Q&A With Dr. Robert Harbaugh ’74

Disclaimer: The opinions expressed here are Dr. Harbaugh’s and should not be construed to represent the opinions of Penn State Health or the Penn State College of Medicine.

What were the most significant challenges the healthcare system faced when the COVID-19 crisis first hit?

When we first saw the ravages of COVID-19 in Wuhan, China, Milan, Italy, and New York City, U.S., our nation was largely unprepared to face this kind of assault on our healthcare system. We did not have the protocols to deal with COVID-19 patients, a plan for where to cohort these patients, or a secure supply chain. It was fortunate that we were one of a few academic medical centers in the United States that received funding to develop the infrastructure and specialized training needed to offer care and limit the spread of lethal contagions.

Our Special Pathogens Team at Hershey had trained for years to respond to a pandemic such as COVID-19. This training helped us react quickly to treat COVID patients and keep our other patients, healthcare providers, and staff safe. It also enabled us to manage the supply chain that suddenly had new demands for the many articles needed to provide safe, efficient treatment and patient care. As an academic medical center, we also needed to figure out how to continue training our students and keep some research efforts while protecting everyone.

Finally, there was a palpable fear that this epidemic would overwhelm our health system. I am very proud of how Penn State Health responded quickly and effectively to these multiple challenges. We set up incident command centers for our hospitals and Penn State Health that functioned admirably to address all these challenges.

What are the biggest challenges the country, and Pennsylvania itself, still face regarding the COVID-19 pandemic?

A quote, often inaccurately attributed to Mark Twain, comes to mind: “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” We have learned a lot about COVID-19 in the past few months, but there are still many more questions than answers, and we need to recognize this.

We have learned that the overall mortality rate for this disease is much less than initially feared. Estimates have fallen from 4-7% to 0.1-0.4%—a really dramatic change. We also learned that COVID-19 deaths are highly concentrated in the elderly and those with underlying health problems. The mean age of patients who died from COVID-19 in Pennsylvania is about 80 years. Approximately two-thirds of the deaths occurred in residents of nursing homes or other extended-care facilities.

The risk to young, healthy people has not been zero, but it is very, very low. It also appears that this virus spreads preferentially indoors when there is prolonged exposure. Perhaps the New York City experience was so different from much of the rest of the country due to population density, use of subways, multigenerational families in small living spaces, policies that introduced COVID-19 patients into nursing homes, and the early, aggressive use of ventilators. Because New York City is the center of our national media, the horror that occurred there and in surrounding areas was the dominant story for weeks on end.

In 1968 the H3N2 virus killed about 100,000 people in the United States. As the U.S. population was about 200 million in 1968 and is about 330 million now, it is almost certain that the 1968 epidemic killed a higher percentage of the U.S. population in 1968 than COVID-19 will kill in 2020. We don’t know what would have happened in 1968 had we used the lockdown measures we used in 2020 or what the result would be today if we had followed the laissez-faire approach of 1968. We can speculate, but we don’t know.

The challenge we now face is how to do a reasonable risk-benefit analysis with incomplete knowledge. If our only goal is to reduce the number of COVID-19 cases, we can almost certainly do this with extreme lockdowns and severe social distancing. However, we might well cause more deaths and disability from other causes than we prevent from this viral illness. Finding the right balance is the challenge for Pennsylvania, the U.S., and the world.

One of the disappointing things about the last few months is how politicized the response to COVID-19 became. We created false dichotomies of health versus the economy and science versus religion instead of recognizing and discussing the tough decisions that need to be made with incomplete information. I fear this will continue. It would be refreshing to hear an honest assessment from our federal and state public officials, epidemiologists, and infectious disease specialists. I would like a frank discussion about all the things we don’t know and the difficult choices we need to make.

When do you anticipate that a vaccine will be developed? A cure?

The influenza A virus responsible for the 1968 pandemic mentioned above continues to circulate as one of the influenza A strains more than 50 years later. We have influenza vaccines, but as these viruses mutate, the vaccines are not effective against all strains, and we do not have a cure for the flu. I hope I am wrong, but I suspect we will be living with COVID-19, in one form or another, for a long time.

What are some positives we can take away from this crisis? What can we do to be better prepared?

I think the most significant positive is that we learned a lot about this virus and how to respond to a pandemic. If we could redo our response to COVID-19, there are things we could do differently—and better. We have also learned to keep our stores of protective equipment and medical supplies well-stocked.

We will continue to look for better testing options, treatments, and prevention strategies. One important message is that when faced with danger, it is essential to remain calm. During a long neurosurgical career, I have noted that the best surgeons do not respond to an intra-operative crisis with panic. They react with calm, quiet concentration. We rarely make good decisions when we light our hair on fire. Should there be a recurrence of COVID-19 or another pandemic in our future, we will be better prepared, mentally and physically, to deal with it.

Dr. Robert E. Harbaugh, M.D., FAANS, FACS, FAHA

Lebanon Valley College Board of Trustees

Senior Vice President, Penn State Health Medical Group

Distinguished Professor & Chair, Department of Neurosurgery; Professor, Department of Engineering Science & Mechanics Penn State Health Milton S. Hershey Medical Center Penn State College of Medicine