Gov. Andrew M. Cuomo last week used results of early antibody testing across the state to estimate that 7.1% of those in Western New York have been exposed to the novel coronavirus.
That would leave about 1.4 million people in the eight-county region still vulnerable to the virus.
It’s hard to imagine hitting a bar or restaurant, going to a movie or heading to a Buffalo Bisons game with that level of exposure.
“There are so many people that haven't been infected yet that it's a bit like catching fish in a barrel for this virus,” said Dr. Thomas Russo, chief of the Division of Infectious Diseases in the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.
“If we’re going to start to relax our public health measures,” he said, “we need to have broad testing available to identify people if they get infected, so we can do the proper quarantines.”
Russo and other health leaders hope an explosion of coronavirus testing will lead to a gradual relaxation of state shutdown orders in Buffalo-Niagara.
They predict the regional economy will reopen in phases as more testing becomes available, it could be fall before we return to a greater sense of normalcy, and the virus might then re-emerge before a vaccine is ready to prevent further infection.
Why testing matters
The region so far has avoided a surge in coronavirus cases because social distancing worked, Russo said. Disregarding that and other protective measures would boost infection and death rates, and could overwhelm hospitals.
Testing and treatment will help tailor a blueprint for moving safely into next stages of life, he and others said.
“What happens in Buffalo may or may not be the same as what happened in New York City or Beijing,” said Dr. John Tomaszewski, chief of service, pathology and laboratory medicine with Kaleida Health. “These are different populations.”
People in the region tend to be older and less healthy than those downstate. The population is smaller, which is a plus, but a lower percentage of residents have been tested for the new virus, providing a cloudier sense of infection rates and risks.
More testing will allow primary health care providers to catch Covid-19 cases earlier and start treatments that might impact disease progression, said Dr. Raul Vazquez, who leads a collaboration of several family health practices that serve 30,000 patients in Buffalo.
About a week ago, only health care providers, hospitalized patients and essential workers with symptoms of a respiratory infection could be tested in the region.
That has amounted to about 25,000 tests so far in a region of 1,521,060 people.
“We're at about a 20% to 22% positive rate for those tested, because testing is still so low,” Vazquez said. The goal, he said, should be to drive up testing, which will make it easier to find and isolate those infected and drive down the spread.
Restrictions could noticeably change after 15% of residents in the region – about 228,000 – are tested and the positive test rate falls below 5%, Vazquez believes.
He and others cautioned that tests are a snapshot in time. Those who test negative can contract the virus after they are tested.
Russo suspects 25% to 50% of those who get the virus show no symptoms but are contagious for two weeks. More testing will provide a more precise asymptomatic regional estimate.
Researchers already know Covid-19 is a lot deadlier than seasonal flu.
The Centers for Disease Control and Prevention estimates that 24,000 to 62,000 Americans have died from influenza during the just-ended flu season, which started seven months ago.
The number of official U.S. Covid-19 deaths – which most medical experts believe have been underreported – surpassed the top flu death estimate last week, after two months. It continues to climb. An average of 1,938 deaths were reported daily during a seven-day period ended Friday.
The vast majority of countries were unprepared to test for the new coronavirus, SARS-CoV-2, when the pandemic began.
South Korea was one of few exceptions. The nation began stockpiling tests, hiring more epidemiologists and testing travelers from abroad after a Middle East Respiratory Syndrome (MERS) outbreak in 2015 caused 186 confirmed cases and 38 deaths.
“The supply chains have been difficult because a lot of the test kit manufacturers are not here" in the U.S., Tomaszewski said. “It's just like the masks and everything else.”
Limited federally approved testing equipment, a lack of reagent chemicals needed to process results and CDC overconfidence that the agency could handle testing demands hampered early efforts to find and isolate all those who had the virus.
Fewer than 8 million of 327 million Americans – 2.5% – have been tested.
Different parts and fuel are needed for different testing equipment.
Catholic Health announced March 22 that its Cepheid equipment would quickly be able to analyze 800 test kit samples a day. It continues to handle far less because the Veterans Affairs Health System uses the same equipment and the federal government has steered most of the needed reagents to VA hospitals, said Mark Sullivan, president and CEO of Catholic Health.
Catholic Health held onto an adequate supply of reagents to test all those at affiliated hospitals suspected with Covid-19 and to meet an increase in hospitalizations, Sullivan said.
Kaleida Health faced similar challenges until Dr. Andrew Talal approached Tomaszewski last month with an idea.
Talal, a hepatologist, heads liver disease research at the UB Clinical and Translational Research Center. He leads a five-year, $7 million study to provide telemedicine for those who use methadone clinics across the state. Part of that expanded treatment involves testing for Hepatitis C and HIV.
Tomaszewski, Talal and others tied to UB modified testing equipment used for the study to instead gauge the presence of the new coronavirus. UB microbiologists were able to make reagents needed to test swabs, said Tomaszewski, also chairman of pathology and anatomical sciences at the UB Jacobs School of Medicine and Biomedical Sciences.
The university biorepository moved other equipment to Kaleida labs during the last two weeks to further boost testing. The labs had the capacity to conduct up to 500 polymerase chain reaction (PCR) tests a day to detect presence of the virus. They will double that starting this week, Tomaszewski said.
The Erie County Department of Health conducts about 400 tests a week. ECMC can process up to 200 a day and Catholic Health can conduct twice that number. Private labs including Quest and LabCorp launched more regional testing last week. Pharmacies and primary care doctors soon will start participating in the more vigorous effort.
Expanded testing will more easily identify those who contracted the virus so that they and others who came in close contact with them in the preceding days can be quarantined. Cuomo and U.S. Sen. Kirsten Gillibrand advocate creating a new health care force to help county health departments manage contact tracing.
Testing novel coronavirus antibodies started in Buffalo-Niagara in mid-April, after Roswell Park Comprehensive Cancer Center and UB researchers announced they would offer it with the goal of identifying people who contracted the virus and developed antibodies that neutralized it. Their plasma can be donated and used to treat hospitalized Covid-19 patients.
An antibody is a protein the body produces during an infection. Doctors and public health officials are most interested in testing for immunoglobulin G (IgG) antibodies, which proliferate during the later stages of infection to mop up remaining virus.
Kaleida Health conducted more than 1,300 IgG blood tests as of Friday, Tomaszewski said.
Regional labs and pharmacies clamor to conduct this testing, too.
The testing – as it expands – can provide a window into what percentage of people in the region carry protection from reinfection.
Russo said PCR testing for the virus should expand five- or tenfold as quickly as possible in nursing homes and prisons – where many people remain in close quarters – so those who test positive can be separated from others. But he and others said antibody testing will become more important to the return to a much greater level of public living, something unlikely until at least fall.
“We need testing if we're going to understand not only what's happening today, but more importantly the risks in the summer and the fall, next flu season and down the line,” Tomaszewski said.
In the best-case scenario, those with antibodies could return to a more liberated life, one free from mask-wearing or social distancing – though continued hand-washing and personal hygiene is recommended to prevent all infections.
That is far from certain. Because SARS-CoV-2 is a new virus in humans, infectious disease control experts fear the immunity benefit may last no longer than into next flu season, if that long. Four other coronaviruses cause 15% to 30% of common colds, which can strike anyone at any time.
Regardless of which elected official or company opens what part of the economy, most people will prioritize their lives, as well as those of loved ones and fellow citizens, while Covid-19 remains a mystery and threat, health experts expect.
“When you relax from this, you could have a second curve, a second wave,” said Sullivan, the Catholic Health CEO. “This disease can spread quickly. With a vulnerable population, the elderly, and with the disease state of Western New York, you need to figure out how you could phase certain things in but still have a diligence around trying to control the spread.”
Russo predicted masks will remain common, even at some point in restaurants able to open but required to restrict diners to every second or third table. Servers wearing masks and gloves will drop off meals.
Many employers will continue to encourage employees to work at home, he said. The need to isolate for 14 days people who test positive – including those who are asymptomatic as well as others contact tracers deem must do the same – will create unpredictability in child care, work schedules, the size of a company workforce and its ability to meet production demands.
Medical research offers a parallel avenue toward normalcy.
Experimental treatments on the Buffalo Niagara Medical Campus and elsewhere involve antiviral, anti-inflammatory and other existing medications to try to slow the spread of Covid-19 and give the sickest patients a better chance to recover.
Kaleida Health on Friday received its first doses of remdesivir, which has shown early promise helping some critically ill patients recover more quickly. Vaccine development is in the early stages, including at Oxford University in England, which last week started human trials. The University of Waterloo in Ontario, 110 miles northwest of Buffalo, is at work on a potential nasal immunization.
Most researchers believe it will take a year or more to measure the safety and effectiveness of a prospective vaccine.
“The responsible thing for the physician community to do right now is collect data and and help patients make informed decisions,” said Dr. Elad Levy, medical director of neuroendovascular services at Gates Vascular Institute, who is among those studying the connection between Covid-19 and stroke risk. “The more time that goes by, the more patients we're treating and the more data we're collecting, the better our understanding is going to be.”