so far unsuccessful.

“Ensuring that testing is widely available, making testing available and accessible to the groups that are at higher risk for infection,” and having a vigorous contact-tracing program are all crucial to avoid a new surge of the virus, Thorpe said.

As the city moves into fall and winter, the public needs to acknowledge that in order to keep infection rates low, New Yorkers all need to accept that life has entered a new normal and keep protections like masks, and social distancing in mind.

It is “highly unlikely” New York City will go through another lock down, according to Jha. “The level of mismanagement that you would need to have a city-wide lockdown like what happened in March is pretty substantial,” Jha said. But he added that it’s not out of the realm of possibility.

While low case counts and improved testing capacity give New York a leg up in combating a potential second wave, residents must stay vigilant and not put their guard down or they could lose that advantage, according to Jha.

“The most important thing is to not squander that by letting up too much and relaxing too much over the next couple of months,” Jha said. “You don’t want to go into the fall with rising infections.” –Bloomberg

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