May 14 Pennsylvania COVID-19 Update

Below:

  • Contact Tracing information
  • Daily COVID-19 data update
  • UPMC suggests strategy changes
  • DoS temporarily suspends emergency oral prescription time regulations
  • Other states’ actions

 
Contact tracing facts and needs
One week after Gov. Tom Wolf said his administration was struggling to come up with a plan to increase its contact tracing capabilities to help prevent another coronavirus outbreak, officials with the Department of Health unveiled new steps they say will allow the state to safely reopen.
 
State health officials said the plan will rely on a combination of partnerships with local hospital systems, voluntary tracking technology, and federal funding to hire additional staff.  They did not outline the plans as far as how many people would be hired or a timeline, or how they planned to handle this in populous areas like the southeastern part of the state and Philadelphia.
 
As of last week, the state Department of Health employed 131 public health nurses, down from 177 nurses in 2012, which is as far back as the state’s online payroll data shows.  Officials said an additional 16 employees from the department’s epidemiology and hospital-acquired infection teams are assisting with tracing. There were 31 public health nurse vacancies.
 
These nurses are responsible for overseeing 60% of the state’s population — or about one nurse for every 56,000 people –  including rural areas and some populous suburbs like Delaware County.  Only six counties and four cities have their own health departments and contact tracers.
 
The state’s contact tracing system was vastly overwhelmed when COVID-19 was first found in Pennsylvania. Public Health Nurses reported making hundreds of calls to infected individuals each day, without ever being able to catch up with the deluge of new cases.
 
A Harvard University study suggested Pennsylvania would need more than 3,600 contact tracers to meet CDC recommended guidelines, and public health experts say about 2,000 contact tracers are needed in Pennsylvania.
 
The health department has received a $18.7 million grant from the Centers for Disease Control and Prevention for COVID-19 response, “a portion” of which it said has been earmarked for contact tracing.
 
In the first counties to reopen, those in northwest and north-central Pennsylvania, the department said the existing public health nurses, along with the Erie County Health Department, will be able to handle contact tracing. No additional staff will be hired.
 
In the northeast, the state plans to partner with the Lehigh Valley Health Network and has also applied for a grant to hire 110 more tracers. In south-central Pennsylvania, 40 volunteers from the Penn State College of Medicine will assist.
 
In the populous southeast region, the department said it will recruit volunteers through PennServ/AmericCorps and ServPA, and will seek to work with local health leaders and universities. Similarly, it is seeking partnerships in the southwest.
 
For places prone to larger outbreaks — such as nursing homes, prisons, and food packing plants — the department said it has a special team of epidemiologists, masters and doctoral students of public health, and an advisor from the CDC.
 
Across the state, contact tracing efforts will be supplemented with technology, the department said.
 
Nurses will use a web-based tool to send out daily emails, texts, and phone calls to people who test positive for COVID-19 and those who are identified as their close contacts. This will allow the nurses to monitor both groups for symptoms and collect more detailed demographic data, as well as the number of asymptomatic and symptomatic cases per region.
 
The state is also looking into a voluntary, opt-in app that asks people to self-identify if they’ve tested positive, and then uses Bluetooth technology to alert those who have been in close contact with them. The technology maintains the anonymity of all users, the state said. When fully developed, it will have the capability to alert exposed individuals with instructions such as self-quarantining, testing, and other next steps.
 
Dr. Levine emphasized that the contact tracing plan may change as Pennsylvania’s reopening process continues.  “When we need to hire more people, we will hire them to make sure the case investigations and contact tracing moves forward,” she said. But “we’re going to be taking this in a very measured approach.”
 
PA COVID-19 DATA UPDATE
On Tuesday, the Department of Health reported that Pennsylvania had found 707 new confirmed positive cases in the previous 24 hours, for a total of 58,698 confirmed cases.   
 
The death total rose to 3,943 confirmed COVID-19 deaths, an increase of 137 from Monday’s report, all in adult patients.  2,705 of the state’s deaths, more than 68 percent, were nursing home residents. There were 244,171 negative tests in PA as of midnight Monday night.
 
At least 4,066 cases in health care workers – accounting for about four percent of all positive cases.  The total figure includes 1,806 workers in nursing homes.  12,408 – accounting for 20 percent of all cases- are in 543 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, 32,118 positive cases (55%) were female and 25,926 (44%) were male. One percent (654)  were unreported or neither.  Among the deaths, 1,954 (50%) were males 1,972 (50%) were female with 17 unreported by sex.
 
By race, 14,386 positives were Caucasian (24%), 6,721 were African-American (11%) and 715 (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 1,469 deaths were among Caucasian victims, 416 were African American/Black, 43 were Asian and 12 were listed as other.  2,003 deaths (53%) weren’t reported by race.
 
On Tuesday, 2,012 positive patients were hospitalized.  At that time, 453 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 1,324 of the state’s 5,344 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. 
 
Questions for Secretary Levine
What is the latest in Pennsylvania on the inflammatory syndrome children from COVID-19?  LEVINE: There is a recently described syndrome in children who have been infected with COVID it resembles Toxic Shock Syndrome or an atypical Kawasaki disease.  And these children are very ill, often requiring intensive care, often requiring a breathing machine.  We have asked officials to report any cases of this to us. But we have not to date had any cases reported.
 
Luzerne and Carbon Counties are reaching out to the Governor to see if they can transition into the yellow phase.  Is there a possibility these two counties could do that before June 4? LEVINE: We are looking at all of our data over the next two days.  So we’re going to looking at all of our metrics, all of our other types of data and reports we have, as well as the modeling, specifically from CMU, U of Pgh School of Public Health, the CHOP Philadelphia data lab, a new model from Wharton, and of course the model from the University of Washington.  We will make our recommendations to the Governor on what counties might go from red to yellow, and then the Governor will make his decision.
 
How will collecting information on gender identity and sexual orientation help the b
attle against COVID-19?
LEVINE:  We want to collect as much demographic information as possible. We are looking for data on race and ethnicity, we are doing as much as possible, and we are adding that to the NEDDS system to get as much demographic information as possible on the disease.
 
Is there any possibility this information could be compromised, putting Pennsylvanians at risk of persecution?  LEVINE:  No. Our NEDDS system data is completely confidential within the Department of Health and the other agencies we work with.
 
What are the dangers of PPE litter?  How important is it for people to properly dispose of PPE, especially as we move to the yellow phase and see more people out and about?  LEVINE: We have to describe what we mean as PPE.  We mean the equipment we send to doctors, hospitals, EMTs etc. That would be the N95 masks, surgical gowns and gloves. Those materials need to be disposed of in the red biological waste bags, because there might be active virus on those materials. Now the public, we’re talking about masks like you wear in public.  For cloth masks, we really recommend that you wash them every day.  If you’re out and about, wash your hands and wash those masks.  If wearing disposable masks, please put them in the garbage and then please wash your hands.
 
What are your thoughts on Schuylkill County backing off on its proposal to go to yellow status? What communications happened with the county and what will happen now? LEVINE: I would leave those discussions to the Governor and the Governor’s office.
 
Do you think the Governor went too far when he called counties cowardly in his statement? LEVINE: No I support the Governor and the Governor’s statements.
 
Please explain the use of plasma in the treatment of COVID-19?  LEVINE: There are studies that show that plasma, which is part of the blood that contains white blood cells, and other immune factors, from patients who have recovered from COVID-19 after being treated by Blood Banks, can be used to treat patients with really severe cases of COVID-19. So those types of plasma transfusions are part of our arsenal, one of our toolboxes in order to treat severely infected hospitalized patients.
 
This week you called for testing in all PA nursing homes. Can you give us more specific targets for who gets tested, how often and when we will have the testing capacity to accomplish this?  LEVINE: We have called for testing of all the staff and all the patients in our LTC living facilities.  Of course if you test once, that’s not going to be conclusive, so it will have to be individualized to the number of cases in the facility. If no tests, or a few cases vs. many, many cases, it will be different. We’ll be doing a webinar to explain that to the facilities.  We do have the capacity to roll that out.  We’re working with the 693 nursing homes, 1200 or more personal care homes and many more congregate facilities, so it will take some time to roll that out.
 
Today was the deadline Bucks County giving the state to let them know when they might move to yellow.  Did you send them a date,  if so, what was the date, and if not, when will you?  LEVINE: As I mentioned before, we are looking at all of our data and metrics,  we’ll be pleased to work with the Counties and the Governors office will work with the counties when we have more information this week.
 
The state’s plan for reopening says for a region to reopen there must be enough testing for individuals with symptoms, and target populations such as those at high risk, health care personnel and first responders.  How are you defining a high risk in this context?  LEVINE:  High risk vulnerable populations would include those in LTC living facilities, other seniors, particularly those with comorbid conditions, such as chronic heart failure, COPD, and uncontrolled high blood pressure.
 
The White House’s plan for reopening says state should set up sentinel surveillance sites, to test for COVID-19.  So where in Pennsylvania are these sentinel sites?  LEVINE: A sentinel site would be something like our mass testing sites that we have available. They would be screening asymptomatic people.  There’s a lot of ways to do that, and we are working on that.  We actually do not have the lab capacity to do that now.  We do have the capacity to do the testing I was talking out before like in LTC nursing homes. In terms of that population based surveillance testing, we will need to continue to increase our lab capacity to do that. The best way to do that would be to have a rapid simple point of care test that perhaps health care providers could do in 15-20 minutes, perhaps a home test.  That’s not available yet. That would aid that type of population based screening greatly.
 
Columbia County Commissioners declared that they would move their county to yellow on May 15 if the Governor hasn’t declared by then that the county would move to yellow by May 22. Do the county’s numbers support that move?  Are there specific concerns you have about Columbia County? LEVINE: We are looking at all that data now, and we will be making our determinations and recommendations to the Governor presently.
 
A lot of people are uncomfortable with Allegheny County moving to the yellow phase and asking for specific justification for why it is time.  What information can you provide to make people’s concerns evaporate?  LEVINE: We feel very comfortable with Allegheny County moving from the red to the yellow phase in terms of the number of cases they have had, the ratio of cases, the metrics, and the modeling I’ve discussed before. We also had discussed all of this with the Health Commissioner of Allegheny County, we speak with her regularly and she’s doing an excellent job, and we all feel very comfortable with this.  But we all need to vigilant, as any county goes from red to yellow to watch to make sure there is testing, enough contact tracing, and to watch for any clusters or outbreaks in those counties.
 
Is broad surveillance testing a goal in Pennsylvania.  If so, what will it take to get there and when might it be available?  LEVINE: It is an aspirational goal to do that.  We will need more testing capacity and what will be most effective would be if we a rapid point of care test that was very accurate and was very sensitive and specific, that could be done very easily by either a health care provider, or perhaps a mass testing site, or in the home and we could have the results within 20-30 minutes.
 
Would high school sports be able to hold practices and games once their counties reach the green phase? LEVINE: The goal is that within the green phase that would be possible.  Now we have not set the criteria for what it would take for counties to go from yellow to green, but it’s only been five days since any counties have gone from red to yellow.  We will be setting those, and it will be a goal.  Still, we need to be vigilant and be careful.  We still need to make sure that we are washing our hands and protecting ourselves from this dangerous virus.
 
School  districts are already weighing their back to school options.  Does the state anticipate making a blanket decision about whether schools in red or yellow zones will be allowed to open, or does the state anticipate leaving that to the schools, and what criteria might go into decision making on the return to traditional school?  LEVINE:  I  know that the Secretary of Education, Secretary Rivera had a senate hearing about this several days ago, and our goal is that the schools will be able to open in the fall.  We’ll need to be sure, looking at all the metrics and models we use that it’ll be safe, and I’m dure PDE will be having conversations with all the school districts about that reopening.
 
Would you please review what a “probable case” is?  And if an individual is
a probable case, why aren’t they being tested to see whether they have COVID 19?  IF they are tested, does their information shift to the positive or negative categories depending on the test results?
LEVINE:  A probable case is someone who lives in a household where there are confirmed COVID 19 cases, and have symptoms consistent with COVID-19.  Before with limited lab capacity we needed to prioritize the lab capacity, and we were not recommending those patients be tested.  Now we’d be pleased if anyone with symptoms of COVID-19 was tested, I guess if someone isn’t, it would be because with others int eh household sick, it might be difficult to come out to a testing site, a Rite Aid, so it might be hard for that person to come out.  But yes, if they come out and get tested and are positive, it becomes a positive case, and if the test is negative, they become a negative test result in our data.
 
Some High Schools have spoken about having in person graduation ceremonies.  If they employ social distancing guidelines, will they receive any discipline from the state?  LEVINE: We are not recommending any large gatherings in red zones, of course, and even in yellow zones. If you have a large gathering, even if you try to practice social distancing, it is not 100%, and you could potentially transmit this very dangerous virus.  So we would not recommend large gatherings such as a large graduation.
 
In Allegheny County where the population is 1.26 million, 0.12 percent of the population has been sick, and 0.01 percent have died.  Obviously, any death is tragic, but how do you use these figures on how many people are impacted when you consider the pace of reopening. LEVINE:  We are looking at all sorts of data and metrics, we’re looking at the rate of change of that data, we’re looking at all of our models, Looking at all of that, in collaboration with the Allegheny County health department, we feel very comfortable about their moving to yellow on Friday.
 
Can you tell us about the various restrictions that will be put on parks in counties that will move into the yellow phase?  LEVINE: That type of guidance is available on the website of the Department of Conservation and Natural Resources, Our staff have worked with Sec. Dunn and her staff, in terms of social distancing guidelines within our fantastic state parks.
 
It appears there will still be some mitigation efforts in place even when areas move into the green phase.  Can you tell us what communities can expect in the green phase, and what would happen at that point? LEVINE: We haven’t specifically gone over the criteria yet for moving into the green phase.  There is some general guidance available on the website about life in the green zone, versus in the yellow zone or, of course, the red zone. We’ll still need to be vigilant in terms of handwashing, I still think it might be useful to wear masks, when in public, especially if you’re in a setting with lots of other people. We are going to have to be vigilant because this virus will not be gone, even when we go into the green zones, and we want to be careful that it doesn’t have a resurgence.
 
Yesterday you called the new nursing home plan a universal testing strategy, but the advisories  only say  these facilities should only consider testing within the limitations of testing supplies.  Can you explain the discrepancy, and can you say with certainty that there are enough testing supplies to test every PA nursing home resident or staffer?  LEVINE:  We feel comfortable that there’s enough resources to do that. Of course, looking forward, you can’t just test once.  You have to test on a certain schedule. It’s possible in the future that there might be further limitations on supplies that we get from the federal government or from the companies that make it . It’s hard to predict the future so that’s why that type of statement was added.
 
With the total number of COVID-19 cases at 56, 968 since the virus began, is there a way to identify the number that have recovered from the disease from the number who are now actively infected, since the virus has an infectious period of about two weeks?  LEVINE:  We’ve been asked that question a lot.  It is impossible for us to contact all those patients to find out when and if they recovered. But there are some statistical and epidemiological technologies to do that. So we are reaching out to other states to see how they calculated that data, I know that’s important to many and we’re going to try to have answers for that by the end of next week.
 
A state senator said today during a hearing that she heard that no county will go to green while any county is still in red.  Is that true? LEVINE: We have not made that determination at all,” Levine said. “In fact, I was on a call with the Governor and the leadership of the House and the Senate today, and we discussed that very question.  We have not determined the criteria to go from yellow to red.  Remember it was only five days ago that the first counties went from red to yellow.
 
Can you explain why the state established the policy of cohorting at nursing homes? Do you think this contributed to the spread of the disease in nursing homes?  LEVINE: We try to individualize the recommendations to the nursing homes.  How many beds they have, how many positive cases they have, how much staff they have, how many rooms they have, so we have tried to make specific recommendations for a specific nursing home at that location.
 
Why didn’t the National Guard go to Brighton sooner than it did?  Why did they go to eight other nursing homes first? LEVINE: Brighton has been very challenged.  We’ve had other nursing homes that were very challenged.  What the national guard is doing when it comes is supplementing staff, specifically for significant staff shortages. So at the right time, the National Guard came to Brighton, as well as the installation of our temporary manager,
 
Since hospitals have beds available, should nursing home patients who test positive be moved to hospitals so nursing home staff can focus on the rest of their residents?  LEVINE: It really is impossible to cohort convalescing patients who don’t medically need to be in a hospital in a hospital setting so we are not able to do that.
 
If supermarkets and many big box stores are safe for customers, why can’t smaller retail stores open in red counties? Even if they only operated with curbside pickup?  LEVINE: Well, what we tried to do in terms of the businesses is to have essential businesses open. Essential for people to get food. So, groceries are open.  Essential to get medicine so pharmacies are open.  Essential to for home repair, if something breaks, it’s necessary to get supplies to fix that so that’s why those types of stores are open.
 
The data suggest that nearly 70% of deaths are in nursing homes, and an even higher percentage is among the elderly. Some think this data should suggest a shift in strategy to more strongly mitigate long term care facilities, and people with dangerous pre-existing conditions, but ease restrictions on others. In the final analysis shouldn’t students in Elk County now be in school?  LEVINE:  Long term care facilities are a focus and we have a new plan which I  outlined yesterday, but these facilities have always been one of our focuses because of their vulnerable populations.  Of course those facilities live in the community, and the staff go back and forth, in terms of their homes, businesses etc., But as seen last week and again this week and continuing forward, areas that we believe are safe are going from red to yellow and I believe Elk County HAS gone from red to yellow. The Governor did close the schools early because of the significant spread of COVID=19.
 
Why is Pennsylvania the only state that prohibits real estate statewide? Every other state is allowing
realtors to practice following CISA and CDC guidelines?
LEVINE: So after discussion with our Department, and DCED and the Governor’s Office a decision was made that it was the safest thing to do to protect public health was to not have real estate offices be open.
 
Can an employer have an employee have their temperature checked every day before work?  Does the employee have the right to decline? LEVINE: That’s more of a legal issue and I’ll defer that to the Office of General Counsel.
 
If a county has only had one case in the last nine weeks is that good enough to go green? LEVINE: Again, right now we are working on which counties go from red to yellow and we will be starting to focus on which counties right now might be able to go from yellow to green.  Remember the incubation period of this virus is about 5 days, but it could be 14 days so it would be too soon for any county to go to green.  But we’re going to be looking at that, and when that determination has been made by the governor, we’ll announce it.
 
Can you explain whether the Administration has any authority to compel nursing homes to implement
surveillance testing, and does the Department expect the facilities to bear the cost of doing so? LEVINE: We’re going to be working on the costs, and of course we have received funding from the federal government, specifically for testing, so that’s our plan at this time. Do we have the authority to compel them? Of course that’s more of a legal question but we regulate and license nursing homes and DHS licenses personal care homes, so I believe we do, but I don’t think we’re going to have any specific challenges, working with these facilities in terms of rolling out the testing, but we don’t anticipate that.
 
UPMC relates COVID-19 experience, suggests changes in strategy at Senate hearing
Dr. Donald Yealy, chair of emergency medicine at UPMC, and Dr. Steven Shapiro, UPMC’s chief medical and scientific officer, testified Wednesday before the Pennsylvania Senate Aging & Youth and Local Government Committees.  The focus was on safely reopening counties across PA while protecting vulnerable populations.
 
Dr. Yealy testified a lot has been learned since early 2020 about how to care and intervene in treatment. He said that the goal of isolation was to prevent hospitals from becoming overwhelmed and that the curve has been flattened because of Pennsylvanians’ cooperation. He stressed that flattening the curve does not prevent more cases but lessens the number of new infections and deaths over time. He said that although every death is a tragedy, the poor outcomes have been largely concentrated in certain groups, including the elderly and those with underlying conditions.
 
Dr. Yealy continued that at UPMC nearly three-quarters of patient deaths have been among older people and that the median age of death in Pennsylvania is 84. He said that UPMC implemented protection plans in their senior living facilities and plans were adjusted as the system learned more. He acknowledged that there have been no COVID-19 cases in UPMC’s senior care facilities but that other long-term care living facilities have not had the same success. He added that proximity and population density are important risk factors that happen to harm mostly vulnerable populations.
 
He stressed that the elderly have been “ravaged” by symptoms of COVID-19 but that many people may have the virus while showing little to no symptoms. Concluding, he said that the virus is not going away anytime soon but that safety practices and infection control protocols have to be focused on vulnerable populations, including the elderly, sick and poor.
 
Dr. Steven Shapiro, chief medical and scientific officer, UPMC, commented that during the peak of cases in mid-April, UPMC was utilizing about two percent of its beds for COVID-19 patients. He said that as the state begins to reopen, testing has to occur among vulnerable populations. He noted that community infectiousness is low right now, but that Philadelphia has high case rates due to its density and the socioeconomic status of many in the area.
 
He stressed that extensive contact tracing, testing and treatment has to occur in high case rate areas in order to keep rates manageable and give health systems time to prepare for a potential resurgence. Dr. Shapiro asserted that although the virus largely affects those with preexisting conditions and those experiencing other social determinants of health, the focus cannot be on extending social isolation. He continued that those populations are already starting to see adverse mental health consequences from loneliness and that they will only worsen as “economic devastation” continues.
 
He said that protecting vulnerable populations will allow the state to reopen and that even though infections may rise, the measured approach will provide time for more preparation and treatment.
 
Chairman Ward asked what UPMC is doing that others are not to prevent cases in long-term care living facilities. Dr. Yealy responded that UPMC prepared early and provided comprehensive testing and policies that continue to adapt. He added that there needs to be leadership, planning, and execution and that testing and equipment cannot control infection if there is not a coordinated approach in facilities.
 
Dr. Yealy added that he is concerned about people’s fear causing other consequences. He said that people delaying opportunities to address other issues should not go beyond good medical care and judgement.
 
Chairman Martin asked if business in the state can begin to reopen under safety guidelines or would it be counterproductive in what the state is trying to achieve. Dr. Yealy responded that he cannot say every single location has the capabilities to open up safely but that regions like the southwest, northwest, and central part of the state should be able to. He added that communities cannot solely focus on projections and that they have to “keep a finger on the pulse right now.” Dr. Shapiro commented that many communities would be able to keep their case counts low and that it is not an accident that areas with low population density have lower case rates. He stressed that areas need to be able to go out and identify cases in order to prevent clusters from becoming outbreaks.
 
Asked whether slowing down elective procedures was the best course of action in handling those situations, Dr. Yealy said that delaying care can have tragic results and that care can also be preventative in identifying potential problems. He said that the virus will be around for a long period of time and that hospitals are going to have to provide scheduled care and accommodate them within the system while taking care of those with COVID-19.
 
Dr. Shapiro said that during the peak of cases, surgeries at UPMC were down by about 70 percent. He added that once it became clear that capacities were okay, it went back to essential care. He stressed that hospitals need to continue to get personal protective equipment (PPE) and make sure there is capacity and care available for all patients.
 
Chairman Collett noted that Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, testified that states that “jump over checkpoints” and prematurely open up can cause an outbreak in cases. She asked if Dr. Fauci is incorrect and if another surge can cause a longer economic recovery. Dr. Shapiro responded that he is not wrong but that counties with low case counts should be able to reopen and counties with high case rates need more preventative measures. He noted that staff in nursing homes can interact within communities so community prevalence can be separate if those individuals are separated.
 
Dr. Yealy added that there is not going to be one single plan for every area but that regions can follow the same principle of identifying the capacities of the health care s
ystem, identifying communities at risk, and coordinating activities to focus on improving the outcomes of vulnerable populations.
 
Sen. Baker asked about how the use of technology can reduce exposure and fully utilize screening and tracing capabilities. She noted that the northeast region is lacking contact tracing capabilities and that people do not fully realize the privacy concerns that come with it. Dr. Yealy responded that health care delivery is the first step and that within the first two weeks of the shutdown UPMC had telehealth services increase by about 400 percent. He said that health care has been transforming into a safer experience, which can help more remote settings. He remarked that he does not expect telehealth to go back down after this pandemic.
 
Sen. Phillips-Hill said that York County has been “blessed to be relatively unscathed.” She asked how children can get back to school and what type of testing is needed to ensure they are able to return safely. Dr. Yealy responded that children can go back to school if the process is done smartly. He said that many children and staff may come into school not feeling completely well, which could lead to the shutdown of the entire school system. He stressed that testing needs to be done to protect those that are vulnerable, including students and staff with preexisting conditions and older staff.
 
Sen. Regan noted that the administration has relied on Carnegie Mellon University for its modeling and projections for the reopening process. He asked if the administration has contacted UPMC about its medical views and the safety of reopening. Dr. Shapiro responded that UPMC has had communications with most of the state discussing hospital systems and that it has shared its experiences with others. He added that the administration has been interested in what UPMC has to say but that epidemiologist predictions have not performed well because there is still a lot that is unknown. He noted that models are only as good as the variables they include and that many do not consider the seasonality of viruses. He remarked that it is unlikely the virus will survive in humidity but that a lot more needs to be known to make models more effective.
 
Department of State Temporarily Suspends Requirement for Written Prescription Within 72-Hours of Emergency Oral Prescription
The Department of State (DOS) has temporarily suspended a State Board of Medicine regulation related to emergency oral (verbally conveyed) prescriptions. The temporary suspension was requested following recent guidance provided by the Federal Drug Enforcement Administration (DEA) and a related waiver subsequently issued by the Pennsylvania Department of Health (DOH).
 
Access the full emergency oral prescription waiver here.
 
Background on the Waiver
 
DEA rules require practitioners to deliver a written prescription to a dispensing pharmacy within 7-days of an emergency oral prescription for a Schedule II controlled substance. In March, the DEA issued guidance extending this period to 15-days in response to the COVID-19 emergency.
 
Under State Board of Medicine regulations, a prescribing practitioner must deliver a written prescription to the dispensing pharmacist within 72 hours of authorizing an emergency oral prescription for a Schedule II controlled substance.
 
DoH also has a similar 72-hour requirement in its regulations which it recently waived and increased the timeframe to 15 days to match the DEA guidance.
 
To eliminate any potential confusion, DOS has now temporarily suspended the State Board of Medicine’s 72-hour requirement as well. DOS states that prescribers are expected to deliver paper prescriptions for emergency oral prescriptions as soon as is practical, but at the very latest must do so within 15 days to remain in compliance.
 
This waiver shall extend for the duration of the COVID-19 emergency and, to preserve continuity, will continue for so long as the DOH waiver remains in effect
 
Where Can I Find Additional Information?
Statutory and regulatory suspensions, in response to the COVID-19 emergency, continue to be announced. When announced, suspensions and waivers will be posted by DOS on its COVID-19 suspensions and waivers webpage here.
 
Other States’ Actions
The Wisconsin state Supreme Court has ruled against Gov. Tony Evers’ stay-at-home order, ruling that the Democratic governor does not have authority to act without input from the legislature, even a public health crisis. The 4-to-3 decision was written by four conservative judges on the court.
 
Republican state lawmakers had sued Gov. Tony Evers, a Democrat, and Andrea Palm, the state Department of Health secretary, over the administration’s order that nonessential businesses remain closed until at least May 26, saying they exceeded their authority.
 
The mayor of Washington, D.C., extended a stay-at-home order through June 8, and the entire capital region appeared likely to remain shut down.
 
Meanwhile, Maryland Gov. Larry Hogan shifted his stay-at-home order to a safer-at-home advisory.
 
And Virginia Gov. Ralph Northam urged residents to continue social distancing even as that state begins to reopen.