Allegheny County can improve its response to the recent rise in COVID-19 cases. However, before I identify improvements, let me say that Allegheny County has responded better to its recent rise in cases than any other county in Southwestern Pennsylvania.
A week ago I wrote that Allegheny County should close bars and restaurants, the state should require people who’ve been to states with uncontrolled outbreaks to quarantine, and Pennsylvania and Allegheny County should improve their contact tracing programs. Since that post:
- Allegheny County has closed bars, and closed restaurants for one week.
- The State Health Department has stated that people who travel to states with high case numbers “will need to quarantine for 14 days upon return”.
- Allegheny County Health Department Director Dr. Bogen has stated in her press conferences that they are working to hire more contact tracers.
I expect that over the next six weeks Allegheny County will have fewer cases and deaths per capita than its neighbors as a result. So plaudits to Rich Fitzgerald and Debra Bogen for their response. Allegheny County is also doing better than most of the rest of the United States.
However, comparing Allegheny County to other parts of the United States is a lower standard than we should strive for. We should be doing much better.
Recent Rise in Cases is Alarming
This plot shows the increase in cases since Allegheny County entered the green phase on June 5, 2020. There is about a two week lag between reported case numbers and new reported case numbers. Cases started rising around June 19, almost exactly two weeks after the transition to the Green Phase. It is clear that the relaxation in restrictions caused the recent increase. New cases are over ten times higher than they were at the beginning of June.
To appreciate just how bad Allegheny County’s case counts are, they should be compared to other countries. Allegheny County has had 109 cases per 100,000 people in the 14 days prior to July 5, 2020. This is more than any country in the European Union except for Sweden.
This plot shows that much lower case counts are achievable. Let’s discuss how to get there.
The Restaurant Shutdown is too Short
A policy change like closing restaurants starts reducing new infections immediately. However, because it takes time for symptoms to develop and then for test results to be reported, it takes about two weeks for a policy change to start affecting reported case numbers. Therefore restaurants are being allowed to reopen before we have a measure of what impact the closure has had with case counts. We don’t yet know if closing restaurants will be sufficient to even stop the recent rise in cases.
Establish Safe Conditions before Reopening Restaurants
Out of State Quarantines Must be Mandatory
It is not clear from the State health department’s recent statement whether quarantining is mandatory. There are no fines like there are for the New York quarantine program. While it will be difficult to enforce a mandatory quarantine, such a program would reduce the spread of COVID-19 from other states at least somewhat.
If transmission from out of state cause case rates in Allegheny County to continue to grow, people will be too afraid to go to restaurants even if they are allowed to reopen.
Furthermore, if enough cases are seeded in Allegheny County from elsewhere no amount of business closures will be able to stop an uncontrolled outbreak here. For this reason it is concerning that no steps are being taken to reduce transmissions in the other counties of Southwestern Pennsylvania. These have seen case growth that on a per capita basis is almost as large as that in Allegheny County.
Improve the Contact Tracing Program
This is essential to allow restaurants to reopen safely. An effective contact tracing program can identify infected people and isolate them before they have a chance to spread the virus. Countries with effective contact tracing programs have been able to safely open restaurants and bars.
Allegheny County (and Pennsylvania as a whole) has too few contact tracers to do this effectively. It has fewer contact tracers per capita than New York and Massachusetts, and far fewer than experts recommend.
The lack of contact tracers is having an adverse impact. In a document released July 2, 2020, Allegheny County stated that due to the recent volume of cases it is taking longer to reach positive cases and their contacts than in the past.
Speed is essential for an effective contact tracing program. The longer it takes to isolate contacts, the more people they are able to infect.
According to this paper, for an effective contact tracing program between 15 and 40 contacts need to be isolated for every person who tests positive. Before restaurants are allowed to reopen, the county should have the capacity to make an initial attempt to contact at least 15 contacts for every infected person within 24 hours of a positive test result.
When restaurants are permitted to reopen, patrons should be required to sign in with a time and contact number. This way if an infected person dines at an establishment everyone who was in the establishment at the same time can be identified and contacted for testing. This is done in South Korea, which has one of the best contact tracing programs in the world.
Conclusion
Restaurants are inherently riskier than other businesses because it is not possible to eat or drink while wearing a mask. Therefore opening restaurants will result in some additional infections. Since reopening restaurants contributed to such a large rise in recent case counts, it is unclear what will have changed to make it safe for them to open in one week.
Perhaps Dr. Bogen thinks that if there had been better compliance with safety regulations there would not have been an unacceptable rise in cases. If that is true than a week may be enough time to come up with an enforcement process.
However, reopening with only this new safeguard is not a risk worth taking. If cases resume exponential growth (or worse never stop growing exponentially) then restaurants will soon need to close again against the backdrop of much higher case numbers. This would be much worse than getting things right the first time.
Even if better enforcement of restaurant safety regulations is sufficient to prevent an exponential growth of new cases, case counts will drop more quickly if restaurants are completely closed. People will feel safer going to restaurants and engaging in other economical activity if case counts are low. Therefore a longer temporary closure is a worthwhile investment.
