Dr. Donald Yealy, chair of emergency medicine at UPMC, speaks during a news conference Tuesday. Photo provided by UPMC

There is no medical reason to postpone reopening the economies of areas served by the University of Pittsburgh Medical Center, which includes Jamestown through UPMC Chautauqua.

Dr. Donald Yealy, UPMC Department of Emergency Medicine chair, said during a news conference Thursday that UPMC and University of Pittsburgh are prepared and ready to care for COVID-19 patients as well as provide its standard care offerings while pandemic restrictions are lifted in the communities it serves.

“We can safely reopen not only our hospital care, but the region and society in all the areas that UPMC serves by protecting the most vulnerable, particularly the elderly and doing things safely and smartly,” Yealy said. “We know how to do that.

“We’ve flattened the curve long enough to make sure the hospital system has plans ready and can implement them and can continue to manage COVID-19 infected and ill patients. We’ll need to do this as long as we can because the disease is going to be with us for months to years. As long as we have the coronavirus, as long as we have the flu, the issue is protecting those who are most vulnerable, particularly the elderly and not halting every social interaction or driving our economy into a depression.”

Yealy’s comments come in the midst of conversations about how to reopen economies across the country. In New York, Gov. Andrew Cuomo has a checklist of 12 points that must be met before regions can reopen. The regions are set by Regional Economic Development Council boundaries, which means Chautauqua and Cattaraugus counties fall into a region with Buffalo. Once the initial 12 points are met, there are four phases to reopening New York state. The first phase would open manufacturing, construction and restaurants for curbside pickup. The second phase would include professional services, retail and real estate. Phase three would reopen restaurants and food services while the fourth phase would reopen arts, sports and education. Reopening would still come with social distancing and enhanced hygienic protocols.

Pennsylvania Governor Tom Wolfe, on the other hand, moved several rural counties including Warren County into a “yellow” phase of reopening, which requires telework where possible, businesses with in-person operations to be open with restrictions, child care facilities open with guidance, stay-at-home orders being lifted though large gatherings of more than 25 people are still prohibited, in-person retail being allowed with curbside and delivery still preferred and the continued closure of indoor recreation, gyms, hair salons, casinos and theaters.

“We can manage society in the presence of this pathogen and we’re going to have to manage society in the presence of this pathogen if we focus on existing conditions, particularly those related to the harm of the virus,” Yealy said. “Put it another way. We’re not going to be able to fix in the short-term the ability to completely eradicate the virus. We’re waiting on those developments. However the problem we can fix is to focus on isolating and addressing the conditions of the most vulnerable part of the population. If we focus on the elderly, we will bring down the death rate. We can get that below 1% easily by focusing on those who will do poorly.”

‘READY FOR A SMART REOPENING’

When asked how businesses should move forward, Yealy said businesses and individuals should focus on basic things like not coming to work if sick, workers keeping as much distance from each other as possible, wearing masks, limiting congregation and simple personal and workplace hygiene. Widespread testing without forethought may not be necessary to reopening society, Yealy said. Cuomo is requiring 30 tests per 1,000 residents monthly.

“I think by starting with basic, simple things like that will help everyone remain safe while we begin to reopen society,” Yealy said. “I don’t think things like new medications or requiring testing of certain groups without any forethought is going to be the most important part of the strategy. We’re doing that in a coordinated fashion to inform the community. I don’t think for any individual businesses, unless there is anything else going on, that’s really going to be necessary.”

Claims of asymptomatic transmission may be overstated, Yealy said. Of nearly 1,000 patients tested in Western Pennsylvania, no one has had evidence of the virus without symptoms. Only three of 1,500 cases across Western Pennsylvania, New York, Maryland and Central Pennsylvania have come out positive, leading UPMC officials to believe the frequency of silent carriage locally to be low. Yealy said it is likely antibody testing offered in UPMC communities will confirm that community prevalence is low as well.

“We are ready for a smart reopening of society in all of the communities that we serve,” Yealey said. “We know that any long-term shutdown has impacts not only on our personal lives but on our economy, and we have already seen consequences to this on both physical and mental health.”

Yealey noted the experiences of the Diamond Princess off the coast of Japan and Grand Princes cruise ships. Among the more than 3,711 passengers and crew on the Diamond Princes, 712 became infected with the coronavirus. Half had no symptoms. Fourteen people died, nearly all of whom were over the age of 70. Yealy compared that to the USS Roosevelt, an aircraft carrier with a crew of 5,000 that had COVID-19 detected on board. A thousand sailors tested positive, seven were hospitalized and one died.

“The lesson to be learned here is that closeness and density are important risk factors but especially so for people who are vulnerable,” Yealy said. “For healthy people in all walks of life, from school teachers to sailors, having the virus will likely yield either no symptoms or a symptom that feels like the cold or the flu. This contrast has real implications that we haven’t fully embraced yet. COVID-19 is a disease that attacks many, but it ravages those with pre-existing conditions, especially the elderly.”

FLATTENING NEVER MEANT ERADICATION

Yealy said physical distancing and social isolation were necessary in March when restrictions started, but that the curve has been flattened and hospitals and health care providers can provide care without being overwhelmed by virus cases. UPMC hospitals have the equipment, space and plans to move quickly as the COVID-19 pandemic continues regardless of which curve exists and no matter the local experience. There will be new COVID-19 hospitalizations and cases, but the communities UPMC serves are able to handle those new cases regardless of how quickly they come, Yealy said. UPMC facilities have more than enough ventilators, protective equipment and beds on hand.

“We know a lot about the virus,” Yealy said. “We’re at a very different place today than we were at the beginning of our experience. We are much more prepared. We are ready to continue to provide both care and guidance. We started physical distancing and social isolation back in March. One of the reasons was to flatten the curve, which means a slower growth of cases to prevent our hospitals and particularly our ICUs from becoming overwhelmed. This worked in all of our communities that UPMC serves and it worked because of you, and we thank you. But flattening the curve did not mean that we would get rid of the virus or ultimately lessen the number of people who develop COVID-19 infections or illnesses. It simply spreads the cases out over a longer period of time while we learned to provide care and have other interventions. While we await rapid breakthroughs that we’ve talked about like vaccines for immunities through antibodies, we expect that approximately the same number of people will get infected whether we flatten the curve or not. It’s just a matter of when.”