By all accounts, Philadelphia should have been a COVID-19 disaster.
The sixth largest city in the country, its 1.5 million residents were in easy driving distance from New York and New Jersey, some of the worst hotspots of the virus.
Social distancing and working remotely weren’t a possibility for many of its citizens, given that Philadelphia has the highest poverty rate of any large city in the nation, with nearly 25% of its population under the poverty line. Add to that a population rife with high risk factors like smoking and diabetes, and it only made sense for Philadelphia to become a COVID-19 tragedy.
Certainly, the pandemic took a brutal toll on Philadelphia, with more than 34,000 getting infected and more than 1,700 dying.
But the City of Brotherly Love avoided the fate of nearby neighbor New York City. Hospitals were never overwhelmed and, since the beginning of May, the spread of the virus has had a relatively downward trajectory. The rate of positive tests is less than 5 percent, better than several other counties in the state.
Much of that success is due to quick and strong actions from state and city authorities, according to Dr. Yvonne Michael, an associate professor of epidemiology at Drexel University. She cited the city’s early stay-at-home order, its caution regarding opening up (Philadelphia just resumed indoor dining on Sept. 8) and its population’s willingness to wear masks, with the city estimating that roughly 80% of the population is wearing them outdoors.
“I’ve been impressed with the leadership that our mayor and health leaders have shown,” Michael said. “Philadelphia didn’t have the same kind of spike that we saw in New York. I’m not saying we completely skated, but we didn’t hit the crisis point that some other large cities did with other challenging profiles.
“It doesn’t mean it can’t happen, but it does mean that our leadership and our citizens have really taken this seriously,” she said.
Still, Philadelphia is by no means thriving in the midst of the pandemic. COVID-19 amplified chronic challenges for the city, such as poverty, affordable housing and food insecurity. Unemployment rose from 7% in March to 19.6% in July. Frustrations abound as aid programs became overstretched and basic city services, like sanitation, struggled.
Jefferson Health, the hospital system that would ultimately take some of the most COVID-19 patients in the Philadelphia region, began preparing in January.
The system stockpiled personal protective equipment and crafted plans for handling a crisis. It set up an incident command structure, where a central team could develop protocols and implement change when needed. As March drew close, the leadership team met virtually with healthcare workers in Italy, where COVID-19 was already surging, to better understand the pandemic.
“We really partnered around the world to make sure we could closely monitor the situation and prepare,” said Stephanie Conners, Jefferson Health’s Chief Operating Officer.
It was all part of Jefferson’s decision early on to always be on the offensive when it came to the pandemic.
Even then, COVID-19 proved to be a curveball.
“It’s worse than what we expected,” said Conners. “I don’t think anybody could have anticipated the magnitude with what occurred or how it impacted our health system. We prepared for the worst, but I don’t know that we expected the worst.”
The Philadelphia Department of Public Health was developing plans of its own.
Workers prepare a COVID-19 test in a tent at the Jefferson Health testing site in the Navy Yard in Philadelphia in August. Sean Simmers | firstname.lastname@example.org
Led by Dr. Thomas Farley, the city’s health commissioner, the department took decisive action within 48 hours of the city’s first case of COVID-19 on March 10. A prohibition on large public gatherings was issued on March 12. Within a week, Gov. Tom Wolf moved to shut down schools and nonessential businesses statewide. The city issued a stay-at-home order that went into effect on March 23, when there were only 175 confirmed cases.
In contrast, New York City’s order that shut down nonessential businesses didn’t take effect until March 22. By then, there were already nearly 11,000 cases.
Michael credits the stay-at-home order as being one of the most important steps in curbing the spread of the coronavirus.
“Even days mattered at that point, because we’ve got this exponential case increase because of the way it spreads,” Michael said. “Even one day makes a big difference.”
Farley agreed, saying, “I’m sure that was the reason that our peak and our peak mortality is lower than that of New York.”
What made the shutdown order so effective was the fact people took it seriously.
“I thought people would resist it, but I found it was the opposite,” Farley said. “There was a lot of fear, and people were, if anything, wanting us to be more restrictive sooner — even though there were only a few cases at the time.”
New York also highlighted the need to prevent hospitals from reaching capacity.
“There was a threat our healthcare system would be overwhelmed,” Farley said. “Even though we thought it was possible we may never need the facility, we felt we had to make one available.”
Enter Temple University’s Liacouras Center. The college arena was transformed into an emergency surge hospital, outfitted with emergency generators, oxygen masks and 200 beds.
Pennsylvania Task Force 1 member Greg Rogalski walks amongst the beds of a Federal Medical Station for hospital surge capacity set up at Temple University’s Liacouras Center in Philadelphia on March 30, 2020. Matt Rourke, The Associated Press
Just a few weeks after opening on April 16, the field hospital was closed. It only had helped 14 patients. Creating and operating the facility cost the city around $5 million.
“Better to build it and they don’t come, than to not build it at all,” said Philadelphia Mayor Jim Kenney at the time.
The Philadelphia health department said the money spent to make the surge facility wasn’t wasted. All the equipment was purchased by the city and now sits in storage, ready to go if there’s another wave or another pandemic hits.
As the Liacouras Center waited for patients that never came, Jefferson Health was approaching its peak time for COVID-19 hospitalizations. On two days, April 23 and April 29, there were 564 COVID-19 patients in the hospital system.
“At that point, we were starting to get concerned about our critical care beds,” Conners said.
That’s when the health system’s surge plan came into play, making it so Jefferson could move staff from one hospital to the next, as needed. Because of that plan, Conners said that the health system never had to close its doors. It also allowed the hospital to implement changes quickly.
“We’ve changed more policies and procedures in these six months than an organization could reasonably change in years,” she said.
Despite taking thousands of patients, there was no one who became sick from COVID-19 because of their trip to the hospital, Conners said. Only around 1% of employees came down with COVID-19, and Conners said that even those cases can’t be traced back to the hospital. Those two numbers are something she and the health network are proud of.
The side effects
At Philabundance, the food inventory went quickly.
The nonprofit is the largest hunger relief organization in the Philadelphia region, outfitting other food banks and helping with the city’s food distribution efforts. Philabundance and its partners are all reporting a 40%-60% increase in demand. It’s been able to meet it, to a point. When its fiscal year ends on Sept. 30, Philabundance estimates it will have distributed 50 million pounds of food – 20 million more than they had planned.
It’s not enough, though.
The nonprofit Feeding America estimates that an additional 77,000 people will face food insecurity in Philadelphia in 2020, largely because of the coronavirus pandemic. That’s more than the population of Harrisburg. That’ll put the number of people experiencing food insecurity in Philadelphia to around 335,800.
“Quite honestly, food banks never fully met the needs that exist with food insecurity,” said Stacy Behm, the chief programs officer for Philabundance. “That’s where the government steps in quite a bit. Their dollars go much further than what a nonprofit food bank can ever do to meet the need.”
Philabundance teamed up with the city to distribute 400 boxes of food every Monday and Thursday at 40 different sites.
The city’s newly created Office of Children and Families led the way in organizing food distribution. The department’s head, Deputy Mayor Cynthia Figueroa, was appointed on January 6.
“It was an absolute commitment from everybody who was in the room that feeding kids, adults and seniors, and making sure food deliveries happened for individuals with disabilities, was an absolute priority,” Figueroa recalled.
Charles Reyes has been on the frontlines, distributing food three days a week in his role as the community schools coordinator for Murrell Dobbins CTE High School. Prior to COVID-19, he was giving out 400 boxes of fresh fruits and vegetables every Wednesday, roughly 4,000 pounds of produce. Now he’s giving food boxes out Monday, Wednesday and Thursday. He never has food left over.
His food distribution events have become de facto support centers, as many of those he is helping have never needed help getting food. They don’t know how to navigate the city’s support programs. So Reyes tries to bring in other nonprofits to help people find aid, whether it’s information on where to get help with housing, electricity or employment.
Sometimes he has masks to give out, other times there are care packages filled with deodorant, toothpaste and hand sanitizer.
“I think the need is definitely overwhelming,” Reyes said. “But I think the city has done a fantastic job of responding. It does my heart good to see that during a pandemic, there have been a lot of food distributions taking place throughout the city. I’ve never seen as many food distributions in the city of Philadelphia in my 45 years as I’ve seen over the last six months.”
Philadelphia City Council member Maria Quiñones Sánchez set up a site at Ferko Playground in Philadelphia in August to help residents sign up for LIHEAP Recovery COVID Program. Sean Simmers | email@example.com
City councilmember Maria Quiñones-Sánchez isn’t as impressed with the city’s handling of the coronavirus. According to her, the city’s bureaucracy has just added another layer of frustration to the pandemic.
Quiñones-Sánchez represents the 7th district, which is much of North Philadelphia, including the troubled Kensington neighborhood. Most of her constituents are essential workers, which means staying home wasn’t an option for them. They couldn’t afford to quarantine, and calling in sick meant the loss of a much-needed paycheck.
Plus, she had to close her own offices because of the pandemic, which means she hasn’t been able to get in touch with people and help them get what they need as easily as before.
She’s concerned largely with the new poor, who are just figuring out how to navigate the city’s aid systems. Usually her office would be a go-to spot to help them out. Now, they have to look elsewhere.
“People who have never been in this situation are losing their minds. They didn’t know how difficult it was to access services and relief programs,” Quiñones-Sánchez said. “It’s just really mind-boggling the amount of work that we have to do, and how much harder it is to do some of the basic services that we were easily able to do in our offices.”
It speaks to a core problem in Philaelphia’s handling of the pandemic, according to Quiñones-Sánchez. The city, she says, is reacting to the pandemic. It isn’t getting ahead of the problem.
Case in point: the city’s summer trash dilemma, where collection was delayed for days and garbage stacked up in the streets. The cause was a lack of sanitation workers, because so many were testing positive for COVID-19 or having to isolate due to exposure. This came after sanitation workers asked the city for better protective equipment and hazard pay.
“The administration has picked and chosen when they’ve wanted to use the pandemic as a reason to invest and manage,” Quiñones-Sánchez said. “This trash problem should never have gotten so out of control. We knew hundreds of sanitation workers were getting COVID-19 and we knew they were in harm’s way. We should have been prepared for and we should have been willing to do whatever was necessary for them.”
Communication has been a big failing of the government in the pandemic, according to Quiñones-Sánchez. The federal government has one set of rules, the state another and the city yet another.
“It wasn’t that people weren’t working hard and that people weren’t trying,” Quiñones-Sánchez said. “I think we forget that people don’t know how to separate one government from another.”
It didn’t help that there were numerous relief programs, with the federal government, state government and city government each rolling out a new program, each of which required a different application.
“We couldn’t line up our own bureaucracy to streamline that to help more people,” Quiñones-Sánchez said. “It just amplified the fact that as much as we think we work together and are sending one message, we aren’t. The implementation of how we provided help was a perfect example of it.”
A person walks past a storm drain with discarded gloves and other trash in Philadelphia on May 25, 2020. Matt Rourke, The Associated Press
It’s not just a Philadelphia issue, either. She cited the state’s LIHEAP program, which helps people with lower incomes pay for electricity and gas.
“We know people are home. We know millions of people have lost their jobs. Why couldn’t the state just send out pre-populated applications to people who have applied in the past and say update your income?” she said. “But no, we literally have to do brand new applications for folks in the middle of the pandemic.”
Quiñones-Sánchez hosted an outdoor event where residents could schedule appointments to get help with the application process. She scheduled it for two days. It didn’t take long before she was fully booked.
While the city gave out food and city council members tried to help constituents cut through red tape, other organizations strove to help the city’s homeless.
In a pandemic, those living in shelters or who are homeless are some of the most at-risk of getting deathly sick, according to the CDC. In Philadelphia, where before the pandemic more than 6,000 people were living on the street and more than 8,000 were living in shelters, that marked a serious problem.
That’s where Project HOME came in, a nonprofit geared towards helping those in poverty who are struggling to find housing. Project HOME started its plan for the long-term effects of the pandemic back in March.
“For people who are homeless and living in congregate sites, they’re as vulnerable as the prison population or the nursing home population,” said Monica McCurdy, vice president of healthcare services for Project HOME.
Homeless people have a greater potential to infect many others, especially if they’re out and about.
“If you get an outbreak of 100 people who are homeless, they’re not only endangering themselves but the city,” McCurdy said. “All the workers that engage them, all the police, the EMTs, the hospital workers and everybody else who is trying to engage these folks.”
As the pandemic spread, she noticed that people were expressing reluctance at going to shelters, as they were worried about potential exposure. Even though fears of a mass outbreak in a shelter never came to fruition, she couldn’t blame them.
“It was really, really, really stressful when you would walk in places where 25 people would sleep in a room,” she said. She recalled in April walking into shelters that were nearly full. “We needed to figure out how to separate people more, because if one person got it in that space, then we’d be in trouble.”
It underlined the need to open up protective housing for those living in shelters, safe havens or boarding homes. That way those who were at higher risk of COVID-19 could be offered a place to go where there was less dense housing so that they could be safer. That came about in late April, but McCurdy said it was needed much sooner.
Bonnie Chen administers a COVID-19 test to a patient in a car at the Jefferson Health testing site in the Navy Yard in Philadelphia. Sean Simmers |firstname.lastname@example.org
Testing the unsheltered population proved to be another challenge. Project HOME set up a medical tent back in April to help with testing efforts. Since then it has conducted more than 650 COVID-19 tests.
In the beginning, results could take more than a week to come in, which posed problems. Many people didn’t have phone numbers, so Project HOME couldn’t simply call them up with their results. They didn’t have addresses, so mailing results was out of the question. They had to rely on people remembering to come back to get their results or having contact with someone who had a phone.
Then, there was the added dilemma of what to do if someone who was homeless did test positive. In early April, there was no public quarantine housing yet.
“We had this terrible conundrum of having this known positive person and nowhere to send them,” McCurdy said. “If they were willing to go back to shelter, we would tell them they have to social distance and they have to keep away from others. But often the person would say they were just going to go back out on the street. It was a terrible situation.”
For city councilwoman Helen Gym, housing became the number one priority during the pandemic. There didn’t need to be any new people added to that unsheltered population.
“Housing was a no brainer,” she said. “It was top of the agenda. If there is a stay-at-home order, then the home itself has to become sacred.”
That meant keeping people from being evicted. Before the pandemic, Philadelphia was one of the worst cities in the country in terms of evictions, with around 19,000 evictions estimated to have taken place in 2019, according to a report by the Reinvestment Fund. That’s hundreds of evictions every week, Gym pointed out.
“That is not something we can go back to,” she said. “It’s devastating and, in a pandemic, it’s deadly.”
In March, Gym introduced a resolution to explore temporary moratoriums on evictions and foreclosures — a resolution supported by the city’s sheriff department.
The city also set up the Eviction Diversion Program on August 31, a process that all landlords have to go through who are trying to evict tenants who have had a hard time paying rent because of the pandemic. The program is geared towards helping landlords and tenants come to an agreement that works for both of them without having to go to court. On Sept. 9, the municipal court banned all residential evictions through Sept. 23 in Philadelphia.
With winter approaching and restrictions loosening, there still are plenty of unknowns about what Philadelphia’s recovery from the coronavirus will even look like. The virus could become more active as the weather cools, like many other respiratory diseases. A vaccine could be distributed. It could get worse or it could get better. Sean Simmers | email@example.com
If and when the pandemic ends, Philadelphia can’t expect to just return to normal.
“What this pandemic makes clear is that in a city like Philadelphia, which suffers so much from poverty, education deprivation and housing needs — there is no sentimentality or romance in going back to normal,” Gym said. “We will have to alter the way things looked before in order to ensure our health and recovery on the road ahead.”
It’s part of the reason Gym credits the city’s activists as being part of the recovery effort.
“Right now the activists who are demanding housing, justice, policing reform, labor rights and better schools; they are recalibrating our understanding of what is decent, right and just in America,” Gym said. “They’re saying it’s indecent and un-American to be homeless. It’s indecent and un-American to be drowning in college debt. It’s indecent and un-American to be denied schooling because a corporation controls the internet.
“I think that, despite all the struggles Philadelphia is having right now, that activism is a very important key to our recovery. We shouldn’t silence it or be afraid of it.”
With winter approaching and restrictions loosening, there still are plenty of unknowns about what that recovery will even look like. The virus could become more active as the weather cools, like many other respiratory diseases. A vaccine could be distributed. It could get worse or it could get better.
Regardless, there are three key issues the city needs to be concerned about, according to Dr. Yvonne Michael, the epidemiologist from Drexel.
The first is the turnaround time for test results, something that has steadily improved recently. Getting test results in 14 days is “completely unacceptable,” in the words of Michael. People could unintentionally infect others while awaiting their results.
“We’re at the brink nationally and in Philadelphia of an eviction crisis, as people are unemployed and losing the benefits they had throughout the pandemic and the protection against evictions are coming to an end. Putting people out on the street and that kind of level of insecurity could have really big repercussions.”
Dr. Yvonne Michael, an epidemiologist at Drexel University
The second is contact tracing.
Contact tracing involves an infected person sharing information on people they have interacted with, so the health department can call those people and encourage them to quarantine or get tested. But, as of August 13, only 65% of those infected have agreed to participate in the contact tracing, according to the health department. And a third of those who cooperate tell the contact tracers that they didn’t interact with anyone or they don’t want to share names.
“That’s way below what you’d want to see,” Michael said.
Then, there’s one of the biggest looming problems of all — the potential eviction crisis.
“We’re at the brink nationally and in Philadelphia of an eviction crisis, as people are unemployed and losing the benefits they had throughout the pandemic and the protection against evictions are coming to an end,” Michael said. “Putting people out on the street and that kind of level of insecurity could have really big repercussions.”
The crisis shouldn’t happen right away, thanks to a national eviction moratorium issued by the Centers for Disease Control and Prevention. Still, housing advocates are anxious to see how effective these protections will be.
And eventually the eviction moratorium will end and the question will remain: what next?
Over at Project HOME, McCurdy is worried for when that time comes and more people become homeless. “Where is their safety net?” she asked. “The system is already stressed.”
The same is true for the food banks. As demand for food has grown, supplies from donations have dwindled. Philabundance has had to buy more food to help meet the need, and food is more expensive due to high demand. The organization is worried as the weather gets worse, people will have to decide what’s more important: food or heat.
The city can only help so much, according to Deputy Mayor Cynthia Figueroa.
“My main concern is just how long it will take us to economically recover from the pandemic,” she said. “And then to make sure that we have the ability to continue to support families as needed, knowing that the city has faced a tremendous deficit as a result of the pandemic.”
“We’re trying to do as much as we can with the resources that we have, but it does feel like we’re maxed out,” she continued. “I would hate to see us be put in a situation where there’s another huge problem to solve and no resources to figure out how to solve it.”