April 16 COVID-19 Update – Pennsylvania American College of Physicians

April 16 Pennsylvania COVID-19 Update

The updated order from the Department of Health on inventory of PPE, equipment and certain pharmaceuticals in the Governor’s April 8 order requires compliance by  11:59 p.m. on April 16, 2020.  You can find all of the details online here.
The Order requires all health care providers and facilities, whether presently opened or closed, and including, without limitation, physician practices and dentists, to report their inventory.  The items required to be reported are categorized on the Inventory Portal and include the following:
a.      PPE (gowns, gloves, face masks and shields).
b.      Certain durable medical equipment (ventilators, anesthesia machines, unused vent circuits and
      ECMO machines); and
c.      Certain pharmaceuticals that may aid in the support and treatment of individuals with COVID-19 
i.             Various Paralytic agents
ii.            Injectable benzodiazepines
iii.           Opiates
iv.           Other anesthetics (viz., Etomidate, Ketamine, Propofol)
v.            Respiratory treatment pharmaceuticals ( Albuterol MDI, Albuterol nebulized , Norepinephrine)
vi.           Azithromycin and hydroxychloroquine
On Wednesday, the Department of Health reported that Pennsylvania had found another new 1,145 positive cases in the previous 24 hours, for a total of 26,490. The death total rose to 647 deaths, with  reported on Tuesday, all in adult patients. 324 of those deaths occurred in LTC facilities. There were 111,094 negative tests in PA as of midnight Tuesday night.
The Department noted that of the positive cases, 1,327 cases have been in health care workers.
Levine said the Department had been working to get more data on those living in LTC homes and after a “deep dive,” the data resulted in significantly updating the numbers from those licensed facilities. She said 3,316 of the positive cases facilities are in 297 of the state’s licensed long-term care facilities(up from the XXX facilities reported on Tuesday) in 33 counties. A county-by-county breakdown is available online at www.health.pa.gov.
Wednesday at noon, approximately 2,392 COVID-19 patients were hospitalized, approximately 10% of those testing positive. At that time, 662 were using ventilators or ECMO. About 41% of beds, 39% of ICU beds are available, and 1494 of 4909 ventilators were in use (nearly 70% 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; 40% are aged 25-49; 29% are aged 50-64; and 22% are aged 65 or older. 
51% of the patients hospitalized are aged 65 or older, and 29% 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.
Wednesday afternoon, Governor Wolf announced a new order from Sec. Levine directing businesses to make additional specific efforts to protect employees and customers. Wolf said, “We all have a role to play.” (See details below)
During questions from the news media, about data on minorities, Wolf said, “we know from data in other states that minority communities have bene disproportionately affected. We are working to improve our data collection, so we can understand.”  Wolf said he had appointed Lt. Gov. John Fetterman to chair a new health disparity task force. “Working proactively with leaders of those communities we can make sure nobody gets left out.” He took time to thank one community leader – Thomas Tolle, an investor in FIGS who donated $4.2 million to hospitals serving black populations in honor of Jackie Robinson day.
Wolf was asked several questions about legislation being passed this week in the Assembly, including legislation by Senate Republicans that would allow counties to make determinations of reopening businesses on a county by county basis. He said, I don’t support that bill and have concern over handing over the decision making on that score – we need to work together.”
He was asked if he would veto SB 613, which would open several businesses and create a multibranch task force to make those decisions. He said, “We’re using common sense. Uniquely in PA, we are not just handing out a list – we created a waiver program that 40,000 businesses took advantage of. Our focus has been keeping Pennsylvania safe. What we need to do is recognize the course we are on is the least bad choice, and with all the painful decisions, it’s the right choice for PA.” 
The Secretary was asked why we were using out of state labs? Levine said PA needs to take advantage of all lab testing capacity and would not be where we are without their assistance. “The time it takes creates a lot of challenges there, but we want to use every opportunity to expand testing in PA,” she said.
Wolf was asked about NY Governor Cuomo identifying specifics, rate of spread, contact tracing, would help determine what businesses would be opening first, and what were Pennsylvania’s plans. The Governor said, “That’s something we have to do. We would look at new cases, staying within capacity to treat, capacity for surveillance/antibody testing, and then promised “We will come up with specific guidelines as quickly as we can.”
Many Pennsylvanians working in life sustaining businesses make less than $30,000 per year, and 2/3 are below the state median income. What are we doing to assure they can make a living wage? Wolf said, “we need to safeguard their health with new guidance, urge employers to pay employees commensurate with the risks they are taking. It is a tough time for people and an interesting cautionary tale to give employees confidence so they will come to work. Customers need to feel safe, and owners need confidence that the economy will keep them and employees healthy.” 
Do changes in testing (ex. LVHN) lower the numbers of positives? Levine said Pennsylvania is looking to expand testing throughout the state as much as we can. We are working to get reagents for Exton then to health systems to do their own testing.
Other states have begun contact tracing. Is PA? what steps are we taking? Levine said, “That’s correct, our goal is to have a measured approach to reopening, and that would require retesting, instituting isolation and quarantines. Perhaps we could use volunteers to allow contact tracing and use of technology to do that.
Wolf was asked about whether the state would go to a temporary budget mechanism to hold the state over given the lost revenues and increased costs. It was noted that New Jersey moved the start of its fiscal year back. Wolf said, “We’re not only looking at 20-21, but also the 19-20 budget about how we’re going to do that. The big question is how the money is coming from the feds and how much and when. He said, “The economy has tanked, and looking at the state the same way – we need to continue to do what we’re doing for the people of Pennsylvania, but with huge economic meltdown, we need to do more than we have in the past.”
NOTE: The pace of coronavirus testing is  slowing dramatically nationwide as well, while infections continue to rise. The volume of tests analyzed each day by commercial labs fell 30 percent over the past week, a drop that FDA Commissioner Stephen Hahn said the administration is still puzzling over. One explanation could be the narrow testing criteria that officials laid out back in March. 
Testing is already inadequate, and the volume will need to ramp up dramatically to help determine when it is safe to lift social distancing measures. That will first require an expansion of test kit supplies and lab capacity — and likely new guidelines around who should be tested and how often.
Secretary Levine issues new Orders for businesses and employees
As noted by Governor Wolf, Wednesday afternoon, Health Secretary Levine announced new orders for businesses and employees intended to increase worker and customer safety during the COVID-19 pandemic.
Starting Sunday, employers must require all employees and customers to wear masks at work. The order also mandates companies provide masks for workers and deny entry to customers who are not wearing one. Failure to comply could result in citations, fines or license suspension, officials said.
“This order will ensure continuity across all life-sustaining businesses and will further our efforts to protect the health and safety of all Pennsylvanians,” Levine said. “Together, we can all help mitigate the spread of COVID-19.”
As a part of the new protocols, employers must:

  • Provide masks to employees and mandate that they wear them when not eating or drinking.
  • Stagger work start and stop times to limit large groups entering or leaving the business.
  • Provide sufficient space for employees to have breaks and meals.
  • Conduct meetings and training virtually.
  • Prohibit non-essential visitors from entering the business.
  • Ensure that the business has enough employees while maintaining social distancing.

If an employee suspects, or is confirmed, to be infected with COVID-19, employers are asked to conduct temperature screenings before employees enter the business and send anyone home with a temperature above 100.4 degrees Fahrenheit.
Upon discovery of a positive case, employers must:

  • Close off and ventilate areas visited by that person.
  • Wait a minimum of 24 hours before cleaning and disinfecting all spaces.
  • Alert employees who were in close contact with the individual.

Along with all of the above protocols, businesses operating a public building are ordered to:

  • Require all customers wear masks on the premises and deny entry to those not wearing masks. If the business provides medication, medical supplies, or food, it must provide alternative methods of pick-up or delivery of goods.
  • Conduct business by appointment or at an occupancy less than 50%.
  • Alter hours of business to allow for additional time to clean and restock.
  • Install shields or other barriers at restaurants.
  • Encourage use of online ordering
  • Designate a specific time for high-risk and elderly people at least once a week.
  • Schedule handwashing breaks for employees at least every hour.
  • Assign an employee to wash down carts and hand baskets.

The order will be enforced by a group of state agencies, including the Pennsylvania Liquor Control Board, the departments of Health, Agriculture and Labor and Industry, the Pennsylvania State Police and local officials.
General Assembly – Economic Reopening, PHC4 in House
House has added April 16 as a Non-Voting Session day and April 20 & 21 as Voting Session days.
The Pennsylvania state senate spent Wednesday debating and sending  on a 29-21 vote, a bill to lift parts of the Governor’s business shutdowns to the Governor’s desk.
Senate Bill 613, passed 107-95 by the House on Tuesday, would require the governor’s office to align with federal guidelines in determining which businesses can be open during the pandemic, allowing all those that can safely operate with mitigation strategies under CDC and Cybersecurity and Infrastructure Security Agency (CISA) guidelines established in March.
Wednesday evening the Governor’s Office said that Wolf would veto the bill. The Governor and legislative leaders had talked earlier, but clear differences of opinion exist on what is best for the Commonwealth at this stage of the pandemic.
In a statement, Wolf’s office said, “irresponsibly going against the direction of the Secretary of Health and reopening businesses too early will only extend the length of the economic hardships created by the pandemic.”
PA-ACP opposed  the legislation because it was not data driven and moved the state away from the need for strict distancing, before evidence was developed that such actions would continue to flatten the curve.
The Republican senate also approved a bill that would allow county governments to implement their own plans to reopen independent of the state’s plan. Much of the opposition to Wolf’s orders has come from questions about the process of decision making and a waiver process that has lacked transparency. Many lawmakers cited examples from their districts where one business was exempted from the closing orders while another – competitor company – was denied a waiver.
Democrats accused the GOP lawmakers as trying to tie the Governor’s hands, while Republicans argued about the lack of transparency and success of the social distancing programs.
The Senate also sent SB 327 back to the House of Representatives.  This bill extends school property tax payments, allows local governments to conduct remote meetings, allows school districts to renegotiate contracts with service providers to reflect the impact of closings and extends deadlines for businesses to make payments under the state Educational Improvement Tax Credit program.  But the bill also gives power to county governments to determine when businesses would be able to reopen at the local level.

Also on the Governor’s desk after unanimous passage in the Senate is a bill (SB 841) to reauthorize the Pennsylvania Health Care Cost Containment Council, require reporting on COVID-19 related matters, and would also allow local governments, notaries to operate remotely and with electronic processes. 
Protests Planned
On Monday, April 20th at noon thousands of citizens, led by ReOpen PA, End The Lockdown PA and Pennsylvanians Against Excessive Quarantine, will come together to peacefully protest against lockdown restrictions continuing beyond May 1.
Protests are beginning to emerge across the country as concerned citizens strive to return the economy to normal. These protests have been peaceful as will this event. We invite the media to cover our protest at the State Capitol Building.
ReOpen Pa, End The Lockdown PA and Pennsylvania Against Excessive Quarantine are organizations formed in the last 5 days, now with more than 10,000 members. These groups are not affiliated with any political party, political action group, or any other organization.

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