We are now entering the eighth week of social distancing and mitigation efforts across the commonwealth, designed to slow the spread of the COVID-19 novel coronavirus and prevent the healthcare system from becoming overburdened.
To date, those efforts have proven successful, as positive cases are no longer increasing at an exponential rate, hospitals have regular and ICU beds available, and communities have flattened the curve and forced the spread of the virus into a plateau. That success, however, has come on the backs of many citizens who were forced into sacrificing their livelihoods, their sense of security and their very way of life in order to protect their fellow citizens and the much-needed healthcare systems.
With new cases at a plateau in Montgomery County, and minimally affected counties in other parts of the state already beginning the process of easing restrictions, many want to know: what comes next? What requirements must to met to ease restrictions? And what will this new normal look like?
To obtain the answers to these questions, North Penn Now reached out to Dr. Valerie A. Arkoosh, Chair, Montgomery County Board of Commissioners, who described a future where social distancing and masking become newly ingrained customs of American society, and where increased testing and widespread contact tracing are at the forefront of the fight against the spread of COVID-19.
Where We Stand
In order for Montgomery County to move into the “yellow phase” of restriction easing, the county will need to report a 14-day average of 30-or-less new cases per-day, based on the guidance issued by Governor Tom Wolf. As of May 2, the average over the last 14 days was 126 new cases per day, with the lowest daily case count being 68 on April 22.
Included in those daily case counts is several instances of mass-testing at some of the hardest-hit facilities in the county, including several nursing homes and the Montgomery County Correctional Facility. This has led some to question if the totals from those facilities should be included with those who live outside of those facilities, but Arkoosh said the positives are all connected.
“What people have to remember is that, in both cases of long-term care facilities and the correctional facility, these are individuals who go to hospitals, they’re transported by first responders, and when they get there, they are cared for by healthcare workers and their rooms are cleaned by custodial workers,” said Arkoosh. “Anybody who is positive, it is important to recognize that they will be using resources, potentially exposing others, and they are very-relevant to the discussion.”
That position was reiterated by Pennylvania Secretary of Health Dr. Rachel Levine, who issued the following response when a question was raised about Delaware County officials asking for the long-term care and congregate living facility totals to be set aside from their public case count.
“We are not going to separate nursing home cases from other cases in counties,” Levine said. “What we have learned in this global pandemic is that we are all interconnected. One section of the community, such as a nursing home, impacts the general community, and the community impacts that facility.”
Arkoosh said the county has been sending teams to dozens of facilities in an effort to provide resources and guidance, and they will continue to provide and expand that outreach over the coming days and weeks. On the data side, Arkoosh said that the county will soon begin to provide break-out data categories on their website for the long-term care facilities and correctional facilities, so residents have a clear understanding of how they are being impacted.
“These are our parents, our grandparents, our aunts and uncles…these are real people and they matter. We cannot lose sight of that very-challenging situation, and their contribution to total need in the community,” said Arkoosh. “The strength of a community is how we care for the least of us in a crisis.”
“I’m constantly reminding people not to lose sight of our collective humanity during this pandemic,” Arkoosh continued. “We have to care for one another, we have to care about one another; that’s what this country is all about.”
As of May 1—the most recent day that case counts were provided for long term care facilities—the county reported 1,114 cases among long-term and congregate care residents, and another 458 cases within their staff. At a glance, those numbers would seem to represent one-third of the countywide total of 4,310 cases on Friday, but Arkoosh pointed out that those numbers are separate data from the total, and some of the numbers do not count towards to the countywide total because they fall into nursing home residents and staff who have a permanent address outside of the county.
That means that the majority of positive cases in Montgomery County fall outside of those facilities, and those numbers need to decrease in order to move forward, Arkoosh said.
Using the community testing site in Whitpain Township as a sample, Arkoosh said they are testing about 250 people per day, and the rate of positives has held steady at 14-15% over the last 12 days.
“That’s good,” said Arkoosh. “It’s not going up, but we would love to see that number come down more. We’re going to have to move forward with living with this virus.”
Planning to Move Forward
With the understanding that it will be at least several more weeks until the county moves towards the “yellow phase,” Arkoosh said that residents and business owners need to begin planning for a life of living with the threat of the coronavirus.
“Some businesses are going to have to be very thoughtful about how they reopen,” Arkoosh said. “Other places may be pretty straightforward. There’s going to be places where it proves difficult to maintain social distancing, and businesses like those have to be very thoughtful about what they’re doing.”
Arkoosh is urging business owners to use this time to plan accordingly, and to begin to detail the steps they will need to take to continue limiting the spread of the virus. Those steps will have to include the continuation of social distancing and masking, testing for employees and quarantining those who test positive, working from home whenever possible and following a strict schedule to avoid people from grouping up.
“We anticipate that when we relax restrictions, we are going to see a bump up in positive individuals again,” Arkoosh said. “The key is going to ensure that the increase is small enough that we don’t overwhelm our systems and have to go back to a more restrictive state.”
At the county level, Arkoosh said they are working towards a model that involves rapid, widespread testing and robust contact tracing. Though the testing side is a matter of supplies and personnel, the idea of digital contact tracing side is one that many residents may not initially sign on to.
“From what I have seen, many Americans—at least right now—are unwilling to allow digital contact tracing due to worries about privacy,” Arkoosh said. “This is going to be one of those issues where we have to decide as a community whether or not each of us is willing to give up a little privacy in order to get this virus more quickly under control. I’m not sure where our community is going to come out on that [issue] right now.”
With contact tracing in place, officials would establish an arbitrary period—roughly 48 hours before an individual tested positive—and then contact people with whom the positive individual had contact with to be informed to go into quarantine.
“This is just where we are at,” said Arkoosh. “We’re never going to get a handle on this unless we conduct extensive contact tracing as other countries have done.”
As numbers continue to decrease, the county would then move to the green phase. Sans a vaccine, however, it will not be a return to the usual way of life.
The New Normal
“In the absence of a vaccine, we are not going to stop the virus,” Arkoosh said. “So, we need to learn how to live with the virus.”
As much as residents want to go back to the way things were, social distancing, masking and associated mitigation efforts will remain in place for the foreseeable future, so long as the virus continues to pose a threat. And if the virus surges back, or a second or third wave presents, restrictions may be put back into place to protect the healthcare system and save lives.
“Think about it. Extending a hand is so reflexive for us to respond to that, but we can’t do that anymore,” said Arkoosh. “We can’t hug that dear friend that we haven’t seen in eight weeks. People will have to take very-strong personal responsibility for their actions.”
This new normal, even in the green phase, will continue to involve testing, contact tracing, avoiding contact and monitoring case growth. Arkoosh said that even as all businesses are cleared to reopen, they will be doing so in an environment where COVID-19 can spread, and measures will constantly have to be undertaken in order to restrict that spread.
“It’s extremely important that we all behave with that understanding,” said Arkoosh. “If we do not, then so many people will become positive, and some percentage of them will become ill. They’re going to end up in the hospital, which could be overwhelming to our [healthcare system], our first responders and we end up right back where we are.”
Arkoosh added that in this new normal, each person will have to take personal responsibility for themselves and their community.
“One person can’t solve this by themselves, but one person can really screw this up,” said Arkoosh. “One person can have a hugely negative impact on this, so everybody has to take personal responsibility.”
See also:
Gwynedd Square Nursing Center Confirms Multiple Coronavirus Cases, Deaths Among Residents
More Than Half Of Residents At ManorCare Montgomeryville Test Positive For Coronavirus
From The Frontlines: Interview With Volunteer Medical Service Corps Chief Of Operations
Local Nurse Who Lived In Tent To Protect Family Tests Positive For Coronavirus
First Responders Show Support For Healthcare Workers At Lansdale Hospital: Photos
