New York State

How counties led the fight against COVID-19

Local health departments were the first line of defense against the coronavirus. And then it spread out of control.

Westchester first responders paying special tribute to the hospital's staff during a shift change at the Northern Westchester Hospital.

Westchester first responders paying special tribute to the hospital's staff during a shift change at the Northern Westchester Hospital. Lev Radin/Pacific Press/Shutterstock

Gov. Andrew Cuomo has received abundant praise for his performance during the coronavirus pandemic. And a few weeks after he effectively ordered a state shutdown, it seems that the impacts of Cuomo’s mitigation measures have started to pan out. He’s now saying that the state is experiencing a relative slowdown in the number of new cases, at least for now.

While most mandates have come from the governor, the implementation of those edicts happens at the county level. Nowhere is that more true than in the downstate suburban counties like Westchester, Nassau and Suffolk counties that have been hit hard by the outbreak. Just as New York City Mayor Bill de Blasio has been coordinating local efforts – albeit with some missteps – so have county leaders in the surrounding suburbs.

Whether it’s enforcing new social distancing rules, obtaining additional equipment independent of the state or taking early steps to contain the virus, local leaders have been stepping up to help address the crisis. Even as counties have played an important role in responding to COVID-19, the rapid spread and sheer size of the outbreak has meant that many of the responsibilities and critical responses still fell squarely on the state and federal governments.

Early on in an outbreak, detecting new cases is largely the responsibility of local health departments. It was up to local health officials to identify people who may have been exposed to the coronavirus due to recent travel and monitor them while placing them under quarantine. For example, in mid-February, weeks before the county’s first official case, health officials in Westchester County put 26 people in isolation as an early precautionary measure.

Once the state began to confirm positive cases of COVID-19, the counties were the ones to identify the people and investigate their contacts. County workers traced the family, friends and other people that a person who tested positive may have come into contact with. Once identified, county officials would place those people under precautionary quarantine in an attempt to contain the coronavirus. “We were very aggressive at containing it as much as we possibly could,” Nassau County Executive Laura Curran told City & State. “And I think it was very helpful.”

However, those efforts became moot as the extent of the virus’s spread became clear and more cases emerged. The numbers overwhelmed the ability of county health departments to investigate each case and diminished the efficacy of more targeted containment measures. Westchester County’s first case, the second in the state, already couldn’t be traced back to its potential source, such as contact with another sick person or recent international travel. While the county was able to identify, test and quarantine people that person came in contact with, the state stepped in fairly quickly with more aggressive containment measures as the city of New Rochelle became a coronavirus cluster. The man tested positive on March 3 – just one week later, on March 10, Cuomo announced he would limit large gatherings and close schools in a portion of New Rochelle.

At the beginning of the outbreak, local health departments also independently verified all new positive cases and deaths as the state performed tests and set up testing sites. Sometimes they provided numbers that differed from the official state count, generally slightly larger based on local tallies. But Curran said that in Nassau County, at least, the cases became so great that the county began relying on official numbers coming from the state because the county was falling behind on its count.

The shift in reporting the death tally came just this week on Long Island, with officials now relying on official state counts. Previously, local health officials would directly contact hospitals about deaths and determine where the deceased lived in order to create a local count. Curran and Suffolk County Executive Steve Bellone said that the number of deaths increased so quickly that it was hard to keep pace in gathering information. “That’s one example of how I’m relying on the state,” Curran said.

Bellone added that since hospitals are also required to report to the state, it no longer made sense for the county to take up valuable hospital time for county-level verifications. “We didn’t want any reporting obligations or information we were seeking to prevent them from saving people’s lives,” Bellone said.

Where the counties continue to add value, however, is in neighborhood breakdowns of the cases. Nassau and Suffolk counties both have interactive maps that provide a more in-depth analysis than the state provides, even though all the data technically comes from the state. Those maps provide targeted numbers for the villages and hamlets on the island. Westchester County also provides data on cases by town. There is often a lag in those numbers because county officials must sort through raw information sent by the state in order to group it into towns.

School closings and contingency plans for how to handle school meals and day care for essential workers is another pandemic mitigation measure that relies at least in part on localities. When Cuomo signed an executive order closing schools statewide beginning March 18, he required that Nassau, Suffolk, Westchester counties and New York City submit plans for him to approve within a day. Both Curran and Bellone had already announced that schools on Long Island would close starting March 16. They told City & State they had been in the process of developing contingency plans with local school districts and were in contact with the governor prior to their announcement. “We were communicating up with the governor’s office about it,” Bellone said. “It’s part of my job to be communicating up to the state about what is happening on the ground, and I thought we reached a point where we definitely need to close the schools.” 

Westchester County Executive George Latimer officially announced on March 16 that schools in his county would close after a call that morning with school officials to finalize their plans after encountering some initial disagreements.

Counties bear much of the responsibility to enforce social distancing rules, even though most of those mandates came from the governor. “I have spent the last two weekends driving around from park to park on the Saturdays and Sundays to observe that conditions, to make sure that our Parks Department people and our county police are there to enforce it,” Latimer told City & State. In Suffolk County, Bellone said he graduated a new class of police officers early to increase social distancing enforcement efforts. In Nassau County, Curran shut down all tennis courts, ball fields and dog parks beginning March 21, and all playgrounds starting March 23, as additional measures to encourage social distancing.

Another, more morbid, responsibility for localities is figuring what to do with the increasing number of dead bodies as morgues hit their capacity and funeral homes become overwhelmed. Nassau County has leased five refrigerated trucks to increase its morgue capacity from 300 to 540. Suffolk County has plans to use a refrigerated building on a farm to store more bodies. According to a report, Suffolk County’s hospital morgues and funeral homes are at or over capacity. Westchester County has similarly ordered at least one truck to increase its morgue capacity.

Right now, a large part of county leaders’ responsibilities, as Bellone said, is to report conditions on the ground to the state. That means communicating with local hospitals and relaying their needs to the state, and then distributing aid received from the state or federal government to the areas that need it. That also applies to ensuring first responders and others on the front lines receive essential personal protective equipment. While county officials have purchased additional supplies for themselves – Nassau County purchased 100 ventilators to serve as their own emergency supply – much comes from state or federal sources. In Suffolk County, officials were able to get a large shipment of surgical and N95 masks directly from the federal government with the help of Rep. Lee Zeldin.

Counties have certainly been important in responding to the coronavirus threat, as they often do in other natural disasters or emergencies. But ultimately, the current crisis is tough for any one locality to handle on its own. “You have local emergencies, you have statewide emergencies and you have national emergencies,” Bellone said. “This is a classic example of what is beyond the capacity of any local jurisdiction or any one state to handle. This really requires the marshalling of national resources.”

With reporting by Kay Dervishi.