The public in community public health

Pennsylvania Department of Health map, April 4, 2020. Neighboring Indiana, Clearfield and Cambria counties are in blue, left center.

Coronavirus diary

By David Loomis

INDIANA –  Indiana County officials took to the web and local airways last week to cheer citizens confronting the COVID-19 pandemic. With one exception, officials attempted a Fireside Chat approach, encouraging residents of a blue island bordered by neighboring counties to the west with higher numbers of infection and counties to the north and east with lower numbers. None of these largely rural counties has documented a death from the virus assailing cities.

Yet.

History suggests that will change. A widely cited 2007 study of the 1918 Spanish flu by an economist at the Federal Reserve Bank of St. Louis predicted a new pandemic probably would hit hardest in cities, as the 1918 pandemic did. Pennsylvania was home to the three hardest-hit U.S. cities – Philadelphia, Pittsburgh and Scranton.

But the overall ratio of mortality rates had no relationship with population or population density, the 2007 study concluded. Moreover, urban and rural areas are more closely connected today. For example, Indiana County now is counted as a part of the Pittsburgh region.

The Great Influenza” (2004) also documents the Keystone State’s urban death toll during the 1918 pandemic. But author John M. Barry notes that the virus eventually reached every rural corner of the country.

A PBS-TV documentary aired last week included a first-hand account of a man who as a boy in Montana rode on horseback with his father, a local public health agent, to a remote Native American village during the pandemic. Half the village had died.

 

A CENTURY LATER, the coronavirus is ravaging cities, but it’s also creeping into rural America once again.

Meanwhile, federal policymakers are being parsimonious with  and mixing messages about critical health-care equipment. That raises the specter of the overwhelmed health-care systems that prevented prompt disposal of the dead during the pandemic a century ago.

In a bleak news cycle, a daily show of appreciation for health-care workers and essential servants on the front lines of the fight against the virus in New York provides an uplift of social solidarity and civic strength. Similar impulses motivate citizens and students here to make protective equipment for front-line health-care workers.

Such efforts feed the urge to help. But what is the scope of the need? Does the hospital have enough beds? Enough respirators? Masks? Staff? Are elective medical procedures being cancelled?

Such questions call for answers with numbers, specifics. The economic damage, by comparison, is quantified daily in dollars, jobs, stock market averages. But how about measures of local health-care capacity and human capital, on which doubt is cast by national news media every day?

 

Indiana Regional Medical Center CEO Steve Wolfe, on webcast by the Center for Community Growth, April 2, 2020.

ON TUESDAY, Indiana Regional Medical Center CEO Steve Wolfe appeared on a remote webcast hosted by the Center for Community Growth.  He announced the county’s seventh confirmed COVID-19 case. (The number rose to nine by Saturday.) Otherwise, he spoke in general terms about protective supplies, test kits and  hospital admissions.

“We have been blessed,” Wolfe said, because the virus “really is taking longer to get to IRMC,” buying time for the hospital to stock up, he added.

However, Wolfe allowed, test kits “are very limited,” and he spends a couple of hours a day “trying to get protective gear.” He also announced that Indiana County has “reached a stage of community spread.” Translation: The virus has become so common here that the origins of cases cannot be identified.

Is IRMC seeing a surge of patients? No, Wolfe said.

“Could patients overrun the hospital?” he asked rhetorically. “I think it could happen.”

Philadelphia Street, Indiana, Pa., spring 2020. Photo by Anthony Frazier.

State Sen. Joe Pittman followed Wolfe on the webcast. He, too, spoke in general terms.

“This virus is never going to quickly and completely go away,” Sen. Pittman said. “There is a lot of collateral damage that is occurring. That also needs to be managed.”

 

ON FRIDAY MORNING, Indiana County commissioners appeared on a WCCS-AM morning program with second billing behind the county’s emergency-management director. Board Chairman R. Michael Keith read a brief prepared statement.

“We will stay strong and defeat this,” he assured listeners.

Commissioner Robin Gorman echoed Keith.

“It’s just amazing to watch our county work at a time like this,” she enthused.

Commissioner Sherene Hess thanked the radio station for the opportunity “to connect with listeners.”

They didn’t connect, of course. The commissioners’ appearance on the program was not advertised in advance. Listeners had no opportunity to question or interact. And how will they be equipped to question or interact with the commissioners remotely at their next scheduled public meeting scheduled for April 8?

 

AN EXCEPTION to the generalities was Tom Stutzman, director of the county’s emergency-management agency, who channeled Anthony Fauci, at least in tone.

“We are all struggling to provide equipment to all these agencies,” Stutzman reported. “They really don’t know what’s coming at them, as far as patient load.”

And Stutzman reported that the hospital conducts a valuable daily briefing on the county’s COVID-19 situation attended by hospital staff and “outside agencies.”

The reveal of the regular briefing might remind residents of the annual Indiana Area Collaborative Team. It assembles a wide array of public safety agencies and other stakeholders communitywide – led by Indiana University of Pennsylvania’s p.r. office – to manage mobs of students who converge on the community in mid-March for the annual IUPatty’s “high celebratory event.” (IRMC is among I-ACT’s participating stakeholders.)

I-ACT also was born behind closed doors. Later, it opened to public view as the p.r. fallout from the partying dwindled. This year’s IUPatty’s, for example, was short-circuited by IUP’s closure for the coronavirus.

 

AS THE COVID-19 PANDEMIC approaches the country’s rural corners, Indiana might mimic the I-ACT model and likewise muster community stakeholders – public-safety agencies, public-health agencies, the public – to regular public briefings about an issue of considerably more public concern and consequence than preventing parties.

__________

David Loomis, Ph.D., emeritus professor of journalism at Indiana University of Pennsylvania, is editor of The HawkEye.

The HawkEye invites comments on this and other issues of community interest. Email doloomis@iup.edu or click on the “contact us” drop-down menu, above.

 

 

 

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