May 18 COVID-19 Update – Pennsylvania American College of Physicians

• Sunday COVID-19 data update
• Saturday COVID-19 data update
• Drexel study: Stay at Home orders have paid off
• Federal funds not enough for health systems
• Primary care, independent practices face economic realities
• Tech for contact tracing soon?
• Last day to register to vote:  Today, May 18

 
PA COVID-19 DATA UPDATE
 
Sunday May 17 data
On Sunday, the Department of Health reported that Pennsylvania had reported 623 new confirmed positive cases in the previous 24 hours, for a total of 62,234 confirmed cases.   
 
The death total rose to 4,418 confirmed COVID-19 deaths, an increase of 15  from Friday’s report, all in adult patients.  3,057 of the state’s deaths, 69 percent, were nursing home residents.  There were 270,670 negative tests in PA as of midnight Saturday night.
 
At least 4,396 positive  cases in health care workers – accounting for about four percent of all positive cases.  The total figure includes 2,091 workers in nursing homes.  13,447 residents – accounting for 22 percent of all cases- are in 558 of the state’s long-term care living facilities in 45 counties.  Another 2,369 positive cases are in the food industry in 150 facilities.
 
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 Saturday, 34,098 positive cases (55%) were female and 27,463 (44%) were male. One percent (673)  were unreported or neither.  Among the deaths, 2,178 (50%) were males 2,222 (50%) were female with 18 not reported by sex.
 
By race, 15,850 positives were Caucasian (25%), 7,297 were African-American (12%) and 781 (1%) were Asian, with 324  listed as “Other.”  The vast majority, 37,982 (61% of all cases) remained unreported on the race of the patient.  A total of 1,672 deaths were among Caucasian victims, 506 were African American/Black, 53 were Asian and 14 were listed as other.  2,173 deaths (51%) weren’t reported by race.
 
On Sunday afternoon, 1,821 positive patients were hospitalized. At that time, 406 were using ventilators and 16 were on ECMO machines.  About 1,378 (38%) of the 5,199  intensive care unit (ICU) beds were available, 6,917 general medical beds (45%) were available and 1,542 (53%) of the airborne isolation rooms are still available statewide.  And 1,283 of the state’s 5,376 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 29% are aged 65 or older. 
 
Saturday May 16 data
On Saturday, the Department of Health reported that Pennsylvania had reported 989 new confirmed positive cases in the previous 24 hours, for a total of 61,611 confirmed cases.   
 
The death total rose to 4,403 confirmed COVID-19 deaths, an increase of 61 from Thursday’s report, all in adult patients.  3,043 of the state’s deaths, 69 percent, were nursing home residents.  There were 266,225 negative tests in PA as of midnight Friday night.
 
At least 4,380 positive  cases in health care workers – accounting for about four percent of all positive cases.  The total figure includes 2,075 workers in nursing homes.  17 re3,25sidents – accounting for 20 percent of all cases- are in 556 of the state’s long-term care living facilities in 45 counties.  Another 2,369 positive cases are in the food industry in 150 facilities.
 
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 Friday, 33,754 positive cases (55%) were female and 27,196 (44%) were male. One percent (661)  were unreported or neither.  Among the deaths, 2,172 (50%) were males 2,213 (50%) were female with 18 not reported by sex.
 
By race, 15,649 positives were Caucasian (25%), 7,213 were African-American (12%) and 773 (1%) were Asian, with 319  listed as “Other.”  The vast majority, 37,657 (61% of all cases) remained unreported on the race of the patient.  A total of 1,666 deaths were among Caucasian victims, 505 were African American/Black, 53 were Asian and 14 were listed as other.  2,165 deaths (53%) weren’t reported by race.
 
On Saturday afternoon, 1,873 positive patients were hospitalized. At that time, 411 were using ventilators and 18 were on ECMO machines.  About 1,370 (38%) of the 5,199  intensive care unit (ICU) beds were available, 6,784 general medical beds (45%) were available and 1,537 (53%) of the airborne isolation rooms are still available statewide.  And 1,277 of the state’s 5,379 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 29% are aged 65 or older. 
 
There were no media availabilities over the weekend.
 
Drexel U. study says stay at home orders have paid off
Drexel’s Urban Health Collaborative and the Big Cities Health Coalition used real-life numbers to estimate how many lives were saved, and how many hospitalizations didn’t happen in 30 cities around the country as a result of stay at home orders and social distancing.
 
For Philadelphia, it estimates that 45 days of being shut down social distancing spared 6,200 lives, and kept 57,000 people out of hospitals than if life went on as usual.
 
There were sizable results in other cities – in Baltimore, the model estimates nearly 23-hundred fewer deaths. In Dallas, 10-thousand lives saved, while in New York City, 25-thousand lives may have been saved by changing our behavior.  .The researchers say 60-day shutdowns save even more people.
 
Federal funds won’t be enough for health systems to recoup losses
Hundreds of billions of dollars in state and federal funding are going to hospitals to make up for money lost on elective surgeries and other lucrative services that were canceled during the coronavirus pandemic. But for most, the aid won’t cover the losses.
 
The Hospital and Healthsystem Association of Pennsylvania (HAP) estimated that even with the expected $3 billion in federal relief the state’s hospitals are receiving, health systems across the state could lose more than $7 billion this year because of the pandemic.
 
The pandemic has highlighted the disparity between financially strong, growing hospital systems and struggling hospitals that lose money year after year. While all hospitals will suffer financially, health systems with millions to billions in reserve will weather the pandemic better.  Hospitals that were already struggling to keep their doors open will need significant assistance to survive the pandemic.
 
“A lot of rural hospitals and community hospitals that were in bad shape before the crisis hit could easily be destabilized and gone forever in the next six months,” Sager said.
 
DHHS, distributing more than $100 billion in relief funds, moved the first $50 billion to hospitals and other providers based largely on the number of Medicare patients they served. The funding will continue to go out as applications from providers and health systems are evaluated.
 
DHHS recently announced funding for hospitals and providers based on need, including $12 billion for hospitals hit hardest with coronavirus patients, $10 billion for rural hospitals that are financially struggling, and $400 million to Indian Health Service, which provides health care to Native American tribes. The rest of the funding will go to treating uninsured and Medicaid patients, among others.
 
The ACP has been advoca
ting for funding for independent practitioners and primary care practices, noting that more needs to be done for providers who treat Medicaid patients.
 
Primary care, independent practices facing COVID economic realities too
The coronavirus pandemic has wrought on workers of all types is causing serious damage to doctors’ offices much like other small and midsize businesses. 
 
An April survey of physician practices found that 97% reported a negative financial impact from the coronavirus outbreak, according to the Medical Group Management Association. The same survey revealed that, on average, doctors’ offices have experienced a 60% decline in the volume of patients they treat and a 55% decline in revenue. 
 
The Medical Group Management Association estimates that 60% of physicians’ offices had furloughed staff and 36% had laid off workers as of early May. Last week, the federal Bureau of Labor Statistics reported that 1.4 million health care jobs disappeared in April, including 243,000 employees at doctors’ offices.
 
Around the country, physicians’ offices are facing major declines in revenue, leading to layoffs and other cutbacks. Like hospitals, they’re losing money as many elective procedures have been postponed. 
The ACP and PA-ACP along with many other health care industry groups are lobbying Congress and the General Assembly, and health insurance companies for additional relief. Like many other small and medium-sized businesses have discovered, the bulk of the federal relief money is going to larger companies.
 
Doctors in private practice also tend to avoid keeping large cash reserves to protect themselves against malpractice claims, leaving them little fiscal wiggle room.
 
Patients Are Fearful
Physicians are also coping with a reality in which patients are either unable or unwilling to leave their homes and visit offices where other sick people will be.  Many doctors are worried that the health of their patients, especially those who have chronic conditions like diabetes that need monitoring, will worsen because of delayed care. A Primary Care Collaborative survey this month found that 60% of primary care doctors are concerned their patients will suffer an avoidable illness because they can’t or won’t see their family doctors.
 
Beyond the limitations created by state-ordered lockdowns and social distancing guidelines, the plummeting volume of visits is a demand-side problem. Just 39% of respondents reported they would feel comfortable visiting a primary care doctor for medical treatment not related to COVID-19, a Morning Consult poll last month found.
 
Looking At A Slow Recovery
Even when the present emergency subsides, doctors and medical practice administrators predict lasting damage and permanent change to how family physicians’ offices operate. In the shorter term, the massive rise in joblessness translates into an estimated 27 million people losing their employer-based health benefits, meaning those people are more likely to skip needed medical care because of cost.
 
Medical professionals don’t see their businesses ever returning to pre-COVID-19 levels and envision a future with fewer primary care physicians in private practice and a greater reliance on telemedicine services in lieu of in-person visits.
 
Doctors and administrators also foresee more doctors abandoning private practice, accelerating an ongoing trend. As of 2018, more physicians worked as employees for hospitals, investor-owned practices or other larger companies than owned or co-owned their own practices.
 
Advocacy for primary care, independent practices
The PA-ACP continues to advocate for a portion of federal funds distributed to Pennsylvania be designated for physicians whose practices are not hospital or health-system based.  The Chapter has asked Governor Wolf to expand his limited immunity order to independent and small practices, and has joined in a coalition effort to do the same.  Similarly, the Chapter is working with other primary care and general medical and midlevel provider organizations to have an executive decision or legislation to help the health care community deal with the economic impacts of the pandemic and state orders earmark a portion of state funds for these practices.
 
Tech for contact tracing ready for release?
Public health officials are eagerly awaiting Apple and Google’s API that could detect whether a person who’s tested positive for coronavirus has exposed other people based on the proximity of their devices.
 
In the lead-up to the release, lawmakers are racing to promote contact tracing while also providing privacy safeguards. A group of four Democratic senators introduced a bill Thursday to allot $10 billion in funding for states and tribes to hire roughly 100,000 tracers and support staff. It would also require the CDC publish a strategy for contact tracing, including provisions for protecting data.
 
Deadline Alert: 05/18/2020 is the last day to register before the 06/02/2020 election.
If you are not a United States citizen, have not been a resident of PA and your election district for at least 30 days, and will not be at least 18 years of age on June 2, you are not eligible to register or vote.
 
A registration must be completed today, either in your County Voter Services office, or online on the Department of State’s voter services website:
 
If you have one, please have your PA driver’s license or PennDOT ID available to reference as you complete the application.  Any section or field marked with a red indicator or an asterisk (*) must be filled out in order to submit an application. If you have any questions, please call 1-877.VOTESPA  (1.877.868.3772).
 
VOTE BY MAIL DEADLINE IS 5/26/2020
Please note, if you plan to vote using an absentee or mail-in ballot in the 2020 GENERAL PRIMARY held on 06/02/2020, your completed application must be received in the county office by 5:00 PM on 05/26/2020. The deadline to return your voted absentee or mail-in ballot is 8:00 PM on 06/02/2020.
 
If you have a valid PA Driver’s License or PennDOT ID number, you may apply to vote by mail online:   
 
Otherwise, you may visit your local county elections office.