Jeffrey Grosser is the Princeton Health Officer within the municipal health department responsible for promoting health, controlling disease, and protecting against environmental hazards in town, managing much of the department’s response to the COVID-19 pandemic. On Monday, Grosser spoke with the ‘Prince’ about where the town stands in terms of reopening and what the University should consider for the fall.
The first half of the Q&A can be seen on The Daily Princetonian’s YouTube channel.
The second half, lightly edited for clarity and concision, can be read below.
The Daily Princetonian: Back to the beginning of all of this, I wanted to know how it felt for you in the first initial weeks — what steps you and the health department first took when you learned about the coronavirus and just how that felt, going back to those first moments.
Jeffrey Grosser: Yeah. We have a number of diseases that pop up on our radar, a lot of them through networks — CDC, Johns Hopkins, Harvard, New Jersey State Health Department. And you’ll hear about disease threats that appear that they could take on the life of what’s happened with COVID-19. There’s been a lot of false alarms, whether it was MERS or SARS1, and you prepare for those events by getting your staffing response charts together, going through policies and procedures, and making sure you have things in place.
I think what’s happened with COVID-19, and what we’ve seen from the onset is its remarkable ability to spread from person to person has made it difficult to track, because of the sheer number of individuals that could get exposed from just a single person. And Princeton saw this from our first large spread outbreak, which was a single event of approximately 50 people, and we saw a number of individuals from this event actually become symptomatic and test positive. Of course that was a bit of a taste of what was to come, but there was actually a lull after that outbreak in Princeton, and what that did for us was it kind of gave everyone a false sense of ‘Okay, maybe this was a secluded event.’ We started to see the cases up in North Jersey up at this time; this was early March. And the long term care center discussion was just beginning …
The issue is, and this is something we’ve been running into, public health in New Jersey has been drastically under-funded for decades. The probability of something like this happening to public health is likely, and it might be easy to say that in hindsight. However, when it comes to the system in place for facilities like long-term care centers in terms of outbreak response, their training was minimal. And that wasn’t necessarily an issue with the facilities’ management, though they could take some ownership. You know, there was a shortage of personal protective equipment (PPE). There was a shortage of training in disease outbreak response at some of these facilities. There was a shortage in public health officials to do contact tracing. Shortage, shortage, shortage. And unfortunately, we’re starting to realize what we need in place to be able to handle something like COVID-19, I think we’re starting to see that now.
In the beginning, my true feelings were obviously that of hope — hoping things didn’t get worse — but understanding if they get worse, we’re going to have to drastically change how we do public health on a local level. And we can’t always be reliant on authorities from the state and the CDC to save us and give us PPE. We have to be better prepared, we need to do better next time, and we need to do better this time — we need to make sure we have the PPE available so if Penn [Medicine] Princeton or Capital [Health Primary Care] decides ‘We’re short on PPE,’ Princeton can help out; the town can help out.
We need to start to be more reliant locally, and we also need to understand that we need to promote public health in a way that when people hear ‘public health’ they understand what it is and what they need to do in their own responsibilities to reduce things like this ever happening again.
DP: We see in the news, this pandemic is impacting communities of color disproportionately. I was wondering if you’ve seen any of those trends in Princeton, or if there’s enough data to show those trends concretely?
JG: Yeah, so we stratify our COVID-19 positives with racial and ethnic data. In the beginning it was really predominantly Caucasian, and most of that had to do with the population we’re seeing in long-term care facilities. What we’ve seen recently is more of an outbreak in our Hispanic and Latino population, and that’s one that I obviously take very seriously because individuals in some of the Hispanic and Latino populations — especially if they’re undocumented — may have a fear of coming forward to local government or government in general. And that’s something that we’ve really tried, from a social equity standpoint, to try and break down those barriers and just express the fact that we’re trying to help, and we need to get people the help that they need …
We’ve worked with a number of gatekeepers in the community to try to get into these populations, and we’re trying to get out the word on how to get tested, what to do with your employer, if you live with your family or other people who are not family members how to properly quarantine and isolate. And we’ve done a really good job I think of getting the word out, but that job really never ends. It’s ongoing.
DP: Another big thing along with the pandemic is the Black Lives Matter protests going on across the country over the deaths of George Floyd, Breonna Taylor, and other victims of police brutality. How do you think that could affect the spread of the disease?
JG: Obviously there’s a potential to increase community transmission as a result of the protests that are happening. And to add to what you just said, when individuals protest they are clearly passionate, and social distancing, although they’re wearing masks, is not on the forefront of what is going through their minds. So, of course there’s a potential for increased community transmission there. It’s something that I think, as a county, we need to be aware of because there are obviously ongoing protests in Mercer County. And we need to be aware of the fact that this is happening, and that we could see some clustered outbreaks as a result of it.
DP: And I was wondering how this has impacted other kinds of health, besides with COVID-19. Like, have people been seeing primary care physicians less? Have kids been getting fewer vaccinations? And can that pose a public health risk in it of itself, if it's too long before people get their vaccinations on schedule?
JG: So, yes and yes. I mean, people are seeing their doctors less, children are falling behind on their vaccinations, individuals are not following through on their chronic disease treatments because of a fear to even go to the hospital or their health care provider. So we are seeing that, and what we’re going to see in the coming weeks or months — we’re going to see not only a need to vaccinate children. There’s going to be a backlog of children who need to get vaccinated, there’s going to be a backlog of individuals who need chronic care, and that’s all going to need to happen, especially if we plan on getting back to school in the fall, because you need those vaccines to enter school.
We’re working tirelessly with clinics in our area to make sure these children can get seen, whether it's night time clinics or weekend clinics. We would really hate to have COVID-19 increase the likelihood of someone falling ill to these other very preventable diseases … We need to make sure the word is out there that people need to get vaccinated, no matter what. And at this point, it is the right time to call your physician and ask “can you schedule your next vaccine visit.”
DP: And just for the record, it is safe to go and get a vaccine, right?
JG: What I would tell the public is: does your doctor’s office have a protocol? What a lot of doctors are doing is saying, “We’re seeing well patients in the morning and ill patients in the afternoon.” And what that allows doctors’ offices to do is they disinfect everything in the evening and they’re ready for business in the morning. Many places are doing, like I mentioned, weekend or night-time clinics. They’re also doing drive-up clinics. So if individuals are questioning whether or not it’s safe to get one, my suggestion is talk to your physician. Ask them what protections are in place to keep you safe inside the office.’ A lot of other places are actually coming out to your vehicle. So yes, right now it is safe to get a vaccine, but you should also ask questions and educate yourself on what’s available for you.
DP: In terms of returning back in the fall semester, you talked about having the flu season in the fall as well. What do you think is the likelihood that we’ll be coming back? And do you think it’s possible to have something where we come back for part of the semester? And I know you’re not the one making the decisions about when the University opens or closes, but I’m wondering what the conversations around that were.
JG: It’s a good question, Katie. And if I had an answer to that, I’d probably be working for Princeton University. I think there’s just so many things to think about with regards to bringing back a university, because a university itself is basically a community, right? It's its own town almost. There’s academics to think about, there’s living situations to think about, there’s extracurricular activities to think about. Can University Health Services handle a potential surge in cases? There’s contact tracing to think about. I think the likelihood — I can’t speak to whether or not I think it’s going to happen, but I can tell you that the likelihood I think it's going to be a result of what trends we’re seeing at the current moment.
And I know the decision is probably going to be made in July for the fall semester. I think either way you slice it, it’s going to look very different in the fall semester than in the fall semester of 2019. That’s probably the best way I could describe it.
DP: What do you see as some permanent or very long-lasting changes?
JG: Well I think in general, individuals are going to rethink really large-scale group activities for quite some time. What we found is some of these events that were at the earlier part of the COVID-19 pandemic in the United States, we had some really large-scale outbreaks from single events, where there’s a lot of people in one place with a few infected individuals. I think we need to be cognizant of the fact that we really don’t have this thing under control until we have a vaccine for it. It’s just not going to happen. There’s too many countries around the world going through their own epidemic ...
We have a lot of work left to do. I think there’s many things that are in place right now with regards to social distancing, various engineering controls that are in place at workplaces. However, there are certain institutions in America — universities, other schools, sports events — that we’re really going to have to figure out, and I don’t believe they are yet. Obviously, sports are a big thing in America. Professional sports, they have a lot of talented people working for those agencies and organizations. When we start seeing those plans come out, and what they’re going to do with spectators, and how they’re going to protect players and coaches, then I think we’ll have a better idea as to the direction of this.
But I feel like we’re in a place now where we’re just starting to get ahold of the number of new cases — we’re starting to really get good epidemiological trends in terms of hospitals and everything else — but we have to be cautious over what gets reopened because we could quickly create another outbreak if we make the wrong move.
So I think we need to continue to have the discussion, we need to continue to plan, and we need to continue to try to safeguard everyone’s health because at this point we understand how quickly things get out of control if we close one eye, so we’ve got to make sure we’re on top of this.