It is week 27 of the COVID restrictions in the Commonwealth of Pennsylvania. We are definitely seeing another surge now that fall has arrived.

We’ve actually set a record number of new cases per day with 2200 new Pennsylvania “cases” on 23 October compared to the Spring peak in mid-April at about 1700 cases per day. Happily, at this new peak, hospitalizations are only 37% of their peak in the spring. The death curve remains flat.

Around here we are seeing some activity, including in my own hospital, but so far it is not overwhelming. And we have tons of potential ICU capacity based on our reshuffling of beds earlier this year.

A little perspective however is in order. According to the most recent data on the Pennsylvania COVID 19 dashboard, the test positivity rate for the state is still around 5%, and the overall percentage of ER visits for “COVID like illness” is .8%. There is considerable variation among the counties.

Other states are surging also. States like Minnesota, Wisconsin, and Ohio are having what one might say is their first big peak, with an accompanying admission peak, more commensurate to what we saw in April.

Governor Wolf has so far resisted the temptation to re-impose our Spring restrictions. I’m hoping he realizes that for many businesses, another shutdown would be fatal to their existence. This virus is apparently going to be persistent, at some level we are going to have to figure a “workaround “.

It should be a hopeful sign, that President Trump, and his affected staff, have emerged from their infections essentially unscathed. I do recognize there are people reading this that may have wished for another outcome. I also note that he was by current practice rather aggressively treated. When you compare his disease course to that of Boris Johnson, who became ill in the spring there is a symbolic cause for optimism.

Mr. Johnson is you may recall in early April, contracted the virus. He became rather seriously ill to a point of needing an ICU, and by contemporary accounts required considerable supplemental oxygen. Much like his American counterpart, I am sure he received the maximum therapy available through the National Health Service of Britain at the time. But now we have Remdesivir, antibody cocktails, anticoagulation, and dexamethasone. 5 months later, our head of state, despite being older, had a much milder illness and quickly returned to a rather vigorous schedule.

If I keep writing these articles on a 2-week schedule, the next one will be after the election. It is been fashionable to accuse our Democratic Governors of playing politics with the virus, I myself have been guilty of this. At times, like in mid-July when restrictions were reimposed while cases were still flat, it seemed likely.

There are those who find the current case surges in swing states suspicious. They note that many democrats have already voted by mail, whereas Republicans tend to wait to cast their votes directly. They suggest that these case “surges” are manufactured to discourage Republicans from in-person voting. I might have been open to this concept except as mentioned above, there appears to be real illness associated with the increasing case numbers, at least in our commonwealth. Still, with masks and distancing, I have no fear of the polling stations.

in response to these articles in the past, I have been criticized, particularly on Facebook, for what some people feel is a cavalier approach to this outbreak. I think I’ve been fairly consistent, suggesting that we not react merely to the number of positive tests, but to factors such as hospital utilization, and of course deaths, to decide public policy regarding COVID 19. Given what been going on in the last week, I think it is time to be more careful now. We need to go back to more frequent handwashing, the wearing of masks (for what it’s worth) social distancing, and protection of the vulnerable. We need to carefully balance our understandable desire to socialize, with the risks of gatherings indoors.

There is some reason for cautious optimism. Obviously, with every new case that is either asymptomatic or recovers, that’s one less person who can transmit the virus. With over 5000 positive tests for instance in Luzerne County, if you factor in the asymptomatic’s that were never tested, you may have a lot of immune people in the region.

We also note that the virus is thought to be getting less virulent as time goes on, which is predictable. So far it seems to be the case, that in regions that are having their second or third peak, hospitalizations and death are far lower than when the virus first appeared.

Also, according to Dr. Fauci, we are perhaps 3-4 months from when a vaccine will be available. It is my hope that we can all find safe ways to patronize our small businesses to keep them afloat until the end of the pandemic but still avoid unnecessary spread. We need to come out of this, intact and healthy both as individuals and as a society.

We need to be not fearful, just careful.

As always, I would be honored if you would share this post.

Header image: Witch Hazel (Fujifilm X100V, TCL X100)