So this is what consequences look like: Delaware County, population 560,000, now has the Philadelphia region’s highest 14-day rate of COVID-19 cases nine weeks into a painful lockdown and its economy may remain in limbo because of this, even as numbers are easing elsewhere.

This is what you get after decades of Republican rule that resisted calls to create a health department.

This is the black-and-white portrait of wreckage created by years of ideological myopia: A half million Pennsylvanians in possibly the most populous county in the United States with no health department now unable to rescue themselves from a mess in the making for generations.

You hate to write about these I-told-you-so moments. But here we are. And it is terrible, any way you cut it.

When I first warned about this prospect in a March 11 column, the worry was mostly hypothetical: How would such a densely and highly populated county under fairly new Democratic control wrestle the emerging pandemic without a health department?

Fair Acres Geriatric Center, a 600-plus-bed, 24-hour full-care facility, owned by Delaware County is shown on May 6, 2020. Signs in the windows offer encouragement - Fair Acres Strong and We Love You.
CHARLES FOX / Staff Photographer
Fair Acres Geriatric Center, a 600-plus-bed, 24-hour full-care facility, owned by Delaware County is shown on May 6, 2020. Signs in the windows offer encouragement - Fair Acres Strong and We Love You.

Everywhere else in Southeastern Pennsylvania — Philadelphia, Chester, Montgomery, and Bucks Counties — there were health departments with boots on the ground working to contain the monster that would soon lead to stay-home orders across the country.

Now we have our answer: Not well at all.

Nursing homes, we learned through the first-ever release of institution-specific numbers Tuesday by the Pennsylvania Department of Health, have been a locus of devastation across the suburbs. But in Delaware County some facilities reported downright terrifying numbers.

As many as 40 people died of the novel coronavirus at a single long-term care complex in Broomall. At county-owned Fair Acres in Middletown, 29 have died.

While the numbers were not super in the other suburban counties, at least they had health departments. Those agencies can run year-round efforts to address infection control in schools, hospitals, and other institutions.

In Delaware County, what we have seen instead is a pandemic that remains unwieldy even three months after the initial phase.

Just consider how differently things have gone in neighboring Bucks County, which has an 85-person-strong health department in place. They, too, are struggling with high numbers of cases and deaths in long-term care facilities. This is uniformly the case across the region. But they have a handle on things.

“We have staff in place who do case contact [investigations] for all kinds of diseases — 70 reportable diseases, whether it’s salmonella or any other foodborne illness, or an outbreak of MRSA, whooping cough, chicken pox,” Bucks County physician and head of the department David Damsker told me Tuesday. He’s led the office for 12 years.

“We have staff. We have relationships in Bucks County with all of the schools already,” Damsker continued. Also, there’s the “Bucks County Health Improvement Partnership, a consortium of all six hospitals in Bucks, all the CEOs, plus some community members, plus me. We meet six times a year. ... We were able to jump on this pretty early.”

The only way to rein things in at this point in a place like Delco, he surmised, is to have people working furiously to identify where infections are and work to contain them. Bucks has had such a team from Day One and is building it out even more, he said.

Bucks County Chief Operating Officer Margie McKevitt, left, and Bucks County Health Department Director Dr. David Damsker divide temporal artery thermometers for distribution following a news briefing on March 14, 2020 about the coronavirus.
CHARLES FOX / Staff Photographer
Bucks County Chief Operating Officer Margie McKevitt, left, and Bucks County Health Department Director Dr. David Damsker divide temporal artery thermometers for distribution following a news briefing on March 14, 2020 about the coronavirus.

The Chester County Department of Health in recent weeks became deputized as Delco’s de facto health department after efforts brokered by the Wolf administration and prodding from Delaware County. But officials in that office did not respond to my or my Inquirer news colleagues’ requests this week for interviews.

“You need to do a case investigation on every case and know where these cases are coming from,” Damsker said. “If you’re just counting cases, you don’t know where to focus.”

In the earliest stages of the outbreak in March, Delco was at the mercy of the state Health Department, which was responding to suspected COVID cases in the county with staff at offices two hours west in Harrisburg. For weeks, the state was withholding from local officials even information as basic as the municipalities where new cases were being found.

"Delaware County started behind the 8-ball to begin with,” said State Sen. Tim Kearney, who won Republican Tom McGarrigle’s Swarthmore seat in 2018 in an electoral wave that culminated in flipping control of county government to Democrats in November 2019.

Even Montgomery County next door, with a massive health department of its own, garnered early resources that Delco is still struggling to get. Namely: a federally funded testing site.

Medical workers perform a coronavirus test on drivers at the Temple University Ambler campus in Ambler, Pennsylvania on Saturday, March 21, 2020.
YONG KIM / Staff Photographer
Medical workers perform a coronavirus test on drivers at the Temple University Ambler campus in Ambler, Pennsylvania on Saturday, March 21, 2020.

“Montgomery County has more people in long-term care facilities than we do," Kearney said of the region’s first COVID hot spot, "but they also had a county plan to deal with it.”

Because it was first out the gate, Montco got a federal testing site early on. Far more densely populated and impoverished Delco continues to toil without one even though officials say they’ve been requesting one for weeks.

The time has come to urgently demand resources from the state and federal government. It is time also for detailed public updates from the proxy Chester County officials now in charge of cleaning up this mess.

Send tests and PPE and bodies and expertise and money. Because it is time to fix what others broke.