April 23 COVID-19 Update – Pennsylvania American College of Physicians

April 23 Pennsylvania COVID-19 Update

On Wednesday, the Department of Health reported that Pennsylvania had found another new 1,156 positive cases in the previous 24 hours, for a total of 35,684. The increase includes 981 confirmed cases and 315 probable positives. The death total rose to 1,622 deaths, an increase of 58 deaths from Tuesday, all in adult patients.  That number includes 1,325 confirmed and 297 probable deaths.  The Health Department said the change was due to better data collection and confirmation of cases and probable deaths will be reported in the future. 
The DoH has now included trend animations on its website as well, for reference.  We are bolstering our contact tracing efforts and looking at the best ways to utilize these resources and help us identify early if an outbreak begins to happen.  These were the tactics we used at the start of the pandemic and they helped to mitigate the spread. 
Social distancing is still our best defense.
The state Health Department’s breakout of virus data for long-term care living facilities indicates 845 of the state’s deaths, about 52 percent, were nursing home residents.  There were 136,272  negative tests in PA as of midnight Tuesday night.
At least 1,896 are health care workers – accounting for about five percent of all positive cases; the total figure includes  617 in nursing homes. And from the department’s website, 5,337 cases – accounting for 14.5 percent of all cases- are in 407 of the state’s long-term care living facilities in 39 counties.
Two percent of hospitalizations were under 29 years of age, five percent were 30-49, nine percent were 50-64, 19% were 65-79 and 20% were 80+.  The remainder were unclassified yet per age.
Of the total through Tuesday, 18,959 positive cases (53%) were female and 16,003 (45%) were male. Two percent (722) were unreported or neither.  Among the deaths, 758 (54%) were males and 649(46%) were female with 215 unreported by sex.
By race, 6,639 were Caucasian (19%), 3,289 were African-American (9%) and 339 (1%) were Asian, with 123 listed as “Other.”  The vast majority, 25,418 (72% of all cases) remained unreported on the race of the patient.
On Wednesday at noon,  2,764 were hospitalized, slightly less than eight percent of those testing positive.  At that time, 685 were using ventilators or ECMO.  About 42% of beds, 36% of ICU beds are available, and 1487 of 5120 ventilators were in use (just over 70% of ventilators were still available.) 
Of the patients who tested positive to date the age breakdown was: 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 25% are aged 65 or older. 
See below for Wednesday’s Questions and Answers with Governor Wolf and Secretary Levine.
Governor Announces Plans to Reopen PA
Governor Wolf Wednesday night presented his plan for reopening the commonwealth with a targeted May 8 start.  He categorized the reopening into three phases, red, yellow and green.  Phases will be assigned based on conditions in a county, counties or regions, with the first requirement being at least 14 days maintaining a ratio of less than 50 positive cases per 100,000 population.  Currently, 39 counties would qualify for the minimum, according to the Department of Health.
Wolf said additional metrics would include testing rates, the state’s ability to investigate, contact tracking, and local health and economic factors.
The entire state is currently in the Red Phase.  Under the Yellow, some retail businesses and childcare would be permitted to open with online and telephone sales and curbside deliveries, but the state would continue to limit high risk activities, prevent large social gatherings, etc.  Telework would continue where feasible and Stay at Home restrictions would be lifted.  Taverns and restaurants would not be permitted to open other than for food sales at curbside or delivery.
Wolf said that the state would continue to require CDC and DoH guidelines be met, and that universal masking may still be required.
He said the state had not determined the metrics for a county or region returning to Green status at this time.
State Senate Holding Joint Hearing on COVID-19 Response
The State Senate Community, Economic & Recreational Development and Senate Veterans Affairs & Emergency Preparedness Committees are holding a hearing Thursday morning at 10 a.m., in the Senate Chamber on Governor Wolf’s COVID-19 response  and its impacts
House to consider several health insurance bills
The House Insurance Committee scheduled a voting meeting for Monday on several bills, including  
HBs 469, HB 470, HB 471, HB 1439 and HB 1696.  We fully expect significant amendments to be offered to these bills in Committee or later in the legislative process, as most are aimed at forcing changes by health care insurers.
HB 469 would require most health insurance policies cover the ten Essential Health Benefits, and would virtually eliminate Short Term Limited Duration health care polities as a result.
HB 470  prohibits lifetime and annual limits on Essential Health Benefits for individuals.
HB 471 prohibits insurers from discriminating against a qualified individual or group based on a pre-existing medical condition.                                        1
HB 913 modifies state law re children’s coverage on parents’ health care insurance, allowing children on parents’ policies even if that policy is owned by an employer.  The bill also would put Pennsylvania in line with federal age coverage provisions, reducing the maximum age from 29 to children under 26 years of age.
HB 1439 – requires insurers issuing or administering a health insurance policy or plan to file a written annual certification that they have completed a comprehensive review of all health insurance policies and health plans with mental health or substance use disorder benefits and meet the standards of  the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.
HB 1696 requires insurers to file information with the Department, to determine whether the insurer is in compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act.
Federal Assistance for Providers
The Department of Health and Human Services (HHS) announced Wednesday that it would provide $10 billion for COVID-19 hot spots, $10 billion for rural providers, and $20 billion to shore up the first round of payments, as well as the opening of a portal for providers to submit claims to help cover the costs associated with caring for uninsured patients. Providers can find more information on this additional relief HERE. 
HHS has already disbursed $30 billion to nearly 500,000 providers based on Medicare fee-for-service data from fiscal year 2019. The portal for providers to sign an attestation confirming receipt of these funds launched the week of April 13, 2020. Recipients have 30 days to complete the required filing. You can find that information HERE.
Congressional Relief Bill Moving
After two weeks of stalemate and days of negotiations, the US Senate approved a nearly $500 billion coronavirus aid bill on Tuesday afternoon with the House set for passage on Thursday.
The agreement centers around providing $380 billion for small businesses and also includes $75 billion for hospitals and $25 billion more for disease testing.
Polls Support Social Distancing
A Politico/Morning Consult Poll shows wide support for continued social distancing measures, and majorities still say they are more concerned with the public health implications of the coronavirus. 
But the poll — conducted Saturday and Sunday as small protests percolated in a handful of states — does show an uptick in the percentage of voters worried about the U.S. economy. Just over a third in the new poll, 35%, say they are more concerned about the economic impact of the coronavirus, up 6 points from last week. The majority, 58%, say they are more worried about the public health impacts, down 6 points from 64% last week.
Reality check: Ending social distancing now is still a fringe position. Only 14% say Americans should stop social distancing to stimulate the economy even if it means increasing the spread of the virus, though that’s up 4 points from last week. More than three in four, 76%, say Americans should continue to social distance for as long as necessary, even if it means continued economic damage.
Q/As with Sec. Levine and Governor Wolf
An unemployment Compensation client had to call five hours straight and couldn’t get through  today, why can’t L&I extend their hours past 4 pm into the evening hours to meet the demand of those who have lost their jobs?  WOLF: We were overwhelmed by the initial surge of applications for relief.  We’re adding people, bringing annuitants back, using new technology and new people in processing claims, increasing employees in mail room.  We apologize for the inconveniences this has caused.
Why wait till May 8 in counties that will NEVER his 50 per 100,000 residents?  WOLF: People will move around more freely when we start to life those orders. May 8 is the soonest even in areas where were doing quite well.
HAP said nonemergent services talks are ongoing with the Department.  What do you need before hospitals can begin treating those patients? LEVINE: We’re discussing when non-emergent procedures can occur.  We’re coming up with guidance using their information and nationally to get non-emergent but urgent procedures they need. 
How will the  state reassure people It’s safe to go to hospitals when the orders are lifted?  LEVINE: We have models and data and we’ll feel confident that people who go will be safe.
Why are coroners and medical examiners not being informed about the daily numbers?  LEVINE: We’re drawing a balance between hospitals and coroners.  I plan to talk to them and strike a balance.
What are the state’s funding sources for its actions?  LEVINE: We have received funding from the CDC in terms of our public health response.  Congress for relief of small businesses and hospitals.
Roughly 4-5 cases come back negative – how can a death be a probable cause if no testing has been done?  LEVINE: It may have to do with symptoms, the clinical course, the hospital and health system and the contacts that person had.  For example, someone in a family with a positive test, or someone in a long term care facility.
Article making rounds citing latest computer projections from U Wash which identified May 25-31 for PA as earliest date for relaxing .  Regardless of what models say, are you going to proceed? WOLF – The SE and NE are the worst,  and as you move further west, density and occurrence declines.  PA is not a monolithic thing, so May 8 is when we’ll be starting.
Has there been a change in enforcement of traffic violations in PA?  WOLF: No not as far as the state is concerned.
How do you intend to enforce wearing masks in public?  WOLF: It’s self-enforcement, it comes down to each individual coming down to a decision they don’t want to infect friends, co-workers. 
Today there was a widespread outage affected many customers in Armstrong County.  Are you doing anything about that?  WOLF:  We have a number of things in place and we will continue to do that.
Did you permit resumption of construction to begin May 1 instead of May 8?  WOLF: Yes.
The Susquehanna and Sullivan County Commissioners have expressed concerns that if they reopen earlier, they are afraid people will flock into their counties.  Is there anything they can do to protect themselves?  LEVINE: I think that’s unlikely, with the progressive approach the governor has outlined.  Its unlikely that we will see the large spread of people traveling to these counties.  We will be testing, contact tracing and will prevent outbreaks.
CDC guidance said the distinction between confirmed and probable would be counted on April 2.  Why did you wait until April 20 to do that?  LEVINE: We’ve been reviewing hospital charts, so it’s taken time to collect that.
Coroners continue to say they cannot make sense of the state’s death numbers. What do you say about that? LEVINE: We’re getting them from a number of sources, and we’ll reconcile that data with them.
We’ve seen two big spikes this week, adding probable and reconciliation of dates. Can we expect more?  LEVINE: Two reconciliations we had to do; those will be the only changes.
How are you doing personally, and what do you do when you are swamped?  LEVINE:  I’m a pretty calm person, so this is pretty natural to me.
Can you define NC and NW regions?  What counties would be involved?  WOLF: For example, Tioga and McKean,  but data is gonna drive this.  Lowest density counties, but we will be applying the metrics I mentioned to be sure we’re doing this in data-driven evidence based way.  We have to look out for interest of the entire state.  Close partnership with counties, but our ultimate call is the interests of the entire state and we’ll look at this from that perspective.  Every one of the 12.8 million Pennsylvanians will determine how successful we are.
The Senate is  hearing on the Administration efforts tomorrow. What do you have to say about that? WOLF: That’s what happens in a Democracy. This is part of their responsibility.
Would hairdressers and barbers be open under yellow?  WOLF: We haven’t gotten that granular. 
What  is the rationale for making it 50/100,000  for 14 days as opposed to 40, 45? LEVINE: areas that have not had widespread community spread.  Need adequate testing and
then we’ll be comfortable.
The criterion for the yellow phase is at 50/100,000.  What’s GREEN?  We haven’t established that yet.  It will be an evidence-based decision. Truly minimal impact – somewhat arbitrary, but could be 45/55, lets all recognize we are trying to get to a truly minimal impact in that area.
Tomorrow at Mohegan Sun they are open from 10-4 daily.  What prompted the move to test anyone symptomatic, not just those over 65?  LEVINE: We’ve been able to acquire more chemicals and reagents, so we can do more tests.  This will let us get a better sense of the penetrance of the virus, but we wanted to loosen up the criteria
Will there be phone registration for mass testing sites?  Yes, 1-877-PA Health starting tomorrow.