Dr. Kenneth Croen has been watching from the beginning. He’s been studying COVID-19 data worldwide, nationally in New York State, regionally in Westchester County and at Scarsdale Medical Group, which had set up an early testing center on Heathcote Road once commercial testing became available.
Thanks to social distancing and the more recent introduction of mask wearing, he likes the trend he’s seeing. At SMG’s peak, they tested just over 450 patients the week of March 23-28, of whom 39% tested positive. The next three weeks showed close to 400 tests at 38% positive, just under 300 tests at 37% positive and just over 200 tests at 31% positive. In the two-week span from April 20 to May 1, SMG tested fewer than 300 with 14.5% positive. The week of May 4-8 saw just over 100 tests at 6% positive. They are now down to a handful of positive tests per week, according to Croen.
SMG’s average patient age among those tested was 52 and, according to its report, “Most of the 580 cases of COVID infection were mild to moderate severity.” Twenty-three patients were hospitalized and seven died. There were 103 asymptomatic patients tested, and 15 of those results came back positive.
“The data shows how much disease was out there,” Croen said. “It was pretty dramatic in mid-March. It has steadily been getting better to the point where it’s almost gone. I think we only had three positive patients this week by Friday [May 22]. We haven’t gotten Thursday and Friday results, but the numbers are incredibly small compared to those weeks when we were seeing close to 200.”
As Croen noted in an interview with the Inquirer in early March, testing was going to be key in determining just how widespread COVID was. Students were coming back from Europe and couldn’t get tested. One patient spent three weeks in China and couldn’t get tested.
“It was pretty clear to me that if we weren’t doing any testing we were going to be in big trouble,” Croen said. “I will admit I didn’t anticipate at the time we really probably had thousands of cases here, but that’s probably the reality. We had thousands of cases in the New York area in early March, not the half dozen or 20 they were talking about.”
While coronavirus testing is still ongoing, the new push is for antibody testing. The New York State Department of Health did random testing of Westchester residents at supermarkets, pharmacies and other locations and 12.3% tested positive for already having had COVID-19. SMG’s antibody test data is showing 11.4%, but it’s not a random sample.
“The official count in the county is about 32,000, so they’re probably off by a factor of three, which is nationally probably about the same,” Croen said. “We’re saying we have 1.5 million cases in the United States, but it’s probably closer to 5 million. Most of those are inactive now, because most of the cases were two months ago. What counts is how many people have active infections now, how many people are contagious now. We need to be able to identify them. That’s not so easy to capture people when they are just getting infected. Shortly after they are exposed we have to do contact tracing in order to be able to do that.”
With Phase 1 of being taken off Gov. Andrew Cuomo’s New York on PAUSE reaching almost every region of the state and the weather turning nicer, people will be out in larger numbers going forward, which is something Croen and other experts will be monitoring.
“The best thing we have done is stay at home,” Croen said. “The dramatic drop in numbers in that bar graph is purely the result of staying at home. We have helped our community a ton by doing that. By wearing masks we’re also helping a lot. Unfortunately we’re going to be very dependent on mask wearing as we go forward because that’s our only tool, plus social distancing, once we start venturing out of our homes.”
Croen said if there are too many cases in the fall and winter — if the virus “begins to ramp up again” — there are going to be problems. “If we have any intention of keeping our economy open and keeping people working, we are going to all have to wear masks and maintain social distancing,” he said. “But if you walk around Westchester, if you walk around Manhattan, there are tons of people out not wearing masks. It’s just major trouble.”
If people do those two things, the warmer weather could be an advantage “to help suppress the virus a little bit,” according to Croen, and SMG is encouraging patients with allergies to keep an eye on themselves and check in so they don’t miss a possible diagnosis of coronavirus. Keeping up with a pace of 25,000 new cases a day in the United States is something “we can’t afford,” Croen said, adding, “We need to have under 1,000,” and citing South Korea, which has 10 new cases a day, he said,
“They’re a much more densely packed country than we are and for them to have to have that much control shows that when there’s cooperation and leadership you can really control the virus.”
There are obviously differences between South Korea and the United States as far as being accustomed to wearing masks and governmental control, which are both stricter in South Korea.
“What I have learned is we need real, effective leadership to fight an infection like this,” Croen said. “We need a uniform message from our leaders. We really cannot afford to have a president who doesn’t think that a mask is essential. He’s giving everybody the right to say, ‘I’m not wearing a mask,’ and people do say it. They say it with anger, ‘You can’t tell me what to do.’ That’s because of him. The way we run our country is the way we deal with a pandemic. We need people with skill. Dr. [Anthony] Fauci is a highly skilled guy. I am sure he knows exactly what we need to be doing and he can’t say exactly what we need to do because he’ll lose his job.”
When asked what myths he’d like to dispel, Croen said, “To the extent that people want to believe what Donald Trump says about hydroxychloroquine, I would dispel that belief. I do have patients who ask me if I would prescribe it for them and it’s just inappropriate. It’s not a drug that has been shown to be affective in any scientific way.”
Croen also wants people to understand the true severity of the disease, as the United States recently topped 100,000 COVID-19 deaths. While most people recover relatively easily with mild symptoms, that doesn’t make the virus something to take lightly — for those who get severely sick and put on a ventilator, it takes weeks to recover, if they recover at all.
“You just have to see what it’s like inside a hospital in the middle of the peak of this pandemic to understand what a catastrophe it is,” he said. “It’s really like a war zone in the intensive care units, in the emergency rooms. Every hospital in this area was absolutely under the gun. Had it been twice the size, there would have been many, many more casualties and many people who would not have been able to get treated because the hospitals were at capacity. We really do need to limit this. I drove past White Plains Hospital at the peak and it was so quiet outside — you couldn’t tell it was so chaotic inside.”
Scarsdale Medical Group was monitoring its patients through telemedicine and on-site for the weeks after a positive diagnosis to make sure they weren’t getting sicker. Not only did 23 patients have to go to the hospital, but many SMG staff members went to work on the frontlines, as they are affiliated with White Plains Hospital.
“It was a frightening thing,” Croen said. “They got potentially exposed themselves and they would be potentially bringing it home to their families. Some of them have older parents living with them, some of them have young kids. They were all uncomfortable having to be there, but they did it and it looks like they’ve all done fine.”
Croen is board certified in internal medicine and infectious diseases. At White Plains Hospital, Croen was chief of infectious diseases from 1999-2003 and chief of the department of medicine from 2004-08. Before joining Scarsdale Medical Group, he was involved in infectious disease research at the National Institutes of Health and University of Cincinnati.
“We’ve heard about, read about pandemics in the past, and we’ve been fortunate the last century not to have a very effective pandemic virus since the 1918 flu pandemic,” Croen said. “We were very lucky not to have SARS and MERS be viruses with the same capability as this particular virus.
“This virus is perfectly designed to be a worldwide problem. That’s because people get infected and they are asymptomatic for days before they have a clue that they’re shedding virus. Any virus that can get around and be spread by asymptomatic people is going to be tough to identify, tough to isolate and tough to stop.”
Croen and SMG are looking to participate in outpatient treatment protocol studies with drugs that are available and used for other purposes. Croen expects in the next four to six months to have “a lot of information” that could lead to preventing the progression of the virus early in order to improve the survival rate of those who become most critically ill.
“We all need to learn from these past few months that this is a virus that we do need to control, that this is a virus we can control,” Croen said. “Staying at home has had a tremendous impact. Continue to take social distancing and mask wearing seriously … getting everybody to do that can help allow the economy to revive itself. If we fail to do that, we pay the price in the fall.”