May 11 COVID-19 Update – Pennsylvania American College of Physicians

• DoH updates guidance on non-urgent, elective care
• Counties running the light on phasing
• Daily COVID-19 data update
• Nursing home crisis
• Government standoff – a constitutional battle?

 
Dept. of Health updates guidance on COVID-19 for health care providers
Late Friday, the Department of Health revised guidance for health care providers as a component of Governor Wolf’s phased reopening plan, particularly related to performing nonurgent procedures.
 
As Pennsylvania slowly reopens, the following guidance should be followed by all health care providers, as defined by the Governor’s Order issued on March 19, 2020, and subsequently amended, except hospitals, ambulatory surgical facilities, dental practices, and any others operating under separate Department guidance. All such health care providers should consider the operating protocols throughout the COVID-19 pandemic state-wide regardless of region or county reopening color designation.
 
Providers may resume non-urgent and elective care in addition to providing urgent and emergency care, only when appropriate personal protective equipment (PPE) is available and telemedicine is not clinically sufficient.
 
The Department said that each health care provider will need to apply their clinical judgment along with their knowledge of the incidences of COVID-19 cases in their area, the needs of their patients and staff, and the availability of any necessary supplies to assess whether to re-engage in the provision of non-urgent or elective care.
 
Several PA Counties may declare themselves in “yellow phase”
By Saturday at least eleven Pennsylvania Counties have declared that they intend to begin reopening despite still being considered in the red phase by Governor Wolf. 
 
Adams, Beaver, Berks, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Schuylkill and York Counties have all either said they will reopen or taken steps toward reopening whether or not the Governor proceeds with plans to transition to the yellow phase in those counties.  Juniata, Mifflin and Perry Counties have written the Governor demanding they be allowed to move to yellow next Friday.
 
The governor’s office urged caution on restless county leaders in a statement issued  Saturday night.
 
“The governor believes it is important to save as many lives as possible during this once in a generation pandemic. He also understands that this world-wide crisis has placed pressure on individuals, businesses, and the economy. Because we have banded together, Pennsylvania continues to weather this storm,” according to Lyndsay Kensinger, Wolf’s Press Secretary.
 
“Prematurely opening up counties, however, will result in deaths, and not just the loss of jobs. The administration is aware of the statements and is hopeful that everyone will act in the best interest of public health. Reopening businesses too early will only extend the length of the economic hardships created by the pandemic.”
 
If a county does jump the state’s timeline, early legal interpretations suggest that individual municipalities would still have the power to abide by the state’s status for their area, regardless of what the county commissioners said.
 
PA COVID-19 DATA UPDATE
 
Sunday May 10 data
On Sunday, the Department of Health reported that Pennsylvania had found 1,295 new confirmed positive cases in the previous 24 hours, for a total of 56,611 confirmed cases.   
 
The death total rose to 3,707 confirmed COVID-19 deaths, an increase of 19 from Friday’s report, all in adult patients.  2,529 of the state’s deaths, more than 68 percent, were nursing home residents.  There were 227,772 negative tests in PA as of midnight Saturday night.
 
At least 3,656  health care workers – accounted for about four percent of all positive cases.  The total figure includes 1,645 workers in nursing homes. And 11,645 cases – accounting for 20 percent of all cases- are in 539 of the state’s long-term care living facilities in 44 counties.  On Friday, 2,122 positive tests were found in workers in the food processing industry in 127 facilities statewide.
 
Two percent of hospitalizations were under 29 years of age, five percent were 30-49, 10% were 50-64, 20% were 65-79 and 19% were 80+.  Forty-four percent were unclassified yet per age.
 
Of the total through Saturday, 30,938 positive cases (55%) were female and 25,042 (44%) were male. One percent (631)  were unreported or neither.  Among the deaths, 1,849 (50%) were males 1,842 (50%) were female with 16 unreported by sex.
 
By race, 13,526 positives were Caucasian (24%), 6,411 were African-American (11%) and 682 (1%) were Asian, with 284  listed as “Other.”  The vast majority, 35,708 (63% of all cases) remained unreported on the race of the patient.  A total of 1,357 deaths were among Caucasian victims, 388 were African American/Black, 40 were Asian and 11 were listed as other.  1,911 deaths (53%) weren’t reported by race.
 
On Sunday, 2,239 positive patients were hospitalized.  At that time, 469 were using ventilators and 20 were on ECMO machines.  About 1,468 (38%) of the 5,199  intensive care unit (ICU) beds were available, 7,198 general medical beds (45%) were available and 1,631 (53%) of the airborne isolation rooms are still available statewide.  And 1,344 of the state’s 5,329 ventilators were in use (nearly 73% of ventilators were still available.) 
 
Of the patients who tested positive to date the age breakdown was: less than 1% are aged 0-4; less than 1% are aged 5-12; 1% are aged 13-18; 6% are aged 19-24; 37% are aged 25-49; 26% are aged 50-64; and 28% are aged 65 or older. 
 
Saturday May 9 Data
On Saturday, the Department of Health reported that Pennsylvania had found 1,078 new confirmed positive cases in the previous 24 hours, for a total of 55,316 confirmed cases.   
 
The death total rose to 3,688 confirmed COVID-19 deaths, an increase of 72 from Friday’s report, all in adult patients.  2,518 of the state’s deaths, more than 68 percent, were nursing home residents.  There were 22,791 negative tests in PA as of midnight Friday night.
 
At least 3,616  health care workers – accounted for about four percent of all positive cases.  The total figure includes 1,605 workers in nursing homes. And 11,239 cases – accounting for 20 percent of all cases- are in 530 of the state’s long-term care living facilities in 44 counties.  On Friday, 2,122 positive cases in workers in the food processing industry in 127 facilities statewide.
 
Two percent of hospitalizations were under 29 years of age, five percent were 30-49, 10% were 50-64, 20% were 65-79 and 19% were 80+.  Forty-four percent were unclassified yet per age.
 
Of the total through Friday, 30,212 positive cases (55%) were female and 24,482 (44%) were male. One percent (622)  were unreported or neither.  Among the deaths, 1,833 (50%) were males 1,839 (50%) were female with 16 unreported by sex.
 
By race, 13,215 positives were Caucasian (24%), 6,262 were African-American (11%) and 671 (1%) were Asian, with 277  listed as “Other.”  The vast majority, 34,891 (63% of all cases) remained unreported on the race of the patient.  A total of 1,348 deaths were among Caucasian victims, 386 were African American/Black, 40 were Asian and 11 were listed as other.  1,903 deaths (53%) weren’t reported by race.
 
On Saturday at noon,  2,306 positive patients were hospitalized, about six percent of those testing positive.  At that time, 482 were using ventilators and 20 were on ECMO machines.  About 1,411 (39%) of the 5,199  intensive care unit (ICU) beds were available, 7,094 general medical beds (45%) were available and 1,592 (53%) of the airborne isolation rooms are still available statewide.  And 1,382 of the state’s 5,339 ventilators were in use (nearly 73% of ventilators were still available.) 
 
Of the patients who tested posi
tive to date the age breakdown was: less than 1% are aged 0-4; less than 1% are aged 5-12; 1% are aged 13-18; 6% are aged 19-24; 37% are aged 25-49; 26% are aged 50-64; and 28% are aged 65 or older. 
 
Nursing home crisis is focus of hearings, questions re state response, legislation
Speaker Mike Turzai said he will introduce legislation to establish a public-private partnership to administer and manage personnel, protocols, testing, and expenditures to protect seniors in these facilities. According to Speaker Turzai, the collaboration would ensure consistency of programs, responses, and studies.
 
At the Speaker’s request, UPMC experts prepared a prototype plan for Southwest Pennsylvania and a construct for the entire state.
 
The legislation will provide $500 million from Pennsylvania’s allotment of $3.9 billion in COVID-19 funding from the federal government. The Speaker plans to use the Commonwealth Financing Authority (CFA) to distribute funds to private sector entities (required to be academic health systems) that can provide oversight and take charge of implementation. The state would be divided into regions delineating all facilities within their parameters – 697 nursing homes statewide, 1,143 personal care homes, and 58 assisted living facilities.
 
Senate considers next steps -Governor refuses to comply with subpoena re business closure decisions.
The Senate is weighing next steps as Gov. Tom Wolf claimed executive privilege in not complying with a subpoena and releasing documents about waivers granted in the state’s appeals process of determining “life sustaining” businesses. More than 43,000 businesses had requested waivers, and more than 6,100 were approved by DCED. 
 
The Wolf administration has put off requests from news organizations for information related to the business waiver process, which has been cloaked in secrecy. The state has declined to say what criteria they used to make determinations. And many businesses complained bitterly that there seemed to be no rhyme or reason to why some companies had received them, while others in the same industry were rejected.
 
Senate Republicans have repeatedly sought access to the records in order to examine if legislative action would be necessary to correct inequities, both as part of the ongoing pandemic, as well as future emergencies, according to Senate President Pro Tempore Joe Scarnati (R, Jefferson),  Majority Leader Jake Corman (R, Centre) and Senator Mike Regan (R, Cumberland and York), whose Veterans Affairs and Emergency Preparedness Committee voted to subpoena the records.
 
Friday evening, in a letter responding to the subpoena, the Governor said he cannot release the information to the Senate due to executive privilege; he also suggested and an audit being conducted by the state’s Auditor General at the request of the Senate would provide answers.  A list of the names of companies which received exemptions from the appeals process was published Friday night on the DCED website.  However, a number of businesses have reported that their waivers had been approved, but then suddenly revoked before the Department published the list.
 
The list on the DCED Web site covers only one of 14 areas of information requested by the Senate Committee.  The Republican leaders are reviewing their next steps, which could include asking the Commonwealth Court to intervene and force the administration to comply with the subpoena.