Where does Centre County stand in the fight against COVID-19? Clarity could come soon, expert says
Centre County has reached a turning point in its fight against the COVID-19 pandemic — and, according to one medical expert, clarity could soon be on the way.
It’s just unknown at this point whether that will yield good news or bad.
Dr. David Rubin, the director of PolicyLab at the Children’s Hospital of Philadelphia, updated the Centre Daily Times on the county’s status Thursday and offered a “bellwether” date of Oct. 1. At that point, he said, the picture should be clearer: If cases and testing positivity rates start going down at that point, and hospitalizations haven’t yet started climbing, data suggests the county could still contain the virus. But if they are increasing? An overwhelmed local hospital and an impossible-to-ignore situation seem a lot more likely.
“You’re still kind of in the middle of this,” said Rubin, who’s consulted with the state Department of Health. “So, to me, I don’t anticipate us having a clearer picture where Centre County is going until the end of this month.”
The stakes are high. According to the state DOH, Centre County already has the commonwealth’s highest incidence rate with 322.5 infections per 100,000 residents over the last week — in addition to the state’s highest positivity rate of 12.1%. If those upward trends continue, Rubin said, the county’s lone hospital could eventually be overwhelmed, meaning patients might be referred to out-of-county care and/or emergency medical situations might not receive the care they normally would.
But, at this point, Centre County’s future remains in limbo.
Penn State officials have tried to downplay concerns, with both university President Eric Barron and Provost Nick Jones telling faculty earlier this week that positive cases alone shouldn’t create a panic. “Those numbers aren’t the key,” Barron added, explaining the most important metrics are hospital capacity, community transmission, and quarantine and isolation spaces.
“So far, so good,” Jones said Tuesday. “We’re in Week 4.”
Rubin wasn’t quite as optimistic with the county’s 1,241 new COVID-19 cases so far this month, most of which came from Penn State students.
“They don’t want people to panic, I guess,” Rubin said, referring to the university’s messaging. “They have a public role to kind of not scare people as well but, at the same time, there is a calculus to this in terms of understanding what’s going on and how to contain things.”
What is and isn’t the problem?
Positive cases among students technically aren’t the biggest causes for concern, experts said, because the younger population can better weather the virus. But those cases do influence the more critical factors of hospital capacity and community transmission.
Experts said most college towns typically follow the same order: 1. College students get infected, 2. Infections spread to the community, 3. Hospitals see more patients from infected community members.
And preventing community transmission, a key to the county’s COVID-19 picture, is exceedingly difficult.
“I can control my campus and I can put measures in campus that mean there’s a very low chance of spreading the virus on campus — but I cannot control what’s happening in the community,” said Dr. Ali Mokdar, the chief strategy officer of population health for Washington’s Institute for Health Metrics and Evaluation. “So these students are going back to their community and their fraternity house and going back to the store and, if the circulation of the virus is very high in my community, it doesn’t matter — you can quote me — it doesn’t matter what I do on campus.
“It doesn’t matter what a wonderful plan I have for campus because they’re going to get the infection outside and come to campus. So that’s my concern with universities.”
The biggest question at this point appears to be just how high community transmission might be. Because the state DOH does not differentiate students from non-students and because it does not track age groups by ZIP code or county, there’s no fool-proof way to measure student-to-resident transmission, especially in State College.
Penn State officials say it’s minimal at this point, and not without reason. Overall cases in nearby ZIP codes haven’t sky-rocketed at the same rate of the university although, in some areas, there has been an uptick: the Bellefonte and Pleasant Gap area has seen 15 new confirmed cases this month, Boalsburg has experienced 10 and Howard six. (Those areas had five, one and three new cases, respectively, during the previous 19-day period.) Rubin believed the transmission wasn’t yet catastrophic but also declined to label it as minimal.
“I think there was some evidence of some community spread the last couple weeks,” Rubin added. “I’m not saying it can’t be contained by the public health response in those communities and people who are now sheltering who got sick, but there was clearly an increase in testing positivity. You have to expect that; it’s not like there’s an impenetrable wall with the virus.”
Preventing further community transmission
To prevent an overwhelmed Mount Nittany Medical Center, community transmission must first be prevented, experts said. It’s as simple and as difficult as that.
“It’s not that it can’t be done,” said Dr. Amesh Adalja, an infectious-diseases specialist at Johns Hopkins. “But it requires aggressive vigilance.”
According to Adalja, that means an emphasis on quarantine and isolation, testing and contact tracing. And all three have had their own unique set of challenges or confusions at Penn State.
Take contact tracing, for example. Sophomore Grace Cunningham wrote in Onward State, an online student publication, that it took the university six days to contact her after she tested positive for COVID-19. The university pushed back in an email to the CDT, saying it actually contacted her Sept. 5 and she did not answer.
Still, it’s unknown how many other students didn’t answer an unrecognized phone number and went days without contact tracing.
“As you can imagine, the logistics of putting into place and operating monitoring, testing, contact tracing and mitigation plans is large and complex,” a university spokesperson wrote. “... We appreciate knowing of these experiences, as they help us continue to improve. The health and safety of our students, faculty and staff and community is of primary importance.”
Students have posted in message boards about long waits on the COVID-19 hotline, which the university recently sought volunteers for. There’s some confusion about where to receive test results, and off-campus landlords have also decried the lack of communication from the university.
Still, there have been signs of progress, both countywide and universitywide. Local officials have had a number of meetings with the state Department of Health this past week, and the state DOH announced Friday that a free, temporary testing site will be utilized at the Nittany Mall starting this coming Friday. Up to 500 registered patients can be tested per day.
The university has also now made its contact-tracing forms available online, so students can choose to initiate the process. Rob Schmidt, executive director of the Downtown State College Improvement District, said the university will soon meet with landlords to directly address issues. Barron outlined several “off-ramp” scenarios (e.g. quarantining a residence hall). And Secretary of Health Dr. Rachel Levine hinted that more state help could be on the way.
“I have directed my staff to assist Centre County in identifying localized containment and mitigation efforts to reduce the spread and facilitate communications between large employers, county officials and local governments,” Levine said in a written statement.
The goal in all those efforts is to reduce community transmission so the hospital is not overwhelmed. Rubin said hospitalizations typically lag about three weeks behind spikes of the coronavirus, while Mokdar said college towns can see lags in excess of six weeks because of the younger population.
So far this month, according to a spokesperson, Mount Nittany has seen four COVID-positive patients admitted.
“We have been extremely fortunate so far that the rapid rise in cases locally has not translated to growth of hospitalizations,” said Dr. Nirmal Joshi, chief medical officer of Mount Nittany Health. “However, this can change very quickly. We are gathering information and monitoring local trends daily.
“The overall growth in cases is cause for significant concern. As a community, we must absolutely work to keep our numbers from continuing to grow at this rate.”
Where the county goes from here
Both Rubin and Barron have said sending the students home is not an option — even, Rubin added, if Mount Nittany Medical Center does become overwhelmed.
It’s a sentiment that is widely shared by public health officials, including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Sending students home early could lead to student-sparked outbreaks across the state, region and potentially the country, they said.
“I think you broke it, you own it,” Rubin said. “I agree with them on that.”
As it stands, students will head home after class Nov. 20. Penn State would like to test all students prior to their departure, based on a Sept. 9 report from Zachary McKay, the president of the University Park Undergraduate Association.
But, for now, the advice this week mirrors last week’s — and will likely be the same from here on out: Be careful. Wear a mask. Wash your hands. Social distance.
Mokdar recommended all residents who venture outside simply behave by assuming they’re infected. Joshi emphasized every effort today will impact tomorrow’s spread. And Rubin, who enjoys fishing in Happy Valley, offered even more specifics.
“I’d be ordering out,” he said. “I’d be keeping my gatherings small. This is what I mean by ‘contain.’ You’re not just a defenseless victim there in Centre County, as it blows up with these students, right? You do have a response, which is to limit the number of times you go to the grocery store the next couple weeks, eat out a little bit more and support restaurants by getting takeout.
“I would be avoiding crowded locations, even like markets and stuff, because your positivity rate in Centre County is extremely high. So the likelihood people are walking around when you’re in a room of 20 people with COVID is high. Much higher than it was a few weeks ago.”
Rubin voiced his faith in the Penn State administration, “but this virus is pretty efficient when it wants to be.” Residents will have to be careful, especially in areas where masking is not compelled by an ordinance.
And if they’re not?
Then Oct. 1, and beyond, likely won’t bring good news.
