Pennsylvania is facing a rebound of Covid-19, and Dr. David Rubin says Lancaster County is one of the areas he worries about the most.
Rubin is the director of the PolicyLab research center at the Children's Hospital of Philadelphia.
"We're at significant risk of losing control," he told One United Lancaster this week, calling on the community and officials to recommit to masks, social distancing and other recommended mitigation measures.
Policy Lab has been tracking the coronavirus pandemic nationwide, county by county, using the data to project trends based on a model that incorporates demographics, social distancing and weather.
Earlier this month, PolicyLab identified Lancaster as one of four "quickly deteriorating" counties, along with Berks, Lebanon and York.
The organization's latest data, released Wednesday, shows Lancaster with 68.2 new weekly Covid-19 cases per 100,000 people. Projections show that number climbing to 100 per 100,000 by early November, the threshold for "substantial" transmission.
Lancaster's test positivity rate is 5.9%. Levels above 5% are considered problematic.
That said, the other three counties PolicyLab cited are doing worse. The case count in Lebanon County, the worst-hit, is 177 per 100,000, and its test positivity rate is 9%.
But Lancaster has no grounds to be complacent, Rubin said.
PolicyLab's data for Lancaster County:
Pennsylvania officials agree a resurgence is under way. This week, Gov. Tom Wolf called on Pennsylvanians to "double down on our efforts to keep ourselves and those around us safe."
Asked for comment on Rubin's prognosis, Penn Medicine Lancaster General Health provided a statement saying it is "cautiously optimistic" about how autumn will play out.
LG Health's "ongoing investment of resources and staff training continues to strengthen our preparedness and ability to address the Covid-19 pandemic," it said. "Our community’s continued diligence in social distancing and using masks will help minimize the spread and exposure to the virus."
County Commissioner Josh Parsons said Covid-19 hospital admissions remain low in Lancaster County and death rates have plummeted. It's important to look at those numbers in conjunction with case counts, not case counts alone, he said.
He reiterated his call for a "middle course" that deals with the virus without crippling the economy. The Wolf administration's approach, he said, has decimated the livelihoods of small business owners, construction workers, restaurant workers and others who can't work remotely.
"Those are the people I have tried to speak for," he said.
'There needs to be some enforcement'
Rubin contended LG Health's inpatient numbers — as of Thursday, there were 25 Covid-19 patients, five in the ICU — already warrant concern.
"You want to see the slope rising early" and take action then, he said. "You don't want to do it when (hospitals are) 90% full."
So, what does Rubin think Lancaster County — and Pennsylvania — should do?
For starters, there's a need for more compliance regarding masks, social distancing and respecting limits on gatherings, he said.
"There needs to be some enforcement," he added.
Families need to be cautious as the holidays approach, he said. It's natural to let your guard down around relatives — grandparents want to hug their grandchildren, everyone wants to swap stories around the dinner table — but mixing households together multiplies risk, and can drive transmission across age groups, Rubin said.
Consider quarantining before a holiday gathering, or meeting online, he suggested.
As for schools, PolicyLab is seeing evidence that safety protocols and robust contact tracing are showing results, allowing in-person learning even in some areas with moderate transmission rates. In most cases, reopening schools has not driven increases in community transmission, PolicyLab found. (PolicyLab's school guidance, updated this week, can be found here.)
Even if there is a instance or two of on-campus Covid-19 transmission, it can be handled without closing down, if contact tracing identifies and isolates them promptly and overall safety practices are solid, PolicyLab said.
In Lancaster County all 16 school districts, the Lancaster County Career & Technology Center and the La Academia charter school have reported at least one Covid-19 case, according to LNP newspaper, more than 100 in all. To date, 10 schools have had temporary school closures due to the virus.
"It is a trying time to be a school director," said Adam Aurand, a spokesman for the School District of Lancaster.
The district had to delay its return to in-person instruction this month, in light of local case rates.
"It remains our goal to return students to their classrooms as soon as it is safely possible to do so," Superintendent Damaris Rau said in a statement.
Said Aurand: "There is a danger to keeping children out of school, and we need to weigh those factors as well."
School sports appear safer than some researchers initially feared. Cases associated with school sports seem to stem from activities off the playing field: Bus rides, meals, team parties and so on.
Rubin said feelings of "pandemic fatigue" are understandable, but now is not the time to give up.
“People are sort of like, ‘Well, maybe we can just blow through this,’” he said.
“You can’t blow through this. Some sacrifices need to be made."