April 30 COVID-19 Update – Pennsylvania American College of Physicians

April 30 Pennsylvania COVID-19 Update

On Wednesday, the Department of Health reported that Pennsylvania had found 1,102 new confirmed positive cases in the previous 24 hours, for a total of 44,366 confirmed cases.  The death total rose to 2,195  total confirmed COVID-19 deaths, an increase of 479 from Tuesday, all in adult patients.  The Department said the jump in deaths came from updates in the “electronic death reporting system, as a result of our continued work to reconcile data from various sources,” even though the deaths “have taken days or a week or more to occur.”
The state Health Department’s breakout of virus data for long-term care living facilities indicates 1,428 of the state’s deaths, 65 percent, were nursing home residents.  There were 170,517 negative tests in PA as of midnight Tuesday night.
At least 2,634 are health care workers – accounting for about five percent of all positive cases; the total figure includes  975 in nursing homes. And from the department’s website, 7,698 cases – accounting for 17 percent of all cases- are in 461 of the state’s long-term care living facilities in 42 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 Tuesday, 23,992 positive cases (54%) were female and 19,789 (45%) were male. One percent (58) were unreported or neither.  Among the deaths, 1,146 (52%) were males and 1,037 (47%) were female with 12 unreported by sex.
By race, 9,327 positives were Caucasian (21%), 4,538 were African-American (10%) and 46 (1%) were Asian, with 204  listed as “Other.”  The vast majority, 29,831 (67% of all cases) remained unreported on the race of the patient.  A total of 791 deaths were among Caucasian victims, 218 were African American/Black, 26 were Asian and seven were listed as other.  1,153 deaths were not reported by race.
On Wednesday at noon,  2,781 positive patients were hospitalized, slightly more than six percent of those testing positive.  At that time, 602 were using ventilators or breathing machines.  About 1,473 (about 40%) of  intensive care unit (ICU) beds were available, and 7427 general medical beds (47%) were available and 1,620 (53%) of the airborne isolation rooms are still available statewide.  And 1,443 of the state’s 5,199 ventilators were in use (72% 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; 38% are aged 25-49; 27% are aged 50-64; and 26% are aged 65 or older. 
Wednesday Questions for Sec Levine
What’s being done to help the homeless population during the pandemic?  LEVINE: This is a very serious question.  We’ve addressed this and have regular discussions with our local health departments, Philadelphia and Pittsburgh.  It’s a significant public health concern and we’re working on that.
Has there been a decision on which businesses can open under yellow and when will it be published?  LEVINE: We will be discussing those specifics later this week.
Reopening with rules limiting size of gatherings, how soon can we expect to be able to allow some group events?  LEVINE: The virus determines the timeline. Those kids of places will not reopen under yellow, but we’ll all be hoping for that during the summer.
If large childcare centers are operating under yellow what kind of guidelines will they have to follow? LEVINE: They will have to reopen under yellow and those guidelines will be released soon.
Will the same go for summer camps?  LEVINE: We haven’t made that decision, but it’s under discussion.
Is there any evidence that coronavirus spreads in water, pools and lakes?  LEVINE: We have no evidence of that.
PA doesn’t meet the estimated need for contact tracing with only 160 staffers.  How does health plan to address needs for contact tracing?  LEVINE: We’ll release that later in the week.  We will work with county and municipal partners and collaborate with hospital and health systems.  We have an excellent plan.
The northcentral region is expected to go yellow next Friday. Which factors, metrics and timeline will be used to decide when a region goes green? And who’s in charge of making that decision?  LEVINE: We’re concentrating on red to yellow right now.  We’ll be watching to be sure there are no outbreaks or clusters, and that we can contain them really well and we’re working on that now. As counties and regions do go to yellow, we’ll be thinking of what the next step is.  The Governor will make the final decision. 
Can some counties go green as long as some are still red?  LEVINE: It’s kind of hard to speculate on that.  It depends – in large metro areas such as Philadelphia, it’s hard for me to determine.
Do you know what the regulations will be for restaurants if we get to green?  LEVINE: Don’t have granular details, but we’re working on that. We are concentrating on the yellow phase of the plan.
What are you doing to make nursing homes safer for patients and workers?  LEVINE: That’s an Excellent question. For anyone living in congregate settings, we’ve put out guidance and CMS has put out guidance.  We’ve jumped on cases and clusters with consultations and guidance, reaching out on how to use PPE and pushing PPE out like N95 masks.  And we have more consultations coming.  We’ve had fantastic partnership with the National Guard, but these homes and facilities are very challenged and we’re still seeing more cases and tragically more deaths.  We are questioning what more we can do for the patients, families and staff.  We will do absolutely everything we can.
The number of cases in these homes has remained alarming.  Half of the new cases have come from those settings.  Why? LEVINE:  They are very vulnerable, because of the nature of the care, it tends to spread, and predominantly they are seniors who are more at risk.  The comorbidities make them more prone to getting it and having a more serious response when they do.  We are looking at many other states and countries as well for ideas.  We will do everything we possibly can.
Any clear idea why so many rises in Northampton yesterday?  The county went from 55-85 deaths today and you are matching with the coroner now.  LEVINE: Staff is looking into that now.  A large amount of info came from the commercial laboratories in a data dump, which brings info in an asynchronous way. We are constantly in a mode of assimilation and reconciliation of data.
The state announced a plan, then  issued revised plan on Saturday morning.  Why did this happen? LEVINE: We are taking a regional approach – but the Health regions are an example, but no specific schema and we don’t have to follow those designations.
With latest reconciliation, can you break out how many deaths actually occurred yesterday? LEVINE:  I don’t have that granular data and which number came from NEDDS reporting and vital records, but we can do that.
Armstrong County commissioners asked to be excluded form SW because of case counts? Is there any plan to consider them?  LEVINE: We are always happy to read and consider them in the end the Governor will make his decision.
Does the possibility that people can’t get to Mohegan Sun impact the regional date?  LEVINE: No matter where we put a site like that, it creates problems for travel for someone.  The number have increased to what we expected, and we’re pleased with that.
How are nursing homes reporting deaths to the state? Have they refused to provide case information?  L
EVINE: They put it into NEDDS and that is updated at least daily.
There was another spike in cases today – how will that affect decisions on reopening?  LEVINE: There really wasn’t a spike today, we’re looking at a framework of at least two weeks, so that wouldn’t affect those decisions.
Are all flu cases being added? LEVINE: No they are not it’s a completely different virus.  We had 130 lab confirmed cases of influenza and 102 deaths this year.  No one has had immunity to this virus, it’s more contagious than the flu and probably at least 10-20 times more lethal than the “flu.”
In Butler County where the Brighton Rehabilitation facility is,  numbers jumped from 59-65 can you confirm the cases were from there? LEVINE: The situation there has been challenging. We’ve brought in our consultant, pushed out PPE, and we are concentrating on that nursing home to protect the  vulnerable residents and staff.
It now has 248 cases and 58 deaths in the building but you say they’ve done nothing wrong. How can you say that with more than half the residents positive?  LEVINE: WE are working with them every day and I won’t address if they did anything wrong.
Florida is allowing horse racing; would PA consider letting horse racing begin? LEVINE:  I don’t have an answer to that. I would refer that question to the Governor.
Will the state offer guidance to physicians in dealing with people who don’t want to go back into businesses when they open under yellow?  LEVINE: That will be part of the process, and we are working through those details.
Are you looking at data from Yale study about deaths so far to reexamine whether pneumonia or flu deaths prior to March were from the novel coronavirus? LEVINE:  I haven’t seen it but would be happy to look at it.
Has the state analyzed who makes up these 1,000 new cases?  Is it still people contracting it by doing things like going to the store, or in nursing homes, congregate settings, etc.?  LEVINE:   in the hardest hit areas, there is still evidence of community spread.  We are seeing many new cases in health care workers and LTCs which are very vulnerable.
There will be a lot of subjective decisions – can you talk about them, especially in relation to Southwest PA?  LEVINE:  We will be looking at quantitative metrics, but also testing, contact tracing, ability of the health care system to deal with COVID if there’s an outbreak and those will go into our recommendation to the Governor.
You have a new policy for hospitals in place.  Are dentists allowed to open?  LEVINE: They were not included with hospitals and ambulatory surgical facilities.  We may have new guidance that will come out in the near future.
Will you release the names of the nursing homes where these cases and deaths have occurred?  LEVINE: We are discussing this and there’s a balance to strike – so we are still discussing.
How is Health taking into account the number of cases in State Correctional Institutions? Huntingdon SCI has 23 but the whole county has only 29.  LEVINE: I’ll check back with the team to get back to you on that question.
Electronic app from Google and Apple for contact tracing is voluntary. Can that help? LEVINE:  It’s voluntary but people want to do the right thing for themselves, their counties and for PA.  Using simple technology to help us Pennsylvanians will do the right thing.
How long will wearing masks be required?  LEVINE: The requirement for wearing masks will certainly not be lifted in moving from red to yellow, and even when we go green COVID won’t be gone and we’ll have to look for outbreaks and clusters.  It’s important to wear a mask to protect the community.
In yellow regions,  should people avoid congregating in small groups outside the home?  LEVINE:  I think it will still be prudent not to socialize in groups outside the home. Staying home would still be the right thing to do when we go from red to yellow in a region.
Auditor General DePasquale calls for release of nursing home information
Pennsylvania Auditor General Eugene DePasquale Wednesday called for more information to be released to the public about coronavirus outbreaks in nursing homes and other long-term care facilities.
DePasquale said, “every Pennsylvanian should know the number of cases and the number of deaths in every facility.”
He said the information is crucial to strategic decisions on when to lift coronavirus mitigation measures, and for Pennsylvanians to make decisions about the health care of loved ones.  The state Health Department has been reporting the number of nursing home infections by county but has not identified the individual facilities where infections and deaths have occurred. A Health Department spokesman said decisions about what information to release publicly are made to protect the privacy of Pennsylvania residents but are constantly being reviewed.
DePasquale, the state’s elected fiscal watchdog, also said he supports coronavirus testing for every nursing home resident and staff member, but acknowledged a broad mandate might run afoul of individual rights.
Wolf discusses food security issues
Governor Wolf held a briefing with State Agriculture Secretary Russell Redding. He discussed state efforts to promote food security and a letter he sent to the state’s Congressional delegation urging Congress to act on the Supplemental Nutrition Assistance Program (SNAP)
He also wrote USDA asking for reconsideration of SNAP interpretations to allow college students to be counted toward household benefits and to prevent UC benefits from being counted as income in qualifying for the program.
Wolf and Redding also discussed food and meat processing security, and the need to maintain the food supply chain’s life sustaining industries. Wolf was asked about essential workers raising concerns about their workplace not adhering to safety orders. What assurances can you give them that the orders will be enforced? Wolf responded that no one can “wave a magic wand” to fix all of the issues but that he knows employees will not go to work if they do not feel safe. He added that enforcement will come down to the employers and that they have to do the right thing to look out for their employees.
Sec. Redding said that mitigation efforts have been implemented and that he is disappointed to hear that some employees do not feel safe. He noted that PDA monitors its employers through the Food Safety Bureau but that any worker with concerns should bring them up with their employer and the administration.
Asked their reaction to President Trump’s executive order directing meat processing plants to reopen, Redding said there were concerns about meat processing plants closing and that there are discussions everyday about the fragile system. He added that Pennsylvania has already been adhering to its own masking orders and other requirements for food processing workers, so the executive order just captures what is already being done here.  Last week, state officials deemed employees at food processing plants could be given priority for COVID-19 testing.
Gov. Wolf encouraged food producers to follow guidelines but added that it will be up to the employees to hold their employers accountable with implementing safety guidelines. “If employees don’t feel safe, they’re not going to go to work.  So it comes down to the employers, every employer, they have to make sure their employees are safe,” Wolf said.
Wolf was asked if daily press briefings would become in-person as the reopening process begins – he has not done that in more than five weeks.  He said he would love to have in-person press conferences but that he is unsure how many people would be a
ble to attend while still maintaining social distancing. He added that the video format allows reporters to ask questions and that having in-person conferences might limit questions to only a few reporters spread around the room. There was no opportunity for a follow up question.
Senate democrats unveil plan for CARES funds; Republicans plan subpoenas
Sen. Jay Costa (D-Allegheny) and Sen. Vincent Hughes (D-Philadelphia) highlighted their plans for using the money Pennsylvania will receive from the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act on Wednesday.  Pennsylvania anticipates receiving $5 billion in total aid, $4 billion of which will be implemented through the state budget.
The Democrats’ proposal would:
•provide assistance to health care workers and emergency responders,
•provide assistance with education and childcare, and
•provide business assistance to help small businesses and restaurants.
Sen. Hughes emphasized the need to prioritize front-line workers, families, seniors, and small businesses. He listed items to assist people, including housing assistance grants, utility assistance grants, student debt assistance, childcare assistance for health care and front-line workers, testing for health care workers, and access to personal protective equipment (PPE) for health care workers.
Sen. Hughes outlined broad spending categories, including:
•$1.1 billion for working people;
•$900 million for education and childcare initiatives;
•$650 million for the health care industry, first responders, and front-line workers;
•$425 million for small businesses;
•$350 million for local governments; and
•$300 million for historically disadvantaged communities.
This is essentially one-time spending to be spent by December 31, 2020.
Does the $650 million assistance for health care workers include support for isolation, and if so, do you know how much it will cost? Sen. Costa said the Senate Democratic Caucus is working with health experts to see what is needed. He said, “We will continue to work to see what front-line workers need and how health experts believe we should be spending the dollars.” When asked where the other three caucuses were on these issues, Sen. Costa said that this is the beginning of a process, “Senate Democrats laying out what we believe is the best plan.”
Meanwhile, Senate Republicans have called a meeting of the Veterans Affairs and Emergency Preparedness Committee for Thursday afternoon to vote on whether to subpoena the Wolf Administration over its refusal to provide information on business closure decisions, requested exemptions and justifications for refusing those exemptions.  Administration has refused to provide that information or to answer Right To Know Act requests from the General Assembly and news media. 
House Republicans on Wednesday said that they had written at least 10 letters to the Governor and Secretary Levine since March 19, and have not gotten a response to any.