April 8 COVID-19 Update – Pennsylvania American College of Physicians

April 8 Pennsylvania COVID-19 Update

By Monday April 6 at midnight, Pennsylvania had found another 1,579 new positive cases in the previous 24 hours, for a total of 14,599 in all 67 counties. The death total rose to 240, with 78 on Monday, all in adult patients. There were 76,719 negative tests in PA as of midnight Monday night.

Percentages of those testing positive did not change significantly from Friday afternoon.  Approximately 1,665 patients have been hospitalized since 3/6 ( <11% 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 beds and 70% of ventilators are still available.  At that time, 548 patients had required use of ventilators or breathing machines.

Health care workers constituted 564 of the total cases – roughly 5%, and 574 in nursing and personal care homes – 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. 
General Assembly Actions
The House and Senate were in Harrisburg Tuesday, and each approved bills responding to the COVID-19 pandemic, but neither chamber took up the other’s bill when the day was over.  Both adjourned until later in the month, with the House scheduled to return April 14, but at a 12 hour call of the Speaker.  The Senate is not scheduled to return until April 20, but adjourned until the 12 hour call of the President Pro Tempore.

Leaders of the House and Senate failed to reach agreement on moving forward with legislation over several issues, with one of the largest being how to deal with property taxes.  Meanwhile, the House amended legislation (SB 327) to create a 23 member interbranch Task Force to track and manage recovery plans, which requires the Governor to notify the General Assembly of any proposed actions to suspend, modify or waive state regulations during the emergency. 

Besides its monitoring duties, the task force would identify immediate issues requiring government action, develop a recovery plan focusing on the reopening of society and issue a final report six months after the emergency is over, according to a House Appropriations Committee fiscal note.  As proposed, the task force would be heavily weighted with 16 of 23 members coming from or appointed by the House and Senate.

House Democrats unanimously opposed the bill, saying its provisions would tie the Governor’s hands in dealing with the pandemic.  House Majority Leader Bryan Cutler said a special task force is needed because the pandemic challenge is too great for different parts of state government to “waste time and resources”.

The Senate passed bill, SB 841, deals with local governments, giving them the options of waiving fees and penalties on property taxes, extends deadlines for discount property tax rates, allows school districts to renegotiate contracts, extends EITC payment deadlines, allows local governments to conduct remote meetings and allows notaries to conduct business through electronic communications.

The House Appropriations Committee amended another bill setting the stage for a vote on allowing businesses following CDC and  CISA guidelines from March 28 to reopen.  PA-ACP opposes this language.  Dr. Levine wrote the legislature saying that reopening businesses prematurely would lead to more COVID-19 cases and undermine the state’s collective response to the pandemic.

PA-ACP will continue to push for legislation asserting limited liability from civil litigation for manufacturers of PPE and critical equipment, and for health care practitioners during the COVID-19 pandemic and response.

DHS sets limits for hydroxychloroquine prescriptions
The PA Department of Human Services has announced guidelines limiting prescription of hydroxychloroquine during the COVID-19 crisis in PA.  Details are online here
The FDA had issued an Emergency Use Authorization that allows individuals with COVID-19 to be treated with Hydroxychloroquine on March 28. In an effort to prevent potential shortages and stockpiling of hydroxychloroquine, the Medical Assistance Program, including the fee-for-service (FFS) program and the physical health HealthChoices and Community HealthChoices managed care organizations (MCOs), is implementing quantity limits.

Philadelphia Testing Site Changes Announced
Testing Sites: The Department of Public Health announced the Citizens Bank Park testing site will be discontinued after 6 p.m. on Friday, April 10. This determination was made by FEMA, which the City supports. It allows for remaining testing kits to be redistributed to indoor sites to expand their testing capacity, and any remaining personal protective equipment (PPE) will be redistributed to support hospitals and long-term care facilities.

The City-run location in Center City, announced last week, will continue to serve those who are over the age of 50 and are displaying symptoms consistent with COVID-19 coronavirus, as well as health care workers who are displaying symptoms consistent with COVID-19 coronavirus. The site is available by appointment only and a referral is required. Those who meet the criteria and want a test can call (267) 491-5870 to obtain a referral.

Full list of testing sites here – https://www.phila.gov/programs/coronavirus-disease-2019-covid-19/guidance/getting-tested-for-covid-19/
Questions to Dr. Levine
Dr. Levine conducted a daily briefing without the Governor on Monday.  After providing the data update, she accepted questions from the news media.
Is there a lag in reporting new deaths?  Tuesday has been always higher.  Not inflated? LEVINE: There are lag times for reporting, particularly deaths into data system.
Do you expect dramatic increase in deaths to increase even with plateau? LEVINE: So today’s total is due to a lag time, but we do expect an increase in deaths as the numbers of positives plateaus – it’s been seen in other states.

What’s being done to protect patients in nursing homes and long term care facilities? LEVINE: We’re seeing significant increases there; we’re doing everything we can to protect them. We put out guidance for those facilities, contracted with a company to consult for them to discuss infection control procedures and education. Already asked for them.

What about the Brighton Health and Wellness Center in Beaver County? Are all patients and staff in that facility confirmed with COVID-19? LEVINE: While not commenting on any specific nursing home, if there were many positives, all staff and residents could be considered probable cases…if they have symptoms, they would be tested.

Are we breaking down deaths by comorbidities? Do we know how many of deaths have these comorbidities?  LEVINE: We are seeing significant increases with these conditions – heart disease, COPD, Chronic kidney disease, etc.

Would you consider breaking down deaths by age as well?  LEVINE: We will consider that – most have been 65 and older.

Cuomo said DoH has developed antibody testing and working with NJ and
CT in regional approach – are we involved in those or developing our own?  LEVINE: We have not been involved  We won’t develop our own, but would buy the platform and reagents – first test was approved last Thursday, when available, we’ll be working with that to test immunity, and at that point, we’d consider them immune.  That’s really really important.

What do you recommend for people to get transportation if they don’t have cars – many people with symptoms have been referring questions to DoH.  Who’s responsible for helping with that?  Any recommendations coming?  Best practices?  LEVINE: Telehealth is important.  Call first, then make a decision on getting tested.  Call 911.

If cases being undercounted, how will that play into decisions to reopen things?  LEVINE: We know there’s an undercount.  What we’re looking for and rationale is to watch for the surge of very serious cases that would test the health care system. Key is protecting the system – the surge would be serious, not mild cases.

Would warmer temps make it different in spread ?  LEVINE: It’s NOVEL, so we don’t know how it will react.  Flu is less transmissible with warmer temps.
Are there racial disparities in PA?  Other states releasing this material – will PA do the same?  LEVINE: Our info system depends on what’s put in.  We are looking for that info and will release it if we get it.

Health inequities around care – what’s the current demographic and when would we have it?  We’re looking at ways to collect it. Health inequity is an important issue in general.

Are life sustaining businesses required to provide masks and PPE to employees?  If not, what can you do to protect the workers?  LEVINE: We’ve recommended people wear masks, but it would be great if the businesses could.  Simple instructions on how to make them.

If a county has no local health department is DoH considering releasing locations of positives?  LEVINE: No, because of privacy concerns.

Complexities of data – curves flattening in some areas, surge coming in others, what’s happening in the state and Western PA?  Do we look statewide and in terms of regions?  LEVINE: The situations would be very different.  We are using data as best we can.