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

• Monday COVID-19 data update
• State adopts new system for COVID-19 fatality counts
• Q/A’s with Sec. Levine
• Second round of remdesivir distributed
• Wolf praises PEMA, National Guard; Q/As with the Governor

 
PA COVID-19 DATA UPDATE
On Monday, the Department of Health reported that Pennsylvania had reported 822 new confirmed positive cases in the previous 24 hours, for a total of 63,056 confirmed cases.   
 
This includes 4,479 positive  cases in health care workers – accounting for about four percent of all positive cases.  The total figure includes 2,111 workers in nursing homes.  13,626 residents – accounting for 22 percent of all cases- are in 561 of the state’s long-term care living facilities in 45 counties.  Another 2,422 positive cases are in the food industry in 159 facilities.
 
The death total rose to 4,505 confirmed COVID-19 deaths, an increase of 15  from Friday’s report, all in adult patients.  3,086 of the state’s deaths, 69 percent, were nursing home residents.      There were 277,553 negative tests in PA as of midnight Sunday night.
 
Two percent of hospitalizations were under 29 years of age, five percent were 30-49, 10% were 50-64, 20% were 65-79 and 18% were 80+.  Forty-five percent remained unclassified per age or unreported by the Department.
 
Of the total through Sunday, 34,542 positive cases (55%) were female and 27,803 (44%) were male. One percent (711)  were unreported or neither.  Among the deaths, 2,184 (49%) were males 2,235 (50%) were female with 18 not reported by sex.
 
By race, 16,056 positives were Caucasian (25%), 7,408 were African-American (12%) and 791 (1%) were Asian, with 332  listed as “Other.”  The vast majority, 38,469 (61% of all cases) remained unreported on the race of the patient.  A total of 1,680 deaths were among Caucasian victims, 507 were African American/Black, 53 were Asian and 14 were listed as other.  2,183 deaths (51%) weren’t reported by race.
 
On Monday afternoon, 1,885 positive patients were hospitalized. At that time, 385 were using ventilators and 16 were on ECMO machines.  About 1,345 (38%) of the 5,199  intensive care unit (ICU) beds were available, 6,319 general medical beds (45%) were available and 1,562 (53%) of the airborne isolation rooms are still available statewide.  And 1,282 of the state’s 5,377 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. 
 
State adopts new system for counting COVID-19 fatalities
Dr. Levine said Monday that a new system of counting COVID-19 fatalities will yield “as near to real time data,” as possible on people statewide who are succumbing to the disease.
 
After weeks of pushback over ongoing discrepancies in county and state fatality counts, the state’s Electronic Death Reporting System will count COVID-19 fatalities based on the deceased person’s county of residence, instead of listing them based on the county where they were receiving hospital treatment or were living in a nursing home at the time of death.
 
The state’s County Coroners Association has been critical about gaps between death counts between the state and local levels.
 
During a news briefing, Dr. Levine said the state’s old system, which took deaths from each provider and matched them against people who had tested positive, had been overwhelmed by the pandemic. As a practical matter, that meant it often took several days for the state to reconcile its fatality count with information being reported by county coroners.
 
She said the new system is in concert with guidance from the CDC. County coroners will continue to be required to calculate fatalities based on where someone died.  Those fatality counts, both by county, and by nursing homes, will be listed in two different places on the department’s website.  As a result, the total death counts, and facility death counts may not add up.  Levine said the agency won’t be “double counting.”
 
Q/As with Secretary Levine
When is the Secretary rolling out the plans for mass testing at residents and staff nursing homes and LTC    and what are specific details, will 100% of the staff be tested weekly, will there be retests, how will the department determine if PTC providers are doing the testing?  LEVINE: We’ll be rolling out that plan this week, but not every facility will be tested weekly.  It’s going to be individualized to the facility, depending on how many cases of COVID-19they have.  Those that have a significant number of cases will be tested differently than those that have a few, that will be different than a facility that has none.
 
When is the Department going to release the early plan for battling the COVID-19in long term care facilities that was not implemented?  LEVINE: A lot of that was discussed by the Governor and Director Padfield.  We had talked about having teams to go out to facilities, and we have had that with the National Guard and now the CDC that we call strike teams, that was in our original draft, but that HAS been rolled out.
 
According to your office, collection of data from nursing homes only started yesterday. There was confusion that those numbers were to be reported last week.  Did something change in that process?  LEVINE: There was some hope that we would be able to report it last week, but it turns out that the data was not started to be collected till yesterday and we are going to start the reports tomorrow.
 
Your office said the deadline for facilities to cooperate was today. What happens if they don’t?  LEVINE: If they don’t then we’ll be contacting them to ask them to cooperate.  This is the same data that they are mandated to report to the federal government and CMS.  We did wait on our data reporting plan so that our data system was the same as CMS’s, so that reporting would be consistent.
 
Why does the Department need even more  time to release the individual facility infection and long term death data?  You said that the Department was collecting this data May 11 so why the wait to release it? LEVINE: We have been collecting data, but we have been collecting it in a different way.  We wanted to make sure ours was consistent with CMS, so we waited for CMS guidance, which came ten days ago, and we worked on it last week, and we’ll start on it tomorrow.
 
Are you seeing improvements in nursing homes since the new strategy has been released?  LEVINE:  I think we are seeing progress in Long Term Living facilities with all of the strategies we have in place and the many programs we have to assist these facilities, but I don’t want to underestimate the challenges.  We do have seniors, many if not most with chronic medical conditions, in a congregate setting, so Pennsylvania, as has NY, NY, MA, and IL, and other states, has had a significant challenge with these facilities, and we will continue to do everything we possibly can to protect the residents and staff.
 
This morning the Department was reporting 38 deaths in Westmoreland County while the coroner was reporting 32.  Can you offer any information about what led to this discrepancy? LEVINE:  I don’t know about the specifics, but our team can investigate, and we’ll get back to you, but there will be some differences in reporting based on what we just discussed about reconciliation with CMS guidance.
 
What is the state suicide rate since the shutdown, and what has it been since the shutdown began? LEVINE: I don’t have that information. It takes a while for those numbers to come in.  Suicide rates are challenging to get, and our coroners report that, but we are concerned – we know that people get depressed, feeling isolated and might be at risk for suicide.  We’re also concerned in terms of substance abuse, particularly opioid abuse and those are both things we’l
l be working on with our sister departments.
 
What has the overdose rate been since the stay at home orders took effect?  LEVINE: I don’t have those numbers.  It takes a while for overdose numbers to come in as well, and we have worked with our excellent coroners on that.  We are very concerned about opioid abuse and opioid deaths.
 
Over the last month we’ve noted that while early on, the number of cases in both Luzerne and Lackawanna county were high, but the number of positive appear to have been dropping in Luzerne County while the cases in Lackawanna County seem to be stable.  Is there some reason while Luzerne County’s number would be dropping while Lackawanna is maintaining those numbers of positives?  LEVINE: I don’t have granular detail, but our team can do a deep dive in terms of the data and then get back to the reporter.
 
The death toll in Lackawanna County dropped substantially today, with smaller decreases in Luzerne and Pike Counties.  Any idea what happened, and did it have to do with the switch in reporting systems?  LEVINE:  Yes, it appears that is the case.  Unlike coroners who have to report on the county of death, we have to report for the county of residence, so that it likely, but we can check on that.
 
The data you provided to Speaker Turzai appears to show that 88% of all deaths are in patients 65 and older. Are you surprised by the magnitude and what does the data on comorbidity tell you?  LEVINE: IM not surprised. The data from Pennsylvania, other states and other countries supports the fact that seniors are most at risk of having significant complications with COVID-19and are most likely to pass away.  The seniors that are most at risk are those with other types of comorbidities.  We know those individuals are most at risk.  There are others, young and middle aged adults, and now children are also at risk.
 
If and when youth are allowed participation in  organized sports activities, is there evidence to suggest that COVID-19would spread among them asymptomatically, and that they would infect their parents, grandparents and other care givers? Are youth being found less likely to contract the virus altogether? LEVINE: We’re still learning a lot of information about COV.  In general youth are less likely to have significant symptoms. And be either asymptomatic or have very mild symptoms.  They could in fact carry that to their parents.  So that’s one of the concerns about this kind of community spread.  Now the multisystem inflammatory disease is actually post-infectious.  It can be several weeks after the infection and seems to be an inflammatory response to the virus.
 
Can you give an update on antibody testing in the state? IS it widely available and can Pennsylvanian’s easily access it at a low cost?  LEVINE: We are working at getting that laboratory testing available at our laboratory, and should have that by the end of the month.  There are some hospitals doing antibody testing, and Quest and LabCorp are as well. Someone could get that test by talking to their doctor, and having the blood drawn, to look for antibodies.  What we don’t know is how long-lived those antibodies are, how long they last, and how much immunity they provide to a person, so we’ll be looking to get that information as we get into the summer.
 
Why is the National Guard leaving Brighton tomorrow? What goal did they achieve?  LEVINE: They achieved a significant amount of progress; their mission is ending and there is additional staffing coming to Brighton. There is some overlap, and then the National Guard can leave for their next mission.
 
Can you explain what the new death data dashboard is doing and how it is different than what was there before? Specifically, what is the percentage column showing? LEVINE: I’m going to have to look at the percentage column, but this data is different. It’s from our new reporting system and is obtained in a different way. We have to deal with things like where a person passes away and what county that is reported in.
 
The state is reporting 87 new deaths today, but a look at the county figures shows that a number of counties have actually decreased overnight.  Why doesn’t the Department’s messaging reflect the full scope of what is happening? LEVINE: I believe our messaging is reflecting the full scope, as we are reporting it in several different ways.
 
Any update on the recovery tracking and when will the public be able to see any of that data?  LEVINE: We’ll have that available this week.
 
Instead of moving recovering COVID-19 patients into nursing homes, is the state considering other options in order to keep nursing home residents safe?  LEVINE: We want to do everything we can to keep patients safe and we will explore every possibility of how to do that. Nothing has been easy, especially with the challenge of those Long Term Care facilities. 
 
We noticed a number of changes in the deaths reporting in our local counties.  Any insight into what that is? LEVINE:  These would be do to exactly what we talked about.  Where someone’s residence was as opposed to where they died. From now on it will be consistent because this is how we will be reporting deaths.
 
Will clubs, legions be able to open.  With social distancing, they could do that easily and they support so many community endeavors.  LEVINE: Certainly not in the red zone.  We’ll have to look at the yellow zone guidance in terms of those types of facilities, and we’re developing our green zone guidance this week.
 
Would the Department consider removing cases in long term care facilities from the 50/100,000 benchmark, and for example, in Schuylkill County, the number outside of residents of the one facility are well below the benchmark. LEVINE: We’ve discussed this before. In terms of public health we consider all the facilities in a county. Long term care facilities, hospitals, prisons and food processing facilities all are part of the community in those counties.
 
Have county death numbers been reallocated retroactively, in terms of county of residence vs. nursing home deaths? LEVINE:  I’m not sure of that, I’ll have to get back to you on that.
 
Can you offer a comment on the EMS efforts across the state during this pandemic? It’s EMS week.  LEVINE: Absolutely. Our Emergency medical technicians and staff have done an absolutely fantastic job during this crisis – they were doing a fantastic job before. We owe them a debt of gratitude for their heroism and their bravery, and I would like to thank them.
 
Second Shipment of Remdesivir Distributed to PA Hospitals to Treat COVID-19 Patients
DoH  announced that it distributed a second shipment of remdesivir to Pennsylvania hospitals on Monday.  Last Friday, 1,548 doses of medication were sent to 21 hospitals, and a second shipment of 6,390 doses were distributed to 58 hospitals on Monday. The federal government had sent the medication to the department on May 15.
 
Wolf stresses importance of PEMA, National Guard
Governor Wolf Monday stressed the critical roles the Pennsylvania Emergency Management Agency (PEMA) and PA National Guard and took questions.  He said the two organizations coordinate much of the state’s preparedness and response to COVID-19. He was joined at his press conference by PEMA director Randy Padfield and PA National Guard Colonel Frank Montgomery.
 
Along with the Department of Health (DOH), PEMA has been monitoring the virus since January, establishing the DOH’s operations center at PEMA before the vi
rus was first detected in the United States.  PEMA’s Commonwealth Response Coordination Center (CRCC), typically used only during weather emergencies, stood up full operations just a few weeks later, supplementing planning and coordination efforts with staff from dozens of state and federal agencies, and partners.
 
PEMA works with emergency management agencies in each of the state’s 67 counties to identify and eliminate potential issues by providing the necessary guidance and support to execute their unique, local emergency plans, including coordinating the community-based testing sites in Montgomery County and more recently in Luzerne County in the northeast with the PA National Guard.
 
The governor emphasized PEMA’s role in obtaining the Battelle Critical Care Decontamination System in Delaware County from the federal government. The free service to decontaminate certain N95 masks is helping health care providers and first responders stretch PPE by being able to safely reuse these masks. The governor encouraged more facilities to take advantage of this service.
 
The PA National Guard, present in the CRCC every day, has been working to provide support to mass testing sites and the state’s nursing homes that require more help than can be provided with facility staff. To date, the Guard has assisted 10 nursing facilities in the state, including Brighton Rehabilitation and Wellness Center in Beaver County.
 
“Pennsylvanians haven’t had to worry that we’ll miss out on federal disaster aid, they haven’t had to worry about 9-1-1 centers becoming overwhelmed, and they haven’t had to worry that other emergencies won’t be taken care of during the pandemic,” Gov. Wolf said. “That’s all because PEMA efficiently and effectively does its job.”
 
After the briefing, the three men took questions submitted by the news media:
 
What are the penalties for gyms that reopen? WOLF:  The real penalty is that people risk getting sick.  I’m not sure how gyms are regulated, al all but if they depend on a license from DoS, DoH,  that’s where the responsibility lies.  The real responsibility lied with the business  and the customer.  Every time they go to the gym, they risk getting sick.
 
Gym owners say that they can have fewer patrons and follow social distancing and provide health precautions in place and it would be safer than the crowded workouts people are having outside right now.  What is your response to that?  WOLF: Again , we’re looking at a situation where if you bring people together and they touch things that other people have touched they increase the possibility that they get the disease.  We’re trying to keep people safe, and every time people get together for any reason, they risk getting sick, and we want to keep that from happening.
 
At the very least, to survive, gym owners say they need a timeline as for when they can reopen.  Can the state provide that?  WOLF:  No, again, we have a timeline that’s being set by the coronavirus, not the state and we’re looking at ways to defeat that virus.  We’re taking advice from people who have done this before, from public health officials, from the federal government and local governments, the state and all of this is trying to keep people from getting sick.
 
NASCAR is scheduled to race at Pocono at the end of June.  On Friday you said you weren’t ready to make a decision about that race.  What criteria are you waiting for to make that decision?  Will you allow NASCAR to race without fans if Monroe County is in the yellow phase?  WOLF: Yeah, if Monroe County goes to yellow before that race and if NASCAR in fact has that competition without spectators in the stands and the follow guidelines to keep the competitors safe, then yeah,
 
Curbside retail has opened up across the bridge in New Jersey, but here it is not permitted in the red phase.  Why, Small business owners see restaurants being able to do curbside pickups. Why can’t retail?  WOLF: Actually retail is open now as of this Friday in 2/3 of the state, in the yellow phase.  Again, we’re trying to keep people safe.  The ore you congregate, the less you stay home, the more you give the virus an opportunity to spread. We need to avoid contagion and congregating.
 
Lots of people were seen over the weekend at the beach in south Jersey many without masks.   Is there a concern that this region with see an uptick?  Also can you discuss how some outdoor activities can be low risk as long as you have a mask on? WOLF:  OK  I wouldn’t go to the beach. You’re putting yourself at risk.  I wouldn’t do that, and I haven’t done that.  I’m not sure why the Governors of Maryland and New Jersey have opened their beaches, but they have.  The mask protects other people, When I wear a mask, I’m protecting you from getting anything that might come from myself. When you’re not wearing a mask, you’re being fairly cavalier about the people around you who you might care about very much..
 
A Bucks County gym reopened this weekend despite being in a red zone.  What message do you have for the owners, and who is responsible for enforcing the business shut down order and how are they going to ensure other businesses don’t follow that gym’s lead. WOLF: First of all, I’m not sure about the enforcement, but no one in public life should want to put their customers in harm’s way, and that’s where if you were the owner of a gym, where you’re close together and you touch things that other people have touched, that’s just not someplace I would feel comfortable going.
 
This past weekend marked the first weekend most of SW Pennsylvania was in the yellow phase.  Are you getting any information on how things went in the region this last weekend?  WOLF:  I talked to the County Executive, and he said not too many people are coming into downtown Pittsburgh. We can do anything we want in terms of snapping our fingers and going from red to yellow to green, but ultimately the people are the decisionmakers.  And they can decide as apparently they did in Pittsburgh this morning, that they are not going to show up, that’s the reality we’re all trying to deal with. They are trying to understand what that virus is going to do. They are trying to fight the virus as we all should be.  And that’s a good object lesson, that some things are different now that the southwest is in the yellow zone, but at the same time, so many things haven’t changed because people  are still looking to feel confident
 
During your Friday announcement, you seemed to suggest that most Pennsylvanians don’t understand the risks of COV. After two months of self-distancing and putting their lives on hold, to flatten the curve, we have succeeded in that.  You appear to be telling people who are wondering why flattening the curve goal wasn’t enough that they just aren’t smart enough to understand the risks  of which they’ve been reminded every day, and that they can’t be trusted to do the right things.  Was that the intention of your remarks on Friday?  WOLF:  Absolutely not.  The ultimate arbiters of success here are the people of Pennsylvania.  Every single one of us.  A lot of people like me, who haven’t been trained in Public Health can learn a lot, but ultimately, we each have to make our own decision.  We are the experts.  Each and every Pennsylvania making that decision has done phenomenal things for Pennsylvania.  Drexel said today that what Philadelphians have done has saved 7,000 lives just  in Philadelphia by staying at home and reducing the possibility that the virus would spread.  That has saved lives.  The idea is that there are things we can learn.  how to deal with a virus like the coronavirus,  We have done a phenomenal job.
 
US Representative Scott Perry called for a federal investigation into your administration, alleging you have failed to adequately protect senior citi
zens in long term care facilities during the pandemic. How do you respond to this?  Do you think it is another example of politics getting in the way of recovery efforts?  WOLF: I think that question ought to go directly to Representative Perry, but let me just point out that we have weekly calls with the Congressional delegation where Sec. Levine and others give a briefing,  an update on what’s happening with the epidemic in Pennsylvania, and that is an opportunity to make sure that we’re sharing information, and in terms of challenging the Commonwealth on what we’ve done, that’s the nature of a democracy and I welcome those questions and criticisms.
 
As of now do you see having to extend the Philadelphia region’s stay at home order past June 4, or should businesses and residents there prepare as if it is when they will enter the yellow phase?  WOLF: We haven’t made a decision, Philadelphia has its own health department and we are communicating  daily, and I think we’re all trying to do the same thing, which is keep people safe.