Rehoboth needs culture of compliance for COVID-19
In 1993, I served on the Montgomery County, Md. HIV/AIDS Task Force. Over 200,000 Americans had died of this disease and there was no treatment. Disease-prevention public education programs were in place, but the infection rate continued to rise. The task force needed to determine what else was needed to stop HIV/AIDS, and task force member Tony Fauci had the answer: The public must be motivated to change risky behavior and must receive explicit information on the use of barriers to block virus transmission. In the context of HIV/AIDS, barriers included sexual abstinence and latex, and the use of surface disinfectants and protective gear by healthcare personnel.
The first COVID-19 cases in Sussex County were in the Rehoboth Beach ZIP code in early March and climaxed in the worst hotpot in Delaware in the Georgetown area with 595 cases per 10,000 people. There are now 153 deaths and 4,487 cases in Sussex County corresponding to 232 cases per 10,000 people.
In January, federal and state agencies began to communicate COVID-19 barrier strategies: Stay-at-home, social distancing, hand-washing and surface disinfection. More recently the use of face masks and shields were shown to be effective barriers.
In February and March in Rehoboth Beach, groups gathered on the beach, Boardwalk, and Rehoboth Avenue. Social distancing was ignored, and face masks were not to be found. Gov. Carney ordered the beaches closed on March 21, and on the following day Mayor Kuhns issued a proclamation and order concerning the COVID-19 pandemic. A second order was issued May 12. The proclamations reiterated state and federal guidelines for disease control but lacked provisions to motivate residents and visitors to alter disease-transmission behaviors and use barriers to block virus transmission. In February and March, Rehoboth Beach officials could have developed a culture of caring and compliance that would make COVID-19 disease prevention part of the fabric of the city. Essential businesses throughout Sussex County successfully implemented cultures of caring and compliance through their employees and customers. A visit to any local grocery store exemplifies this.
The city commissioners developed a reopening plan that did not fully use the prevailing wisdom on using barriers to reduce COVID-19 dissemination. Masks were required only on the Boardwalk, and sidewalks on Rehoboth Avenue were widened for extra sidewalk space. The reopening plan was confusing and lacked specific direction on controlling disease transmission. Recalling Dr. Fauci from 1993: To reduce illness and deaths from contagious viruses, the public must be motivated to change risky behavior and must receive explicit information on how to use barriers to block virus transmission.
I have observed over the last six weeks that less than 25 percent of the pedestrians on Rehoboth Avenue and the beach had masks and half of those were not using them correctly. There appeared to be some enforcement of wearing masks on the Boardwalk. It only takes one infected person not wearing a mask to transmit respiratory droplets and aerosols to dozens of barrier-less people to start a COVID-19 epidemic.
With thousands of visitors from diverse locations concentrated on the beach, Boardwalk, Rehoboth Avenue, a new hot spot in Rehoboth Beach is a possibility. Delaware is still ramping up COVID-19 disease surveillance capabilities and the state may not be able to contain a Rehoboth Beach hot spot through testing and contact tracing.
It is not too late for Mayor Kuhns and the board of commissioners to change a course that is heading Rehoboth Beach into a possible COVID-19 resurgence. Barriers for preventing COVID-19 dissemination are not foolproof but barriers are all we have for now to reduce the possibility of a COVID-19 outbreak. Local citizens and experts from the Delaware Department of Health and Human Services could be mobilized to create and implement a culture of caring and compliance to better ensure a healthy future for Rehoboth Beach.