ALBANY COUNTY — On Wednesday afternoon, the Capital Region was still two metrics short of meeting the seven criteria set out by Governor Andrew Cuomo to begin the first phase of reopening on May 15.

As COVID-19 rates decline in Albany County, the tenuousness of meeting metrics was made clear as one metric the Capital Region had met on Tuesday was too high on Wednesday.

A mark the region has never met is to have a 14-day decline in hospital deaths or fewer than five deaths in a three-day rolling average; the Capital Region as of Wednesday had six daily deaths. Albany County Executive Daniel McCoy had said earlier that the region has a large number of nursing homes, which he called “ground zero” for COVID-19.

He said on Wednesday that “nursing homes should be counted differently” and he had asked the state to look at that but had not yet heard back.

The region’s once-met metric requires a sustained decline in the three-day rolling average of the people hospitalized with COVID-19 on a given day over the course of a 14-day period, or, alternatively, if the daily net increase in total hospitalizations measured as a three-day rolling average has never gone over 15. The Capital Region is at 18.

Albany had met the mark on Tuesday, but went over 15 by Wednesday. McCoy had said on Tuesday that regional hospitals, like Albany Medical Center and St. Peter’s, which draw patients from outside the area, shouldn’t have the deaths of those patients counted in the tally.

“The plan is done,” McCoy said on Wednesday. “Now I’m just getting sign-offs from the other counties.” He said earlier in the week that he hoped to submit the plan by Friday.

In addition to Albany County, the Capital Region includes Columbia, Greene, Rensselaer, Saratoga, Schenectady, Warren, and Washington counties. McCoy noted that each of the counties have individual needs, citing tourism in Saratoga County with the trace track and agriculture in Greene County.

On Wednesday, Cuomo announced that the North Country had met the metrics to begin the phased reopening, joining three other regions that had qualified earlier in the week: Finger Lakes, Mohawk Valley, and Southern Tier. He also said that the Central New York Region is close. A dashboard with each region’s progress is posted on the state’s website.

“New Yorkers will know exactly what is happening in their region and in their county on a daily basis, and the state will continue to monitor these metrics to determine when regions are ready to reopen and if we need to adjust the reopening plans,” Cuomo said on Wednesday.

The first phase opens construction; manufacturing and wholesale supply chains; retail for curbside pickup and drop-off or in-store pickup; and agriculture, forestry and fishing. A guide to the state’s “NY Forward” reopening plan outlines both the plan’s philosophy and strategies.

The Capital Region can start whenever it meets the metrics and has its plan accepted, McCoy said; it doesn’t have to wait for June 2, the date the second of four phases can begin. (See related story.)

New York’s region-by-region phased reopening comes in the midst of a national debate, with the president having lifted national restrictions, leaving it to individual states but encouraging “liberation,” while Anthony Fauci, an expert on infectious disease and an outspoken member of the White House Coronavirus Task Force, has said, if reopening happens too quickly, there is a risk of resurgence.

In his North Country press briefing Wednesday, in Jefferson County, Cuomo said, “You see how fast we went up and how much slower the decline was and that’s important. That’s what the national experts are talking about when they say you could have an outbreak that you couldn’t recover from … You see how fast it went up and how many days of super effort by New Yorkers it took to get that spread under control and to reduce the rate of new cases.”

New York State, particularly the greater New York City area, has been the epicenter of the disease for the nation. Hospitalization and death rates have been steadily declining, as Cuomo announces in his daily press conferences, and he has fashioned a plan for reopening with what he calls a “circuit breaker.”

The numbers in each region are to be closely monitored by a “control room” so that, if the numbers of hospitalizations and deaths start to climb, the next phase of reopening won’t occur until the metrics are met.

Meanwhile, more testing is required and each region is to have 30 tracers for every 100,000 people.

Albany County alone would need at least 90 tracers; the county’s health department currently uses 30. McCoy has said he talked with the county’s sheriff who is “on board” for training emergency medical services workers to serve as tracers.

Tracers will be trained through a Johns Hopkins module and will work remotely off of a state database. (See related story.) As Albany County has been doing all along, the tracers talk to patients with COVID-19 to discover who they have been in contact with and then trace those contacts so that they remain in quarantine for two weeks to prevent the spread of the disease.

“We’re not gonna open up if it’s not safe,” McCoy said on Wednesday. “If the numbers start to go up, I hate to say it, we’ll shut down.”

Testing

Albany County continues what McCoy frequently terms “aggressive testing.” This includes mobile walk-up testing in at-risk neighborhoods — in Albany; Watervliet; Cohoes; and, on Wednesday, in Ravena. It also includes drive-through testing at a Rite Aid pharmacy in Colonie, run by the federal government and Rite Aid, and at Priority1 Urgent Care in Guilderland, which has also started doing antibody tests.

Most of the local testing is being done at a drive-through facility run by the state at the University at Albany uptown campus, which this week broadened its base for testing. Until now, only people with symptoms were given the diagnostic tests.

Added categories of people to be tested include health-care workers and first responders as well as anyone working in a nursing home or long-term or congregant setting, which includes parole officers, nutritionists, and psychiatrists among others. A complete list is on the county’s website.

Also included are “essential employees” who work with the public. Again, the list is long and includes, among many others, bank tellers, mail and shipping workers, faith-based workers, transit workers, and utility workers.

Broadening the test base, said Albany County Health Commissioner Elizabeth Whalen on Friday, is “essential in any effort to reopen.”

Flattened curve

At county press briefings throughout the week, officials have been hopeful about the declining rates of new positive tests, of hospitalizations, and of deaths.

On Sunday, Albany County Sheriff Craig Apple said that a portable morgue used locally for a week has been shut down. “I never thought in 33 years of public service that we would have a portable morgue in the county,” said Apple, calling it “very heart-wrenching.”

“Our EMS calls have hit a plateau,” said Apple of the county’s emergency medical services.

“Finally, I’ll tell you, things are turning. Things are slowing down a little at the EOC, which is a great sign,” Apple said of the Emergency Operations Center, which was set up on March 1. “I think it’s the constant education and awareness.”

On Wednesday, McCoy reported that another county resident, a man in his seventies, had died the day before, bringing the county’s death toll for COVID-19 to 62.

Currently, 1,386 residents have tested positive for the virus with 881 in mandatory quarantine and 19 in precautionary quarantine. Thirty-one residents are hospitalized with seven in intensive-care units.

The five-day average for new positive tests was 15.4 even as testing had expanded to asymptomatic people, McCoy said, adding it was the third day for a decline in that rate.

“We are seeing our numbers going down in terms of new cases diagnosed each day, which is encouraging,” said Whalen. “We are seeing low rates of hospitalization. This indicates to me that what we have been doing has flattened the curve.”

Whalen stressed the importance of continuing with those protocols: social distancing, hand-washing, staying home, and wearing a mask when in public.

“It’s unlikely this is happening because the coronavirus is going away,” Whalen said of the declining numbers. “It is unlikely that COVID will go away until we have a safe, effective, and widely available vaccination and this is many months away.”

So, she said, it is imperative for the public to follow the same protocols, once agengencie reopen, that have been followed for the past two months.

“As we open, it is likely we will start to see cases increase,”said Whalen. “What we want to guide against is a spike that will be difficult to manage.” the health department will actively monitor those cases she said, to “stop outbreaks in their tracks.”

She called the health department’s contact tracing, isolation, and quarantine practices “our major weapons going forward as we reopen.”

Whalen warned, “Because our cases are down does not mean COVID is gone.We still need to protect ourselves as we re-enter society in a responsible way. So, as we do this, we’ll be talking a lot more about mitigation strategies.”

Whalen concluded, “We will really need the cooperation of every single member of the county as we move forward … so we don’t face the situation that we have to go backward.”

Elective surgery

On Wednesday, Cuomo announced 12 more counties — including Albany County — are now eligible to resume elective surgeries. He previously announced that the state will allow elective outpatient treatments to resume in counties and hospitals without significant risk of COVID-19 surge in the near term, and a total of 47 counties can now resume elective surgeries.

Ambulatory surgical centers in Albany County will also be able to resume elective surgeries.

Also, the state’s Department of Health clarified that these centers may continue providing certain diagnostic or screening procedures such as for cancer. Empire State Development Corporation also clarified that doctors’ visits continue to be permitted and remain open as essential businesses.

Work

Also on Wednesday, the state’s Department of Labor announced that, in just over a month, more than 330,000 New Yorkers have been approved for the Pandemic Unemployment Assistance Program, which provides unemployment benefits to people who do not qualify for traditional unemployment insurance.

In total, the Department of Labor has now paid $7.4 billion in unemployment benefits to New Yorkers since the COVID-19 pandemic began in March — three-and-a-half times the total paid in benefits last year.

McCoy said earlier in the week that his region is looking for clarification on reopening barber shops, beauty salons, gyms, and places of worship, which he said haven’t been addressed by the state.

“I know some people are defying it and opening up so we need to address that … We need more information from the state,” he said. McCoy noted on Wednesday how easy it would be for someone who, say, wants a haircut to drive from a closed region to an open region to get it.

McCoy said the county is looking at staggering shifts so employees, once they return to work, can spread out and, for the same reason, is also looking at setting up working spaces in the hockey facility and the Times Union Center.

He said on Wednesday that the county is identifying how many of its workers have children and is looking at ways they can be cared for when the workers return to their jobs or if some of the county employees can continue to work remotely from home.

“We do have to reimagine what the outside world will look like,” McCoy said on Wednesday.

Nursing homes

During the past week, both McCoy and Whalen talked about difficulties in carrying out the new directive from Cuomo to have all nursing-home residents and staff tested twice weekly for COVID-19. McCoy said the county had been looking for guidance from the state for the last three weeks.

“I don’t know how you do that,” said McCoy of the requirement to test twice weekly. He said lab results may not even be back from one test by the time the next test is administered. He also said the testing is uncomfortable.

“Nobody likes getting swabbed down that far down their nostrils,” he said.

“We want to comply,” said McCoy but implored of the state, “DOH, please give us guidance on how this is going to be done.”

Whalen said, “In terms of the nursing homes, we are working closely with the state’s Department of Health and our nursing homes to ensure that we can move forward with the point prevalence initiative.”

Point prevalence surveys are structured to collect uniform data from multiple sites over a specific period of time.

“Our nursing homes have all been very cooperative on this; many of them have done this testing very recently,” said Whalen. “So right now we’re working with them to fill in the gaps. We’ve received extra test kits from the state’s department of health.”

The twice-weekly testing, Whalen said, “is a layer above what’s being done.” Currently, workers entering a nursing home — no visitors are allowed — are screened by having their temperatures taken and are given personal protective equipment.

Whalen said the point prevalence initiative is “good from an infection-control perspective” since, she said, there have been incidences of people without symptoms unwittingly spreading the disease. People with COVID-19 have been kept under quarantine “until such time as they don’t present a danger to the resident they work with.”

However, Whalen also said that  there are practical concerns that need to be dealt with, such as having the resources — including staffing and labs — to carry the point prevalence survey.

On Wednesday, McCoy said he is worried about the interruption in training, in professions like nursing, that will stop the flow of needed workers. There are already strains on nursing-home staff, he said, since workers who test positive for COVID-19 must stay home for 14 days.

“Where are we going to get the fresh troops?” he asked.