March 24 COVID-19 Update – Pennsylvania American College of Physicians

March 24 Pennsylvania COVID-19 Update

The PA Department of Health confirmed there were 207 additional positive cases of COVID-19 and four new deaths on Monday, bringing the statewide total to 851 in 40 counties and seven deaths.  Philadelphia has 177 cases, and more than half of all positives are in Philadelphia and its suburbs.  York County now has 18 cases, Cumberland County has 13, and Lancaster County has 10.  All people testing positive are either in isolation at home or being treated at hospitals.  There are 8.643 patients who have tested negative and seven total deaths.  Data is not available on the total number of tests pending.
On Tuesday afternoon, Governor Wolf extended his stay at home orders to Erie County.  Those orders now extend to eight counties: Allegheny, Bucks, Chester, Delaware, Erie, Monroe, Montgomery and Philadelphia.  During her daily briefing, Health Secretary Rachel Levine said, that sustained community spread is a factor in deciding which counties are being issued “stay at home” orders. 
Stay at home instructions/directions are available on line from the Governor’s Office.
Dr. Rachel Levine, PA Health Secretary also was available to the news media this afternoon.  Levine said the state has 3,400 ICU rooms, and is working with HAP, medical organizations and County Health departments, preparing for a surge.  She said the difficulty is providing space for the whole continuum of care from primary care to the ICU, Med-Surg, post-acute beds and convalescence.  She said efforts were underway to even repurpose ASFs, and to use some hotels for post acute patients during convalescence.
She said that DoH has some stores of N95 masks and ventilators which are being replenished by federal government as PA moves stocks to need.  The state is also purchasing ventilators and working to purchase masks, having companies repurposing their manufacturing for production of PPE, as well as looking to other states and other countries. Sec. Levine said the state’s last request of the federal government was for PPE and that the materials were received from the national stockpile.
Levine said she expects to see spread soon to rural areas, without the same large numbers because of population density.  Stay at home decisions are being made daily.  She said Pennsylvania is continuing to see an exponential rise and that the state’s number of cases is doubling about every two to three days. Pennsylvania is seeing sustained community spread in southeast counties and Allegheny County, which are all of the counties that were included in the stay-at-home order.  She said that rural hospitals could be used for urban/suburban overflow if it becomes necessary, but that she would rather not transport patients.
Sec. Levine said there have been cases reported in a nursing home but she is not sharing information regarding the specific facility. She noted that DOH and county health departments are assisting in those cases.
After President Trump said he’d like to see America “back at work” by Easter, Dr. Levine said that the state is not looking to pull back restrictions. She emphasized Pennsylvania’s three-pronged strategy to mitigate spread, practice social distancing, and track cases through testing. She stated that it is “far too early” to change those prevention and mitigation orders but that she will leave it to attorneys to decide between federal and state regulations.  In reality, the states (and local governments) have primacy on theses decisions, and the US government cannot mandate state and local governments life local restrictions.
A moratorium has been placed on all MA terminations with passage of the Families First Act last week.  The state is coordinating with DHS to make sure no MA terminations take place. 
Insurance Commissioner Jessica Altman and Department of Human Services (DHS) Secretary Teresa Miller held a press call today to highlight special enrollment periods (SEPs) for health insurance.
Commissioner Altman noted that COVID-19 business closings and reduced staffing at many others is increasing unemployment and the numbers of people without health insurance. Options are available through the Affordable Care Act (ACA) marketplace, Medicaid, or the Children’s Health Insurance Program (CHIP) in addition to COBRA benefits.  Pennsylvanians who lose comprehensive health insurance from another source such as their employer should already be eligible for an SEP to get coverage on the marketplace.  Those seeking coverage have 60 days to apply for enrollment in marketplace coverage after loss of initial coverage, but the SEP is only available for those who have lost current coverage and not uninsured individuals or those with short-term plans.
Gov. Tom Wolf sent a letter to the federal government requesting an SEP. Miller urged Pennsylvanians with changed income or employment statuses and lost coverage to apply for Medicaid as they “may qualify without realizing it.” Individuals can apply for Medicaid and CHIP online, she explained, or at 1-866-550-4355. Both programs cover COVID-19 testing without copays or prior authorization.
General Assembly: 
The House was in session with remote voting for the first time in the history of the Commonwealth.  During the session, the House amended SB 422, which establishes the Pennsylvania election law advisory board and changes the date of the 2020 primary to June 2.  The approved amendment also includes this language:
The House also amended and moved up for a vote tomorrow HB 1564, which among other things, allows notaries to notarize documents through electronic means.
On March 7, 2020, The Pennsylvania DOH State Lab in Exton confirmed the state’s first presumptive positive COVID-19 cases, and Governor Wolf signed the COVID-19 Disaster Declaration.
On March 13, 2020, the United States declared a national emergency. PADOH continues an incident command structure to coordinate monitoring, response, and messaging. The Department Operations Center is located in room 112 of the PEMA building. PADOH is coordinating with other state agencies, as needed. Communications personnel from various agencies have established a virtual Joint Information Center to address inquiries related to COVID-19.
On March 16, 2020, Governor Wolf ordered statewide shutdown of non-essential stores as of midnight, including all community centers, gyms, entertainment centers, and non-essential retail. Bars and restaurants are included, except for takeout and delivery.  
On March 18, 2020, Governor Wolf confirmed the state’s first COVID-19-related death. On March 13, 2020, Governor Wolf ordered statewide school closings. On March 19, 2020, Governor Wolf further ordered all non-life sustaining businesses in PA to close physical locations.
Beginning March 23, 2020, the state police will assist in enforcement of closure of non-life-sustaining businesses. On March 23, 2020, Governor Wolf issued a stay-at-home order for Allegheny, Bucks, Chester, Delaware, Monroe, Montgomery, and Philadelphia counties.  This order was extended to Erie County on March 24, 2020, as was the state’s list of essential life-sustaining businesses.