One of Gov. Phil Murphy’s daily mantras at media briefings is “data determines dates,” yet state health officials can’t provide either the number of people recovered from COVID-19 or the number of cases that might be transmissible to New Jerseyans when they venture out and resume their normal routines in two weeks.
Murphy announced Monday that additional businesses will reopen, and outdoor dining can begin June 15. But he acknowledged during his news briefing that unless residents feel comfortable that they will not get sick by going back out in public, these moves will not help business owners or the state’s economy.
“Our economic restart will fail if we fail to instill the confidence we need among our residents and visitors that their safety, and that of their families, is our number one priority,” he said.
State health officials say reporting how many individuals have recovered from the virus is difficult for a host of reasons. The only statewide estimate comes from the Johns Hopkins University Center for Systems Science and Engineering COVID-19 Dashboard, which on Monday put that number at 26,560, or close to 17% of the total 161,000 positive tests to date.
“We have a general sense, and the general sense is where most people would be expecting it, that certainly an awful lot of them (new cases) are coming from places like long-term care facilities, health care workers, correctional facilities, those sorts of places, but if you ask me to put an exact number as to what percentage, I can’t do that,” Dr. Ed Lifshitz, medical director of the communicable disease service at the state Department of Health, said during last Friday’s press briefing on the virus.
Trying to track COVID-19’s travels
Publicly available data from a number of state agencies do give a partial answer to the question of where the virus has been spreading during the third month it has been known to be circulating throughout the state.
From April 28 through May 29, an analysis of data by NJ Spotlight shows that both the number of people testing positive and the number dying rose higher in group settings such as long-term care facilities, prisons, psychiatric hospitals and homes for those with developmental disabilities than in the general public. During that period, positive tests in group settings increased by about 91% compared with 29% among the general public. Meanwhile, the number of people who died doubled in both settings, but at a higher rate in group quarters (136%) than in the general public (110%).
The data shows that a majority of new cases (57%) still occurred outside group locations, while most new deaths — almost seven of every 10 — happened in group settings, with the majority of those among residents of nursing homes and other long-term care facilities and their staff.
The data change over the last two weeks of May was even more striking, with deaths occurring in group settings at more than twice the rate of the general public: 969 people died in long-term care facilities, and similar places, compared with 424 deaths in less restricted settings. That deaths in nursing homes is so much higher is not surprising, given most of their residents are older or have underlying medical conditions that put them at higher risk of complications from COVID-19.
COVID-19 cases missing from the count
But the numbers undercount group totals because they do not include county jails and federal prisons, for which data is not easily available.
State officials also don’t have data that could further indicate the origin of cases outside normal public interactions — for instance, the number of health care workers testing positive. A mid-April report from the U.S. Centers for Disease Control and Prevention estimated that health care workers made up 11% of the new cases at that time. But that was based on data in which the occupation of the victims was known in only 16% of all cases (as of April 9) because many states were not providing that information.
In New Jersey, part of the problem appears to be the lack of manpower to track these cases. Local and county public health departments have faced cutbacks over the past decade or more and have been trying to keep up with daily cases — including providing instructions about self-isolation and contact tracing for those who may have been exposed to a COVID-19-positive individual — while also working with community testing sites, answering questions from the public and performing other duties not associated with the virus.
“We don’t get quite as much information as we would like,” said Lifshitz. “With cases well over 100,000 at this point, not every one has been investigated.”
He further said that tracking who has recovered is not easy.
“That’s actually something that sounds simple but it’s really very difficult to do because, again, we don’t follow every one of these people forward and ask them six weeks later, ‘Hey, how are you feeling today?’” Lifshitz said.
Some departments are providing more information than others. For instance, the Warren County Health Department’s COVID-19 data shows that about 500 people had recovered from the virus as of May 26, which would represent about 44% of the 1,136 cases in the northwestern county as of that date. The report states that the department follows up on all cases and that while most recoveries are self-reported “information on recoveries is also provided by primary care providers and long-term care facilities.” On Monday, Elizabeth reported that 1,541 cases had been closed, about 28% of its total positives since the start of the pandemic.
Working to define ‘recovered’
In his daily updates to Woodbridge residents, Mayor John McCormac breaks out the number of new cases from state facilities. Over the weekend, the township had three new cases from the community and 35 from state facilities, which the general public does not visit.
“We care about all victims regardless of where they live but it is very important to separate out state facilities so our residents are aware of the true impact on their community,” he wrote. “Reporting 38 cases over the weekend would be a lot more alarming just than three in two days.”
Lifshitz said there is not yet a good definition of who has recovered.
“What a lot of people just do is they basically say, well, if it’s been more than two weeks or a month and you’re not dead, you’re probably recovered,” he said last Friday. “And we haven’t done that because we’re not quite comfortable with that definition. So until either there is a more formal definition that everybody can agree on, or some other better way to count them, at this point, we wouldn’t feel comfortable guessing at those numbers.”
Asked Monday how many active cases of the virus remain in the state, Lifshitz called that number “unknowable” and gave a vague answer that may or may not quiet fears among residents.
“Clearly there are a whole lot less (cases) now than there were two weeks or four weeks ago,” he said. “There are all sorts of different things that go into trying to figure out that number. It is much lower than it has been, but it certainly isn’t zero.”