On visiting the Adirondacks in the time of COVID-19
When to lift the restrictions under which we’ve been living since March should depend on local conditions. In New York City, where the number of new cases of COVID-19 is still over 2,500 per day, a major concern is “flattening the curve.” On the other hand, in some North Country counties, days may go by without a new case and a major concern is jobs. Employment in the Adirondacks is heavily dependent on tourists, but they might bring the coronavirus with them. The risks posed by tourists and other visitors and how they can be monitored and minimized is the subject of this column.
What is the chance that visitors to the North Country will bring the coronavirus with them? Even people who have sheltered in place and practiced safe distancing can harbor the virus without showing symptoms. Visitors to the Adirondacks could contract the virus en route on airplanes, trains, buses and in automobiles when they stop for gas, food, restrooms and lodging.
There are not enough tests to check visitors for the virus or for antibodies to the virus before they enter. Antibodies have not yet been proven to protect against infection. Moreover, some tests for the virus (PCR and antigen) may give worrisome false negative results and tests for antibodies worrisome false positive results. What, then, should be done to prevent visitors from infecting year-round Adirondack residents?
Health officers in North Country counties recommend that people entering their respective counties voluntarily quarantine in their homes for 14 days. This is most easily accomplished for people with second homes in those counties who plan on staying for more than two weeks. (Full disclosure: I am in that category.) If they develop signs of COVID-19 during their quarantine, the county health department should be promptly notified. If they are healthy at the end of their quarantine, they should adhere to the rules and recommendations that apply to year-round residents.
Backpackers from out of the region who camp in the backcountry but seldom stay for more than 14 days should be able to enter. They should be warned to safe-distance from others and to promptly turn around if they show signs of COVID-19. A forest ranger, if they meet one, can arrange to have them tested for the virus.
More problematic are the many who come for two weeks or less to camp, hike, swim, fish, kayak and canoe. If public and private campgrounds agree to maintain safe distancing between families and frequently disinfect facilities used in common such as tables, showers and restrooms, they should be able to open on a trial basis. Here, too, anyone who develops symptoms of COVID-19 should be reported promptly to the local county health department.
In these three categories — second homeowners, backpackers and campers — the local health departments should test all suspected cases of COVID-19 for the virus, quarantine those who test positive, trace and test all their contacts regardless of whether they have symptoms, and trace and test contacts of the primary contacts. A shortage of valid tests for the virus has reduced the full capability of contact tracing in the North Country. Of seven criteria laid out by Gov. Cuomo for gradually reopening regions within New York, the only two that the North Country counties have not met involve testing. Funds recently authorized by Congress should alleviate these shortages, although more money may be needed.
Most problematic are the visitors who traditionally fit the tourist label — those who come for a few days, stay at motels and hotels, day hike, shop, eat and drink in restaurants and bars, visit museums, theaters, concerts and sports events. They comprise the largest category of visitors and are the most likely to be in contact with many others. They also are the basis for many jobs in the region. It would be prudent to keep the facilities that attract them closed until resources are in place to quickly contact, trace, test and quarantine a large influx of tourists.
Data from comprehensive contact tracing can help local authorities decide whether health care resources in the North Country will be able to manage the number of new cases. If they are, then the number must be low enough to make another epidemic unlikely. If these two criteria can be satisfied, facilities that can maintain safe distancing and sanitary conditions should be allowed to reopen. If these precautions prove successful, then venues and events at which congregating, if not crowding, is an in integral part might be opened in stages.
Contact tracing of visitors who show signs of COVID-19 is essential for safely allowing tourism to return and the businesses and services it supports to flourish without igniting another epidemic.
Dr. Neil A. “Tony” Holtzman, MD, MPH, lives in Menlo Park, California, has a second home in the Upper Saranac Lake area and is an emeritus professor of pediatrics at the Johns Hopkins School of Medicine. He is also the author of the Adirondack Trilogy of novels: “Axton Landing,” “The Railroad” and “Forever Wild.”