April 6 COVID-19 Update – Pennsylvania American College of Physicians

April 6 Pennsylvania COVID-19 Update

By Saturday April 4 at midnight, Pennsylvania had found another 1,493 new positive cases in the previous 24 hours, for a total of 11,510 statewide in 65 counties (all except Elk and Jefferson.)  The death total rose to 150, with 14 on Saturday, all in adult patients.

Percentages of those testing positive did not change significantly from Friday afternoon.  Approximately 1,072 patients have been hospitalized since 3/6 (10% of the positive cases), and about one-half were agreed 65 or older.

There were 66,261 negative tests in PA as of midnight Saturday night.

Through Friday midnight, Pennsylvania had 1,597 new positive cases of COVID-19, for a total 10,017 total cases statewide in 64 counties.  Some 1,004 patients have been hospitalized since 3/6 ( 10% of the positive cases).  Of those patients, 276 required stays in the ICU and 170 required use of a ventilator or breathing machine.  To date, 136 total deaths had occurred statewide, 34 on Friday, all in adult patients.

Health care workers constituted 489 of the total cases – roughly 5%, and approximately 14% of 695 nursing centers had reported at least one case.

There were 60,013 patients tested negative through Friday.  Of the patients who 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. 

51% of the patients hospitalized are aged 65 or older, and 28% are aged 50-64.  19% are ages 25-49.  Most of the deaths have occurred in patients 65 or older. There have been no pediatric deaths to date. More data is available here

Economic Impacts/Legislation
One indicator of the rising economic toll– 1,017,101 workers in Pennsylvania have filed for unemployment as of Friday, about 15 percent of Pennsylvania’s labor force.  As part of its regular update on state revenues, the Independent Fiscal Office said it will provide rough estimates of the impact the COVID-19 shutdowns will have on revenue April 8.  They said the estimates will include two potential scenarios based on the duration of business closures. 

On April 1 the Department of Revenue gave a preview of those impacts by reporting a $294.6 million reduction in state revenue during March.  The chairs of the Appropriations Committees in the House and Senate said the 2020-21 state budget could face a $4 billion budget deficit for the year.

The State Senate and House are scheduled to return to session April 6, 7 and 8 using their new remote voting procedures, with the Senate scheduled to consider budget-related bills, and the House set to consider legislation to reopen the construction industry and other bills unrelated to the COVID019 crisis which may see amendments that seek to override some of the Governor’s orders.
Special Order signed on Building Safety during COVID-19 Crisis
Dr. Levine signed and posted a new order on building safety requirements on Sunday afternoon April 5.  That order can be found online here.
Dr. Levine answered questions from the news media on April 4:
Will you be releasing case and death info by hospital?  LEVINE:  Not at this time – we are releasing the info by county only.

What is the PA breakdown between men or women?  LEVINE: Don’t have that at fingertips.  Men are slightly more impacted.

Is diabetes a condition of concern in COVID patients? LEVINE:  Yes, diabetes would predispose someone to COVID19. It’s not exactly known why, but it is.

What’s the best way to clean the masks?  Can you use a microwave? LEVINE:  We don’t recommend the microwave for cotton masks – could be dangerous.  We recommend you wash them with soap and water.

How’s it working?  LEVINE: We don’t have data, but we’ll be looking for it.  The fight thing is to stay home, except to get food and medicine.  Exercise in a solitary way. No other actions are planned at this time.  We’re depending on Pennsylvanians to do the right thing.

Masks to keep US from shedding? Yes, designed to avoid shedding virus. My mask protects you.

What are you doing to ensure those found positive are remaining home? LEVINE: We are not getting reports from hospitals, but there are criteria.  We believe people are following those orders.  If not having significant symptoms, they should stay at home, otherwise, they are in the hospital.  Stats from Ebola suggest 95% plus of those infected do follow those orders.  We are relying on people doing the right thing.

Stress in Eastern PA – are you tracking state’s ICUs and what capacity is less?  LEVINE: Yes we are, and tracking carefully over time and day by day.

NY is getting ventilators from Oregon.  Are we asking other states, or competing?  LEVINE:  We’re doing everything we can to be sure we have PPE, gowns, gloves, ventilators.  We have gotten resources from national stockpile and sent PPE to nursing homes and LTC facilities.  We have stores and purchased ventilators to restock hospitals.  Our work continues to ensure adequate capacity in the health care system to address a surge.  “I want to emphasize that right now we have adequate capacity in our system,” said Levine. “We have enough beds, we have enough ICU beds, we have enough ventilators, we have enough personal protective equipment for our hospitals, and we are continually pushing out more of that equipment to hospitals as they need it and then getting in supplies.”

We haven’t reached out to other states, but we might do that.  But we are anticipating for the surge over the next couple of weeks or month.  The KEY is to limit the surge.
18% increase over yesterday – day to day has been between 18-20% daily?  LEVINE:  There is no evidence that it is slowing down.  Continued growth of new cases, especially in SE and NE.  Daily reporting is based on a number of factors, including when reports come in from labs.  We are looking at trends over time in three day segments.

When is the peak?  LEVINE:  I can’t tell you when.  “the virus sets the timeline.”  We’ll get additional date from Pitt next week, and the University of Washington model says mid to late April.

Should there be further measures if the previous measures aren’t working?  Social distancing scoreboard gives us a C grade.  LEVINE: That was before the governor’s mask order. It will improve. 

Other pandemic measures for the federal government?  LEVINE: We continue to push out the PPE and ventilators – we’re working with FEMA, CDC, FDA, DHS, testing materials, etc.  and expect continued cooperation.

WH says states largely on their own – how frustrating it that?  LEVINE: It’s not on me to comment on the White House response.  Under Govs’ leadership PA is doing everything it can to test, get resources and work with health care industry.  The ederal government’s part is to restock when they can.
OMAP Clarifications re Telehealth
In order to encourage the use of telehealth services, the Department issued guidance lifting restrictions for the MA fee-for-service program. Under this guidance, reimbursement for telehealth is no longer limited to audio-video conferencing and now includes voice only services. In addition to physicians, provider types that can be reimbursed for telehealth were expanded to include Certified Registered Nurse Practitioners, Physician Assistants, and some Early Intervention Therapists. Services rendered through telemedicine will be paid at the same rate as if they were rendered in-person at an enrolled location. This guida
nce can be found at: https://www.dhs.pa.gov/providers/Quick-Tips/Documents/PROMISeQuickTip229.pdf.

The Office of Medical Assistance Programs instructed our HealthChoices managed care organizations they must cover telehealth services in a manner that meets or exceeds fee-for-service coverage for telehealth. We instructed MCOs to utilize telehealth the same as a physician office visit for examination, diagnosis and treatment of an illness provided the service is provided by the family practitioner, general practitioner or pediatrician.

We continue to evaluate and update our guidance to providers for MA coverage during the COVID-19 emergency on an ongoing basis. With the release of additional guidance from CMS, we are reviewing the current telehealth guidance and anticipate issuing an update in the near term. As we conduct our review, we will carefully consider your suggestions. A complete list and links to coverage during the COVID-19 emergency for MA providers is located at: https://www.dhs.pa.gov/providers/Quick-Tips/Pages/default.aspx.

ACP Statement on Medical Ethics
Patients’ expected life span has become an especially contentious factor. Last week, the online version of the Journal of the American Medical Association published a viewpoint article calling for ventilator allocation to take into consideration “the number of years of life saved.”
The American College of Physicians countered with a public statement warning against age discrimination.   “We do not think we should be using the concept of maximizing the number of life-years that are achievable afterward,” says Robert McLean, ACP president and a physician in New Haven, Conn. “It is inherently biased against the elderly or the disabled, who may not live as long after they would potentially recover.”
If a younger person is given preference for scarce medical care, McLean says it should be because that person has a better short-term prognosis, not simply because the person is younger.
ACP asks Congress for Small Business Support
ACP President Robert McLean, MD, MACP wrote the Chairs and Ranking members of the US House and Senate Small Business Committees this week advocating for financial assistance to sustain physician practices during this national emergency.