INSIDE THIS REPORT:

• Lebanon joins green counties on July 3
• Daily DOH Health Data Report
• Philadelphia puts breaks on green light; numbers increasing elsewhere
• Allegheny County steps back from alcohol sales on premises, PA Officials watching other areas closely over COVID-19 infection rates
• DoH, DHS Issue new guidelines for nursing homes, LTC facilities
• Wolf Administration: it’s mitigating COVID-19 spread through education, testing, resources

Daily Department of Health Data Reports
On Sunday, the Pennsylvania Department of Health confirmed as of 12:00 a.m., June 27, there were 505 additional positive cases of COVID-19, bringing the statewide total to 85,496. Approximately 6,484 of the state’s total cases are in health care workers.  DoH estimates that 78% of all PA positive cases are individuals who have recovered.

In nursing and personal care homes, there are 17,677 resident cases of COVID-19, and 3,212 cases among employees, for a total of 20,889 at 687 distinct facilities in 51 counties. A county breakdown can be found here.

There have been 6,606 total deaths attributed to COVID-19, an increase of three new deaths. Out of the total Pennsylvania deaths, 4,528 (69%) have occurred in residents from nursing or personal care facilities.  County-specific information and a statewide map are available here.

There are 657,486 patients who have tested negative to date. There are 633 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.

On Saturday, the Pennsylvania Department of Health confirmed as of 12:00 a.m., June 26, there were 621 additional positive cases of COVID-19, bringing the statewide total to 84,991. Approximately 6,446 of our total cases are in health care workers.

In nursing and personal care homes, there are 17,622 resident cases of COVID-19, and 3,193 cases among employees, for a total of 20,815 at 684 distinct facilities in 51 counties. A county breakdown can be found here.

There are 6,603 total deaths attributed to COVID-19, an increase of 24 new deaths. Out of our total deaths, 4,528 have occurred in residents from nursing or personal care facilities. County-specific information and a statewide map are available here.

There are 646,780 patients who have tested negative to date. There are 633 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 26:

• Announced Lebanon County will move to green on July 3..
• Reminded masks are mandatory in Pennsylvania businesses.
• Provided the latest on work being done surrounding testing, education and resources to assist Long-Term Care Facilities.
• Released guidance for Long-Term Care Facility visitation.

Philadelphia puts breaks on green light move
Just as the last of the state’s counties are approved to move to green phase of reopening, Philadelphia health officials say a second wave has started in the city, and because of that, masks will now be mandatory in the city.

Philadelphia  health officials said Friday they are not meeting the target reductions in new infections to move next week as planned to the green phase.  Philadelphia won't officially move to green until Friday, July 3 - and there will still be some differences between what green looks like in the city from its surrounding suburban counties.

The following activities reopened on Friday June 26 in the City of Philadelphia: Residential swimming pools and private swim clubs; Zoos (outside only); Personal services such as salons; barbers; and spas; Small indoor social and religious gatherings (up to 25 people)

The following activities can reopen on Friday July 3 in the City of Philadelphia: Indoor dining; Indoor shopping malls; Gyms & Indoor Exercise; Outdoor Group Sports

County health commissioner Dr. Thomas Farley said Philadelphia is seeing a slow increase in cases in the city; with a specific spike in people ages 16 to 19; likely because of social gatherings.

The city announced a mandatory mask order for both indoor and outdoor spaces for those in contact with someone they don’t live with; and Farley urged people to quarantine themselves if they come to the city from other states or counties where case counts are rising.

“Today; we will be issuing a mandatory mask order for the City of Philadelphia;” Farley said. Masks will now be required inside all public locations in the city and outside if people aren’t six feet apart.  “There will be limited exceptions; such as an exception for children under the age of 8;” Farley said.

Even with a green reopening designation from the state for all of southeastern Pennsylvania; Philadelphia kept many restrictions in place for another week.  The plan to lift them on July 3 is now in jeopardy.

“Given the numbers we have right now; we are not meeting our target for reopening next Friday;” Farley said.  He said he was especially concerned about allowing indoor activities to resume next Friday; like dining in restaurants

PA Officials are watching other areas closely for upticks in COVID-19 infection rates
(Associated Press) -- Officials in Allegheny County are halting all on-site consumption of alcohol in bars and restaurants due to what they call an “alarming” spike in COVID-19 cases.  County Executive Rich Fitzgerald and Dr. Debra Bogen, the county Health Department director, said the recent spike has been largely among young people and involved out-of-state travel, often including night life during travel, and going to local bars and restaurants.

Under the order, which goes into effect at 5 p.m. Tuesday, bars and restaurants can remain open but won't be allowed to serve alcohol other than takeout options allowed by the state. In addition, masks will be enforced in restaurants until food arrives, and outdoor seating is being encouraged.

Governor Wolf  commended the Allegheny County Executive and Health Department for the for the decision to shut down bars and restaurants for on-premises alcohol sales in Allegheny County effective June 30.  He said, “This was the right move to work to stop the recent spike of COVID-19 cases in its tracks,” and said the situation in Allegheny County is a reminder for the entire state to follow mask-wearing and other mitigation requirements.

Fitzgerald said officials are keeping an eye on sports and in particular youth sports, since there are some indications there might be a growing problem there.

The county reported an additional 96 cases Sunday, six higher than the previous high of 90 on Saturday, and 393 in the last seven days.  The county’s case counts and percentage of positive tests both more than tripled in the last seven days, compared with the previous seven-day period, according to state data.

County health authorities said the average age of new cases Sunday was 27, some of whom reported traveling, attending protests and family gatherings or visiting or working in bars and restaurants. Travel included to places struggling with rising cases, including Myrtle Beach in South Carolina, Houston and Florida.

Bogen said she was “very concerned” not only by the rapid rise in cases but because most cases had no known source, indicating they were “community spread.”

County health authorities said Friday two-thirds of the cases were among those 19-49 years old, some of whom reported traveling, attending protests and family gatherings or visiting or working in bars and restaurants. Travel included to places struggling with rising cases, including Myrtle Beach in South Carolina, Houston and Florida.

County health authorities also asked residents to consider postponing plans to travel to a coronavirus hot spot, and to self-quarantine for 14 days and get tested when returning. Officials said there had been no significant increase in hospitalizations and deaths — “at least not yet,” Bogen said, noting that hospitalizations lag cases by at least a week or more, and current cases are mostly in younger people less prone to serious cases.

Pennsylvania health officials are looking closely at other areas where COVID-19 infection rates and deaths are ticking back up, threatening to turn back progress against the pandemic, the state’s health secretary said Friday.  The rise may be attributable to the gradual reopening that has been taking place in Pennsylvania, as well as more extensive testing, Dr. Rachel Levine said.

“We are doing a deep dive into all of the counties that have had increases,” Levine said, warning that “community spread” is occurring in some parts of Pennsylvania.  Statewide, new case counts grew by 30% and the percentage of positive tests also ticked up in the last seven days, compared with the previous seven-day period, according to state data.

The Health Department announced 600 new confirmed cases of COVID-19 in Pennsylvania on Friday, and even more on Saturday, the state’s highest one-day total reported since early June, bringing the state total to more than 84,000 confirmed cases — eighth-highest among states, according to federal data.  Still, hospitalizations have continued to drop.

At UPMC in Pittsburgh, Dr. Donald Yealy, the senior medical director and chair of emergency medicine, said in an interview Friday that, even with an uptick in cases in the area, the number of people hospitalized with the coronavirus or in the intensive care unit is lower than it was in April.

Yealy said he didn’t know why, but that just looking at the number of cases does not tell the entire story.

“It’s an important part of it, nobody’s denying that, but what’s important is also how many people are having severe illnesses, what’s happening to them and are we are identifying who has it,” Yealy said.

DoH, DHS Issue new guidelines for nursing homes, LTC facilities
The PA departments of Health and Human Services this weekend issued updated guidance for residents in nursing homes, personal care homes, assisted living residences and private intermediate care facilities.

“We continue to practice a careful, measured approach in long-term care facilities so all staff and residents can safely welcome visitors and return to a more normal routine,” Dr. Levine said. “We developed this guidance through collective input from residents and families, stakeholders, academia and facility representatives to allow safe visitations with strong public health measures to balance the mental and physical well-being of Pennsylvania’s most vulnerable residents.

“COVID-19 has presented a tremendous challenge, but long-term care facilities have felt these challenges acutely due to the often fragile health of residents at these facilities. Precautions and restrictions implemented at these facilities were necessary to keep residents and staff safe, but we recognize that they are not permanently sustainable,” said Human Services Secretary Teresa Miller.
Guidance issued today will help this process begin, and we will continue to support our long-term care facilities through every step.”

The Departments will now require all LTCFs to meet several prerequisites before proceeding into the official three-step process of reopening:

• Develop an implementation plan and post that plan to the facility’s website that specifies how reopening and visitation requirements will be met.
• Administer tests within 24 hours of a resident showing COVID-19 symptoms and complete baseline testing as required in the Secretary’s Orders issued on June 26.
• Develop a plan to allow visitation that includes scheduling and other safety measures,
• Develop a plan for cohorting or isolating residents diagnosed with COVID-19 in accordance with PA-HAN 509.
• Establish and adhere to written screening protocols for all staff during each shift, each resident daily, and all persons entering the facility.
• Have adequate staffing and supply of personal protective equipment for all staff.
• Be located in a county that is either in the yellow or green phase of the Governor’s Reopening Plan. and

Once a facility meets the required prerequisites, the facility will enter a three-step process of reopening:

Step One: A facility must maintain no new COVID-19 cases among staff or residents and have no spread in the facility for 14 consecutive days in order to enter step two.

Step Two: Facilities are required to maintain no new cases of COVID-19 among staff or residents and have no spread in the facility for 14 consecutive days to progress into the final step.

Step three: The LTCFs can operate as outlined for the remainder of the Governor’s COVID-19 Disaster Declaration if there are no new COVID-19 cases among staff and residents for 14 consecutive days.

If a new COVID-19 case is known, facilities will cease implementing their reopening plan and wait until they have no new COVID-19 cases for 14 consecutive days before re-entering step one.

Each step of the plan includes specific criteria for conducting dining, activities, non-essential personnel, volunteers, visitors and outings.

Visitations will only be allowed in steps two and three as long as the facility determines a resident is able to safely see visitors and will prioritize those with diseases causing progressive cognitive decline and residents expressing feelings of loneliness. A facility must designate visitation hours, locations (preferably outside or a pass-through not typically occupied or frequented by residents), and screenings to permit a visitor into the building. Facility staff will monitor visits to ensure all safety guidelines are met and enforced. After each visit concludes, staff will need to sign out the visitor and properly disinfect the designated visitation location. Guidance for visitors is available here.

Since the beginning of the COVID-19 pandemic, the Wolf Administration has taken a three-pillar approach to protecting the residents living in LTCFs by:

• Ensuring resident safety through testing, education and resources,
• Preventing and mitigating outbreaks, and
• Working in partnership with state agencies, local health departments and LTCF operators.

The guidance issued today will supersede the previous guidance issued for nursing homes and personal care homes, assisted living residences and private intermediate care facilities. Previously, the ongoing visitor limitations, personnel restrictions, and other measures in LTCFs remained in place at least 28 days after the respective facility’s county enters the green phase in the Governor’s Process to Reopen Pennsylvania.

Wolf Administration mitigating the spread of COVID-19 through testing, education and resources
Secretary of Health Dr. Rachel Levine and Secretary of Human Services Teresa Miller also took time to emphasize work being done through testing, education and resources to help LTCFs in mitigating the spread of COVID-19 to protect residents and staff living and working in these congregate care facilities.

The secretaries also announced an expanded testing order for LTCFs, extending to personal care homes, assisted living residences, and intermediate care facilities licensed by the Department of Human Services.

As of June 19, the departments of Health and Human Services have deployed these mitigation efforts and engaged with facility management and local health systems to further stop the spread of COVID-19 and best protect residents and staff of all LTCFs:

• Distributed over 2,300 shipments of Personal Protective Equipment (PPE) to date, which includes 306,944 gowns, 336,559 face shields, 1,023,800 gloves, 2,807,570 N95s masks and 1,175,200 surgical masks.
• Deployed 69 Pennsylvania National Guard Strike Teams to 34 different LTCFs. Work includes 32 site assessments, 10 PPE trainings, 13 COVID-19 mass testing missions, and 14 facility staffing missions.
• Responded to 100 percent of outbreaks, defined as one or more confirmed positive case among staff or residents, in LTCFs.
• Provided advice and consultation on infection control and outbreak response to facilities and, where needed,
• Collaborated, partnered and received reports from local, state, and federal resources, along with contracted support from ECRI.

Through the collaborations and partnerships with ECRI and Patient Safety Authority (PSA), the department provided infection control and technical assistance to over 100 and 90 different LTCFs, respectively. The US Public Health Service has also been deployed to 19 LTCFs for onsite assessments and training.

The Wolf Administration is committed to testing all residents and staff in Pennsylvania’s long-term care facilities as part of the statewide comprehensive testing strategy. On June 8, the Department of Health issued an Order to require nursing homes to complete baseline universal testing no later than July 24. Since then, testing across all LTCFs over the last four weeks has increased 30 percent as compared to the month before. The test positivity rate within all LTCFs is the lowest it has been since the start of the outbreak: 7.8 percent. Now, over 100 facilities have now reported completion of universal testing.

The Department of Health today issued a testing order extending universal testing requirements to DHS’ licensed assisted living residences, personal care homes, and intermediate care facilities effective July 1, 2020. Under this order, these licensed facilities are directed to test residents and staff at least once before August 31, 2020. Facilities included under this order were already following previously issued testing guidance and many have ramped up testing but were not included in the original order due to differences in how these facilities would cohort patients and due to DHS’ facilities not always having medical directors or on-site clinical staff. Instituting this requirement in July allows the Regional Response Health Collaboratives, which will be in place in early July, to provide testing and clinical support to these facilities as they ramp up testing and prepare for a potential second spike of cases in Pennsylvania.

The long term care facility data mandated by the Department of Health includes the number of cases, number of employee cases and number of deaths that have occurred at each facility. Facilities who are not reporting, or not reporting properly, have been assisted to ensure the data is being shared properly. As testing becomes more widespread, it is important that all facilities report all necessary information. More information on data reporting requirements for nursing home facilities can be found here.

Individuals with complaints about a nursing home can file that complaint with the Department of Health in several ways. Complaints can be made anonymously by calling 1-800-254-5164, filling out the online complaint form, emailing c-ncomplai@pa.gov or sending the complaint in the mail to the department. Complaints regarding personal care homes and assisted living residences can be sent to DHS at RA-pwarlheadquarters@pa.gov.