Pennsylvania Health Secretary Dr. Rachel Levine urged the public Thursday to avoid gatherings of any kind and to cooperate with COVID-19 contact tracers. As LNP | LancasterOnline’s Nicole C. Brambila reported, the current rise in COVID-19 infections “indicates community spread. Pennsylvania’s percent positivity rate, or the percentage of all positive COVID-19 tests, is nearly 7%. According to the World Health Organization, positivity rates above 5% are considered too high. Lancaster, with a positive rate of 6.5%, is among 52 counties with a rate above 5%.” And that’s the rate among those who have been tested. Universal testing is not yet available.
As we face another COVID-19 surge, we’re more convinced of this than ever.
Across the United States, hospitals are struggling with a shortage of COVID-19 beds or staff, or both.
Last week, Dr. Michael Ripchinski, chief clinical officer at Penn Medicine Lancaster General Health, acknowledged that he has lost sleep worrying that the COVID-19 surge here could crush his front-line workers.
“If we have prolonged periods of caring for patients with COVID-19, it will take a toll on our staff,” Ripchinski told LNP | LancasterOnline’s Brambila. “I worry about being able to sustain that for months.”
Caring for COVID-19 patients is draining — mentally, emotionally and physically. It requires painstaking adherence to infection-control measures. The disease is vicious and capricious, sparing some but devastating others. Nevertheless, doctors, nurses, respiratory therapists and other health care workers provide such care, even as they fear they might carry the virus home to their own families.
No wonder Ripchinski is worried.
Edwin Hurston, the county’s public health emergency adviser, however, told Brambila that he’s not losing any sleep over the surge.
Maybe the retired Air Force colonel with an extensive resume in emergency management just has been through so many crises that he’s immune to worry now.
Or maybe because he’s merely an adviser now, and not someone who has to implement an actual emergency response, he doesn’t need to worry.
But someone at the county should, because Gov. Tom Wolf — previously criticized for being heavy-handed — now is leaving it to counties to handle local COVID-19 surges as they see fit.
And Lancaster County has no public health department to take charge, to advise local school districts whether to remain open, to coordinate among our hospitals, to gather data, to offer guidance to local businesses, to counter disinformation, to lead public messaging.
And unfortunately, Commissioner Josh Parsons — who for months tweeted favorable hospital statistics as proof that all was well and that the worriers were overreacting — offered few details to Brambila about how the county might deal with a surge in hospitalizations.
Parsons isn’t a health expert, so that’s understandable. But he leads the governmental body that could establish a county health department.
As LNP | LancasterOnline’s Jeff Hawkes reported in Wednesday’s edition, there was a serious effort to launch such a department in 2007, but it was stalled by the Great Recession.
Now, community leaders including Warwick School District Superintendent April Hershey, Manheim Township Commissioner Tom O’Brien and hospitality company CEO Al Duncan want the county to create a health department.
It would take time to establish such an entity, in whatever form it would take. In the absence of a health department, Parsons and the other commissioners — with Hurston’s assistance — are going to need to step up. The surge before us demands a coordinated response.
Friday, Pennsylvania and Lancaster County set new records — again — for the most new COVID-19 cases in a day. Pennsylvania had 5,531 new cases, bringing the statewide total number to 254,387. Lancaster County had 247 new cases, bringing its total to 11,712.
LGH and WellSpan Ephrata had a combined total of 76 COVID-19 patients Friday, up from 68 the day before and the most since at least mid-May or earlier.
LGH reported 16 COVID-19 patients in intensive care — the most since May 29. Twelve of those patients were on ventilators, the most since mid-May or earlier.
Health experts say that hospitalizations and deaths follow an increase in cases.
A ‘patchwork’ response
In an email to LNP | LancasterOnline, Parsons maintained that Lancaster County has responded to the pandemic “as quickly and effectively as virtually any county,” even those with health departments.
Susan Baldrige disagreed.
Baldrige is executive director of the nonprofit Partnership for Public Health in Lancaster. The Partnership plays a role in research, advocacy and education, but it does not do the work that a county health department would.
Baldrige called the county’s response to the pandemic “a patchwork” with hospitals, health centers, emergency medical services, nursing homes and others “trying to get us through this.”
A “patchwork” is an apt description. What the county has lacked is a central entity that could coordinate and lead the county’s pandemic response.
As Hawkes reported, “the counties with health departments had access to COVID-19 data, established 24-hour COVID-19 hotlines, had stockpiles of personal protective equipment and began contact tracing within two weeks of the first cases. In contrast, Lancaster County waited two months for federal funds before ramping up contact tracing.”
And health facilities had to rely on their own resources for months to get protective equipment.
Depending on the federal government has proven to be a risky proposition — as the struggling families, business owners and municipal and school officials still waiting for a second stimulus bill can attest.
What could have been
In addition to Lancaster County’s hospitals — LGH, WellSpan Ephrata and UPMC Lititz — there is also, in Lancaster city, Lancaster Health Center, an outpatient facility that treats the medically underserved.
Alisa Jones, the center’s president and CEO, told Hawkes that a county health department could have developed and launched a countywide response at the outset of the COVID-19 crisis.
“When we don’t have that professional, accountable, countywide perspective, then we waste time” formulating a response, Jones said. “It takes us time to … figure out what’s happening and to interpret the guidance” from state and federal officials. “Every minute that we delay is a potential for lives lost.”
Where to turn?
Now, facing another COVID-19 surge, where will local health care facilities turn for assistance if they need it?
Hospital officials told Brambila that they will leverage their respective health systems to deploy personal protective equipment, medical supplies and staff to hot spots, as needed.
Unfortunately, much of Pennsylvania — and indeed, much of the U.S. — is either in, or nearing, hot-spot status.
What happens if, as reported in Delaware County last week, hospitals reach capacity and patients need to be diverted elsewhere?
Parsons, Brambila wrote, declined to elaborate “on the worst-case scenario the county could face or how nimble plans might need to be to battle the current surge in coronavirus cases.”
“Just like we did in the spring, if our hospital systems need additional support we will work with (the Pennsylvania Emergency Management Agency), (the Federal Emergency Management Agency), and our federal and state representatives to get what is necessary,” Parsons said in an email.
But what happens if hospital systems across the commonwealth need such support at the same time?
Ripchinski said LGH has offered premium pay, overtime and extra shifts to ensure sufficient staffing.
We hope this will suffice. But no one knows if it will.
The part we need to play
So we have to do our part.
As Dr. Leon Kraybill, chief of LG Health’s geriatric division and post-acute care, writes in today’s Perspective section, we all are going to need to make some tough decisions about how to safely celebrate the coming holidays.
The current COVID-19 surge is being driven by small, indoor gatherings of people, Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, recently said.
Please do as Kraybill and Redfield advise — rethink any such gatherings. Wear a face mask. And practice social distancing.
Hospital employees and emergency responders shouldn’t need to fight the COVID-19 surge alone.