For most people, “social distancing” has been the watchword during the COVID-19 pandemic.
Danielle Herring has had a somewhat different experience.
Herring, a doctoral student in the Health Education program at Teachers College, normally works as a Program Management Officer for the New Jersey Department of Health (NJDOH) in Trenton. In March, she was assigned to a COVID-19 drive-up testing center at Bergen County Community College in Paramus, where she now serves as a screening supervisor.
In her new role, Herring rises each morning at 4:45 a.m. and drives 25 minutes to Paramus, in time for a 7 a.m. briefing with staff and senior personnel from NJDOH, the New Jersey State Police, Bergen County, the New Jersey National Guard, and a team of 50 nurses who will screen and register people and distribute tests that day. At 7:30, she meets with the 15 nurses who report to her, goes over any additional details for the day, and walks down the hill to the first white tent on campus. She shrugs on an orange vest, dons an N-95 face mask and gloves, and lines up her team of nurses along the coned lanes. The first car rolls up at 8 a.m., and she is on her feet until her day ends, handing out colored cards for patients who meet the testing criteria, directing traffic, consulting and trouble-shooting, especially on cases that present more than just physical problems.
Seeing people in full PPE [personal protective equipment] can be scary. My nurses are good, and they know when a patient needs a few minutes to calm down.
“Seeing people in full PPE [personal protective equipment] can be scary,” says Herring, who earned a master’s degree in public health from Rutgers University-School of Public Health and has 14 years of experience in emergency preparedness. “My nurses are good, and they know when a patient needs a few minutes to calm down. We understand how important it is to have compassion for people. When we greet our patients with a ‘good morning,’ ask ‘how are you,’ and tell them ‘have a good day and feel better,’ that means the world to them.”
In general, Herring adds, emergency preparedness entails remaining collected and level-headed during a crisis. During a global pandemic, she says, “the insurmountable level of dedication of people on the front lines speaks volumes about the good of humanity. We show up with smiles.”
The COVID-19 pandemic has claimed more than 210,000 lives worldwide since December. Health experts believe that diagnostic testing is critical to containing further spread of the virus, but because of a severe shortage of test kits, only a tiny fraction of the U.S. population has been tested to date.
As one of the hot spots in the United States, however, New Jersey has taken an aggressive approach. The state reported its first COVID-19 case on March 4th. On March 9th, Governor Phil Murphy declared a State of Emergency in response to the outbreak. By March 20th, New Jersey’s first Federal Emergency Management Agency (FEMA) Community-Based Testing Center opened in Paramus, where Herring works. On four days of each week, anyone with proof of New Jersey residency who reports having COVID-19 symptoms can get a test. The drive-through at Bergen County Community College lasts until 4 p.m. or until the day’s supply of 500 tests is gone.
The limited supply of test kits meant that “in the beginning, we were meeting our mark at noon or 1 p.m.” and shutting down until the following day, Herring says.
In fact, on the heavily advertised opening day, cars began lining up on the streets outside the college at 4 a.m. When word got out that the site was running out of tests around noon, the lineups started even earlier -- at 2 a.m., then 12:30 a.m., then 9 p.m. the night before, with cars carrying up to six passengers each.
“If we had 1,000 test kits a day, we would use them,” Herring recalls.
In recent days, first arrivals have eased back to 4 a.m., but even now, on a typical morning, people seeking testing may find that it takes up to two hours just to get on campus, and then another hour and a half to get through the screening and testing process. Rain or shine, Herring walks the line, listening with her nurses as windows are rolled down just a crack to allow passengers to describe their symptoms.
If a patient says they’re experiencing symptoms — shortness of breath, deep cough and fever — then they are given the test.
“If a patient says they’re experiencing symptoms -- shortness of breath, deep cough and fever -- then they are given the test,” she says. “Unfortunately, we've seen some very sick people come through our line” who are immediately transported by ambulance to a nearby hospital.
Occasionally, someone will admit that they don’t have symptoms but are frightened nonetheless “We get some ‘worried well,’” Herring says, who are directed to New Jersey’s website for resources (Covid19.nj.gov). The state’s Department of Human Services also operates a toll-free “warm line,” which is a resource for people seeking mental health service. Herring and her team have cards with that printed information on them as well.
The test itself has changed, too. In the beginning, nurses inserted a long nasopharyngeal swab up the patient’s nasal passage, but new tests can be self-administered. The swabs are then sent to a private lab for processing, and in three to five days, testing results are communicated to the patient. For confirmed positive cases, NJDOH and local departments of health also play a role in contact tracing.
Herring encourages the nurses to see themselves as educators as well as health care providers. She developed a script to help explain the testing site process to patients step by step, and her team of nurses constantly provide feedback to help refine the document. “I’ve grown to depend on my nurses for their clinical expertise as well as their willingness to help my operation run smoothly,” Herring says. “Their work at the testing test goes beyond screening and assessing patients, detailing and enforcing registration protocols, and performing swabs. They are contributing to the response efforts of New Jersey while ensuring resilience is achieved through the collaboration of NJDOH, other state and local agencies, the federal government, and our National Guard.”
After the last test is handed out and any remaining cars are turned away, Herring and other site leaders debrief with the nursing staff. She then drives home, arriving at about 6 p.m. and shifting into parenting mode.
“As soon as I hit the door, it’s game on; that’s my second job of the day. I’m all about making sure they have what they need,” she says of her 14-month old daughter, a 15-year-old daughter (who is homeschooling right now while her high school is shut down) and her husband, whose car-service business has stalled as clients stay home.
“I take off my clothes at the door, take a shower, put my dirty clothes in the washing machine, get dinner ready, get my things ready for tomorrow, and next morning I do it all over again,” Herring says. “When I’m not at the Bergen site, I spend an average of three to four hours preparing for the next day and combing through emails related to my normal project management responsibilities.”
While the demands of her job and the needs of her family have forced Herring to postpone work on her doctoral dissertation, she says her experience of the crisis has sharpened the focus of her research. Originally, she planned to examine the role of health educators in disasters, but now she wants to write about her own experience as a health educator during the pandemic.
Herring’s TC advisor, John Allegrante, Professor of Health & Education, believes that topic couldn’t be timelier.
If we are serious about getting the American public to voluntarily adopt and maintain the complex and difficult changes in behavior that can stem the next waves, then we will need to rely on public health education—and people like Danielle Herring, who, as a health education specialist, has the necessary evidence-based skills to make a difference.”
“Infectious diseases like this novel coronavirus will always be a threat to humans,” Allegrante says. “If we are serious about getting the American public to voluntarily adopt and maintain the complex and difficult changes in behavior that can stem the next waves, then we will need to rely on public health education—and people like Danielle Herring, who, as a health education specialist, has the necessary evidence-based skills to make a difference.”
Herring also sees the importance of community health education coming into focus in a way that it never has before.
“When I started my master’s in public health program, I had a lot of people ask me, ‘What is that’? After this public health emergency, everyone will know what public health is. I can absolutely see this line of work and health education in particular getting a surge of interest as soon as things get back to normal.”
The Tale the Numbers Tell
- COVID in New Jersey: As of May 5th, the state had reported 137,593* positive diagnoses and 8,244* deaths, second only to New York State's 321,192* positives and 19,645* deaths.
- COVID in New Jersey's Bergen County: As of May 5th, the county had the highest number of positives in the state, at 16,460**, but not the highest number of deaths, at 1,261**.
* —The COVID Tracking Project
** —The New Jersey State Department of Health