How Essex County tamed COVID

A largely rural, tourist destination managed to achieve one of the state’s lowest infection rates

By Tim Rowland

Essex County Supervisors Chair Shaun Gillilland can smile about it now, though it is not a wide smile.

On the 23rd day of March, 2020, he penned an emphatic letter to the hundreds of thousands of hikers, vacationers and second-home owners who are driven to the mountainous and sparsely populated county each year in search of fun and relaxation.

Last year they were being driven by something else: fear of their neighbors in the crowded cities to the south that were being ravaged by disease.

Rather than stay put, urbanites would flee to the mountains, setting down the equivalent of a small city in a county where there were scant medical services or, for that matter, services of any kind. It wasn’t just that Gillilland was worried about how people would find a ventilator. He was worried about how they would find a gallon of milk.

“As a vaccine does not exist, we have no capacity to test, our hospitals are small and incapable of handling additional influx and our stores and infrastructure are incapable of providing supplies to a larger population, we are asking that you respect the integrity of our hospitals and infrastructure and not travel to Essex County from any area at this time,” Gillilland wrote then. 

He may as well have ordered the Ausable River to flow back up the shoulders of Mount Marcy. Somehow, though, through a sustained public health campaign and a responsive local population, the tourism epicenter of the Adirondack Park would go on to record the lowest rate of infections of any county in the park. 

This June, more than a year into the emergency, its rate of 4,242 infections per 100,000 people was second-best in the state, despite top destinations such as Lake Placid resorts, High Peaks trails and Whiteface Mountain, New York’s self-styled “Premier Ski Resort.”

How they did it

About the same time as the county was asking people not to come, Linda Beers, director of the Essex County Health Department, was driving to her Schroon Lake home and happened to gaze across the waters to an unfamiliar sight: Almost overnight, the summer homes along the east shore were already lit up like Broadway—in March.  

Public officials began to scramble. “There were some very tense conversations; we even talked about shutting down the Northway,” Beers said. “Our hospitals could never handle that number of people—what would we do if they all got sick?”

At the Elizabethtown Community Hospital, Dr. David Clauss was taking inventory. Gov. Andrew Cuomo had ordered hospitals to stock up on two things ECH did not have: ventilators and ICU beds. An arm of the University of Vermont Health Network, ECH had only a couple of transport ventilators for patients on their way to city hospitals, and the Ticonderoga campus didn’t have any overnight beds at all. 

Meanwhile, the situation in New York City was becoming dire, and the virus was moving north to Albany and then beyond. Gillilland said he and County Manager Dan Palmer “were learning epidemiology on the fly. We didn’t have an understanding of how fast this would travel, and we began to get scared of what would happen if we got a cluster.”

They weren’t the only ones. Residents were scared by the influx of out-of-towners. Supervisors and the sheriff began to receive calls whenever someone saw an out-of-state license plate.

There was pushback from the hikers, too, who didn’t see the risk of being outdoors. When people ignored warnings against congregating at the Rattlesnake Mountain trailhead in Willsboro, Gillilland and the mountain’s private owners decided to close it. Hikers simply moved the orange barrels, drove through the tape and hiked anyway.

In normal times vacationers come and go without knowing that local governments even exist; 2020 would be different.

Girding for war

In a low brick building that houses the county health department, Beers and her coworkers pushed their desks into closer proximity to each other. In the coming months there would be no time for picking up phones and dialing extensions. Thirty-eight thousand residents were implicitly counting on them for protection, as were hundreds of thousands of impending vacationers. And the Essex County Health Department had a staff of six.

On Feb. 27, Andrea Whitmarsh, the department’s public health educator, put out a warning of a “rapidly evolving” health threat. That missive was the first of an almost daily drumbeat of information, tracking the virus and imploring Essex County residents to refrain from gathering together, and to be vigilant with hand washing and disinfecting.

Clauss, whose medical training coincided with the outbreak of HIV, said the potential devastation of a pandemic was well understood, and in some circles viewed as inevitable. But still. When the first whispers of a new strain of the coronavirus began to materialize at the end of 2019, there was no particular reason to see it as an immediate threat to the Adirondacks. 

Clauss had seen the SARS and MERS virus scares come and go and this appeared to be of the same ilk. “Both were closely related, and they never quite broke out,” he said. “So I thought yes, we need to keep an eye on it, but it will probably fizzle out. Boy, do I wish I’d been right.”

The hospital began to prepare by setting up virtual war rooms and participating in what became a mind-numbing number of phone calls and video conferences. Medical providers including Hudson Headwaters Health Network, Champlain Valley Physicians Hospital in Plattsburgh and Adirondack Health in Saranac Lake were constantly holding strategy sessions and sharing information. “No one was competing, and there was a tremendous level of cooperation,” Clauss said.

That was true across the county. At the Department of Mental Health, Director Terri Morse was preparing for the psychological and emotional effects of the shutdown. At the Office for the Aging, Krissy Leerkes made sure the elderly had what they needed without undue exposure. Sheriff Dave Reynolds was training his deputies to be EMTs. The North Country Chamber of Commerce and Regional Office of Sustainable Tourism kept information flowing.

“We had to completely rethink how we were going to provide care,” Clauss said. “We had no ICU on campus, and we had to convert outpatient rooms to inpatient rooms in Ticonderoga.” Everyone braced for the worst, he said, and then “waited and watched as the wave came toward us.”

Tracking contacts

Beers said she and emergency services officials have joked that Essex County is well-prepared for natural disasters, with garages full of big trucks, powerful generators and heavy equipment—none of which mean squat in the face of a pandemic. 

Instead, what the health department understood very well was how to corner the disease once it appeared in the community through a process that the general public would come to know as contact tracing. 

Epidemiologists noted that if everyone in the world would just stay put for two weeks there would be no more COVID-19. Travel is the one way to ensure the spread of the disease, and travel is the calling card of Essex County, said Jessica Darney Buehler, Essex County Health Department’s director of planning. “Communicable diseases have no respect for any borders,” she said.

And neither did the hikers. While the big, commercial hotels shut down, many small inns, bed-and-breakfasts and Essex County’s mushrooming population of short-term rentals did not, and as the summer progressed, Essex County tax collectors—who had assumed sales and occupancy taxes would fall off a cliff—in fact saw numbers trending in the opposite direction.

Layered in was the calliope of quarantines and travel bans of travelers from other states, all of which was in constant flux. Though seemingly impossible to enforce, the county took the work seriously. Beers, with her broad smile and almost pathological cheerfulness, would confront unauthorized travelers by saying, “We’re very glad you’re here, but you’re going to have to leave.”

Painful as it was for business owners, a key factor in keeping infections low early on was the state’s economic shutdown, which helped ensure visitors were either outside or in small, self-contained groups. “They were coming almost exclusively to enjoy the outdoors,” Clauss said. “They didn’t have the option of sitting around a bar after a hike and having a beer.”

On March 17, regional health providers called a press conference in Elizabethtown to announce that the virus had indeed arrived in Essex County. Meanwhile, the contact tracers pounced. The first patient was interviewed, and then people that patient had been in close contact with for more than a few minutes were called and told they would have to quarantine. Some took the news better than others. 

For the health department, that was just the beginning. Each patient and close contact required follow-up calls to see how they were feeling. Those placed in isolation required a drive-by and a wave to make sure they were complying with the rules. Beers said it needed to be explained: “‘No you can’t walk the dog. No you can’t go to the grocery. Forget about the hairdresser.’ There wasn’t any wiggle room, because we could watch the chain of events and see that these (procedures) absolutely work.” In the end, she said, “very few people said we were taking away their rights.”

Health department employees found hotel rooms for people who had to be isolated. They brought meals to people who couldn’t leave their homes. If they needed medicine, they brought that too. And they were calling, always calling. 

On March 26, the health department reported that five people had confirmed cases of COVID-19 and were under mandatory isolation, along with 33 people who had been in close contact with a patient and were under quarantine. That was just the first week. 

Most natural disasters come and go. Floodwaters, said Beers, recede in a day or two. But for health officials, it felt like chaos with no discernable end. Throughout the healthcare spectrum, people were working long hours, weekends and holidays. Dr. Kristin Mack of Hudson Headwaters’ Ticonderoga clinic saw the handwriting on the wall. “She told us, ‘Gals, this is going to be a marathon,’” Beers said.

They had to boil down, make sense of, and communicate to the public more than 500 guidance documents. Some guidance they had to make up from scratch, such as advising the Adirondack Mountain Club that outdoor group activities were too risky. 

As May proceeded, Essex County’s COVID total exceeded 50 people, and the number of quarantines were no longer countable. Prior to a Mother’s Day celebration, Beers overheard a snippet of Jess Buehler’s phone conversation with her family, which would become something of a harbinger for the office in the coming months: “No, I won’t be leaving anytime soon; you go ahead without me.”

Bearing down

Covid testing was a problem across the country, but in the North Country it was particularly severe. Because tests were taking up to 14 days to process, the Bronx company that owns the Essex Center nursing home didn’t realize that an asymptomatic employee was going to work every day while carrying the disease. A major surge erupted, and by the time the nursing home declared itself COVID-free nearly two months later, 16 residents had died and 60 residents, 38 staff members and 12 close contacts of staff had been infected.

Essex County ultimately took matters into its own hands, partnering with the Trudeau Institute and Adirondack Health in Saranac Lake to establish the North Country’s own $1 million, state-of-the-art testing lab that would be able to process 160 samples a day. Essex County contributed $50,000 and begged other North Country counties to pitch in. None did.

So the county turned to what it could control. It turned bus drivers—sidelined by social distancing guidelines—into sanitation officers, going over every inch of county office space with new UV disinfecting lights. “We didn’t lay anyone off,” Gillilland said. “In a county as small as ours we made the determination that every employee was essential.”

Supervisors themselves were tasked with foot patrols, breaking up parties and scattering crowds mingling outside of hot dog stands. That stung. Many had lost work and were now being told to go home, yet here were wealthy people from the cities coming to play.

“People were angry that the hiking trails were still super crowded, they were angry at the tourists and they were angry at the second-home owners,” Gillilland said. “They couldn’t understand why everyone was allowed to do these things while they were losing their livelihoods.”

The county’s early and unyielding line against gatherings is now seen as a success story, but it was initially abrasive. “I have one friend who still won’t speak to me,” Gillilland said. And hell, officials discovered, hath no fury like the mother of a bride who has just been informed that a long-planned wedding on Marcy Field is a no-go.

Putting out fires

By the time the hiking season was over, Keene Supervisor Joe Pete Wilson estimated 150,000 hikers had passed through his town’s two most popular trailheads alone. In Lake Placid, as state restrictions eased, infections struck the hospitality industry, and residents with no history of travel or contact with people who had already tested positive became sick—an indication that the disease was being transmitted by vacationers. As the summer progressed, a full-blown health crisis always seemed to be simmering just beneath the surface.

“It was bumpy at the start because the people who were positive had an amazing number of contacts. From the beginning, all we were doing was stalling for the day a vaccine would arrive.”

— Linda Beers, public health director, Essex County Health Department

So every time the virus flared—at a restaurant, brewery, hardware store, fruit stand, group home, private party or church—the health department and volunteers from the Medical Reserve Corps were there to snuff it out. It was exhausting work, going from one hot spot to another. Yet for the health department, it was also a point of pride. Each positive case felt personal, Whitmarsh said, every cluster a gut punch. 

But if COVID were to win, it would have to go through the Essex County Health Department. “While so many people went home, the small public health team went to work, organizing, calling, contact tracing, and keeping the county informed of the situation every day,” said Krista Berger, the county’s Women, Infants, and Children coordinator. “While most people were home eating dinner with their families, the staff was still calling, counting and planning for what came next. If I didn’t know any better, I would have thought there was a team of 50 or more people for all of the work that was achieved.”

Two weeks after Columbus Day, by the time the dust from the hikers’ boots had settled, the numbers told an astounding story: Only 150 people had been infected, and aside from the nursing home—which was outside the county’s jurisdiction—no one in Essex County had died of COVID-19.

Essex County’s infections would spike in the winter, as a stir-crazy public ignored pleas against travel to infected areas. But even so, as COVID passed its one-year anniversary, only one of New York’s 62 counties, Tompkins, had a lower infection rate per 100,000 people than did Essex.

Buying in

A key takeaway in an examination of the county’s success was that residents ultimately trusted their government leaders and, with some colorful exceptions, bought into the advice. By the end of the summer, the average number of close contacts the health department needed to quarantine had dwindled to four or five. “People listened and tightened their circles,” Beers said.

On Facebook, the department’s followers went from 1,500 to 6,500 with individual page views at times topping 100,000, a testament to the hunger for information. “I don’t think anyone remembered there ever being that much interest in public health,” Whitmarsh said.

“We tried to be honest with people, and when we made a mistake, we acknowledged it. I think that led the community to trust us.”

— Andrea Whitmarsh, senior public health officer, Essex County Health Department

Not only did the community trust the health department, but it dropped off pizza, homemade cookies, handwritten thank-you notes—and destroyed anyone on Facebook who tried to raise a stink about quarantine policy.

A second factor was that second-home owners were typically older, and as such made a point of educating themselves prior to their return. So when they showed up, they brought a two-week supply of groceries and self-quarantined to reduce public risk. 

Essex County’s isolation relative to the rest of the state gave it an immeasurably valuable two extra weeks to strategize, and the county took full advantage. “Shutting down events where people could gather made all the difference,” Clauss said.

Some of the lessons on preparedness came out of a post mortem of 9/11, and one of those tenets was that in time of crisis everyone needs a job to do. So the health department made sure as many people as possible—public and private employees, business owners, residents—had a task and a purpose, even if it was just checking in on an elderly neighbor.

And finally, the perhaps instinctive notion that it was safer outdoors proved to be correct. A breath of air would scatter contagions like flecks of glitter. That paid off for hikers and for local residents, for whom social distancing is a way of life. 

Both groups deserve credit, Buehler said, for being open to government guidance, even if it spurred a little grumbling and griping. “We asked them to do the right thing,” Buehler said. And for the most part, “people took it to heart.”