‘They did not have any tests’: how Covid-19 tore through the tri-state area

A+graphic+of+cases+throughout+the+tri-state+region%2C+which+has+been+devastated+by+Covid-19.+Circles+represent+relative+size+of+outbreak+but+may+not+be+to+scale.

Jared Mitovich

A graphic of cases throughout the tri-state region, which has been devastated by Covid-19. Circles represent relative size of outbreak but may not be to scale.

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.

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.”

— Aria Chalileh

“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.

A field hospital for treating coronavirus patients at Central Park. The facility has since begun to close after releasing most of its patients. (Jared Mitovich)

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.

Walter DiMattia, one of the first Woodcliff Lake residents to test positive for the coronavirus, with his wife. (Contributed by Walter DiMattia)

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.”

I felt like I was thrown off a building. My temperature went up and down throughout the night.”

— Walter DiMattia, Woodcliff Lake resident

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.”

— Walter DiMattia

“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. 

The exponential mood change mirrored the virus’ rapid spread. When DiMattia had first visited, there were only 50 confirmed cases in New Jersey. A week later, more than 1,000 had tested positive. Teaneck had imposed its self-quarantine, and hospitals across Bergen County were beginning to fill up with patients –– including those whom, like DiMattia, had not yet been tested for Covid-19. Untamed, the pandemic was already deeply rooted in the tri-state area, and the concept of containment was as short a possibility as the irregular, labored breathing now affecting thousands of people. 

A doctor took the temperatures of DiMattia and his wife, in addition to measuring their blood oxygen and swabbing for the flu and Covid-19. DiMattia had low blood oxygen and a 102-degree fever; his wife’s numbers were normal.

“We went home and later got the call from the doctor’s office and the flu test came back negative. So now we had to assume that I was positive for Covid-19.” The actual test for the virus would take four to seven days to process, a lifetime in a pandemic. 

After days of fatigue and taking Tylenol, DiMattia’s symptoms persisted.

“By Saturday, March 21, my wife was asking if I wanted to go to the emergency room. Of course I did not,” DiMattia explained. “She spoke to the doctor again, and now he was worried that since I had a temperature for so long, I would develop pneumonia. So around 4 p.m., my wife drove me to the ER.

“I told her to just drop me off by the entrance. I did not want her to be exposed to anything in the hospital. I was now at the Valley Hospital. There were no people in the waiting room so they took me right away. They took my temperature, blood pressure and asked a few questions. They asked me to wait in the hallway –– not the waiting room. 

“I sat there for a while, very uncomfortable, shivering, and just wanted to go to sleep. After about 40 minutes, I knocked on the door to the main office and asked if I can lay down on the empty gurney in the hallway. They said yes. About five minutes later, they wheeled me into the ER.”

The Valley Hospital in Ridgewood, NJ. It has treated hundreds of Covid-19 patients. (The Valley Hospital website)

“The ER was a bit busy. Some people were in beds in the hallway,” DiMattia recalled.

He was put in a private room with walls and no curtains. The same day, Governor Murphy would enact a stay-at-home order, mandating the closure of all non-essential businesses. Since then, Valley Hospital has treated hundreds of Covid-19 patients, and the virus has taken the life of one of the hospital’s doctors. While many patients have been discharged at an increasing rate, Dr. Robert Brenner, president of clinical integration at the hospital, said that at one point, three-fourths of all care was devoted to the coronavirus.  

DiMattia was treated under the assumption he had Covid-19 and began to feel better with a Tylenol drip, saline, and a Z-Pak. He went home after three to four hours, instructed to return if his blood oxygen levels went lower than 90. 

“I also had my mother’s medication at my home for hydroxychloroquine,” DiMattia said. He took the hydroxychloroquine and Z-Pak twice a day for five days and began to feel better. Although hydroxychloroquine may have benefited DiMattia, it is important to note that the FDA has cautioned against its use against Covid-19 outside of the hospital due to the risk of heart problems. All the same, President Trump has advocated for its use.

DiMattia began to see brighter days, ones that were less unpredictable and more reliably improved. “My wife was like a general, yelling at me to get up and walk around the bed. As I did, my blood oxygen would go up a bit… Although lying down and sleeping felt so good, I believe it was the worst thing I could do.”

Although lying down and sleeping felt so good, I believe it was the worst thing I could do.”

— Walter DiMattia

 

By moving around and breathing deeply, DiMattia said his condition improved. At that point, nearly two weeks after first falling ill, DiMattia got a call with the test results. He tested positive, and to his surprise, so did his wife. 

“I knew I had it all along, but I did not think my wife had it. She was running around the house helping the kids with virtual schooling, working remotely, taking care of me, reaching out to family and friends. She had next to no symptoms whatsoever.”

The majority of Covid-19 cases, like DiMattia’s wife, are mild or asymptomatic. While this may appear a silver lining, it is a driving factor in the virus’ spread. 

“I was happy that she felt good, but [her positive test result] is also concerning because there can be many people out there with no symptoms spreading this virus,” DiMattia explained.

Several other Hills students reported knowing people who contracted the virus.

“My aunt, uncle, and cousin had Covid-19, but they’ve been symptom-free for the last three weeks,” said junior Stephen Schmidt. “My aunt is a nurse, but my uncle knows he got it from someone at his work.” Both live in New York City.

What comes next

Now recovered, DiMattia has been part of a case study at Hackensack Hospital, which has treated thousands of Covid-19 patients. 

I’ve donated [blood plasma] twice, and they are having success with giving it to ill patients.”

— Walter DiMattia

“My antibodies were the highest you can have. I’ve donated [blood plasma] twice, and they are having success with giving it to ill patients.” The antibody testing is a crucial factor in monitoring who is potentially immune from the virus; in New York, the testing has begun to be widespread as the state slowly reopens from the upstate region on down. However, DiMattia said his third donation was canceled because his antibody levels dropped.

If the nation is to reopen further, antibody testing will be key to tracking how widespread the virus is. All 50 states have already loosened restrictions to some degree, including New Jersey, which has reopened its beaches and nonessential businesses for curbside pickup. In doing so, it cited a decline in hospitalizations as well as ventilator use, accompanied by a lower percentage of Covid-19 tests coming back positive.

Robust contact tracing –– where volunteers are in charge of tracking, notifying, and testing those exposed to someone with the virus –– will also be imperative to preventing a resurge in cases. In fact, now is the opportune moment to do so, as new cases have returned to a more manageable level. The city of Paterson, which has seen more than 5,000 of its residents contract the virus, began a large tracing program and has reduced its number of new cases further.

The fact of the matter is that, without a cure, we cannot envision a return to any semblance of normalcy if we don’t understand where this virus is, and who has already had it. Although DiMattia and millions of others have recovered, we have already lost too many. Nearly 100,000 Americans have died –– this isn’t just a statistic. They are the vulnerable: those in nursing homes ravaged by the virus’ spread, those alone who could not get to a hospital in time. They are Holocaust survivors, immigrants, parents, grandparents –– and in devastating cases, children. They are Black, white, Latino, Asian, and Native American; their blood may be the same as ours, but racial inequity may have had a bearing on their health. They are teachers and doctors, cashiers and bus drivers, scientists and war veterans. They lived on the same streets we live on, went to the same places we go to, loved someone the same way we love, believed in the same America we still do.

Through our grieving, we have an obligation. Attentive to facts instead of fiction, we must dedicate ourselves to ensuring our actions don’t lead to more of these beautiful lives lost, and in doing so, we must honor them.

New York City on April 19. (Jared Mitovich)