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

April 19 Pennsylvania COVID-19 Update

On Saturday the Department of Health reported that Pennsylvania had found another new 1,628 positive cases in the previous 24 hours, for a total of 30,792. The death total rose to 836 deaths, 49 in the last 24 hours, all in adult patients.
The state Health Department’s breakout of virus data for long-term care living facilities indicates 459 of the state’s 836 deaths, roughly 55 percent, are nursing home residents who had tested positive for the virus. There were 122,896  negative tests in PA as of midnight Friday night.
Levine said that of those testing positive, 1,558 are health care workers (up from the 1,401 such cases reported on Friday) – accounting for 5 percent of all positive cases; the total figure includes 462 workers in nursing homes. And from the department’s website, 4,185 cases – accounting for 12.6 percent of all cases (and up from Friday’s 3,716 cases) – are in 347 of the state’s long-term care living facilities in 35 counties (up from 321 facilities in 34 counties on Friday).
Of the total Saturday, 16,455 positive cases (53%) were female and 14,143 (46%) were male. Two percent (470) were unreported or neither.  Among the deaths, 464 were males and 367 were female with five unreported by sex.
By race, 5,275 were Caucasian (17%) 2,670 were African-American (9%) and 269 (1%) were Asian, with 97 listed as “Other.”  The vast majority, 22,758 (73% of all cases) did not report the race of the patient.
Saturday at noon, approximately 2,601 COVID-19 patients were hospitalized, slightly less than 10% of those testing positive.  At that time, 639 were using ventilators or ECMO.  About 48% of beds, 41% of ICU beds are available, and 1470 of 4909 ventilators were in use (more than 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; 39% are aged 25-49; 28% are aged 50-64; and 24% are aged 65 or older. 
Wolf Provides Outlines for Relaxing Restrictions
Gov. Tom Wolf on Friday presented the broad outlines of his administration’s requirements for relaxing restrictions on businesses and residents in Pennsylvania, including expanded testing and systems for tracking when people are becoming sick with the coronavirus.
But he did not provide a specific timeline for reopening the state, nor did he provide benchmarks on which he would base that decision. He advocated taking a gradual and regional approach toward opening certain business and industry sectors, with a requirement that hospitals and health systems in those areas have adequate bed space and personal protective equipment.
He also pushed for stringent standards that businesses must meet before they reopen in those areas, including the ability to follow CDC guidelines for monitoring employees for illness and sanitizing shared workspaces.  He said his administration would provide more details on his plan next week.
Newly released federal guidelines call for a phased reopening of states. Earlier this week, the White House has provided a guide recommending that states wait until they report a downward trajectory of documented COVID-19 cases, or a downward trajectory of positive tests as a percent of total tests, within a 14-day period.
The guide also calls for the ability to both conduct robust testing and treat all patients “without crisis care.” At the moment, Pennsylvania lacks the testing capability experts say is needed to safely reopen the state.
Wolf said reopening areas would require the following standards.

  1. Data driven – regional based
  2. Guidance and recommendations for employers, individuals and health care facilities.
  3. Adequate personal equip and testing
  4. Adequate monitoring
  5. Protections for vulnerable populations, limitations on visitors, etc.
  6. Limitations on large gatherings should remain in place for the duration of the process.

The Centers for Disease Control and Prevention (CDC) issued updated interim guidelines for implementing safety practices for critical infrastructure workers who may have had exposure to a person with suspected or confirmed COVID-19. The Pennsylvania Department of Health (DOH) is providing these updated guidelines for life-sustaining business workers. Additional guidance for healthcare personnel is forthcoming.
FRIDAY Q/A WITH THE GOVERNOR –  questions submitted by the Capitol News Media:
Is there any consideration to lifting some restrictions, like ones preventing elective surgeries? Where cases are low, you previously used a measured approach in establishing mitigation efforts a few counties at a time. Why not use the same approach in removing them? Gov. Wolf said that is a “great point.” He said more specifics regarding reopening will occur next week.
Since you closed counties individually at first, do you foresee opening counties up similarly as rates decline? Gov. Wolf said different parts of Pennsylvania experienced the impact of COVID-19 differently but claimed reopening needs to be a “staged approach.” He affirmed it would be.
Are you concerned the adversarial attitude towards closures will result in decisions not based on science, rather from an impulsive compromise or standing ground on the issue? Gov. Wolf said he is not sure whether people are willing to ignore science. He said all residents want to get back to work and businesses want to reopen, but the challenge is keeping people safe. He said he is trying to balance both in a measured, evidence-based way. In the meantime, he said, individuals have to recognize everyone is anxious to get back to work.
Is there a specific benchmark for testing that the administration will require before reopening areas of the state? Gov. Wolf said he does not know of any state with a specific target. He said the administration is learning more about testing each day as the capacity increases. He said the commonwealth does not know exactly where they need to be in terms of testing capacity to feel comfortable reopening. He said this affects every individual in terms of returning.
Do you feel the White House is putting the onus on increasing testing entirely on states? Is the federal government’s role crucial in increasing testing capacity? Gov. Wolf said the federal government plays a very important role in increasing testing capacity. In terms of too much stress, he said the federal government is enabling what states can do with testing within borders, but also focusing on increasing testing for all Americans and building capacity as quickly as possible.
On Twitter, President Trump urged people to “liberate Minnesota, Virginia and Michigan” — all states where people have protested against restrictions this week. In Harrisburg, a protest is scheduled Monday against the commonwealth’s restrictions. What impact do comments from the president have on states? Gov. Wolf said he does not think that tweet has an impact on states, rather the individuals protesting. Regarding the protest, he said the country is a democracy. He said every single resident is eager to reopen, including himself. The governor said he does not want Pennsylvania to reopen and then get “hit” by the virus in a way which overwhelms the health care system. He said Pennsylvania is making good progress and encouraged it to continue.
Saturday Q/A with Sec. Levine  – the state officials did not have a public availability on Sunday.
What’s being done to secure more tests so we can begin to lift social distancing?  We need to expand testing especially in areas where the restrictions can be relaxed.  Both our testing capacity for the Bureau in Exton and hospital and health care systems, and private laboratories.  We’re looking to expand those capabilities.
Is this the state’s job of the US Government?  The Federal government needs to provide supplies and resources, and we need to establish the systems.  We are dependent on them for chemicals and reagents.  We need to come up the plan.
Who are you consulting besides Dr. Fauci and Birx? You’re not an expert or epidemiologist.  Dr. Sharon Watkins is our state epidemiologist and president of the Council of State and Territorial Epidemiologists.  We do have many reach outs to academic centers – CHOP data lab, U of Pgh, CMU.  For that matter, I am president-elect of the Association of State and Territorial Health Officials.
A reader went to the ER and was tested but because she was sent home, several weeks ago.  Apparently the test was never sent to lab – she has had no response.  Is that normal?   That would not be standard procedure.  If a test was performed, I would think it would be run.  Reach out to hospital and get results – and to us if that doesn’t work.
It’s being reported that people are testing positive after treatment.  Is that accurate?  There is no accepted treatment for COVID, but there are trials – being tried in PA in Phila, UPMC, Penn State and Geisinger.  But after recovery we have heard some reports of patients retesting positive.  It could mean they were re-infected, or could mean they have DNA still in their system, despite not having active virus.  Studies need to be analyzed.
Is there anything people need to bring to NE site?  Need to register and bring their appointment time, and because it’s a mass testing site, they don’t need a prescription from a physician.
Will there be travel restrictions in the Mohegan Sun area?  There will be officers and personnel to direct traffic, and back onto the highway.
How does someone register if they don’t have access to internet?  Have to check on that.
Why not a mass testing site in the Lehigh Valley?  Decision was made to do northeast PA.  We’re looking at lots of other possibilities for mass testing sites. The Mohegan Sun site is next.
Can you tell us anything about the viability of the antiviral drug, remdesivir? We have seen reports and some positive about this treatment at Penn State and other institutions.  Was developed it to treat Ebola but it has shown some promise.  Trials need to continue.  It would be used for most ill patients in the hospital – not for mildly ill, or as preventative.  But studies are not definitive yet and need more studies.
Difference between tests for those with symptoms vs. those without symptoms?  Antibody testing not yet able to do that.  Test for virus itself (DNA) serology testing is for your immune response.  Most of these tests have just been released in the last week, and we’re looking at them to see which might be most effective.
You had said that county by county data wouldn’t have been useful, but now you’re using it.  Why?  We were in containment mode then.  Now we’re in another phase, into a mitigation phase, and public health value of negative tests is of more value now. And in interest of transparency,
How many COVID patients in each county have recovered? Will you  share that info?  We’re not able to track recovery of COVID patients, only with those in the hospitals – thru discharge data with PHC4.  When serology tests are available, that will be helpful, but there’s still a lot to learn, including how long they last and how effective they (antibodies) are.
Do you believe PA is close to the peak?  Any subsequent decline is a good indicator?  We have lots of indicators, but this is not going to be a grand reopening – it will
either be county or regionally based, and we have to see how trends go in regions.  We will need to have systems in place before that.
What is your reaction to people who are going to protest on Monday?  People have the right, but I have significant concerns about HOW that happens.  If they come out and are congregating together in a large crowd, that could facilitate the spread and I’d worry about the health of those people.
Are nursing homes mandated to report deaths due to COVID 19?  They are responsible to report to the DoH
Johns Hopkins researchers said our deaths were 921, but DoH page doesn’t say that – why are there two different numbers.  We’re working to reconcile all our data; we have very close associations with Phial and Allegheny Health Departments – talk to them every day.  Our reporting time is midnight.  Hopkins collecting data at some other time could impact that. 
There are virtually no new cases in McKean County, but we’re also hearing testing is being underreported.  What’s being done in rural areas like ours?  There is less testing in those areas, and community spread is more in population dense areas.  NYC had highest pop density and highest numbers in New York, and its been Philadelphia and suburban counties here.  We also want to make sure we have testing capabilities throughout the state. Will be working to improve that.
Why are there disparities between counties and state in reporting deaths?  Northampton county said 30 deaths on Thursday and the state said 25.  On Friday it was 34, and you said 27.  We don’t record as a PA death someone who lives in another state.   For example, if a New Jersey resident dies in PA, it’s considered a NJ death.  In addition, there’s a difference in terms of time reporting.
Are any nursing homes being assisted by National Guard?  There are some homes being assisted, to provide care and help them with infection control procedures.
What do we know about COVID immunity?  That’s why we’re going slow and in a measured fashion. It’s a good question  but we need to know a lot more about immunity.  Novel means new and we’re learning more every day.  Clearly there is an immune response, but what needs proven is how powerful the antibodies are, how much protection they offer and how long they stay.
The President put testing on the  states.  Could that reasonably be undertaken now here? If not, how long will it take to get these tests done before reopening parts of the state? We have the state laboratory, hospital and health systems labs and the private laboratories plus mass testing sites now.  We depend on the resources, so it has to be a collaboration and we’re looking forward to doing more.
Are there individual hospitals at or near capacity for beds?  Some in Philadelphia and the Southeastern counties are challenged, we’re tracking their situation, watching in real time.  We will collaborate with them to be sure they have enough beds, staffing, masks and ventilators which we’re doing very well on.  If it becomes an issue, set up alternate care sites (as we did with one at Temple)
Will the modeling tool the Governor mentioned be available to the public?  What thresholds will you use for making decisions on each county?  It will not be public facing.  We’ll be looking at public health and social/ economic parameters.  It will be a great collaboration.