Members of Lancaster County’s Health Advisory Council on Friday continued their discussion of Covid-19 pandemic, and whether mitigation policies such as masking, lockdowns and vaccination mandates were misguided and should have been recognized as such as the time.
As he did at the council’s previous meeting in September, Dr. Bryan Cicuto maintained that those directives were either useless or counterproductive, and that the Amish, who largely continued normal life and let the coronavirus take its course, had the right approach.
“I think that the data is starting to show that now,” he said.
Actually, while data on Amish Covid deaths is limited, it suggests the community fared significantly worse, not better, than the general population, said Dr. William Fife of Penn Medicine Lancaster General Health, who attended Friday in place of council member Dr. Jeffrey Martin.
Fife cited a study by West Virginia University researchers published in the Journal of Religion & Health. It found that Amish deaths in 2020 — the first year of the pandemic, before vaccines became available — jumped about 45% compared with the 2015-19 baseline average (and by 55% looking only at the period March-December). By comparison, deaths in Lancaster County jumped 17.5%.
Several council members objected that the excess-death data doesn’t assign causality. The Amish stopped coming to hospitals during the pandemic due to the protocols that were in place, and so may have died from treatable conditions, suggested Dr. David Gasperack, regional medical director for WellSpan Health.
Cicuto agreed. The idea that the Amish would have fared better had they embraced mainstream guidance is “a big leap” and “absolutely wrong,” he insisted.
But Alisa Jones, CEO of Union Community Care, urged common sense. If a deadly new virus appears, followed by a sharp spike in deaths, surely it’s reasonable to attribute cause and effect, rather than stretch for more indirect explanations.
Fife also took issue with Cicuto’s citation in September of a Cochrane Library review to conclude categorically that masks don’t work. The review was inconclusive, he said, in large part because people don’t follow mask mandates consistently. While randomized controlled trials have come up short, physical and epidemiological studies provide considerable evidence that masks work.
It’s wrong to impose a mandate unless there’s rock-solid evidence for it, and for masking there isn’t, Cicuto said. Mainstream government and health institutions, he said, weren’t transparent about the rationales for their policies, and that has bred deep public distrust. Decisions made by outside entities were being imposed top-down.
Consider all the effort that went into masking and social distancing in schools, he said, compared to the miniscule risk to healthy children of serious illness or death due to Covid. Consider the disruption, and the ongoing mental health and trauma issues.
Loren Miller, Elizabeth Township administrator, said local officials like himself and his wife, a school board member, were blamed by the public for “capricious” guidance issued by higher levels of government. He said as a constitutional originalist, he is committed to citizens’ fundamental right to government access, and accordingly kept township offices open throughout 2020.
Council members agreed on the value of analyzing what was done and acknowledging any missteps. At the same time, several cautioned, many Covid policy decisions, especially early on, had to be made on the fly, based on limited and ambiguous data. That would likely be the case in a future pandemic, too.
The county commissioners are not council members, but one usually attends each meeting. Commissioner Alice Yoder, who attended Friday, was LG Health’s executive director of community health during the pandemic. There was a local stakeholder committee that regularly met and discussed policy and guidance, she said: “Many of you took part in that.”
Remember what it was like in the first weeks and months, Jones said. The fear of death was acute and ever-present, and anything that could reduce the risk was being tried. Yes, most children are at low risk from Covid, but there was concern about them bringing infections home to vulnerable grandparents. The zeal over masks and social distancing and vaccines and all the rest was all about trying to keep people safe.
Yet amid all of that, “I know we didn’t create space for folks with a different opinion,” she said. “What I’m hearing you say is that there was an amount of trauma in that experience (and) no one has heard you out.”
That’s regrettable, she said, and going forward, there should be more space to take dissenting views into account, “because ultimately, the physicians in our county need to have a united message for the county.”
During the pandemic, people experienced deaths they never should have “because of efforts that we thought were the best at the time,” said council Chair Dr. Susanne Scott, a family doctor who works in hospice and palliative medicine. Leading a healthcare institution requires confidence, but also enough humility to acknowledge that “we don’t always know,” she said.
“I certainly appreciate you saying that,” Cicuto said. “I haven’t heard that from a healthcare leader in four years.” All he’s asking, he said, is for an honest review of the data, and candid acknowledgement if it shows certain practices were misguided.
Improving real-time access to data would be one way to be better prepared next time, Fife said, suggesting it as an action item that the council could put before the commissioners for consideration.
