April 10am COVID-19 Update – Pennsylvania American College of Physicians

April 10 (morning) Pennsylvania COVID-19 Update


On Thursday, the Department of Health reported that Pennsylvania had found another 1,989 new positive cases in the previous 24 hours, for a total of 18,228 in all 67 counties. The death total rose to 338, with 28 on Wednesday, all in adult patients. There were 87,374 negative tests in PA as of midnight Wednesday night.

The Secretary noted that of the positive cases, 850 cases have been health care workers (an 11.8-percent increase – 90 cases – over infections reported on Wednesday), and another 1,058 of the positive cases facilities (a 27.3-percent increase over Wednesday’s reported total) are in 168 of the state’s licensed long-term care (up from the 157 facilities reported on Wednesday).

Percentages of those testing positive did not change significantly from Friday afternoon.  Approximately 2,053 patients have been hospitalized since 3/6 ( 10% of the positive cases). At this time, 599 have required use of ventilators or ECMO.

As of noon, 51% of beds, 40% of ICU beds and 1459 of 5036 are in use (71% of ventilators are still available.) 

Of the patients who tested positive to date the age breakdown is as follows: less than 1% are aged 0-4; less than 1% are aged 5-12; 1% are aged 13-18; 7% are aged 19-24; 41% are aged 25-49; 29% are aged 50-64; and 21% are aged 65 or older. 

51% of the patients hospitalized are aged 65 or older, and 28% are aged 50-64.  19% are ages 25-49.  Most of the deaths have occurred in patients 65 or older. There have been no pediatric deaths to date.
Governor Orders Schools Closed for Remainder of Academic Year
Governor Wolf announced Thursday that all Pennsylvania schools will remain closed for the remainder of the 2019-20 academic year. The governor made the decision in consultation with Secretary of Health Dr. Rachel Levine and Secretary of Education Pedro A. Rivera. Students and families can continue to pick up meals at designated sites.

Although schools are closed, schools have been strongly encouraged to provide continuity of education for all students in the most appropriate and accessible ways possible. PDE has secured resources intended to help all schools that want to use them – including those not currently offering online platforms, those requiring additional technology support, and those that may rely on traditional methods, such as paper lessons, to continue educating students. There is no cost to schools or students for these resources.

The decision applies to all public K-12 schools, brick and mortar and cyber charter schools, private and parochial schools, career and technical centers and intermediate units. All Department of Education early learning program classrooms, including those for Pre-K Counts, Head Start Supplemental Assistance Program (HSSAP) and Preschool Early Intervention, will also remain closed.

Colleges and universities may not resume in-person instruction or reopen their physical locations until the governor permits them to open or lifts the closure of non-life-sustaining businesses.

Schools will remain closed though the end of the 2019-2020 academic year as it is defined by the local school calendar.  Under the state’s directive, schools could begin summer programming on the day after their academic year ends, and that all re-openings will be contingent on public health guidance provided by the Secretary of Health and stay-at-home orders issued by the governor.
State Provides Business Risk Assessment Tool
The Commonwealth has available a “COVID-19 Risk Assessment Tool” for those businesses that remain open during the pandemic.  The tool is available online at https://www.health.pa.gov/topics/Documents/Diseases%20and%20Conditions/COVID-19%20Business%20Risk%20Assessment%20Tool.pdf
Consultant Hired to Assist LTCs, SNFs and Assisted Living Facilities
The Commonwealth has retained ECRI, an independent non-profit health services company, to offer individualized infection control and prevention assistance to long-term care facilities throughout the state to prevent the spread of COVID-19.
The Department of Health will coordinate with ECRI to evaluate how facilities are currently working to maximize resources and to provide support for facilities. More information is available here
General Assembly Actions
The House and Senate have recessed at the 12 hour calls of their presiding officers.  No legislation impacting the state’s COVID-19 response passed both chambers this week, although each passed legislation that was sent to the other.
The House was scheduled to return next Tuesday, April 14, and the Senate was slated to return May 4.
Budget Questions Abound
The state Independent Fiscal Office on Wednesday suggested that between the current fiscal year and the coming fiscal year, which begins on July 1, Pennsylvania could see revenues fall by between $2.7 billion and $3.9 billion due to the COVID-19 shutdown of the state (with $1.3 billion to $1.8 billion of that during the current fiscal year).
According to the IFO, the estimates represent potential outcomes based on the length of mandated business closures under two scenarios, with the lower number assuming a six-week closure (ending on April 27) and the upper end assuming a ten-week closure (ending on May 25). The estimates also include a potential gain of $400 million to $500 million from federal stimulus funds.

Last week, the state Treasury extended a $2 billion line of credit to the Commonwealth in order to help it with likely cash flow issues during the next few months.
It appears likely that the state may have to find a new way to budget for 2020-2021, with the possibility already being raised of two six-month budgets, or a massive borrowing of up to $5 billion.

Nation’s Only Doctor Governor Offers Sober Voice on Virus
Virginia Governor Ralph Northam is a pediatric neurologist.
Daily Media Questions to Dr. Levine
Can you provide an update on whether providing county officials where cases are in their counties?  LEVINE: Yes, we will be. Working on doing that by end of the week.
We continue to see an increase in the number of cases – what’s driving it and what’s it mean?  LEVINE: It means we have widespread community transmission, particularly in Southeastern PA, the Philadelphia collar counties and in the Northeast in Lehigh, Luzerne and Monroe Counties. This highlights the significant importance of the mitigation factors the Governor has ordered.  Closure of schools and non-life sustaining businesses, and Staying Home orders.

If a life sustaining business like a grocery store has an employee test positive for COVID-19 do they have a responsibility to tell their customers?  LEVINE:  It would be difficult for that to happen because they have different customers every day.  There are specific rules and guidance for cleaning that we would expect them to follow.

HAP said hospitals are losing $2 billion a month – are you aware of the problem and willing to do something?  Yes, it’s put a strain on ALL businesses – and we appreciate the assistance we’ve received from hospitals and
from HAP.  There will be federal assistance, and we’ll also be looking for resources to help them.

The home health care field is starting to see an influx of requests from hospitals to take care of COVID-19 patients who are being discharged. What is the state doing to help there?  LEVINE: It’s very important for patients diagnosed and discharged to have that support.  We need to make sure the home health workers have sufficient PPE and know how to use it.

Is social distancing working?  If not, what can be done?  LEVINE: The provisions are working, as outlined by Drs. Fauci and Birx – we’re still seeing increases, but it’s gone from doubling every couple of days to less, so we need to continue to maintain vigilance, social distancing, and to buttress the health system.

What signs will you look for before reopening things?  LEVINE: We don’t know, but there will be a time to relax them – it won’t be one grand day, it will have to go in a slow, progressive fashion, community by community, county by county,” she said.

Are mass testing sites planned in the NE?  LEVINE:  Yes, there are plans for a mass testing site in the NE and a field hospital in East Stroudsburg. We’re implementing those at this time.

What efforts are you undertaking to protect patients in nursing homes?  LEVINE: Patients in LTCs and personal care homes are among the most vulnerable of our citizens.  Those with chronic medical diseases. We’re working with all of them to implement our guidelines, and in contact when they have a case over infection control procedures. 

​Reports are questioning the role of ventilators and data shows that 85% of those on ventilators ultimately die.  What do you think about these reports?  LEVINE:  I read those articles, and repeat this is a NOVEL coronavirus.  It’s only the sickest patients that get put on ventilators in the first place.  The physicians in the ICU ultimately will have to take that info and visualize the care for each patient for each outcome.