People gathered at the North Shore Tavern Bar on the North Side of Pittsburgh in late June. Photo / AP
Pittsburgh, a sister city to Wuhan, China, saw only modest cases for months. In the last two weeks, cases are suddenly soaring.
A little more than three weeks ago, officials in Pittsburgh announced a milestone enviable for almost any major city in America: A day had gone by without a single new confirmed case of the coronavirus. It was good news for a city that had seen only a modest outbreak all along, even as the virus raged through places like Philadelphia and New York.
That was then.
Western Pennsylvania is suddenly experiencing an alarming surge of infections. Allegheny County, which includes Pittsburgh, reported more than 100 new cases for the first time on June 30; two days later, the daily case count surpassed 200. Over two weeks in late June and early July, the county recorded more new cases than in the previous two months combined, and on some recent days has accounted for nearly half of all new known cases in Pennsylvania.
"Allegheny County is the big area of concern at this point," Gov. Tom Wolf said at a news conference last week. "There have been others more modest," he said, "but right now Allegheny County is the area."
The spike in the Pittsburgh area offers a cautionary tale: Even after months of vigilance, an outbreak can flare up all of a sudden. While the nation's current flood of new cases is being driven primarily by the spread of the coronavirus in the South and the West, experts fear that other parts of the country — including places like Cleveland, Milwaukee and Kansas City, Missouri, which are all seeing new growth — could be close behind.
"You are seeing what could be the beginning of what we've been seeing in Texas and Arizona," said Dr. Bill Miller, a professor of epidemiology at the Ohio State University. He described upswings in urban counties in Ohio, a state that saw weeks of steady or declining cases but is now averaging more than 1,000 new confirmed cases a day, the worst so far of the pandemic.
"We can't let our guard down," he said.
For months, Pittsburgh had been both diligent and lucky.
The virus began spreading here later than in some early centers of the nation's crisis, like New York City or Detroit. That gave Pittsburgh time to prepare. At the same time, Pennsylvania, which began facing skyrocketing rates in the eastern half of the state, took a more aggressive approach to shutting down public life than states like Florida and Texas, which closed later and reopened earlier.
Pittsburgh, which has an economy driven by the health care industry and is a sister city to Wuhan, China, where the coronavirus first emerged, took the threat seriously. Its 300,000 residents largely abided by the new way of life, ordering their pizzas from Mineo's to go, drinking their Yuenglings on the porch at home and wearing masks for grocery trips to Giant Eagle, even as the case numbers remained relatively low.
From March 23, when the governor ordered everyone to stay at home, until June 5, when Allegheny County was allowed to lift the more stringent restrictions, the city had hunkered down. But it was not long after that limited reopening in June, as people flocked to bars for the first time in months, that the seeds of the current surge were planted.
"You have to realize: The virus isn't going to go anywhere until there is a vaccine," said Dr. Amesh Adalja, a Pittsburgh-based physician and a senior scholar at the Johns Hopkins University Center for Health Security. "You are going to see these flare-ups in any city because wherever there are people, there is this virus."
Two weeks ago, Wolf, a Democrat, issued a statewide mask order in response to the mounting cases, a move that was swiftly followed by the governors of West Virginia, where the order applies to indoor public spaces; and of Ohio, where the order applies to hard-hit spots including Cleveland, Cincinnati, Columbus and Dayton. On Thursday afternoon, the governor of Kentucky announced a statewide mask order as well.
On Wednesday, health officials in Allegheny County banned indoor dining for two more weeks.
The next few weeks could prove pivotal for Pittsburgh. There has been a modest if notable rise in hospitalisations, but so far very few Covid-19 patients at the major hospitals are in need of ventilators, hospital officials said. On several recent days, the median age of people testing positive for the virus has been 29, far lower than it was several months ago. Many of them have not had symptoms, officials said, and were prompted to get a test only after learning from a friend or a contact tracer that they had been around someone who tested positive.
"I wasn't necessarily scared," said Christian Glikes of Pittsburgh, who learned that he may have been exposed at an outdoor game of cards this month. He drove more than an hour to get a test at a CVS store in St. Clairsville, Ohio, the closest he could find on short notice.
"I'm healthy, I'm 24 years old," Glikes said while at home waiting for his results. "My only concern is giving it to people who aren't so healthy."
Some rise in case numbers is inevitable when lockdown orders are lifted and cities enter less restrictive stages of the pandemic response — what the Pennsylvania government has deemed "the green phase." When Allegheny County entered the green phase in early June, hair salons and gyms opened for the first time in months, though under strict rules, and bars and restaurants allowed some indoor dining. At the same time, large anti-racism protests were taking place across the city, and some Pittsburghers were taking vacations in places like Miami and Myrtle Beach, South Carolina.
"I knew we would have a bump," said Mayor Bill Peduto, a Democrat. "The question is whether or not it would exceed the numbers that we had seen earlier. It not only exceeded them; it doubled and I think tripled them. It wasn't supposed to do that."
The main source of the current outbreak is largely undisputed. People who had been cooped up for months flocked to the city's bars and clubs, crowding shoulder-to-shoulder like old times on East Carson Street. Complaints poured into the health department about bars ignoring the pandemic rules. "It was almost like the entire city turned 21," said Adalja, who added that he took walks past crowded bars that he suspected would turn into hot spots.
Kyle Majerick, a 29-year-old insurance salesman whose evenings before the virus were typically filled with intramural soccer games, happy hours and charity and networking events, was more than ready to have a few beers with friends when the bars reopened. He said he took care to avoid the most crowded spots.
"You go from having something to do every single night to, 'OK, where am I going to order takeout from and sit at my condo by myself,'" he said. Sitting at a half-empty outdoor bar patio and ordering from a list of options on his phone instead of a touchable table menu, he said, felt safe.
"It was a change of scenery, which was a breath of fresh air," Majerick, who has not had symptoms, said.
Through contact tracing, county officials found that bars and restaurants were the most common denominator of new cases and once again shut down indoor dining. For business owners, the new rules have been dizzying and disheartening.
Even after the city's reopening, Jamie Patten kept customers out of her quiet neighbourhood wine bar, the Allegheny Wine Mixer, so she could ensure that it was safe. She set up a reservation system for the first time, bought outdoor furniture and installed plexiglass along the bar itself. On Jun 27, the bar opened and regulars returned. A day later, under countywide orders banning the on-site consumption of alcohol, it closed again.
"We did all this work, we did everything we were supposed to do, and we were seeing results," Patten said. "Now it's all just kind of swept away."
Now officials say they are trying a more targeted approach as they search for a way forward, and are adjusting them weekly. Under the latest county order, for example, gyms and hair salons can stay open, at least for now, but indoor dining is barred.
Rich Fitzgerald, the Allegheny County executive, said the county now was using what officials learn from contact tracing to more precisely identify venues that pose the most significant risks. And the county also was turning more attention to enforcement, Fitzgerald said.
"Get rid of the bad apples," he said.
State and county officials expressed little appetite to return to a full lockdown, though they said nothing was off the table.
Bethany Hallam, a member of the Allegheny County council, said that terminology the state uses may also need rethinking. Under the governor's plan, moving counties into the "green phase" never meant a return to normal, only to a less restrictive set of rules. But that is not how many people apparently heard it.
"To anybody from a 2-year-old to a 100-year-old, 'green' means go," Hallam said "We went to green, and everybody went wild.
"The world is not green," she said, "until we have a cure or a vaccine."
Written by: Campbell Robertson and Sarah Mervosh
© 2020 THE NEW YORK TIMES
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