Health

St. James Memorial Day celebration 2018. File photo by Sara-Megan Walsh

After a Memorial Day weekend when beaches will be open under new social distancing rules, Suffolk County is on track to reopen the economy starting next week.

Camp grounds will reopen starting on June 1. Starting tonight, residents can make reservations to visit those camp grounds starting on July 15, which is “a positive sign of the progress we’ve made,” County Executive Steve Bellone (D) said on his daily conference call with reporters.

Gov. Andrew Cuomo (D) said today that Long Island was on track to potentially reopen. What that requires is additional contract tracers, which Suffolk and Nassau officials said they were currently working on acquiring, and a 14-day total decline in deaths. The latter is likely the most tentative, and will surely depend on no spikes in numbers in the coming week.

The governor announced he would allow construction staging on Long Island, in anticipation for phase 1 of reopening, which would allow construction companies to start up again.

Bellone said people often think of Memorial Day weekend as the start of the summer season. This year, as the county and state look to loosen restrictions caused by COVID-19, summer will “serve as the unofficial transition to reopening our economy,” Bellone said.

Bellone encouraged residents to participate this weekend in the first of the Suffolk County Veterans runs. Interested participants in the virtual race, which is free but accepts donations to support veterans, can sign up at suffolkveteransrunseries.com.

The Suffolk County Police Department reiterated its plan to enforce social distancing and wearing face masks over the Memorial Day weekend. The SCPD anticipates crowds in downtown areas and said its Together Enforcing Compliance (or TEC) Team would be on foot in downtown areas and parks. Marine Bureau officers also expect more boaters on the water than usual after the end of New York Pause and planned to adjust their staffing levels and patrols accordingly.

Bellone raised the white flag in his ongoing effort to honor veterans who are buried at Calverton National Cemetery and Long Island National Cemetery. After putting together a proposal about how the county could plant flags safely at the cemeteries, Bellone received several rejections, interrupting an annual tradition that began in 1995.

The county executive still plans to plant flags for deceased service men and women at 15 non-national cemeteries tomorrow.

Bellone provided the daily update to the viral numbers.

An additional 119 people tested positive for COVID-19, bringing the total number of residents who tested positive to 38,672. That does not include the 12,013 people who tested positive through the antibody test, which indicates they had the virus at some point.

The number of hospitalizations from the virus decreased by 28 to 425 through May 20. The number of people in the Intensive Care Unit increased by two to 131, also through May 20, which is the most recent 24 hour period for which the county had data.

With 882 beds available from a total of 3,009, the occupancy is just over 70 percent, which is the target for reopening. The number of available ICU beds is 193 out of a total of 547, which means ICU occupancy is at 65 percent.

In the last day, the number of people who died from complications related to the coronavirus increased by 12, bringing the total who died to 1,814.

Separately, the county executive office distributed an additional 30,000 pieces of personal protective equipment.

Bellone said 16 sites at CVS drive-through locations would provide self-administered COVID-19 tests. Residents will drive to the drug stores and will receive instructions with the kit. Someone from CVS will observe the process to ensure it is done correctly. Residents will get results within three days.

The county had six pediatric cases in the hospital as of May 20, which does not necessraily mean they have the rare inflammatory condition the Centers for Disease Control and Prevention has been tracking.

Gregson Pigott, the Commissioner of the Suffolk County Department of Health Services, said the inflammatory condition caused by COVID-19 was still “very rare.”

Along Nicolls Road, where dozens of people held signs thanking the hospital workers both leaving and arriving at Stony Brook University Hospital, another truck, one bearing a large screen and speakers, rumbled down the road bearing another kind of thank you to the folks on the front lines.

Christian Guardino, a Patchogue resident, came down to the hospital late on Thursday, May 22 to serenade the workers just after their 8 p.m. shift change. The singer, a America’s Got Talent’s Golden Buzzer and Apollo Theater Competition Grand Prize Winner, sang three songs to a crowd gathered in front of the children’s hospital. Others watched from the windows above, even waving lighters from a dark room as Guardino finished a rendition of Billy Joel’s “New York State of Mind.”

He said he too has been stuck at home because of the pandemic, unable to perform because practically all venues have been shut down. First performing at Mather Hospital in Port Jefferson, he came to Stony Brook to make sure those workers knew they were top in people’s hearts and minds.  

“The one thing I want to say and for them to get out of this is just thank you, how grateful we are for everything they’re doing for us,” Guardino said. “They’re on the front lines taking care of the people who are sick, risking getting the disease and I just want to thank them.”

Nicole Rossol, the chief patient experience officer at SBUH, said Empire Entertainment, a New York City-based event management company, reached out to Stony Brook looking to do a late show. At the same time, the patchogue singer also made mention he wanted to give back to the hospital. Guardino’s mother, Beth, had worked as a nurse at the hospital previously for nearly a decade.

“We thought if we could do it together, it would be a very beautiful thing for our staff,” Rossol said. “I think the staff has been looking for things to keep them upbeat and help them through this time. Every piece of support from the community really makes a difference.

Empire Entertainment, with their Illuminate Our Heroes tour has brought crews from the city, to New Jersey, and now out to Long Island. Alyssa Bernstein, a senior producer for empire entertainment is herself a Setauket native, and she said she made it a point to come back and support her hometown during the ongoing pandemic.

“We decided, what is a way that we can give back and say thank you, and that’s putting on a little show, that’s what we do best,” Bernstein said. “The work that they’re doing means that we’ll get back to work.”

 

Photo by Rita J. Egan 2018

Frustrated by a Veterans Affairs office that has denied his repeated requests to conduct flag planting at Suffolk County’s two national cemeteries over Memorial Day weekend, County Executive Steve Bellone (D) is asking President Donald Trump (R) to get involved.

“I’m asking for his support once again on an incredibly important issue in this moment,” Bellone said on his daily conference call with reporters.

Bellone thanked U.S. Rep. Lee Zeldin (R-NY-1) and Trump for their help in securing personal protective equipment for the county and for helping to ensure that the county can tap into the municipal liquidity fund, which will allow the county to provide temporary property tax relief until July 15.

Without help from the president, Bellone said he is “afraid that a tradition that goes back a quarter of a century will end this Memorial Day weekend.”

Even if the county can’t place flags at Calverton National Cemetery and Long Island National Cemetery, Bellone and the county plan to place flags at 15 cemeteries. The County Executive is still looking for volunteers, who can sign up through his facebook page at facebook.com/SteveBellone. He is also looking for a donation of 3,500 8×12 inch or 12 x 18 inch flags in good condition.

Separately, the county executive indicated that Suffolk County residents shouldn’t expect fireworks displays in July to celebrate Independence Day.

“We know reopening our economy safely and being able to sustain that is directly connected to keeping our curve flat,” Bellone said. “Opening back up to mass gatherings” which would include July 4th fireworks “would undermine our goals.”

Viral Numbers

Hospitalizations continue to decline. The number of people in Intensive Care Units has declined by 29 through May 19 to 129, which is the “largest decline the county has seen” in a while, Bellone said.

The number of people who are hospitalized was 453, which is a decline from two days earlier, when the number was 497.

In the past day, 53 people have come home from the hospital.

The number of deaths due to complications from COVID-19 rose by 11 to 1,802.

The number of people who tested positive for the virus increased by 142 over the last day, rising to 38,553. That doesn’t include the 11,461 people who have tested positive for antibodies to the virus.

Stony Brook Update

Stony Brook is cutting back the hours of its drive-through testing site in the South P lot. It will be open from 8 a..m until 6 p.m. on Monday through Saturday and from 8 a.m. to 1 p.m. on Sunday. Residents must make appointments in advance through the New York State Department of Health Hotline, at 888-364-3065 or at coronavirus.health.nygov/covid-19-testing. The site will not accept walk ins.

Finally, America’s Got Talent Golden Buzzer and Apollo Theater Competition Grand Prize Winner Christian Guardino will perform tonight at 8 p.m. at the entrance to Stony Brook Children’s Hospital.

The performance is for hospital personnel only.

The musical tribute will include a light show.

When the initial impact of the coronavirus pandemic truly hit home back in March, after businesses were forced closed from state mandates, many turned to their insurance providers and filed for business interruption insurance, which they expected would be used for just this sort of occasion.

Only many received notifications back that their claims were denied. The reason: Insurance companies put in provisions within their policies that excluded coverage due to damages “caused by or resulting from any virus, bacterium or other microorganism that induced or is capable of including physical distress, illness or disease,” according to the Insurance Services Office, an insurance advisory organization.

Though business owners and small business advocates such as The Ward Melville Heritage Organization President Gloria Rocchio pay the premiums year after year, she said they and so many others were denied coverage despite the fact that small businesses didn’t close because they or their shops were confirmed with the virus, but government orders forced them to close. 

“Very simplistically, [business owners] buy themselves a job for the community, and now they’re made to lay off people, keep their business closed, pay all fixed overheads and maybe they don’t have a reserve at home,” Rocchio said. “Everything the government is putting forth is not helping the small businessman — the one who doesn’t have a million in the bank and is paying fixed expenses.”

Efforts on Local and State Levels

The provision in many insurance policies was instituted little less than two decades ago after the severe acute respiratory syndrome, or SARS, epidemic of the early 2000s. It is only now, almost 20 years later, that owners filing claims learn of the provision despite them having paid premiums for years.

There is a combined bill in the New York State Assembly and Senate to require companies to accept current interruption claims. 

WMHO submitted a public letter to Gov. Andrew Cuomo (D) April 22 requesting he supports the Assembly and Senate bill. 

“What we’re saying is to do business in our state, we in the state government do have the power to make sure contracts are fair and equitable.”

— Steve Englebright

“An insurance policy is a contract between the insured and the insurer that clearly spells out those conditions covered and excluded,” the letter reads. “In recent years, because of severe losses, insurers have added exclusions to their policies, slowly diminishing the very purpose of insurance.”

The state Assembly bill is being sponsored in part by Assemblyman Steve Englebright (D-Setauket) and Fred Thiele (I-Sag Harbor), and there is a concurrent bill in the state Senate. It would require insurance agencies to cover businesses during the COVID-19 pandemic, and would renew any policy that would have covered businesses during shutdown if they expired in the meantime. New York is just one state of seven which is proposing bills to mandate coverage.

“Insurance is controlling risk, that’s what insurance companies do,” Englebright said. “What we’re saying is risk transfer needs to occur with this type of policy in a more predictable manner and a more eligible manner than the fine print currently allows.”

The bill is still in the Assembly Insurance Committee, but Englebright, a ranking assemblyman, said it is picking up widespread support in the Democratic-controlled state Legislature. 

He added he does not believe what insurance companies say when they argue accepting businesses claims would bankrupt their agencies.

“What we’re saying is to do business in our state, we in the state government do have the power to make sure contracts are fair and equitable,” Englebright said. 

Multiple local government and industry groups have come out in support of such a bill. The Long Island Builders Institute released a letter supporting the legislation, saying that if a business has been paying for its insurance, it should honor the claims. 

Mitch Pally, CEO of LIBI, said the insurance companies denying these claims will only create a deeper hole in the economy, which will be an even greater burden to the insurance companies if they go under and no longer can pay their premiums. He also predicted dire consequences to many businesses if claims continue to be denied by June 30 “because the people who bought them didn’t assume their business can be interrupted by something that doesn’t apply [to the insurance].” 

The Brookhaven Town Board and Supervisor Ed Romaine (R) also signed a letter asking Cuomo to throw his support behind the bills.

Federal Efforts

There is a bill currently lingering in the U.S. House of Representatives Committee on Financial Services, co-sponsored by Rep. Tom Suozzi (D-NY3) that would require insurance companies in the future from denying company’s claims based on a pandemic, but even that has seen “tremendous pushback from the insurance industry,” he said during a Zoom call hosted by Discover Long Island May 19. “It’s very controversial — I’m getting the crap kicked out of me by certain people.”

Suozzi, who was appointed by President Donald Trump (R) to the economic reopening task force, said he did not believe anything regarding interruption insurance will see the light of day in some of the large stimulus bills Congress is currently working on.

Some policyholders nationwide have sued their insurance companies for denying their claims. A barbershop owner in San Diego has created a class action lawsuit against his policyholder, Farmers Insurance Group, for denying his claim under such virus damages provisions. Several other class-action lawsuits have been filed in the past month and a half against several other insurance companies.

Though such lawsuits take months if not years to get going, and especially with many court systems largely shut down from the pandemic, it will be a while before any cases see a judge.

“By the time those lawsuits get done, those businesses will be out of business,” Pally said.

Insurance Providers Respond

The American Property Casualty Insurance Association has said if governments required the companies process these claims, it would mean companies would have to process over 30 million businesses suffering from COVID-19-related losses. APCIA President David Sampson was quoted on Twitter saying requiring so would “significantly undermine” their abilities to cover such things as wind damage, fire or other losses.

The industry as a whole currently sits on an $800 billion surplus, according to the National Association of Insurance Commissioners. That business group released a report May 15 with statements from 50 experts from the Wisconsin School of Business insurance panel that if local governments force insurance companies to accept the claims, it will “threaten the solvency of the insurance industry.” Though the report is sponsored by the association through its independent research division, most experts on the panel largely agreed the private marketplace could not handle all the losses with the current surplus in the industry. 

“By the time those lawsuits get done, those businesses will be out of business.”

— Mitch Pally

Though in that same study, some experts, 13 percent of the 50, argued the industry could be able to handle the claims, depending on how federal legislation was enacted. 

Industry lobbyists have said the federal government should be providing help, but one example of small business aid, the Paycheck Protection Program, which was supposed to help keep many small shops in business, has been mired in problems since its inception, and many owners are simply refusing to use the funds fearing they will have to pay back the money long term as a loan. 

The Washington Post reported last month that insurance associations and business groups are hiring lobbyists specifically to play out this fight in Washington, D.C.

What some are hoping for is some kind of middle ground, a place where insurers and the federal government’s interests meet. One suggested draft bill, the Pandemic Risk Insurance Act of 2020, would pay agencies losses when those exceed $250 million and capped at $500 billion over the calendar year, though that bill would only cover future pandemics, and more insurance companies have come out saying it should be the federal government which needs to handle such calls for aid, according to The Wall Street Journal.

Suozzi said he agreed most insurance companies would be “wiped out” trying to cover interruption claims during the pandemic, but also put stock in a public-private partnership, including the possibility of using the infrastructure of the insurance industries to funnel money back into these businesses.

“The bottom line is there’s no relief right now — it’s not going to solve anybody’s problems right now — and I don’t want anybody to get their hopes up,” the congressman said. “But it’s something I’m conscious of and other people are working on it — we just don’t know what the right answer is yet to get it done, because there is so much incredible pushback from the other side.”

In the meantime, Pally said it’s best for businesses to continue writing their state and federal officials. Rocchio suggested that owners, despite the fact some agencies are advising not to bother to file a claim, should apply anyway should anything change in the near future.

Suffolk County has had difficulties coming up with PPE devices during the ongoing pandemic. Stock photo

Suffolk County continues its steady daily decline in hospitalizations from COVID-19, with 26 fewer hospital beds occupied with patients who have the virus, dropping the total through Friday to 513.

At the same time, the number of people in the Intensive Care Unit rose by 10 to 186 through May 15, the most recent day for which the county has data.

Hospital bed capacity remains close to 70 percent, a target metric for reopening the economy.

In the last 24 hours, 42 people have left the hospital, continuing their recovery at home.

The number of people who have died continues to climb. In the last day, 15 people died from complications related to the pandemic, bringing the total to 1,748. Suffolk County accounts for 7.7 percent of the total deaths in New York State from the virus, which is the same figure the county represents in the total population of the state.

Over the last 24 hours, the county has distributed 74,000 pieces of personal protective equipment, bringing the total to 5 million since the pandemic began.

With the Memorial Day Weekend approaching next week, the county is preparing to open Smith Point and Cupsogue. County Executive Steve Bellone (D) said the beaches would have a beefed up staff, which will help people as they are entering the beach to understand protools and the new ways the beach is operating.

When residents are on the beach and socially distanced, they won’t have to wear masks, but when they go to public facilities, like the rest room, they will need to wear face coverings.

The county will have attendants cleaning the bathrooms on a continual basis. The staff will wear appropriate face coverings. Anyone working at the beaches will have their temperature taken each day.

When the beaches reach capacity, the parking lots will close until some residents create openings for additional guests.

The new front entrance of the emergency room. Photo by Victoria Espinoza

As the number of people who need hospitalization from COVID-19 decreases, Suffolk County health care facilities will be able to engage in hospital procedures that may have been put off for weeks or months.

Governor Andrew Cuomo (D) said today that Suffolk and Westchester Counties were eligible to resume elective surgeries and ambulatory care.

County Executive Steve Bellone (D) said the county was waiting for an executive order from the governor to resume those procedures, which he expected soon.

“This is another indication of opening up and getting back to more normal” activities, which includes the announcement yesterday that South Hampton and Cupsogue beaches would be opening for Memorial Day weekend, Bellone said on his daily call with reporters.

Elective surgeries are “another step forward in this transition away from a pause and to a management of public health concerns,” Bellone said.

The county executive said the surgeries would be helpful for the hospitals, as they return to other procedures and practices beyond caring for COVID-19 patients, while they would provide necessary treatment for people who need these operations.

The number of hospitalizations from COVID-19 decreased by 15 over the last 24 hours, dropping to 539. The number of people in the Intensive Care Units, meanwhile, rose by one to 186.

ICU beds were at 68 percent capacity, while overall hospital beds were right at the targeted 70 percent for reopening.

In the last day, 40 people left the hospital, which is “a very good number,” Bellone said. “We wish all those who have come from the hospital a continued speedy recovery.”

The number of people who have died from complications related to the virus increased by 24 to 1,733.

A Thursday rally in Commack calling for the state to reopen the economy led to multiple protesters acting in an agressive fashion toward Kevin Vesey from News 12, walking toward him with megaphones as he tried to keep a distance from the people who took off their masks to shout at him. That video shortly went viral.

President Donald Trump (R) tweeted about the incident Friday and Saturday, reciting chants from the group of protesters writing “FAKE NEWS IS NOT ESSENTIAL!” in all caps, and calling the protesters “great people.”

Bellone did not mention the president but instead expressed his support for journalists.

“I will make sure and the Suffolk County Police Department will make sure that everyone who is attending a rally like this, which includes members of the media, are protected,” Bellone said.

Separately, Bellone heard back from Veterans Affairs that residents would not be able to place flags at the graves of veterans at Calverton National Cemetery and Long Island National Cemetery. Bellone plans to send another letter, urging that VA Secretary Robert Wilkie reconsider, allowing the county to honor these servicemen and women during Memorial Day.

Town of Brookhaven's Cedar Beach. Photo by Kyle Barr

Even before Suffolk County officially clears all the hurdles for a phased economic reopening, the county is planning to open Smith Point and Cuspsogue beaches over Memorial Day weekend.

County Executive Steve Bellone (D) suggested that keeping children home during the holiday weekend and the unofficial start to summer would be unrealistic, especially after all the limits placed on them to contain the spread of COVID-19.

While the beaches would be open, the visit to some of Long Island’s more inviting summer destinations won’t be the same as it is in any other year, as physical games, such as football and basketball, are limited.

Guests who visit the beaches will need to wear masks when they can’t maintain social distancing with other families or groups visiting the beach.

The bathrooms will be open and will have hand sanitizer. Attendants will also monitor the restrooms to ensure they remain sanitized.

Residents “won’t be playing contact sports,” Bellone said on his daily conference call with reporters, but they can go in the water.

It’s in the wake of more bad news for Long Islanders hoping Suffolk would be able to clear the hurdles necessary to open in a short time frame. Friday, Gov. Andrew Cuomo (D) extended the New York Pause stay-at-home order until May 28, excluding the five of 10 upstate regions already set to start the reopening process.

Downstate, including Nassau and Suffolk Counties, have not met the seven criteria in order to open. Long Island is being counted as one region for the purposes of reopening, and New York State’s dashboard shows LI has still only met four of seven criteria. Long Island still requires a 14-day decline in hospital deaths, a supreme decrease in new hospitalizations and hundreds of new contact tracers.

As for the update on figures for the county, Bellone reported 175 new positive tests for the virus, bringing the total, without antibody tests, to 37,719.

Through Wednesday, the most recent period for which Bellone has data, the number of hospitalizations fell 21 to 554 which is “still a high number,” albeit one the county hasn’t seen for six or seven weeks.

The number of people in Intensive Care Unit beds increased by two to 185.

The county was below the 70 percent target for bed capacity, with 69% of hospital beds and 65% of ICU beds in use with patients who are battling COVID-19.

In the last day, 44 more people returned home from the hospital to continue their recoveries.

The number of people who have died from the virus increased by 12, bringing the total to 1,709.

Karen Tsai, class of 2017, reviewing donations with another volunteer from DonatePPE.org. Photo from Stony Brook Medecine

Perhaps no figure is as indicative of the strain on the health care system as the number of residents battling the pandemic in the Intensive Care Unit. A month ago, that number was close to 550.

Kevin Tsai, class of 2019, carries donations of PPE.

Through Tuesday, the most recent period for which data is available, the number of people in the ICU dropped by 31 to 183.

“That’s the first time in a long time that [the number] is below 200,” Suffolk County Executive Steve Bellone (D) said on his daily conference call with reporters.

At the same time, the rolling three-day average of the number of new hospitalizations was below the threshold needed, 30, to reopen the economy for a second straight day through Tuesday.

“That’s very good news,” Bellone said. “We are meeting that for at least two days now. We are hopeful that the trend will continue.”

After an increase of 10 in the number of people hospitalized because of COVID-19 on Monday, the number fell by the same amount on Tuesday, bringing total hospitalizations to 575.

The hospital capacity for beds overall and for ICU beds is tracking close to 70 percent, which is the target figure to reopen the economy.

As for testing, the number of positive tests increased by 239 over the last day, which is considerably lower than the average over the last few weeks. The number of people tested during that period was 3,229 for a positive testing rate of 7.4%.

COVID-19 continues to take the lives of Suffolk County residents. Over the last day, 17 people have died, driving the total number of coronavirus-related deaths to 1,697. To put that number in perspective, the number of deaths in the county is 60 people below the total enrollment at Ward Melville High School.

Bellone offered his thoughts and prayers to those who are grieving these losses.

As he has for several weeks amid discussions about reopening the economy, the county executive reiterated his desire to see the county reopen in such a way that it doesn’t need to shut down later in the summer or in the fall, amid a potential second wave of the virus.

Having a strong testing regime in place and an aggressive contact tracing plan is “going to allow you to identify quickly” any potential areas of transmission of the virus, Bellone said. These measures, which include 450 contact tracers, will put the county in a position to close a business or specific type of activity in as “targeted a way as possible,” he said. “That’s a much better scenario than seeing infections spike and not having a sense of where they are coming from.”

One of the lessons from other parts of the world that have reopened and then had to close businesses again has been that these measures will hopefully keep Suffolk County from sliding back after it is ready to open.

Separately, Bellone’s office delivered 45,000 personal protective equipment to nursing homes and adult care centers in the last day, bringing the total PPE to 4.7 million pieces since the crisis began.

SB Medical Graduates Pitch In PPE

Meanwhile, two Stony Brook Medical School graduates, siblings Karen Tsai, who graduated in 2017, and her younger brother Kevin, who graduated in 2019, created an organization called DonatePPE.org, which has contributed over 1.2 million pieces of personal protective equipment to areas including New York City, the Bay area, Southern California, New Orleans, Atlanta, Chicago and Boston.

Karen helped launch DonatePPE and created a volunteer team, which included her brother. The team has 30 people which includes web developers and health care workers. Kevin helps run the website and is writing articles about donations and collaborations with PPE producers and sponsors. He also offers insights from his anesthesiology perspective.

The group also worked with illustrator Guy Gilchrist, who worked with Jim Henson on the Muppets television show, to post downloadable coloring pages, sketches and comic strips. DonatePPE launched on March 19. In the first two weeks, the site donated 100,000 articles of PPE, which included the coveted N95 masks, surgical masks, face shields, gowns, shoe coverings and goggles.

While COVID-19 has become the dominant catastrophe of the moment, other longstanding crises have taken a backseat in the public eye.

Graphic by TBR News Media

The opioid crisis, an epidemic that has taken many more lives over a much longer stretch of time, is seeing a new rash of overdoses since the start of the pandemic.

Data provided by Suffolk County Police shows overdoses have generally increased from the same months last year to this year. In March, police counted a total of 14 fatal overdoses compared to 27 in 2019. There were 108 nonfatal overdoses compared to 93 last year. In April, the numbers jumped wildly from 15 fatal overdoses in 2019 to 30 in 2020. Nonfatal leaped from 67 to 113.

District Attorney Tim Sini’s (D) projections of overdose numbers tell an even more morose tale. With data that includes ODs that weren’t confirmed yet by toxicology reports, seeing a total increase of 19 percent of both fatal and nonfatal overdoses compared to the previous year. Though those numbers include all overdoses, not just related to opioids.

While it may be too soon to determine a specific link between the pandemic and the increase of overdoses, drug counselors and rehabs say they have seen the marked connection between isolation, mental illness and drug dependence. As time goes on and the country faces economic turmoil, some worry the situation may not improve for the rest of the year.

Addiction Relief Shifts to Remote Help

Dr. Carol Carter, the director of the Sunshine Prevention Center in Port Jefferson Station, works especially with youth and parents dealing with mental health and drug-related issues. She said her center quickly had to scramble after the state first started closing down. Since then the center has been hosting most programs over Zoom or in Facebook Live sessions. They have especially tried to focus on appreciating diversity, the issues of isolation and other anxieties. They have done children’s book reading and puppet shows over the internet as well, looking for ways to maintain positivity. They have also connected with families by dropping off care packages and calling families each week.

Sunshine Prevention Center in Port Jefferson Station created a “Blessing Box” for people to take necessary items when they need it and drop it off as a donation. Photo from SPC Facebook

But while such meetings may be a substitute for counseling sessions, Carter said the main difficulty is preventing people from getting on drugs, especially as so many remain cooped up indoors,  many in unstable situations.

“We’ve seen an increase of response hotline, in depression and suicidal ideations,” Carter said. “We’re still collecting data, but we’ve heard of an increase in domestic abuse, an increase in substance use, alcohol abuse, as their way of coping with isolation.”

Director of Drug and Alcohol Counseling Services at the Smithtown Horizons Counseling and Education Center, Matthew Neebe, said it’s hard to gauge if there has been an increase in drug use since the pandemic as the center is not facilitating toxicology screenings. Yet, he added there is “anecdotal” evidence for the pandemic causing and increase in relapses and drug use.

“Two of the biggest risk factors for substance use are social isolation and stress,” he said. “Both are consequences of the stay-at-home orders.”

While the center itself is considered essential, they have continued to operate at a reduced level. However, with most staff working from home, all therapy sessions are done via telehealth. They have been conducting some group sessions virtually, though they have reduced the number of sessions from their regular schedule.

Anthony Rizzuto is the director of provider relations for Seafield, a drug rehab with inpatient facilities in Westhampton and outpatient facilities in Amityville, Medford, Mineola, Patchogue and Riverhead. He said they too have been hearing of the increase in overdoses and the increased use of alcohol and other drugs as more are quarantined at home.

“We know people will turn to drugs or alcohol, and God knows right now we have plenty of stressors — we have people who have lost loved ones, people who have lost their jobs, people who are in financial ruin, some are losing their businesses,” Rizzuto said. “We see an increase right now, and quite honestly I expect a huge increase as this continues going on and after this is over, if this ever happens.”

While there are obvious downsides to telehealth, the push is one that was in the docket for a while, and with the current pandemic, has finally pushed many institutions into taking it seriously, said Dr. Christian Racine, the senior director for clinics for the Family Service League Long Island. The nonprofit social services agency also runs the Diagnostic, Assessment and Stabilization Hub in partnership with Suffolk County.

The benefits, Racine said, include allowing people who may have had mobility issues or other mitigating problems the chance to get into the system. People who call the hotline for the clinic or DASH center are now immediately put into the system, where they can connect with people to understand what the person is going through and what services they should get connected to. It also allows for flexibility in time and location, no longer requiring a person to drive what can be a long distance to start the treatment process. 

FSL’s Mobile Crisis Teams continue to operate, often going to a person’s home to talk through the door or even speak to a person through video chat or phone right on the person’s driveway.

“We didn’t see a drop in services, [but] an increase in services because of flexibility of being able to use telehealth,” Racine said. “People are being frank about increased cravings or relapses.”

Sarah Anker, the legislative chair of the opioid panel, said they too are concerned of increase in opioid overdoses. File photo by Erika Kara

Though there still are several downsides to telehealth. Perhaps the most egregious is for those living in unstable home conditions, where the person on one of the calls may not want others to listen in.

“Even if you get along with the rest of the family, you’re worried about what you’re sharing or you’re hesitant to share certain details,” he said. “Some don’t have the best relationship with their families. It’s absolutely a concern, and we’re very conscious of that.”

While Rizutto acknowledged some of the benefits of telehealth, he said he preferred the in-person meetings where he said “a lot is being said nonverbal.” 

Otherwise, with so many resources shut down, from in-person AA meetings to churches to gyms, “Zoom really played a part to give people something,” Rizutto said. “People are in those meetings who had never been to therapy, before people from all over. It is definitely meeting a need.”

Government and Police Response

Suffolk County Police Chief Stuart Cameron said cops have noticed increased incidents of drug overdoses, though despite the emphasis on social distancing police are still able to administer Narcan, a life-saving drug that halts an opioid overdose. 

But with treatment and prevention as the more important component of substance abuse, the pandemic presents its own unique challenges.

“It’s not just opioids — people are self medicating, people are isolated,” said Suffolk County Legislator Sarah Anker (D-Mount Sinai). Anker is the legislative chair of the Suffolk County Heroin and Opiate Epidemic Advisory Panel.

The trend is troubling, especially compared to Suffolk County’s previous models showing total overdoses are on the decline. In January, Suffolk released a report showing 2019’s projections of opioid-related deaths was 283, compared to 2018’s 380. Those decreased numbers of deaths were attributed, in part, to the greater use and availability of Narcan.

Anker said the numbers have caused real concerns among other members of the opioid advisory panel. In a meeting Friday, May 8, panel members discussed tapping into county forfeiture funding to create public service announcements on mental health and the different places to receive drug treatment. The panel also would look to advocate that the federal government should allow people to use Medicaid funds for teleconferencing, which it currently does not cover.

Suffolk County District Attorney Tim Sini says the issues with overdoses and drugs won’t improve with the ongoing pandemic. Photo by Alex Petroski

Sini said Suffolk County has not seen a decrease in drug-related activity despite the pandemic. This is mostly due to the nature of how drugs enter into Suffolk — smuggled into New York City then is sold wholesale to dealers on the ground, who usually drop it off to peoples’ houses or are picked up at select homes.

“We’re not seeing any drop except for powdered cocaine, but we’re not seeing that same situation with heroin or fentanyl,” the DA said.

Sini said while other crimes like break-ins have declined, the office has allocated more resources to the narcotics bureau, now standing at 13 narcotics prosecutors, which works closely with police to track dealers and prosecute them.

The DA’s office is also planning to roll out a new program that would work with a yet-to-be-named nonprofit and shuttle people in addiction to treatment providers. Sini said there will be more information on that program in the coming weeks.

The initial rise in COVID-19 cases forced the rehab facilities to cut back in bed capacity, especially as hospital-based detoxes turned into beds for COVID patients. Since then, as the number of hospitalizations declined, Rizzuto said now bed supply is better, but of more concern is funding for these facilities.

“Either a state-funded facility, nonprofits or private entities, I think the budget is going to be ravaged and with the lack of being able to collect, they will be looking to cut,” Rizzuto said. “I think they are going to have to cut in many different areas to meet the needs financially. Historically behavioral health is one of the things that gets slashed.” 

Anker said members of the advisory panel have expressed their concerns for many different programs’ funding, especially as New York State reports huge drops in income. Many nonprofit rehabs and centers rely on such funding.

“Drug addiction is not decreasing, it’s increasing and they may be taking away those resources,” Anker said. “We may not hear it now, but we will see repercussions come out as we deal with pandemic.”

Maintaining the breadth of services, from inpatient care to outpatient care to paying for nursing and other medical staff, the rehabs and prevention centers requires a heavy dose of government funding. Racine said restructuring Medicaid could provide a necessary boost of aid.

“The idea of state funding being reduced is really a concern — a lot of services are expensive,” Racine said.

Despite the efforts of both government, for profit and nonprofit organizations, officials said they don’t expect numbers to return to the way they seemed to be heading only a year ago.

“I think it would be very hard to end 2020 on a decline,” Sini said. “We will see an increase in 2020, but we will all be working to bring those numbers down in 2021.”

To reduce binge eating, take the dog for a walk while social distancing. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Obesity is an ongoing struggle for many in the United States. The latest statistics suggest that 40 percent of the population is obese. Obesity is a disease unto itself and is defined by a BMI (body mass index) of >30 kg/m2, but obesity can also be defined by excess body fat, which is more important than BMI.

Obesity has been associated with COVID-19, especially in the U.S. In a study involving 5700 hospitalized COVID-19 patients in the NYC area, the most common comorbidities were obesity, high blood pressure and diabetes (1). Of those who were hospitalized, 41.7 percent were obese.

In a study in China, results showed that those who were overweight were 86 percent more likely to have severe COVID-19 pneumonia, and that percentage increased to 142 percent when obesity is reached (2). The study has yet to be peer-reviewed, but it complements other studies.

Another study from France indicates that those with a BMI >35 (severely obese), were more likely to be put on ventilators (3).

In fact, one study’s authors suggested quarantining should be longer in obese patients because of the potential for prolonged viral shedding compared to those in the normal range for weight (4). And though age is a risk factor for COVID-19, among those younger than 60 and obese, there is a two-times increased risk of being admitted to the hospital, according to a 3,615-patient study at NYU Langone Health (5).

Why are you at higher risk for severe COVID-19 with obesity? 

According to the prevailing theory, obesity may interfere with mechanical aspects of breathing, thus increasing airway resistance and make gas in exchange more difficult in the lung. It may also impede on lung volume by exerting pressure on the lungs and may involve weaker muscles necessary for respiration (6).

Why is excess fat more important than BMI? 

First, some who have elevated BMI may not have a significant amount of fat; they may actually have more innate muscle. More than 25 percent of my patient population is “solidly built,” which means they have greater muscle mass as well as too much excess fat. (I have a body analysis scale that detects muscle mass and fat through two different currents of ohms.) Visceral fat is the most important, since it’s the fat that lines the organs, including the lungs.

For another, fat cells have adipokines, specific cell communicators found in fat cells that communicate with other fat cells but also other systems such as the brain, immune system, muscles, and liver. Adipokines can be mediators of both inflammation and insulin resistance, according to an en-docrinology study (7). In a study of over 4,000 patients with COVID-19, the author suggests that inflammation among obese patients may be an exacerbating factor for hospitalizations and severe illness (8). 

If we defined obesity as being outside the normal fat range – normal ranges are roughly 11-22 per-cent for men and 22-34 percent for women – then close to 70 percent of Americans are “obese.”

Inflammation reduction and weight-loss combined

In a randomized controlled trial with 75 participants comparing a plant-based diet to a control diet, there was a greater than 14 lbs. weight reduction and roughly 10 lbs. fat reduction over a 14-week period (9). Of the weight lost, about 70 percent was excess fat. Remember, excess body fat, through adipokines, may be inflammatory and increase the risk of severe COVID-19. 

The weight reduction with a plant-based approach may involve the increase in fiber, reduction in dietary fat and increased burning of calories after the meal, according to Physician’s Committee for Responsible Medicine (PCRM) (10).

You also want a diet that has been shown to reduce inflammation.

We are currently submitting a small study for publication involving 16 patients from my clinical practice. It shows that those who ate a whole food plant-based LIFE (low inflammatory foods every-day) diet over a seven-day period had a significant decrease in inflammation measured by hsCRP (high sensitivity c-reactive protein). This occurred in those who completely changed their diets to the LIFE diet, but also occurred in those who simply added a greens and fruit-based smoothie daily to their existing diet.

In my practice, I have seen a number of patients lose a substantial amount of weight, but also excess body fat, over a short period. For instance, a 70-year-old male lost 19 lbs. of weight and 12 lbs. of excess body fat over a six-week period. His inflammation, which was very high to start, dropped substantially to the border of optimal levels, using hsCRP as the inflammation measurement. This patient and many others have seen tandem reductions in both weight and inflammation. To boot, this was a cardiac patient whose cardiologist had considered a stent, but later said he did not need it after reducing his inflammation.

Exercise to reduce binge eating

While sheltering in place with fewer physical activities available, it is very tempting to binge eat or use food as a leisure activity. But there is a way around this. 

In patients who are overweight and obese, those who exercised compared to those who were sedentary, showed a significant reduction in binge eating over a 12-week intervention (11). The participants at baseline had a mean BMI of 30.6 kg/m2 and a mean age of 43 years. Of the 46 participants, almost two-thirds were women. Exercise can be as easy as walking or running outside while social distancing; doing exercises with your own body weight, such as calisthenics; taking online exercise classes (of which there are plenty); or using exercise equipment you have at home, might help allay binge eating.

If COVID-19 does not convince you that losing excess body fat is important, then consider that obesity contributes to, or is associated with, many other chronic diseases like cardiovascular disease, high blood pressure, and high cholesterol, which also contribute to severe COVID-19. Thus, there is an imperative to lose excess body fat. Now, while we’re sheltering in place, is the time to work on it.

References:

(1) JAMA. online April 22, 2020. (2) https://doi.org/10.2139/ssrn.3556658 (2020). (3) Obesity. online April 9, 2020. (4) Acta Diabetol. 2020 Apr 5: 1–6. (5) Clin Infect Dis. Online April 9, 2020. (6) Chron. Respir. Dis. 5, 233–242 (2008). (7) Front Endocrinol (Lausanne). 2013; 4:71. (8) MedRxiv.com. (9) Nutr Diabetes. 2018; 8: 58. (10) Inter Journal of Disease Reversal and Prevention 2019;1:1. (11) Med Sci Sports Exerc. 2020;52(4):900-908.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.