The COVID-19 pandemic is not over. Daily cases are reaching or exceeding springtime numbers, and every indication tells us that the current phase will be worse than the first wave last spring. As cases began to rise in this region over the past month, our hospitals at first saw very small increases in their COVID-19 census. Patients in the hospital were younger at first and were getting well and going home quickly. The trend changed quickly: The average age of patients admitted to Penn Medicine hospitals is now greater than 60. The number of patients arriving is growing each day, as are those who need to go to the intensive care unit — a week ago 10% of our COVID patients were in the ICU; now it’s 25% of them. These beds are at a premium, and some hospitals in the area have had to divert patients coming to them by ambulance to avoid overcrowding.
We are at a crucial inflection point where civic leaders and individual members of the public need to take immediate action to reverse this course.
Since the pandemic hit, we have learned much about the disease and the best ways to treat it, so deaths are less frequent. But the lower mortality rate has tricked many members of the public into believing that the serious hazards of the pandemic may be passed. That is fool’s gold. Serious consequences of COVID remain prevalent, including long-term disability — across the nation and in our health system, doctors have had to develop specialized COVID recovery clinics to monitor and manage persistent symptoms that stretch on long after patients leave the hospital. And we know enough now about this disease to know the statistics are portentous: Even if the death rates remain low, higher numbers of deaths will surely follow as we see greater numbers of cases.
Twenty- to 29-year-olds are now the most commonly affected age group, and there has been a remarkable upsurge in cases among 10- to 19-year-olds. In part, that explains the lower mortality we’ve seen in this phase. The shift in age from the first wave of the pandemic, when infections were more prevalent in older age groups and settings such as nursing homes, is perhaps a measure of the fragmentation of our nation over the pandemic. Today, it’s sports events and social gatherings small and large that have driven infections. After months of isolation, our guard has come down, replaced by our innate yearnings to gather.
Anecdotal and contact tracing evidence reveals that weddings, funerals, Halloween parties, and athletic activities have all been implicated in the spread of the virus. And most ominously, many of those affected do not know where they might have been exposed.
Our communities in Pennsylvania performed very well in the spring lockdown by adhering to the layered set of personal safety activities that brought the first wave under control. Let’s be clear: no one is eager for another round of lockdowns. Society has tired of the constraints, and government leaders seem to have lost the stamina to implement the restrictions necessary to keep the virus in check. The early mysteries of the virus are gone, and that’s a blessing: by now, we know how to control the virus, but we don’t do it as often anymore or with as much discipline.
Schools have thoughtfully implemented robust screening, masking, and social disciplines that have, to date, kept them from becoming major drivers of the pandemic. Yet, the first reaction as the second wave takes hold seems to be to return to all-virtual education even before taking action in the broader community, with schools left to their own devices to decide when they should dial down in-person instruction. Civic leadership is trying to thread the needle between keeping essential services and the economy open and tamping down the pandemic. The balance has shifted disproportionately to the economy — to the distress of schools, and at the expense of the public’s health.
There are no easy answers, but this much is clear: We will not have an economic recovery and be able to return our lives to some semblance of normalcy until the pandemic is controlled. This week’s news about the promising early results of the Pfizer COVID vaccine candidate has buoyed hopes, but it will take many more months before we have enough vaccine to administer it widely in the community. It may be a year or more before we can take down our safeguards.
As we await the results of further vaccine trials and the delivery of the products, our civic leadership must not flinch from the responsibility to take charge again. Leaders must clearly articulate the facts about the necessity of additional measures to protect our communities and the success of public health measures. This will require more than admonitions and recommendations. It will require mandates for masking and the curtailment of nonessential services, social activities, and indoor gatherings. The pursuit of public health must unite us all.
PJ Brennan, MD, is an infectious disease physician and chief medical officer of the University of Pennsylvania Health System.