Why Centre County’s COVID-19 case numbers are down, for now — but concern shouldn’t be
Penn State’s COVID-19 case numbers may be slowing and Centre County’s testing positivity rate may be decreasing — but, according to a lead investigator of one COVID-19 forecasting model, coronavirus concerns are still only mounting in central Pennsylvania.
At issue is the troubling nature of Centre County’s increased hospitalizations, according to Dr. David Rubin, director of PolicyLab at the Children’s Hospital of Philadelphia. Rubin said that indicates greater transmission among the non-student community, and it could be an early sign that the hospital might face future capacity problems.
“This is not the moment with the winter coming to declare an end to this,” Rubin told the CDT on Thursday. “Right now, we’re going back into the belly of the beast. We’re going back into the middle of this.”
According to data provided by Mount Nittany Health, the medical center experienced just four COVID-19 hospitalizations between Sept. 1-18. This week alone, 17 patients were hospitalized — with 11 simultaneously hospitalized Friday between the ages of 52 and 92.
The hospital also implemented its Surge Capacity Plan last week, which calls for the rescheduling of elective procedures and surgeries that require overnight admission — a move that was labeled a warning sign Thursday by Rubin and in an interview last month by Amesh Adalja, an infectious-diseases expert from Johns Hopkins.
“Pennsylvania is rapidly devolving, moving very much in the direction of Michigan and Ohio, and Illinois and Wisconsin — and we may just be a few weeks behind,” Rubin said. “And you guys are already at surge capacity. So I don’t want to understate it: It’s a really concerning concept.”
What is at risk?
If Mount Nittany should become overwhelmed as temperatures drop and cases are expected to again increase, patients would be diverted to other hospitals and there would be delays in treatment as with most hospitals, Rubin said.
But that concern is hardly unique to Happy Valley.
Houston hospitals were forced to weather an identical issue over the summer. One public hospital ran out of a medication to treat COVID-19 patients, ambulances diverted patients elsewhere, hospitals put beds in hallways, and officials doubled-up rooms. Fatalities rose.
That’s far from an inevitability in Centre County, but it’s the worst-case scenario that Rubin, along with other experts and officials, are hoping to avoid.
“If this thing accelerates, I can’t tell you how quickly it would happen,” Rubin said, referring to how quickly Mount Nittany might be overwhelmed. “You can see this thing will gain a head of steam by the time you recognize it, and this has got a lot of steam behind it.”
For its part, Mount Nittany has worked to be proactive as opposed to reactive, developing a 21-bed specialized COVID-19 unit with the potential to expand. It’s also been transparent in its hospitalizations, now sharing a weekly list of coronavirus updates.
But with just seven currently available ICU beds and 20 available medical/surgical beds, according to the state’s hospital preparedness dashboard, it can only plan so much before size becomes an issue.
“We’ve reached a critical point in COVID activity in our community, and we understand and share in your concern regarding the rising numbers of positive test results we seen in recent weeks,” Dr. Nirmal Joshi, Mount Nittany Health’s chief medical officer, said in a written statement Friday.
“Community members can be assured that at Mount Nittany Health, we continue to carefully observe activity both in the community and within the Medical Center.”
Why are some numbers up, some down?
Glance at a few numbers on paper, and it might appear as if everything is moving in a positive direction. The testing positivity rate is down, student infections are decreasing, and the incidence rate is slowing.
But those changes were previously predicted and will likely be only temporary, Rubin said.
Rubin told the Centre Daily Times three weeks ago, when the positivity stood at 9.3%, that he expected Penn State’s cases to tail off because the highest-risk students had already gotten COVID-19. (It’s a pattern that’s followed many other universities.) He also expected the number to rise again as temperatures drop, because studies — such as the one Rubin published in the Journal of the American Medical Association — suggest the two are interlinked.
In other words, it’s premature to start celebrating. Hospitalizations are increasing, as are the percentage of emergency room visits pertaining to COVID-19 — up to 2% this week from 1.7% last week —and Rubin had a brief explanation to why all the numbers aren’t just rising or declining at once.
“You’re seeing a shift in the age distribution of your data,” Rubin explained. “Your case incidence is really high, but who’s being affected has changed. So 90% of your cases back in September may have been students, but now it’s more equally distributed across age. It’s widespread throughout the community.
“So, yeah, your positivity rate came down to reflect that wider transmission rate in the community because the surge of the opening of the college is over. But now you’ve got a wider age distribution, so you’re having increasing hospitalizations because you have more older folks represented in your data.”
In other words, infections outside of Penn State and State College are on the rise. Bellefonte and Pleasant Gap had 66 confirmed infections Aug. 16, before Penn State students’ official move-in. So far this month, there’s been 43 confirmed infections in the 16823 ZIP code.
What should Centre County do?
Whatever it does, it won’t be able to prevent the growth of COVID-19 over winter.
“But if you can suppress it enough that you can maintain your hospital capacity, well, then that’s what you’re trying to do this winter,” Rubin said. “The problem is that many areas of this country are not suppressing it or are really not effectively suppressing it. They don’t have, at this point, the political will to make the changes that need to be made.”
Penn State has already taken a step forward in its enforcement, a move praised by Rubin, after an agreement with the State College borough that allows university police to enforce an ordinance that issues $300 fines to those wearing no masks or gathering in groups larger than 10 indoors and 25 outdoors. Rubin also mentioned implementing additional precautions at restaurants and bars, further disciplining those who hold large gatherings and issuing mask mandates as other options.
State College borough — along with Ferguson, Patton and College townships — have already passed mask mandates. Bellefonte remains the largest borough holdout in the county.
“To me, you have a lot more capability in Centre County if you’re an individual resident, to protect yourselves and your family,” Rubin said. “It’s a lot more spread out; it’s not a concentrated city. So your ability to kind of space out and keep gatherings small, to do the kinds of things that could allow a lot of the more rural areas to kind of do fine.
“But if I’m Bellefonte and I’m doing no masking during the middle of winter with Penn State down the road, that’s just craziness to me.”
In the meantime, experts said: Wear a mask. Wash hands. Social distance. That’s something Mount Nittany’s Joshi also emphasizes every chance he gets.
“We can help to keep ourselves and one another safe,” he wrote, “but we must work together.”
This story was originally published October 17, 2020 at 4:54 PM.
