On March 13, the day school closures were announced statewide, there were 50 reported Covid-19 cases in New Jersey. By April 13, the virus would infect over 100 in Woodcliff Lake and Montvale alone. With preliminary studies in New York indicating that 14.9% of its population had contracted the coronavirus, the question persists: Why, and how, has it so thoroughly devastated the tri-state area in particular?

After combing through local and state reporting, the detailed chain of events leading to the Pascack Valley remains hazy. Nevertheless, part of the answer begins across the ocean –– not in China, but in Europe. The larger picture can provide detailed insight for dealing with future pandemics, and getting us out of this one safely. 

Covid-19 takes root in the tri-state –– and explodes

While the illness first spread through the Asian republic, analysis of coronavirus patients in New York indicates that most of them had a strain of European origin, meaning cases in both areas had the same mutations. Unlike travelers from hotspots like China and Iran, Americans traveling from hard-hit Italy to New York in February and early March were not asked by customs of their travels, despite the State Department issuing guidance against visiting Italy on February 29 (New York Times). This allowed the virus to spread under-the-radar in New York, which boasts three international airports and whose residents most frequently visit (in normal conditions) Italy and Spain for travel (Orbitz). 

Although the virus gained a preliminary foothold in the region through foreign means, several additional factors contributed to community spread that, before March 13, was unmatched in the rest of the country. 

The story of New York’s second confirmed case, a 50-year-old married father of four from Westchester County, provides the best insight into the virus’ rapid spread through Bergen County. Like many Pascack Hills parents and thousands of New Jerseyans, Lawrence Garbuz commuted from a New York City suburb to work in Manhattan every day. An attorney, Garbuz was an active member at the Young Israel of New Rochelle synagogue. So were his four kids and his wife.

Their numerous daily goings, which for one daughter included attending the private SAR Academy in the Bronx, allowed the family and their contacts to expose around 1,000 people. It was a bar mitzvah where all six converged, celebrating along with dozens of SAR students, other children, and other adults who lived not far from New Rochelle: across the state line, in Bergen County. 

This specific cluster, originating through completely ordinary events, exploded. Confirmed and suspected cases led to quick closures of the temple, SAR Academy, Yeshiva Academy, and Garbuz’ law firm, as well as The Frisch School in Paramus, whose students shook hands with Pascack Hills debaters at a league meet on March 3.

“A few days pass” after the debate, said junior Aria Chalileh, “and we get an email from [debate coach] Ms. Horn. We went to see her after our second period class, and she told us that multiple students at [The Frisch School] who had attended the debate with us were in self-quarantine after their classmates were awaiting Covid-19 test results.” The Jewish day school closed the same day.

“We were completely shocked, and a bit nervous, even though the odds of us contracting the disease were slim to none,” Chalileh continued. “Regardless, we were informed that our parents would be notified of the situation” by the school nurse.

In part a result of the New Rochelle cluster, Teaneck, where many SAR students commute from every day, was one of the first cities in America to ask its residents to voluntarily self-quarantine. As of May 15, it has reported more than two cases for every 100 residents (CDRSS, NJ Department of Health).

But Teaneck and New Rochelle were only the beginning. In fact, the virus was likely spreading long before its residents began to test positive; Garbuz had no recent history of travel to high-risk countries. He worked, however, in what was quickly becoming one of the hardest-hit cities on the planet.

Besides the constant commuting in and out of the city, the characteristics of the tri-state area fueled an even larger hotspot. According to data from the United States Census Bureau, nine out of the ten most densely populated cities in the country are located within the New York metropolitan area. Seven out of those nine are located within New Jersey, which is in itself the most densely populated state in the nation with more than 1,200 residents per square mile. These conditions, on top of the select super spreaders, the frequency of transportation, the international airports, and the sheer size of its population, helped make the tri-state area account for more than a third of the nation’s 1.5 million confirmed coronavirus cases and nearly half of its 90,000 deaths.

What’s more, studies have suggested that both confirmed cases and deaths are an undercount –– deaths in New York City have reached six times their normal level this year (New York Times). Preliminary tests have estimated around one in four residents of the city have antibodies for the coronavirus, meaning it was in their system at some point. Conversely, one in 50 Bergen County residents have tested positive, although antibody studies have not yet made an estimate for the virus’ true prevalence here, which scientists say is likely similar to that of New York state. One of the first Woodcliff Lake residents to test positive, Walter DiMattia, provided insight into his experience with the disease.

Woodcliff Lake resident tests positive

“I think I got the virus from either the dentist or in New York City. I had to go to New York for a site survey of a construction site,” DiMattia explained. He started feeling unwell on Friday, March 13, the day schools closed throughout New Jersey. At that time, there were no confirmed positive cases in the borough or in neighboring towns such as Montvale.

“About two hours later, I started to get the chills. I went to bed shivering and had a fever of 101 degrees,” DiMattia continued. 

The timing of DiMattia contracting the coronavirus was not incidental. According to Kinsa, a company that makes smart thermometers, reports of flu-like illness in Bergen County reached a peak the same week DiMattia fell ill –– suggesting that he caught it when the virus was spreading at its quickest rate, before the effects of social distancing began to be seen. This data also suggests that if those same distancing guidelines were enacted merely two weeks earlier, reports would have peaked at half the rate that they did. 

With the benefit of hindsight, it is evident that a lack of testing and understanding of the virus further delayed action by government and health officials.

When DiMattia went to Valley Medical Group to see his doctor, he said they “stressed that they did not think I had Covid-19 because I did not have major breathing issues.” Nonetheless, “they did not have any swab tests for the flu or Covid-19.”

After receiving a prescription for TamiFlu, DiMattia’s condition began to worsen. “I felt like I was thrown off a building. My temperature went up and down throughout the night.”

One of the most confounding parts of the coronavirus according to scientists is its unpredictability. Like other viruses, its symptomatic inhabitants, including DiMattia, have experienced worsening followed by improvement. With the coronavirus, amelioration is often disappointingly deceptive.

DiMattia’s case of Covid-19 appeared to rest on Sunday, March 15. “I woke up feeling better,” he recollected, describing what was a “good day.” He was convinced the TamiFlu had warded off the worst of the seasonal flu.

“Sunday night was a different story.”

Major body aches. High temperature. No appetite, and no desire to drink fluids. “I just wanted to sleep,” DiMattia said.

As DiMattia and his wife switched from one pain medication to another, both Tylenol and Advil failed to improve his condition in the long-term. “A few days went by and my symptoms did not get any better. In fact, it got worse.”

“I have never seen the look of worry in my wife’s eyes like this.” 

DiMattia and his wife returned to the Valley Medical Group to a much different scene from just a week earlier. There were new procedures in place, including waiting to receive a call in the parking lot to meet a nurse at the door who distributed gloves and advised the DiMattias not to touch anything.