Think about one year ago.
On Feb. 2, the Super Bowl was played in front of more than 62,000 fans packed into Miami’s Hard Rock Stadium. A month later, 18,548 watched the Penguins play the Carolina Hurricanes on March 8 at PPG Paints Arena.
A few days after that, the NHL, NBA and NCAA basketball shut down completely.
Movie theaters, museums, live concert venues, schools, restaurants, bars — just about any place where people gathered in public — soon followed suit.
A deadly virus that took root in China in late 2019 swept the globe.
A ripple turned into a wave, sparing no one, sickening 114 million and killing more than 2.5 million worldwide, including 523,000 Americans and more than 24,000 Pennsylvanians.
Almost one year from the day when the first cases of covid-19 were diagnosed in Pennsylvania on March 6, 2020 — in Delaware and Wayne counties — there is cautious optimism.
Infections are down.
Vaccines are being administered.
There is hope that someday soon, a new normal will emerge.
But with this milestone comes questions about the handling of the virulent illness that killed without prejudice, wreaked havoc with the world economy and spawned a vast societal divide between those who took the warnings seriously and those who continue to dismiss health officials’ pleas to wear masks, maintain social distancing and get the vaccine.
Some health experts say the most crucial lessons come from missteps by government officials that left the nation largely unguarded against the virus, then slowed attempts to contain it, including:
• Dismissing warnings in January 2020 that a virus paralyzing Wuhan, China, would spread quickly to the United States if immediate preventive measures were not taken
• Failing to develop quick, easily accessible and accurate methods of testing large numbers of people for the virus
• Drafting rigid guidelines limiting who could be tested, permitting many who were infected to unknowingly become super-spreaders
• A catastrophic level of unpreparedness regarding personal protective gear available to health care workers
• A failure to protect nursing home residents who proved the most vulnerable and accounted for more than a third of all covid-19 deaths in the nation
• An inefficiency in distributing a vaccine that was developed in record time
• A system of contact tracing that has fallen short, with only about 50% of infected people nationwide and statewide contacted providing information about their interactions with others
Pittsburgh-based infectious disease expert Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, was among the first to say the rapidly spreading respiratory virus in China would become a worldwide pandemic.
“The story of this pandemic was our government was not prepared and did not have enough competent people in place to be able to do this,” he said.
“What needed to happen in the United States at that time was a policy that they were going to meet cases as they came by setting up extensive testing and also having enough contact tracers, thinking about hospital capacity and personal protective equipment early on,” Adalja said.
From the start, he called for measures protecting nursing home patients, knowing they were among the most susceptible.
To date, more than 160,000 patients and staff at nursing homes and other long-term facilities across the nation have died from covid-19, according to an AARP Public Policy Institute/Miami University Scripps Center study.
“None of that really happened in January, February or half of March and when things did happen, they were so fouled up,” he said.
Government directives about who could get tested proved deadly, he said.
“You could only test someone if they’d been to China in the last 14 days. We knew that this virus was already outside of China. In fact, it was in France around Christmas time. And you could only test people that had lower respiratory tract symptoms,” Adalja said. “If they had a sore throat, they were not allowed to be tested, so they went on their merry way to spread the infection.”
He believes the divide among elected officials about the seriousness of the outbreak gave the virus time to spread unchecked.
“You had a president that thought the more we test the worse we look or that this was going to magically disappear,” said Adalja. “All of that underscores how badly this whole thing has been handled.”
Shane Dunlap | Tribune-Review
A demonstrator stands atop her car with a sign as demonstrators rallied against the closure of business in Pennsylvania on Grant Street in Pittsburgh on April 20, 2020.
But Dr. Donald Whiting, Allegheny Health Network’s chief medical officer, said it’s important to understand the crisis was unprecedented in this century.
“The rapidity with which the medical community locally, nationally and internationally really connected to share best practices was phenomenal,” he said.
“Ventilators in the beginning were thought to be the right thing to do and then soon after that we found out that wasn’t necessarily the right thing to do in all situations. There were other techniques for maintaining ventilation that were better. That was disseminated very, very rapidly by free sharing of the information,” he added.
While President Trump was criticized for referring to the coronavirus as the “Chinese virus” or “Kung Flu,” vaccine expert Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said the Chinese government should shoulder its fair share of the blame.
“China wasn’t a very good neighbor here. When that virus was killing people in Wuhan, it shouldn’t have required a whistleblower to tell the world what was going on,” Offit said.
Offit’s reference is to Dr. Li Wenliang, who sounded an early alarm about the emergence of what would become known as covid-19 in Wuhan, but was rebuffed by the government. He died Feb. 7, 2020, of the virus.
But Offit isn’t letting the Trump administration off the hook. In particular, he blames it for failing to quickly develop a test.
“I mean if you look at South Korea, Japan, other countries were much better at developing a test, testing to see where the disease was, quarantining people who were either infected or exposed to those who were infected. We didn’t do that well at all and I think we’ve paid an enormous price,” said Offit. “We have 20% of the world’s deaths and 4% of the world’s population.”
Dr. Donald Yealy, UPMC’s chair of emergency medicine, said the U.S. government’s initial response to covid-19 was problematic.
“I think the federal government responded in a fashion that was very similar to how they responded to previous respiratory pathogen outbreaks. In this case, that wasn’t soon enough or advanced enough, both in the mitigation efforts and then also in some of the therapeutic efforts,” said Yealy.
“You can help thwart the progression of the virus with early aggressive actions but you actually have to do them early. Each week or two that you wait, those same actions become less effective,” he said.
Experts point to the 2014-16 Ebola crisis in West Africa, which killed 11,300, but was mostly prevented from spreading to the rest of the world, partly through intensive contact tracing and effective quarantining.
Nate Smallwood | Tribune-Review
Allegheny Health Network’s medical professionals administer collection of samples for testing of covid-19 at their drive-up collection site in Monroeville on March 19, 2020.
Pennsylvania officials defend their efforts and point to citizens’ responsibility to follow mitigation measures.
State health department spokeswoman Maggi Barton said public health workers did as many case investigations as possible. Case investigations — when information is gathered about who an infected person was around — have to happen before contact tracing can begin. She said about 28% of all probable and confirmed covid cases have received a case investigation.
“As cases rose to their peak,” she said, “it was not possible to contact all cases confirmed in one day.”
The result was an online form introduced in December meant to gather more information from more people.
Dr. Maureen Lichtveld, dean of the University of Pittsburgh Graduate School of Public Health, pointed to an overall lack of accurate information being disseminated, particularly by the federal government.
She said permitting each state to handle the crisis in its own way was a deadly error.
“This was handled in a silo-driven mode. Have the states do their own thing. The fundamental principle around crisis communication is that you need to be first out of the chute at messaging, you need to be credible and you need to be right,” said Lichtveld. “We struck out in all three areas. There were conflicting messages about masking, about distancing.”
A shot in the arm
The approval of three vaccines has created hope.
But even the state and national vaccine efforts have been marked by missteps, experts said.
Pennsylvania ranks 33rd out of all U.S. states and territories in terms of the percentage of the population that has received at least one dose of the two-dose vaccines, according to The New York Times.
Kristina Serafini | Tribune-Review
Chief Quality Officer Tamra Minnier preps the arm of Children’s Hospital Emergency Medicine Physician Sylvia Owusu-Ansah prior to administering Pfizer’s covid-19 vaccine at UPMC Children’s Hospital of Pittsburgh on Dec. 14, 2020.
To date, about 10% of the U.S. population has been fully vaccinated and about 7% of Pennsylvania’s residents have received the required two shots. The latest estimates put the state’s population at right around 12.8 million people, though only those 16 and up are eligible for vaccinations.
Dr. Debra Bogen, director of the Allegheny County Health Department, has expressed optimism as cases trend downward — with the caveat that “for now, we must stay the course.”
“I am hopeful that we will see the end of this pandemic sometime this year,” she said.
The next pandemic
Experts say another pandemic will occur, but will the country be better prepared?
Adalja points to the U.S. handling of the 2009 H1 N1 pandemic as a template for responding to disease outbreaks.
“Although there were massive flaws in the vaccine rollout program and a lot of misinformation early on, it was handled better,” said Adalja. ”We were much more science-based where you had briefings from the CDC director almost on a daily basis and you had the experts speaking. What we saw in the United States during this pandemic was around February (2020) the CDC became bound, gagged and thrown in the trunk of a car.”
Adalja has regularly expressed exasperation over what he sees as mistakes being repeated, going back to when states such as Pennsylvania shut down last spring. The ensuing backlash from residents led to restrictions being removed when it got closer to summer.
“But in that interim, did they actually set up testing, contact tracing? Did they increase their public health infrastructure or their hospital capacity? No,” said Adalja. “So, then they’re all scratching their heads in the summer saying ‘wow, we’ve got this surge! Where did it come from?’ ”
He said that today the U.S. still doesn’t have the testing, tracing and isolation capacity it needs.
Nate Smallwood | Tribune-Review
Sample collection for covid-19 tests are administered at a Central Outreach Wellness Center testing site in the parking lot of the Pittsburgh Zoo & PPG Aquarium on March 24, 2020.
However, Whiting said there are lessons that have been learned from the pandemic, particularly in this region.
“What we’ve learned locally is that people came together to do the right thing and certainly in our region, the situation was much less severe than anywhere else. People pulled together to help each other,” said Whiting. “I think one of the biggest things we learned is that a strong, national unified response based in science is really the key to getting the country best prepared the quickest.”
Adalja sees opportunities ahead.
“This pandemic, because it was so severe and it touched everyone’s life, I think that we will likely have an opportunity to fix some of these problems, to put in place a system that will be resilient to the next threat. Because there will be a next threat.”
Hundreds of people lined up in their cars as the Greater Pittsburgh Community Food Bank began another round of food distribution on April 6, 2020.
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