June 2 Pennsylvania COVID-19 Update

It’s Primary Election Day – Don’t forget to vote!
Tuesday, June 2 is Pennsylvania’s primary election day.  Don’t forget to vote – yours can make a difference!  Polls will be open from 7 a.m. until 8 p.m. A tool to find your PA polling place is available online.
If you applied for a mail-in ballot and did not use it – or have not received confirmation it was received - you can still vote in person at your polling place.  If you live in Allegheny, Dauphin, Delaware, Erie, Montgomery or Philadelphia County only, and applied to vote by mail-in ballot, you can also still mail that ballot in as long as it is postmarked June 2.

  • Daily report from DoH re COVID-19 cases
  • Health Action Network update on risk exposures and work restriction
  • A 30,000 foot look at reports for PA
  • Dr. Levine answers Questions Monday
  • Levine and Torres discuss state efforts to protect seniors in LTC facilities
  • CDC updates guidance on how COVID-19 spreads, sample training plans for contact tracing
  • State House Speaker cancels seven June session days

The Pennsylvania Department of Health today confirmed as of 12:00 a.m., June 1, that there are 356 additional positive cases of COVID-19, bringing the statewide total to 72,282. All 67 counties in Pennsylvania have cases of COVID-19.
There are 5,567 total deaths attributed to COVID-19, an increase of 12 new deaths. County-specific information and a statewide map are available here
There are 616 patients who have a positive serology test and either COVID-19 symptoms or a high-risk exposure, which are considered probable cases and not confirmed cases. There are 389,431 patients who have tested negative to date. Of the patients who have tested positive to date the age breakdown is as follows:

  • Nearly 1% are ages 0-4;
  • Nearly 1% are ages 5-12;
  • Nearly 2% are ages 13-18;
  • 6% are ages 19-24; 
  • Nearly 37% are ages 25-49; 
  • 25% are ages 50-64; and
  • 28% are ages 65 or older.


Most of the patients hospitalized are ages 65 or older, and most of the deaths have occurred in patients 65 or older. An estimated 67% of people statewide who were tested positive have now recovered. 
In nursing and personal care homes, there are 15,545 resident cases of COVID-19, and 2,663 cases among employees, for a total of 18,208 at 608 distinct facilities in 44 counties. Out of our total deaths, 3,557 have occurred in residents from nursing or personal care facilities. A county breakdown can be found here.
Approximately 5,463 of our total cases are in health care workers.
For the latest information for individuals, families, businesses and schools, visit “Responding to COVID-19” on pa.gov.
Statewide – The Wolf Administration has since noon, May 31:

Updated Coronavirus Links: Press Releases, State Lab Photos, Graphics

Health Action Network update on risk exposures and work restriction
This guidance has been updated to simplify the determination of risk exposures warranting work restriction. Highlights of the guidance include:

  • Resume contact tracing and application of work restrictions in areas where spread of COVID-19 in the community has decreased
  • Focus on exposures believed to result in higher risk for healthcare personnel (HCP) (i.e., prolonged exposure to patients with COVID-19 when HCP’s eyes, nose, or mouth are not adequately covered) 
  • The definition of “prolonged exposure” was extended to refer to a time period of 15 or more minutes of close contact (within ≤ 6 feet). However, any duration should be considered prolonged if the exposure occurs during performance of an aerosol-generating procedure.
  • If you have additional questions about this guidance, please contact DOH at 1-877-PA-HEALTH (1-877-724-3258) or your local health department.

This updated guidance describes the process for resumption of contact tracing and application of work restrictions that should occur in areas where spread in the community has decreased and when capacity exists to perform these activities without compromising other critical infection prevention and control functions.
Guidance has been simplified to focus on exposures that are believed to result in higher risk for HCP (i.e., prolonged exposure to patients with COVID-19 when HCP’s eyes, nose, or mouth are not adequately covered). Other exposures not included as higher risk, including having body contact with the patient (e.g., rolling the patient) without gown or gloves, may impart some risk for transmission, particularly if hand hygiene is not performed and HCP then touch their eyes, nose, or mouth. The specific factors associated with these exposures should be evaluated on a case by case basis; interventions, including restriction from work, can be applied if the risk for transmission is deemed substantial.
State summary from 30,000 feet
The historic positive test rate – the total number of cases reported since March 6 divided by the total number of test results since March 6 – has been on  a continual decline with more tests being performed.  The rate of positives on Sunday was 15.3%, where a week ago it was 16.5%.  In late April, the figure was more than double that rate.
The last seven days total positive cases was 3,931 compared to last week’s 4,845, and the 5,404 of two weeks ago; the 14-day total as of Monday had dropped to 8,776 from the May 25 total of 10,249, and the Monday, May 18 total of 12,155.
And if the 50 cases per 100,000  population metric initially used for determinations of moving to yellow  were applied to the entire state, the state’s figure would now be 69; a week ago, that figure was 80, two weeks ago it was 95, and, at its peak on April 17 and 18, it was 164.
The administration has indicated it’s placing more of an emphasis on positive test rates, and the trends associated with that metric, citing the metric as the reason for their confidence to move virus hot spots like Philadelphia and its collar counties into the “yellow” phase as of June 5.
41 counties experienced a drop of their to-date positive test rate compared to their rate on Sunday, 24 counties saw no change (though their rates have dropped since the prior week) and two counties experienced an increase.
COVID-19 hospitalizations also continue to drop, down to 1,294 at noon on Monday, down from 1,335 at noon on Sunday, the 1,533 a week ago and the 1,882 of two weeks ago.
Additionally, the Health Department’s data on Monday at noon showed another drop in the number of patients on ventilators, now down to 279 compared to 283 on Sunday, 324 a week ago, and 386 two weeks ago.
Q/As with Sec. Levine
Will the protests and riots cause a delay in Philadelphia county going into the yellow zone on Friday?  LEVINE:  We have no plans at this time to have that make a change in our plans.  We do have concerns about the potential for spread of COVID-19 without social distancing, but don’t plan to change our plans.
With the looting and transfer of goods, along with the massing of people, isn’t that a concern?  LEVINE:  We do have concerns as do other states with problems like this, and if we see that if social distancing is not being observed, or masks are not being worn, we will do everything we can to mitigate that.
There was new testing guidance for Long Term Care facilities released over the weekend.  What’s new or different about that?  LEVINE: It really wasn’t much different, coming from CMS. They want us to test every member of staff and every resident and we’re already working towards that. We’ve already tested 45 facilities, and will be testing all of the more than 1900 facilities.  We will be prioritizing those with a lot of cases and those in areas that have a lot of prevalence of COVID-19 and high population density.
What about that is new?  LEVINE: I’m not sure what was new, it was just released this weekend.  We’ll do a deep dive and if there’s something they want us to do, we’ll do that.
Where’s Governor Wolf today?  Did the Department look at the big Reopen PA rally a month ago to see if there was any spread as a result of that?  LEVINE: The Governor is in Philadelphia today.  WE have not seen any specific spike in cases from the protests in Harrisburg. But it’s difficult to tell because people at protests don’t have identifiers.  We’ll be looking at the protests in Philadelphia, Harrisburg and Pittsburgh, but again it’s hard to say because people come from all over, not just the city of the protest, some from out of state.
The mayor of Atlanta recommended those who participated in protests there get themselves tested this week.  Do you recommend that for protesters here?  LEVINE: The incubation period is from 2-14 days so getting tested today may not be beneficial.  I had not heard that before, but it’s something to consider.  Of course if they have symptoms, they absolutely should get tested. I’m not coming out with an official recommendation for that, but it would be interesting. 
With testing all employees and residents of these long term care facilities, is that once, or in perpetuity?  LEVINE:  We will need to do that on a regular basis, individualized to the specific facility and their specific circumstances.  You need to continue the tests.
How long do you expect that process to go in these facilities?  ManorCare has had that huge outbreak. Where would they be on that list?  LEVINE: I don’t know specifically, but we’ll get back to you.  This is going to be ongoing and to continue till we have a vaccine and it no longer needs to be done.
The very nature of congregate care facilities makes them vulnerable.  Are you worried that a second wave of virus outbreak in the fall would again hit these facilities, and what are you doing to prepare for that?  LEVINE: We are working on plans to continually expand testing.  It would be helpful to have an accurate rapid point of care virus test.  We have concerns about the false positive/negatives on the current test.  We need to be able to test asymptomatic carriers and hopefully prevent the spread.  WE can work on different ways of clustering in the homes, need to push out PPE for these facilities, not just for these facilities, but for the general public.  What would also be very helpful is an accurate antibody test.  Hopefully by then we will have proven that the antibody tests are somewhat protective, which has not yet been proven, and that there’s a rapid accurate antibody test.  If you put those together, we’ll be way ahead of the game in terms of LTC facilities.
What guidance can you give to tour bus companies, especially those with trips to other states whose restrictions are different than Pennsylvania’s. Is there a limit to how many people can be on a bus at once?  LEVINE: I’d have to check the guidance, but probably about 50% occupancy with appropriate social distancing, six feet, masks and handwashing.
Wouldn’t it have been better to keep them out of that facility?  LEVINE: They contracted the virus IN the facility, so they weren’t bringing it in to the facility.  There’s not that many options, we were concerned about overwhelming the hospitals, because of payment and throughput needs.  Some of the homes have the ability to congregate people in different wings, but some of the smaller ones don’t have that ability.  But we worked with each to develop the best plan.
In your data, there’s a line that says with LTC facilities, s
taff that work at more than one facility are only reported as a positive at one.  If the idea is to show where facilities have positives, why are they not included with each?
  LEVINE:  I think that’s done to provide an accurate count of individuals and avoid double counting, but I’ll check on that and get back to you.
Can you briefly describe what contact tracing is going to look like for someone who has had contact with an individual who has been exposed to someone with COVID-19? Am I supposed to answer questions about everyone I’ve been with for two weeks and everyone I’ve talked to personally?  LEVINE: That’s critically important now, and will be in the future.  It’s unlikely they will knock on your door because of the personal contact.  It will be some kind of virtual contact, and we’ll say anonymously that you have been in contact with someone who has COVID-19. We’ll ask you to quarantine, and you’ll get a quarantine letter, and we’ll ask you about who else you might have been in contact with.  WE have found that people, for example with Ebola comply with quarantine and case investigation extremely well and we’re very pleased with the public’s response to that.
Given that the response to the virus restrictions are fractured at the very least, don’t you expect that contact tracing is going to run into difficulty, with people not wanting to answer, or not tell you all they could?  LEVINE:  It’s possible, but that has not been our experience.
Have you ever considered putting out numbers for nursing homes of the percentage who recovered and the numbers for the staff? LEVINE:  We do break out between the staff and residents every day.  We are going to put that on an epicurve so we can see the course of it, the numbers are going significantly down for all, but we need to make that more accessible to the public and we will do that.
Until there’s a vaccine, what would you recommend for a staffer at these facilities, who is positive, but stays asymptomatic?  Do they have to quit their job?  LEVINE: The staff are amazing, and we thank them for their service.  They are wonderful and the senior really need them.  We don’t want them quitting their jobs.  We need them to wear masks, wash their hands, etc. and will be testing them, and ensure that while they are asymptomatic, they are not bringing it into the facility.
Do you have any updates on the Vaccine clinical trials that are going on?  LEVINE:  I really don’t have any updates.  We’re all going to be hopeful that with the President’s “Warp Speed” program we’ll be successful, but I don’t have any information on the ones that are ongoing in Pennsylvania though.
With the Governor saying schools will definitely be open this fall, and guidance coming out this week, have you given though to sports, and guidance for athletics, for example with athletes being tested for COVID-19? LEVINE: Yes, we’re having discussions among the Departments of Education, Health and the Governor’s Policy Office over high school sports, and more guidance will be coming out this week.
Levine and Torres discuss state efforts to protect seniors in LTC facilities
At today’s daily COVID-19 press conference at the Pennsylvania Emergency Management Agency, Sec. of Health Dr. Rachel Levine and Sec. of Aging Robert Torres highlighted efforts to protect seniors and other vulnerable Pennsylvanians.  The two cabinet members spent well over 15 minutes defending the steps the state has taken to protect seniors, and those working in skilled nursing facilities, long term care facilities and personal care homes.
“Because long-term care is a part of so many Pennsylvanians’ lives, we have steadfastly sought to make this care the best it possibly can be. That’s why we’ve implemented recommendations from the Auditor General and are in the process of rewriting regulations based on a report from the Nursing Home Task Force and, that’s why we’ve enforced our existing policies,” Dr. Levine said. She noted that they had followed up on recommendations from the state Auditor General as well.
She advised that the majority of Pennsylvania’s long-term care facilities are strictly following existing policies and have successfully prevented COVID-19 from becoming widespread, but in some facilities COVID-19 was harder to contain.
Whenever a long-term care facility in Pennsylvania reports just a single case of COVID-19, the Department of Health reaches out to conduct an assessment of the situation and offers a number of resources to the facility, as needed. Those resources could include having the facility work with ECRI, our infection control consultant, with our internal infection control teams, with the Patient Safety Authority, or deploying the Pennsylvania National Guard to assist with staffing.
Sec. Torres outlined the Department of Aging’s work to prepare for safely reopening operations of older adult services located in counties that are moving into the Green Phase, as well as initiatives to combat social isolation among older adults during the COVID-19 pandemic and beyond.
“In preparation for Pennsylvania’s phased-in reopening, the Department of Aging, in collaboration with representatives of Area Agencies on Aging and adult day centers, has developed procedures and best practices for resuming operations of adult day centers, senior community centers, aging services that involve in-person consumer contacts and in-home visits, and protective services,” said Aging Secretary Robert Torres. “This has all been done with the overriding objective of ensuring the health and safety of both participants and staff. The process of reopening will be conducted gradually, strategically and cautiously, while allowing flexibility at the local level to keep older adults and staff safe.”
Recognizing that seniors may have ongoing concerns and fears, alternative services and practices implemented as a result of this pandemic, such as maintaining different modes of getting meals to seniors, will continue for some time. Older adults needing a meal or in-home support can still call their local AAA. Questions regarding available aging services and resources can be directed to the PA Link at 1-800-753-8827.
CDC Updates on Monday:
COVID-19 is thought to spread mainly through close contact from person-to-person. Some people without symptoms may be able to spread the virus. The CDC Monday said, “We are still learning about how the virus spreads and the severity of illness it causes,” and provided an update online.
The CDC also provided sample training plans including training topics that may be helpful for state and local public health jurisdictions to consider when designing their own training plan for COVID-19 contact tracers, investigators and supervisors.
State House Speaker cancels seven June session days
Speaker Mike Turzai sent notice to staff in the House of Representatives on Monday, advising them that the House is cancelling voting session days the week of June 15-17 and June 25, 26, 29 and 30.  According to the Speaker, after June 24, the House will stand in recess at the call of the chair, in the event they need to return to session prior to September 15.
The House is scheduled to be in session June 8-10 and June 22-24 before recessing until the fall.