May 13 COVID-19 Update – Pennsylvania American College of Physicians

• Administration reverses course on nursing home testing
• Daily COVID-19 data update
• DoH distributes first shipments of remdesivir to 51 hospitals in PA
• Shapiro announces criminal investigations of nursing homes
• Senate actin re COVID-19
• House to move Turzai’s PPP legislation for senior congregate living centers
• Wolf faces federal lawsuit over emergency orders, business classifications

 
In major reversal, Wolf administration says Pa. will begin weekly testing of nursing home residents, employees
The Wolf administration on Tuesday reversed a policy in place for months, and unveiled a plan to begin universal testing of staff and residents in the state’s hundreds of long-term care facilities.
 
Since March, the Administration had argued that it was doing everything possible to protect nursing homes and maintained that only people with symptoms should be tested.
 
According to guidance released by the state Tuesday, the Department of Health is now calling for widespread testing at any facilities with confirmed or suspected cases of COVID-19 to detect potential carriers among residents or staff that could spark an outbreak. At facilities with no confirmed cases, they recommend testing 20% of staff and residents weekly.
 
The guidance also suggests facilities retest residents who initially test negative and also urges them not to delay testing residents who are exhibiting symptoms. Guidance also covers efforts to separate exposed and potentially exposed residents.
 
Health Secretary Rachel Levine said the testing would be conducted by the state lab in Exton in partnership with private labs and mobile testing facilities provided by the National Guard.
 
As recently as last week, Levine had said this type of widespread testing was unrealistic, both because of a lack of supplies and the inaccuracy of tests. “It is not clear universal testing is the answer,” Levine told the Senate last Thursday.  She had previously told the Senate that universal testing was at least six months away.  Also last week, state health officials put out information for families with members in nursing homes saying residents should only be tested after two symptoms of the virus had been identified, and after a test for the flu had come back negative.
 
But on Tuesday morning, Gov. Wolf told reporters the state would implement a “fairly radical” plan to conduct surveillance testing “once a week for everybody — employees and patients and clients.” Levine later told the news media that the state was doing this testing last week, while noting that the testing circumstances would be facility based, and not a universal mandate for all.
 
As of Tuesday, Pennsylvania reported 12,130 cases of COVID-19 inside 540 long-term care facilities. More than 2,600 residents have died, almost 70% of the state total.
 
News this weekend revealed that the state had a plan to protect nursing homes in March, but never fully implemented the plan.  Other states committed to widespread testing at nursing home facilities weeks ago.
 
After last week’s hearings and even Monday afternoon, Senators of both parties continued to express their frustration and anger with the state’s response to outbreaks in personal care and nursing homes, and long term care facilities. 
 
PA COVID-19 DATA UPDATE
On Tuesday, the Department of Health reported that Pennsylvania had found 837 new confirmed positive cases in the previous 24 hours, for a total of 57,991 confirmed cases.   
 
The death total rose to 3,806 confirmed COVID-19 deaths, an increase of 75 from Monday’s report, all in adult patients.  2,611 of the state’s deaths, more than 68 percent, were nursing home residents.  There were 237,989 negative tests in PA as of midnight Monday night.
 
At least 3,923  health care workers – accounting for about four percent of all positive cases.  The total figure includes 1,724 workers in nursing homes.  12,130 – accounting for 20 percent of all cases- are in 540 of the state’s long-term care living facilities in 44 counties. 
 
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 Monday, 31,733 positive cases (55%) were female and 25,616 (44%) were male. One percent (642)  were unreported or neither.  Among the deaths, 1,899 (50%) were males 1,891 (50%) were female with 16 unreported by sex.
 
By race, 14,039 positives were Caucasian (24%), 6,614were African-American (11%) and 707 (1%) were Asian, with 296  listed as “Other.”  The vast majority, 36,335 (62% of all cases) remained unreported on the race of the patient.  A total of 1,402 deaths were among Caucasian victims, 398 were African American/Black, 41 were Asian and 12 were listed as other.  1,953 deaths (53%) weren’t reported by race.
 
On Tuesday, 2,187 positive patients were hospitalized.  At that time, 477 were using ventilators and 20 were on ECMO machines.  About 1,411 (38%) of the 5,199  intensive care unit (ICU) beds were available, 6,720 general medical beds (45%) were available and 1,602 (53%) of the airborne isolation rooms are still available statewide.  And 1,391 of the state’s 5,353 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. 
 
Levine broke from her recitation of data to talk about issues at long term care facilities.  She said, “Our common enemy is the coronavirus. We have focused our efforts to protect our citizens living in these nursing and personal care homes.  The Wolf Administration has worked across state agencies; the Departments of Health Human Services, Insurance, Aging, PEMA and the National Guard have all been engaged on assisting and providing help to our seniors in these facilities.
 
She said, “Using the best clinical information from the CDC, we have leveraged our existing expertise to help them control existing outbreaks.”
 
She outlined a series of actions that were to demonstrate all the state has done for the long term care facilities, including delivery of 1,700 shipments of PPE directly to nursing and personal care homes, training, education, advice, consultation and expanded testing.
 
Testing is another essential  Robust universal testing strategy for all staff and residents in these facilities.  If a patient is hospitalized and has to return, before they can, they must be tested for COVID 19 so that the facility can take special precautions and that they have all the care they need.  Sent an alert today about testing, cohorting, etc.  We will provide testing supplies, swabs and laboratory resources.  NG will provide a mobile testing option.  To ensure PA is in line with federal guidance, I am also ordering nursing homes to report deaths, cases and tests performed using the same system hospitals are using beginning May 17 and this info will be reported publicly. This will give us a clearer picture of outbreaks in nursing homes and give us a head start at stopping them.  We can all help by social distancing.  COVID didn’t suddenly appear in a nursing home.  It had to be brought in by someone.  Sometimes it’s hard to do the right thing, and sometimes, the sacrifice seems greater than the reward, but we are committed to doing everything we can so that Pennsylvanians remain safe.  I’m proud of gov wolf and his leadership.
 
Questions for Secretary Levine
We’re hearing you moved your mother from a nursing home to a hotel.  What kind of message does that send to the thousands of Pennsylvanians whose parents are in nursing homes and can’t afford to move them out, and the person who’s in charge of nursing homes and the state response from coronavirus moves her own parent out? LEVINE:  My mother is a resident of a personal care home, not a nursing home, and that is regulated by the Department of Human Serv
ices, not the Department of Health.  My mother requested and my sister and I complied with moving her to another location during the COVID-19 outbreak.  My mother is 95 years old and very intelligent, and more than competent to make her own decisions.  I remain committed to protecting patients in Pennsylvania no matter where they live and wherever they go, whether in a facility I regulate, whether it is in their homes and communities, and whether or not they agree with our strategy.
 
With 70% of the state’s COVID-19 deaths coming from nursing homes and long term care facilities where is our greatest area of need for improvement in these facilities? Do we need better and more testing? How long will it take to get to where we need to be?  LEVINE: We are looking at continuing much or all of the outreach we have made with those facilities, and we now have the capability of doing the mass testing in these facilities that we had hoped to do.  We started that last week and are continuing to roll that out this week.  Many of those tests can be done in our state laboratory, and commercial labs.  We want to test all of the staff and residents, and then congregate them and take care of them the way they need to be taken care of.
 
How many tests a day or a week do you expect this will take, how much will it cost and who will pay for it? LEVINE: We have released an advisory that was released to nursing homes today that will advise them to develop a testing schedule based on their current situation.  For example, if a facility has no cases, its strategy will be to catch cases early.  If there is an ongoing outbreak, there will be initial testing and more regular testing may be warranted.  It will be individualized to each facility.
 
Under the Long Term Care testing plan, what is considered a long term care facility?  LEVINE: We’re talking about congregate facilities such as personal care homes, nursing homes and assisted living facilities.
 
How long will this weekly testing go on for and how much is budgeted for this? LEVINE: We’ll be doing this as long as it’s necessary.  The funding, if we do the testing at our laboratory, especially will come from our resources, and there are other resources from federal sources like the CDC and funds designated by Congress to fund the states, as well as FEMA because of the disaster declaration.
 
Why did the state wait until now to implement such a testing plan?  Before last week (and last week we began the testing) we have not had the testing capabilities to perform this.  It’s been extremely challenging to get the supplies and the swabs needed to perform this significant amount of testing.  But we are better resourced through the federal government, as well as through the testing companies so we have more resources and testing capability to perform that testing.
 
Would it be more effective to focus on protecting our nursing homes instead of continuing a broad based shut down of our economy? And, have the state’s efforts to protect our nursing homes failed?   LEVINE: Well, one of the things we’ve been emphasizing all along and the Governor emphasized, is that we’re all interconnected, with the scope of this global pandemic.  And in communities, nursing homes reside in communities, staff that are taking care of patients in nursing homes reside in the communities. They take care of those patients, they go home to their families, they go to the grocery store, they go to the supermarket, they go to the pharmacy to pick up medications, so we’re all interconnected.  WE are working, we have been working, and we will continue to work to protect the vulnerable residents and patients in these facilities.  But they are part of a community and that’s why they are included as part of a county’s numbers, and this has to be an integrated strategy.
 
Will state inspections take infection violations more seriously now going forward? Right now, the majority of these violations are categorized as “minimal harm” or “no harm”  LEVINE: We have been taking it seriously, and even more important than how its categorized in the report is what we are doing about it.  Inspectors n our Department have reached out to every facility that has had cases, and then we have further consultations, we have ECRI, and as I pointed out earlier and Director Padfield pointed out, we have the National Guard engaged in ten of these facilities. We will do whatever we can to protect the residents and staff of these facilities.
 
The nursing home industry says it was left behind in the early days of COVID-19 with the focus being on hospitals. Was it?  And can you provide details on what supplies went to each health care facility in the state?  LEVINE: We have had more than 1,700 pushouts of equipment to these congregate facilities, and I would respectfully disagree with the organizations saying they were eft behind. They were not. We were focused on these facilities from the beginning as well as focusing on hospitals to make sure they were not overwhelmed by patients with COVID-19.  So we have been working to balance that in all of our work and we have done so.
 
Can you clarify the benefits of population based testing in facilities such as nursing homes, prisons and jails, and what purpose does that serve, considering the lag between testing and having results could be more infections than originally tested?  LEVINE: So what we’re trying to do is find people who are asymptomatic.  We have been testing symptomatic patients in these facilities all along. But as we’re learning as we go along, many patients have no symptoms and so they might be transferring the virus before symptoms develop.  And so we’re missing people.  So now we have the testing capabilities to do this surveillance testing within the facilities and that’s why we’re implementing it.
 
Can you tell us what data points will be made public about long term care facilities, and if the Department will include assisted living and personal care homes?  LEVINE: We are working to provide all of the data that is in CMS’ guidelines, so whatever is in their guidelines we’ll be providing on our website, to be consistent with their guidelines and reporting as well.  We are working with DHS because they regulate the personal care homes and assisted living facilities, to provide the same type of data.
 
It seems the Department is on the verge of releasing specific data on COVID-19 cases and deaths.  Why did we wait two months into the pandemic to release this information when many other states have been doing it From here on out, will disclosure be the standard you use?  LEVINE: We were waiting and all along wanted to be very transparent.  We were waiting for the federal government’s guidance about what they were recommendations were in terms of data to release, and now we are going to implement that release.
 
A lot of backlash from Brighton rehab, some calling for federal investigation.  Your reaction? And what was the delay in getting extra help – the temporary manager and the National Guard – into the facility?  LEVINE:  We have been working with the Brighton facility since their first case, to provide guidance.  A consultant was placed weeks ago, and we installed a temporary manager and there became a point where the National Guard came in and so they did.
 
Montgomery County says there was some confusion over which agency was to help long term care facilities in the early days of COVID-19.  Whose job was it to make sure nursing homes were prepared for COVID-19?   LEVINE:  Well, it’s all of our collective responsibility. It’s a collaborative effort against this dangerous virus. It’s the state’s responsibility so the Department of Health but also working with DHS for the facilities they license and regulate, Aging, PEMA and of course the National Guard, in addition in counties where they h
ave a County Municipal Health Department, they have a responsibility so with this collaboration, I am confident that we will be successful against this virus.
 
DoH distributes first shipments of remdesivir to 51 hospitals in PA
The Health Department announced on Tuesday that the state received its first shipment of the antiviral medication remdesivir from the federal government and had distributed 1,200 doses in a first shipment, to 51 hospitals across Pennsylvania.
 
Remdesivir is the first drug that appears to help some COVID-19 patients recover faster, and is typically administered through an IV once-per-day up to 10 days, depending on how sick the patient is.
 
The FDA states that remdesivir may help decrease the amount of coronavirus in the body, which could lead to faster recovery time.
 
The Pennsylvania Health Department says the first hospitals chosen to receive the shipments were determined based on the volume of Covid-19 patients over a recent seven-day period. Illness severity and ventilator necessity were also taken into account.  The department says it looks to continue working with federal officials to acquire additional doses for patients across the state.
 
“The department is working to give our hospitals every opportunity to treat patients with Covid-19,” Health Secretary Dr. Rachel Levine said in a release. “It is important to note that there is limited information on the safety and effectiveness of using remdesivir to treat people in the hospital with Covid-19. However, it was shown in a clinical trial to shorten the recovery time in some people, which is why the Food and Drug Administration has authorized the emergency use of the medication for treatment.”
 
Attorney General Shapiro announces criminal investigations of nursing homes
Also Tuesday, Pennsylvania Attorney General Josh Shapiro announced that over the past several weeks his office opened criminal investigations into several Pennsylvania nursing homes and reaffirmed that the Office of Attorney General will investigate any nursing home engaging in criminal neglect of patients and residents.  He urged those with concerns about criminal conduct to contact his office.
 
“Active criminal investigations are already underway, and we encourage people to share relevant complaints with us on our special tip line so we can best protect people in nursing homes,” Shapiro said in a statement.
 
The Attorney General’s office is launching a public email for criminal complaints and reports of neglect in nursing home communities at neglect-COVID@attorneygeneral.gov. For concerns relating to wellness checks, adequate PPE, or COVID-19 testing within a facility, please contact Department of Health at 1-800-254-5164.  For emergencies involving immediate danger to the person, people should contact 911 or 1-877-PA-HEALTH.
 
General Assembly Actions
 
Senate passes bill directing $507 million for long term living programs
The State Senate passed legislation today directing $507 million for long-term living programs. Nursing homes and long-term care facilities are ground zero for the coronavirus and it is in those settings and among PA’s senior citizen population that it has its most devastating impact.
 
Senate Majority Leader Jake Corman said, “This outbreak has been called a war, and for good reason. If this is a war, then undoubtedly PA’s nursing homes, long-term care facilities and senior citizens’ services are the frontlines. This money will provide those on the frontlines with the resources needed to meet  this challenge.”
 
The bill would distribute $245 million to skilled nursing facilities, $140 million to personal assistant services, $50 million to assisted living centers and personal care homes, $13 million to adult day services, $8 million to LIFE providers and $1 million for residential habilitation.
 
Senate Hearing set to consider safety of vulnerable populations and counties ability to open safely
The Senate Aging and Youth and Local Government Committees will hold a joint public hearing Wednesday morning to take testimony and ask questions of individuals on the subjects of safety in the state’s vulnerable populations and counties ability to open in the yellow phase safely.
House moving Turzai’s bill to finance
 
The House Appropriations Committee will hold a meeting Wednesday to move out HB 2510, sponsored by Speaker Mike Turzai, that would  appropriate $500 million of Pennsylvania’s remaining $3.9 billion from the CARES Act to establish a coordinated public-private partnership using regional academic health systems as collaboratives to administer and manage personnel, protocols, testing and expenditures to nursing homes, personal care homes and long term care facilities.
 
Wolf faces a federal lawsuit over emergency orders, closures
A state House candidate from Perry County and an alliance of business owners have filed a federal lawsuit, claiming Gov. Tom Wolf’s stay-a-home and business closure orders
are not only unconstitutional but ineffective as well.
 
Candidate William Benner and his four allies who are from Perry, Delaware, Chester and Montgomery Counties, are urging U.S. Middle District Judge John E. Jones III to void Wolf’s edicts as illegal. Wolf is insisting the restrictions must remain in place until they are gradually phased out to prevent the spread of COVID-19. He has promised to punish to punish any counties and businesses that open ahead of his schedule.
 
The governor has won the other court fights waged against his directives. The State Supreme Court backed his use of executive power to battle the virus. And last week, the US Supreme Court rejected a petition to stay his directives.
 
The plaintiffs cite growing criticism of Wolf’s restrictions by county officials, including those in Dauphin, Lebanon and Cumberland counties, and statements by county law enforcement officials that they won’t pursue violators.  They also cite statistics. Nearly 1.7 million Pennsylvanians who are out of work due to the lockdown have filed for unemployment compensation, they note, and the state is projecting a budget shortfall of up to $3.7 billion.
 
“The business closure order has not prevented or suppressed COVID-19, nor has it slowed the spread; COVID- 19 has spread exponentially during the period of time the business closure order has been in effect,” the suit states.
 
“Instead, the business closure order has forced the closure of plaintiffs and tens of thousands of businesses, deprived those business owners of their constitutional rights, caused over one million Pennsylvanians to lose their jobs, and has caused severe economic hardship and devastation to plaintiffs and all businesses and entities closed by the business closure order and to the entire Pennsylvania economy,” the opponents contend.
 
The imposition of the lockdown violated th
eir constitutional rights to due process of law and equal protection of law and amounts to the “unjust taking” of their businesses without compensation, they claim. They have asked Judge to rule Wolf’s business closure, stay-at-home orders and also his school closure order are unconstitutional. They seek unspecified financial damages as well.