Delayed Recognition of COVID-19 in New York City: A descriptive analysis of COVID-19 illness prior to February 29, 2020.

BACKGROUND: On January 30, 2020 COVID-19 was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization. Almost a month later, on February 29, 2020, the first case in New York City (NYC) was diagnosed. METHODS: Three-hundred-sixty persons with COVID-like illness were reported to the NYC Department of Health and Mental Hygiene (DOHMH) before February 29, but 37 of these tested negative and 237 were never tested for SARS-COV-2. Records of 86 persons with confirmed COVID-19 and reported symptom onset prior to February 29, 2020, were reviewed by four physician-epidemiologists. Case-patients were classified as possible delayed recognition (PDR) of COVID-19 when upon medical review the reported onset date was believed to reflect the initial symptoms of COVID-19, or insufficient evidence to classify, when the onset could not be determined with confidence. Clinical and epidemiological factors collected by DOHMH and supplemented with emergency department records were analyzed. RESULTS: Thirty-nine PDR COVID-19 cases were identified. The majority had severe disease with 69% presenting to an ED visit within 2 weeks of symptom onset. The first PDR COVID-19 case had symptom onset on January 28, 2020. Only 7 of the 39 cases (18%) had traveled internationally within 14 days of onset (none to China). CONCLUSIONS: COVID-19 was in NYC before being classified as a PHEIC, and eluded surveillance for another month. The delay in recognition limited mitigation efforts; by the time city and state-wide mandates were enacted,16 and 22 days later, there was already widespread community transmission.

Coronavirus Disease 2019 (COVID-19) Outbreaks at 2 Construction Sites-New York City, October-November 2020.

During 23 October-16 November 2020, the New York City Department of Health and Mental Hygiene investigated coronavirus disease 2019 (COVID-19) outbreaks at 2 construction sites. Challenges in adhering to the New York State Department of Health "Interim COVID-19 Guidance for Construction" were reported. To minimize outbreaks, jurisdictions should increase tailored outreach to the construction industry, emphasizing infection prevention.