April 3pm COVID-19 Update – Pennsylvania American College of Physicians

April 3 (afternoon) Pennsylvania COVID-19 Update

Pennsylvania had 1,404 new positive cases of COVID-19 through Thursday, for a total of 8,420 total cases statewide in 63 counties.  Approximately 852 patients have been hospitalized since 3/6 ( 10% of the positive cases).  Of those patients, 241 have required stays in the ICU and 147 required use of a ventilator or breathing machine.  To date, 102 total deaths have occurred statewide, 12 on Thursday, all in adult patients.

Health care workers constitute 419 of the total cases – roughly 5%, and approximately 12% of 695 nursing centers have at least one case.

There are 53,695 patients tested negative to date.  Of the patients who have tested positive to date the age breakdown is as follows: nearly 1% are aged 0-4; nearly 1% are aged 5-12; 1% are aged 13-18; 8% are aged 19-24; 41% are aged 25-49; 29% are aged 50-64; and 20% are aged 65 or older. 

One half of the patients hospitalized are aged 65 or older, and 28% are aged 50-64.  Most of the deaths have occurred in patients 65 or older. There have been no pediatric deaths to date. More data is available here

NOTE: Dr. Levine said that there is much discussion in the public health community as to whether masks are effective in slowing the spread.  She said that while staying HOME is the most effective way of protecting yourself and your family.  Wearing a mask or a bandanna could be an extra layer of protection.  Do it yourself info will be posted on the DoH website.  Governor Wolf said, simply, when you leave home, wear a cloth mask.
Governor Wolf and Dr. Levine answered questions from the news media on April 3:
Are PA hospitals reasonably staffed and supplied for what’s to come?  LEVINE: We’ve been working tirelessly to make sure they have the supplies, beds, PPE and other resources they will need with the surge to come over the next weeks or month.  Models suggest we will have enough supplies. We need to prevent a surge that would overwhelm any hospital system.

Do you envision masks in public will become mandatory?  Have the dynamics of transmission changed? LEVINE: The views of the public health community have changed of the whole community using masks.

Should we wear a mask only if shopping or where people will be?  If truly isolated, its probably not necessary, but if you are hiking and others might be there, you might want to wear one. 

Is there a plan to order medically vulnerable inmates released from the Corrections system?  GOV WOLF: Working with legislature to streamline the process of people ready to leave the system.  Within the prisons, stopped visitation, gone to lockdown in all state prisons, and small groups for meals to keep our prison population and the administrators as safe as we can.

Seen surge in cases in nursing homes in the state.  What is the state doing?  LEVINE:  you are right, patients in these homes are older, more likely to suffer serious complications, so DoH and DHS are doing all we can to protect the homes and the staff.  Watching data carefully, transferring patients to hospitals, and other ways to help protect them.  Looking to contract with a SWAT team.

Increase in cases in Luzerne County – how do you plan to reach the Hispanic community? LEVINE: Translated our materials into Spanish and doing outreach. Are curfews helpful in this?  That’s a local decision but we want people home and safe.

Social media, despite the statewide order, people continue planning trips for Elk viewing, horseback riding, etc. in rural communities.  Plans to limit social and other travel enforcement?  GOV WOLF: No, it’s about self-control.  Do you really want to go out and jeopardize the people you love?  No you don’t.

Documents from FEMA on PPE says PA hasn’t received as much as requested – has the federal government responded to your requests?  LEVINE: We have several requests in and have received resources several times.  Scouring PA and places in the US to purchase gowns, masks, ventilators and looking for more all the time.  Even looking to make the equipment or sterilize the masks. 

Projections in Penn’s model show peaks in July – would it be possible to explain your thoughts on modeling?  LEVINE: Virus determines the timetable, not models.  Dependent on variables you put into them. GOV WOLF: if we don’t do the right thing, and we spread it, we will overwhelm the health care system and the peak whenever it comes will be awful.  It all comes down to what 12.8 million Pennsylvanians do.

Are there plans to extend the deadlines for waivers for businesses?  GOV WOLF: No. 
U of Penn conducting poll on COVID-19 impact on physician practice finances
POMA reports that the University of Pennsylvania’s Wharton School of Business is seeking to quantify the financial impacts on physicians, their clinical staff and support staff.  The current reality has forced physician practices to limit the spread of coronavirus by suspending preventative care and non-urgent visits, as well as elective surgeries and procedures. The result of these necessary public health changes in many cases, has resulted in a cash flow crisis, threatening physician practices. 

You can complete the online short survey which will help gather needed real-time information on the economic effects of the pandemic. The results of the survey will be presented to Governor Wolf.  If you have any questions or concerns directly related to the survey, please contact the survey project lead at: Alison Leff, DO, dralison.leff@gmail.com.
Pennsylvania:  Ventilator Status
Pennsylvania has received a fraction of the equipment it has requested from a federal stockpile to help battle the coronavirus, new data shows, as state officials look to other sources to purchase more supplies, including life-saving ventilators.

Health officials said there are approximately 4,000 ventilators available at hospitals across the state, enough to meet current demands.  

On March 24, the Pennsylvania Emergency Management Agency requested $3.5 million to purchase 200 ventilators, a procurement document shows. Those would be given to hospitals if a region sees a surge in cases, PEMA spokesperson Ruth Miller said.  A spokesperson for the health department, Nate Wardle, said the state has “worked to procure” about 400 ventilators in total, though he doesn’t know when they will arrive.

The state also has requested 1,000 ventilators from the Strategic National Stockpile, Wardle said, but federal officials have not said “when or if we would receive those at this time.” Representatives for the Strategic National Stockpile did not respond to requests for information. But data released Thursday shows limited help has come from the federal source so far.

As of March 30, Pennsylvania had received 18% of the more than 600,00 N95 respirators it had requested from the stockpile, according to a document released to the U.S. House Committee on Oversight and Reform. The state did, however, receive nearly 70% of the 690,346 gloves it requested.

The document does not show any requests for ventilators. Wardle of the health department said the request has been mad
e but is on “hold” until Pennsylvania demonstrates a need for additional equipment.

Pennsylvania’s procurement portal that allows companies with ventilators as well as personal protective equipment like masks to come to the state, has gotten use, and several companies have registered, with at least 5,500 units available.”

Hospitals and health systems can also purchase ventilators on their own, although it’s unclear how many are taking that step. Penn State Health has ordered 10 ventilators to supplement the 115 it has on hand, spokesperson Barbara Schindo said. The health system, with hospitals in Hershey and Reading, also has about 65 anesthesia machines and a number of devices that can offer some respiratory support.

WellSpan, headquartered in Central Pennsylvania, has “adequate supplies and equipment, including ventilators” to meet current demand and is working to increase resources in case they are needed, said spokesperson Ryan Coyle.

Geisinger Health, located primarily in northeastern Pennsylvania, has seen challenges acquiring some supplies but has enough “to meet current and projected needs in our communities,” spokesperson Ashley Andyshak-Hayes said.

UPMC is viewing the problem from the perspective of a large health system with facilities across the state, spokesperson Kelly McCall said, with plans to route staff and supplies where they are most needed.

Flu Report
Pennsylvania health officials have stopped updating a weekly report on flu activity for the season.

Flu activity was down over the past few weeks and now below epidemic levels, according to a report from the Pennsylvania Department of Health for the week ending March 28. A final total of 129,912 laboratory-confirmed influenza cases were reported this season: that’s up 1% from the week before.

Surveillance for the 2019-20 season started on Sept. 29, and the report does not include covid-19 cases.

“This is the most cases on record in Pennsylvania during a flu season,” Health Department spokeswoman Brittany Lauffer said. “Although there were many cases, they were not as severe as the 2017-2018 flu season. There are many factors on why we saw more cases this season, including more individuals getting tested for flu-like symptoms, especially as the concern for covid-19 grew.”

A total of 102 flu-associated deaths were reported, up by two from the week before. Both of the new deaths were people age 65 or older; that age group saw the majority of deaths for the season, with a total of 70.

State Layoffs
The Wolf administration on Friday told nearly 9,000 state employees — more than 10% of its workforce — that it will stop paying them by the end of next week in order to reduce state spending as the COVID-19 shutdown continues to batter the economy.

The affected employees have jobs that cannot be completed through teleworking, Starting April 11, those workers will have to use vacation, sick, or other personal leave time if they want to continue receiving paychecks. Otherwise, they can file for unemployment. The administration said it will continue providing health care benefits for all affected workers.

More than half of the 9,000 affected employees — or about 5,700 people — work for the Department of Transportation, according to the administration. Another 908 are employed with the Department of Labor and Industry, and an additional 849 are with the Department of Revenue. State officials said essential jobs in those agencies, which have performed critical tasks during the pandemic, will not be affected.