Allegheny County reported a record of 90 new cases of COVID-19 today (June 27, 2020). This is not a one day anomaly, but part of a clear trend of rising case numbers. There is about a two week delay on average between a new infection and a publicly reported case number (see chart 7A here), so the reported number of cases today represents the number of infections from two weeks ago.
Allegheny County moved to the green phase on June 5. The case counts for the following two weeks (until June 18) represents the culmination of our hard won efforts over the preceding two and a half months. During these two weeks Allegheny County averaged only 11 new cases a day. In the 9 days starting June 19, Allegheny county has averaged 39 cases per day, with a clear trend of exponential growth.
For every day in April and May, Allegheny County reported fewer cases per capita than the rest of Pennsylvania. Allegheny county had more new cases per capita than the state as a whole on June 22, 26, and 27. On June 27, Allegheny County made up 14.5% of new reported cases despite comprising only 9.5% of the states population.
Westmoreland County has seen a similar rise in cases on a per-capita basis over the same time period. Other counties in southwestern PA have seen a smaller rise in cases. See my plots here.
The Pittsburgh metro area could soon replace Philadelphia as the main concentration of cases in the state.
What Happened?
The Allegheny County Health Department published a document describing the sources of transmission from their contact tracing work. The document states:
People contacted by the Allegheny County Health Department’s case investigation staff reported traveling all over the country. Myrtle Beach, Houston, Nashville, and places in Florida such as Miami, Tampa and Naples came up multiple times during case investigations.
New cases also told the Health Department they had recently been to bars and restaurants all around the county. Some of the new cases include staff at local bars and restaurants. Of the 15 different bars and restaurants new cases reported recently visiting or working at, five facilities were reported multiple times.
The document states that only a small number of the new cases report having participated in the protests. Philadelphia, which also saw significant protests but is still in the yellow phase, has had a much smaller recent increase in new cases.
What We Should Do
Quarantine out of state arrivals
The case counts in several states are sky-rocketing. The county’s contact tracing work shows that this is causing a significant number of cases to be imported into our county. I wrote in my last blog post about how a small number of seeded cases from elsewhere can then be amplified by local transmissions.
Pennsylvania has done a better job than a majority of the United States at controlling COVID-19. We should not let other states undo our hard work. New York has started requiring arrivals from states with out of control outbreaks to quarantine for 14 days. Pennsylvania should do the same. We should modify New York’s program by allowing people to end their quarantine early if they take a test for the virus and test negative.
Close Bars and Dine in Service
The recent rise in cases has shown that we are not yet at a point where we can safely reopen bars and restaurant dine in service. Some would argue that a new shutdown isn’t worth the economic cost. However, framing the decision as economics versus safety is a false choice. Thousands of people dying is bad for the economy. Sweden has tried responding to the virus with minimal restrictions. As this article explains, Sweden’s economy has been impacted by the virus to a similar degree as its neighbors which have imposed restrictions.
Until we are able to figure out how to reopen safely, the choice is between a bad economy and few deaths and a bad economy and many deaths. Framed this way, the choice is clear.
A further consideration is that it is important for schools to be able to reopen in the fall. It is more important that case numbers be low enough for schools to open relatively safely than for people to be able to go to a bar for a drink.
Improve Contact Tracing
I have previously written here and here that both Pennsylvania and Allegheny County should improve their contact tracing programs. Alarmingly, Governor Wolf was quoted in a recent Economist article as saying, “The idea of population-wide testing-tracing is a fiction.”
The successful implementation of contact tracing in other countries shows that this is not a fiction. Countries with effective contact tracing programs have been able to open bars and restaurants safely. See here for an article on South Korea’s program.
Fault doesn’t just lie with our state and county leaders. The Federal government has failed to provide local governments with sufficient funding to perform contact tracing. The CDC has failed to provide them with enough technical expertise. No US state or municipality has yet matched the quality of South Korea’s program.
To be fair to the United States, South Korea developed their program after their outbreak of MERS in 2015. As a result, they had more time to get it right. Still, other countries like Germany have also had better contact tracing programs than the United States.
People who are angry that the government is ordering business closures should instead be angry that the United States government at all levels has failed to develop a contact tracing program that allows businesses to reopen safely.
[…] week ago I wrote that Allegheny County should close bars and restaurants, the state should require people […]