LC covid-19 update 3

Local elected officials offer COVID-19 updates at the Lancaster County Public Safety Training Center on Wednesday, April 22, 2020.

THE ISSUE

Last week, Gov. Tom Wolf announced his plan for reopening Pennsylvania businesses in phases and by regions. Using a data tool developed by Carnegie Mellon University, state officials will consider factors such as a region’s population density and mobility, availability of testing and health care resources. According to the plan, “a regional assessment will measure the COVID-19 cases per the population. A county can make the list for consideration to open if they, on average for the past 14 days, had 50 or less new cases per 100,000 residents per day.” Reopening is targeted to begin in the commonwealth’s north-central and northwest regions May 8.

The vocabulary of this pandemic becomes ever more complicated.

To now-familiar terms like “social distancing” and “flattening the curve,” we are going to need to add “asymptomatic spread” and “contact tracing.”

That last one — which simply means tracing everyone who has come in direct contact with an infected person — will be especially important in the weeks to come.

According to Wolf’s plan, a region will need to have robust “case investigation and contact tracing infrastructure” in place so outbreaks can be identified early.

Does Lancaster County have such an infrastructure? It’s hard to tell.

Health center’s efforts

The only entity that has been forthright in discussing contact tracing is Lancaster Health Center, a community health center that offers comprehensive medical and dental care to more than 22,000 patients regardless of whether they have health insurance.

In an op-ed in last Sunday’s Perspective section, Alisa Jones, the health center’s president and CEO, noted wisely that widespread testing and “contact tracing are how we flatten the curve of COVID-19 infection and return our community to a semblance of normalcy.”

She wrote that Lancaster Health Center began contact tracing March 30 “when our first positive case of COVID-19 was confirmed.”

In a subsequent email, Jones explained that the center’s nurses “do the initial contact with the patient who tested positive for COVID-19. They ask for permission to obtain information on contacts the person has had looking back 48 hours before symptoms began.”

Then administrative staff members, trained in the contact tracing principles of the Centers for Disease Control and Prevention, reach out to those contacts.

As the CDC principles state, those individuals must be warned of “their potential exposure as rapidly and sensitively as possible.” Importantly, they aren’t given the name of the infected person. Instead, they are given information about their risks, how they should separate themselves from others, and how to monitor themselves for illness. They are advised that they could spread the infection to others even if they have no symptoms.

Contact tracing is critical in limiting the spread of infection.

As of Friday, 433 households had been contacted by Lancaster Health Center staff members.

Another plea

We applaud the health center both for its transparency and its efforts to not just treat COVID-19 but to get a handle on the scope of infection here.

As a letter writer notes today, the health center seems to be “the closest thing we have to a health department in Lancaster County.”

It is indeed an excellent resource, staffed by health practitioners who view their work, as Jones noted, “through the lens of the individual, family, community and larger society.”

But as fortunate as we are to have the health center, it can’t possibly replace a county health department.

So, yes, here comes another plea for the county commissioners to acknowledge the glaring need for one here.

That need has been thrown into sharp relief by this reality: Getting detailed COVID-19 data from the state has proven to be a torturous process.

As we wrote April 12, if we had a county health department, we would know more about the county residents who have contracted and died of COVID-19. Whether they had underlying health conditions. What race they were. Their ages.

“There are important reasons we should know this demographic information,” we noted then. “Chief among them: Information saves lives.”

COVID-19, for instance, has exacted a disproportionately harsh toll on African Americans and Latinos. Are outcomes for people of color differing here, too?

Lancaster Health Center is gathering that data to the extent it can. But it can’t be the only entity collecting it.

Information struggle

We only learned last week where COVID-19 infections are clustered in Lancaster County when the state health department — finally — launched a website revealing COVID-19 cases by ZIP code.

Counties with their own health departments, like Chester County, have been releasing more detailed information since the pandemic took hold.

Lancaster County Coroner Dr. Stephen Diamantoni has sought to fill in some of the information gaps, offering LNP | LancasterOnline reporters regular updates on the local death toll. (As staff writer Hurubie Meko reported last week, there is an often confusing disparity between the numbers released by county coroners and the state Department of Health.)

As LNP | LancasterOnline’s Jeff Hawkes reported last week, Lancaster city Mayor Danene Sorace “is pressing the state Health Department to let the city fight COVID-19 through contact tracing. ... The effort could be overseen, the mayor says, by the existing city health board or by creating a city public health department.”

Or by creating a county health department.

The unknown

Dr. Michael Ripchinski, chief clinical officer at Penn Medicine Lancaster General Health, told LNP | LancasterOnline last week that he “definitely” believes “we have slowed the surge.”

“But I don’t think we in the county have enough data to know where we’re at in this pandemic today,” Ripchinski added.

Fewer than 1.5% of county residents have been tested, he said.

How are we going to know whether it’s safe to reopen the local economy if only a tiny fraction of county residents have been tested? And if we don’t have the data needed to show us where we stand?

A county health department would make testing and data collection — as well as contact tracing — priorities.

We are heartened that the county commissioners have hired Edwin A. Hurston of Martic Township on a contractual basis as their public health emergency adviser.

As LNP | LancasterOnline’s Hawkes reported, Hurston will be “the commissioners’ point person in working with hospitals, health care providers, local governments, business leaders and others who are trying to end the outbreak and plan for reopening the local economy.”

Hurston has an impressive resume. According to a county press release, he’s retired from the Air Force Medical Service Corps, having held command, leadership and support roles following the Japanese tsunami of 2011; the Haiti earthquake of 2010; the 2001 anthrax attack in Washington; and the Sept. 11, 2001, terrorist attack on the Pentagon.

We wish him luck in his new position. We hope he impresses on the commissioners the need for a county infrastructure to deal effectively — and comprehensively — with public health emergencies. Because, sadly, there will be others. And we need to be better equipped next time.