Gov. Tom Wolf and other top officials again pleaded with the public to stay home during a Monday news conference, citing Pennsylvania's surging coronavirus infections and crowded hospitals.
“There are fewer resources to go around for the sickest Pennsyvlanians, whatever the sickness that you’re suffering. Already we’re hearing stories of hospitals forced to divert patients to other treatment facilities because of full emergency rooms and overwhelming needs,” said Wolf.
On a weekly, sometimes daily basis, the governor has issued variations of this dire warning since March, begging Pennsylvanians to think not just of themselves but of their neighbors. And while the tone of his press briefings has grown increasingly foreboding, the governor has yet to order another shutdown like was seen in the spring.
Mixed messages
The state's inaction frustrates people like Hope Campbell of Plum Borough, who said a shutdown should have been issued months ago, well before the state began reporting sometimes more than 10,000 new cases a day.
“If you can’t go eat at a table in a restaurant because they’re closed ... that’s going to limit spread if people just can’t go places,” said Campbell, who works as a content manager for a website that covers daytime soap operas.
Campbell knows a shutdown – or stay-at-home order – wouldn’t completely stop the virus’s spread. But she believes it would help, especially as hospitals might soon need to start rationing care.
“You’re still doing nothing but asking people to do the right thing? If you see that’s it going to get more out of control, do something about it,” she said.
One reason some government officials give for not taking more aggressive action is they say contact tracing indicates that the virus mostly spreads in private settings – therefore closing public spaces seems ineffective.
“Parties breakout on the weekend or after work. People know what to do, but sometimes let their guard down,” Allegheny County Executive Rich Fitzgerald recently told WESA’s The Confluence.
Fitzgerald noted some private gatherings brazenly flout public health recommendations. For example, parents at the Plum Borough School District recently organized an unauthorized homecoming dance, which was held in neighboring Westmoreland County at Five Pines Barn, a popular wedding venue.
“It’s disappointing that these irresponsible parents, they snuck across county lines, took 150 people with them, and now they’re basically covering up what they’ve done,” said Fitzgerald, referring to the fact that the dance’s organizers initially refused to share the invite list with contact tracers. They eventually turned over the list, and at least two cases of COVID-19 were subsequently identified.
But if there was a shutdown, Five Pines Barn wouldn't have been able to host the dance in the first place. The same can be said for bars and restaurants: public health officials plead with people to avoid socializing indoors, yet these venues remain open.
Targeted efforts with incomplete data
While it may have been true at one point that most transmission was occurring in private settings, it’s hard to know if this still holds. The explosive growth of infections has made contact tracing and case investigation increasingly difficult, as has a reluctance by members of the public to participate in this vital public health intervention. As a result the data on the virus’s spread are less robust.
But even if transmission during private gatherings continues to be the main mode of spread, some still argue in favor of closing non-essential public spaces.
“Enough of those people then go to the casinos and the bars and restaurants, and then those people spread it, and then go to other small gatherings,” said University of Pittsburgh social epidemiologist Christina Mair.
It remains unlikely that the governor will enact a shutdown. On Monday he called it “a blunt instrument” that was used back in the spring when less was known about the virus.
“We didn’t know what we needed to do to treat it, and we were not even clear about things as fundamental as masking,” said Wolf. “We know a lot more about the virus, and the vaccine is on the horizon.”
Wolf says his administration is using a more targeted approach towards mitigation, which include capacity limits on gatherings and requiring venues to serve food alongside alcohol.
But as a walk down Carson Street in the South Side or Butler Street in Lawrenceville shows, many people seem unconcerned by their risk of coronavirus exposure at bars and restaurants.
Now, as roughly 100 or more Pennsyvlanians die from COVID-19 everyday, the state’s medical system is careening towards disaster, state officials say.
“We need to close what we can close. Control what we can control,” said Mair, who argues that allowing society to function like normal sends the message that everything is OK when it’s not, thus encouraging dangerous behaviors.
Public health Catch-22
Public health officials often cite the economic harms when asked why they haven’t issued another stay-at-home order.
“Closing business now comes with more pain than in March. Gone is the financial assistance and extra unemployment to laid off workers,” said Dr. Debra Bogen, director of Allegheny County’s Health Department, at a press conference last week.
Also, the federal moratorium on evictions expires at the end of December, though some are occurring already.
Housing and food security issues are also public health issues which disproportionately affect people of color, already more likely to become severely ill or die from COVID-19.
Another public health risk of a shutdown is that closing the places where people can more safely socialize might actually increase the virus’s spread.
“You're not going to be nailing people into their houses,” said Dr. Amesh Adalja, an infectious disease physician at Johns Hopkins University Center for Health Security. “I think of stay-at-home orders as an abstinence-only approach. We know that's going to have ancillary consequences on people's behavior that are going to then not be so visible to public health.”
Just like abstinence-only sex education or the war on drugs, people still engage in prohibited activities but often at greater risk. When these behaviors are more public, it allows government and health care workers to intercede and offer safer alternatives.
Examples of COVID-19 harm reduction include wearing a mask while shopping, visiting with friends outside, and only permitting outdoor seating at bars and restaurants – Pennsylvania has not taken this last action.
But harm reduction with the coronavirus is difficult, due in part to a lack of tests. Adalja said finding out if you have the virus should be as easy as taking an at-home pregnancy test.
“To me, the original sin of this pandemic is the fact that we cannot test people as frequently as we need to and people cannot know their status,” he said. “We simply can’t answer this basic question of who is infected and who is not 11 months into this.”
Such abundant accessibility to testing would also make it easier to keep the economy open while mitigating the risk of spreading COVID-19.
Wolf's (limited) political reach
Enforcement of a shutdown order would largely be up to local officials, and in some corners of the state there is little appetite for that.
“When departments only have one officer on duty during daylight shift, we don’t have the resources,” said Beaver County’s District Attorney David Lozier.
During the spring shutdown Lozier directed police departments under his jurisdiction not to enforce the governor’s forced closure of non-essential businesses, saying whether a business qualifies as essential is a constitutional question.
“You can have 500 people in a Wal-Mart, but you couldn't have five people in a small Hallmark shop selling the same things,” he said. “[Prosecutors are] supposed to only enforce laws that are predictable, that are well- defined, and that can be equally applied across the population.”
But Wolf’s former press secretary, J.J. Abbott, said politics are at play, as well.
“We’ve seen that localities across the board, particularly run by Republicans, have resisted those efforts [to mitigate viral spread,]” said Abbott, who left the administration in March and now runs a progressive communications firm. “We’ve dealt with over the last seven, eight months is a tremendous misinformation and disinformation campaign, particularly driven by the president.”
Getting local officials to convince constituents of the pandemic’s seriousness is difficult if they doubt it themselves, or oppose Wolf's mitigation efforts on philosophical grounds – believing that mask mandates or restrictions on businesses amount to government overreach.
Despite the political risk, toward the end of his Monday press conference Wolf hinted at the possibility of additional restrictions.
“We’ll be continuing to look at this, and may have something to share with you in the coming days,” he said.
Some mitigation measures do remain in place, such as limits on crowd sizes, the requirement that restaurants serve food with alcohol and the universal masking mandate. But largely, it appears that public officials will stay their current course of action – which is to beg people to stay home, scold members of the public who don’t comply, and wait for a vaccine.
