April 17am COVID-19 Update – Pennsylvania American College of Physicians

April 17 (morning) Pennsylvania COVID-19 Update

Civil Immunity Update
PA-ACP and other provider organizations had urged the Governor to issue an executive order granting limited civil liability to physicians and other health care providers earlier in the week.  On Thursday, the PA-ACP sent this letter(Link to letter), asking the leaders of the House and Senate to introduce and pass legislation to grant health care practitioners limited civil immunity during the emergency declaration for COVID-19.  This is a second leg in our efforts to protect members who are putting their health and lives on the line for patient care. 
In the House, Majority Leader Bryan Cutler said House and Senate leaders believe the issue should be addressed through legislation and that “we continue to engage with our colleagues on both sides of the aisle to find a solution” in the absence of an order from Wolf.  “I hope the governor will recognize the unique stresses medical professionals, along with the producers and suppliers of life saving equipment, are under at this difficult time and join us in finding a solution that empowers and protects doctors on the front lines of this crisis,” said Cutler, a Republican from southern Lancaster County.
House Democrats opposed an amendment on civil liability last week because it was “broad and vaguely worded,” and because it also awarded immunity to “institutions, large and small,” said a spokesman. nursing homes on the front lines of providing care should not have to look over their shoulder for potential
During a news media availability on Thursday, the Governor was asked, Hospitals and malpractice lawsuits. How close are you to issuing some immunity for the medical community like several other states have done?
Gov. Wolf responded that he is not aware of what other states have been doing with that but that he is interested in keeping Pennsylvanians safe. He stated that medical professionals are doing the right thing and providing good care, so they have not expressed much concern about liability.
Look for an email and more information on this website shortly.
On Thursday the Department of Health reported that Pennsylvania had found another new 1,245 positive cases in the previous 24 hours, for a total of 27,735. The death total rose to 707 deaths,  60 in the last 24 hours, all in adult patients. There were 113,745  negative tests in PA as of midnight Wednesday night.
The Department noted that of the positive cases, 1,401 cases have been in health care workers, an increase of 94 since Wednesday.
A total of 3,684 of the positive cases are in 306 of the state’s licensed long-term care facilities (up from the 295 facilities reported on Wednesday) in 34 counties.  There are 394 cases among employees of those facilities. 
For the first time, the Department released data on sex and ethnicity of positive patients.  Of the total Thursday, 14,554 positive cases (52%) were female and 12,717 (46%) were male. Two percent were unreported.  Among the deaths, 397 were males and 305 were female with five unreported by sex.
By race, 4,540 were Caucasian (16%) 2324 were African-American (8%) and 237 (1%) were Asian.  The vast majority, 20, 551 (74% of all cases) did not report the race of the patient.
Thursday at noon, approximately 2,503 COVID-19 patients were hospitalized, slightly less than 10% of those testing positive.  At that time, 676 were using ventilators or ECMO.  About 41% of beds, 37% of ICU beds are available, and 1489 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; 6% are aged 19-24; 40% are aged 25-49; 29% are aged 50-64; and 23% 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.
DoH Updates Infection Prevention and Control Recommendations
The Department of Health on Thursday updated its Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for 2019 Novel Coronavirus (COVID-19) in a Healthcare Setting.
To address asymptomatic and pre-symptomatic transmission, implement source control for everyone entering a healthcare facility (e.g., healthcare personnel, patients, visitors), regardless of symptoms.

  • Actively screen everyone for fever and symptoms of COVID-19 before they enter the healthcare facility.
  • As community transmission intensifies within a region, healthcare facilities may consider foregoing contact tracing for exposures in a healthcare setting in favor of universal source control for HCP and screening for fever and symptoms before every shift, as well as the end of every work shift as described in HAN 492.

Statewide – The Wolf Administration has since noon, April 15:

For the latest information for individuals, families, businesses and schools, visit “Responding to COVID-19” on pa.gov.
General Assembly
The House had added Thursday as a Non-Voting Session day and April 20 & 21 as Voting Session days.  The Senate is recessed at the 12 hour call of the President Pro Tempore.  On Thursday, Speaker Turzai signed SB 613 and SB 841 which now are in the Governor’s hands.  The Governor has said that he intends to veto SB 613.
The House voting calendar set Thursday for next week includes bills and amendments relating to the COVID-19 pandemic and economic activity.  Bills on the calendar include legislation affecting taxes, liquor and wine sales, auto dealership openings, senior citizen protections, mental health patients’ protections from abuse, protections for rape victims, and the General Fund budget.
That’s according to data compiled by Altarum, the largest single-month loss in at least 30 years as the economic shutdown took hold. Those losses were largely concentrated in physician and dental offices, as well as among home health workers.  Hospital jobs remained essentially flat between February and March, but Altarum predicted that there could be even greater job losses across the board in April. 
Independent, physician-owned medical groups have suffered sharp revenue declines amid the coronavirus outbreak, with some warning that they could run out of money within months.
Roughly 60 percent of medical groups surveyed by the American Medical Group Association said they’ll deplete their cash reserves in the next two months, according to polling conducted by the trade group. And doctors in nearly all groups have taken pay cuts, as non-essential procedures are put on hold and patients postpone appointments.

COVID-19 Crisis Line Available for First Responders, Healthcare Workers
The increased stress caused by COVID-19 affects all Pennsylvanians, but our first responders and healthcare workers face even greater pressures in helping the state respond to this public health emergency. Magellan Health recently opened a free national crisis line for all first responders and healthcare professionals who are serving on the front lines of the pandemic.
The hotline is open 24 hours a day and connects callers directly to licensed mental health clinicians for support. The toll-free number is 1-800-327-7451 (TTY 711).
Questions with Secretary Levine
Why did you issue the mask order now?  LEVINE: We have been successful and want to protect the workers in these life sustaining industries.  The mask provides SOME protection for someone transmitting it if they have it with mild symptoms or none.  It is by no means 100% which is why people should stay home.
Does the mandate apply to public transit, taxis, Uber and Lyft? We would prefer if they did. We are recommending that but wasn’t part of the order.  It’s not specifically required.  We have instructions on the website on how to make a mask.
Would you consider exemptions where it’s a safety hazard to WEAR a mask?  LEVINE: Not aware of any such industries, but would consider that.
On the new business orders, thermometers are impossible to get online.  Will there be some leeway for businesses that can’t get them?  What kind of guidance to food retailers?  More time to adapt to yesterday’s orders?  LEVINE: If someone doesn’t have a mask, they should be asked to go home and get a mask.
Cleaning supplies are hard to get for businesses – would the state consider relaxing regs on warehouses that supply?  LEVINE: We’ll all do the best we can with the challenges to get the resources and supplies we need.
Businesses asking why they remain closed when their counties may only have one death?  LEVINE: We know there’s underreporting.  We know the number of cases is higher than we can verify in rural counties.  Because there’s less population density, there’s less risk, but it’s still there and we need to keep up to prevent that community spread.
Positive coronavirus cases in more than 300 LTCs?  How many LTC facilities are there? LEVINE: This is our most vulnerable population.  We’re doing all we can to help them deal with this dangerous virus. There are  695 licensed nursing homes, several thousand personal care homes.  Far more PCHs. 
What specific measures were taken by the state to protect them and when?  LEVINE: Since the beginning, we put out guidance “weeks and weeks ago.” Was also info from CDC and CMS, and working with those who had positives, and working to get PPE.  Hiring ECRI is doing more infection control consultations.
Is there a plan to ask nursing homes to have a separate wing or unit?  LEVINE: Specific staff to take care of them, or separate nursing homes? So no mixing of staff. 
Nursing home employees, does the number of deaths count anyone who died including them?  LEVINE: Yes, its inclusive
What is the timeframe for rollout of the antibody tests?  T LEVINE: the original test was last week.  FDA approved two last night, and we’re looking to see what we can get for the lab in Exton, then hospitals, Lab Core and Quest.  More important from a surveillance and public health point of view, but first for health care workers and LTC employees.
Are we reaching the peak as expected? Best case or worst case?  LEVINE: It depends on what model you use.  Washington model says today and a peak in deaths will be in a few days.  But modeling is just modeling.  Compared to FEMA models, we have certainly bent that curve in terms of positives, hospitalizations and death rates.
With lower testing rates are we really flattening the curve or flying blind with under reporting and under testing? LEVINE: We’re looking at a number of factors, influenza like illnesses, ER visits, etc. all are going down.  We need to expand testing and we’re discussing that vigorously this week.
What is PA doing for contact tracing program – would PA do what Massachusetts did and hiring thousands to do that?  LEVINE: We’re having those discussions.  We want to do contact tracing, as well as quarantine and isolation of positives and their contacts.
What tests would PA need weekly to be satisfied – it’s been estimated that US would need 750,000/week? LEVINE: We’ll be looking at further sites.
Who’s eligible for testing now?  LEVINE: high risk individuals, health care workers, senior citizens with symptoms.
Is the Department considering other locations given the opposition to Mohegan Sun?  Will it be open to all or just residents of certain counties?  LEVINE: No, but we’d like to have other sites in the future.  It will be open to all residents, but we don’t think people will drive hours for a test.
Herd immunity.  Is stay at home limiting getting herd immunity?  LEVINE: SARS was a different coronavirus, and while more virulent, was much less contagious. Letting this spread would have been catastrophic.
Why a field hospital in East Stroudsburg, not Hazleton?  Will it do overflows from NY and NJ?
LEVINE: We strongly felt it was the
best location for northeast Pennsylvania.
Is it possible the state could open health insurance to all if they lost their insurance?  LEVINE: Fed govt has said no one will be left in lurch if they are tested or treated for COVID-19
Underreporting is a concern.  A number of deaths are listed as anyone COVID related, or could it be higher for lack of reporting?  LEVINE: Deaths are confirmed COVID-19 deaths.  Not counting probable deaths or others.
The Scranton coroner says they have 38, but you’re reporting 28 .  WHY? LEVINE: We’ll call him.
When do we start to ease?  Are you looking to change guidance on relaxing family visits?  LEVINE: No plans to relax that order. People will do the right thing.
Extension of NY till May 15.  Do you foresee that happening here? LEVINE: We’re discussing what we will do and the Governor will make those decisions and announcements.
On Monday, thousands are coming to Harrisburg to protest your orders.  Do you have any comment?  LEVINE: if you’re not practicing social distancing, you’re threatening yourself and putting yourself at risk.  We understand that the majority are in SE Pennsylvania, and pleased the rest of the state is better off, but I’d recommend not coming.