April 28 COVID-19 Update – Pennsylvania American College of Physicians

April 28 Pennsylvania COVID-19 Update

Hospitals, ASFs allowed to perform elective surgeries, procedures
Dr. Levine and Governor Wolf today said that the Commonwealth has issued new guidance that will allow hospitals and ambulatory surgical facilities to perform elective surgeries and procedures.  The PA-ACP welcomed this good news! 
Our patients need ongoing and urgent care too, to avoid more critical health problems, and prevent more hospitalizations, even during the COVID-19 pandemic.
The guidance is available on the PA-ACP website
The guidance allows these procedures as long as they meet with the additional guidance standards of the American Hospital Association, American College of Surgeons, the American Society of Anesthesiologists and the Perioperative Registered Nurses, as well as guidance from the Children’s Hospital Association of the United States.
Wolf reminds providers to include race, ethnicity data with test results
Governor Wolf on Monday reminded COVID-19 health care providers and medical facilities to follow the Department of Health’s mandate and include race and ethnicity data in demographics provided to the department with COVID-19 test results. He also asked for more robust, free and accessible testing for minority and vulnerable populations.
“All Pennsylvanians deserve the same access to testing and treatment during the COVID-19 pandemic. That’s regardless of race, income, location, and every other factor. The goal for this task force is to help communicate issues with how the pandemic is affecting the state’s minority and vulnerable populations.
“Despite a mandate by Secretary of Health Dr. Rachel Levine, 69% of race data is still unreported and there is little to no data when it comes to ethnicity. “We need to get more medical professionals collecting and reporting race data about their patients.
“We also need to make sure our vulnerable populations have equal access to testing. By identifying issues, like testing locations and hours of operation, and providing information on these locations to our minority communities, we can make sure testing is accessible to everyone and help us detect COVID-19 before it becomes widespread in a community,” he said.
“The COVID-19 Health Disparity Task Force, led by Lt. Governor John Fetterman, is comprised of members of the Wolf Administration includes the executive directors of each of the five state commissions representing minorities, members of the Department of Health’s Health Equity Response team and those that serve as the contact for stakeholders, constituents and legislators on issues and concerns surrounding health disparity in Pennsylvania’s vulnerable communities.  The Task Force has met three times, and working with the Department of Health’s Office of Health Equity, is seeking more specific information on how to tackle these issues and identify others.”
On Monday, the Department of Health reported that Pennsylvania had found 885 new confirmed positive cases in the previous 24 hours, for a total of 42,050 confirmed cases.  The death total rose to 1,597 total confirmed COVID-19 deaths, an increase of 47 from Sunday, all in adult patients. 
The state Health Department’s breakout of virus data for long-term care living facilities indicates 990 of the state’s deaths, almost 62 percent, were nursing home residents.  There were 161,372 negative tests in PA as of midnight Friday night.
At least 2,394  (a decrease of more than 300!) are health care workers – accounting for about five percent of all positive cases; the total figure includes  862 in nursing homes. And from the department’s website, 7,037 cases – accounting for 14.5 percent of all cases- are in 441 of the state’s long-term care living facilities in 40 counties.
Two percent of hospitalizations were under 29 years of age, five percent were 30-49, 10% were 50-64, 19% were 65-79 and 19% were 80+.  The remainder were unclassified yet per age.
Of the total through Friday, 22,741 positive cases (54%) were female and 18,725 (45%) were male. One percent (584) were unreported or neither.  Among the deaths, 850 (53%) were males and 741 (46%) were female with 6 unreported by sex.
By race, 8,542 positives were Caucasian (20%), 4,150 were African-American (10%) and 435 (1%) were Asian, with 185  listed as “Other.”  The vast majority, 28,738 (68% of all cases) remained unreported on the race of the patient.  A total of 590 deaths were among Caucasian victims, 171 were African American/Black, 22 were Asian and 5 were listed as other.  809 deaths were not reported by race.
On Monday at noon,  2,799 positive patients were hospitalized, slightly less than eight percent of those testing positive.  At that time, 625  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. 52 percent of the 1,704 airborne isolation rooms are still available statewide.  And 1,574 of the state’s 5,197 ventilators were in use (nearly 70% of ventilators were still available.)  47% of  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 26% are aged 65 or older. 
Wolf announces May 1 reopening of some outdoor activities.
Governor Tom Wolf today announced that he is lifting some restrictions on businesses related to certain outdoor activities starting Friday, May 1.
He said golf courses, marinas, guided fishing trips and privately owned campgrounds may reopen statewide and are required to follow updated life-sustaining business guidance and FAQ issued by the Administration.  These include specifics for how these outdoor recreational industries can resume activities while prioritizing public health and safety. Campgrounds in state parks will remain closed through Thursday, May 14.
Monday Questions for Sec Levine
How many positives have we found from the Mohegan Sun mass testing site – LEVINE: Approximately 5-7% are positives, which is low, but it underscores the fact that we want more people to get tests done there at the drive-through site. I would encourage people to come and get tested if they have symptoms consistent with COVID-19. Now we have the ability to test more people.
Do you have a target reopening metric? Will it be by County or region? – Will it average all the counties in a region?  LEVINE: We’ll look at a county in a region.  We’ll be looking at the Community Health  regions in the Dept. of Health, but not specifically be held to any particular schema.  Many other things are on the list.
What is “enough” testing and treatment?  Are there metrics for that?  LEVINE:  That’s a good question.  We’re going to be looking globally at how we can expand testing –  she then listed all the possibilities, plus mass testing, mobile vans and said the Department will have more info on that later this week.  Contact tracing will be done as well with hospitals, hospital system employees and nurses as well.  They are our disease detectives. 
Several counties’ officials plan formal requests to be moved to other regions for reopening purposes. What do you say to them?  LEVINE: We’re not going to be specifically held to the regions on the map.
How many business complaint forms have been filed.  It this a case of too much government being big brother?  LEVINE:  I don’t have a number on that – a lot of our mitigations efforts have been positive.  We don’t want to be big brother, but we’ve been working on mitigation of the spread, with almost 1,600 who passed away.  You can see the impacts on other countries, other states.  Closures and stay at home orders have been helpful, but now we’re ready to move forward May 8.
How are our hospitals factored into reopening decisions?  LEVINE: Their ability to take care of COVID 19 patients and respond to an outbreak, and help with investigations in contact tracing are very important.
The temporary hospital at E Stroudsburg has been open for several weeks, but has no patients.  How long will you keep it open?.  LEVINE:  I can’t tell you how pleased we are at that.  What it shows is the mitigation effort under the Governor’s leadership has been successful.  We have been able to flatten that curve.  Exactly how long we will keep it open, I can’t say.
On Saturday, the state said you would not be using the average of new cases in a region, three days after the plan came out saying you would use an average.  What happened in those three days?  LEVINE: We have worked to refine the metric but I don’t want to dwell on that.  It’s something we put down to have something quantitative to look at but our decisions will be qualitative.
Will the administration be releasing a map with the new 14-day case counts?  Is there some other way for the public to see that?  LEVINE: We haven’t made a decision on that – but it seems reasonable for those moving, but we’re not going to give a statewide calculation for that – you can calculate it yourself.
Should we be counting nursing homes or prisons out, wouldn’t we meet the numbers quicker in the SE region if we did? LEVINE: We do not want to take them out – that is part of those counties, and the facilities have staff who live and travel within the region.  But the SE will eventually be able to go from red to yellow, but clearly not at this time.  I’m optimistic, that we’ll get there.  We’d rather be safe than quick.
If the panel says all but 1 county can go from red to yellow in a region will that county hold the others up? LEVINE: I don’t think so, but that will become clear to you when we start outlining decisions.
Is part of the strategy for the 50/100,000 benchmark that if you have fewer its easier to do contact tracing?  LEVINE: We wanted a number that we could use to quantitatively compare county to county and region to region.
Do you have any concern about reopening border counties, like those in the northern tier bordering counties in NY that have higher numbers?  LEVINE:  We will be watching for all potential outbreaks.
NY is looking at declines in hospitalization rates as part of its decision making. Is PA?  LEVINE:  That’s a real interesting point of data that we’d be willing to look at.
The quantitative is one of several others things you are looking at.  Do you plan to release the list of other factors?? LEVINE:  I’ve already done that.
Gracedale Nursing Home alone has had over 700 sick day call outs this month over COVID and the National Guard is being used to provide staffing.  Is that typical?  LEVINE:  Yes, it’s a problem and we’ve used the National Guard and contracted with ECRI to help in other nursing homes.
Why can’t pet groomers reopen?  Most of these dogs and cats are now six weeks, causing mats, overgrown faces with hair, nails are getting long, etc.  LEVINE: We’re going to be following the Red Yellow Green schema for businesses.
Which types of businesses, golf courses, manufacturers, beauty shops? LEVINE: Many will and many will not.  Restaurants, bars, large venues, movie theatres will not reopen under yellow; others like pet groomers will. We will still want people to wear masks, maintain social distancing, washing of hands, and still be careful about spread.
Relatives of nursing home residents cant get information.  Wil you name specific nursing homes WITHOUT outbreaks like other states have done?  LEVINE:  It’s the responsibility of fhe acilities to notify family, but we will consider other measures.
Do you have updates or leads on testing chemicals and supplies needed to reopen? LEVINE: We’re doing much better on that and our lab at Exton is doing all the testing at Mohegan Sun.  Hospitals and health systems and ASFs should schedule someone to test for COVID 19 before those procedures.  We need a consistent and reliable supply chain to continue and expand testing.
You have said that businesses reopening would have to follow CDC and DoH guidance.  Is the DoH guidance publicly available on line? LEVINE: It’s on website and called guidance for businesses.
There’s not much hope for Phila to reopen soon, is there?  Don’t people deserve some idea of what to expect and how long?  LEVINE:  In the future Philadelphia will go from red to yellow but the virus sets the timeline.  We don’t know when Philadelphia and collar counties will do that.
The Governor Tweeted 2020 graduating classes his congratulations.  Does that mean no graduation ceremonies will be allowed?  LEVINE: That’s a fair assumption. They would be remote and it’s a real shame but this is a global pandemic.
You are no longer reporting probable deaths, what about probable cases?  LEVINE:  Yes, its about 1% of our cases known.
What’s the significance of 2 or more days without COVID deaths in a county?  LEVINE:  We look at trends over time, not daily numbers. We have many different ways to look at that – patients, hospitalizations, deaths – this is a very good sign but we watch the daily trends
Nursing home issue is a problem.  What is the state doing? – LEVINE:  I spoke with Dr. Bogan from Allegheny Co earlier.  We are very concerned about the health of individuals, especially in these facilities which have had specific challenges.
How much does discovery about lack of reporting race impact other categories of reporting.  LEVINE:  This has been an ongoing problem with lead testing as well.  Hoping that a computerized system will make it easier to get that information and we’re hoping technology will improve our ability to do that.
Cambria County does not think of itself as in the southwest – have you considered changing the regionwide requirements?  LEVINE:  We are not looking at just county – we’ll consider all requests.
Some think the requirement threshold is too restrictive for reopening. What’s your response?.  LEVINE: There are many other pieces of the puzzle that will be considered.
US Supreme Court sides with Insurers on ACA Payments
The Supreme Court sided with insurers in a years-long battle over billions in payments promised under the Affordable Care Act. The court ruled 8-1 on Monday that the ACA’s risk corridor program created an obligation for the federal government to pay health plans promised funds. Only Justice Alioto dissented.
The insurers suing for damages sought $12 billion in unpaid funds from the program.
The ACA established the risk corridors to encourage health plans to participate in the exchanges. If an insurer earned massive profits through the individual market, the government would claim some of those funds and pay it out to insurers that are performing poorly.  The government did collect those funds, but did not pay out money to struggling insurers. The risk corridor program closed in 20
16 after three years.
The Paycheck Protection Program and Health Care Enhancement Act – New round of funding
Friday’s new law infuses $370 billion into the Paycheck Protection Program (PPP), Economic Injury Disaster Loans (EIDL), and emergency Economic Injury Disaster Loans grants. This action provides extensions and modifications to these Coronavirus Relief Programs and gives nonprofits, including faith-based organizations, small businesses, rural owned public hospitals, and self-employed individuals and independent contractors another opportunity to receive federal support.  As in the prior rounds,  organizations and individuals should act quickly.
Find an eligible lender and refer to the updated FAQ from the Small Business Association.  
Pennsylvania receives $43.8 million from PREP Act and CARES ACT
HHS released figures today showing state funding to date from the Preparedness and Response Supplemental Appropriations Act (PREP) and the Coronavirus Aid, Relief and Economic Security Act (CARES) in April. The funds were distributed from the CDC.
CDC is using existing networks to reach out to state and local jurisdictions to access this funding, which may be used for a variety of activities including:

  • Establishing or enhancing the ability to aggressively identify cases, conduct contact tracing and follow up, as well as implement appropriate containment measures.
  • Improving morbidity and mortality surveillance.
  • Enhancing testing capacity.
  • Controlling COVID-19 in high-risk settings and protect vulnerable or high-risk populations.
  • Working with healthcare systems to manage and monitor system capacity.

The Commonwealth received $16.9 million in a cooperative agreement with the DHS for testing and laboratory services, another $8.1 million for Epidemiology and Laboratory Capacity grants, and will receive $18.8 million under the Epidemiology and Laboratory Capacity Reopen America program.