COVID-19, a year later: Our lessons

Mar. 12—A year ago, little was known about how COVID-19 spread, its treatment or even who was at the most risk to die from it.

Tests were scarce, results slow. Shortages of ventilators, masks, gowns and other protective gear were daily concerns.

More than 118.1 million people worldwide have caught COVID-19, including more than 29.1 million in the United States. More than 2.6 million people worldwide, and more than 529,000 in the United States have died.

Pennsylvania reported its first two cases March 6 of last year, one each in Wayne and Delaware counties. Since then, the state has surpassed 955,000 cases and 24,000 deaths, including more than 58,000 cases and more than 1,600 deaths in the northeast region that includes Lackawanna, Luzerne, Monroe, Pike, Susquehanna, Wayne and Wyoming counties.

In a year, medical knowledge grew faster than perhaps ever.

We learned COVID-19 posed its worst threat to the elderly and people with underlying medical conditions that weakened their immune systems. Studies showed well-made cloth masks at least prevented wearers from spreading infection. We also learned to keep our distance — at least 6 feet — from each other, realigning plans for travel, vacations and holidays.

Eventually, tests became so plentiful, you could drive to a mall or drug store and get one within five minutes. The medical world found treatments that worked and by the end of 2020, pharmaceutical companies developed two vaccines faster than anyone thought possible and began distributing them. Today, there are four, three of which are available in the U.S.

Here are some of the lessons learned from COVID-19 over the past year from those making key decisions about the virus.

'Masters of our own destiny'

Gov. Tom Wolf stands by his controversial economic shutdown last spring, and allowing school districts to make their own operational decisions in the fall.

The economic shutdown decision was made based on limited information available about COVID-19 at the time, he said. If he knew more about the virus earlier, he said he might have altered his order to shut down nonessential businesses, and definitely would have tried to acquire more personal protective equipment to curb the spread. He did not elaborate on what he might have changed about his shutdown order.

"But keep in mind, we only shut down for a month or two and a lot of businesses, we didn't shut down at all," Wolf told the newspaper this week. "And we started the reopening process in May ... And we have been reopened since then. Now we still have some controls. And I think that that has made a difference, obviously ... the masking and social distancing, those things have made a difference.

"So I think Pennsylvania has done a pretty good job in in going through this. And the reopening, I think I went as fast in terms of reopening as we could. And that we even had a (business) waiver process to say, if you disagree with closing down in the beginning of this, then there's a place to come and state your case."

Many owners of businesses deemed nonessential criticized his shutdown order and the reopening process; the business waiver program also came under criticism as unfair to smaller or politically unconnected businesses.

Wolf forbid schools from in-person classes last spring, but took a different approach in the fall for the state's 500 school districts. The state set up risk profiles and recommendations for all in-person and all virtual classes and hybrids but allowed districts to decide on instructional plans.

"We were relying on the elected school boards to make the decisions," he said. "I was trying to figure out, again, when I shut the schools down, that that was something that I could do. I don't think I had the ability to actually say you shall be open, to force the teacher to go into the school and force parents to send their children to schools."

Better federal leadership last year would have helped, Wolf said. He credited President Joseph Biden's administration for taking a greater role in rolling out vaccines and agrees with the president's expectation the nation will have enough vaccines for everyone by May.

Wolf said he wants a thorough analysis to avoid a repeat. The world avoided a massive outbreak of the Ebola virus, an even deadlier virus, he said.

"What was different about that?" he asked. "I think science has figured out a fairly quick way to come up with vaccines. We ought to be maybe investing more in that kind of thing. These (viruses) are the things that are going to be disruptive for our economy, for our families, for our social life in the future ... Let's not let this wash over us ever again. Let's be more masters of our own destiny."

Data drove decisions

For a year, Alison Beam played a key but background role in Pennsylvania's COVID-19 response as Gov. Tom Wolf's deputy chief of staff. In January, Wolf nominated Beam to replace Secretary of Health Dr. Rachel Levine after President Joe Biden picked her as his assistant health secretary.

"I think one of the areas that we learned a lot about as the crisis evolved was the duration and the stamina that this crisis would require of us," Beam said. "I think that we all really had to dig deep throughout the last year to find the stamina to stay in crisis response mode for a sustained year, and realizing that there's still response ahead of us."

The state response evolved over the last year, but concern for safety drove decisions, she said. Since gradually reopening after last spring's shutdown, Wolf has taken more measured steps. Over the year-end holidays, he restricted travel and banned indoor seating at restaurants and bars as the virus returned worse than before.

"There's no doubt that the last year has been a pressure-filled year," Beam said. "I truly respect the process that the team went through to allow us to try and strike that right balance at all times of where there was the essential business that could be conducted in a way that really had that right balance ... between sustaining lives and the safety of the workforce. That is a fine line to walk, there is no doubt."

Contact tracing also evolved. Once community spread became so wide in the fall and early winter that tracing the contacts of each case became impossible, tracers focused on protecting the most vulnerable populations and on family and work gatherings that could produce spread, Beam said. From the start, the administration's overarching goal was to prevent virus cases from overwhelming the state's healthcare systems.

Overall, the nation's vaccine rollout went poorly, and some have faulted Wolf for adding senior citizens and people with risky medical conditions to the pool of people eligible for vaccination before the state had enough vaccines.

Beam said the move paralleled the desire to protect elderly populations in nursing homes, but the state could have better communicated its intentions.

"And when you don't have a national strategy, it can get very confusing for folks, as we have different folks prioritize within different states," she said. "But nonetheless, we know it's our responsibility to Pennsylvania to make the best decisions we can, knowing what we know at that time. And if we could communicate to each individual explaining our logic and the justification behind it, I would love to have done that, you know, even more abundantly than I think we did."

Beam said the allocation of Moderna vaccines has plateaued, Pfizer vaccine allocations increase weekly only incrementally and the state does not expect more than the initially 94,000 Johnson & Johnson vaccines for a few weeks.

A fundamental goal of the next few months, she said, will involve keeping people informed of their chances for a vaccination and preparing for rapid vaccination when more vaccines become available.

"When we get that additional supply, (we have to) be prepared to have that put into an arm as quickly as possible," she said.

'How do we protect ourselves?'

On a busy day before COVID-19, Commonwealth Health's Regional Hospital of Scranton and its neighboring Moses Taylor Hospital might have used 150 N95 masks.

The day the first coronavirus patient arrived last March, Moses Taylor alone used 1,500 masks.

"And what it said was people were concerned about where we're going to go, how do we protect ourselves and protect our families," said the hospitals' CEO Michael Brown. Early on, experts shooed Americans away from wearing N95 masks because of short supplies. Eventually, the Centers for Disease Control and Prevention shifted to recommending people wear at least nonmedical masks if only to protect others from the virus. Masks turned into a major political football with millions claiming mandates violated their rights.

Now, the CDC recommends wearing two masks if possible. Pennsylvania's mask mandate for public places remains with no end in sight.

"I would argue that everybody in every community has had the opportunity to be, quote, unquote, smarter about this and have learned lessons about what we could or should do," Brown said. "And I think I would make that argument if I were the governor or I ran a business or in this case, run a hospital, the things we've learned from that will be life lessons for us."

Unimaginable evolutions

Dr. Alison Brodginski remembers hoping for the best when she first heard about the novel coronavirus, and thinking it wouldn't be that bad. "And boy was I wrong," said Brodginski, director of infectious diseases for Geisinger Health System's Northeast Pennsylvania region.

Despite a major federal test glitch early, development of a COVID-19 test came easily. Availability did not. Geisinger actually had one of the few testing labs in the state able to produce results within 24 hours. Most health care providers farmed out testing results to major labs with results taking a week or longer. When testing wasn't widespread, health care providers routinely rejected testing patients with milder symptoms.

Now, testing is plentiful and results sometimes take no more than five minutes. Private entrepreneurs set up drive-thru test sites like the one outside the Viewmont Mall.

"It's evolved in so many different ways that we just couldn't even imagine a couple months ago," Brodginski said.

As they fought the virus, she and other doctors dreamed of a vaccine. Last spring, the medical consensus pointed to having one in a year to 18 months. Instead, Moderna and Pfizer began distribution by the end of 2020. Two weeks ago, a Johnson & Johnson vaccine gained federal approval. Sanofi Pasteur, which has a manufacturing plant in Monroe County, hopes to gain approval of another by the last quarter of this year, according to its website. As slowly as their rollout has gone, Brodginski views the vaccines' mere existence as a small miracle.

"If someone said in March (2020) that nine months later, you'd be sitting there talking about vaccination distribution, I'd say you're out of your mind. I really would," she said. "But it's unbelievable what was accomplished. And I don't want to keep going back to the idea of what could occur... when individuals collectively unite for a common cause, but that's exactly what Operation Warp Speed was."

Trial and error

Early on, doctors watched COVID-19 patients whose conditions improved suddenly end up on ventilators, which often were in short supply. With most viruses resistant to antibiotics, victims usually wait out symptoms and don't bother with doctors.

COVID-19 wasn't just any virus so doctors regularly talked about what might work, one on one, in Zoom and conference calls. They read studies. They experimented. They tried Plaquenil, generically known as hydroxychloroquine, a common treatment for malaria. Anecdotally, some patients said they improved.

"We were basing that on what we could see in a test tube, right? If it seems to slow the virus down in a test tube, maybe that would work great in a patient," said Dr. Stanley Martin, director of infectious diseases for Geisinger Health System. "But unfortunately, we've got decades and decades of medicine studies which have shown us that that's not always the case. And indeed Plaquenil turned out to do nothing to really help actual people."

Eventually, effective therapies emerged. Remdesivir, the first directed antiviral therapy, worked. Then, a United Kingdom study showed steroids, dexamethasone in particular, worked well.

"That was a great sigh of relief because dexamethasone is cheap and plentiful," Martin said. "It's a drug that we use for all sorts of things."

Doctors also learned lying someone face down for periods of time, or proning, could relieve lung pressure. They learned COVID-19 antibodies in blood plasma and monoclonal antibodies could help.

Now they focus on learning how well the available vaccines treat variants of COVID-19 that keep springing up.

"We know that getting vaccinated is going to be critical, even more so in the setting of variants," Martin said. "By helping to reduce the pressure that leads to that kind of evolutionary change in the virus, we've got to have as much immunity as possible in the population. And the only way we're going to do that is through widespread vaccination. ... I worry about the variants and what that's going to look like, say, a year from now."

'We've come a long way'

When the first COVID-19 case arose at St. Mary's Villa in Elmhurst Twp. in mid-April, little was known about what to do.

"We didn't understand the disease or the virus, the state didn't understand the virus, we were getting mixed signals, do this or don't do that," said Nancy Newcomb, president of the nursing home facility. "As far as the way we are now, it's much better understood, the transmission, the expectation of this virus. ... We have much more easily accessible, PPE (personal protective equipment), that we can gather, and we're more educated on it. So we've come a long way."

In the early days of the pandemic, nursing homes had more than half the cases and the majority of COVID-19 deaths. St. Mary's had 26 deaths and 70 cases in guests with 33 staff members getting sick but with no deaths, Newcomb said. Some staffers left for fear of catching COVID-19 or because they had to care for children who couldn't go to school any longer.

Staff learned the right way to isolate virus victims in a COVID-19 unit.

"I think we're better prepared on the transmission and also on the prevention," Newcomb said.

Nursing homes shut down to visitors for long periods.

"It was just sad to see the residents how lonely they were," Newcomb said. "We could only do so much as a staff, you know, when they started getting sick of looking at us. They wanted to see their sons or granddaughters or their daughters. It was very sad."

Even now, St. Mary's only allows by-appointment, supervised family and friend visits requiring masks through a special plexiglass enclosure in its lobby. Most of the staff has been vaccinated and all the guests have, she said. That will stay in place until enough people outside the nursing home are vaccinated.

"Most of our cases transpired between middle of April to around the end of May and then we started seeing a decline gradually," Newcomb said. "We have not seen any for 2021, and I wish I didn't say that out loud."

COVID-19 deaths underreported

Lackawanna County Coroner Tim Rowland spent much of the past year chasing down an accurate COVID-19 death count.

The state Department of Health's procedure of allocating nursing home residents' deaths from the coronavirus to their previous home counties or states skews their Lackawanna County count of 427 deaths, he said. The state needs to change that reporting component, he added.

Someone who lives in a nursing home for at least three years no longer resides in another county or state, Rowland said. On one recent day, he counted 34 more virus deaths in the county than the Department of Health reported.

"The numbers are hugely underreported," Rowland said.

Hospitals fairly faithfully report COVID-19 deaths, but nursing homes remain spottier, he said. Sometimes, families or funeral directors reported a COVID-19 death, but a nursing home's death certificate didn't include it.

Early on in the pandemic, he wanted the state to require nursing homes to report suspected COVID-19 deaths to coroners, an idea state health officials dismissed. Gov. Tom Wolf vetoed a bill in November that would have required reporting any suspected COVID-19 deaths to coroners. The governor said it would slow down reporting, which Rowland vehemently disputes.

For a while, nursing homes voluntarily complied in reporting that to him, but Rowland suspects they've lagged lately.

"So I learned that there's a whole bunch of people out there that really don't... care about getting the numbers right," he said. "So, I worked harder. I did my best job of making sure my numbers are accurate."

'It's coming here'

In February 2020, just before heading off on a Presidents Day weekend trip with his wife, Lackawanna County Chief of Staff Brian Jeffers took a yellow binder from human resources director Justin MacGregor on the continuity of government. "And I said, for why? He goes, 'For coronavirus," Jeffers said. "I said, 'So what about it?' He said, 'it's coming here.' I said, 'The stuff that's in the cruise ships?' And he said, 'Yeah.' "

A month later, Gov. Tom Wolf shut down the state's economy except for essential services and travel.

Over the months, as the economy reopened, county officials distributed stockpiled masks and other personal protective equipment to prison guards, local emergency crews and "tons" of local charities, Jeffers said. After the federal government provided stimulus money, the county gradually distributed a share to ailing businesses.

County officials watched reports of new cases and deaths drop during the summer then surge again in the fall and during the year-end holidays. They watched as vaccines arrived and scurried to take calls for help finding appointments after Wolf expanded vaccination eligibility in January to senior citizens and younger people with risky medical conditions.

Jeffers said he learned exactly how extensive county government is because COVID-19 affected every aspect of it — from the 911 center to the prison to the government center to the courts to the elections office. For example, if transmission among prison staff got bad enough the county would have had to transfer inmates to state prisons temporarily. That never happened, but he learned it could.

The county learned it must expand its information technology unit because of the extensive need for computers, he said. Most importantly, officials learned the county needs its own health department, Jeffers said. The county will roll out plans for one that will include an epidemiologist in the coming months, he said.

Local health departments get more rapid data from the state Department of Health, and can collect data on outbreak locations, which would help mitigate spread, he said. He said he also thinks vaccinations would have rolled out more smoothly with a local health department in place, and it could have helped guide local school districts.

"If we had a (local) department of health, we would have been able to handle this ... a lot better than we have now," Jeffers said.

Jeffers said he's pushing for a mass vaccination site. Until it's contained, COVID-19 will continue to consume his days, he said.

"COVID is going to be in our lives for the remainder of this year," he said. "There's just no way that this country will be fully vaccinated before the end of this year."

Contact the writer:

bkrawczeniuk@timesshamrock.com;

570-348-9147;

@BorysBlogTT on Twitter.