Reopening economy in a COVID-19 hotspot stresses doctors in rural Pa.

Businesses are hurt. Unemployment is unprecedented. But coronavirus cases in this rural Pa. town have still been spiking. Now, as restrictions ease, hospitals could be tested.

Chambersburg, Pa. (Jeffrey Stockbridge for Keystone Crossroads)

Chambersburg, Pa. (Jeffrey Stockbridge for Keystone Crossroads)

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Last Friday, Gov. Tom Wolf announced he would ease restrictions on gatherings and businesses in Franklin County on May 29, thanking “the Pennsylvanians who have made tremendous sacrifices since the virus emerged in our state.”

That same week, COVID-19 cases hit a peak at WellSpan Chambersburg Hospital, filling the intensive care unit.

Some doctors there feared they would soon be overwhelmed.

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“A couple more cases could tip the balance,” said one physician who has treated COVID-19 patients there and who asked not to be named out of fear of retaliation. “We have been operating at near capacity [in the ICU] for weeks now.”

As public officials across the country decide whether to ease social distancing restrictions, economic devastation is weighed against the likelihood of loss of life. In Franklin County, momentum has tipped toward reopening but public opinion on the ground falls far short of consensus and some local doctors question the decision. Across the country, rural areas are on the forefront of the political and economic movement to reopen, but these areas are not immune to their own struggles with the virus.

On one hand, businesses are struggling and Pennsylvania’s unemployment rate is officially the highest on record.

“Many small business owners feel they have nothing left to lose. Some have liquidated their life savings because their businesses have been closed,” said county commission Chairman Dave Keller in a letter to Wolf last week.

“Based on the feedback I have received, Franklin County residents want to move forward safely, intelligently, and responsibly out of the stay-at-home order,” he continued.

At the same time, the county has sustained a high level of new cases compared to its population since mid-April, mostly from patients in nursing homes and workers at food processing sites, who largely live in Chambersburg and Shippensburg.

Chambersburg, the county seat, has appeared at or near the top of a New York Times analysis of where cases and deaths are surging nationally in recent weeks.

The county has also not met the state’s initial threshold for reopening, which originally called for the coronavirus spread to slow to 50 new cases per 100,000 residents over a two-week period. The governor later said he would not hinge reopening solely on that metric.

Now, as restrictions begin to ease, anxiety in some corners of the county are rising, including in the area’s sizable Hispanic community, which has been disproportionately hit by COVID-19.

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Members of the local grassroots Latinx advocacy organization the Movement of Immigrant Leaders in Pennsylvania (MILPA) shared their feelings through a translator, but many felt uncomfortable using their full names.

“Friends of mine were isolated this week for symptoms. And people’s fear makes them keep quiet about it. Going back to normal will be very difficult,” Adrian said.

“I think that we’re not yet ready to return to normal, but I also think that it’s very important for us to learn to live with COVID-19. We have to have the indicated precautions, like using masks, distancing. If God permits, soon a cure will arrive for everyone,” Nadia Reyes said.

“I think that we should wait a little bit more because opening the county can be taken by people to mean that everything is fine and there can be a new outbreak that could be much worse,” Esvin said.

‘Long overdue’

Under the ‘yellow’ phase Franklin is entering Friday, all businesses except for salons, gyms and theatres may reopen on a modified basis, but the state says people who can work from home should continue to do so. Child care facilities can open but schools remain closed, and restaurants continue to operate only on a delivery and takeout basis.

Keystone Crossroads surveyed county residents through an online form about the move and received nearly 150 responses at the time of writing. Some questioned the governor’s decision and expressed concern about what they saw as lax precautions in their communities.

Jessica Lawson, 38, of Chambersburg, has lost her job as a cognitive behavioral therapist due to the pandemic shutdown. But she said even though she is personally feeling economic repercussions, she says the area should keep its ‘stay-at-home’ orders.

Jessica and Eddie Lawson. (Photo by Josh Lawson)

“I don’t see a lot of people wearing masks if I go out,” she said. “I think people are feeling like the exceptions, ‘Oh it’s not going to happen to me,” and will not get sick. Two members of Lawson’s extended family in other states have caught COVID-19, and one has died.

“I think it’s too soon,” Lawson said.

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Many other county residents said they believe the area is ready to ease restrictions, either gradually or fully.

“I’m ready for normal. Not a ‘new normal,’ just normal” said Michelle Bush, a 55-year-old buyer for a local hospital who lives in Chambersburg. “I think it’s long overdue, and I think we should be ‘green’ by now to tell you the truth.”

Bush said she feels for those whose loved ones have died, but also feels like her family’s freedom has been unfairly curtailed. She also thinks that Democrats have inflated the risks of the coronavirus to try to disadvantage President Donald Trump in the upcoming election. The move to yellow is nothing worth celebrating.

“You still can’t get your hair cut. My grandkids still can’t play ball.” she said. “There’s not really much I’m looking forward to.”

She added that she wished the disease was less politicized.

Politics, though, have become inherently intertwined with the disease locally. State Sen. Doug Mastriano, R-Franklin, has been one of the loudest voices in the legislature criticizing Wolf’s lockdown orders. Last weekend, he headlined a rally calling for a lift to the lockdown order in Franklin County, and also for Department of Health Secretary Rachel Levine to be fired.

A “Levine needs to go” chant echoed from the crowd.

‘Lost the humanity’

Keller, the Republican commission chair, had opposed reopening against the governor’s wishes, as some in Franklin County had proposed doing in mid-May. But when Wolf’s office reached out last Friday morning to confirm the county wished to move to yellow, he told them Franklin was ready.

Goals such as “flattening the curve; not overwhelming hospitals, medical professionals and first responders; availability of beds, ventilators, and PPE [personal protective equipment]” had been achieved, said Keller in an email.

“I also had to look at this from a countywide perspective. Cases have been concentrated in the Chambersburg area and sentiment was very strong outside the Chambersburg area in particular that business activity needed to resume,” he said.

Yes, cases in the hospital were high and the ICU was slugging along, but Keller said he had been advised that those numbers would drop.

Other key metrics that are supposed to guide the state’s thinking for when to ease restrictions remain a subject of debate.

Recommended benchmarks such as testing 10% of the county’s population cumulatively have not been met. And Department of Health nurses are doing only limited contact tracing.

“I always think of this as a work in progress,” said Dr. Raghavendra Tirupathi, a member of the Chambersburg Board of Health and the medical director of infectious diseases with Keystone Health, another health care provider in the county. “Is our county there with respect to all of these measures? Maybe not at this time…but we also need to celebrate our successes in terms of how many tests we have done and how many bad outcomes we have prevented.”

In the last week, the number of hospital cases have begun to ease, say the local physicians interviewed for this story.

Many sources pointed out that the county does more testing than its neighbors, and thus may appear worse off when silent spread could likely be happening elsewhere.

But other health professionals in the county fear that decisions about reopening have become divorced from the suffering that’s occurring in hospitals. Three physicians spoke on the condition of anonymity because they were not authorized to speak to the press.

“I’m personally frustrated that we have lost the humanity of this,” said a doctor at Chambersburg Hospital, who asked not to be named. He and the others felt the conversation had drifted too far into the political feasibility of reopening, away from the fear and loss that have come with the 759 cases and 31 COVID-19 deaths in the county.

“We’ve upended the norms that let people grieve, at the hospital we can’t let family members in there,” the doctor continued.

“There will be a next time and it will come sooner if we are unsafe,” said another doctor. “It will happen this summer, just weeks from now if we abandon safe practices now.”

Officials at WellSpan Chambersburg Hospital confirmed that COVID-19 cases crested early last week. “We’ve been able to meet our current patient needs without adding critical care capacity,” the hospital wrote in a statement.

So is Franklin County ready, from a scientific standpoint, to begin reopening?

Outside health experts offered different thoughts to consider.

Some believe that a dip in cases wasn’t the point of social distancing at all — it was to give the health care system time to build testing capacity and learn more about the disease.

“Returning when cases go down wasn’t the point…that logic alone is flawed,” said Nita Bharti, assistant professor of biology in the Center for Infectious Disease Dynamics at Penn State University. She said rural areas with low cases counts have often been the first to reopen due to economic and political pressure, but with more social interactions come more cases.

“I think most of the country is prematurely reopening,” Bharti said. “I don’t think Franklin County is exceptional in its economic and political shift towards easing restrictions.”

There is also some evidence to suggest that the shutdown orders themselves may not be the biggest factor in where spikes do or don’t happen. Individual choices no matter government directives play a large role. PolicyLab at Children’s Hospital of Philadelphia has been modeling the spread of the coronavirus in 400 counties across America, including Franklin County.

“Social distancing and masking are the number one thing in our model,” said David Rubin, the lab’s director. He also said the targeted testing that’s happening in the county’s hotspots, such as Chambersburg, may be as effective and more practical than “blanket” testing goals that have not been met yet.

Above all else, how often residents wear masks in public spaces and wash their hands will have a greater impact on the spread of the virus than government shutdown orders alone, he said.

“We’re transferring responsibility back to the individual,” Rubin said.

If people don’t abide by the guidance, then the government may be pushed to step in again.

But, even these personal measures, such as wearing a mask, have become a source of strife  — a political statement even.

“I have seen far too many selfish and ignorant people on social media refusing to wear masks or take any precautions to mitigate the spread,” wrote a resident of Shippensburg who responded to Keystone Crossroad’s survey.

“The masks are dangerous so if a place requires one then I will not be going there!” wrote another Chambersburg resident.

Laura Benshoff produced this story as part of the America Amplified initiative using community engagement to inform and strengthen local, regional and national journalism. America Amplified is a public media initiative funded by the Corporation for Public Broadcasting. WHYY is part of the America Amplified network. Reporter Laura Benshoff is following stories that community members identify as deserving of more coverage in Chambersburg, Pennsylvania.

Q: What did the people you talked to say about the experience of being interviewed for public media?
This story contains unnamed sources, so there was sensitivity involved. Many people told me they had not spoken with a reporter before and wanted to know more about the process and how their quotes would be included. We talked about what the different kinds of attribution are (on-the-record vs. on-background vs. off-the-record). 

Q: What surprised you about this type of community engagement?
For this story, our social media manager made a Google survey asking for Franklin County residents’ feedback on the county’s move to “yellow” and we received a tremendous amount of comments in a short period of time, which surprised me. This story had already been generated with questions readers/listeners raised after my last report, and to know that so many more people cared about the topic and wanted to share their opinions seemed to affirm that this was a worthy story to do.

Q: What lessons do you have for others who want to do the same?
I would not have been able to report this story without already having spent time in the community and written previous stories. Sustained engagement is paying off in terms of building trust with sources and also in leading to richer stories that can include a wider array of voices and perspectives.

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