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Susan V. Donelan, MD, FSHEA

Dr. Susan Donelan, medical director of Healthcare Epidemiology at Stony Brook University Hospital, spoke by phone with TBR News Media about reopening schools, the importance of face coverings and host of other issues related to COVID-19. Here are her thoughts on the pandemic and the virus.

TBR: At what point would the spread of the virus be contained?

Donelan: Let’s look at it this way: If you accept the concept that even if the virus doesn’t change or change so significantly that any exposure before will be useless going forward, if it remains static and doesn’t morph or mutate, you need 70 percent of persons to be infected in such a way that the vast majority don’t get repeatedly infected. That’s a whole different story. It takes time for the world population to reach that 70 percent.

TBR: How do you get to that level?

Donelan: You can get to that 70 percent, being a relatively typical cutoff [for herd immunity], by one of two ways: by natural infection, or you can get it from a successful vaccine. 

TBR: How does the process of distributing the vaccine work?

Donelan: Having enough is not the same as having it equitably distributed throughout the world. Ideally, [it would be] given to all of those who have reliably never been exposed. [There are a] lot of logistics: Having enough and having it distributed well and having it distributed equitably are different parameters. While this all gets figured out, the virus will hop along and continue to spread to the extent we give it the opportunity to spread. 

TBR: Are people who get the virus getting reinfected? Are some antibodies not providing resistance?

Donelan: That is not clear. There are different kinds of antibodies. With a neutralizing antibody, you get infected or you get vaccinated, the antibody you develop neutralizes the virus when it comes calling again, or when it comes calling for the first time. There are antibodies that are just kind of bumper stickers in your immune system. They show that you’ve been exposed. This is early in the pandemic, It’s really not clear at this point what types of antibodies most people are going to develop and how helpful they will be when the virus comes knocking at their door. 

TBR: Anecdotally, we’ve heard that some people may be less susceptible to the worst of the viral symptoms, if they have a certain blood type, for example. Do you know if any of that is true?

Donelan: I’ve seen tidbits here and there — you can be willy-nilly and not careful. I would caution anyone who picks up these reports to not assess their own individual risk in such a way that would make them less likely to follow the basics of trying to avoid getting sick or transmitting it.

TBR: Would a second wave be milder than the first because more people would have some resistance?

Donelan: I’m hesitant to declare if we had a milder second wave it’s the virus as opposed to other factors. In the 1918 [Spanish flu] versus the 1919 wave, the 1919 wave was bigger.

TBR: How did the protests affect infections?

Donelan: The protests are one of many, many instances of people with lacking social distancing, perhaps not wearing masks or wearing masks incorrectly. It’s maybe the most public one, not the only one. Every time I go out, I see people being noncompliant. As I understand from recent data, New York has an R0 [the average number of people who will get a disease from a single infected person] of under 1. We know that there’s going to be a slow creep in the infection. We’re right up against 1. That’s clearly less than the R0 of 2 or more that was early in the pandemic. By the time we see a bump in hospitalizations, a bump in positive cases, the protests are going to be muddled in with the graduations, the beach parties, the bars and the restaurants. 

TBR: What don’t people know about the disease?

Donelan: The biggest misconception about utilization of face coverings, is that the face covering is for me. I think it must be really be emphasized. I wear my face covering to protect you. You wear it to protect me. 

TBR: What do you think of the risks in youth sports, which are starting up again?

Donelan: There’s no uniform understanding of what’s right or wrong. There are other countries that have been ahead of us in terms of the pandemic and then are now easing themselves back into a more normal society. I think that those of us who are interested in what happens in sports, might keep a clear eye on what’s going on in those countries. Any time you interact, it’s not a zero-risk concept.

TBR: What do you think about schools?

Donelan: I’m working with the state and the campus and my own local school district on what school will look like. I have two kids that are heading to college, another one heading for a Ph.D. program. I have a particular interest in what’s going on. I think the schools have been working hard to optimize social distancing, with mouth and face coverings to the extent that each student at different levels is able to. I told them a couple of months ago, at the state and local level, I don’t see how schools cannot plan on having a hybrid learning platform [one that includes a mix of in-person and remote classes]. 

TBR: What advice would you give schools?

Donelan: The most important thing is to make sure however school looks like for the next two or three semesters, [that there is] a hybrid learning platform, with the ability to pivot quickly to a full-distance learning plan.

TBR: How do you think this will play out for colleges?

Donelan: [Many schools will] start in August. Come Thanksgiving, kids will go home and don’t come back [until the next year as influenza-like illness starts to circulate.] Thanksgiving is the first great cross-pollinator event in the winter season, with people traveling, coming back, picking up whatever is going on wherever they traveled to. I wouldn’t want students coming back to school after Thanksgiving recess, then cross-pollinating more. If there’s anything that people should be encouraged to do, it’s get a flu shot — and get it early.

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Nursing homes have become a hotbed of discussion over the large percentage of their residents who have died from COVID-19 while in New York facilities. Stock photo

When the initial COVID-19 surge occurred in New York State, nursing homes were the site of rampant infections and deaths. According to a New York State Department of Health report released earlier this week, the infection was spread by community transmission and asymptomatic staff members. 

The agency aimed to study the impact of the state’s March directive that nursing homes could not refuse admission or readmission to patients because of a confirmed or suspected coronavirus infection. The directive was meant to free up space in overcrowded hospitals as the pandemic intensified.

The number of nursing home staff reporting COVID-19 symptoms peaked March 16, 23 days prior to the peak of nursing home fatalities, which occurred April 8. 

“It is likely that thousands of employees who were infected in mid-March transmitted the virus unknowingly — through no fault of their own — while working, which then led to resident infection,” the report states. 

Critics of the directive argue that it allowed infected patients to return or come into these facilities and in turn spread the virus to other individuals. The findings of the study show 

37,500 workers — one in four of 158,000 nursing home workers — were infected with COVID-19 between March and early June. 

A number of elected officials took issue with the guidance given to nursing homes by the state. U.S. Rep. Lee Zeldin (R-NY1) disputed claims that the state was simply following the federal government’s guidance. He said the U.S. Centers for Medicare and Medicaid Services, the federal regulator for nursing homes, had previously issued guidance stating that not only should nursing homes only accept patients for which they can care for, but that nursing homes should focus on “prompt detection, triage and isolation of potentially infectious residents.” 

Zeldin also called on the U.S. Department of Health and Human Services and CMS to launch an investigation into New York State’s adherence to appropriate health and safety guidelines within nursing homes and long-term care facilities.

In a statement following the release of the NYSDOH report, Zeldin reiterated his stance. 

“An internal review by the State of New York is OK for them to initiate, but this is not a situation where the state is going to be able to objectively investigate itself,” he said. “These facilities should not have been required to accept patients who were diagnosed at the time with coronavirus, especially if they did not have the ability to protect the rest of their vulnerable population. It was also a fatal policy to prevent nursing homes from administering coronavirus tests to patients returning from hospitalization. Our seniors and their families deserve answers, and an independent investigation is clearly necessary.”

A statewide nursing home survey conducted by NYSDOH shows that between March 25 and May 8, a total of 6,326 COVID-19 hospital patients were admitted into 310 nursing homes. Of those facilities 252 already had either confirmed or suspected positive patients, confirmed or presumed fatalities or infected workers, prior to admission of someone with the coronavirus. 

Stephen Hanse, president and CEO of the New York State Health Facilities Association said at the onset of the pandemic, nursing homes and assisted living facilities were not the top priority. Bolstering hospital resources and ramping up hospital bed capacity were. 

“Policymakers now know that the men and women residing in nursing homes and assisted living facilities are the most at risk of infection from the COVID-19 virus,” Hanse said in a statement. “Consequently, it is essential that nursing homes and assisted living providers receive the full support and assistance from elected officials and policymakers to ensure they have the necessary resources to defeat this virus and safeguard their residents and staff.”

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Police Set New Guidelines for Protests

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With Suffolk County entering Phase 4 of a planned reopening, County Executive Steve Bellone (D) provided his final daily media update on the county’s response to the virus. The County Executive had conducted 122 such updates, as residents suffered personal and economic losses that extend far beyond the daily numbers and statistics.

“We reached the final stage of reopening” today, Bellone said. The county has gone “up the mountain and made it down the other side. In the process, we’ve seen terrible tragedy and acts of extraordinary heroism.”

Entering Phase 4 marks a “new stage” in this unprecedented event,” Bellone added.

Even as the county executive is pleased that the county has moved to Phase 4, in which people can gather outdoors in groups of 50 instead of 25 and some businesses that had remained closed can reopen, he is still aware of the additional work necessary to open other enterprises that remained closed, such as gyms, bowling alleys, catering facilities and movie theaters.

Gyms have presented plans for reducing risk, such as individual workout sessions and class-based reservations that would allow contact tracing to reduce risk, Bellone said.

Asked about reopening schools, which will affect so many families and teachers across the county, Bellone said he thinks schools “need to reopen. That needs to be done safely.”

He suggested that putting together those plans was complicated, but that it shouldn’t be a divisive or political issue.

“We know it is good for kids to be in school,” Bellone said. “We can not have a whole generation of kids that are falling behind. We know the devastating impact that would have.”

The county executive called on the federal government to provide relief to schools to prevent them from having to cut areas that he deemed critical, such as arts, music, sports and staff. Reopening schools will require additional expenses, as schools will not be able to operate normally.

“Right now, schools are worried about paying for the basics,” Bellone said. A federal government that didn’t provide disaster assistance would be “absolutely unconscionable.”

Viral Numbers

The number of people who tested positive for the coronavirus was 69, which represents a 1.7 percent positive rate for new tests. While that percentage is higher than the recent average, which is closer to 1.1 percent, Bellone said he doesn’t put too much stock in any one day’s data.

The total number of people who have tested positive for COVID-19 is 41,799.

The number of people who have tested positive for the antibody but who didn’t have symptoms of the disease is 20,104.

The number of people in the hospital declined by seven to 50, which is “an amazing number considering where we’ve been.”

The number in the Intensive Care Units is nine.

Overall hospital bed occupancy was at 68 percent, while ICU bed occupancy was at 59 percent.

Six people were discharged from the hospital in the last day.

The viral death toll held steady at a revised 1,984, as no residents died from complications related to the coronavirus.

To prepare for a possible second wave of the virus, the county developed a contact tracing program and has worked through procurement to stockpile some personal protective equipment.

Police Rules for Protests

The Suffolk County Police Department put several new rules in place in connection with any future protests.

For starters, demonstrators need to contact the SCPD at least 24 hours in advance to indicate the route they plan to take. They can call (631) 852-6110 between 8 a.m. and 11 p.m. from Monday through Friday.

Protests are prohibited from congregating in the street and disrupting the flow of traffic. Police said people who don’t comply with this rule are subject to enforcement action.

Demonstrators cannot block vehicular or pedestrian traffic and may not enter private property without consent.

Demonstrators may also not walk in the traffic lanes of a roadway when prohibited.

Finally, people who are older than two years old who can tolerate a face mask medically is required to wear one in situations where maintaining six feet of social distancing is not possible.

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Suffolk County will enter Phase 4 tomorrow of its economic reopening with the tail wind of strong public health numbers.

The new phase “means that certain low-risk outdoor and indoor activity will begin to open up,” County Executive Steve Bellone (D) said in his daily conference call with reporters. Some arts, entertainment, media and sports will restart.

Residents are permitted to gather in groups of 50, up from the 25 from the previous phase. Houses of worship, meanwhile, can go to 33 percent capacity.

The Long Island Aquarium, the Maritime Museum, and the Children’s Zoo, among others, are all reopening.

“I encourage people to call directly to make sure that the places are open,” Bellone advised. Some of these facilities might have specific restrictions and may have limited hours.

In the last 24 hours, 45 people tested positive for the coronavirus, bringing the total to 41,730. With 4,226 people tested, the percentage of positive tests was about 1.1 percent.

At the same time, 20,003 have tested positive for the antibody to the virus, indicating that their bodies fought off COVID-19 without a positive test.

Hospitalizations fell six to 57, which is the first time since March that the number of residents who were in the hospital with coronavirus symptoms was below 60. At the same time, the number of people in the Intensive Care Unit was 14, which is a decline of two.

An additional nine people were discharged from the hospital and are continuing their recovery at home.

Hospital bed occupancy was at 64 percent, with ICU bed capacity at 60 percent.

One person died in the last day from complications related to the virus, bringing the total to 1,985.

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Suffolk County Executive Steve Bellone. File photo by Alex Petroski

Even as Suffolk County prepares for the final phase of its economic reopening this Wednesday, people came to Fire Island during Fourth of July celebrations, where they reportedly violated social distancing and face covering rules.

After all the work to reduce the spread of the virus in Suffolk County and the economic and personal sacrifices designed to save lives, County Executive Steve Bellone (D) was disheartened by images of people on Fire Island and in Montauk who ignored public health rules.

Bringing groups of people within six feet of each other without wearing face coverings is “just dumb,” Bellone said. “It doesn’t make sense. The way that we will undo all of the progress that we have made is to simply stop using common sense.”Such flouting of rules designed to protect the public “is unacceptable” and will result in enforcement actions, Bellone said.

Future incidents in which people don’t follow health guidelines can result in tickets from the police department. The tickets are a Class B Felony.

Bellone urged residents to remain safe so that the county can consider reopening schools and so businesses that have been able to survive the earlier shutdown can continue to rebuild.

The Suffolk County Police Department received 1,160 firework-related calls from Friday through Sunday.

Viral Numbers

The number of people who tested positive for COVID-19 was 43, which represents a 1.1 percent positive rate among the 3,812 people tested.

The total number of people who have tested positive for the virus was 41,685. The number of people who have had a positive antibody test, who have not had symptoms of the disease but whose bodies have developed antibodies, is 19,978.

Hospitalizations declined by three to 63, while the number of people in the Intensive Care Units was 16, which is also down by three.

Hospital bed use was at 64 percent. The occupancy of ICU beds was at 56 percent.

Over the last day, 13 people were discharged from Suffolk County hospitals.

One person died from complications related to COVID-19. The total number of deaths for Suffolk County increased to 1,984.

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Residents prepare July Fourth at-home firework shows in Port Jefferson Station in 2018. Photo by Kyle Barr

A man in Port Jefferson Station was injured just after 10 p.m. last night when he attempted to light a firework that explored and injured one of his eyes.

Carlos Diaz, 29, was transported to Stony Brook University Hospital with serious, but not life threatening injuries.

Additionally, a 29-year old man in Central Islip was severely wounded in the hand from an exploding firework. The man was at home on Tamarack Street when the injury occurred around 9:10 p.m. He was airlifted to Stony Brook University Hospital.

“Every year, we do these reminders and talk about the dangers of fireworks,” County Executive Steve Bellone (D) said in his daily media call. He shared his hopes that both people injured by fireworks will recover.

Suffolk County Police Department Chief Stuart Cameron said the county did have a higher incidence of fireworks-related calls, due to the limitations on large crowds at the usual fireworks shows.

While the number rose, he said the increase in Nassau County was “much higher.”

Earlier in the day, at 5:30 p.m., Second Precinct officers responded to a fire at the Rodeway Inn in Huntington Station. Canine officers located Raymond Pond, 50, whom they are holding overnight and charging with Arson in the second degree. Pond, who is a resident of the Inn, also has two outstanding warrants. While people were at the Inn when it caught fire, the police reported no injuries.

Viral Numbers

For the fifth time in the last seven days, Suffolk County reported no deaths from complications related to COVID-19. This lower mortality rate puts the county in a good position to reach Phase 4 of its reopening plan this Wednesday.

“We are moving into the new week in very good shape,” Bellone said. The low mortality rate is a “credit to everyone who has done amazing work in this county,” including by the public who he said has, mostly, abided by rules regarding social distancing and face coverings.

The number of new positive tests was 57, which brings the total number of people who have tested positive for the coronavirus to 41,642.

An additional 19,960 people have tested positive for the antibody.

Hospitalizations declined by four to 66. The number of people in the Intensive Care Unit increased by two to 19.

Hospital bed occupancy was at 67 percent, while the percent of ICU beds in use was 60 percent.

In the last day, 10 people were discharged from county hospitals.

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As Suffolk County prepares to enter Phase 4 of its economic reopening, the county has reported the lowest number of weekly fatalities since March.

For for the fourth time in six days, no one died from complications related to COVID-19, which is a pattern County Executive Steve Bellone (D) said he hopes continues as the county fights to hold its hard-earned gains from the lockdown and new rules designed to protect public health.

The number of people who have died from the virus remained at 1,983.

“This is a real reflection of how far we have come,” Bellone said on his daily conference call with reporters. “All the sacrifices are ultimately about saving people’s lives.”

The number of people who tested positive for the virus was 47, bringing the total to 41,585. That represents 1.1 percent of the tests given over the last day.

Hospitalizations declined by three to 7. The number of people in the Intensive Care Unit who are battling the virus fell by three to 17. The two-day decline at the ICU was 10.

Hospital occupancy was at 68 percent, while ICU bed capacity was at 61 percent, both of which are within safe guidelines for continuing to march forward with reopening.

The number of people who were discharged from the hospital was five.

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By Nancy Burner, Esq.

Nancy Burner, Esq.

Federal and state funding of COVID-19 related relief will likely require major budget overhauls and could potentially change the estate and gift tax landscape.

On the federal level, the 2017 Tax Cuts and Jobs Act doubled the estate and gift tax exclusion from $5,000,000 to $10,000,000, as adjusted for inflation, for decedents passing away between 2018 and 2025. However, the increase in the exclusion amount is temporary and is scheduled to sunset on December 31, 2025 and revert back to $5,000,000 (adjusted for inflation).

Currently, the federal 2020 lifetime exclusion amount is $11,580,000 per person, which can be utilized to transfer assets during life or upon death, free of federal estate or gift tax. In New York, the current estate tax exclusion is $5,850,000. New York does not impose a gift tax, although gifts made within three years of death are brought back into the estate for estate tax purposes.

Portability on the federal level allows a surviving spouse to use the deceased spouse’s unused federal lifetime exclusion. Therefore, if the first spouse to die has not fully utilized his or her federal estate tax exclusion, the unused portion, called the “DSUE amount,” can be transferred to the surviving spouse. The surviving spouse’s exclusion then becomes the sum of his or her own exclusion plus the DSUE amount. 

To take advantage of the DSUE amount, a timely filed federal estate tax return must be filed within 9 months from the deceased spouse’s date of death, or within 15 months pursuant to an extension request. Many surviving spouses may not be aware of this requirement or fail to see how filing a return would be beneficial at the time of the first spouse’s death with the current exclusion amount being so high. If ignored, upon the death of the surviving spouse, his or her estate is unable to utilize the DSUE amount unless other specific actions are taken. New York State does not currently have portability.

With the looming sunset, practitioners were concerned with what exclusion amount would be used to calculate the estate tax for a decedent dying after January 1, 2026 who made gifts between 2018 and the end of 2025, or the DSUE amount for the spouse that died between these dates that filed a return for portability. Finally, on November 26, 2019, the Treasury

Department and IRS issued regulations clarifying that the estate tax and DSUE amount will be calculated using the increased exclusion amount that was in place between December 31, 2017 and January 1, 2026, confirming that there will be no “claw back.”

Increased spending associated with COVID-19 will likely leave the government searching for revenue. One such avenue could be a reduction in the exclusion amount on the federal and/or state level, even prior to the current federal sunset date. It is more important than ever for an executor to file a federal estate tax return on the death of the first spouse to lock in the higher DSUE amount. 

Additionally, individuals with high net worth should consider gifting assets now to reduce their taxable estate on both the federal and state levels. 

With so many political and social changes on the horizon, it is of paramount important to work with an experienced estate planning attorney to discuss these issues, review your estate plan and potentially revise your current estate planning documents to include provisions for estate tax planning on the death of the first spouse. The potential to be subject to estate tax could increase for a significant number of individuals if the exclusion amount is lowered in the future.

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office. Visit www.burnerlaw.com.

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Fireworks in Port Jefferson for Independence Day 2019. Photo by David Ackerman

As the county prepares for a Fourth of July following a painful spring, county officials and health care providers reminded residents to remain safe during fireworks displays and to continue to follow health guidelines.

Steve Sandoval, Associate Professor of Surgery and Medical Director of the Suffolk County Volunteer Firefighters Burn Center at Stony Brook University Hospital, urged residents to be cautious around fireworks and barbecues.

The best way to avoid injuries is to “prevent the burn in the first place with safety tips and precautions to eliminate potential dangers,” Sandoval said in a statement.

The Suffolk County Volunteer Firefighters Burn Center offered 10 tips, which included viewing fireworks used by professionals, not leaving hot coals or fire pits, not using the stove top, fire pit or fireplace when residents are tired or have had alcohol.

“If burned, do you go anywhere but a facility that specializes in burn treatment,” Sandoval said.

The Suffolk County Police Department, meanwhile, warned residents of counterfeit oxycodone. Detectives recently seized pills that bear the markings of 30 mg of oxycodone but that were fentanyl instead, which is 1,000 times more potent than morphine. Ingestion can cause overdose and death. The department warned residents that people buying these pills may not be able to distinguish between the counterfeit pills and prescription oxycodone.

Viral Numbers

After two days without a death related to complications from COVID-19, two residents died in the past 24 hours. The total number of residents who have died from the virus is 1,983.

The number of new infections over the last day was 47, bringing the total to 41,538. Gregson Pigott, the Commissioner of the Suffolk County Department of Health Services, said new infections crossed a whole spectrum of ages and included people in their 20’s.

The county distributed 30,000 pieces of personal protective equipment over the last day.

After the success of drive in movies at the Smithpoint County Park, the county is opening a second site for movies, at the Suffolk County Community College on the Grant Campus in Brentwood. The series will include “Pee Wee’s Big Adventure” July 8, “The Karate Kid” July 9, “Matilda” on the 10th and “Back to the Future” on the 11th. Residents interested in getting free tickets can register through suffolkcountyny.gov/driveinmovies.

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It was the winter of 2007 to 2008 when the financial crisis hit. Years of excessive risky loans by banks (and others) and a downturn in the subprime lending market resulted in several years of economic hurt. Many lost their jobs and homes. Some say we truly have never recovered.

For the young people graduating high school or college just over a decade ago, it was walking blind toward a cliff’s edge. They went through school with certain expectations, but the jobs once promised to be there upon graduation were gone. In the following years, young people took what was available, much of the time it was low-paying service industry jobs without a real hope of promotion. A new kind of employment, something people started to call the “gig economy,” was born. People worked freelance without a chance for receiving health insurance through an employer or have any kind of job security.

Now we face a new impending time of economic peril, and there are many thousands of young people graduating this year from high school or college on Long Island.

We as parents and residents need to ask ourselves, “What will we do for them to make sure they can make it out there in a time of wild unpredictability and economic inhospitability?”

Research indicates that people who graduate in a time of economic tension can remain in worse straits than their peers for over a decade. A 2019 study in the Journal of Labor Economics showed the pay and employment rate for people who graduated during the Great Recession have remained relatively low, even after several years. Millennials, the youngest of whom are 24 while the oldest are nearing 40, hold just 3 percent of America’s wealth compared to 21 percent that the baby boomer generation held at around the same age, according to a 2019 U.S. Federal Reserve report. 

This is a pivotal time for young people entering the job market, as not only is this when they can start to accrue wealth and build up savings, but it’s a means to start grinding away at what can be tens of thousands of dollars in student loans. 

Without early starts to their careers, young people will end up running in place, making enough to live but not enough to build their credit or finances (though on Long Island it’s rare they will be able to afford the rent to even the smallest apartment). 

It’s time as a nation we seriously have to consider governmental action to save the future for our graduates. Yes, that includes student loan forgiveness programs, as there is potentially no worse idea than saddling a young person — who likely never even signed a check before — with thousands upon thousands in debt to either private firms or the U.S. government. Even more people will be looking to college as a way to build their job prospects, so it’s time we look at additional subsidies for college. We should also start thinking of handing out incentives to companies willing to hire people fresh out of school.

An unregulated financial sector helped cause the 2008 economic collapse. Now with the pandemic, more research has shown if the government, both state and federal, had responded to the crisis with lockdowns sooner, we could have saved more lives and potentially restarted our economy faster and smoother. 

What’s done is done, but the fact is young people had no part in causing this economic downturn. Let’s have us as parents and neighbors think about how we can still help young people get ahead in life, for the sake of their entire generation.

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