April 24pm COVID-19 Update – Pennsylvania American College of Physicians

April 24 (afternoon) Pennsylvania COVID-19 Update

On Friday, the Department of Health reported that Pennsylvania had found another new 1,599 confirmed positive cases in the previous 24 hours, for a total of 38,652.  That represents 36,665 confirmed cases and 388 probable cases.  The increase includes 981 confirmed cases and 388 probable positives. The death total rose to 1,396 total confirmed COVID-19 deaths, an increase of 69 from Thursday, all in adult patients.  That number includes 1,325 confirmed and 71 probable deaths.  The Health Department said the change was due to better data collection and confirmation of cases, and that probable deaths will be reported in the future. 
The state Health Department’s breakout of virus data for long-term care living facilities indicates 903 of the state’s deaths, almost 61 percent, were nursing home residents.  There were 147,491 negative tests in PA as of midnight Thursday night.
At least 2,160 are health care workers – accounting for about five percent of all positive cases; the total figure includes  726 in nursing homes. And from the department’s website, 6,153 cases – accounting for 14.5 percent of all cases- are in 418 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, 10% were 50-64, 20% were 65-79 and 20% were 80+.  The remainder were unclassified yet per age.
Of the total through Thursday, 20,790 positive cases (54%) were female and 17,298 (45%) were male. Two percent (564) were unreported or neither.  Among the deaths, 758 (53%) were males and 658 (47%) were female with 5 unreported by sex.
By race, 7,497 were Caucasian (19%), 3,719 were African-American (10%) and 384 (1%) were Asian, with 154 listed as “Other.”  The vast majority, 26,898 (70% of all cases) remained unreported on the race of the patient.
On Friday at noon,  2,746 positive patients were hospitalized, slightly less than eight percent of those testing positive.  At that time, 679 were using ventilators or ECMO.  About 40% of the 1,489 intensive care unit (ICU) beds are available, and of the 7909 general medical beds 47% were available.  And 1476 of 5144 ventilators were in use (nearly 70% of ventilators were still available.)  47 5 beds 40% of ICU beds
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; 38% are aged 25-49; 28% are aged 50-64; and 25% are aged 65 or older. 
See below for Friday’s Questions and Answers with Governor Wolf and Secretary Levine.
Governor Wolf
The Governor took time to address stress, anxiety and mental health difficulties caused by the Stay at Home order on Friday.  He said, “we’re at the seven week mark,  limiting trips outside our homes and we understand that many of us are having negative feelings and stress.”  He discussed efforts by the state to fix problems in L&I to reduce wait times for the 1.6 million UC calls, paying $1 billion in extra UC benefits.  And noted the state was assisting others normally not eligible for the new federal program, saying 90,000 applied in the first week and they anticipate more in the next several weeks.
He provided all the state lines for people needing food, help with bills, mental issues, depression, United Way, etc.  He said that there’s a lot of scary information, anxiety, but we all need to work to combat them in new ways, like midday walks, virtual Happy Hours with coworkers.  Suggested that if one is feeling stress and anxiety to text PA to 741741
Launching new page for additional help next Friday, noting, “We’re all in this fight together.  To ward off deadly virus, we need to have the best mental health possible.”
Sen. Toomey released his own plan which called for PA to resume immediately.  Does May 8 still stick?
WOLF: May 8 is still the timeline.  Sen. Toomey and I talk all the time, and he told me he’d make these suggestions.  Sometimes we agree sometimes we disagree.
From an independent appliance store, if appliances are essential why aren’t they, and why are Home Depot and Lowes allowed to sell them?  WOLF: Home Depot and Lowes are open because of the construction, home improvement services and supplies.  If you’re not selling online, that’s the places that will be open.
Why can’t local Garden Centers open before May 8 as it’s now planting time?  WOLF: We’re always having those conversations. But May 8 is what we’re sticking to.
Do you have a reaction to Sen. McConnell’s comments about states filing bankruptcy?  WOLF: I disagree with him and need fed govt to continue doing what it’s doing.
Why can’t you sooner rather than later reopen things like golf, camping, getting dogs groomed? WOLF:  I want to as much as anyone, we’re working as quickly as we can, but May 8 is the date – to get PA reopened but keep people sale.
There’s confusion over benchmarks for reopening.  What was posted on the website – 50 over course of 14 days or per day?  LEVINE: We fixed that. Please go to health.pa.gov and see what we’re doing.  Looking at many different factors for the counties and regions. Stability of hospital systems, in terms of capacity, other factors in availability of testing and contact tracing, working with CMU on modeling and data as well. 
Some places offering antibody testing – have you been in touch with them in state?  LEVINE: We get that information, but there are a lot of antibody tests.  Most have not been approved by FDA. when the time is right, we’ll select one and use it.  It’s a tool but the clinical utility for each patient is not clear about how protective they are and how long they last.  When we have the right test, we will.  It’s not clear how effective this test is at protecting an individual. Its very possible they are partially effective, but not how much, how long.
How effective can community health nurses be doing contact tracing with years of cutbacks?  LEVINE:  I think they are doing an absolutely fantastic job and I say to them, THANK YOU.
Massachusetts hired 500 people two weeks ago to do contact tracing. How many will PA have to hire especially with the shortage of public health nurses?  LEVINE: Hospitals and health systems will be helping, and we will be hiring individuals – we’re also looking at technology to help us as well.  We are looking at county and municipal health departments.  And we talk daily with Phil, Allegheny and others.
Will state allow regions to open without additional tracing staff?  LEVINE: We will make sure adequate tracing is available in any region.
That doesn’t give much hope to Philadelphia to move to yellow soon because of its cases.  How many months, 3? 6?  LEVINE: The virus determines the timeline.  We’re seeing the most in the SE where hospitals are most challenged.  Don’t know when but the SE will open.
Governor Murphy said NJ will forced to return some of its federal relief funding because of restrictions on its use? WILL PA?  WOLF: We don’t believe we will be returning any federal funds.
What do you think of declaring bankruptcy? WOLF: I  disagree.
When will we see the information from the business waiver process?  WOLF: We continue to wrap that up, before its finished, anything that brings it out into open would give a distorted view of the process.  We were the only state to do that, trying to bring a level of common sense to the process. 
How are you balancing working with other governors and with the General Assembly?  WOLF: We’re all trying to do the best we can for the people w
e serve. Trying to keep PA safe and reopen as soon as possible.
Do you have concerns about  people traveling to other states and other regions once you begin to reopen?  WOLF: Right now, yes.  With shelter in place areas when people start moving, the numbers may change quickly, and we will need to retrace our steps. Movement may change things.
Cong. Keller and GOP delegation asked for clarity on how the $$ will be distributed.  What can you say to rural counties?  WOLF:  There are a lot of directives attached to the money PA will get. They stet out exactly how the money should be spent.  Executive and legislative branch will work together to figure that out.
Recent study showed PA lost many clean energy jobs in March.  What do you see in the long term loss of clean energy jobs?  WOLF:  The loss of jobs is affecting every sector.  In a post shutdown world, things will be different and there will be a lot of jobs in that sector in that new economy.
What happened on the call today with VP Pence?  WOLF: He advised us of things the federal government is doing with increasing testing capacity for states, but best stuff we got was from other governors.
How does the case count compare with what other states are doing?  Are you in  consultations with other states?  Any other examples? WOLF: We’re talking with them on a daily basis, but each state determines what its requirements are.  Each will make its own decisions on when and how we reopen.  Some ideas were from other states in and beyond the region.
How are you preparing for a second wave in the fall?  WOLF: That’s a big concern, but it will be determined by how we behave – wearing masks in yellow and even green phases.  Avoid unnecessary trips.  Wash our hands and pay due respect to our neighbors and families’ needs.  As we get into flu season, we can anticipate new problems, but if we practice responsible behavior, the resurgence will not be as great.
Does today’s 1492 death count include probable deaths?  LEVINE:  No it doesn’t.  We are excluding use of probable deaths for the foreseeable future.  With the difficulty in understanding, we are using only confirmed COIVD-19 deaths.
Sen. Toomey also called for allowing  elective/urgent procedures. Will the state agree to that?   LEVINE: We’re discussing allowing ambulatory surgical facilities and hospitals to do those procedures, and some procedures are quite urgent – we’ll have more on that soon.
Regions – why were the Health Department regions were selected Some are a mix of rural and urban and have very different experiences?  LEVINE: Regions are basically our health regions, which we’ve had for years.
State ordered closings county by county – Blair, Cambria and Centre are in other regions. Wouldn’t it make more sense to put some of those counties together?  LEVINE:  We’re using our health regions as the model now.
Outbreaks at LTCs are holding some counties down. Will they count in countywide assessments?    LEVINE: We are looking at them and staff go back and forth.  But all congregate settings will be included in county totals. 
Some are seeing negative results for people who tested positive.  How many of these are there?  LEVINE: There’s no longer CDC criteria for test of recovery, outside initial flurry are tests of recovered positives.
Trump appeared to suggest disinfectant – is he issuing dangerous advice?  LEVINE: Any time any type of ingestion of something of this type is extremely dangerous.  From my personal experience with children I’ve seen very severe burns, need for intensive care, and operations.  It’s extremely dangerous. My highest recommendation is not to do that!