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The Road Toward Recovery
A Story of Leadership and Community

 

Corey D. Fogleman, MD, FAAFP

NOTES OF APPRECIATION
Thanks for picking up this issue of JLGH. We are excited to present several thought-provoking articles this quarter, including features on the effects of SARS-CoV-2 on placenta pathology, pediatric cardiac-related syncope, and emergency contraception. I welcome several first-time writers, their insight and comments.

This is my first issue as editor in chief, and I would like to recognize those who have contributed to this transition. First, I extend gratitude to Dr. Larry Bonchek for his years of vision and leadership at the helm of JLGH. His personal touches and discerning mind brought a high degree of scholarship to this endeavor, the benefits of which continue to live in the memories of all readers and in our ongoing work within the health system and community. He certainly set a high bar, and as I stand on the shoulders of his ingenuity and all he endowed, I appreciate his careful mentoring and credit his enduring vision.

I have also been fortunate for the guidance of Drs. Christine Stabler and Pamela Vnenchak, as well as Designated Institutional Officer Barbara Flory and her colleague Sara D’Ascenzo-Labinski. They have made this transition much smoother than could have been imagined.

Now, it is my pleasure to welcome Maria Boyer, managing editor of JLGH. She is new to Penn Medicine Lancaster General Health, but not to our area, and she brings a wealth of experience in editing and within the health care industry. She has, in turn, been mentored by Jean Korten, the outgoing managing editor, and I am excited about Maria’s energy, her focus, and her many good ideas. You will find as you reach out to her regarding article proposals that she is welcoming and insightful. You can email her at maria.boyer@pennmedicine.upenn.edu. I am looking forward to a long and fruitful partnership! 

LANCASTER COUNTY HEROISM 
Like others, I have been struck by awesome efforts of compassion and leadership over the past two years. While there are too many to honor, this space seems perfect to recognize some who were able to rise to the occasion during the SARS-CoV-2 pandemic. I began by calling Dr. Jeffrey R. Martin, chair of the LG Health Department of Family and Community Medicine, to talk about the interface between medicine and public education. What could he tell me about the LG Health team he helped lead that was instrumental in turning Lancaster County back toward recovery?

The story of how Lancaster County schools safely reopened actually starts with the vision and insight of Lisa Riggs, president of the local nongovernmental nonprofit Economic Development Corporation of Lancaster. Recognizing that reopening our local economy would take a multipronged approach, she and her team — with input from municipal and county leadership — put out a Recovery Lancaster plan and created progress reports in conjunction with private businesses, and county and city leaders.

Riggs and LG Health’s Alice Yoder soon were in touch with Hempfield School District Superintendent Michael Bromirski, who had himself been contemplating this topic. Bromirski represented many school districts in conversations with county commissioners and health system leaders. He and Riggs agreed that functioning in-person school systems are a vital part of the current business processes and the future of our economy.

Lancaster General Health opened the first Lancaster County COVID testing site on March 18, 2020, and, as most know by now, would emerge as a leader regarding mass testing, contact tracing, mass vaccination, and systematic treatments using monoclonal antibodies. Then-CEO Jan Bergen and Dr. Michael Ripchinski were, at the time, quite busy brokering many working relationships.

In the spring of 2020, after intense conversations and lacking adequate state or federal guidance, Yoder, Riggs, and Bromirski called on Martin. CARES Act funding had been approved to help school districts move toward resuming classroom-based education, and the key to getting people back to work was getting students and teachers back in person.

Martin quotes his own residency director, Dr. Nikitas Zervanos, who taught him that “care of the whole community is right there in the name.” Martin is still on faculty with the LG Health Family Medicine Residency Program and a natural collaborator with a vested interest in bridging care gaps. This mentality led him, more than 10 years ago, to initiate a working partnership with IU13 and in 2016 to help establish, along with education leaders Anna Kennedy and Sherry Zubeck, the Medical Education Coalition. Together they have developed nursing care protocols, worked to augment mental health care challenges, and continue to present a semi-annual seminar series to which health care professionals have an open invitation to meet with educators sharing a mutual interest in student health. More information about this training and a lineup of future seminar topics can be found at https://touchstonefound.org/training/

So it was that Martin was an easy choice, along with Rosemary Search and Alice Yoder, to become the face of a contingent motivated to restart the engine and get the Lancaster County education system humming again. As an arrangement between a nonprofit health system, independent public school districts, and private ventures, this collaboration appears altogether unprecedented and yet herculean in both scale and success, garnering approval by the state Department of Health and enduring gratitude on the part of Bromirski, his colleagues and coworkers.

Occupational medicine-style school building walk-throughs included personal oversight by LG Health’s Nicole Meyers; each setting presented its own architectural character that helped clarify social distancing challenges and opportunities. These challenges would later explain why surging COVID diagnoses meant one school would need to close at the same time another could remain open.

The team put together nearly 20 webinars — facilitated by the strong work of Nicole Bumgardner — to describe rising and falling case counts, the science behind R values, how the vaccine manufacturing differed, and what rollout meant to different age groups. The result of this joint venture was the formulation of back-to-school protocol based on custom logarithms for each school created by the LG Health team in conjunction with local school districts.

From May 2020 to February 2022, Martin and the team conducted hour-long conference calls — usually thrice weekly — with district superintendents and principals, nurses, and school human relations representatives. Quick to give credit to Drs. Pat Moreno, Bill Fife, Fran Gross, Pia Fenimore, and Anne Reilly, among others, this team helped interpret and clarify the use of expertly crafted algorithms. Those decision trees needed constant updating and were thus housed in a “living format” that could be accessed on a website developed and maintained by Brenda Buescher.

Further, Martin, Yoder, and Search’s LG Health-based team helped several school districts set up their own testing sites and facilitated the implementation of school-based contact tracing programs. These integrated systems were both elegant and unique, increasing the speed with which action plans could be carried out at the school nurse level.

Altogether this team helped field more than 950 individual nurse case calls, 95 FAQs, and an untold number of individual questions. Eventually these efforts extended to, and helped guide, an even wider circle ranging from faith-based communities to higher education institutions (Franklin & Marshall College and Millersville University).

The results were monumental: In the 2021-22 school year, while our county saw unprecedented rise in SARS-CoV-2 cases due to delta and omicron surges, most Lancaster County school districts had no COVID-protocol closures. And, in spite of the absence of a county or municipal health department, Lancaster County’s case counts have been consistently lower than Berks County, our next most comparable neighbor in terms of size and resources (see Table 1 below).

Undeniably, there has been a tremendous loss of life and lifestyle to many here in Lancaster County, and the pandemic is not over. Yet, surely countless more individuals would have become sick and died had it not been for this tireless effort. Further, our economy would have continued to drag — every missed school day having a ripple effect on small businesses and our society — had it not been for this team of heroic Penn Medicine LG Health representatives. To you, on behalf of our community, I extend admiration and appreciation; truly, your insight into the ties that bind within our community, and your diligence and fortitude, have been life-saving and inspiring!

Statistics on population from https://worldpopulationreview.com/us-counties/states/pa

Statistics on COVID counts from https://www.nytimes.com/article/coronavirus-county-data-us.html

*Has county health department; **Uses neighboring county health department, announced in April 2022 the creation of their own county health department; #Has city health department within the largest municipality