INSIDE THIS REPORT:

• Universal Testing Order for Nursing Homes, Guidance for LTCFs Updated
• Monday’s COVID-19 numbers and links
• PHMC chosen as PA’s health care emergency preparedness vendor
• Senate advances resolution to terminate disaster emergency declaration
• Q/As with Secretary Levine

Universal Testing Order Issued for Nursing Homes, Testing Guidance for LTCFs Updated
The Wolf Administration has issued a universal testing order requiring all nursing homes to complete initial baseline testing no later than July 24. Additionally, the Department  of Health issued updated testing guidance to all long-term care facilities (LTCFs) through the Health Alert Network (HAN).

Between May 11 and May 26 the department implemented a universal testing pilot project in five LTCFs. The department is also working with additional facilities to implement universal testing by providing testing supplies, access to the Bureau of Laboratories and staffing support through the National Guard to train and assist with swabbing.

More than 75 LTCFs completed widespread testing, and the number of tests in LTCFs has increased 48 percent over the last two weeks, bringing the percent of positive cases in this population to its lowest level since the start of the outbreak.

Additionally, the department shared further information on the testing requirements and frequently asked questions on order.  The updated testing guidance the department issued to all long-term care facilities brings a renewed focus on:

• Keeping COVID-19 out of the facility by testing all staff and residents;
• Detecting cases quickly with facility-wide testing when a new case in a resident or health care professional is found; and
• Stopping the spread by continuing weekly testing of all residents and staff through at least 14 days since the most recent positive result.

For the purposes of the updated testing guidance, long term care facilities include, but is not limited to, skilled nursing facilities, personal care homes, assisted living residences, community residential rehabilitation services, long-term structured residence, residential treatment facility for adults and intermediate care facilities.

Levine said that as of Friday, June 5, the department had pushed out over 1,870 shipments of PPE to date, which has included 167,674 gowns, 131,700 face shields, 792,000 gloves, 2,632,280 N95s masks and 881,700 surgical masks.  The department had responded to 100 percent of outbreaks, defined as one or more confirmed positive case among- staff or residents, in LTCFs, providing infection control and technical assistance to 90 different LTCFs. It deployed 55 Pennsylvania National Guard Strike Teams to 27 different LTCFs.  The Educational Support and Clinical Consultation Program (ESCCP) team provided clinical guidance, advice on infection control strategies, and clinical needs identification to more than 250 facilities.

The Wolf Administration’s strategy to protect residents of LTCFs focuses on ensuring resident safety through education, resources and testing; preventing and mitigating outbreaks; and working in partnership with other state agencies, municipal and county health departments and LTCFs.

The long term care facility data mandated by the department 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.

Monday Data Report from the Department Of Health
On Monday, the Pennsylvania Department of Health confirmed that as of 12:00 a.m. June 8 there were 351 additional positive cases of COVID-19, bringing the statewide total to 75,943. All 67 counties in Pennsylvania have cases of COVID-19.

There are 5,953 total  PA deaths attributed to COVID-19, an increase of 10 new deaths. County-specific information and a statewide map are available here.

There are 620 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 451,387 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. More data is available here.

In nursing and personal care homes, there are 16,167 resident cases of COVID-19, and 2,807 cases among employees, for a total of 18,974 at 615 distinct facilities in 45 counties. Out of our total deaths, 4,094 have occurred in residents from nursing or personal care facilities. A county breakdown can be found here.  Approximately 5,742 of Pennsylvania’s 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.

The Wolf Administration has since noon, June 7, also provided an update from Pennsylvania State Police on business closure enforcement actions.

Public Health Management Corporation chosen as PA’s health care emergency preparedness vendor
The Wolf Administration today announced it has selected Public Health Management Corporation (PHMC) of Philadelphia as its health care emergency preparedness vendor, effective July 8, 2020.

“PHMC is well positioned to help move the commonwealth forward in its preparation efforts for future emergencies, including preparations in the case that coronavirus resurges in the fall or winter,” Pennsylvania Department of Health Secretary Dr. Rachel Levine said. “We are looking forward to the opportunity to expand our existing hospital preparedness program, as well as creating an inclusive environment for all members of our health care system through our health care coalitions.”

This agreement is part of the department’s annual federal health preparedness grant.

Health care coalitions (HCC) are a formal collaboration among health care organizations and public and private partners that are organized to prepare for, respond to and recover from an emergency, mass casualty or catastrophic event. The key components include comprehensive health care membership; regional presence developed within states/territories to cover larger geographic areas; and preparedness capability operationalization through plans, exercises, trainings, response, and after-action reports.

The hospital preparedness program (HPP) is a cooperative agreement program administered by the U.S. Department of Health and Human Services that establishes a foundation for national health care preparedness.  Pennsylvania has been contracting with the Hospital and Health System Alliance of PA for these services.

PHMC is a nonprofit public health institute that builds healthier communities through partnerships with government, foundations, businesses and community-based organizations. It fulfills its mission to improve the health of the community by providing outreach, health promotion, education, research, planning, technical assistance and direct services.

Senate advances resolution to terminate disaster emergency declaration
A resolution to terminate Gov. Tom Wolf’s COVID-19 disaster emergency declaration was approved by the Senate Veterans Affairs and Emergency Preparedness Committee on Monday, despite warnings from Democrats that it could endanger the state’s ability to receive federal coronavirus relief funds.

The resolution was passed by the House last month, with many GOP lawmakers expressing ire toward Wolf’s refusal to ease coronavirus-related restrictions at a faster pace. Those same concerns were relayed by Senate Republicans, including those who have been vocal about the impact Wolf’s shutdown had on businesses throughout the state. Sen. Mike Regan (R-Cumberland), the chairman of the committee, said “It’s time for the legislature to act.”

State law gives the legislature the ability to terminate a disaster declaration by passing a concurrent resolution, although the Governor has said he believes he can veto any such resolution.
Since March, the General Assembly has passed a series of bills to allow various sectors to operate despite Wolf’s closure of nonessential businesses, but they were vetoed – although in recent weeks Governor Wolf has eased restrictions, and approved by executive order openings sought by legislation

The declaration itself gives the governor the power to “issue, amend and rescind executive orders, proclamations and regulations” during a disaster, which Wolf has made use of during the COVID-19.
In the wake of Wolf’s restrictions, more than two million Pennsylvanians filed for unemployment as businesses closed their doors and laid off workers. Republicans largely blamed Wolf for the economic fallout and have now resorted to the termination resolution to void his disaster declaration. Democrats said they had concerns over federal funding, impacts on statutory and regulatory suspensions made under the authority of Wolf’s disaster declaration.

The resolution’s sponsor, Sen. Doug Mastriano (R, Franklin) said he spoke with representatives from the White House who assured him that Pennsylvania’s funding would not be lost as a result of passing the resolution.

The Committee also approved by a similar vote, SB 1166, which would change the state's Constitution to alter the way in which emergency declarations are implemented and extended after first being declared by the governor.  The bill would give the Legislature the ability to nullify an attempt by the governor to renew his emergency declaration after the initial 30-day period. Current law allows the governor to issue an emergency declaration for up to 90-days before it must be renewed.

Q/As with Secretary Levine
Can you tell us why you terminated the contract with HAP?  LEVINE:  That contract was ending, and it will now July 8.  We chose to go with another provider, but did not terminate HAP.  There will be a transition and there will not be a time when we do not have an organization under contract and providing these services.

Little leagues aren’t using dugouts in Lycoming County.  Do you have any other guidance for youth sports programs? LEVINE: The governor’s office has been working on that and we expect to get that out this week.

Who will conduct the universal testing, and is it tied to getting the health systems to come in and work with the nursing homes?  LEVINE: The DHS has the lead on that and we’re thankful for the legislature in passing that program and funding it.  In terms of the testing, those that are priorities can be done at our state laboratory in Exton, other facilities might work with hospitals and health systems in their areas, and others will work with commercial laboratories.

How is it funded? LEVINE: In terms of the ESCPP program, there is funding authorized by the legislature. If facilities need testing supplies, we have them from the federal DHHS, remember most if not all of those patients have Medicare, so Medicare will cover the costs of the testing.

What insures this will happen by 7/24 and what will happen to facilities that don’t by then? LEVINE: We will ensure that, and I’m confident that we will accomplish this testing by then.

Can you elaborate on your decision to not continue with HAP?  LEVINE: This was an operational decision to work closely with other facilities, beyond hospitals and health systems.

Did HAP do anything inappropriate?  LEVINE: No, this was just an operational decision.

There’s apparently been a COVID-19 transmission to at least 11 people who were vacationing at the Jersey shore  what can you tell us about that – were they inside or outside? Wearing masks? Social distancing? What was the interaction?  LEVINE: I don’t’ have granular information about those cases, they are in Bucks County.  It’s important to remember that where counties have their own health departments, they are in the lead and they do a great job.

Are you investigating any other similar clusters, and what do you think about the Bucks County case?  LEVINE:  We’re not investigating any other clusters that I know of. But it doesn’t surprise me.  The Governor said he was concerned about people going to the Jersey Shore, especially if they weren’t going to practice social distancing.

A number of counties that are in the green are anxious to move into a next category beyond that even without a vaccine, and a few are preparing letters to you and the Governor.  What kind of things will you be looking for the potential to move beyond green?  LEVINE: We’re pleased to review those letters, but you certainly have to wait at least two weeks or more.  We have to look at what adjustments we can make if the numbers continue to decrease, and we’ll be pleased to discuss that with them, but we haven’t come to ground yet on what that “new normal” will look like, in terms of things like occupancy for restaurants and things like that, but we’re working on it.

How much of a role will PHC have in that?  LEVINE:  No, the PHC would not be involved in that.  Their role is with hospitals, nursing facilities, EMS, distribution of PPE, etc.  It will not influence counties going from yellow to green to new normal.

Will the Department be providing tests to nursing homes, or will they be responsible for obtaining test kits?  LEVINE: For those that need it, we can push out the viral media and the swabs,  If a nursing home doesn’t know how to do it, or can’t obtain test kits, they can call us, and we’ll help them.

Do you believe there’s adequate availability of these kits? If not, when do you expect them to become available?  LEVINE: We are thoroughly confident that we have that capability now – we did not in April, but now we do.

What plans are in place to help nursing homes with costs of future cases of COVID-19 and staff replacement?  LEVINE: We will work with them in all aspects of caring for these patients.  The patients all have insurance, so the cost of care is born by insurance, but we’ll make sure they have the equipment they need to take care of patients.