ALBANY COUNTY — In its 39th week of coping with COVID-19, Albany County broke several records more than once, and the county executive, Daniel McCoy, announced nine deaths from the disease, starting with five last Thursday.

The county broke the 200 mark for new cases with 205 announced on Tuesday; the month before, breaking the 100-mark had seemed remarkable. 

Albany County had a record number of 96 patients hospitalized with the disease and on Wednesday broke its record for patients in intensive-care units at 19.

“Sadly, that’s the highest we’ve ever been,” said McCoy.

Throughout the week, county leaders were waiting for guidance from the state on how Governor Andrew Cuomo’s winter plan would define micro-clusters and what the new protocols would be within those zones.

Albany County had been on the cusp of being named a yellow precautionary zone or, McCoy speculated, even an orange warning zone, under the old system, which was based on infection rates.

“The infection rate is not that relevant anymore,” Cuomo told reporters in a conference call last Friday afternoon. “We’re really focusing on the hospitalization rate and hospitalization capacity.”

This week, the state started releasing daily numbers for each of the 10 regions not just on infection rates but also on the numbers and percentages of patients hospitalized and on the number and percentages of ICU patients and beds available.

Also throughout the week, county and state leaders urged passage of a federal stimulus package and awaited further news on vaccine distribution.

Vaccine

The Food and Drug Administration is expected to authorize the Pfizer vaccine this week and New York could receive its initial allocation of 170,000 doses beginning this weekend, Cuomo said at a press conference on Wednesday.

“Pfizer’s vaccine is expected to be approved by the FDA tomorrow,” he said. “Immediately after that, our New York State panel will convene and review and approve it. They’ve already been speaking to the FDA about the process. I think the New York panel as a second panel to approve is going to go a long way toward battling that skepticism about the approval process. We hope that it does.”

Those first doses — the vaccination is administered in two separate shots — will go to nursing-home residents and staff and to high-risk hospital workers.

Cuomo reiterated that New York State opted into a federal program where pharmacies will do the vaccinations in nursing homes, which he said would take a burden off of the nursing-home staff.”

The Pfizer vaccine requires exceptionally cold storage and 90 cold-storage sites have been identified across the state to store the vaccine.

The Capital Region is expected to get 7,850 doses. The state expects all high-risk hospital staff will receive a vaccine by the end of the second week.

Also, members of the New York Army and Air National Guard who serve in COVID response efforts will be eligible for the vaccine.

At his press conference on Wednesday, Cuomo said that, at his urging, the federal government has agreed not to collect identifiable information from undocumentd immigrants as part of the federal distribution program.

“If undocumented people don’t get vaccinated, it compromises their health and it compromises the whole program,” said Cuomo. “Again, the program only works if you hit a critical mass of the population.”

Cuomo also continued to stress, “This has to be done in a way that protects social justice.” He went on, “The health-care system discrimiates against Black, brown, and poor communities.” He again noted the higher death and infection rates in communities with fewer health-care facilities.

Albany County’s health commissioner, Elizabeth Whalen, said this week of the vaccine, “Although this is the beginning of a light, for the general public there’s likely a much longer delay for when vaccine will be available and, until vaccine is taken by the majority of people, it will not be protective for the community at large.”

Whalen urged residents not to plan the usual gatherings and parties for Christmas.

“It’s not going to get better in any likelihood between now and Christmas,” she said. “It’s likely that we will continue to see cases increase and that they will result in increased hospitalizations and unfortunately increased deaths in the county.

“The only way we can prevent this from happening is from individual behavior,” said Whalen, stressing that in-home gatherings with anyone but immediate family are a risk.

“We believe our friends won’t harm us,” she said, noting that many people with the disease are asymptomatic and can spread it unwittingly.

“We are seeing cases … across all facets of the community ...,” said Whalen. “Your risk is high every time you walk out the door.”

She also urged residents to cancel travel plans.

“Across the country, we’re seeing hospitals hit their surge and that is what we really want to avoid,” said Whalen.

Surge and flex

Cuomo this week directed the state’s health department to begin the surge-and-flex protocol that will have all hospitals expand their bed capacity by 25 percent to handle surges of COVID-19.

“We can issue up to 50 percent,” said Cuomo in a press conference on Monday, noting that the state starts with 54,000 beds.

“Roughly 35,000 of those beds are now occupied,” he said. “If you cancel elective surgery, we estimate that you reduce the number of occupied beds by about half. That takes us to a total system capacity of about 58,000 beds for COVID patients. Today, we have 4,600 hospitalized, so that gives you a range of the capacity for the system.”

Cuomo also noted that about 5,000 field hospital beds could be added.

The governor also issued a call to retired doctors and nurses across the state, asking them to return to service and promising their registration will be renewed at no cost to them. “We believe we can get about another 20,000 nurses and doctors from this mechanism,” he said.

Under the new winter plan, if a region’s seven-day average hospitalization growth rate shows that the region will reach 90 percent within three weeks, it will be named a red zone.

Also, citing new guidance from the Centers for Disease Control and Prevention, Cuomo said that, if a region’s hospitalization rate does not stabilize within five days, more restrictions will be applied to indoor dining.

For New York City, indoor dining will be suspended. For the rest of the state, restaurant capacity restrictions will be reduced to 25 percent.

On Dec. 8,  the state’s health commissioner, Howard Zucker, sent a letter to hospital and nursing-home administrators, saying that increasing case numbers and hospitalizations are expected through at least mid-January.

“We all learned much from the spring surge of COVID cases. It is our responsibility now to implement those lessons,” Zucker wrote. Individual hospital systems have to “balance the volume of incoming patients prior to their being admitted into a hospital,” he said.

Hospitals have to alert the state prior to reaching 80-percent capacity or, in a surge situation, prior to reaching 75 percent, Zucker said.

He wrote, too, about the requirements for stockpiling personal protective equipment, known as PPE.

“Nursing homes must have a 60-day stockpile and hospitals a 90-day stockpile of all required PPE categories (gloves, gowns, face shields, goggles, surgical masks and N95), based upon peak usage in April,” he wrote. “The emergency stockpile is not to be considered as normal inventory.”

Expert advice

In a cordial conversation with Anthony Fauci, the nation’s top infectious-disease specialist, Cuomo asked several critical questions which, Fauci, in Washington, D.C. answered from a large screen in the midst of a press conference.

Cuomo asked Fauci when New York should expect the peak spread of COVID-19 from holiday visits.

Fauci said the peak from Thanksgiving will lead right into the Christmas season. “So you have a surge upon surge,” he said, as people travel for Christmas and gather with family and friends.

“So, if those two things happen and we don’t mitigate well and we don’t listen to the public-health measures that we need to follow, then we could start seeing things get really bad in the middle of January,” said Fauci.

Cuomo then asked about “living-room spread” and the restriction of no more than 10 people gathering in a home, noting, “Compliance is very low on that.”

Fauci called the 10-person limit “a very sound rule,” adding, “I feel 10 may even be a bit too much.”

He also said, “Make sure that, when people come in, that they’re not people who have no idea where they’ve been or who they’ve been exposed to.”

On vaccinations, Cuomo asked Fauci when it was likely the needed 75 to 80 percent of the population would have gotten shots.

“When you have 75 to 80 percent of the people vaccinated, you have an umbrella of protection over the community that the level of community spread will be really, really very low,” said Fauci, anticipating that won’t be until the end of next summer.

Fauci said he was originally surprised that the COVID-19 infection rates in schools were so low because he had anticipated it would look more like the influenza model. The best strategy, he said, would be to subsidize bar and restaurant owners so they could close their businesses without crashing while keeping schools open.

He commiserated on New York being “hit with a sucker punch right from the beginning” as COVID-19 cases flew in from Europe. “You guys got really slammed and then you rebounded,” Fauci said.

He went on, “And you rebounded in a way that you kept your test positivity low because you did the prudent things that you need to do. I was following it from here in Washington and I was seeing that whenever it looked like things were getting a little out of hand, you’d tighten the rope a little bit and then when things went back, you eased up a little bit. “

Cuomo proposed that the two of them take vaccinations in a television ad. “We’re like the modern-day DeNiro and Pacino. You can be whichever one you want,” he said.

“I love them both. I don’t want to insult one or the other. If I say one, I don’t want to hurt the feelings of the other, so either one,” answered Fauci.

 “Yeah. Who’s the politician?” responded Cuomo.

“Exponential growth”

“Exponential growth” in local cases, Whalen said on Tuesday, could “potentially even double our numbers by Christmas.”

She warned residents who are “out and about” to presume they will be exposed to the virus.

Her department is experiencing “a deluge of calls,” Whalen said, and has been scaling up to meet demands. With exponential growth of the virus, though, there can be a lag in getting trained staff on board to meet the needs, she said.

“We are starting to experience a backlog,” said Whalen. “To combat that backlog, I would like to ensure that people are aware of our website.”

She urged residents who test positive for the virus to look at guidance for isolation on the website, and residents who have been exposed to COVID-19 to look for guidance on following quarantine protocols.

Such guidance should be followed until someone from the health department is able to call.

Hospitalization rates usually lag about two weeks behind infection rates, said Whalen.

“You can still make a difference with your individual behavior and, in fact, it’s really all you can do right now …,” Whalen said. “Wearing masks helps. It will decrease the overall numbers of hospitalizations and deaths.”

While the Centers for disease Control and Prevention has changed its guidance for quarantine, shortening it to seven days with a negative test or to 10 days for someone who hasn’t been tested, the New York State Department of Health has not yet changed its guidance from requiring quarantine for 14 days, so Albany County is still using 14 days, Whalen said.

Newest numbers

Statewide, the rate of infection, based on Tuesday’s test results, was 5.44 percent, Cuomo announced on Wednesday. For the Capital Region, of which Albany county is a part, the rate was 5.11 percent.

The Capital Region had 243 patients hospitalized with COVID-19, which is 0.02 percent of the region’s population and left 26 percent of the region’s hospital beds available over a seven-day average.

The Capital Region has 313 ICU beds with 187 of them occupied, leaving 44 percent available over a seven-day average.

As of Wednesday morning, Albany County had 7,105 confirmed cases of COVID-19, an increase of 186 cases since Tuesday, McCoy announced.

Of the new cases, 23 had close contact with someone infected with the disease, 148 did not have a clear source of infection identified at this time, one reported traveling out of state, and 14 are health-care workers or residents of congregant settings.

The five-day average for new daily positives ticked up to 163.8 from 163.6.  There are now 1,319 active cases in the county, up from 1,282 yesterday.

The number of county residents under mandatory quarantine increased to 2,306 from 2,286. So far, 26,855 people have completed quarantine. Of those, 5,786 had tested positive and recovered.

Sixteen new hospitalizations were reported overnight, and there are 94 county residents currently hospitalized from the virus – a net increase of six. The hospitalization rate rose from 1.26 percent to 1.32 percent.

A man in his sixties died of the disease overnight. This brings the county’s death toll to 170.