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Officials respond after polio samples were found in wastewater in 2 New York counties


Polio - it was the disease we all thought we could put behind us. And yet earlier this summer, an individual in New York state contracted the virus and ended up paralyzed - the first such case in decades. NPR's Ari Daniel visited the counties on the front lines of what could be a critical moment in U.S. public health.

ARI DANIEL, BYLINE: Dr. Irina Gelman knew about the paralytic case of polio in Rockland early on. She's commissioner of health in Orange County, N.Y., which is next door.

IRINA GELMAN: I heard the news from a phone call. Clearly, a confirmed case of polio in the United States is major news.

DANIEL: Meanwhile, in Rockland County, word of the individual paralytic case circulated among those in local government before it was announced to the public. Mona Montel, chief of staff for the town of Ramapo, remembers what went through her head.

MONA MONTEL: Here we go again.

DANIEL: She's referring to the pandemic.

MONTEL: Do I as an individual and do we collectively as a county and as a community have the strength to go through this again? Polio cannot be cured. And once it's paralytic polio, you're paralyzed, plain and simple.

DANIEL: During COVID, Montel worked on the county's COVID vaccine information campaign alongside Shoshana Bernstein, who calls herself a health communicator. The news of paralytic polio had her in knots.

SHOSHANA BERNSTEIN: I'll, like, check my phone about seven times a night. I wake up like, oh, my God, is there another case?

DANIEL: A very small percentage of people with polio become paralyzed. Most of the time, there are no symptoms at all, which is why, in public health, just one case of paralytic polio implies a silent outbreak. When I meet Commissioner Gelman outside a municipal building in Orange County, she says it's the tip of the iceberg.

GELMAN: It's very difficult to predict how many people, but it's definitely a number of individuals that would have to be actively transmitting.

DANIEL: Meaning there are more cases, potentially way more cases of polio in these communities than just a single paralytic patient. Then when the county started testing the wastewater for polio, there it was again. Samples taken from both counties going back to May were positive for polio. Then, sequencing the virus's genetic material surfaced something else that was unsettling.

GELMAN: There are multiple strains. So they are different, meaning we do know that it's more than one individual.

DANIEL: That is more than one individual shedding polio virus. In other words, the outbreak isn't contained.

GELMAN: I mean, to put it bluntly, it's just disappointing at this point that we are still here. This is a vaccine-preventable disease. And had everyone just been up to date on their vaccination, we would have continued to report it as being eradicated.

DANIEL: So how did the virus get here? Here's what authorities think happened. A person came to New York state infected with polio they had likely contracted in another country. They probably were asymptomatic and didn't realize they had the virus. Once they got to New York, where some communities have low vaccination levels, the virus started spreading, eventually causing infection and paralysis in a person in Rockland County. Rockland and neighboring counties have some of the lowest polio vaccination rates for young children in the country.

BERNSTEIN: It's a multitude of reasons spread across a multitude of demographics. There's no one single group that is not vaccinated.

DANIEL: Shoshana Bernstein says COVID and all the talk of vaccinations just made everyone tired and confused. She's a member of the large ultra-Orthodox Jewish population here, some of whom, she says, choose to live a more insular lifestyle.

BERNSTEIN: Social, you know, and secular media is not really something that's brought in. So it's a lot of word of mouth.

DANIEL: Which Bernstein says makes some within her community vulnerable to anti-vaccine messaging.

BERNSTEIN: We always say it's extremely easy to instill fear and extremely difficult to undo it.

DANIEL: The county's a mosaic of communities where vaccination rates are also low, and there's mistrust of health authorities.

BERNSTEIN: Any press release from the CDC is just - no one's even reading it.

DANIEL: So Bernstein and Mona Montel, Ramapo's chief of staff, have joined forces to become a vital conduit between all the official public health language and the hearts and minds of their neighbors. The duo show me a large printed infographic hot off the presses - four versions in English, Spanish, Haitian Creole and Yiddish. Montel says it's carefully worded.

MONTEL: People have had PTSD with the word vaccination. So we're immunizing; we're not vaccinating. And that's the messaging.

BERNSTEIN: My dream is that, after this, the CDC will actually have, like, a game plan of, OK, we're using Rockland County as our model. And now we're going to repeat that model across the country.

DANIEL: Back in Orange County, I sit outside with Commissioner of Health Irina Gelman. She says she doesn't get much sleep these days. She's up at 3:30 every morning. Things haven't let up since she began her job four years ago.

GELMAN: We started with a measles outbreak. And we've gradually progressed into COVID-19. And simultaneously, we are now dealing with monkeypox and with now polio.

DANIEL: Polio.

GELMAN: Polio, yeah.

DANIEL: It was gone from here.

GELMAN: It was officially eradicated, yes. It does pose a tremendous amount of concern.

DANIEL: Ari Daniel, NPR News. Transcript provided by NPR, Copyright NPR.

Ari Daniel is a reporter for NPR's Science desk where he covers global health and development.