April 7 Pennsylvania COVID-19 Update

PA COVID-19 DATA UPDATE
By Sunday April 5 at midnight, Pennsylvania had found another 1,470 new positive cases in the previous 24 hours, for a total of 1 2,980 in 66 counties. The death total rose to 162, with 12 on Sunday, all in adult patients. There were 70,874 negative tests in PA as of midnight Sunday night.

Percentages of those testing positive did not change significantly from Friday afternoon.  Approximately 1,145 patients have been hospitalized since 3/6 ( 12% of the positive cases), and 51% were aged 65 or older.

The DoH is getting data three times a day from hospitals.  As of noon, 51% of beds, 40% of ICU space and 70% of ventilators are still available.  At that time, 533 patients had required use of ventilators or breathing machines.

Levine said the Commonwealth distributed 1.5 million N95 masks, 106,000 gowns, 710,000 procedure masks, 560,000 gloves, 990 goggles and 120,000 face shields to hospitals, EMS, senior agencies.

Health care workers constituted 588 of the total cases – roughly 5%, and approximately 14% of 695 nursing centers had reported at least one case.

Of the patients who tested positive to date the age breakdown is as follows: less than 1% are aged 0-4; less than 1% are aged 5-12; 1% are aged 13-18; 7% are aged 19-24; 42% 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

Governor Wolf said that every state and country is looking to build supplies – while we continue to pursue by inward means.  On Saturday Pennsylvania launched the manufacturing call to action portal  to connect supply chains for needed equipment.  He said the state is asking manufacturers to visit portal to see our needs, workforce gaps, and capabilities, etc.  (See story below)
 
PA-ACP statement on COVID-19 and proposals to alter the existing Stay at Home and Business closure orders:
The PA-ACP is opposing legislative and state actions that are not evidence-based, and continues to advocate for strict social distancing until the peak of new cases has significantly passed and the risk of a resurgence in COVID-19 cases is minimized.  The Chapter released the following statement to the General Assembly:

“The Pennsylvania Chapter of the American College of Physicians (PA-ACP) and its 7,800 members support evidence-based proposals that reasonably protect the health of Pennsylvanians and minimize viral spread. 

The College is an advocate for strict social distancing until the peak of new cases has significantly passed and the risk of a resurgence in COVID-19 cases is minimized.  Pennsylvania has been relatively strict on this front, and PA-ACP believes that this is not yet the time to relax those provisions. While we understand and appreciate the desire to reopen businesses and have life return to normal as rapidly as possible, we do not want to see a disease resurgence and strongly believe that any consideration of changing standards and guidance should be based on best practice recommendations based on current science.

Federal agencies have been changing their guidelines and recommendations on a continuing basis throughout the last several weeks as new scientific evidence becomes available.  Should CDC guidelines or CISA recommendations change again on this subject, Pennsylvania might be locked into mitigation strategies different than deemed appropriate by these federal agencies.

PA-ACP’s member internists and internal medicine subspecialists treat adults with particularly increased risk for serious complications from COVID-19, such as those with heart and lung problems, rheumatic disease or transplant recipients.  PA-ACP would hope that some provision be made to protect these patients from losing jobs, income and/or benefits by abiding with their physician’s orders in an effort to manage these chronic conditions.”

General Assembly
The State Senate and House returned on Monday, and three new members of the House of Representatives were sworn into office.  Reps. Kathleen Tomlinson (R, Bucks), Tim Bonner (R, Mercer) and Eric Davanzo (R, Westmoreland) bring the GOP total to 110 members, with 93 Democrats in the lower chamber.  Both House and Senate used their new remote voting procedures, with the Senate scheduled to consider several budget-related bills, and the House set to consider legislation to reopen the construction industry and to amend other bills to override some of the Governor’s orders.  Not surprisingly, the Governor has said he will veto any such legislation that reaches his desk.

The GOP proposals in House amendments include freezing increases to school property taxes, giving judges a say in the early release of some state prison inmates and creating a COVID-19 Cost and Recovery Task Force to carve out a legislative role in “managing the crisis now and in the future.”
 
House and Senate Democrats advocate their own COVID-19 package
Senate and House Democratic leaders announced a package of six new bills on Monday, aimed at providing safety and economic protections for workers during the COVID-19 crisis.

Their proposal calls for an emergency expansion of paid sick leave/family medical leave for employees not covered by the CARES Act; job protection for employees under medical quarantine; several bills address the immediate needs of workers and small businesses, including those employed in hospitals or as first responders due to the pandemic; and another bill that provides state funding for resumption of early learning programs this summer if the crisis has passed.

A Senate proposal would require companies with less than 500 employees to provide sick pay and paid family leave up to certain amounts, for employees not covered under the CARES Act and extend paid sick leave for an additional four days to cover a full two-week quarantine period.

House Bill 2362 would provide job protection to individuals forced to miss work due to a quarantine order by the government or a health care  practitioner.
A Senate proposal would allow school service providers, such as food service, custodial and security employees, to renegotiate contracts to ensure that contracted fixed costs and personnel are maintained during a school closing;

House Bill 2372, would allow small businesses to receive reimbursement for COVID-19 claims under their “business interruption insurance” coverage;
A House proposal would add COVID-19 as a “presumed disease” for essential employees seeking workers compensation, including nurses, doctors, EMS, police, firefighters, pharmacists and grocery store workers. This provision would remove a burden of proof on them to receive WC benefits;

And another Senate proposal would provide $227 million in state aid to child care centers, Pre-K and Head Start programs.

Health Action Network Info released Monday:

  • Healthcare providers who are evaluating patients for COVID-19 should instruct the patient to isolate. Patients should be asked to develop a list of people who were in close contact (defined as being within 6 feet for a period of 10 minutes to 30 minutes or more depending upon the exposure) with them from the period 48 hours before symptom onset to the time at which the patient isolated.
  • All persons diagnosed with COVID-19 should self-isolate until at least 7 days have passed since symptom onset, and symptoms are improving, including being afebrile, for 72 hours without antipyretics.
  • These steps should be taken immediately. Do not wait for test results to come in.
  • Close contacts of laboratory confirmed COVID-19 cases should be instructed to self-quarantine for 14 days since exposure to the patient being evaluated for COVID-19.
  • Healthcare providers should give the attached documents to any patient being evaluated for COVID-19.

The Pennsylvania Department of Health (DOH) is asking that clinicians provide the current guidance on isolation to patients being evaluated for COVID-19 to ensure that timely recommendations are provided to reduce spread of disease.

When ordering COVID-19 testing, make sure all fields in the submission form are completed. In-house or commercial (depending on the lab) testing may provide faster results than DOH testing. Please report any confirmed cases of SARS COV-2, the virus that causes COVID-19 through the DOH electronic disease surveillance system, PA-NEDSS.

Instructions for Patients Waiting for COVID-19 Test Results

  • Self-isolate at home
  • Compose a list of close contacts. Currently, close contact is defined as being within 6 feet for 10 minutes or more from the period 48 hours before symptom onset to the time at which the patient went into isolation.
  • If the patient lives with others, self-isolate in a private room and use a private bathroom if possible
  • Wear a mask when entering general living areas and interacting with others
  • If the patient develops additional symptoms or if their symptoms get worse, notify the HCP

Instructions for Patients with Positive Test Results

  • Self-isolate at home.
  • Monitor symptoms.
  • Notify close contacts (including your workplace) and ask that they self-quarantine. Currently, close contact is defined as being within 6 feet for 10 minutes or more from the period 48 hours before symptom onset to the time at which the patient went into isolation. For patient encounters with HCPs during the infectious period, a close contact is defined as being within 6 feet for 2-3 minutes or more.
  • Under the CDC’s non-test-based release from isolation strategy, patients with COVID-19 should self-isolate until:
    • At least 7 days after symptom onset, AND;
    • Symptoms are improving, including being afebrile, for 72 hours without antipyretics.

Instructions for Close Contacts of Patients Diagnosed with COVID-19

  • Data are limited to define close contacts. Currently, close contact is defined as being within 6 feet for a period of 10 minutes to 30 minutes or more depending upon the exposure from the period 48 hours before symptom onset to the time at which the patient isolated.
  • Close contacts of patients diagnosed with COVID-19 should be instructed by the patient to self-quarantine for 14 days from the last time of their last contact with the patient.
  • If a close contact develops symptoms during those 14 days, they could be tested by a healthcare provider for COVID-19, or they may be advised to self-isolate at home.
  • Close contacts who are healthcare providers (HCP) should be instructed to notify occupational health immediately for additional information.

COVID-19 Patients who are Healthcare Providers

  • Patients diagnosed with COVID-19 who are HCP, including staff in long term care or other residential facilities, should contact their supervisor and occupational health to report their diagnosis, and isolate at home.
  • HCP who are diagnosed with COVID-19 should be excluded from work until:
    • At least 7 days have passed since symptom onset, AND;
    • Symptoms are improving, including being afebrile, for 72 hours without antipyretics
  • HCP should work with occupational health to determine an appropriate return to work strategy based on the current capacity and facility surge situation.
  • After returning to work, HCP should:
    • Wear a facemask at all times while in the healthcare facility until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer
    • Be restricted from contact with severely immunocompromised patients (e.g., transplant, hematology-oncology) until 14 days after illness onset
    • Adhere to hand hygiene, respiratory hygiene, and cough etiquette in CDC’s interim infection control guidance (e.g., cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles)
    • Self-monitor for symptoms, and seek re-evaluation from occupational health if respiratory symptoms recur or worsen

 
Manufacturers Call to Action Portal Opened
DCED set up a Pennsylvania Manufacturing Call to Action Portal, to mobilize manufacturers, distributors and other suppliers that are producing or moving COVID-19-related products and supplies. The portal is intended to match manufacturers and distributors to fill specific supply chain needs to meet increasing demands for medical supplies and related products; assist manufacturers that have workforce needs or gaps and aid them in identifying skilled workers; and identify manufacturers that can pivot or innovate to fulfill the demand for medical supplies and related products.
 
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 provided direction for maintaining and cleaning buildings for businesses authorized to maintain in-person operations under the state’s life-sustaining business orders.  The new order is for owners of buildings of at least 50,000 square feet used for commercial, industrial or other enterprises, including but not limited to facilities for warehousing, manufacturing, commercial offices, airports, grocery stores, universities, colleges, government, hotels, and residential buildings with at least 50 units.