April 14 COVID-19 Update – Pennsylvania American College of Physicians

April 14 Pennsylvania COVID-19 Update

On Monday the Department of Health reported that Pennsylvania had found another new 1,366 positive cases in the previous 24 hours, for a total of 24,199. The death total rose to 524 deaths, with 17 reported on Saturday, all in adult patients. There were 105,593 negative tests in PA as of midnight Sunday night.
1,179  and 1,688 are in 215 ltc living facilities The Secretary noted that of the positive cases, 1,067 cases have been in health care workers, an increase of 112 since Saturday and another 1,688 of the positive cases facilities are in 215 of the state’s licensed long-term care facilities(up from the 195 facilities reported on Saturday).
At Monday noon, approximately 2,228 COVID-19 patients were hospitalized, approximately 10% of those testing positive.  At that time, 677 were using ventilators or ECMO.  About 44% of beds, 38% of ICU beds are available, and 1470 of 4909 ventilators were in use (nearly70% of ventilators were still available.) 
Of the patients who tested positive to date the age breakdown was unchanged from Saturday: 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.\
Health Department Issues revised Interim Crisis Standards of Care Guidelines
The Department of Health has issued a newly revised set of guidelines for interim crisis standards of care.  The 86 pages of Guidelines are available at: https://www.health.pa.gov/topics/Documents/Diseases%20and%20Conditions/COVID-19%20Interim%20Crisis%20Standards%20of%20Care.pdf
OMAP clarifies ICD-10-CM during the COVID-19 emergency
The Office of Medical Assistance Programs (OMAP) Monday issued an Operations Memorandum clarifying the use of ICD-10-CM during the COVID-19 emergency disaster.
When the Centers for Disease Control and Prevention (CDC) announced a change in the effective date of new diagnosis code U07.1, COVID-19, from October 1, 2020 to April 1, 2020 OMAP clarified that providers should use the new diagnosis code U07.1, COVID-19. This announcement is an update to the CDC’s official diagnosis coding guidance issued on February 20, 2020, and subsequent interim coding guidance issued for health care encounters related to the 2019 novel coronavirus (COVID-19) previously named 2019-nCoV.
OMAP said that Physical Health MCOs should notify providers to begin utilizing ICD-10 code U07.1, COVID-19. And PH-MCOs should bring their systems into alignment with the guidance described in this Operations Memorandum.
PA  to participate in regional joint planning for reopening economy
Governor Wolf on Monday joined with Governors from NY, NJ, CT, DE and MD in a conference call to announce that these states will work toward a joint plan to reopen various aspects of society when the coronavirus pandemic begins to ease.
The group will include three officials from each of the participating states, including the governor’s chief of staff, a public health official and an economic development official, according to NY Governor Andrew Cuomo who hosted the call. He said the joint group will start its work tomorrow.
The mission for the group that will come up with the “reopening” plan, Cuomo said, is, “We want it ASAP but we want it smart.”
Wolf said he was glad Pennsylvania was going to be a part of the effort. He said it was not only important to plot a comeback in terms of public health and interwoven economies, but in restoring a sense of hope to people.
Wolf said, “We can do anything better when we work together in this region.”
Monday evening, the Governor gave a short video message to the public and news media, noting “The process of dealing with this COVID-19 crisis and getting through it has, as I see it, three stages.
“The first stage – the one we’re in now – is focused on simply buying time to allow our healthcare system to build the capacity we need it to have. We cannot afford to allow it to be overwhelmed. We cannot allow this deadly disease to continue to claim more victims at an increasing rate. We want this stage to be over with as quickly as possible.
“The second stage will be a transitional one as well; it will take us from where we are now to the new normal that we’ll face down the road.
“And finally, the third stage is that new normal.”
On Saturday, Health Secretary Rachel Levine was asked by the news media how state officials were preparing to re-open Pennsylvania for business and when.  At that time, she said that the resumption of business in the state won’t be one big, grand re-opening. She said Pennsylvania will reboot with some counties, even specific municipalities, getting the all-clear based on key COVID-19 data, while other parts of the state will remain shut down, Levine indicated.
Levine said the total number of cases in an area, the number of new cases being reported there, as well as the percentage of positive test results per capita all will play a key role in decision making.  “When we see COVID-19 is going down … and there is much less community spread, I think that is the time in certain area of Pennsylvania to lift the ban,” Levine said, “while watching closely for new outbreaks.”.
Hospital Guidance issued Monday
Pen Health Secretary Dr. Rachel Levine on Monday announced the department has finalized interim guidance for hospitals if they become overwhelmed by COVID-19 patients with critical medical needs.
“Our team began to develop a document that helped hospitals make decisions in extreme circumstances after it saw what happened in the aftermath of major hurricanes and earthquakes throughout the world,” Dr. Levine said. “Initially, this was intended to be a year-and-a-half process, but four months into its development COVID-19 became a global pandemic, so it was fast tracked. While a committee worked with key stakeholders to ensure it is a balanced approached to a difficult topic, this document is a work in progress and may change in future versions.”
The Interim Pennsylvania Crisis Standards of Care for Pandemic Guidelines, developed with The Hospital and Healthsystem Association of Pennsylvania, is a guide to help hospitals determine how patient resources are allocated during an overwhelming public health emergency when the needs of the community dramatically exceed the supply of resources available. The guidelines specifically prohibit discrimination in regard to patient age, race, gender, creed, religion or exercise of conscience, color, sexual orientation, gender identity or expression, disability, ethnicity, national origin (including limited English proficiency), or socioeconomic status.
First PA Corrections inmate dies from COVID-19
Dr. Levine reported that on April 8, an inmate at the State Correctional In
stitution at Phoenix, Montgomery County, died at the Einstein Medical Center. On April 11, the Montgomery County coroner notified prison officials that the cause of death was determined to be acute respiratory distress from pneumonia due to COVID-19 with contributing factors of hypertensive cardiovascular disease and liver cirrhosis.  The inmate was a 67-year-old African American.
This is the first COVID-19-related death in a state correctional facility. Should additional COVID-19-related inmate deaths occur, the DOC will include that information on its website and will not issue individual news releases.
General Assembly – Essential Busineses, Business Reopenings
The State House of Representatives will be in voting session on April 14. The Republicans will have a quorum filling 102 members present in Harrisburg for the session, where they are expected to move legislation relating to the construction industry, car dealerships, retail stores and corporate services allowing them to remain open in spite of the Governor’s emergency declaration and orders concerning life-sustaining businesses.  These three bills all require the reopening businesses to follow CDC guidelines for operations to prevent the spread of COVID-19.  Governor Wolf has said he opposes the bills as being premature.
On Monday evening, Senate President Pro Tempore Joe Scarnati and Senate Majority Leader Jake Corman announced the Senate plans to return to session this week to consider legislation to “provide a safe path for re-opening the state’s economy” shutdown by the COVID-19 virus.  The expectation is that the Senate will pass the House-passed bills and send them to the Governor’s desk.
In a statement, the two Senate GOP leaders said, “Throughout the COVID-19 public health emergency we have endeavored to work together in a bi-partisan manner to do what is in the best interest of our Commonwealth.  Unfortunately, it has become abundantly clear that the Governor’s waiver process for employers to remain open during this time has been extremely flawed and lacks transparency.  The Senate is likely to also consider Senate Bill 327 (Argall-R-Schuylkill) on a concurrence vote in House amendments.
The bill would create a legislative-executive-judicial branch COVID-19 Cost And Recovery Task Force to identify urgent needs during the emergency that requires executive, legislative or judicial actions, develop a recovery plan and do a final report on the pandemic six months after the emergency is over.
PA-ACP has opposed legislation and amendments that would tie businesses to CDC and CISA recommendations from any specific date, as those recommendations and guidance are changing as more data and evidence is developed about the novel coronavirus.
State Supreme Court Rules with Wolf on Essential Business Authority
The State Supreme Court on Monday threw out a challenge filed by a mixed group of business owners and a state House hopeful that sought to overturn Gov. Wolf’s business shutdown order.  The Court majority found that the administration did not overstep its constitutional authority when it shuttered thousands of non-“life-sustaining” businesses statewide last month.
In a 51-page opinion, Justice Christine Donohue wrote that Wolf’s executive order authorizing the shutdown “results in only a temporary loss of the use of the Petitioners’ business premises, and the Governor’s reason for imposing the restrictions on the use of their property, namely to protect the lives and health of millions of Pennsylvania citizens, undoubtedly constitutes a classic example of the use of the police power to ‘protect the lives, health, morals, comfort, and general welfare of the people.’”
The plaintiffs filed suit on March 24, asking the high court to use its emergency powers to immediately hear their case, claiming, among other things, that Wolf’s executive order violated their due process, equal protection and free speech rights.