Since March, when New Hampshire began feeling the repercussions of the COVID-19 outbreak, state officials have largely prioritized diagnostic tests for high-risk groups to conserve the limited supply.
It started small. But COVID-19 testing for Cheshire County residents has expanded significantly over the course of the pandemic, according to newly released state data.
The data are incomplete and likely contain some margin of error, due to the challenges of regularly collecting demographic information from thousands of people. But they show an unmistakable trend.
In the week ending April 4, the state recorded 70 test results for people believed to live in Cheshire County. In June, some weeks had more than 1,000.
New Hampshire’s nine other counties followed a similar trajectory.
Widespread testing is important, as more tests lead to a better understanding of the virus and the extent to which it’s spreading in New Hampshire.
State officials often point to the percentage of tests coming back positive — which has been below 5 percent for over a month — as a key metric. Public health experts say a relatively low positivity rate shows that an area is doing enough testing to catch a large portion of cases.
The state’s efforts to boost its testing ability are a step in the right direction, but there is still work to do, said Dr. Aalok Khole, an infectious disease physician at Cheshire Medical Center in Keene.
“We do have the [testing] capacities, but having said that, it is only serving the purpose for now,” he said. “We need to keep our eye on surrounding states surging in the country, whether these supplies are going to dwindle over the next few months and, God forbid, we see a surge.”
As of Friday morning, 80 Cheshire County residents had tested positive for COVID-19 since early March, according to the N.H. Department of Health and Human Services. A small number were still considered active.
Statewide, there have been almost 6,400 confirmed cases, 575 of them still active.
“New Hampshire is continuing to see stable, low, but persistent levels of community transmission throughout many areas of the state,” Dr. Benjamin Chan, the state epidemiologist, said at a news conference Tuesday.
Time spent ramping up
The state released the county-level testing data — which run from the end of March to early July — in response to a records request from The Sentinel.
The increase in Cheshire County tracks the state’s build-up of its testing capacity and gradual expansion of who could get tested.
Early in the crisis, state guidance limited testing to health care workers, first responders, people who were hospitalized and residents of long-term care facilities. State officials cited shortages of testing supplies and personal protective equipment in explaining the need to target a few key groups.
Between late April and late May, the state set up new testing locations. One, on Krif Road in Keene, has now conducted well over 2,000 tests, according to the state health department. It also opened eligibility to new groups — seniors, people with underlying health conditions, people with mild symptoms and, finally, anyone at all who wants a test.
By June 5, Gov. Chris Sununu was urging everyone to get tested, regardless of whether they were sick.
“We really want to encourage folks, even if you don’t have any symptoms at all, to go get that test,” he said at a news conference. “Find out.”
The data provided by the state show Cheshire County tests starting to rise sharply around early May, coinciding with the increasing availability of testing statewide.
Meanwhile, the state was also working to bolster testing at nursing homes and other long-term care facilities, which have accounted for about one-third of the state’s COVID-19 cases and more than 80 percent of its deaths. The ongoing monitoring at those institutions has played a large role in boosting the county’s testing totals.
One local facility alone, Maplewood Nursing Home in Westmoreland, tested 246 staff and 130 residents in early June, according to Kathryn Kindopp, administrator of the county-owned facility. Two additional rounds of testing — each covering 15 residents and more than 200 staff — occurred in the last two weeks of June.
None of those residents tested positive. Two employees initially tested positive during that time but were negative when re-tested, according to the county. (One part-time worker without direct-care responsibilities also tested positive in April.)
Genesis HealthCare’s four facilities in Cheshire County have also been testing all staff and 10 percent of residents about every 10 days, according to Chief Medical Officer Dr. Richard Feifer.
Khole, the Cheshire Medical physician, said he feels the Monadnock Region now has sufficient access to COVID-19 testing.
But he also noted that even more tests could have been done.
He said that with New Hampshire reporting relatively low numbers of COVID-19 cases, people may not have felt the need to get tested even though the virus was still circulating.
That’s borne out in a June survey of 791 state residents by the University of New Hampshire Survey Center and the Geisel School of Medicine at Dartmouth. People who said they wanted to get tested for COVID-19 dropped from 24 percent in early May to 14 percent in early June.
After its sharp increase through May, testing in Cheshire County fluctuated week to week but continued to stay at a higher level than before. The state-provided data captured about 1,000 tests per week, on average, for the five weeks ending July 4.
Where you go matters
When someone will get their test results back remains inconsistent, and depends on where the test is done.
That’s been exacerbated by new surges in other parts of the country, because most of New Hampshire’s tests are processed by large companies like Quest Diagnostics and LabCorp, state officials said Tuesday.
“It’s really nothing to do with New Hampshire,” Sununu said. “The main reason is because there’s so much demand across the country. The number of people requesting a test in places like Texas and Florida and California is just absolutely through the roof.”
At the state’s Keene site, the average turnaround time has been about seven days, Kathy Remillard, a spokeswoman for the state health department, said Tuesday.
The time frame is slightly shorter at urgent care sites like ConvenientMD, with results typically coming back within three to five days, spokesman Adam Rosenthal said.
At Cheshire Medical Center — an affiliate of the Dartmouth-Hitchcock Health system — results are usually given in less than a day, though can take up to 48 hours if they need to be sent to Dartmouth-Hitchcock’s lab in Lebanon, according to Khole.
Monadnock Community Hospital in Peterborough, which also offers COVID-19 testing, did not provide specifics about its turnaround time.
The state public health lab also turns results around quickly, but can process only several hundred of the approximately 2,500 tests per day done in New Hampshire. It prioritizes nursing-home outbreaks and other situations that need rapid results.
The state is exploring ways to process more tests locally, so surges elsewhere don’t hamstring New Hampshire’s efforts, especially as schools and colleges reopen around the country, officials said Tuesday.
“My sense is that system is going to be under continually high demand for the next couple months,” Sununu said.
Since March, when New Hampshire began feeling the repercussions of the COVID-19 outbreak, state officials have largely prioritized diagnostic tests for high-risk groups to conserve the limited supply.
Before this week, New Hampshire was one of 30 states in the country with no law specifically addressing sexual violence on college campuses.
That changed Monday when Gov. Chris Sununu signed House Bill 705. The new law is the nation’s first student-written campus sexual assault legislation, according to the Every Voice Coalition, the Massachusetts-based group of students, young alumni and survivors of sexual violence that led the charge for the legislation.
Davis Bernstein, a rising senior at Keene State College, sits on the group’s New Hampshire steering committee. Over the past six months or so, the Northampton, Mass., native, who also serves as Keene State’s student body president, called legislators across the state, urging them to support the bill. He also recruited about two dozen of his Keene State peers to do the same.
“This is such a noble cause,” Bernstein said in a phone interview this week. “You can have differences between Democrats and Republicans about many issues, but sexual assault ... needs to be addressed by everyone, because it’s not a partisan issue whatsoever. I was really happy to join an organization that was going to make a difference with this. And since [Monday], we have.”
The bill passed both the House and Senate with strong bipartisan support, and proponents hailed it as a victory for the entire state.
“HB 705’s passage into law is more than legislative action. It is a statement that as a state, we stand with our victims and survivors of sexual assault,” the bill’s lead sponsor, State Sen. Martha Hennessey, a Hanover Democrat whose district includes Charlestown, said in a statement. “It is a statement that our survivors cannot be silenced and they should not be denied justice. It is a statement that our victims and survivors are not alone. Not now, not ever.”
More than one in five women, and one in 20 men, experience rape or sexual assault as college undergraduates, according to the Rape, Abuse & Incest National Network, the nation’s largest anti-sexual-violence organization.
Among other mandates, New Hampshire’s new law requires all colleges and universities in the state to develop comprehensive policies on sexual misconduct, provide free access to medical and legal support services for sexual assault survivors and implement educational programming to prevent sexual violence. Leaders at Keene State and Franklin Pierce University in Rindge say the schools already meet many of these requirements. But they added that the new law will put all colleges statewide on the same page, and generate greater collaboration to address and prevent sexual misconduct.
“Keene State is, I think, very much in line with what this bill is requiring of institutions,” Deirdre Loftus, the college’s Title IX coordinator, said in a phone interview Friday. “But when you’re functioning within a state with institutions all around the state, I think what I’m looking forward to seeing is having a cohesive prevention and response model all across the state for institutions in New Hampshire.”
Loftus added that Keene State likely will make “a few very tiny additions” to the school’s existing sexual misconduct policy to bring it in line with the new law.
“I plan on adding some more information about forensic rape exams into our policy, and adding some more detail into our policies about reporting sexual misconduct to the police,” she said. “But those two things were already in the policy. I think that there will just be more added to them, after reading through this legislation.”
Franklin Pierce University’s policy may require some minor changes, too, spokeswoman Marissa Colcord said. The bigger change, she noted, will come from the new law’s mandate on gathering data on sexual misconduct on campus. The legislation calls for the creation of a statewide task force, which will develop questions for a campus climate survey, which New Hampshire colleges and universities will be required to conduct every other year.
“Here at FPU, we have conducted a biennial Sexual Assault Climate survey since 2017,” Colcord said in a recent email. “Moving forward, the survey questions will be recommended by a state-wide task force and we will need to submit a summary of findings to the state and also post them online.”
Keene State has done a Sexual Assault Beliefs and Experiences Survey every three years since 2015, and posted the results of the survey online, Loftus said. The college will now conduct the survey biannually, in accordance with the new law.
Under a federal law known as the Clery Act, all colleges and universities are already required to publish annual campus crime reports, including instances of sexual assault.
The data from the state-mandated surveys will play a crucial role in another key aspect of the new law: sexual assault prevention education.
“We need to focus on education to stop people from sexually assaulting anyone in the first place, instead of trying to pick up the pieces once it happens,” Bernstein, the Keene State student, said. “So I think it’s going to be important to note the specific statistics of specific campuses across the state, that we’ll be able to say, ‘Sexual assault was down on our campus, and we’re making a difference.’ And we will see where there needs to be a lot more work, where there needs to be bigger education campaigns.”
Keene State already requires all incoming freshmen to complete bystander intervention training, which teaches students how to spot signs of sexual misconduct and step in to stop it, Loftus said. Additional education and prevention programs are mandated for student leaders, like orientation volunteers and resident assistants, and college faculty and staff.
The new law, Loftus added, gives institutions a framework for how to execute these trainings, and hopefully will help schools statewide develop a strong, and standard, educational approach to sexual violence prevention.
“So, if it’s raising the bar for how institutions are preventing and responding to sexual misconduct, that means every institution will become on the same page with how we are serving our students, and therefore be working with each other on creating a model within New Hampshire that is forward-thinking, student-centric and in line with best practice recommendations in the field of violence prevention and response,” she said.
The Every Voice Coalition, which began in 2015, works to address campus sexual violence nationwide. The group has partnered with legislators to introduce bills similar to the New Hampshire law in Massachusetts, where the organization started, Connecticut, Hawaii and Illinois.
They’re among the most powerful actors in the criminal justice system, deciding which charges to file, making bail recommendations and shaping the plea negotiations that determine the sentences in most criminal cases.
And in most of New Hampshire, they’re running unopposed.
In seven of the state’s 10 counties, the incumbent county attorney — the chief local prosecutor, what other states call a district attorney — has not drawn a challenger this year.
“There’s not a lot of interest, frankly, in county attorney races,” said Strafford County Attorney Tom Velardi, a Democrat, who is also president of a statewide county prosecutors’ group. “We’re pretty close to the bottom of ballots.”
County attorneys and their staffs prosecute most felony criminal cases in New Hampshire, and sometimes misdemeanors as well. The N.H. Constitution makes them accountable to the voters, and they stand for election every two years.
But most of the time, voters don’t have much choice.
Of the 100 county attorney races between 2000 and 2018, just 25 had more than one candidate on the ballot during the general election, according to an elections database published by N.H. Public Radio. Another four or five had a contested primary but not general election.
Cheshire County’s last contested race was in 2006. After a late withdrawal by the sitting county attorney, former officeholder Peter Heed won both major-party primaries as a write-in and cruised to election in the general with 84 percent of the vote.
Sullivan County Attorney Marc Hathaway was elected in 1986. He has not faced a challenger since.
“I would like to think it’s because we’ve done a good job,” Hathaway, a Republican, said. “But I can’t speak for what other people may or may not do.”
‘A powerful position’
Prosecutors wield a great deal of power over criminal cases. After police departments investigate and make arrests, prosecutors decide whether to move forward with those cases.
Importantly, they also determine which charges to file. The facts of the case — as reported by police — are the basis for that decision. But an action can violate multiple provisions of the criminal code. A prosecutor has wide latitude to charge the most serious possible violation, a lesser offense or several separate charges, each outlining a different “alternative theory.”
Prosecutors also have the authority to include — or omit — factors that enhance a charge’s severity, like prior convictions.
“It’s a very, very powerful position,” said Albert “Buzz” Scherr, a professor at the UNH Franklin Pierce School of Law. “It can be a source of abuse, and it can be a source of justice.”
The vast majority of cases are resolved through plea bargaining, rather than trials. Charging decisions give prosecutors “a lot of leverage” in that process, said Alex Parsons, the managing attorney of the Keene public defender’s office.
Drug cases are one example, he said. Someone caught with a handful of unprescribed OxyContin pills could be charged with unauthorized possession of a prescription drug, which is a misdemeanor, or possession of a controlled drug, a felony.
Ultimately, prosecutors will usually bump that down to a misdemeanor as part of a plea deal. But the risk of a felony conviction — which carries the potential for prison time and can hinder later attempts to find housing or a job — can put pressure on defendants to plead guilty instead of taking their chances at trial, Parsons said.
“That’s kind of the going rate,” he said of the misdemeanor charge. “That’s what’s fair and right. But prosecutors will often bring that as a felony. And they don’t necessarily want a felony conviction, but that will make sure that they get the misdemeanor conviction.”
Sentences are typically hammered out in negotiations outside the courtroom, though a judge must sign off at the end, said Steven Briden, the deputy county attorney in Carroll County and a candidate for Rockingham County attorney.
“A prosecutor has basically unlimited discretion to go to defense counsel and say, ‘This is a case that requires no time,’ ‘This is a case that requires suspended time’ or ‘This is a case where I’m not gonna agree to any plea resolution unless your client is willing to go to prison,’ ” Briden said.
Different offices have different philosophies, according to Richard Guerriero, a Keene-based defense attorney who practices in various parts of the state.
“I will speak highly of Cheshire County, and maybe some other counties,” he said. “… I think other county attorneys look at situations more harshly.”
County attorneys noted that their discretion is not unlimited. Defense attorneys, judges, police departments and, ultimately, voters can push back against decisions they feel go too far.
“Let’s say somebody came into that office and said, ‘I’m going to mandate at least a year in jail for every simple possession case,’ ” said D. Chris McLaughlin, the Cheshire County attorney. “The defense bar is gonna say, ‘Well then we’re gonna have a lot of trials.’ ”
Nationally, district attorney elections have received more attention in the past half-decade, with reform-minded prosecutors winning in Philadelphia, Chicago, Boston and elsewhere.
But most races are foregone conclusions, especially in smaller communities. A report this year by a University of North Carolina law professor looked at more than 2,300 jurisdictions nationwide; fewer than 700 had contested races in the election cycle studied.
In New Hampshire, prosecutors and other observers gave various reasons for that. You have to be an attorney to do the job; that limits the pool of potential candidates, especially in more rural counties. The pay’s not great. It’s not traditionally a stepping stone to higher office, said Scherr, the UNH law professor. The public may not pay much attention, or even really know what a county attorney does. Unseating an incumbent is hard. And people may simply be happy with how things are going.
“Running unopposed or getting re-elected through a contested race is a really good endorsement that what you’re doing is the right thing,” said Velardi, the Strafford County attorney.
McLaughlin echoed that. A Westmoreland Democrat, he was appointed Cheshire County attorney on an interim basis in 2013 to succeed Heed. He has been elected without opposition since 2014 — a would-be challenger was bounced from the ballot in 2016 because he wasn’t a lawyer — and faces none this year.
“I think if someone was in the position and was not doing a good job, that there would be competition for the position,” he said. “I think it is the type of position where you have to build relationships with law enforcement, you build relationships with the local bar, and people, they get a sense of you.”
Races tend to be more competitive in larger counties. The state’s three most populous counties, Hillsborough, Rockingham and Merrimack, account for most of the contested elections in the past 20 years — and all three of them this year.
Challengers in those races gave different reasons for why they decided to run. Some criticized what they saw as poor leadership by incumbents.
“To me it appeared that the county attorney’s office leadership was struggling,” said John Coughlin, a Republican, citing the rocky first term of Democratic Hillsborough County Attorney Michael Conlon. A former judge and county attorney, Coughlin said that prompted him to run for his old office this year. “I think there’s a real need for someone with some experience.”
Others said they want to implement a different approach to criminal justice. Briden, a Democrat challenging Rockingham County Attorney Pat Conway, a Republican, said he would focus more on alternatives to incarceration for nonviolent crimes. He argued that treatment and rehabilitation make society safer in the long run by reducing recidivism.
Briden said he’d like to see more contested county attorney races.
“People should always be re-evaluating what they think,” he said. “And one of the best ways in our electoral system to do that is to have a challenger talking about how things could be different.”