March 31 Pennsylvania COVID-19 Update

WHITE HOUSE APPROVES MAJOR DISASTER DECLARATION FOR PENNSYLVANIA
Monday evening, the White House and Federal Emergency Management Agency approved Pennsylvania’s request for a major disaster declaration retroactive to January 20, 2020.  The Governor told the media he had made this request on Sunday.

At Monday’s press briefing, the Governor, along with Stephanie Watkins, MD, the state epidemiologist, provided the daily update – Dr. Levine took a well-deserved day off.

PA-ACP ASKS COURT TO HALT TRIAL LAWYERS DEPOSITIONS, DISCOVERY DURING COVID-19
The Chapter joined with 29 other medical organizations Monday in a letter to Supreme Court Chief Justice Tom Saylor asking the Court to formally suspend all pre-trial activities involving health care practitioners during the COVID-19 crisis response.  The trial lawyers’ PA Association for Justice had written the Court asking that they be expressly allowed to continue these practices during the crisis, despite the fact that doing so would be pulling physicians off patient care at a critical time. A copy of the letter is available here.
 
PA COVID-19 DATA UPDATE
Carbon, Cumberland, Dauphin and Schuylkill were added to the Governor’s Stay at Home order, which was expanded through April 30, and now includes 26 counties and half of the state’s population.

As of midnight Sunday, 37,864 Pennsylvanians have been tested for COVID-19, an increase of 10,221 since Friday.  There were 693 additional positive cases yesterday, bringing the statewide total to 4,087 in 59 counties.  33,777 patients have tested negative.   Four percent of the positive cases are health care workers.  Less than one percent of the cases are in nursing homes, and we have our first in correctional facility.  Of the positive cases, 386 required hospitalization (10.2%), consistent with ongoing figures from daily reports.  Of those, 110 have required ICU and 67 have required use of ventilators.

The DoH reported 10 new deaths among positive cases, bringing the statewide total to 48.  Breakdown of positives by age: <1% are 0-4; <1% are 5-12; 1% are 13-18; 10% are 19-25; 41% are 26-49; 28% are 50-64; 19% are 65 and older.

Since Friday, eight more counties have reported their first cases (Cameron, Clarion, Huntingdon, McKean, Mifflin, Perry, Snyder and Venango counties), bringing the statewide total to 59 out of 67 counties that now have at least one case of COVID-19.

Questions Asked and Answered
CDC has purchased ventilators – when will they be available?  We have a supply, but the Governor said Pennsylvania has been passing them on to other states when their hospitals require them.  “So far, we’ve kept up,” he said.  “If we could get another 1,000-1,400 that would be great.”

The Governor said we are seeing infected people coming from higher concentration areas.  Philly OB/Gyns are getting demand from New Yorkers who didn’t want to deliver in NYC.  Ditto in the Poconos. They are using OUR health care system.  But it’s not yet an unmanageable challenge.

The news media asked if because daily increases last week were 30% higher, and now in the 20% range, does that mean we are peaking?  Dr. Watkins said that case counts are seeing positive indicators, but it’s too soon to say. 

Are we building temporary hospitals at Farm Show, Scranton/WB, etc.?  Is the National Guard helping?  Wolf said PA has two temporary hospitals now in the Philadelphia area from the feds and that’s one option.  The other is for the state to keep existing health providers in business like it did with the Easton Hospital, and to use other public buildings that are available for use.  Wolf said he was open to any number of things for post-acute care.  East Stroudsburg University has dormitories under consideration as temporary hospital site because dorms have kitchenette suites.  Bloomsburg as well.  Geisinger expressed that interest, and as rooming for health care workers, etc.
How would federal disaster declaration help? It would give latitude and more federal dollars to support our efforts.  Wolf said he expects to hear in a day or two on that status.(NOTE: See Above. President Trump Approved Wolf’s request retroactive to January 20, 2020.)

Reporters asked how close PA is to going statewide with Stay at Home orders.  Wolf said, “We’ve tried to take a measured and balanced approach, rolling it out where county leadership asked for it and where there is real need.  We feel that the way PA has done it is the appropriate way, and now that it’s reared its ugly head in the majority of counties, we have that option.”

Wolf was asked about patients being separated from family, and some people being put on ventilators even when against POLST or their Living Wills.  Wolf said that theoretically could happen, but health care is working tirelessly with family and patients. 

Because we’re up against a clock, how much time do you believe we have? Wolf said there are many  models, so that depends on assumptions we make, and decisions Pennsylvanians make in their day to day lives. To the extent we relax or ignore advice, the death rate will be much higher than otherwise.

UC and Business
L&I Secretary Jerry Oleksiak says since March 15, 834,684 new unemployment claims have been filed in PA…In response to one State Senator who asked that the Governor rescind his close business orders, Wolf said, “we’re buying time.  The death rate in Italy is over 10%, and we don’t want that here. We need a hard stop, mitigation is required, in order to not get to that point here.”  He said, “Until now, I’ve been saying ‘another two weeks,’ Now I’m going to leave the date indefinite.”

The Governor was asked about inconsistency in waivers for businesses where some get them and others don’t.  He said “human beings are making these decisions – when we uncover them, sometimes its perceived, not real.  We’re doing what we can to be sure the waivers are handed out in consistent fashion.  At what point would you consider fines for ignoring closure orders?  “So far, we’re just giving warnings.  No one’s pushed back yet,” he said.
 
CMS Waivers Announced
CMS had recently approved hundreds of waiver requests from healthcare providers, state governments, and state hospital associations and on Monday announced blanket waivers so that other states and providers begin using the flexibilities immediately.  The ACP had lobbied CMS strongly for these waivers in recent weeks.

Other temporary CMS waivers and rule changes dramatically lessen administrative burdens, knowing that front line providers will be operating with high volumes and under extraordinary system stresses.

CMS’s temporary actions announced today empower local hospitals and healthcare systems to:

  • Increase Hospital Capacity – CMS Hospitals Without Walls
  • Rapidly Expand the Healthcare Workforce
  • Put Patients over Paperwork
  • Further Promote Telehealth in Medicare

For additional background information on the waivers and rule changes, go to: https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient

For more information on the COVID-19 waivers and guidance, and the Interim Final Rule, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers

For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website
 
L&I PROVIDES UPDATE ON COVID-19 RELATED UNEMPLOYMENT COMPENSATION
Jerry Oleksiak, Secretary of the Pennsylvania Department of Labor and Industry (L&I), provided an on workers’ compensation and unemployment compensation (UC) related to COVID-19, noting that the number of unemployment claims hit “historic highs.”  Since March 15, 2020, 834,684 new UC claims were filed, “eclipsing anything we experienced for a weekly total and maybe even a yearly total.”

L&I has waived some work requirements and signing requirements, and has done away with the wait week at the state level. He encouraged applicants for UC to use the website as much as possible and noted the wait times for phone calls. Sec. Oleksiak indicated that L&I is also processing approximately 138 workers’ compensation claims, 81 of which are for first responders or health care staff.  L&I is waiting for federal guidance on how to administer those programs, which include pandemic unemployment assistance to help self-employed people.