April 9 COVID-19 Update – Pennsylvania American College of Physicians

April 9 Pennsylvania COVID-19 Update

On Wednesday, the Department of Health reported that Pennsylvania had found another 1,680 new positive cases in the previous 24 hours, for a total of 16,239 in all 67 counties. That figure is a one day high total since March 6.  The death total rose to 309, with 70 on Tuesday, all in adult patients. There were 82,299 negative tests in PA as of midnight Monday night.

Health care workers constituted 760 of the total cases – roughly 5%, and 831 in 157 nursing and personal care homes approximately % of 695 nursing centers had reported at least one case.

Percentages of those testing positive did not change significantly from Friday afternoon.  Approximately 1,892 patients have been hospitalized since 3/6 ( 11% of the positive cases). At this time, 1,169 patients had required use of ventilators or breathing machines.

As of noon, 51% of beds, 40% of ICU beds and 70% of ventilators are still available. 

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; 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.

Secretary Levine announces Hospital Preparedness Dashboard
On Wednesday, Health Secretary Rachel Levine announced that with ongoing data being received by the Department, the Commonwealth has established a Hospital Preparedness Dashboard, available online. The webpage provides data on hospitalizations, patients on ventilators, patients on ECMO, and total ventilators in use, as well as available beds, both on a statewide and county level basis.
Governor Mandates Inventory and Transfer of PPE, Ventilators, Supplies to High Impact Areas
Governor Tom Wolf today signed an Executive Order to provide critical aid to hospitals with targeted PPE and supplies distribution.

“Combating a pandemic means we all have to work together and that means we need to make the best use of our medical assets to ensure the places that need them most have them,” Gov. Wolf said. “Today, I am signing an order that will allow us to transfer supplies and information between medical facilities to both high-population, high-impact areas and lower population areas that might not have as many existing medical resources.

“This will also prevent sick Pennsylvanians from having to choose which hospital to go to for fear that some have less access to equipment than others and it will help us make use of every ventilator, every piece of PPE, and every medical worker.”

The order is intended to ensure the efficient allocation and effective use of critical medical resources, such as N95 face masks, ventilators, respirators, face shields, safety goggles, disinfectants and other sanitizing solutions by hospitals in the state.

The order reads, that “despite the voluntary efforts of health care providers and despite the exhaustive work of commonwealth agencies to procure PPE and other medical resources from private industry to support Pennsylvania’s health care workers, facilities and emergency responders, a critical shortage of PPE, pharmaceuticals and other medical resources remains.”

The order mandates that private, public and quasi-public health care providers and facilities, as well as manufacturers, distributors and suppliers of PPE, pharmaceuticals and other medical resources located within the commonwealth, submit current inventory quantities of PPE, pharmaceuticals and other medical resources to PEMA within five days of today’s order. Health care providers and facilities are further ordered to provide written reports detailing facility health care needs and other pertinent information in the form, manner and frequency directed by PEMA.

PEMA will make arrangements with other commonwealth agencies to reimburse facilities for PPE and other supplies and equipment, then arrange for supplies to be allocated to where they are needed most.

General Assembly Actions
The House and Senate have recessed at the 12 hour calls of their presiding officers.  No legislation impacting the state’s COVID-19 response passed both chambers this week, although each passed legislation that was sent to the other.
The House was scheduled to return next Tuesday, April 14, and the Senate was slated to return May 4.
Questions to Gov. Wolf and Dr. Levine
Does the new PPE order constitute a taking of PPE from some to others?  What do you say to those you’re taking them from?   WOLF: We need to take this scarce resource and deploy them where they are needed the most.

What are your takeaways from call with President Trump?  WOLF: My last call was with VP Pence, and my last call with the President was last week.  It was about coordination of supplies.  Yesterday we talked about a control tower operation where the federal government works to get scarce resources to where they are needed the most.

Should high school athletes and others continue to train for the spring?  WOLF:  It’s  too early to call what happens in the fall.  Unfortunately, amateur and professional sports have closed down.  Our first priority is to save lives.

There were fights in the House yesterday over your other orders.  What is your response to Republicans criticism of your orders?  WOLF: We’re trying to buy time, trying to get ahead of spike in demands and to keep people safe.  Forces us to make tough decisions and all of us want to save lives.

What challenges are you facing to get supplies? LEVINE: Distributed 1.8 million 900,000 surgical masks.  Seeking supplies from manufacturers in PA, the US and the world, working on systems to sterilize N-95 masks.

Is progress being made in identifying race and gender? LEVINE:  We don’t get that info on regular basis but are working on ways to do that.

The Surgeon General suggested minorities may have more pre-existing issues and less access to health care, working more jobs, and dealing with other social determinants of health including nutrition, transportation, access, environment.  LEVINE: There are challenges in equity for African, Spanish-Americans.  We were working to address those before COVID and will be trying to make sure those disparities don’t.

If you have no plans to send guard to Hazleton area, what is the state going to do to help Luzerne County get things under control?  WOLF:  I had a call with (Congressman) Matt Cartwright, and our discussion didn’t include calling up the National Guard.  Will continue to have those conversations.  Let me get back to the last question.  The federal government is taking a closer look at ethnic how COVID affects people differentially, and taking it much more seriously.

What’s business and industry’s response been to the Critical Supplies Portal?  WOLF:  We’ve had over 400 applications in last two days.  Maybe 70 or 80 can be very helpful.  The business community has stepped up and today even more have tried to access the portal offering help.

The rate of new infections has decreased each of the last seven days. Is that a sign we’re okay?  LEVINE:  We expect to see raw numbers increase, but a subtle flattening of the curve.  Still significant increases, no longer exponential increases are actually good news that the Governor’s efforts…have been successful.  But we can’t become
complacent. We do expect a surge, but if we can keep that curve flatter, we won’t overwhelm the system.

Has there been direct federal support for Philadelphia, which the federal government said it expected to become the next hot spot?  LEVINE:  It remains an area of specific concern, as does the Northeast.  There have been 4,004 cases in Philadelphia. We’ll be watching the west as well. WOLF: the federal government is bumping PA up in terms of getting us equipment, etc. according to VP Pence today.

Stabilizing means the curve is no longer going up exponentially, but the key is the social and physical distancing. 

Why not open golf courses when fishing is allowed? WOLF: The Fish and Boat Commission did that, but fishing is done individually, whereas golf is carts and other people. Going out in the middle of the stream fishing by yourself won’t make one bit of difference to the spread.

Explain the new order?  WOLF:  My New Order could involve supplies for hospitals, health systems, EMS agencies, nursing homes and balance needs where we see them to take care of sick patients with COVID.

Are there legal requirements for notification to others of positives in nursing homes? LEVINE: Anyone positive will be notified, close contacts would be as well.  We want facilities to balance notifications with privacy rights.

Do you have any plans to designate facilities exclusively for positive patients?  LEVINE: A facility or a wing to cohort patients and staff is something we’ve discussed.  We will be looking at  how we could operationalize that.

Three nursing homes in Pittsburgh areas have had serious outbreaks.  Are you doing anything different there?  LEVINE: We’re working with all the LTCs and DHS with personal care and assisted living facilities. We’ve contracted for consulting services, working “really, really closely” with the consultants, and are discussing cohorting to protect vulnerable patients.

East Stroudsburg University has a Field House – is it a possibility it would be used, and patients moved into it? LEVINE:  We’re looking for both a temporary medical facility and a mass testing facility in northeastern Pennsylvania.

UC and wage changes have had drastic effects.  Some companies have raised their own minimum wages on their own. Will this fall into place on a state level? WOLF:  I was not aware of that happening in companies.  As someone who supports raising the minimum wage, I applaud companies raising their rates to accomplish that.