Each time history repeats itself, the price goes up

We have officially entered Phase III of the reopening plan, which will be the final phase until there is a vaccine or treatment for COVID-19. In the first release of the Phase III reopening guidance, gyms and fitness centers, museums, outdoor and indoor entertainment events and recreation can all reopen following specific safety standards. We spent so much time educating the public about the importance of staying home that it almost feels uncomfortable to tell everyone it is safe to get back out there and participate in all of these activities.

I see the news about the increasing COVID-19 cases in other states and I am of course concerned about our own health and safety. I am hopeful that a carefully calculated phased reopening plan will allow us to have some sense of normalcy in these totally not normal times. In addition, to this gauged reopening, I am also hopeful that all of my chattering about washing hands, wearing a mask and maintaining distance has really sunk in.

I was a part of the planning for summer programs for the Parks and Recreation Department, as well as the HCA summer programming for children and so far I am very impressed. Each department thought very deeply about how to implement the guidelines to ensure the safety of all participants. It is also obvious that parents have spent the time to talk to their children about mask wearing, cleaning and sanitizing hands and maintaining social distancing. All of the things that we are asking businesses, schools, camps, individuals to do are foreign. It takes time, practice and education to make these new protocols feel more natural and for us to become "experts"

I see it though...and that is the most important thing. Of course, there are still some people or businesses that still continue to fail to get it right but overall our compliance as a community is greater than our non compliance.

Almost one month ago, we completed our first "drive thru" COVID-19 testing event and I would say that it was a great success. Prior to the testing event, our intern helped to compile all of the testing data for Hopkinton to be able to compare data pre and post the testing event. Here is the data for testing for the town of Hopkinton prior to June 18, 2020.

The COVID-19 testing event tested a total of 271 individuals. Of the 271 individuals, 0 tested positive for PCR or virus testing and 5 tested positive for antibodies. Of the 5, 2 of them I knew as prior cases so I was not surprised by their results. However, there were 3 individuals that were unknown cases to me. Two of them had similar stories. Both cases were sick in February with mild symptoms which varied from cough,elevated body temperature of 99-100, sore throat and aches/fatigue. If your following me, what I am trying to relay to you is that COVID-19 was here in Hopkinton and circulating before we knew it.

There is still so many unknowns about COVID-19 and uncertainty makes people uncomfortable. It makes it difficult to make decisions about reopening because no one wants to be responsible for causing harm. The only way to stay grounded is to make choices based off of facts and experience. It is important to reflect on the successes and failures of plans and actions that were in place in March so that we can potentially avoid "costly" mistakes in the future.

Education

• The bad: I don't know about you but I would have never thought that 2020 was going to be the year there would be a global pandemic. I could have spent more time educating myself as well as the public about Coronavirus and the things that were going on in China. Once COVID-19 was an issue in the US, I started to do a little more research about signs & symptoms, viral shedding and the contagious period. I will cut myself a little slack because COVID-19 is new and much of what we know now is different than what we thought we knew in March.

• The good: I have spent a great deal of time educating the public on what exactly COVID-19 may look like, how to protect yourselves, and I will say that I am proud of the community for taking COVID-19 serious.

Isolation & Quarantine

• The bad: Isolation and Quarantine requirements were very confusing in the very beginning the pandemic. We could quarantine a case if they traveled from a certain country but not other areas with sustained transmission. There was not a clear distinction about the requirements for household members of confirmed or possible cases. We had no guidance on how long a case would need to be followed or how they would exit quarantine once they were a confirmed case. We would get a confirmed case from the state lab and then still were supposed to wait for the CDC verification days later.

• The good: After reading a thing or two and actually witnessing some of the failures of cluster events, I decided that best course of action would be to hold a whole household up, regardless of symptoms or a confirmed result. Contact cases were to remain at home, with their families until I knew they were not a risk to the community. I feel like the early implementation of this tactic, limited our community spread in Hopkinton.

Contact Tracing

• The bad: I got my first case sent to me without a phone number. It only took me about an hour to find the contact information for the person but imagine being told there is a land mine in Hopkinton and nothing else. COVID-19 was so new that many people didn't know enough about it, to know that they were supposed to stay home and quarantine, symptoms or absent symptoms. Many people thought that they only had to stay home if they were sick and many people didn't really feel that sick so they continued to go to work, schools, stores ect. The definition for "close contact" was literally changing each day. When cases started to explode, there was no one that was ready to be able to handle the amount of contact tracing that is required to help contain COVID-19.

• The good: Right away I had the school nurses available to help me with my contact tracing and investigation. It was a literal miracle to have them help me complete contact tracing, charting and investigations when we had our highest active caseload of 73 individuals. The CTC was formed and initially the system was impossible to use but it has improved.

Testing

• The bad: Clearly, we were not prepared in anyway to test for COVID-19 as a country. Testing criteria was so limited in the very beginning of the pandemic that only the sickest patients were tested. Providers were not sure how to order COVID-19 tests, didn't have the proper PPE to perform these tests and no one had a solid plan in place for how testing was obtained. Even when I was able to secure testing for an individual it took up to 7 days for the test results to come back. At that time, the recommendation was only to quarantine for 7 days, depending on the availability of testing I would tell the case you can get tested and wait 7 days to find out if this was a waste or you can just stay home for 7 days. It was extremely frustrating to not be able to help people. Testing was turning around really quickly in June but has started to slow down again and results are taking 48-72 hours or longer.

• The good: Testing has obviously improved in the US. There are a few options for rapid testing now and testing criteria is not as strict. It is much easier to find testing sites now and PPE is now more widely available to protect the individuals collecting the samples.

Hygiene & Compliance

• The bad: Frequent disinfecting, hand washing, sanitizing and mask wearing are not part of our everyday culture and it is uncomfortable to adjust to changes.

• The good: I feel like most people understand and are educated enough to know that these changes profoundly affect the health of those around us and are willing to make these changes for the greater good.

Overall, I look back at the last six months and I am proud of the way that the town has handled the COVID-19 pandemic response. My proudest accomplishment was the early use of a screening tool that helped to preserve the functionality of our essential services and prevent the spread of COVID-19 in these critical areas during the surge. My biggest regret would be that I was not able to initially focus my efforts to educate and protect the health and safety for those that in the risk population for adverse effects from COVID-19.