Small towns can make list with few cases

In mid-October, Connecticut’s public health department unveiled a new tool devised to help communities keep tabs on the spread of COVID-19: A color-coded map that has levels tied to recommended actions for areas with greater caseload rates.

If a city or town moves to a red alert level — indicating it has a rate of 15 or more cases per 100,000 people daily on average over 14 days — for example, the state recommends they consider

placing restrictions on business capacity, event capacity and weigh remote learning options for schools.

Even so, health officials and local leadership in the state say the decision-making process is more nuanced than the shade of their municipality on Connecticut’s map. In cities and towns with smaller populations, for example, having just a handful of cases can edge an area into the higher orange or red levels.

“Keep in mind that with our small population, even one or two cases can make a difference in that 100,000, you know, cases per 100,000,” New Milford health director Michael Crespan cautioned in a Wednesday night Board of Education meeting.

“It’s not always a good idea, or I would recommend against, just using that framework, those cases per 100,000,” he said later in the meeting. “I think it’s better to assess what’s going on overall, how we’re doing in the school system, and how well the models are working and how good our mitigation strategies are working.”

New Milford, a town of about 27,000 people, saw 28 cases recorded last week and 17 the week prior.

The map and “initial process” was created to help officials and residents alike get a sense of the virus’ spread and where possible hotspots would be, said Max Reiss, a spokesperson for Lamont’s office, and the per 100,000 population measure is “widely accepted as a useful metric” for understanding community spread.

“The virus doesn’t care about your border or your population. It’s something that spreads,” Reiss said. “We recognize of course, that if you have a smaller population in the case of New Milford or any smaller town — three, four, five cases could end up really skewing your figure. However, one case could lead to multiple cases, because we’re, we are seeing now sustained virus spread on a slow but increasing clip.”

That sort of overall picture Crespan described is what North Canaan first selectman Charles Perotti tried to take into account when he saw his town shift into the red.

Before the state’s map updated on Thursday, there were 10 cases recorded in the town from Oct. 11 to Oct. 24. Since North Canaan only has a population of about 3,250 people, that meant the town’s case rate per 100,000 over two weeks clocked in at 22 — enough above the 15 case average threshold to be in the red alert category.

Perotti knew where their spike was mostly confined to: An outbreak at a senior living facility called Geer Village that he said ended up infecting 34 patients and 15 staff members. The map doesn’t reflect cases of people who live in nursing homes or assisted living facilities, so those cases wouldn’t show on the state system.

So, since the cases were mostly in “one isolated spot,” the town intended to stay in Phase Three of the reopening process, Perotti said, even as the town moved to red.

“We only have like three little restaurants, and my thought was, we cut those back more than they are right now, we’re really going to be hurting,” he said. “And it wasn’t from them, you know, it was all isolated in one particular part of town in one building, where our big spike was.”

It didn’t end up mattering much, though — Gov. Ned Lamont said the whole state would flip to reopening restrictions his office dubbed “Phase 2.1,” which begins Friday. To curb the virus’ spread, part of the limitations include cutting back on indoor restaurant capacity from 75 percent to 50 percent.

In the Uncas Health District, towns in the eastern portion of the state with small populations such as Franklin and Voluntown recorded six cases and five cases between Oct. 11 and Oct. 24, which quantified to case rates per 100,000 of 22.2 and 14.1, putting them in the red and orange respectively.

Patrick McCormack — the health director of the Uncas Health District, which covers 11 municipalities — referred to the map and its color phasing as a “helpful tool” that can aid in community awareness.

“It has certainly increased the amount of dialogue we’ve had about the data,” he said. “It gave people at least a benchmark to start the discussion. Because you know, we would have that discussion with towns before is: Is six really bad, or is six really good? Should I be concerned, or should I not be concerned?”

And in towns with greater caseloads, McCormack said, fewer calls would come in as towns were able to better prepare.

“They had had the discussion already, they had developed a plan, they had established their own benchmarks, they had determined where they were concerned, they were looking at trends,” he said. “So, you know, part of the discussion isn’t just, how many cases did you have, but it’s, how many, where were we two weeks ago? Where were we a month ago?”

Robert Rubbo, the health director for the Torrington Area Health District that North Caanan falls into, said that if specific towns switch into the higher orange or red categories, health officials have gotten some calls from people who live there inquiring about the alert level. Rubbo said they try to “take those opportunities to educate people so the word spreads appropriately.”

“I could tell you that all of our town officials, regardless if their town is small or large, when they see their numbers go up or if their category changes to orange or red, we’ve talked with those local leaders and we sometimes take a deeper look into the data,” he said. “We have been taking those numbers seriously, whether it be a small town or not, and just trying to evaluate the data to see where these clusters may be and whether or not any further action is warranted.”

Making decisions from there typically begins with communication among officials and the state health department, Rubbo said. They also consider where the cases are located, he added, and factors such as whether the individuals affected are part of the school system.

“Sometimes we need to take a look, are all those cases in one household? You know, we’ve had scenarios where you may have three, four cases in a household,” Rubbo said. “As we know, this virus is highly contagious and it tends to transmit pretty easily within a household. So, we need to, that’s one of the first things we look at, OK, where are these cases? Are there eight new cases in only two households?”

And even if the cases are limited to just one household, Reiss said, the implications can be larger.

“Do the kids spend time with other kids? Do the kids go to another relative’s house? Do the parents work from home? Do the parents work out there?” he said. “There are a lot of other questions, and as long as the bubble keeps getting expanded, there remains a pretty significant risk of spreading the virus, perhaps even unknowingly.”