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State of the Lehigh Valley 2019-2020

www.lehighvalleyresearch.org

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Table of Contents Letter from the Director ...... 3 Community Resilience in the Face of a Pandemic ...... 4 Kristen Wenrich Perspectives from the 1918-19 Influenza Pandemic in Allentown, Pennsylvania ...... 5 Eike Reichardt An Examination of Food Access and Affordability in the Lehigh Valley at the Beginning of the COVID-19 Pandemic ...... 12 Chrysan Cronin, Cathy A. Coyne, & Hollie Gibbons Economic Challenges, Responses, and Outcomes During Spring and Summer 2020 ...... 20 Christopher S. Ruebeck & Sabrina Terrizzi Understanding the Psychosocial Impact of COVID-19 and Social Isolation on Mental Health and Emotional Well-being: Facing Challenges and Building Resilience ...... 26 Todd Hastings & Mae Ann Pasquale Members of the LVRC Executive Committee ...... 33 LVAIC Staff...... 34

Artwork throughout this report was contributed by LVAIC Schools Collection Compiled by Jill Odegaard Professor of Art, Cedar Crest College

*Cover Art Lehigh University Student, Ava Gellis, Shoes, tape, Spring 2020

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State of the Lehigh Valley 2019-2020

Letter from the Director

Dear Community Members of the Lehigh Valley,

I won’t be the first to say that we are living in unprecedented times. COVID-19 has challenged our region in ways unimaginable just a few months ago. Yet, despite the obstacles we face, the Lehigh Valley continues to push forward – the essence of community resilience.

That is why this year, the State of the Lehigh Valley focuses on community resilience and examines various ways our region has addressed COVID-19. In the pages that follow, readers will learn about some of the economic impacts on local businesses, the ways the coronavirus has affected food access, and the mental health implications of social distancing. While COVID has proven to be unique for our time, the Lehigh Valley has faced public health crises before and this year’s report also includes an historical examination of how Allentown fared during the 1918 influenza outbreak.

The members of the Lehigh Valley Research Consortium and authors and editors of the State of the Lehigh Valley hope this report will serve as a starting point for community-based conversations – be they face-to-face or virtual – on the ways COVID-19 has revealed both our strengths and weaknesses as we seek to become an ever more resilient region.

Thank you for your support and participation.

Sincerely,

Christine Carpino, Ph.D. Director, Lehigh Valley Research Consortium Assistant Professor of Political Science, Cedar Crest College

COMMUNTIY RESILIENCE IN THE FACE OF A PANDEMIC 4

Community Resilience in the Face of a Pandemic AUTHOR: Kristen Wenrich, M.P.H., C.P.H., Health Director, City of Bethlehem

A key cornerstone of public health Early on in the pandemic, preparedness is community resilience. Local organizations collectively met to discuss health departments play an integral role specific vulnerabilities and coordinate in resilience by preparing the community for all response efforts to address needs among types of disaster situations, responding when specific populations. The main goal of this emergencies occur and providing support collaborative effort was to ensure that through the recovery process. inequities weren’t intensified during the Although only Allentown and Bethlehem pandemic. Because many of these networks are covered by local health departments, the were already in place to address these issues Lehigh Valley is fortunate to have a strong prior to the pandemic, needs were emergency management infrastructure, two quickly prioritized and grant funding was exceptional health care networks as well as allocated to support agencies that provide a non-profit presence that, combined together, these critical safety-net services. This has fostered resilience during the pandemic in already existing infrastructure enabled the region. These collaborations served well organizations to successfully respond to the during the COVID-19 pandemic because key challenges presented during the community partners have been pandemic. The additional money that many planning for public health emergency situations governments and organizations are receiving for quite some time. through the CARES Act should be utilized So, what is community resilience? to augment our resources, which in turn will The Office of Human Services Emergency contribute to building a more resilient Preparedness and Response defines community. community resilience as the ability to withstand, Communities that are engaged in adapt to, and recover from adversity (Spark- strengthening systems and policies to Robinson, 2016, para 1). Although we still have address inequities on an ongoing basis are a long way to go, the Lehigh Valley has actively much better positioned to recover from been working on addressing issues that impact disasters than those who only address community resilience during disasters such as, medical and social needs during a housing, access to healthcare, food security, and disaster. The Lehigh Valley must continue social connectedness. These issues have been to prepare and respond to new threats and exacerbated during the pandemic as individuals the challenges they may pose while and families suffered from job loss, loss of continuing to address the social income, school closures and social determinants of health on a daily basis. isolation. These adversities are even more pervasive among specific populations who Reference already experience disparities, such as low- Spark-Robinson, L. (2016, March 31). Understanding income and minority community members. community resilience. U.S. Department of Health and

Human Services, Administration for Children & Families. https://www.acf.hhs.gov/archive/blog/2016/ 03/understanding-community-resilience

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Perspectives from the 1918-19 Influenza Pandemic in Allentown, Pennsylvania AUTHOR: Eike Reichardt, Ph.D. Social Sciences Division, Lehigh Carbon Community College Abstract Allentown, Pennsylvania’s response to the influenza pandemic that struck much of the globe in 1918 and beyond was dominated by a preoccupation with supporting the war effort in the Great War and struggles to balance public health measures with economic activity and patriotic duties. As a microcosm of the terrifying influenza pandemic that struck much of the world in 1918, the response and outcomes in Allentown, Pennsylvania seem to indicate that a swift and disciplined response was necessary in order to prevent the worst. However, residents of all income levels saw a financial or patriotic need to continue their contribution to the war effort, leaving few choices in how they would respond to restrictions on gatherings. Keywords: influenza, Allentown, pandemic, Pennsylvania

Perspectives from the 1918-19 Influenza Pandemic in Allentown, Pennsylvania

Although geographically in the Through immigration and migration, the mostly Pennsylvania German population Mid-Atlantic region, its economic and transportation ties to New York City have was becoming more diverse. New always placed Allentown in the periphery immigrants from Southern and Eastern and crossroads of the Northeast. After its Europe, as well as the Near East, fueled beginnings as a country town, Allentown the growing economy, despite their became a city in 1867, with a population condemnation in the local press, and their that still numbered less than 15,000 (Hall & numbers soon began to decline again as a Hall, 1987). In 1881, the Adelaide Silk Mill percentage of the population of Allentown opened, ushering in a new age of industrial (Adams, 2000, p. 5). success. Within five years, the Allentown In 1917, Allentown mobilized for Spinning Mill, the Pioneer Mill, and the war. When the war appeared to be near its Iowa Barb Wire Company (later part of the conclusion, the influenza pandemic struck American Steel and Wire Company) in September 1918. By 1918, freedom of followed. By 1882, the local cigar industry opinion, and varying public attitudes was producing over 17 million cigars toward the War, had been replaced by annually. In 1883, the Allentown Electric officially enforced patriotism. This Light Company, soon to be the Allentown situation complicated efforts to restrict Electric Light and Power Company, was public movement in order to fight the incorporated. Furniture workers were the pandemic, as martial attitudes, the first to organize “under the banner of the manufacture of war supplies and victory Knights of Labor” (Hall & Hall, 1987). parades took precedence.

Author Note Correspondence concerning this article should be addressed to: Eike Reichardt, Lehigh Carbon Community College, 4525 Education Park Drive, Schnecksville, PA 18078. Email: [email protected]

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Resources and Attitudes Concerning Public Health in the early 20th-Century Pennsylvania Although a Pennsylvania National Guardsman reported seeing “Chinamen Although initially lagging behind driving trucks” (Compton & Yessler, other U.S. states in the creation of public 2019, p. 41) in the Allied areas of France, health oversight and implementation, this cannot be seen as evidence of the since 1905, Pennsylvania’s Department of actual national origin of the truck drivers, Health had emerged as an exemplary nor as an indication of the spread of the institution. By 1917, the Board of Health influenza virus. Evidence of the pandemic operated on a budget of six million dollars in war-torn France, however, is all too and claimed having saved over 100,000 clear, and claimed as one of its victims the lives in the previous dozen years only nurse from Allentown to die in the (Higgins, 2017, p. 233). In the final war. Anna Marie McMullen, a 1915 analysis, the question is why the state graduate of the Allentown Hospital School government’s strong support for public of Nursing, succumbed to pneumonia on health still resulted in Pennsylvania October 6th, 1918, in France (Morning suffering the greatest numbers of Call, 1984). influenza victims in the country. The answer appears to be that public health The Influenza Pandemic Appears In the policing was a local option that was Lehigh Valley implemented with significantly varying degrees of conviction, resources, and Because of Allentown’s vital role outcomes. in contributing to war industries, the U.S. Public Health Service recommended that Overview of the Global Influenza all places in Allentown where the public Pandemic might gather indoors be closed. Mayor Alfred Reichenbach rejected the Federal Among historians, the debate over government’s suggestion, because the origins of the pandemic continues to Allentown was already the first city in the this day. According to Norman Davies, state to require mandatory reporting of flu the influenza pandemic could be traced to cases. By October 1st, there were 30 cases a swine flu outbreak in Iowa in January and two fatalities (Bartholomew, 1987, p. 1918, and arrived in Europe with 522). According to Higgins, the city of American troops that spring (1996, p. Allentown, under the leadership of mayor 777). Pamela Kyle Crossley et. al. write Reichenbach, attempted to ignore the that, “the disease appears to have pandemic. Schools and houses of worship originated in Kansas, perhaps when a in Allentown did not close until high virus among birds mutated into a form absentee rates and undeniably dangerous that could infect and be transmitted to conditions made their shuttering humans” (2013, p. 82). James Higgins unavoidable (Higgins, 2020). Far from states that, “an avian influenza virus quarantining at home, however, school moved from birds to human beings” in students began working in war industries, China (2018, p. 394). Davies and Kyle and only those under the age of fourteen Crossley et. al. agree that the first major were forced to return to class when the impact of the epidemic was felt among schools reopened (Bartholomew, 1987, p. the armies of the belligerents in France in 512). 1918.

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Allentown officials declined to implement Civilians were prohibited from entering the a joint quarantine with the city of camp except for official business. New Bethlehem and refused the help of medical arrivals to the camp were placed in guarded personnel from Camp Crane (Higgins, quarantine for 72 hours (Camp Crane, 2020).From a military perspective, the 2020). By October, Slee ordered the situation at Camp Crane, a temporary wearing of masks in certain situations. Army camp at the Allentown fairgrounds Enforcement proved difficult, however, was of primary importance. Located near because of the lack of oversight outside Muhlenberg College, the camp served to Camp Crane, as well as the dispatching of train and equip ambulance corps for the medical staff to other Pennsylvania war effort. The importance of the camp is hotspots, such as the anthracite coal mines. evident in that it served as the initial In addition, civilians such as musicians and headquarters of the United States Army sporting event participants continued to Ambulance Service (Camp Crane, 2020). enjoy access to Camp Crane. Overall, 355 Reflecting the collective expertise in cases of influenza were diagnosed at the medicine by its residents, Camp Crane had camp, with 62 developing into pneumonia, already been under quarantine in March and 13 fatalities (Camp Crane, 2020). The 1918, in order to prevent the measles from first fatality at Camp Crane had been spreading beyond the camp, and from reported on October 10th, taking the life of mumps reaching the camp (Bartholomew, 26-year old private Willard A. Babcock of 1987, p. 469). By late August, 1918, the Elk River, Minnesota (Morning worry about communicable diseases had Call,1918b). Nevertheless, Camp Crane subsided, and over 30,000 people managed to have “the lowest mortality rate converged on West Park to honor the of any military installation in the nation” soldiers at Camp Crane (Bartholomew, (Higgins, 2020). In late 1918, medical 1987, p. 516). The first stop for recruits and teams from Camp Crane helped out in soldiers leaving Pennsylvania was Camp Shamokin, Wilkes-Barre, Pottsville, Dix, New Jersey, which on September Reading, and in the Philadelphia 26th, 1918, reported 806 new cases, 252 of shipbuilding areas (Bartholomew, 1987, pp. these requiring hospitalization, and 36 468-469). Although data on the ethnic fatalities in a 24-hour period (Morning diversity of Camp Crane’s staff is not Call, 1918a). Allentown was now a city of evident, when 77 volunteers from Camp over 73,000, and Camp Crane held Meade, MD., were sent to the Trojan anywhere from 2,000 to 10,000 personnel. Powder explosives company in the Seiple As soon as the camp surgeon and sanitary area of Allentown, because no women officer had drafted a plan for isolation, workers could be found, Ann Bartholomew observation, and inspection, the first writes that the “white” soldiers were influenza cases appeared among three housed in the West End Hotel, while the officers and a private who lived off-site African American troops were forced to (Camp Crane, 2020). Captain J. H. Owens stay at the Allentown Rescue Mission of the Sanitary Corps, acting under the (1987, p. 500). Despite the unequal camp’s commanding officer, Lieutenant treatment of military personnel in general, Colonel Richard Slee’s authority, Camp Crane’s staff was able to provide prohibited officers and enlisted men from essential services to the communities of the entering places of amusement or region. The situation was different in the participating in public gatherings, and city itself. urged them to avoid public transportation and to reduce visits to stores. 8 PERSPECTIVES FROM THE 1918-19 INFLUENZA PANDEMIC

Allentown Red Cross volunteers were busy making hospital items for the war effort, The influenza pandemic seemed to including over 100,000 hospital dressings. By disappear as quickly as it had arrived. September 1918, “they switched to making Recurrences, however, continued. On masks and pneumonia jackets” for the November 4th, 1918, the Morning Call influenza pandemic (Bartholomew, 1987, p. reported that the quarantine had taken the 465). pep out of the Allentown Halloween By the end of October, over 3,500 cases had parade, which despite a ban on parties and been reported. The number of patient beds dances, took place with reduced numbers. available to Allentown Hospital had to be Reflecting the racial insensitivity of the time, the newspaper reported that the increased from a daily average of 266 patients “perennial blackface minstrel make-up ran to requiring 500 beds. The Nurses’ Home had as strong in popularity as ever.” (Morning to be filled with patients, and nurses who used Call, 1918i). Dance halls remained closed. the Home as a dormitory relied on alternate In the meantime, the public was invited to accommodations. Twenty-eight nurses were ill watch Camp Crane’s football team play with the flu. In an attempt to quell the against Susquehanna University and contagion, city officials ordered lime to be Dickinson College on the Muhlenberg spread in the streets. The community gridiron. On November 16th, the Camp responded with soup kitchens, food deliveries, Crane football team was scheduled to and health advice. A “Mrs. John F. Saeger” compete against the Muhlenberg Student opened her home to the Kiwanis Club to be Army Training Corps team (Morning Call, used as the “Children’s Temporary Protective 1918f). Following a United War Work Home,” in order to house children whose Campaign rally at Allentown High School on the 14th, for the next evening, the parents were affected by the flu. More than Y.M.C.A.’s “United We Serve” women’s twenty of the children had to be placed in committee arranged a victory pageant in institutions, because the breadwinner in their the school, including two featured families did not survive the pandemic. The speakers and an orchestra (Morning Call, month of October claimed more than 200 lives 1918j). On November 21st, 158 cases in Allentown, followed by 115 in November, were reported (Morning Call, 1918g). The because of flu and pneumonia (Bartholomew, pandemic had also moved across South 1987, pp. 526-527). In the end, Allentown’s Mountain, into the Perkiomen Valley. number of fatalities was more than three times Yoder’s School near Old Zionsville was that of Bethlehem, with twice the mortality closed, while Shimersville School was rate (Higgins, 2020). able to reopen (Morning Call, 1918h). By early December, every day several dozen The influenza pandemic seemed to new influenza cases were reported in disappear as quickly as it had arrived. Allentown (Morning Call, 1918k). An Recurrences, however, continued. On initial analysis of the outbreak provided November 4th, 1918, the Morning Call some short lived certainty: In 1919, Adam reported that the quarantine had taken the pep L. Kotz, a pathologist at Easton Hospital, out of the Allentown Halloween parade, which declared that based on experiments on despite a ban on parties and dances, took place rodents, bacillus pestis was responsible for both the bubonic plague and the influenza with reduced numbers. pandemic (Morning Call, 1918e).

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Pandemic Responses in Pennsylvania In the much larger city of Philadelphia, Throughout Pennsylvania, over the Fourth Liberty Loan Parade on 200,000 had been reported by the end of the September 28th, was now famously first week of October (Bartholomew, 1987, allowed to go on (Stetler, 2017, p. 467). p. 523). In Bethlehem, mayor Archibald By October 4th, all public gatherings Johnston, who also served as vice president were banned (Stetler, 2017, p. 468). of Bethlehem Steel, implemented the closure Almost 15,000 individuals perished of flu of schools and houses of worship, and pneumonia in Philadelphia (Stetler, coordinated a pandemic response, and 2017, p. 478). Evidently, responses across opened an emergency hospital for isolating the state differed vastly. Overall, cases. These measures helped Bethlehem, Pennsylvania was the hardest hit state in which was more industrialized than the U.S., and Allentown may be seen as a Allentown and more densely populated, to cautionary example of why this was so. achieve better outcomes, regarding the pandemic (Higgins, 2020). Despite mayor Conclusion Reichenbach’s prejudicial claim that “Bethlehem is filthy and dirty [...and] the As a microcosm of the terrifying worst breeder of disease” and Allentown influenza pandemic that struck much of clean (Bartholomew, 1987, p. 522), the city the world in 1918, the response and of Bethlehem more effectively controlled the outcomes in Allentown, Pennsylvania effects of the pandemic than Allentown did. seem to indicate that a swift and In Pennsylvania's anthracite region, coal disciplined response was necessary in production languished at half capacity, with order to prevent the worst. Mere days of sixty fatalities in one week. On October delays in quarantine procedures could 11th, 1918, Governor Martin Grove Brumbaugh called upon nurses to volunteer lead to vastly different results. When the their services, including those serving as city finally responded in full measure, companions in the homes of the wealthy officials were confronted with the reality (Morning Call, 1918d). In Stroudsburg, that the socio-economic makeup of the health officials recommended wearing gauze city’s population did not allow all citizens masks and to dip them in antiseptic solution. to passively sit out a shutdown, but that Reports in the city mentioned 415 overcrowding and missing wages among cases of influenza. Schools and numerous the industrial workforce were not just businesses were closed, although among problems that other municipalities had to some controversy, churches were allowed to deal with. In addition, people among all remain open. St. Luke’s and St. Michael’s income levels saw a financial or patriotic Lutheran churches and Keneseth Israel need to continue their contribution to the temple reportedly suspended services, with St. Michael’s pastor opting for outdoor war effort, leaving few choices in how services (Morning Call, 1918c). In the state they would respond to restrictions on capital, schools and churches closed. indoor gatherings. Without the quick and Nevertheless, Harrisburg suffered 440 decisive response by the leadership of fatalities (Wilson Carter, 2020, p. 148). Camp Crane, the situation within Allentown’s city limits could have been far worse.

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References Adams, Ann (2000). Hidden from history: The Latino community of Allentown, Pennsylvania. Lehigh County Historical Society. Bartholomew, Ann (1987). A history of Allentown: 1917-1920. In Mahlon H. Hellerich (Ed.), Allentown 1762- 1987: A 225-Year history (pp. 421-554). Lehigh County Historical Society. Bubonic plague and influenza bacillus identical (1918e). Morning Call 12/31/1918. Camp Crane. http://chm.med.umich.edu/research/1918-influenza-escape-communities/camp-crane/ Camp Crane (2020). http://chm.med.umich.edu/research/1918-influenza-escape-communities/camp-crane/ Camp Crane To Send Doctors Where Needed (1918c). Morning Call 10/11/1918. Camp Crane. http://chm.med.umich.edu/research/1918-influenza-escape-communities/camp-crane/ Compton, Paul L., & Yessler, Wendy A. (2019). Private Compton. WAY Art & Life Design. Davies, Norman (1996). Europe: A history. Oxford University Press. First Camp Crane victim of influenza (1918b). Morning Call 10/10/1918. Camp Crane. http://chm.med.umich.edu/research/1918-influenza-escape-communities/camp-crane/ Higgins, James E. (2018). A lost history: Writing the influenza epidemic in Pennsylvania, 1918-1922. Pennsylvania History 85(3), 394-405. Higgins, James E. (2017). “Under the stimulus of great epidemics.” Reformers, epidemics, and the rise of state level public health in Pennsylvania, 1872-1905. Pennsylvania History 84(2), 214-238. Higgins, James E. (2020). “A tale of two cities, Allentown and Bethlehem, during 1918 flu.” Morning Call 4/17/20. https://0-infoweb-newsbank-com.wave.lccc.edu/apps/news/document- view?p=NewsBank&docref=image/v2%3A176EB29A911B5D30%40NewsBank- 17A6518797E73AED%402458957-17A6519F81E5FAF7%4015-17A6519F81E5FAF7%40 Influenza Cases (1918k). Morning Call 12/4/1918. Camp Crane. http://chm.med.umich.edu/research/1918- influenza-escape-communities/camp-crane/ Influenza Epidemic Shows No Signs of Abating in Such Places That Are Affected (1918d). Morning Call 10/12/1918. Camp Crane. http://chm.med.umich.edu/research/1918-influenza-escape- communities/camp-crane/ Influenza Spread Keeps on Unabated; Draft Call Cancelled (1918a). Morning Call 9/27/1918. Camp Crane. http://chm.med.umich.edu/research/1918-influenza-escape-communities/camp-crane/ Kibler Hall, Karyl Lee, & Dobkin Hall, Peter (1987). A history of Allentown: 1874-1900. In Mahlon H. Hellerich (Ed.), Allentown 1762-1987: A 225-Year history (pp. 289-339). Lehigh County Historical Society. Kyle Crossley, Pamela, Hollen Lees, Lynn, & Servos John W. (2013). Global society: The world since 1900. Wadsworth.

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References Many influenza cases in the Perkiomen Valley (1918h). Morning Call 11/23/1918. Camp Crane. http://chm.med.umich.edu/research/1918-influenza-escape-communities/camp-crane/ Markel, Howard, Lipman, Harvey B. & Navarro, Alexander, et. al. (2007). Nonpharmaceutical interventions implemented by US cities during the 1918-1919 Influenza Pandemic. JAMA. 298(6):644-654. https://jamanetwork.com/journals/jama/fullarticle/208354 Muhlenberg plays Camp Crane this afternoon (1918f). Morning Call 11/16/1918. Camp Crane. http://chm.med.umich.edu/research/1918-influenza-escape-communities/camp-crane/ Oklahoman claims to be area WW1 Army nurse heroine in a past life (1984). Morning Call 11/11/1984. Philadelphia, Pennsylvania (2012). http://www.influenzaarchive.org/cities/city-philadelphia.html Return of influenza imminent (1918g). Morning Call 11/211918. Camp Crane. http://chm.med.umich.edu/research/1918-influenza-escape-communities/camp-crane/ Stetler, Christina M. (2017). The 1918 Spanish [sic.] influenza: Three months of horror in Philadelphia. Pennsylvania History 84(4), 462-487. Victory pageant tonight at A.H.S. (1918j). Morning Call 11/15/1918. Camp Crane. http://chm.med.umich.edu/research/1918-influenza-escape-communities/camp-crane/ Wilson Carter, Sarah (2020). The 1918 influenza outbreak in Harrisburg. Pennsylvania History 87(1), 148-154.

Muhlenberg College Student, Jarrett Azar, untitled diptych, photography, Spring 2020

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An Examination of Food Access and Affordability in the Lehigh Valley at the Beginning of the COVID-19 Pandemic AUTHORS: Chrysan Cronin, Dr.P.H., M.P.H., M.S. Director, Public Health Program, Muhlenberg College Cathy A. Coyne, Ph.D., M.P.H. Associate Professor, Moravian College Hollie Gibbons, M.P.H., R.D. Assistant Professor, Cedar Crest College

An Examination of Food Access and Affordability in the Lehigh Valley at the In 2018, more than 14 million Beginning of the COVID-19 Pandemic Americans experienced food insecurity, with the number potentially increasing to The global COVID-19 pandemic and 54 million in 2020 due to the direct social distancing efforts have impacted effects of the COVID-19 pandemic household food security and food system (Feeding America, 2020). The pandemic operations leading to hardships for families has impacted the cost of food and and industry. Food security is affected by threatened food availability, reductions in household income resulting accessibility, and utilization. Niles et al. from job loss or job instability. Food (2020) studied the early impact of insecurity occurs when a household does not COVID-19 on food insecurity in have enough money to buy food leading to Vermont from March through April poor eating patterns, reduced food intake, 2020. The study included data from 3219 and poor physical and mental health survey respondents. Study results outcomes (Niles et al., 2020). The food indicated a one-third increase in food system, including farmers, meat producers, insecurity prevalence from the year grocery stores, and emergency food before the pandemic, with 35.5% being providers have been impacted by disruptions newly food insecure due to physical and in transportation, distribution systems, labor economic barriers since the pandemic’s access, and consumer demand throughout the start (Niles et al., 2020). Study pandemic. participants reported food access as a In 2018, more than 14 million concern, especially those who use food Americans experienced food insecurity, with pantries and participate in school the number potentially increasing to 54 breakfast and lunch programs. A million in 2020 due to the direct effects of decrease in household income, limited the COVID-19 pandemic (Feeding America, availability of food, and increased food 2020). The pandemic has impacted the cost prices also contributed to household food of food and threatened food availability, insecurity (Niles et al., 2020). accessibility, and utilization. Niles et al. (2020) studied the early impact of COVID- 19 on food insecurity in Vermont from March through April 2020. 13 AN EXAMINATION OF FOOD ACCESS AND AFFORDABILITY

Factors contributing to loss of As the virus continued to surge in Florida, income, including furlough and a reduction California, and Texas, and in mid-Western in hours were also associated with a higher states, any existing supplies were being risk of food insecurity. In a national study of depleted. While meat continues to be in the pandemic’s impact, over one-third of short supply, Gasparro and Stamm (2020) respondents reported either being laid-off, report that some products are becoming having hours reduced, or experiencing more available. For example, laundry workplace closure, further increasing their detergent, over-the-counter medication, and risk for food insecurity (Wolfson & Leung, even some paper products returned to about 2020). In the Vermont study households 80% of normal by August 2020 while other subjected to job loss were three times more products such as cleaning supplies, food likely to report food insecurity as compared storage bags, baking supplies, and specialty with those who did not (Niles et al., 2020). grocery items are still difficult to find This has significance for the Lehigh Valley (Gasparro & Stamm, 2020). which experienced an increase in the Across the country purchasing unemployment rate from 4.6% in February behaviors at the beginning of the COVID-19 2020 to a high of 16.6% in May 2020 due to pandemic were somewhat surprising and stay at home orders and mandatory business unexpected. Most notable was the rush to closures in reaction to the pandemic (PA buy toilet paper. Shortages of toilet paper Department of Labor and Industry, 2020). became a source of frustration for Although this rate decreased to 10.3% in consumers and fodder for late night comics. August 2020, it still reflects over 35,000 The Tonight Show’s Jimmy Fallon joked workers in the Lehigh Valley are without that he was going to “start using CVS jobs (PA Department of Labor and Industry, receipts as toilet paper” if he couldn’t get 2020). any soon, but toilet paper was not the only The food system throughout the item in short supply. An average of 21% of United States, including food production all paper products were out of stock at US industries and grocery stores, has been stores as of August 9th (Terlap & Gasparro, greatly impacted by efforts to mitigate 2020). Overall, grocery stores ran out of spread of the virus. The meat manufacturing approximately 13% of their total items in the industry was particularly hard hit by first weeks of the pandemic (Gasparro & COVID-19 in the spring of 2020 resulting in Stamm, 2020). While the supply of toilet reduced availability of meat products to the paper and other items improved due to consumer. A loss of food stock in grocery ramped up production, they were still not at stores resulted in significant revenue loss, pre-pandemic levels six months after the not only because an item was not available pandemic was declared. Other items that for purchase, but also because the consumer were scarce at the beginning, such as baking sought items at other stores, abandoning items and cleaning supplies, including paper store loyalty. According to the Wall Street towels, remained difficult to find. In a Journal (WSJ) nearly 10% of all grocery national study of households with incomes store items were out of stock in August at or below 250% of the federal poverty 2020, compared to 5-7% pre-pandemic level, a majority of households reported in (Gasparro & Stamm, 2020). As stated in the March 2020 that they were not able to WSJ, the supply chain was not designed for obtain such essential household items a pandemic (Terlap & Gasparro, 2020). (Wolfson & Leung, 2020).

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Challenges experienced by The survey was designed to elicit consumers to obtaining food was examined information regarding how the pandemic by Niles and colleagues (2020) in their study impacted the operations of these of Vermont residents. Regardless of level of organizations and the food access related food security, respondents reported struggles services they provide. In addition, barriers to in finding food they wanted to purchase, maintaining services and responding to having to go to more places to find food, increased demand were identified. Most and not being able to find the food their survey items were open -ended in order not household prefers to eat. Many respondents to restrict answers to predetermined barriers also expressed concerns regarding lack of or solutions. A survey link was sent to social distancing when getting food which members of the Lehigh Valley Food Policy may have impacted their willingness to food Council and emergency food providers shop. including food pantries and meal services. Thirty-four organizations responded to the Methodology survey. Twenty-eight organizations operate food pantries, seven provide meals to In effort to understand the impact of seniors and four provide meals to people of the COVID-19 pandemic on food access for low income. In addition to direct service residents of the Lehigh Valley, surveys were providers, six farmers markets, four farmers, administered to two distinct groups: and 4 organizations that work on food policy consumers that use conventional grocery responded. It is noted that several stores for food shopping and non-profit organizations provide more than one type of organizations operating emergency food service such as a food pantry and a meal service programs including food pantries site. and meal sites or delivery programs. Surveys were conducted in the summer of 2020. Findings reported here illustrate the

food access hardships Lehigh Valley residents and non-profit organizations experienced since the start of the COVID-19 pandemic. The consumer survey was completed both in person at the Kellyn Foundation Marvine Elementary School mobile market site and online by 70 grocery store consumers at various locations in the Lehigh Valley. Survey items were designed to examine consumers’ grocery shopping experience and purchasing habits during the first six months of the pandemic. The 13- item survey required less than 3 minutes to complete. Descriptive statistics were used to analyze survey findings. A six -item online survey was developed to examine how Lehigh Valley non-profit organizations responded to the Cedar Crest College Student, Cecelia pandemic. Wright Bricks and Bikes, acrylic paint and mixed media on canvas, Spring 2020 AN EXAMINATION OF FOOD ACCESS AND AFFORDABILITY 15

Results

Grocery Store Consumer Experience Grocery Environment Shopping Behavior More than 4 out of five respondents Findings from the Lehigh Valley (84%) reported that their grocery store consumer survey indicate that certain non- provided sanitizing wipes and hand sanitizer food items such as paper products and for use in the store to help reduce the risk of cleaning supplies continued to be the most spreading the virus. In addition, 81% difficult to purchase (Fig. 1) six months into reported that their store installed plexiglass the pandemic. Items such as canned goods, at the check-outs and prominent signage baking supplies, and meat products were the indicating 6-foot distancing throughout the most difficult food items to purchase (Fig. store. Respondents reported restrictions to 2). Nearly all survey respondents (93%) the number of people permitted in the store reported that there were limitations on the at any one time, and the discontinuation of number of certain items they were permitted hot/cold self-serve food. One-way aisles and to purchase, and that stores limited the designated entry and exit doors were also number of hours they were open. One used to prevent close contact between Lehigh Valley respondent stated, “I used to shoppers (Fig. 3). Many shoppers reported find everything I needed at one or two that they were not allowed to bring their stores. Now I find myself having to go to own grocery bags into the store, which three, four, or even more to find the required the store to supply them. products I need because some stores do not The shopping behaviors and types of have the items or do not have them at purchases made by Lehigh Valley grocery reasonable prices.” Interestingly, over 20% store shoppers were significantly impacted of respondents reported using a delivery by the COVID-19 pandemic as expressed by service for groceries for the first time. A consumers that participated in the survey. majority of consumers (60%) reported that Emergency food providers, serving they shopped less often than they did prior consumers that are not able to frequent to the pandemic and 9% reported that they conventional grocery stores, were also also bought fewer items when they did shop, impacted. indicating a change in shopping habits. Nearly all respondents noted significant Non-profit organizations’ response increases in their grocery bills. Over 40% Challenges to Operations reported an increase in spending on meat products, 24% on produce, 20% on paper In efforts to respond to the pandemic products, and 16% on dairy products. while continuing to provide healthy foods to Overall, store prices remain about 5% higher their consumers, all non-profit survey on average than they were a year ago. respondents reported barriers that made it difficult, if not impossible, for them to Acknowledgements continue regular services. All respondents reported having fewer volunteers due to fear We thank the college students who helped us of contracting COVID-19. Volunteers at with data collection and analysis including food pantries and meal sites tend to be Lara Struckman and Alayna Biltcliff from retired, over the age of 65, and more likely Cedar Crest College, Nicole Peluso from to have co-morbid conditions, putting them Moravian College, and Brynn Cardonick from at greater risk for severe complications from Muhlenberg College. Without their COVID-19. contributions we would not have been able to complete this report.

16 AN EXAMINATION OF FOOD ACCESS AND AFFORDABILITY

Similar to reports from consumers Organizations providing meals to using conventional grocery stores, non- seniors were impacted by transportation profit organizations had difficulty obtaining challenges faced by consumers. With supplies for cleaning and sanitizing their delivery services curtailed in some areas due work and service delivery sites. Personal to lack of volunteer drivers or changes in protective equipment such as face coverings, meal delivery strategies, it was more gloves and hand sanitizer were also difficult difficult for seniors to obtain food. Seniors, to find. Food pantries and meal sites were understanding that they are at greater risk impacted by disruptions in the food supply for complications from COVID-19, are chain similar to conventional grocery stores. hesitant to leave their homes to pick up Certain foods, particularly fresh fruits and meals or go to the grocery store. This vegetables, were difficult to obtain. behavior threatens the tenuous food security Some challenges resulted from lack of this vulnerable population. of coordination and communication regarding changes in operations and Overcoming the Challenges supplies. Individuals and organizations were not able to access information needed to find In order to continue providing cleaning supplies, personal protective needed food to seniors and low-income equipment and volunteers. Communication households, and to help those newly affected also was cited as a challenge by non-profit by food insecurity, organizations made organizations in their efforts to inform significant changes to how they operated. individuals and families who obtain food Meal service agencies, which normally from pantries or meal sites. Changes in provided meals cafeteria style in a operations, as described below, needed to be communal dining area, needed to adjust communicated for consumers to know service delivery to accommodate social where, when and how to obtain food. Food distancing. Meals were packaged by staff pantry and meal site users tend to follow a and volunteers as ‘grab and go’ and handed routine in terms of where they obtain food. to consumers individually, generally with Disruptions in this routine can be difficult the consumer remaining outdoors. Sites for individuals and families to adjust to required anyone receiving food to wear a contributing to the anxiety people feel about face covering and to keep six feet from the pandemic. These disruptions could be people around them. Face coverings were particularly stressful and anxiety producing provided to consumers who did not have for seniors who rely on routine and them. Portable handwashing stations were familiarity. Lack of consistency in provided by several organizations to enable messaging from public health authorities consumers to adhere to public health also contributed to confusion about how to handwashing guideline. These mitigate the spread of the coronavirus, accommodations were added expenses to including who should wear face coverings, service operations which rely on grants and guidance for meal distribution, and whether philanthropy for funding and have very little packaged food could carry the virus. Based expense margins to absorb the added on an understanding of how to keep workers expense. and consumer’s safe, emergency food providers needed to change their operations. This took significant planning and resources to accommodate the safety guidelines promulgated by the federal, state, and local governments.

ANAN EXAMINATION EXAMINATION OF OF FOOD FOOD ACCESS ACCESS AND AND AFFORDABILITY AFFORDABILITY 17

Additional accommodations were Several strategies were implemented made to allow for social distancing to to address the challenges in communication protect staff and volunteers from infection. experienced by the organizations and the Shifts were staggered and remote working public. Buy Fresh Buy Local of the Greater was permitted to reduce the number of Lehigh Valley (BFBL) served as a central people onsite at any one time. Personal clearinghouse for information regarding protective equipment was provided, and COVID-19 and mitigation strategies. BFBL safety protocols established and developed a guide for coronavirus response communicated to staff and volunteers. Early that served as a useful tool for organizations in the pandemic service hours were adjusted that are part of the food system in the to allow time for changes to be made and Lehigh Valley. In addition, graphics were communicated to staff, volunteers, and available from the website that other consumers. During this time there was much organizations could use in their confusion over what safety guidelines to communications. BFBL and the Lehigh follow and how to adjust to the new Valley Food Policy Council also provided restrictions. Some organizations ceased links on their website to other credible operations for a period of time until they sources with useful information regarding were able to determine what needed to be the control of COVD-19. Non-profit done and to implement the required changes. organizations regularly updated their websites with revised service schedules and the locations of other meal sites and pantries

as well as resources regarding the current status of the pandemic.

AN EXAMINATION OF FOOD ACCESS AND AFFORDABILITY 18

Discussion Many of these changes resulted in Lehigh Valley residents and food unexpected expenditures to retailers and system continue to be affected by efforts to food producers. Coupled with the loss of control the COVID-19 pandemic. In revenue due to lack of stock, the pandemic addition to changes in personal behavior to caused significant financial loss to food accommodate social distancing and wearing retailers, producers and distributers. masks to protect others from the virus, According to Gasparro and Stamm (2020) in Lehigh Valley residents have needed to the WSJ, it is estimated that the first six change their food shopping and buying months of the pandemic cost the behaviors in response to modifications made supermarket industry nearly $10 billion in by the food system. Changes in the food lost revenue. Food consumers in the Lehigh system designed to protect workers, Valley have financially felt the impact of the volunteers and consumers while maintaining pandemic, noting increased food prices at food access imposed significant demands on grocery stores, perhaps imposed in response the system. to lost revenue.

19 ANAN EXAMINATION EXAMINATION OFOF FOODFOOD ACCESSACCESS ANDAND AFFORDABILITYAFFORDABILITY

Typically, prices fluctuate between References

1-2% from year to year (Gasparro & Stamm, Gasparro A. and Stamm, S. (2020, August 10). Why are 2020), but in the Lehigh Valley as elsewhere in the United States, prices on certain food some groceries still so hard to find during items increased more significantly. Not only COVID? The Wall Street Journal online.

did prices increase, grocery stores were less https://www.wsj.com/articles/why-are-some- likely to offer special deals such as “buy

one, get one free” and other promotional groceries-still-so-hard-to-find-during-covid- offers as they struggled to keep their 11597069761#:~:text=Stephanie%20Stamm,Bi inventory adequately stocked. Limited food ography&text=At%20the%20beginning%20of availability, increased prices and social %20the,cleaning%20supplies%20or%20canned distancing requirements are likely to have reduced consumer unplanned purchases, or %20soup.&text=The%20even%2Dstronger%2 impulse buying, which in turn affects the 0demand%20for,enough%20to%20keep%20sh total amount of spending per shopping elves%20full event, contributing to additional loss of Hunger in America. (2020). Feeding America. Retrieved revenue for grocers. The increasing number of people September 19, 2020, from experiencing food insecurity in the Lehigh https://www.feedingamerica.org/hunger-in- Valley, coupled with increased food prices america?s_src=Y20YG5F1Z&s_subsrc=c&s_k and limited food availability, put many eyword=us%20hunger&&gclid=Cj0KCQjwtZ people at risk for health complications. Throughout the COVID-19 pandemic the H7BRDzARIsAGjbK2Z0D250p2M8hNRKY7 Lehigh Valley has demonstrated that it cares mxjCz7qkiME9huNVyhE2zngrGNcE9IuVfjW for its residents and has concern for ensuring _YaApHzEALw_wcB that food is available to keep people healthy Niles, M. T., Bertmann, F., Belarmino, E. H., during this difficult time. Organizations have partnered together to get the word out Wentowrth, T., Biehl, E., & Neff, R. (2020). to residents about where to obtain food and The early food insecurity impacts of COVID- supplies to help mitigate spread of the virus. 19. Nutrients, 12(7), 1-23. Individuals and organizations have also https://doi.org/10.3390/nu12072096 partnered to ensure that food is accessible, and that the local food industry survives PA Department of Labor and Industry. (2020) regardless of disruptions in distribution and https://paworkstats.geosolinc.com/vosnet/analy transportation. The Lehigh Valley has a zer/trend.aspx?enc=HofuwY22SoLTS/uC+bpm strong local food system and food suppliers i4Agh+beziZgnGf4fw9SQdQ=) at all levels that continue to provide access to healthy foods. Through cooperation and Terlap, S. & Gasparro A. (2020, August 21). Why are coordination, and listening to the voices of there still not enough paper towels? The Wall consumers, efforts to reduce food insecurity Street Journal online. and improve food access continue. https://www.wsj.com/articles/why-arent-there-

enough-paper-towels-11598020793 Wolfson, J. A. & Leung, C.W. (2020). Food insecurity and COVID-19: Disparities in early effects for US adults. Nutrients, 12(6), 1648. https://doi.org/10.3390/nu12061648

ECONOMIC CHALLENGES, RESPONSES, AND OUTCOMES 20

Economic Challenges, Responses, and Outcomes During Spring and Summer 2020 AUTHORS: Christopher S. Ruebeck, Ph.D. Associate Professor, Lafayette College Sabrina Terrizzi, Ph.D. Associate Professor, Moravian College

Economic Challenges, Responses, and In March and April, employment here had Outcomes During Spring and Summer 2020 declined 16% compared to the same time a year earlier, which was slightly larger than In this section, we highlight trends in the national decline of 15%. As the situation employment and wages within the Lehigh began to ease in the summer and early fall of Valley, greater PA region, and nationally from 2020, Table 1 shows that by September our April 2020 through August 2020. This time area mirrored the US with annual period spans the initial lockdown period in our employment levels approximately 6.3% local area, the economic recession and the lower than in September 2019 (Bureau of beginning of recovery. We identify differences Labor Statistics, Mid-Atlantic Information observed at various groupings by industry and Office, 2020). level of aggregation and comment on the diversity of outcomes inherent in these wide- ranging economic outcomes. In highlighting these trends we are mindful of the fluid situation of the COVID-19 pandemic and its effects on wages and employment. Further, we note that at the time of writing we cannot make predictions for the fall and winter months. The Lehigh Valley has not been spared the detrimental employment effects created by COVID-19. However, as an area with some focus on education, healthcare, and manufacturing, the Lehigh Valley is positioned to navigate this crisis better than others. Our focus is on the region’s two counties, though some of the data we report is for the Allentown-Bethlehem-Easton (ABE) metropolitan statistical area (MSA) that also includes Pennsylvania’s Carbon County and New Jersey’s Warren County. Annual employment had been growing steadily at slightly less than an annual rate of 2% in both our MSA and in the US through early 2020 (Bureau of Labor Statistics, Mid- Atlantic Information Office, 2020).

ECONOMIC CHALLENGES, RESPONSES, AND OUTCOMES 21

The rows of Table 1 are ordered by the The leisure and hospitality industry’s very final column, the industry’s percentage of significant unemployment level is of note nonfarm jobs, so that we can see how the because it includes the highly visible structure of the labor force has contributed to restaurant sector, which is important to the the economic recovery in our area. The most health of today’s three city-center significant declines were seen in industries economies in the Lehigh Valley. that represent a lower percentage of When restaurants pivoted to take- employment in our area, i.e. are farther down out and curbside pickup, many of their in the table. Specifically, the leisure and employees were still without jobs, given the hospitality industry and other services1 lower need for labor in those new business experienced the largest percentage decrease in models. As a second brief example, employment levels, yet they represent little construction was affected drastically for more than 10% of the nonfarm payroll in our indoor work, but outdoor work was region. Mining, logging, and construction permitted to resume earlier. However, the experienced a significant decline of 14.4%, ability to generalize beyond in-depth yet this industry makes up only about 3% of considerations like these two examples the area’s nonfarm employment. These remains a challenge due to the state industry declines appear consistent with government granting varying exceptions mandated lockdowns in the state of (within and across sectors) for business Pennsylvania during the initial peak of the activity during the lockdown and during the pandemic. subsequent easing of restrictions. In contrast, we note that some of the Analyzing unemployment rates at most important employment sectors in our the state level through the first six months of MSA had much better outcomes. There was a 2020 provides additional insights into the 0.6% decline within the trade, transportation, initial economic effect of the pandemic and and utilities industry compared to a year the early stages of recovery in our area. earlier, while we actually experienced Table 2 contains a snapshot of the six-month increased employment of 2.9% within the trends in unemployment among states education and health services industries. geographically near PA, sorted by These two sectors sum to almost 50% of non- unemployment rate in July. There was a farm jobs in the four counties of the spike in unemployment rates in April, with Allentown-Bethlehem-Easton area. The next an uneven and slow recovery throughout the three sectors, accounting for an additional early summer months. State-level and 25% of non-farm employment, also saw sector-level economics and the policies relatively small year-on-year decreases in meant to address them have been many and employment, though professional and varied, and it is clear that the variation in business services saw an almost 11% decline. our area’s sectoral employment, which we We can consider two of these analyzed above, could be pursued in a employment sectors in more detail for similar fashion within and across states to additional insight into how aspects of the understand the varying effects and rates of recovery vary even within sectors. recovery.

1 According to the North American Industry Classification System, other services includes those: “primarily engaged in activities, such as equipment and machinery repairing, promoting or administering religious activities, grantmaking, advocacy, and providing drycleaning and laundry services, personal care services, death care services, pet care services, photofinishing services, temporary parking services, and dating services.” (US Bureau of Labor Statistics, accessed September 2, 2020) 22 ECONOMIC CHALLENGES, RESPONSES, AND OUTCOMES

Table 2: Unemployment, sorted by July 2020 rate We could likely explain some aspects of the differences across counties and across Jan Feb Mar Apr May Jun Jul incomes with industry-level information State 2020 2020 2020 2020 2020 2020 2020 such as that in Table 1 above, but regardless of its source we are left with a striking differential in recovery across New York 3.8 3.7 4.1 15.3 14.5 15.6 15.9 incomes and region. As is being widely reported for country-level data, it is clear New Jersey 3.8 3.8 3.7 16.3 15.4 16.8 14.2 that income inequality will continue to rise without additional efforts to address the Pennsylvania 4.7 4.7 5.8 16.1 13.4 13.2 12.5 varied effects that the recovery has had thus far. With a further eye on resiliency, Delaware 4.0 3.9 5.0 14.9 15.9 12.6 10.5 Figure 1 displays changes in consumer spending, showing a precipitous fall from Ohio 4.1 4.1 5.8 17.6 13.9 11.0 8.9 March to April with a gradual trend upwards that has stabilized between 10% and 20% lower than pre-pandemic Maryland 3.3 3.3 3.3 10.1 10.0 8.3 7.8 spending levels (Chetty et al., 2020). (Bureau of Labor Statistics, The Economist Daily, 2020) Preliminary data (as indicated by the dashed lines on the figure) suggests, The resiliency in our collective consumer spending is 19% lower in response to this pandemic has come from Northampton County as compared to mid- many quarters. This includes efforts to January, while Lehigh County is 12% supplement federal agencies’ data in ways lower. Although there is still ground left to important to our understanding of the be regained, we can see the federal diverse effects from both the pandemic government’s rapid response with a fiscal and the government response to it. One policy answer to the crisis. group of note (Chetty et al., 2020) has

gathered data from private sources to learn Table 3: Changes in Employment more about the ways in which the recession and recovery has varied by Annual Income Lehigh County Northampton County income. Jan. - July Jan. - Sept. Jan. - July Jan. - Sept. In Table 3, each cell shows the

breakdown of changes in employment by Low Income -3.6% -3.5% -16.0% -12.1% income (rows) for the Lehigh Valley’s two counties; the left column for each county is (<$27,000) from January to July 2020, and the right Middle Income -1.8% +3.0% -6.4% -7.1% column for each county is from January to September 2020. In addition to illustrating ($27,000 - the very different outcomes in the $60,000) Northampton and Lehigh counties, there is also an important similarity across the two High Income +2.5% +2.2% -6.4% -7.1% counties in the effects on low-income (>$60,000) households as compared to others.

Overall -1.3% +2.2% -6.4% -7.1%

(Chetty et al., 2020) ECONOMIC CHALLENGES, RESPONSES, AND OUTCOMES 23

By providing funds directly to both Yet once again there is more to working and out-of-work consumers as this story. When we break down these well as assistance to businesses, the changes by income at the national level, initial shock of the crisis was reduced Figure 2 shows that the recovery in and recovery was spurred. However, the spending has been most complete for stalled increase in consumer spending in those with the least resources. This is in July suggests that a lack of additional direct contrast with the employment governmental policy measures to story of Table 3, where we noted that the stabilize incomes is having a negative recovery for the lowest-income effect on consumer spending in our area. households has been weakest.

Figure 1: Changes in Consumer Spending in the Lehigh Valley

Figure 2: Changes in Consumer Spending Nationally, by Income

ECONOMIC CHALLENGES, RESPONSES, AND OUTCOMES 24

A significant fraction of this spending is At the writing of this report, most of those clearly coming from assistance rather than business closings (11) occurred between the from work. Further, we note continued beginning of April and mid-August, which decreased spending among those in the appears to correspond to the height of the highest income groups. These changes in economic effects of the pandemic, yet we spending habits have consequences for should also take heart in the 6 business individuals in lower income groups, who openings in Easton during the same time often work in the service sector, where period. individuals with disposable income spend Although the economic difficulties much of those funds. As long as spending continue, there are positive effects of efforts on leisure and other non-essential activities to address them at the individual, business, remains stagnate, it will continue to be local, state, and national levels. We need to challenging for individuals in the service remain cognizant of differing effects at all industry to make employment gains. of these levels, by industry and especially Outcomes like these are arguments for by income. Despite overall consumer continued assistance to those in need, most spending having returned nearly to pre- importantly for them, but also to support the COVID levels and unemployment continued aggregate recovery. continuing to decline, sustained efforts at all As consumers feel safe to go out and levels will need to be maintained to extend spend money, we can hope that the the benefits of the recovery to all sectors economy will continue to recover. We look and households. again to the restaurant sector as an example of adaptation in an effort to assuage fears of the virus while dining outside of the home.

This story of adaptation and resilience has been one of embracing changes to established business practices, most clearly visible in the bustling outdoor restaurant scene in our area. Another source of both caution and resiliency is new business openings. Reviewing data obtained from Easton’s Main Street Initiative, we note that from 2015 through 2019, Easton has seen an average of 5.5 more business openings as compared to business closings each year1. Businesses open and close for a variety of reasons, and many of those reasons remained relevant in 2020. Through August of this year there have been 15 business openings and 16 closings in Easton. Muhlenberg College Student, Stephanie Ng, Narcissus, digital collage, Spring 2020 2 On average, 29 businesses opened annually and 22.5 closed annually in this time period. ECONOMIC CHALLENGES, RESPONSES, AND OUTCOMES 25

References Bureau of Labor Statistics, Mid-Atlantic Information Office. (2020, August 4). Allentown area Economic Summary. Area Economic Surveys. Retrieved September 2, 2020, from https://www.bls.gov/regions/mid-atlantic/summary/blssummary_allentown.pdf Bureau of Labor Statistics, The Economist Daily (2020, August 27). Unemployment rates by state, January 2020–July 2020. https://www.bls.gov/opub/ted/2020/unemployment-rate-16-point-1-percent-in- massachusetts-4-point-5-percent-in-utah-in-july-2020.htm Chetty, R., Hendren, N., Stepner, M., & the Opportunity Insights Team. (2020, September 1). The Economic Impacts of COVID-19: Evidence from a New Public Database Built from Private Sector Data. Opportunity Insights Tracker. Retrieved October 1, 2020, from https://opportunityinsights.org/wp- content/uploads/2020/05/tracker_paper.pdf

Cedar Crest College Student, Emma Ryan, handmade paper, Spring 2020 UNDERSTANDING THE PSYCHOSOCIAL IMPACF OF COVID-19 26

Understanding the Psychosocial Impact of COVID-19 and Social Isolation on Mental Health and Emotional Well-being: Facing Challenges and Building Resilience AUTHORS: Todd Hastings, Ph.D., R.N., C.N.E. Assistant Professor, Cedar Crest College Mae Ann Pasquale, Ph.D., R.N. Associate Professor, Cedar Crest College

Understanding the Psychosocial Impact of COVID-19 and Social Isolation on Mental Health and Emotional Well- being: Facing Challenges and Building Resilience During recent months, the As we collectively work to halt the unprecedented eruption of coronavirus virus’ spread by following preventative disease 2019 (COVID-19) has created a efforts such as wearing masks, washing our remarkable challenge to the health and well- hands, and maintaining a safe distance from being for much of the world's population others, the COVID-19 pandemic is still including the United States. Though the ongoing, with no clear end in sight. The outbreak of COVID-19 and its rapid global nation is pinning their hopes on a vaccine to spread suggests a primary threat to physical combat the virus; however, it may take a health, the potential of adversely affecting much longer time than anticipated which the psychological health of individual and now presents additional challenges for communities is of substantive concern. managing both physical and mental health. The pandemic continues to impact People differ widely in how they many aspects of everyday life and the struggle, respond, and bounce back from resulting social isolation and economic challenges and difficult life events, like uncertainty is leading to a source of those experienced from the pandemic. In unexpected stress and hardship for many individuals, resilience is described as the people. Routines of daily life have been ability to adapt to adversity, trauma or other disrupted and common existence as we stressful events and remain whole or even know it has been upended. Adapting to a grow stronger because of them (Luther & new normal can feel challenging, Cicchetti, 2001). Community resilience unmanageable, and even impossible at looks at the sustained ability of a community times, therefore, it is only to be expected to make use of their available resources (i.e., that significant increases in feelings of transportation, food, housing, etc.) to anxiety, depressive symptoms, uncertainty, respond to, withstand, and recover from a fear, and suicidal ideation have been disaster or public health emergency reported (Alonzi et al., 2020; Czeisler et al., (Killgore et al., 2020). As we move into the 2020; Fitzpatrick et al., 2020; Killgore et al., next and perhaps prolonged phase of 2020). COVID-19 response, the need for innovative strategies and community-driven initiatives to promote emotional well-being and resilience are increasingly clear.

UNDERSTANDING THE PSYCHOSOCIAL IMPACF OF COVID-19 27

Emotional Health and Those at Risk The pain and emotional suffering experienced during this public health crisis During a crisis like the COVID-19 are undeniably real for everyone, however, epidemic, individuals need their immediate, the Centers for Disease Control and basic needs met first before they can focus Prevention (2020) has warned that some on anything else. Physical health is of top groups may be more vulnerable than others concern. However, ongoing fear and worry to the psychosocial effects of the COVID-19 about the health of loved ones, growing outbreak. In particular, older adults, financial losses, uncertainty about the future, children, and individuals with pre-existing home-confinement directives, and mental health conditions, underlying serious conflicting messages from government and medical conditions, and substance abuse public health authorities can place people of disorders are at an increased risk for all ages at an increased risk for maladaptive emotional distress. In an alarming context, behaviors, emotional distress, and post- the World Health Organization (2020) has traumatic stress disorder (PTSD) (Brooks et acknowledged that healthcare professionals al., 2020; Pfefferbaum & North, 2020). The and first responders are also particularly reaction to the current circumstances may vulnerable given their ongoing risk of further translate into a wide range of exposure to the virus, concern about being psychiatric conditions, unhealthy behaviors, infected and infecting others, pain of losing and even noncompliance with public health patients and colleagues, physical fatigue, directives (Pedrosa et al., 2020; Pfefferbaum lengthy separation from families, and & North, 2020). shortages of personal protective equipment There is no published guide for and supplies. To mitigate the psychological maintaining emotional health during a sequelae of the pandemic, prevention efforts global pandemic, but it goes without saying such as screening for mental health that people are undoubtedly stressed and problems, education, and psychosocial anxious. In a Kaiser Family Foundation support should focus on these and other (KFF) issue brief related to recent polling in groups at risk for poor psychosocial mid-July, 53% of adults in the United States outcomes (Pedrosa et al., 2020). reported that their mental health and well- being have been negatively impacted due to Strategies to Promote Resilience the coronavirus; this is significantly higher than the 32% reported in March (Panchal et Stresses inherent with the COVID-19 illness al., 2020). Many adults reported specific and ongoing periods of quarantine and negative impacts such as difficulty sleeping social isolation raise concern how (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and individuals will react individually and worsening chronic conditions (12%) collectively; given the fact that the (Panchal et al., 2020). In addition, a pandemic looks to continue for another 12 to significant increase in feelings of functional 18 months is even more troubling. impairment, stigma, boredom, frustration, Encouraging social connectedness, and even anger has been observed (Brooks enhancing coordination of health and human et al., 2020; Pedrosa et al., 2020; services through partnerships, and building a Pfefferbaum & North, 2020). culture of resilience are described as public health priorities during this crisis (Killgore et al., 2020). UNDERSTANDING THE PSYCHOSOCIAL IMPACF OF COVID-19 28

o Limit excessive exposure to distressing There is no easy way through this pandemic, media. The sudden and near-constant but there are several recommendations from stream of news reports about an outbreak professional societies and organizations that can cause anyone to feel anxious or have been identified to prevent or mitigate the distressed. It is suggested to minimize psychosocial effects triggered by COVID-19. watching, reading or listening to news It is important to keep in mind however, that about COVID-19 that induces stress; seek there are some individuals that will need a information only from trusted sources, referral for professional mental health health professionals, and local health evaluation and care, but on the milder end of authority platforms in order to help the psychosocial spectrum, a large proportion distinguish facts from rumors (World of the population may benefit from supportive Health Organization, 2020).

interventions, such as those highlighted below, o Practice stress management techniques to support mental and psychosocial well-being. and relaxing activities. Managing challenging emotions with acceptance, o Stay connected to others. Recent research mindfulness, relaxation techniques, and has strongly supported the promotion of soothing and/or pleasurable activities can social connectedness as a means of decrease stress and improve physical and reducing the incidence of depressive and mental well-being (Chen & Bonanno, anxiety-related symptoms associated with 2020). Spiritual health is another facet of social isolation (Brooks et al., 2020). In the well-being to consider, as frequent prayer current environment, however, necessary has also been independently associated restrictions such as stay-at-home orders, with greater resilience (Brooks et al., social distancing, quarantine, and other 2020). There are numerous evidence-based measures can make this challenging. As apps available that teach how to regulate such, we may need to be intentional and emotions and practice mindfulness-based find creative ways to foster relationships therapies designed to relax the mind and that allow us to stay connected with body (Ackerman, 2020). family, friends, and the community (i.e., virtual meetings, video chatting and o Foster community and find ways to help conferencing, phone calls, social media, others. Working together as one text and other messaging, email, and even community can help to create solidarity in sending cards and letters) (International addressing COVID-19 sequelae. Protecting Council on Active Aging, 2020). yourself and assisting others with compassion and kindness in their time of o Maintain healthy behaviors and regular need can benefit both the person receiving routines as much as possible. support and the helper (Pedrosa et al., Strengthening self-care and healthy 2020). Sharing your time with others can lifestyle practices like maintaining a validate that you are not alone, and that this healthy sleep schedule, exercise, nutritious pandemic is a global shared experience. meals, and exposure to sunlight and the outdoors have been shown to be associated with greater resilience (Killgore et al., 2020). Regular physical activity and exercise help balance dopamine and serotonin, which are neurotransmitters that impact anxiety and mood (Killgore et al., 2020). Keeping to a familiar daily routine can also lend a sense of normal in abnormal times.

Cedar Crest College Student, Christina Ventrillo, Portrait of a classmate, Fall 2020 UNDERSTANDING THE PSYCHOSOCIAL IMPACF OF COVID-19 29

Strategies to Promote Resilience in the The regional office for the National Lehigh Valley (LV) Alliance on Mental Illness (NAMI) LV offers a range of supportive resources and For members of the LV community mental health awareness activities (NAMI- who may be struggling to cope with the LV, 2020). Since March, NAMI-LV has realities of COVID-19, there are a number created a public service announcement of resources (Table 1) available to assist encouraging individuals to seek social during this difficult time. Healthcare engagement and treatment during the providers at Lehigh Valley Health Network quarantine period. In addition, a special and St. Luke’s University Health Network resource guide has been created to help continue to provide mental health treatment individuals examine strategies for services in various specialty and integrated supporting better coping during the care settings; telehealth options are also pandemic. NAMI-LV provides positive available if needed. messages about connection and “sharing Broader supports are provided stories” through Instagram, Facebook, and through county mental health offices such as Twitter. Further, this advocacy group has a those at the Lehigh County Mental Health 24-hour helpline (800-950-6264) and also Department (Lehigh County Human offers virtual support groups that are Services, 2020; see Table 1 for Lehigh facilitated by peer specialists (trained County Mental Health Department individuals with personal experience resources). Other mental health advocacy managing mental illness (NAMI-LV, 2020). and human service organizations in the The United Way (UW) of the LV region provide additional and ongoing emphasizes the promotion of individual and support initiatives such as the Advocacy community resilience. A notable initiative Alliance in the LV and surrounding and resource is observed on their general northeastern area (Advocacy Alliance, website named Resilient Lehigh Valley 2020). During the pandemic, the Advocacy (United Way of Lehigh Valley, 2020; see Alliance has “emphasized the importance of Table 1 for resource). The site is sensitive to maintaining social connections and outreach the nature of trauma and how trauma- in addition to identifying resources awareness underlies programs and supports supporting recovery.” (C. Hammann, facilitating resilience across all age groups. personal communication, September 15, Given the current fear and uncertainty 2020; see Table 1 for Advocacy Alliance associated with the COVID-19 crisis, these resources). To overcome feelings of programs are particularly important. There disconnection, the organization’s office in is also emphasis placed on school-aged Allentown has promoted social networking children and victims of racial injustice and using Zoom and Facebook, using the includes a link to special considerations for Advocacy Alliance as a centering point. addressing challenges during the pandemic. IN addition, UW-LV offers resources focusing on emotional regulation and wellness during the pandemic using multi- tiered systems of support. A particularly notable project is framed as “Creating Calm, Together Partnership” focusing on the psychosocial and physical mental wellness of children and families (United Way of Lehigh Valley, 2020).

UNDERSTANDING THE PSYCHOSOCIAL IMPACF OF COVID-19 30

Table 1: Lehigh Valley Resources Supporting Psychosocial Health and Resilience During the Pandemic

Regional Resource Website Access Agency Focus Lehigh Mental health https://www.lehighcounty.org/Departments/Human- County as well as Services/Mental-Health/COVID-19-Information-and-Resources Human emergency Services shelter, food, financial help, and supports. Advocacy Mental health https://www.theadvocacyalliance.org/resources/resources.html Alliance as well as emergency shelter, food, financial help, and supports. NAMI-LV Mental health General site: http://www.nami-lv.org/ (National resources with Added public service announcement during the pandemic: “Mask Alliance on an added focus Germs Not Emotions” - https://www.nami-lv.org/mask-germs-not- Mental during the emotions/ Illness) pandemic. Added resource guide during the pandemic: http://www.nami- lv.org/coronavirus-resource-guide/ United Way Mental health General site: https://resilientlehighvalley.org/ of Lehigh resources COVID19 specialized resources: Valley focusing on https://resilientlehighvalley.org/about-2/ coping with Creating Calm, Together: https://resilientlehighvalley.org/creating- trauma, as well calm-together-partnership/ as specialized resources per COVID19 pandemic.

Conclusion

As we continue to navigate uncharted waters, it is our sincerest hope that the information that we have included here equips the LV community with resources to help better face the psychosocial impact COVID-19 has had on mental health and emotional well-being. By facing the challenges that are in front of us and building resilience in our community, we will hopefully be more prepared for the next inevitable crisis. In weathering this storm, it is important to recognize though, that during times of crisis, there is heightened opportunity to bring out the best in society. Better times are ahead, and the Cedar Crest College Student, Eileen Gallagher, new knowledge garnered from this situation Portrait of a classmate, Fall 2020 will allow us to emerge even stronger as a collective body, ready to fight the next fight.

UNDERSTANDING THE PSYCHOSOCIAL IMPACF OF COVID-19 31

More Resources and Additional Readings o There are online tools based on validated, psychometrically sound measures of depression and anxiety that can help determine the threshold of a diagnosable mental health problem and when to seek help.

o Many resources are provided by the Centers for Disease Control and Prevention and the National Alliance on Mental Illness to help identify treatment strategies and ways to improve emotional well-being.

o For individuals experiencing suicidal ideation, the National Suicide Prevention Cedar Crest College Student, Delilah

Lifeline at 1-800-273-8255 is available. Schwartz, Portrait of a classmate, Fall 2020

o The nature of social stigma associated with a COVID19 positive status is addressed through the World Health Organization

Author Note

As nursing faculty, Drs. Hastings and Pasquale are members of the Nursing Research Collaborative of the Lehigh Valley (NRCLV), which is an alliance of the Nursing Programs of Cedar Crest College, DeSales University, and Moravian College. The NRCLV is a program of the Lehigh Valley Association of Independent Colleges (LVAIC), a 501(c)(3) organization, which includes Cedar Crest, DeSales, and Moravian, as well as Lafayette College, Lehigh University, and Muhlenberg College. The NRCLV is committed to creating and sustaining a local nursing culture that encourages and supports the spirit of scientific inquiry, nursing research, and application of evidence-based nursing practice through mutually shared efforts and goals.

UNDERSTANDING THE PSYCHOSOCIAL IMPACF OF COVID-19 32

References Ackerman, C. (2020). Top 14 apps for meditation and mindfulness

https://positivepsychology.com/mindfulness-apps/ Advocacy Alliance (2020, October 26). Resources. https://www.theadvocacyalliance.org/resources/resources.html Alonzi, S., La Torre, A., & Silverstein, M. W. (2020). The psychological impact of preexisting mental and physical health conditions during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice and Policy, 12(S1), S236–S238. https://doi.org/10.1037/tra0000840 Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395(10227), 912-920. Centers for Disease Control and Prevention. (2020) People who are at increased risk for severe illness. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-increased-risk.html Chen, S., & Bonanno, G. A. (2020). Psychological adjustment during the global outbreak of COVID-19: A resilience perspective. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S51. Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M. W. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 Pandemic - United States, June 24-30, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(32), 1049–1057. https://doi.org/10.15585/mmwr.mm6932a1 Fitzpatrick, K. M., Harris, C., & Drawve, G. (2020). Fear of COVID-19 and the mental health consequences in America. Psychological Trauma: Theory, Research, Practice & Policy, 12, S17–S21. https://doi.org/10.1037/tra0000924 International Council on Active Aging (2020). 10 ways to stay connected during COVID-19. https://www.icaa.cc/blog/2020-04/10-ways-to-stay-connected-during-COVID-19.htm Killgore, W. D., Taylor, E. C., Cloonan, S. A., & Dailey, N. S. (2020). Psychological resilience during the COVID-19 lockdown. Psychiatry Research, 113216. Lehigh County Human Services (2020, October 26). COVID19 information and resources. https://www.lehighcounty.org/Departments/Human-Services/Mental-Health/COVID-19- Information-and-Resources Panchal, N., Kamal, R., Orgera, K., …Chidambaram, P. (2020). The implications of covid-19 for mental health and substance abuse. https://www.kff.org/report-section/the-implications-of-covid-19-for- mental-health-and-substance-use-appendix/ Pedrosa, A. L., Bitencourt, L., Fróes, A. C. F., Cazumba, M. L. B., Campos, R. G. B., de Brito, S. B. C. S., & Silva, A. C. S. E. (2020). Emotional, behavioral, and psychological Impact of the COVID-19 Pandemic. Frontiers in Psychology, 566212. Pfefferbaum, B., & North, C. S. (2020). Mental health and the Covid-19 pandemic. New England Journal of Medicine, 383, 510-512. United Way of Lehigh Valley (2020, October 26). Resilient Lehigh Valley. https://resilientlehighvalley.org/ World Health Organization. (2020). Mental health and psychosocial considerations during COVID-19 outbreak. https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf

MEMBERS OF THE LVRC EXECUTIVE COMMITTEE 33

Members of the LVRC Executive Committee

Brian Alnutt, Ph.D. Professor of History Northampton Community College

Michelle Bolger, Ph.D. Assistant Professor of Criminal Justice DeSales University

Christine Carpino, PhD Director, Lehigh Valley Research Consortium Assistant Professor of Political Science Cedar Crest College

Michele Moser Deegan, Ph.D. Professor of Political Science Dean of Academic Life Muhlenberg College

Hollie Gibbons, M.P.H. SOLV Report Editor Assistant Professor of Health Sciences Cedar Crest College

Katherine Grasso, Ph.D. Cedar Crest College Student, Sydney Assistant Professor of Communication Szeliga, site installation, Spring 2020 DeSales University

Ranajoy Ray-Chaudhuri, Ph.D. Assistant Professor of Economics and Finance Muhlenberg College

Eike Reichardt, Ph.D. Associate Professor of Social Sciences Lehigh Carbon Community College

Christopher Ruebeck, Ph.D. Associate Professor of Economics Lafayette College

Chelsea Toth, D.S.W. SOLV Report Editor & Graphic Designer Assistant Professor of Social Work Cedar Crest College

Sabrina Terrizzi, Ph.D. Associate Professor of Economics and Business Moravian College LVAIC STAFF 34

LVAIC Staff

Diane Dimitroff Executive Director

Carrie Gradin LVAIC Office Coordinator

Charlene D. Bergstresser Program Director

Nick DeSalvo Director of Sustainability Initiatives

Lehigh University Student, Owen Rahr, C'mon,

Do Something, tape, Spring 2020