By Donald Gilpin

The first confirmed case of COVID-19 in Princeton was reported two years ago, on Friday, March 13, 2020. Two days later the Princeton Health Department recorded the second, third, and fourth cases. By Monday, March 14, 2022, as the Omicron variant spike continued to decline, the two-year total had reached 2,372.

Princeton Deputy Administrator for Health and Community Services Jeff Grosser recalled the battle that he, the Princeton Health Department, and the community have been waging against COVID-19 over the past two years. He reflected on successes, decisions made that helped to mitigate the impact of the pandemic; turning points; areas where Princeton and other communities could have done better; and lessons learned, especially those that might help in confronting the next new virus.

Grosser’s memories of the first weeks of the pandemic were especially vivid. “It seemed at the time that more information was coming in than could be digested in a 24-hour period,” he said. “We often compared it to final exam cramming every day for those first six months. The first couple of months of the pandemic, on my drive into work, it felt apocalyptic. Oddly enough it became normal after a while.”

In March 2020 municipal buildings were closed to the public, and public meetings went remote. “This transition should not be overlooked,” said Grosser. “The moving of nearly all municipal operations to an electronic format was, and still is, a remarkable feat.”

In the early days of the pandemic, then-Mayor Liz Lempert and then-Police Chief Nick Sutter created a COVID-19 Emergency Task Force. The Princeton Board of Health, with its breadth of medical and governmental public health expertise, sat in on those meetings, which were held seven days each week from March to June 2020 before being scaled back to five days a week until November 2020.

Along with Dr. Meredith Hodach Avalos, Dr. George DiFerdinando, and other Board of Health members, who were constantly researching and keeping watch on the quickly evolving pandemic, the health department worked through local community issues.

Grosser cited the impact of crucial reinforcements brought in to support the health department, including the hiring of Kathy Korwin as full-time public health nurse, and the acquisition, through the Centers for Disease Control and Prevention (CDC) and New Jersey Department of Health (NJDOH) funding, of vulnerable population outreach coordinator Gwen Krol and COVID-19 generalist Julie Venema.

Korwin had previously been part-time with the municipality, and her promotion to full-time status in July 2020 provided much needed support in responding to the many educational institutions in town seeking health guidance.

Grosser commented on the value of having not just more staff, but the most qualified staff. “Having the right staff that are devoted and committed to being part of a team proved instrumental during the pandemic,” he said. “It’s a pleasure to work alongside of them, and I am deeply grateful for their commitment to Princeton.”

Grosser also emphasized the importance of the COVID-19 vaccine and the successful local initiatives to make sure that as many Princeton residents as possible were vaccinated. Vaccination status of Princeton residents age 5 and older as of March 7 stands at 88 percent.

In early 2021, with COVID-19 vaccines available only at mega sites and regional vaccine centers, the Princeton Health Department realized that many local residents were either unable to travel or were unable to find a vaccine.

“Mayor Freda led the charge in working to receive local vaccine doses, and by March or April 2021 our office began offering local clinics serving residents and workers of Princeton with COVID-19 vaccine,” said Grosser. This included several joint vaccine clinics with Princeton University to serve both town and university communities. 

Grosser went on to cite a number of groups that played crucial role in the continuing struggle against the pandemic. He mentioned the mayor, Council, and administration for providing support and necessary resources and their emphasis on keeping the community safe based on scientific guidance; the Princeton BOH, especially DiFerdinando and Hodach Avalos; Princeton University for personnel and facility support in hosting vaccination clinics and for regular communication providing disease surveillance; the Princeton Senior Resource Center for assistance in supporting older Princeton residents and for helping to host vaccine clinics; the College of New Jersey Public Health/ Nursing Programs for providing interns and nurses; and Princeton K-12 schools — public, charter, and private — who worked through a year of remote and hybrid to a return back to in-person schooling this year.

Grosser also applauded the Princeton business community, which had never before worked so closely with the health department on health and safety protocols. “Princeton is fortunate to be served by retailers who are concerned with both their staff health and also the customers coming through their front doors,” he said.

Grosser focused on the long-term care centers (LTC) in pointing out major turning points in the pandemic. By executive order New Jersey Gov. Phil Murphy restricted patient visitation on March 12, 2020, mandated mask wearing for all LTC staff on April 1, 2020, and mandated testing of staff and patients every three-seven days on April 27, 2020.

On April 22, 2020, Princeton began weekly meetings with Princeton Care Center and Acorn Glen administration, head doctors, and nurse leadership. “We identified equipment shortfalls, reviewed CDC and state guidance, and improved communication and lessons learned between facilities,” said Grosser. “The NJDOH also began providing high-level disease prevention training and on-site support to the facilities, along with the New Jersey National Guard.”

He went on to point out, “The long-term care facilities and nursing homes accounted for more than one quarter (25.9 percent) of the total number of people who tested positive for COVID-19 in the first eight months of the pandemic.”

Grosser emphasized the difficulties of dealing with multiple uncertainties, an inadequate public health system, and a lack of timely information in the pandemic’s early days.  “There were so many unknowns,” he said, “and much of our game plan continued to change because the data and surveillance we were initially receiving was backlogged or behind from the start. In my opinion, public health did a remarkable job of adapting to uncertainty and quickly-changing information.”

He cited the need for better disease surveillance systems, increased disease testing including genomic sequencing, improved methods and technology for contact tracing and reporting, and greater investment in public health personnel. 

“We need to ensure that public health departments are able to handle not only the day-to-day responsibilities, but also set up to manage long-lasting emergencies,” he added. “The benefit here is that public health has been underfunded for so long that we understand how to get things done by collaborating with other municipal departments and community stakeholders.”

In addition to the value of the COVID-19 vaccines and the importance of communication between the health department and various community partners, Grosser stated that the most important lesson learned during the pandemic has been the highlighting of the “serious health disparities that exist in our community.”

“The pandemic magnified the inequities within each community,” he said. “As we quickly realized, those that were lower income and from our Black and Brown communities had a higher rate of COVID-19 infection compared to white, non-Hispanic, moderate to high income.”

There were also disparities in vaccination distribution and uptake, particularly in the early months of COVID vaccinations when ability to navigate online often determined access to vaccinations.

“Those factors led our efforts into the neighborhood streets, where we were providing pandemic education on foot along with setting up pop-up vaccine clinics in trusted community locations like La Mexicana and Conexion,” said Grosser.

He continued, “Investing in primary prevention, with an emphasis on those who are at an increased risk of negative health outcomes, can help alleviate these disproportionate outcomes in the future. Primary prevention should include recognizing social determinants of health and making changes in the community to address those concerns.”