As we now face the second wave of COVID-19 in Philadelphia, it’s worth asking: How did we do in the first round?
The answer depends on where you stand. But the past year tells us that Philadelphia has to take the city’s “Safer at Home” policies seriously, or we will suffer tragic, preventable losses — just before the vaccine is available to all of us.
Since March, we have lost more than 2,127 Philadelphians to COVID-19, with particularly high death rates in African American communities. Almost a quarter of the city’s deaths have occurred among African American residents between the ages of 55 and 74. These losses are compounded by shuttered businesses, unemployment, family illnesses, and interrupted schooling.
Philadelphia also succeeded by some metrics, all of which feel perverse in light of the pandemic’s terrible toll. In New York City, which delayed its spring shutdown, more than 24,000 residents have died from COVID-19. If we had experienced death rates like those in the Bronx, we would have lost 5,535 Philadelphians already. That means over 3,400 of our city’s residents are still alive today who could have been lost to COVID-19, had Philadelphia not taken early, strong precautions.
Importantly, Philadelphia’s health-care system was not overrun this spring. Hospital beds and ventilators were available to those who needed them. In our own health system, the rate of health care worker infections was low and did not compromise our ability to provide clinical services.
But in this current wave, Gov. Tom Wolf is warning that we may not be so fortunate. Caseloads are far higher than they were in the spring and still rising fast. The medical care Americans have come to expect may not be available to you or your loved ones, if the current trajectory persists and hospitals continue to fill.
So how should we tackle this next wave?
We can start with what got us through the first one: sacrifice. Our health system’s prevention efforts and preparations were staggering, and sometimes invisible to the public. We “stood up” auxiliary intensive care units, response teams for unmet needs like housing and food, community testing sites, communication teams, patient monitoring programs, tools like chatbots to answer patient questions and identify emergent health concerns, and engineering teams to create personal protective equipment because it was in such short supply. Health-care workers prepared to radically shift toward both telemedicine and critical care, assuming that our ranks would be taxed by high patient volumes and depleted by hospital-acquired infections. Labs across the university pivoted to study SARS-CoV-2, racing to fill vaccine and treatment voids. We staffed contact tracing teams and built digital tools to support them. And in solidarity, Philadelphians stayed home.
These efforts likely saved lives.
We should maintain that same vigor and determination we applied in the spring. But we fear the drag of “COVID fatigue” has delayed and diluted the current policy response, as well as public commitment to prevention. Philadelphia’s modified Stay at Home order, which began on Nov. 20, feels more like business as usual than a “lockdown.” And frankly, that terrifies those of us in public health who see how high COVID-19 rates are in our community. When we were ordered to retreat to our homes in mid-March, we averaged just over 100 confirmed cases per day in the city. Now we’re averaging over 1,000 cases per day, and the current closures are less stringent than the first time around.
As public health experts, we’re concerned that our city’s decent management of the first wave — with a heavy toll that could have been far worse — is working against us. In prevention, success is deceptive. Nobody can identify the 3,400 “extra” Philadelphians who were alive to celebrate Thanksgiving this year, in contrast to the identifiable patient whose life was saved by successful cancer treatment. When we do our public health jobs right, it looks like not much really happened.
In this holiday season, we are determined to be cautious and not risk infecting others — and we hope all of Philly will do their part too, as we’ve done before. We also hope to see stronger messaging from city and state officials, sounding the alarm and waking our city up to this rapidly escalating emergency. We need to make those case numbers and hospitalizations visible, so that we telegraph the urgency of both public and personal action. We should be home, leaving only for essential work or medical needs. Our roads should be empty, and our city quiet, as it was in the spring.
These changes are temporary but critical. These public health measures may feel like overkill, or like an unwelcome disruption to your plans. But we need you to help beat Philadelphia’s next COVID-19 wave. The life you save may be your own.
Carolyn Cannuscio is associate professor of family medicine and community health at the Perelman School of Medicine, Rachel Feuerstein-Simon leads contact tracing at Penn Medicine and the Center for Public Health Initiatives, and Kevin Volpp is the founders presidential distinguished professor at the Perelman School of Medicine and Wharton School.