Maureen Casey compared the influx of COVID-19 patients at Penn State Milton S. Hershey Medical Center to waves on a shoreline, saying "They just keep coming."
Casey is a registered nurse who on Monday reported that the medical center was already at capacity and its staff exhausted, even before this year's flu season starts in earnest.
Her plea for Pennsylvanians to wear masks — just as they did in the spring, which helped flattened the curve of cases then — was echoed by state health officials during a news conference Monday that highlighted her story and others from hospitals with warnings of dire situations.
Gov. Tom Wolf said the state's plea about two weeks ago for residents to do the right thing with mitigating COVID-19 during the Thanksgiving holiday seems to have failed. Given the increase of cases, Wolf said the state is still looking at what else can be done to help flatten the fall resurgence and avoid hospital capacity and staffing issues.
“If we don’t slow the spread of this dangerous virus now, the reality is that COVID-19 will overwhelm our hospitals and our health care workers,” Wolf said. "That’s dangerous for everyone who needs medical care in a hospital for any reason, because it stretches resources and staff to the breaking point."
New recommendations could come "very shortly," Wolf said, adding that the red-yellow-green shutdown phases that were instituted in the spring were a "blunt instrument" that he feels is no longer needed. With a vaccine on the horizon, more medical knowledge about the coronavirus and more testing kits and personal protective equipment, Wolf said targeted mitigation is key and seems to be what other states are doing in trying to wrest control over the rising numbers of cases.
However, targeted mitigation may be difficult considering health officials are losing a grasp as to the reason behind the spread of cases.
The number of COVID-19 cases in Pennsylvania over the course of the pandemic has topped 400,000, up from 200,000 just six weeks ago, according to Health Department data. The statewide positivity rate went up to 14.4% from 11.7% last week. And every county in the state has a positivity rate above 5%, considered a threshold for positivity being too high.
Cumberland County's positivity rate for last week rose to 16.2%, up from 11.8% the previous week. The county's incidence rate per 100,000 people last week rose to 412.9, up from 270.5 the previous week.
Health Secretary Dr. Rachel Levine said that when the state sees 12,000 new cases in a single day, there isn't a way for officials to successfully investigate all those cases or perform contact tracing, even if the affected patients did answer the questions from the state. Instead, the state's contact tracing team is prioritizing investigations for cases in schools, long-term care facilities and prisons.
Without contact tracing on the general population, Levine couldn't say whether the current rise of cases is due to Thanksgiving gatherings, though officials suspect that is the case, along with the spread from other states in the Midwest.
Whatever the case, Wolf and Levine said everyone in the state, in order to protect health care workers and ensure emergency services are available for non-COVID emergencies at hospitals, should stay at home, not attend gatherings outside the household and wear a mask.
“This is a significant challenge for our health care system, one unlike our modern health system in Pennsylvania has ever faced,” Levine said. “Sadly, we have now seen deaths from COVID-19 in every county in the state, and our hospitals in many locations are at or near capacity.
"The steps each of us take, as part of our collective responsibility, are essential to protect us from the spread of COVID-19."
The same mitigation efforts could help prevent flu cases from spreading. According to Deputy Secretary of Health Preparedness and Community Protection Ray Barishansky, flu season is underway, though not at epidemic levels yet. The state had its first flu case of the season on Nov. 10 and has already seen 480 laboratory-confirmed cases and one flu-associated death.
Naomi's 5 favorite stories of 2020
Naomi's 5 favorite stories of 2020
Historic look at pandemics
Before Pennsylvania officially got its first positive COVID-19 test, I took a deep dive into the history of modern global diseases.
Although the attempt was to show how other diseases spread and how they were contained, it was just as educational for me to learn what exactly was considered a pandemic and what wasn't, as well as what failed and what worked in mitigating the diseases.
In the last two decades, the bulk of the information regarding the causes, failures and successes of global spread of diseases was available after the concern and media attention had passed. Unlike the COVID-19 pandemic, which has lingered and surged over the last nine months, the others were better contained and more easily fell under the radar of those unaffected by the disease.
Just as it was interesting to read scientists' studies of what transpired with these other modern diseases, it may be as much of, if not more of a lesson in the future when officials determine the exact spread and rise across the globe, if politics in various countries allow such studies to take place.
Pushing for more information
The scope of information that the state Department of Health had to handle and make public was unprecedented. The department may have been used to reporting data on the seasonal flu and West Nile Virus cases, but a global pandemic was simply on a different scale.
And though the department has steadily grown its output of public information and data, not all of that was available at the beginning of the spread of COVID-19.
One area of chief concern was long-term care. With the governor's shutdown order, the majority of the worst cases were being detected in nursing homes.
The problem was, the only information the Department of Health offered to the public was a look at cases in each county - not by facility.
I think it was important for our newspaper, as well as plenty of others, to keep noting discrepancies and the need for further information that readers and residents wanted as concerns rose over the disease. With push from residents and others across the state, the department now has weekly updates to facilities (though they are still self-reporting) as well as other breakdowns of information covering age, co-morbidities and hospitalizations.
Need for primary care
When COVID-19 hit Pennsylvania and the country, there were obvious concerns over certain areas of health care: emergency treatment, hospital capacity, long-term nursing care, finances and availability of personal protective equipment.
With Gov. Tom Wolf's shutdown order, however, primary care physicians sounded the alarm about a potentially unseen danger: waiting for non-COVID care.
Dr. Baxter Wellmon of Wellmon Medical Associates in Shippensburg contacted The Sentinel in hopes of getting his and other patients back to see their doctors, whether that meant just a phone call or assuring them of safety measures for an in-person visit.
From a reporting standpoint, it's not often we hear from doctors directly without having contacted them first, but Dr. Wellmon clearly had a passion for getting his message out that he hoped would save lives.
One nurse's sacrifice
Especially in the early months of COVID-19, convincing residents of the dangers of the disease was a difficult task.
With the shutdown order, few people knew someone first-hand who had the disease or worried for someone in an affected long-term care facility, and a pandemic on this scale had simply not been experienced by most people living today.
That's why it had been so important to hear from someone who both saw patients struggling with the disease and who struggled with it herself.
Jan Mercer, who volunteered to move from her department to help with COVID-19 patients at Holy Spirit Hospital, then-owned by Geisinger, was very open about the fear she saw in patients and her own fear she experienced after her diagnosis and hospitalization.
And, perhaps more importantly, she was very detailed about the aftermath of the disease - how it wasn't just the brush with death at the hospital, but its lasting effects on her lungs about which she wanted people to know.
Her story was the clearest sense early on just what dangers this disease truly posed to health care workers and residents in general.
Learning a new story
As coverage continued with COVID-19 and the election, The Sentinel staff got chances to write something a little different with a different focus. With our paper's Inspire quarterly section, we've been able to profile people known and unknown with stories we may not have heard before.
I hadn't heard Don Geistwhite's story before.
When I first arrived at The Sentinel as just a cub reporter, I was assigned to cover two municipalities - Mechanicsburg and Middlesex Township. The latter is where I would meet Geistwhite as one of the township supervisors.
More than 10 years later, I'd finally learn more about the man and his unusual path in the military. Not every story made it to print, but it was a joy to sit down with him and hear about the colorful characters he's met, all at a time when connecting with someone new (or someone from the past) wasn't an easy achievement.
Email Naomi Creason at email@example.com or follow her on Twitter @SentinelCreason