Coronavirus cases have been spiking recently in Lakewood, Ocean County, where at least one in four of the residents tested Saturday were found to be positive for COVID-19. But exactly how and where people are becoming infected remains somewhat of a mystery to New Jersey officials.
Gov. Phil Murphy said his team would visit Ocean County on Friday to hold a roundtable-style public briefing with local school officials, members of law enforcement and leaders from Lakewood’s growing Orthodox Jewish community to try and learn more about the recent outbreak. Ocean County has had the highest number of new cases for at least a week, comprising up to 40% of daily diagnoses statewide.
“We’re turning over every stone and we’ll continue to do that,” Murphy said at his regular media briefing Wednesday. “This is something we’re taking very seriously.”
The concern highlights one of the weaknesses in New Jersey’s contact tracing system, which has relied heavily on local health leaders to identify individual COVID-19 cases and meticulously track how they may have spread the virus. Tracers have struggled to get patients to share information about whom they have been in contact; privacy issues limit the types of information health officials can collect and share, and limited details about their findings are made public.
New Jersey has created an extensive COVID-19 data dashboard that is updated daily with new and total numbers of cases, deaths and hospitalizations, plus outbreaks at long-term care and state-run facilities. In some situations, the data is broken down by demographics or county and, to a limited extent, ZIP code.
New information on outbreaks in schools
On Wednesday, the state added a section on schools to the dashboard, showing that 11 schools in seven counties have current COVID-19 outbreaks, which together are linked to 43 positive cases among staff or students. The state defines an outbreak as two or more otherwise unconnected cases at the same school within 14 days.
The new school coronavirus tracker does not name the district, community or individual facility impacted, but Murphy insisted that those connected to a school with an outbreak are fully informed. State education officials said a form letter is sent to parents and staff when an outbreak is confirmed.
“All of this goes through the local health departments,” with input from school officials, state Department of Health Commissioner Judy Persichilli said Wednesday. “The case investigation, the contract tracing, the who, what, where, when and how, all takes place at the local health department.”
Persichilli has indicated she was interested in making public more of the information collected by contact tracers, but state officials declined to provide a timeline for this process Wednesday. “We hope at some point that our contact tracing dashboard can be more robust in that regard,” Persichilli said last week.
New Jersey is one of just 14 states to make contact tracing data available to the public online, according to an ongoing survey by NPR, and one of just a handful that shares both contact tracing staff numbers and the number of cases they succeed in tracing. Crystal Watson, a senior scholar at the Center for Health Security, who collaborated with NPR on the project, called New Jersey’s data presentation “really fabulous.”
Other states give location details
But, unlike New Jersey, several states — including Louisiana and Maryland — publish information on the types of locations connected to outbreaks or individual cases, NPR found. For example, as of Wednesday, 813 cases in Louisiana were linked to food processing plants, 477 were traced to bars and 220 to casinos.
Isolating the definitive location of transmission is a challenge with the coronavirus, according to DOH epidemiologist Dr. Christina Tan, and it may often be impossible. “I would say in the vast majority of our cases you’ll never know what the actual source is, because the fact is, as long as you have (COVID-19) in the community, it’s going to be kind of hard to necessarily pinpoint where a person might have been infected,” she said last week.
Another way to help identify the location of spread is to make COVID-19 data available by ZIP code, as New York state has done. New Jersey has provided some ZIP code breakdowns, but officials have said privacy concerns have kept them from sharing numbers related to communities with fewer than 20,000 residents. In New York, such details helped officials quickly recognize that recent spikes were occurring in multiple Orthodox communities, including parts of Brooklyn and Queens and upstate enclaves in Rockland and Orange counties.
Dr. Ed Lifshitz, who heads the DOH’s communicable disease service, said he talked to city and state health officials from New York about the potential for spread between the Orthodox communities in the tri-state area. In May 2019, New Jersey found that a measles outbreak in Lakewood was tied to cases in Israel, Brooklyn and upstate New York, the result of family and religious visits among members of the tight-knit group.
‘Anecdotal information’ about spread in Ocean County
“We hear anecdotal information that suggests some of this is happening (with COVID-19), but I don’t have a hard number to put on that,” Lifshitz said Wednesday.
Last week Murphy said he believed the spike in Lakewood involved “some amount of relationship to worship” from the recent Jewish holidays; Rosh Hashanah and Yom Kippur were both celebrated within the past two weeks. Whether this relationship is evidenced in the state’s data collection remains unclear.
Murphy underscored Wednesday that his team is working closely with Orthodox leaders in the Lakewood area; he has repeatedly noted that people have the right to worship, but they should do it safely. State regulations call for indoor services to be held at 25% capacity, or 125 people, whichever is less, and worshippers must wear masks.
“Everybody is trying to do the right thing,” Murphy said, noting that the Lakewood faith leaders he talks to support the regulations. However, “the man-on-the-street reality” doesn’t always reflect these requirements, he said.
Given the unknowns, New Jersey has deployed additional resources to Ocean County to help combat the rising case numbers. Persichilli said 20 additional contact tracers from a group hired and trained by the state were sent earlier this week to assist the local tracing team and the state provided extra testing kits late last week, allowing for up to 1,000 people to be screened daily — twice the number that had been getting tested in that community.
“Part of that (contact tracing) investigation will help us focus in on what may be the issue,” Persichilli said. As for testing, “we need to step that up, which is what we’re doing,” she added.