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Brian Lehrer: Brian Lehrer on WNYC. Is that a second wave on the horizon or just a ripple? On Tuesday, Mayor Bill de Blasio announced the daily testing positivity rate in New York City of 3.25%, the highest daily rate since June, but then, yesterday, that number fell back down to under 1%. Now yesterday happened to be the day that indoor dining resumed at New York City restaurants and today is the day that public high school students are going back to school in person.

Remember, the mayor's policy has been that he will keep schools going with reopening unless the city sees a seven-day rolling average of over 3%, not just a one-day 3% number. We're not there yet, hopefully, we won't ever be. Nevertheless, three neighborhoods in the city currently have positivity rates over 6%, South Brooklyn, Gravesend, Borough Park, and Bensonhurst. When asked about New York City's fluctuating numbers, in a press conference yesterday, Governor Cuomo said that the police have to start cracking down on social distancing and mask-wearing.

Governor Cuomo: It's not that people don't know there's a mask ordinance. They know there's a mask law. They're defying the law, and that's when you need to enforce the law. If you are unwilling to enforce the law, I will enforce the law.

Brian: He later singled out local governments being too soft on certain Orthodox Jewish communities, in this respect, saying that law enforcement was turning a blind eye to breaking up unmasked religious gatherings. With me now to talk about COVID right here, right now, our Gothamist reporter, Elizabeth Kim, who follows this daily. Sometimes, she's posting hourly on Gothamist as COVID news breaks, and Dr. Irwin Redlener, professor of pediatrics and director of the National Center for Disaster Preparedness at Columbia University, cofounder of the Children's Health Fund and the author of the Future of Us: What the Dreams of Children Mean for Twenty-First-Century America. Welcome back to the show both of you.

Dr. Irwin Redlener: Thanks, Brian.

Elizabeth Kim: Hi, Brian.

Brian: Do you have a sense of what accounts for that drastic change in daily positivity rates? It's rare that we see a change of over one percentage point from day to day, I think. Dr.Redlener?

Dr. Redlener: The key thing is not to focus on the daily change but to focus on the seven-day average, which is really the thing that's going to be most telling because if you focus on a day to day, you're liable to jump to policy changes or policy implementations that may have different criteria one day later. It's very important to stop talking about or thinking about the one-day change as the driver for doing something. The more critical thing is the seven-day rolling average, and that's still at about 1.5%.

That said, we have to pay a lot of attention to outbreaks in specific communities. The Gothamist has been really great at reporting on and tracking, so thanks to you, Liz. This is a complicated issue. The rule about the seven-day rolling average, when that reaches 3%, is when the more drastic actions needs to take place. The pointed specific actions, with respect to where these outbreaks seem to be happening, is absolutely critical.

Brian: Liz, I mentioned that there are three neighborhoods with more than a 6% positivity rate, but yesterday, Governor Cuomo released an updated list of the top 20 zip codes in the state that have been identified as COVID-19 hotspots or clusters based on daily test positivity of 5.5%. That's 20 zip codes over 5.5%. A majority of these sites are in the city. Liz, I know you and your team are working hour by hour to crunch these numbers, can you give us a sense of where the cluster sites are and the latest numbers that they have?

Elizabeth: What's interesting about the governor's list is it's a lot more broad than the current list that the city has been putting out. The governor's list has 14 zip codes that touch every single borough, and it has places like, for instance, in Manhattan, Washington Heights, it lists as having a 4% daily positivity rate. Now, this hasn't come under the city's radar, to our knowledge yet, but one of the reasons could be that the state DOH relies on slightly more recent data. There's a several day lag with the data that the city or that the mayor announces every day as part of his daily press briefings. That could be a possible reason

Also, as Dr. Redlener said, it's hard to put too much stock in the daily numbers, it's much more important to look at the seven-day rolling average. I think what contributes to some confusion though is that elected officials have, on a daily basis, been reading the daily positivity rates, so when it fluctuated on Tuesday, it caused a lot of alarm, but we only needed to then learn from the mayor that, "No, we're not going to keep reading that. We're also going to give you the average, and we want you to focus on the average." I think that's a key thing for New Yorkers to keep in mind.

Brian: Dr. Redlener, what would you make, for example, of that Washington Heights zip code. It's 10040, which I know, first of all, includes where you work, the Columbia School of Public Health is in that zip code, on 168th Street in that area. There is an Orthodox cluster in the Bennett Avenue-Hudson Heights, part of Washington Heights, but does that account for it in the 10040, or how would you look at that or some of these areas that may be more expansive geographically than what we heard a few days ago?

Dr. Redlener: This is the second challenge when it comes to data, Brian. The first being this issue of-- As Liz was just saying, we can't just focus on the daily number because of the fluctuations so we look at the seven-day rolling average. The other challenge is to get a lot more micro in our understanding of where the outbreaks are and why they are. Still, even if you have a zip code that has higher positivity numbers, you have to get the microscope out and look at where exactly is that outbreak seem to be concentrated because it could be, let's say, a school, a place where restaurants have opened.

If you look at just children and school children, then, what schools in particular? Are they religious schools of any type, or what's going? Are there a couple of public schools in the community, for example, where the ventilation has not been great? I know all the schools supposedly have been checked for the quality of the ventilation system, which is absolutely critical to keeping sweat under control. We need to get into the weeds here and do a lot more investigation so we really understand the details of what's causing the uptick before we do anything in terms of policies relative to opening and closing schools, Brian.

Brian: Listeners, COVID questions for Dr. Irwin Redlener welcome here, and Liz came from Gothamist, 646-435-7280, 646-435-7280. Let me stay on the question of the Orthodox communities' concentration here. We had a call from a self-identified Orthodox listener yesterday who said he did not believe other New Yorkers have to worry about COVID spreading from them citywide because these communities have been engaging in a herd immunity strategy. That is, let us get the virus and suffer the consequences and be done with it. The higher case count in those communities is a result right now of them doing more testing than other New Yorkers as they monitor their families and pursue this herd immunity strategy.

Dr. Redlener: Oh my God.

Brian: Is that consistent with your understanding of what's happening or of how this works?

Dr. Redlener: What you just said gives me the chills. That is an absurd and dangerous idea that somehow you could develop a localized herd immunity, so let it run its course there. That will cause people to die and that will cause increases in general communities spread. It's incredibly reckless and irresponsible for the community itself, and that may be one of the barriers to why there is so much resistance to following the rules about being prepared. I hope that's not the widespread view of the people in the Orthodox community. I don't know what to say. It's just-- [crosstalk]

Brian: I should say that, of course, one caller doesn't represent any whole community, but because that got on the air yesterday and near the end of the show and we didn't have a chance to dive into it, I wanted to fact-check that with you. Liz, how about the hospitalization rate or the death rate in New York with this increase in cases that's being seen in the last couple of weeks? Are we seeing the dire effects that can come of more Coronavirus in terms of hospitalizations or deaths?

Elizabeth: What the city has told us is that they have been seeing a slight uptick in hospitalizations, and these are for people that are being admitted with COVID-like illnesses. The actual percentage of those people who are actually testing positive for COVID would be less than that, but it is something that they're carefully watching. It tends to be that hospitalizations are a lagging indicator. With deaths, there were several deaths reported recently at one Brooklyn hospital that were said to be Orthodox individuals. That is also very worrying too because if that's the community that the city is targeting and now we're hearing that there have been a few deaths in that community, that's pretty alarming.

Brian: You also reported that infections are rising in areas that are bordering cluster sites. What's an example of that?

Elizabeth: That is what really drew us in last night. The city has been putting out these daily updates on the surging cases. Originally, it was six neighborhoods. It's now been expanded to 10 neighborhoods. They're also watching about roughly seven other neighborhoods. For example, in a place like Queens, originally told us that they're focused on Kew Gardens, but now, the list of neighborhoods has expanded to include a neighboring place like Fresh Meadows or Hillcrest.

I've talked to experts and they say it's not unthinkable to think that there will be rising infection rates in neighboring areas because people, as you know, do tend to move around and travel a bit, so that's to be expected. The concern, which I think Dr. Redlener can best speak to, is how much does this signal that there's more community transmission, and at what point does the city really need to do a lot more to tamp down the infections in these areas in the form of possible closures of non-essential businesses or maybe even just specific schools?

Brian: Dr. Redlener, you want to take that?

Dr. Redlener: Yes, I do. Liz is very right here. We have to keep an eye on this. First of all, I am not-- Let me restart. I was extremely impressed with how well New York has done for months now in terms of controlling the spread and very low rates of infection, hospitalizations, and deaths. That is starting to creep up as Liz points out, and it is concerning.

It is impossible in any city, including- especially maybe New York to say, "Okay, I got this zip code or this neighborhood, whether it's Kew Gardens or someplace in Brooklyn," you can't control it because there's vendors that come in and out of there, there are delivery people. There's teachers in schools in a particular neighborhood may come from any other neighborhood around the entire city. There's an inherent reality that says we are not going to be able to control the spread, even if it's popping up in one small community that is erroneously considered living in a bubble. They're not.

The second thing is that, on a larger macro-scale, there's almost no way that we're not going to have a huge surge in New York and around the country in the winter coming up. There's still many, many states, for example, where there's a continuing rise, half the States, by the way, of COVID cases and fatalities, and it's not containable is the problem. We are going to see a major problem. This is coincident with the timing of reopening restaurants for indoor dining, which I'm very worried about.

We have rules about 25% capacity only and other safeguards, but I'm just worried that all these things that have been opened in our enthusiasm to grasp onto hopefulness, which I completely get, we may have to shut a lot of this down again at some point, which is very, very unfortunate for so many reasons. Yes, I'm worried about it. I think the main point there is no such thing as isolated community containment, and that's something we just have to live with and understand. I would say most of us in the field get that. We're bracing for a really big problem in the next few months.

Brian: Here's another call about the 10040 Washington Heights zip code but with citywide implications. Liz in Washington Heights, you're on WNYC. Hi.

Liz: Hi, thank you so much for taking my call. I live across the street from the northern dividing line of the 10040 zip code. I think it's important to keep in mind that that information that came out yesterday was 7 positive tests based on 198 total tests. I'm not going to freak out about seven positives in a zip code that contains two nursing homes, a huge high school, three yeshivas, several public schools, and a naturally occurring retirement community. I just--

Brian: Liz, I'm going to leave it there for time, but I'm going to address your point. I'm going to ask Liz Kim to address your point. Liz, how many cases does it make to define a heightened positivity rate, and could the fact that we're looking at percentage of tests that come back positive as the metric give people a misleading impression of things being worse than they are because maybe it's only seven positive tests in a whole zip code?

Elizabeth: Right, that's an excellent point that she brought up. I was looking at that too, that it's not a huge number of cases, but going back to what Dr. Redlener said, let's not focus or get too excited or alarmed by these daily rates. Let's keep our eye on the average. If you look at the city's website, I think the average for that neighborhood has been around only 1%. Like I said, the city is on a little bit of a lag, so we'll see if that holds up. What I would tell residents in that neighborhood is keep your eye on the average, go to the city's website, check that regularly, and see how the average is changing. Don't put too much stock in a daily number.

Brian: Dr. Redlener, can I get you on this? Because I see this is happening elsewhere too like the Huntington Station, Long Island zip code was on the governor's list, but again, that was just a handful of cases.

Dr. Redlener: This is what I'm referring to earlier, Brian, that we have to get really into the weeds to understand the reality. I totally agree with what Liz just said. You've got to look at the rolling averages. You've got to get quite a bit more micro in your understanding of why this is happening. Yes, there's times where just a few cases can make a real difference, but the other thing to remember is we're not really testing enough people anyway to get, as far as I'm concerned, a clear sense of the actual positivity and community spread. There are so many people who will get the SARS-CoV-2, which causes COVID-19, and are completely asymptomatic and may not get tested.

I've been saying this for a while now. Anywhere we go, any community anywhere, where we're looking at test positivity, you have to ask who's determining who's getting tested. Are they just sick people? Are we doing a scientifically randomized study where we're taking a number of people, whether they're symptomatic or not, and doing testing. The whole system-- There's something deceptive a bit about any number that we're talking about. If you don't have good basis for collecting the samples and doing the testing in a randomized scientifically way, it's not unexpected that we're going to have problems interpreting the outcome and making policies determine the outcome. If you have a relatively very small percentage of people being tested, the whole result could be skewed.

Brian: I heard Mayor de Blasio say yesterday that given this little bit of a spike, everybody in New York City should get tested so that we know what the real numbers are and the real context.

Dr. Redlener: Exactly.

Brian: Do you support that call at that level, everybody in New York City should get a Coronavirus test?

Dr. Redlener: Well, in some theoretical place, we might say that, but we don't have the ability to do that actually, which is why one of the big things that I am waiting for, a rapid, reliable, what's called point of care testing, that could be done without having to send a sample to a lab-

Brian: We can't do that today.

Dr. Redlener: - or having any special equipment. Well, we can maybe in a few weeks. Yes.

Brian: Maybe in a few weeks so we're going to come back to that-

Dr. Redlener: Maybe.

Brian: - and talk about those, and how they will work, and how people can get them when they're more widely available. Dr. Redlener, thank you as always. Liz Kim from-

Dr. Redlener: You're very welcome.

Brian: - Gothamist, thank you as always.

Elizabeth: Thank you, Brian.

Brian: The Brian Lehrer Show is produced by Lisa Allison, Mary Croke, Zoe Azulay, Amina Srna, and Carl Boisrond. Zach Gottehrer-Cohen works on Our Daily Podcast. Juliana Fonda at audio controls.

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