May 15am COVID-19 Update – Pennsylvania American College of Physicians

Below:

• Governor to announce more counties moving to yellow Friday
• Daily COVID-19 data update
• Q/As with Secretary Levine
• CDC issues guidelines for decisions on schools, childcare, restaurants and bars

 
Governor Wolf set to announce more counties moving from red to yellow?
This afternoon, Gov. Wolf asserted that people can have differences of opinion while agreeing on staying safe to defeat the virus. He said, “I think Pennsylvania has done a phenomenal job of limiting the impact of the virus. We are bending the curve, and over half of the counties in Pennsylvania will be open tomorrow.”
 
When asked if he was planning to announce more counties moving to the yellow phase tomorrow, the Governor said he will make another announcement tomorrow and will decide tomorrow morning which additional counties will enter the yellow phase.
 
Wolf was asked if there was a process for counties in the red phase to argue that their county should be considered for the yellow phase, and said there are workers in his office and in legislators’ offices whose job is to keep in contact with the county commissioners and that he’s meeting with the County Commissioners Association of Pennsylvania. He said, “this is not about some abstract policy or law. This is the virus deciding, and what we need to do is figure out how we can fight this virus.”
 
During debate on the floor of the House today, both Democratic leader Frank Dermody and State Government Minority Chair Kevin Boyle said that they expected as many as three quarters of the state’s counties could be transitioned to the yellow phase next week.
 
PA COVID-19 DATA UPDATE
On Thursday, the Department of Health reported that Pennsylvania had reported 938 new confirmed positive cases in the previous 24 hours, for a total of 59,636 confirmed cases.   
 
The death total rose to 4,218 confirmed COVID-19 deaths, an increase of 44 from Wednesday’s report, all in adult patients.  Another 231 deaths were added to the total via “reconciliation of data.  2,896 of the state’s deaths, almost 69 percent, were nursing home residents.  There were 251,559 negative tests in PA as of midnight Wednesday night.
 
At least 4,217 positive  cases in health care workers – accounting for about four percent of all positive cases.  The total figure includes 1,922 workers in nursing homes.  12,677 residents – accounting for 20 percent of all cases- are in 549 of the state’s long-term care living facilities in 45 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 remained unclassified per age or unreported by the Department.
 
Of the total through Monday, 32,660 positive cases (55%) were female and 26,327 (44%) were male. One percent (649)  were unreported or neither.  Among the deaths, 2,082 (50%) were males 2,118 (50%) were female with 18 not reported by sex.
 
By race, 14,751 positives were Caucasian (25%), 6,935 were African-American (12%) and 736 (1%) were Asian, with 303  listed as “Other.”  The vast majority, 36,911 (62% of all cases) remained unreported on the race of the patient.  A total of 1,583 deaths were among Caucasian victims, 484 were African American/Black, 52 were Asian and 14 were listed as other.  2,085 deaths (53%) weren’t reported by race.
 
On Tuesday, 1,983 positive patients were hospitalized. – less than 2,000 for the first time in several weeks.  At that time, 428 were using ventilators and 18 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 1,323 of the state’s 5,357 ventilators were in use (more than 75% 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 noted that the COVID-19 pandemic had made it difficult for parents to get their children to their pediatricians for immunizations. She discussed the importance of parents getting these visits in and the need for use of these reliable and safe vaccines.  She suggested parents not wait, and noted that school attendance in the fall would be dependent on being current with vaccines.  She said, having your child get the appropriate vaccines on time is a great way to protect yourself and your family. 
 
QUESTIONS FOR DR. LEVINE:
Local county coroner asks why the state hasn’t withdrawn those who tested positive for COVID-19 and been cleared under the county’s number of cases, or at least provided the number of people who have recovered in each county. Is this something the state will consider doing?  Why or why not?  LEVINE:  Yes, it is.  It is challenging to determine an exact number of those who have recovered but we realize that this is important to the public, and our epidemiologists are working on a way to estimate recovered patients in Pennsylvania and we’re hoping to have that sometime next week.
 
Is there currently a mechanism in place for counties to argue their case for moving to the yellow phase if they feel they meet the standards for doing so?  If not, how often are the groups of counties considered for moving through the progression to the yellow phase?  LEVINE: We’re looking at our data now and all our metrics and modeling, and we’ll be having discussions.  In terms of counties that have questions about their status, we are always pleased to discuss with them, and our department of intergovernmental affairs, the Governor’s Office, and the Department are always pleased to speak with county health officials.
 
In what phase of reopening will pet groomers be allowed to operate?  Some say they don’t understand how their services pose a public safety threat if pets are dropped off, and no humans are allowed inside except employees. What is the risk of the virus spreading in a pet grooming environment?  LEVINE: I’m going to have to check the FAQs about that specific business, but for any business questions about life in the yellow zone and then the green zone, we have in depth information on the Governor’s website, and our website as well, and we’ll have discussions about the green zone starting now and into next week.
 
Northeast PA has three local contiguous counties, Wyoming, Susquehanna and Wayne, whose thresholds are and have regularly been below the state’s benchmark guideline.  Officials in each are urging the Governor to shift to yellow.  Why aren’t they certain to be on the yellow list? LEVINE: We are looking at all that data, those numbers, those metrics and our modeling as we speak.
 
CVS just announced they will be opening drive through self-swab testing in Pennsylvania. What will the criteria be for who is able to get a test? LEVINE:  We are so pleased that CVS will be doing more testing, We are prioritizing patients who are symptomatic, at least some symptoms, they don’t have to be severe symptoms of COV, but I know for instance that RiteAid will test asymptomatic people. I don’t exactly know CVS’ specific criteria, but I believe there’s a website to go onto to register for testing, maybe a phone number, and check with CVS for the criteria for their testing.
 
As we await tomorrow’s announcement on the next counties to move to the yellow phase, are you pleased with the results of last week’s yellow counties, and have there been any concerning data spikes in those counties?  LEVINE: There have not been specific concerning data spikes, but you have to remember that it’s been six days since those counties moved into the yellow phase.  The average incubation period is five days, but can be up to 14 days, so we are going to continue to look really closely now and, in the future, particularly at the counties that go from red to yellow.
 
Do you expect Governor Wolf to announce a new set of counties that will eventually move from red to yellow in the future, tomorrow on the 15th?  The previous two announcements came on Fridays and we were wondering if the same would continue this week.  LEVINE:  We are looking at our data as we speak, and we will leave it to the Governor to determine when and the pace of the announcements.
 
When will you know the criteria for counties to move from yellow to green?  And what can we expect?  LEVINE: It’s a very important question. We’ve been asked that many times.  It’s been six days since any county went from red to yellow, but we are going to start to look at that next week.
 
Once grade schools reopen, what should happen to transportation?  Buses can hold dozens of students. LEVINE: I’m going to leave it to the collaboration between our Department, the Department of Education, to discuss what might happen with bus transportation when schools open, but of course that wouldn’t happen before the fall.
 
Department of Health data shows 55% of the positive cases are in women and 44% in men. Is there any significance to those numbers?  Are women more likely to contract the virus? LEVINE:  There’s some suggestion, but some of the data is contradictory.  It looks like men might have more serious cases.  Actually, because this is a novel coronavirus, there is much that we need to learn.
 
HAP President Andy Carter said that he’s disappointed with the Governor’s veto of the telemedicine bill and with the Governor not including hospitals in his executive order on immunity from liability for COVID-19 health care workers, and for offering loans to hospitals rather than pandemic relief that doesn’t need to be repaid.  Do you have a comment?  LEVINE: No, I’ll leave comments on those types of issues to the Governor.
 
There was a spike in deaths today. Your reports on Tuesday and Wednesdays usually have these due to a lag in reporting. Is the spike for this reason, or is it indicative of what’s happening in counties now in the yellow phase? LEVINE:  This is part of the continuing reconciliation process that we talked about. We have been working very closely, very successfully with Philadelphia now, in terms of reconciling our data on a daily basis, we are still working on reconciling our two data systems, which are very different, so today there were 44 new deaths, but 231 from over the last several weeks.
 
Based in your professional opinion is it safe to attend in-person summer camps this year? Has the state made a decision yet on whether summer camps will be open or closed for the summer? LEVINE: We are working on that now with the Governor’s Office and other departments, and I expect a decision and reports to go out soon.
 
How would you propose young children social distance themselves from each other in that environment?  LEVINE: That’s part of the guidance we’ll be putting out soon.
 
Is the state responding to any local spikes in the 24 counties that reopened last Friday? The surge in a Lycoming County facility pushes the county above the 50/100,000 threshold, does that threaten to push that county back in the red phase? LEVINE: We’re aware of the Long Term Care living facility outbreaks, and we’re watching them very closely. We’re aware of the increased cases in Lycoming County, and it will not threaten its status at this time.
 
Has there been any guidance on future trade shows or conventions taking place in the Commonwealth this year? These events are planned well in advance and attract thousands of people. Do you expect to ban these types of events for the remainder of the year? Should promoters who plan for the summer or fall keep on planning or would you urge them to cancel or postpone their events?  LEVINE: We haven’t made decisions on what things will be like in the green zones.  Certainly, those type of large gatherings would not be permitted in yellow zones. We remain concerned about the spread of this very contagious virus, COVID-19 and very large gatherings propose a serious risk, but I have no specific recommendations at this time, but we are looking at that.
 
Carbon and Columbia Counties stated they are planning to move into yellow with or without the Governor and DoH’s okay. What would you say to those county officials who are making those moves? LEVINE: I have no political response to the counties and county commissioners. I’ll leave that to the Governor.  Certainly, we want the counties to work with us in the Department of Health and the Governor’s Administration in terms of moving counties from red to yellow. We want to collaborate with counties in terms of doing that, and strongly recommend they follow the governor’s guidance.
 
Would you and the Governor consider moving PART of a county from red to yellow?  There is an idea floating around Luzerne County that Hazelton could go yellow.  What are your thoughts?  LEVINE:  There are no plans to get beyond the county level in terms of granularity.  We have no plans to go to the zip code level or anything like that.  We’re going to continue at the county level.
 
Today some Republican lawmakers joined together in support of a barber shop owner in Cumberland County who received a warning from the state for reopening in spite of the Governor’s orders. What is your message to other business owners who are considering going against the Governor’s orders?  And from a Health perspective, why do you believe that Cumberland County needs to stay in the red phase right now?  LEVINE:  We’re looking at all of our county data, our metrics and our modeling right now.  I have no comment on that specific situation.  But we have said before that we have significant concerns in the yellow zone in terms of hands on service activities such as barbers, such as hairdressers, massage therapists, etc. It is impossible to practice social distancing if the very important act of performing the service is going to involve hands on activity such as cutting hair, styling hair and performing massage therapy.  So that is why in the yellow zones we are not opening those businesses.
 
For the sake of clarity for our readers, can you speak of why contact tracing is important and why it shouldn’t be viewed as “Big Brother” watching? LEVINE: Oh, no, this is a very well established public health activity.  If someone tests positive, for COVID-19 They go into isolation under CDC guidelines, then we will do a case investigation, contact that person in terms of their symptoms, the timing of their symptoms, demographic information, and then who their contacts might be.  Then we will contact the contacts, and tell them anonymously that they have been in contact with someone with COV, we will verify that information, and then they would go into quarantine for two weeks. If they develop symptoms, they will be tested.  We do this with other diseases, it’s just as widely discussed.  Given the ramifications and the extent of this pandemic, it’s become even more important.
 
Several District Attorneys across the state have gone on record in opposition to punishing business owners who reopen their businesses in defiance of Governor Wolf’s closure orders instead of waiting for their county to be cleared for opening.  What would you advise to law enforcement and business owners who might participate in such actions?  LEVINE: My recommendation from a public health perspective is of course to follow the Governor’s guidance in terms of the counties that go from red to yellow for businesses.  I have no comment on District Attorneys or law enforcement. I will leave that to the Governor.
 
Lycoming County Commissioner outlined the DoH numbers on Tuesday and said by focusing on positive cases it is spreading fear.  What is your response? LEVINE: All along we have tried not to sp
read fear.  We have tried very hard to give accurate information in a calm way about COVID-19 numbers.  We have tried to be transparent, and working every day to be more transparent and give out more information so that the public is informed.  We’ll have figures on the recovery rate sometime next week, and we’re trying to make people stay calm and be informed and then make the right decisions in terms of social distancing, hand washing, mask wearing, etc.
 
Bucks County Commissioners say they were told by state officials that they were rapidly approaching the yellow phase.  Is that how you would classify where you think Bucks County is?  And does that apply to the rest of the Philadelphia region given their case counts are well above the state threshold? LEVINE: You can see the numbers, so we are pleased to collaborate with the Bucks County health department and commissioners, and all of the health officials in the southeast. And we’ll we’re looking at all of our numbers now and will determine which counties may go from red to yellow. 
 
Are you still using the same reopening metric? LEVINE: There’s not one metric. The 50/100,000 metric is one thing we’re looking at – called the incidence rate. Then there are the other quantitative metrics and the qualitative more subjective decisions as well, and then we will present our findings to the Governor and he will make his decisions on which counties go from red to yellow.
 
Yesterday the PA Dental Hygienists Association notified dental offices that cleanings and other routine procedures should not be performed. But on the 8th the PA Department of Health approved such procedures. Which directive should dentists’ offices follow?  LEVINE: Dentists should follow our guidance that we put out last week.  It’s important for people who need to deal with acute – maybe not just emergency issues that occur, having a crown replaced for example.  The CDC has also put out dental guidance.  Our guidance notes that routine dental cleanings can be delayed until its safe
 
Do you have any advice for organizers of big events such as the Kenny Chesney concert that’s still scheduled for the end of this month at Heinz Field in Pittsburgh?  LEVINE:  My recommendation is not to have large events in yellow zones so Pittsburgh it’s still not recommended to have large gatherings like that.  COVID-19 is still in the community and we would worry about community spread.
 
Two top infectious disease specialists at two health systems in the Lehigh Valley said in public forums that the Lehigh Valley region “could and should” be more open than it is now.  In fact one said, “We should be in the yellow headed towards green.” What do you have to say about these doctors?  LEVINE: I have conversations scheduled with those experts.
 
Huntingdon County has a high percentage of its positive cases coming from an outbreak at the SCI-Huntingdon, and the number of cases in the general population is similar to the cases in counties moving into the yellow phase Friday.  Would the Department consider reporting inmate cases separate than other cases in the community as suggested by some lawmakers? How to inmate cases weigh into the  decision on reopening a county, given that those cases are contained in a facility outside of society?  LEVINE: We’ve said all along that correctional facilities as well as long term care living centers, as well as food manufacturers or processors are all part of the community, and the staff go back and forth in the community. And so we will continue to count in terms of counting numbers.
 
Renowned pathologist Cyril Wecht wrote in The overall restrictive measures that have been imposed are simply unsustainable.  Do you have a response to Doctor Wecht?  LEVINE:  I don’t know of those specific comments, but we have taken all a very moderate phased approach to how the different counties in the state close and closing schools, etc.  and now that rates of COVID-19 are changing, we are taking that same moderate phased approach to reopening counties in PA.  I think we’ve been extremely careful and moderate, but consistent throughout this process.
 
Do you think the role of temp agencies in staffing nursing homes has played a role in the spread of COVID-19 in nursing homes? LEVINE:  The staff in the nursing homes have been doing an absolutely fantastic job and trying so hard under very challenging circumstances in congregate settings with seniors, elderly patients, many with comorbidities, and medical problems.  Whenever anybody enters a nursing home from the community, they could spread COV.  I don’t think temp agencies have played a role other than its possible that someone they place could be asymptomatic and promote the spread.  But they have also been absolutely necessary in terms of staffing.
 
Have you received any updates on whether Pennsylvania has any cases of the childhood inflammatory condition believed to be connected to COV?  Some national maps appear to show Pennsylvania has at least some cases.  LEVINE:  We are making those calls to the six fantastic children’s hospitals  today and I hope to have more information tomorrow.
 
Why are there nursing home cases reported in only 45 of 67 counties?  LEVINE:  I’m not sure I have that specific answer.  I don’t have that map in my head.  There are certainly counties that have had more cases, and staff lives in the community and that’s how you start to have more cases of spread.  I’ll have to look at the granularity of tat data.
 
Do you think the country has an adequate distribution system in place to distribute the COVID-19 vaccine once it is tested approved and available? LEVINE: I think that’ll be a challenge, so that will be something we’ll need to work on when that vaccine is available. And we’ll be working on that now.
 
Do you know how many children have missed vaccinations in this time? And what are you hearing from pediatricians? LEVINE: I’m hearing from Pediatricians – there was a report in the Journal of Pediatrics – about missed opportunities for vaccines because of the COVID-19 pandemic. I don’t have specific information about that in Pennsylvania, but we know that during the stay at home period , people have not been going for their well child visits and that’s why we made our specific comments today. We’ve had ongoing discussions with the PA Chapter of the American Academy of Pediatrics.  There was a conversation between our staff and the AAP this week. We’re strong partners and we collaborate with them all the time. We just want to make sure that children get all the immunizations they need to stay healthy.
 
Governor Murphy announced today that Jersey Shore beaches will be open in time for Memorial Day.  Is it safe to go to the beach and what recommendations do you have for someone who it going? LEVINE:  I have no comment on the Governor’s announcement in New Jersey. I would be concerned about traveling into another state that has a significant amount of community spread of COVID-19 and certainly in a public setting.  My recommendation would be to people who go there to practice social distancing, wear a mask, wash your hands, and take all the precautions that we talk about every day.
 
CDC releases guidance on reopening childcare centers, schools, restaurants and bars
The Centers for Disease Control and Prevention released a set of documents on Thursday designed to provide guidance on how childcare centers, schools, restaurants and bars, and other establishment
s could begin the process of reopening in the face of coronavirus. The direction comes after calls from lawmakers and state officials mounted for the CDC to weigh in on how regions should reopen their economies.
 
The decision tools the agency released recommend that all workplaces hold off on reopening unless they are ready to protect employees at higher risk for severe illness, including those 65 and older and people of all ages with underlying medical conditions.
 
If an organization can protect workers and goes forward with reopening, the CDC recommends intensifying cleaning and sanitation and establishing health and safety actions “as feasible,” such as hand washing, wearing a cloth face covering and social distancing. The documents also advise employers to encourage workers to stay home if they feel sick.
 
Schools, childcare centers and camps should not reopen, the guidelines stipulate, unless they are able to implement coronavirus screening protocols, evaluating employees and children daily for symptoms and potential past exposures to COVID-19.