June 25 Pennsylvania COVID-19 Update

•     Daily Department of Health Data Report
•     Levine announces partnership with CVS Health for Nursing Home testing
•     Wolf, Levine answer questions at Hershey Medical Center
•     Senate GOP Policy Committee hears unique views on COVID-19 from UPMC
•     NY, NJ, CT place quarantine on visitors from high infection states

Daily Department of Health Data Report
On Wednesday, the Pennsylvania Department of Health confirmed as of 12:00 a.m., June 24, there were 510 additional positive cases of COVID-19 in the prior 24 hours, bringing the statewide total to 82,696. Approximately 6,260 of our total cases are in health care workers.

In nursing and personal care homes, there are 17,294 resident cases of COVID-19, and 3,082 cases among employees, for a total of 20,376 at 669 distinct facilities in 49 counties. A county breakdown can be found here.

There are 6,464 total deaths attributed to COVID-19, an increase of 38 new deaths. Out of the total Pennsylvania COVID-19 deaths, 4,410 occurred in residents from nursing or personal care facilities. County-specific information and a statewide map are available here.

There are 596,407 patients who have tested negative to date.  There are 631 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. Of the patients who have tested positive to date the age
breakdown is as follows:

  • Nearly 1% are ages 0-4;
  • 1% are ages 5-12;
  • 2% are ages 13-18;
  • Nearly 7% are ages 19-24;
  • Nearly 37% are ages 25-49;
  • Nearly 25% are ages 50-64; and
  • Nearly 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. More data is available here.

Statewide – The Wolf Administration has since noon, June 22:

Levine Announces new nursing home facility testing partnership with CVS Health
Dr. Rachel Levine today announced a partnership with CVS Health to assist with nursing home facility testing as part of the state’s COVID-19 response.

The DoH and PEMA are partnering with CVS Health to offer COVID-19 testing services to skilled nursing facilities statewide, free of charge. This is in order to make sure facilities are compliant with Secretary Levine’s universal testing order issued June 9, 2020.

“We are so pleased to have this level of collaboration and assistance from CVS Health,” Dr. Levine said. “COVID-19 is a particularly challenging situation for congregate settings, particularly our nursing home facilities. This partnership strengthens and increases access to ensure universal testing is completed in nursing homes, as required in the order issued earlier this month. It will provide us the opportunity to better address outbreaks and work to prevent future outbreaks in nursing home facilities. These teams are assisting us in our response in the hardest-hit areas as we work to protect the public health and safety of Pennsylvanians.”

Omnicare, a CVS Health company, will administer up to 50,000 tests for skilled nursing residents and staff members beginning the week of June 29. The department will roll out a three-tiered priority list for testing beginning with facilities with new or ongoing outbreaks, then to facilities with a history of a resolved outbreak and finishing with facilities with no outbreaks.

“At Omnicare, we are dedicated to providing outstanding service to our long-term care customers and their patients. Our COVID-19 testing solutions are a prime example of our capabilities, and a critical component of our broader response to the pandemic,” said Jim Love, President of Omnicare. “We are pleased to partner with the Commonwealth of Pennsylvania to increase access and availability to testing for these critically important long-term care facilities and their vulnerable patient populations.”

Testing is accessible for Pennsylvanians through a variety of locations. Adding CVS Health, Patient First, Rite Aid, Walmart and other testing sites for symptomatic and asymptomatic individuals through select retail locations across the state has further allowed for Pennsylvanians to get tested close to home. Adding these locations to those already offered by hospitals, health systems, Federally Qualified Health Centers (FQHCs), health clinics and other locations significantly expands the testing network in the state.

More information about Pennsylvania’s testing sites, including a map of the sites available in Pennsylvania, is listed on the department’s website.

Wolf and Levine visit Hershey, answer questions
Speaking after touring Penn State Milton S. Hershey Medical Center and discussing plans for a possible coronavirus resurgence in the fall, Governor Wolf today thanked Penn State and frontline health care workers.  Wolf noted that the CDC last week said only three states had shown 42 straight days of decline in COVID-19 cases, and that Pennsylvania was one.  He said two have been kicked off the list (using seven day average). Wolf said this was largely due to good policy guidance from DoH and Rachel Levine and the efforts of our citizens, and our health systems.  Cleaning crews, medical professionals, HR staff, food service, all are responsible for that statistic.  Pennsylvania has done phenomenal work, he said.
“We’re in the eye of this pandemic.  We have a little bit of a breather, but we’re gonna get back into full active duty when we get back into the fall and we’re doing everything we can to prepare for that.  We bought time in March, April and May and we succeeded,” he said.  Now, our daily testing rate is up to 16,000 tests per day from hundreds and things that we now know will make a difference.  Keep wearing masks, practice social distancing, wash your hands, and stay home if you don’t feel good.  Wolf said, “The real hero of the commonwealth is Dr. Rachel Levine, who’s done a phenomenal job of leading PA through this crisis.”

Levine, noting she was still on staff at Penn State Health, thanked the staff and said our health systems have saved thousands of lives under the most difficult and extraordinary circumstances.  She noted the new partnership with CVS Health to conduct up to 50,000 tests in nursing facilities, and then the Governor and Secretary made themselves available for questions.

A lot has happened to put us in a better position, but is there a chance we would have to go back to more draconian steps like closing schools? Is it even possible?  WOLF: I don’t know what the future holds, but we’re doing everything we can to avoid that happening. We are in a much better place now.  We have almost 600 contact tracers, and have learned things that actually work.  Businesses opening up are doing responsible things.

What would you do differently?  WOLF:  Take advantage of the resources we have now, that we didn’t have.  Examples are testing.  We’re doing more tests daily now than we did through the entire month of March.  We’ve gone from having 60 to 600 community nurses to do tracing.  In early March, no one thought about masks and social distancing, or how to behave differently.  All these things will reduce the risks of getting the disease if there’s a resurgence in the fall.

How long will Lebanon be the only county in the yellow?  WOLF:  We are working on that – and actually Philadelphia is still in the yellow as well.  Dr. Levine is working closely with Lebanon County.

LEVINE: Phila could go green from our standpoint, but they are holding off officially for another week.  Lebanon had had significant increases last week.  We spent weekend doing a deep dive on Lebanon County, and like most counties, we found a combination of community spread and LTC/SNFs, but they reflect the prevalence in the county. Staff carry it in and that’s the key to universal testing.  We’re increasing testing and contact tracing sin the county.  I spoke with officials yesterday and when the number show the cases are decreasing, they will be able to go to green.

We are still hearing from frustrated, desperate and scared families of residents in SNFs like Brighton in Beaver County, being hung up on and not knowing what’s going on with their family members.  They have said they didn’t have this problem when the National Guard was there for a week.  What’s being done to hold the owners accountable and responsible?  LEVINE: The Secretary discussed what the DoH and DHS are doing.  It is the facility’s responsibility to keep loved ones up to date, but we have once a week updates on our website.  A number of them still aren’t properly reporting, and we’re working with them individually.  Because no visitors have entered, it’s the staff that unknowingly brought it in and are spreading it.  If loved ones are being hung up on should call us and complain – with their name or anonymously.

Do you have staffing to do those inspections?  LEVINE: We will continue to expand our staff at Quality Assurance, and have a contract with ECRI.  Have a new contractor via National Guard as well.

Does it concern you that the families wish the Guard was back there?  LEVINE: We will investigate that.

If all resident and staff test negative at a facility, is there guidance for visits?  LEVINE:  We’re hoping by Friday, or maybe a drift to early next week, but we’ll have guidance on visits.  But we need to do it in the most safe way so we don’t bring in asymptomatic individuals.

A growing number of people are pushing back against the masks – Rep. Metcalfe for example.  What do you have to say to them?  LEVINE:  I want to emphasize this is not a political issue or a partisan issue.  This is a public health issue.  IF I am wearing a mask, I have less chance of droplets going out and you have less of getting them.  We are protecting our community, loved ones and our family from the spread of this very dangerous virus.  It’s been extremely challenging, but COVID 19 is not gone.  The mitigation policies have bought time – and we not only bent but flattened the curve.  You can see that when you look at other states like Arizona, Texas and Florida.  Safe social distancing and sanitizer may sound simple, but I’m not tired of saying it, because it’s that important.  WOLF:  it’s not a liberal or conservative thing.  What if we had a society where only liberals or only conservatives stopped at stop signs?  We need to internalize this and understand it’s the new normal.  It’s not me, not Dr. Levine, and not Donald Trump that’s the enemy.  It’s the disease that’s the enemy.

What attitude should people have regards to COVID 19 – crowds of people gathering together?  WOLF: In March, there was a greater sense of fear, what should people have now.  In March it was an infectious disease that’s very contagious.  Now it’s June, but it’s still an infectious disease and very contagious.  We should all think, “I don’t want to play roulette with this.“  I took part in a protest demonstration, but I knew I was taking a risk.  I knew I was increasing the possibility that I would get the disease.  Back to my stop sign analogy, you may run through an intersection and make it, but you may not!  If we’re going to succeed, it’s because each of the 13 million Pennsylvanians sits down and does what they need to do.  There’s been a bit of relaxation here, but the virus is still out to get us, and we need to do what we can to protect ourselves.

Senate GOP Policy Committee hears unique views on COVID-19 from UPMC
Dr. Steven Shapiro, executive vice president of UPMC, told the Senate Republican Policy Committee Wednesday that UPMC’s approach to COVID-19 was unique but deeply rooted in data analysis. He added that from the beginning UPMC recognized that COVID-19 would not be a tsunami that hits the whole country equally, but would affect regions differently depending on their geography. He said Philadelphia was the most at risk for a severe outbreak while the western part of the state was in a better position to manage outbreaks through testing and contact tracing.

Shapiro noted that during the peak, two percent of UPMC hospital beds and six percent of UPMC ventilators were being used by COVID-19 patients. He remarked that when UPMC began resuming elective surgeries in early May, they were one of the first health systems in the region to do so. He added that UPMC staff are using personal protective equipment (PPE) liberally and are testing all patients for COVID-19.

He said the positive test rate is currently one in 400 patients in western Pennsylvania and one in 300 patients in central Pennsylvania. He noted that the patients who do test positive have a viral load that is 200 fold less than the viral load COVID-19 patients had earlier this year.

Dr. Shapiro went on to say that UPMC has only had one COVID-19 case in its 30 nursing homes, which was a 92-year-old asymptomatic woman who had recently moved to the facility from another home. He added that nationally COVID-19 cases are up, but mortalities are down. He stated that this is because COVID-19 cases are now the most prevalent among younger adults that live or work in crowded conditions. He described this as a step toward herd immunity and noted that while it takes some time to see changes to the death rate, ventilator use is up in only a handful of states.

Shapiro repeated his recent comments that social isolation was beneficial for Philadelphia but probably not for the rest of the state. He stated that vulnerable populations can be protected without the negative effects of widespread social isolation and added that the United States needs to be better prepared for future pandemics.

Chairman Argall noted that he has not heard many medical perspectives similar to Dr. Shapiro’s. He asked Dr. Shapiro if UMPC was in the minority or if the media is amplifying the more dire-sounding health perspectives. Dr. Shapiro said UPMC was in the minority when COVID-19 started, partially due to personal fear clouding the judgment of some medical professionals.

He noted that doctors are often uncomfortable supporting activity that involves risk, even if the risk is small. He said UPMC’s perspective was popular among psychiatrists from the beginning. He added that Dr. John Ioannidis, an epidemiologist at Stanford University, published a paper suggesting that COVID-19 is not as deadly as initially thought. He noted that Dr. Ioannidis was accused of writing a paper to fit his own narrative and is now under investigation by Stanford.

Dr. Shapiro said that in general a hypothesis was developed that turned into a dominant paradigm, which is now difficult to shift due to people’s fear. He added that UPMC is constantly trying to disprove its own hypothesis and would have changed it if necessary.

NY, NJ, CT place quarantine on visitors from high infection states
Out-of-state visitors coming to New York, New Jersey and Connecticut from areas of the country with high COVID-19 rates will be required to quarantine for 14 days under new guidelines from Albany.

Under the advisory, individuals coming from states that have high infection rates must spend two weeks under self-quarantine to help prevent the spread of the virus.

Under the policy, states that have 10% per 100,000 or 10% of the total population positive over a seven-day rolling average would be subject to the advisory. States currently in that position include Alabama, Arkansas, Arizona, Florida, North Carolina, South Carolina, Washington, Utah and Texas.

The policy also applies to residents of these states who travel to one of these states and then return home.  The policy took effect at 12:01 a.m. Thursday, June 25.