‘4-alarm blaze’: New York’s public health crises converge

In Health


Strike two

But amid the scramble to respond to monkeypox, a new threat emerged.

On July 18, Bryon Backenson, director of the department’s Bureau of Communicable Diseases, received a call from Kirsten St. George, director of virology and chief of the laboratory of viral diseases at the Wadsworth Center, the state’s public health lab. The health department had, days earlier, reminded health care providers to watch out for signs and symptoms of acute flaccid myelitis, a polio-like disease.

“It just so happened that that advisory showed up … pretty much the day before the individual who turned out to be our polio case presented at the hospital,” Backenson said in August. ”This particular advisory that we put out … had really put in the forefront of their minds to be on the lookout.”

St. George was one of the first to find out about the positive case in a person living in Rockland County.

“The molecular supervisor from the lab appeared in the doorway of my office and said, simply, ‘Kirsten, that paralysis case down in the city … we have the result: It’s probably a Type 2 polio,’’’ St. George recalled. “I simply looked at him and said, ‘You’re kidding.’”

She asked for the sequence to be run again.

“As soon as he told me the result, my mind, your mind, I think, for anyone in that situation, starts to run in quite a few different directions at once,” St. George said. “The importance of the finding, the public health implications, the many people who need to be notified … the consequences. But also just a single thought: Where on earth did it come from?”

Scientists at the center had no immediate answer.

Flooded with thoughts about the worst-case scenario, St. George and her team at the Wadsworth Center contacted the CDC. The CDC, members of the Wadsworth Center and officials from the health department convened via phone to develop a plan to determine how the individual contracted the virus and the exact degree to which it was spreading. It’s still not completely clear, officials said.

The CDC is testing New York wastewater to get a sense of where the virus may be circulating. Samples have tested positive in several counties, including New York City, Sullivan, Rockland and Orange.

Epidemiologists have determined that the Rockland case is genetically linked to a sample pulled from wastewater in Israel and the United Kingdom — but that doesn’t mean the individual contracted the virus there. It means that the mutations in the wastewater samples are similar.

“We don’t really know where the transmission occurred,” said Emily Lutterloh, director of the division of epidemiology at the health department, in an August interview.

And that’s part of what’s causing anxiety within the department. Polio can spread undetected — and at least one of the counties where wastewater samples have tested positive has a lower rate of polio vaccination than many other areas in the state.

“I’m worried about people not taking polio seriously,” Backenson said. “Because it spreads somewhat invisibly … [and] the vast majority of people don’t have any signs and symptoms, we can rapidly increase the amount of polio that may be circulating in a particular area, which just increases the risk. And it gets us to the point where we’re going to see additional cases of paralytic polio.”

As officials worked quickly to respond to a possible spread of polio, monkeypox cases kept climbing. By August, New York City reported almost 2,700 cases.

On Aug. 9, the White House announced that the Food and Drug Administration was proposing an alternative method of administering the monkeypox vaccine to help increase the number of doses available. The shots, the FDA said, should be given intradermally, or in between the layers of the skin. The new method, officials said, would increase vaccine supply by five-fold.

Since then, monkeypox cases in New York have leveled off, bringing much-needed relief to the health department.

But concerns about polio only seem to be growing.

Over the past several weeks, health department officials and top Biden health and White House officials have debated ways to ramp up vaccinations in communities that traditionally resist shots. On Sept. 9, Gov. Kathy Hochul announced a public health emergency for polio, hoping it will convince more people in the state to get vaccinated. And last week, Bassett declared poliovirus an imminent threat to public health, opening up additional state resources for local health departments to increase vaccinations.

“Human resources are the crux of public health infrastructure,” Santilli said. “Being able to really support [staff] … is really going to be critical to making sure that infrastructure can continue to support the responses and the everyday public health activities.”


Read More: ‘4-alarm blaze’: New York’s public health crises converge

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