May 1pm COVID-19 Update – Pennsylvania American College of Physicians

May 1 (afternoon) Pennsylvania COVID-19 Update

Governor announces 24 counties moving from “red” to “yellow” May 8
Gov. Tom Wolf announced Friday that 24 counties in rural northern Pennsylvania will see some relief from his strictest orders for residents to stay at home and businesses to close as part of a strategy to contain the spread of the coronavirus.
All of the counties that are moving from “red” to “yellow” in Wolf’s color-coded reopening plan are in the northwest and north-central regions of Pennsylvania, which have seen far fewer virus infections and deaths than the rest of the state.
The changes are to take effect next Friday, May 8. Stay-at-home orders will be lifted, and retail shops can start to reopen, though other restrictions will remain in place.
The counties to be included in Wolf’s announcement Friday are Bradford, Cameron, Centre, Clarion, Clearfield, Clinton, Crawford, Elk, Erie, Forest, Jefferson, Lawrence, Lycoming, McKean, Mercer, Montour, Northumberland, Potter, Snyder, Sullivan, Tioga, Union, Venango and Warren.
Wolf said population density – and other criteria like contact tracing and testing plans in place were considered in making his decisions. 
Many businesses will be reopening with re-engineered business models, he said. This includes retailers, and services such as childcare. He noted that outbreaks are still possible and those gyms, theatres restaurant dining rooms and school buildings would not reopen even under yellow. Visits to nursing homes and prisons will still be prohibited. 
“Regardless whether you are still in a stay at home order, we need to maintain social distancing,” he said. Stores can use curbside pickups, and telework as much as possible and have employees stay physically away from each other as much as possible.
He said, “If we see an outbreak, we’ll have to revert to the red category until the cases fall again. “Those in these areas, should strongly consider their actions.  Those in stay at home orders can make choices that will allow us to transition more quickly.”
He noted that many counties in the SW and a few in the Southcentral regions have low case rates, but we want to maintain public safety all of us working together.  He urged residents in yellow areas to continue social distancing, to allow moving into Green phase.  “We all should aspire to this.  Your actions will determine our future.”
Wolf said, “We should be proud we should feel motivated. I’m in awe of the strength shown by Pennsylvanians.”
On Friday, the Department of Health reported that Pennsylvania had found 1,397 new confirmed positive cases in the previous 24 hours, for a total of 46,971 confirmed cases.  The death total rose to 2,354  total confirmed COVID-19 deaths, an increase of 62 from Thursday’s report, all in adult patients. 
The state Health Department’s breakout of virus data for long-term care living facilities indicates 1,560 of the state’s deaths, 66 percent, were nursing home residents.  There were 180,477 negative tests in PA as of midnight Thursday night.
At least 2,807 are health care workers – accounting for about six percent of all positive cases; the total figure includes  1,097 workers in nursing homes. And from the department’s website, 8,478 cases – accounting for nearly 18 percent of all cases- are in 474 of the state’s long-term care living facilities in 42 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+.  The remainder were unclassified yet per age.
Of the total through Thursday, 25,452 positive cases (54%) were female and 20,918  (45%) were male. One percent (601) were unreported or neither.  Among the deaths, 1,212 (52%) were males and 1,130 (48%) were female with 12 unreported by sex.
By race, 10,144 positives were Caucasian (22%), 4,951 were African-American (11%) and 519 (1%) were Asian, with 219  listed as “Other.”  The vast majority, 31,138 (67% of all cases) remained unreported on the race of the patient.  A total of 866 deaths were among Caucasian victims, 230 were African American/Black, 26 were Asian and eight were listed as other.  1,224 deaths were not reported by race.
On Friday at noon,  2,677 positive patients were hospitalized, slightly more than six percent of those testing positive.  At that time, 561 were using ventilators or breathing machines.  About 1,369 (about 39%) of the 5,199  intensive care unit (ICU) beds were available, 6,935 general medical beds (46%) were available and 1,672 (53%) of the airborne isolation rooms are still available statewide.  And 1,423 of the state’s 5,344 ventilators were in use (70% 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; 38% are aged 25-49; 27% are aged 50-64; and 27% are aged 65 or older. 
Levine said that the state had developed and was providing their plans for contact tracing and testing:
She said the state is Investing in infrastructure focused on people. They plan robust investigations, partnering with established health care community, and looking at vulnerable communities. Community health nurses, case investigators and teams with partners, academic institutions, volunteers and hiring personnel when needed.  A new alert system is set up that will help with daily check-ins with contacts.  They plan to carefully collect data on race/ethnicity. And to focus on large congregate settings, food processing and packaging plants, health care, workers, prisons and nursing facilities. 
She said that a CDC Senior policy advisor was being housed permanently at DoH for this, and that they would also be using grad students.
Levine said Increased testing capacity is a critical aspect in moving from red to yellow to green.  The state strategy is to make this testing accessible and available for all symptomatic Pennsylvanians and be  adaptable.
She said testing widely would be available by partnering with retail pharmacies and FQHCs, target resources in long term care and skilled nursing facilities, personal care homes, and that the DoH would build our community based testing sites.
Equipment and materials would come from working with DCED and other state agencies PEMA and federal partners. DoH will determine who is tested based on best science available.  DCED will seek out FDA approved testing supplies needed.  PEMA will assist in deploying testing to communities.  She said, “We will remain flexible.  New technologies  are developed, and more data will be made available. 
“Our goal has been to save lives while assuring the system doesn’t become overwhelmed by taking care of people with COVID-19.”
Questions to Governor Wolf:
When cases of COVID Spike, what are the metrics to go back to red and how will that be announced?  We’re going to try to keep people safe.  We will look at it like teaching a child to ride a bike.
Some people working from home fear they will be forced to return to an office too small for social distancing  Do they have a choice?  As a former employer, I’m sure every employer will do everything they can to have their employees safe. The reality of the virus is its’ easy to infect somebody.  If we don’t do the right thing, the virus will spread.  Businesses have every incentive to encourage telecommuting.
As businesses gradually reopen, will employees lose unemployment benefits if they have to stay home to take care of their children?  I’m not an attorney but I’ll have Lindsey get you an answer to that question.  I’m not sure the UC system allows for that.
Will continued closure of license centers affect voter registration, and how will you address it?  If you apply online, you can register with the last four digits of your Social Security Number.  We will continue to work on that, and it shouldn’t be a hindrance on registering.
Is it your intention to do a weekly update or more frequently?  We haven’t talked about that, but we want people to be safe.  We’re learning to ride a two wheeled bicycle.
Can churches open?  They can have services, but they have done everything they can to keep their congregants safe  We have a limit of 25 people congregating and that will continue to be operational.
What about Mitch McConnell’s idea about states filing for bankruptcy? I disagree with Sen. McConnell.
Do you expect state in green by June 2 election?  That is not a deadline, the virus will set deadlines, not dates.
Will you allow opening Home and Garden centers?  NO
How long before other counties are moving to yellow? Weeks or months?  Depends on how long it takes to control the virus.  To the extent we all work together, all those things can speed up the process.  We control our destiny.
Foster Care Alumni sent a letter about keeping people in the system what do you plan to do.  Vulnerable populations task force is working on a formal response to them right now.  We have a lot of work to do and will do all that we can.
A Berks County Commissioner is asking to forego regional and consider decisions county by county. Will you do that?  We have done that as we have reopened, with businesses across the state starting with essential businesses.  Golf, fishing, measured, logical and evidence-based way.
Food security is important.  Will you consider expanding Medicaid?  I did expend ma.
You suggested the SW and SC regions may be next.  Do you have a timeline?? The issues in the SW we’re starting with standpoint of keeping people safe.  Constraints over contact tracing, testing, takes infrastructure.  It’s up to the people in those regions as to whether we go faster or slower.
Would the state, with a $2.2 billion revenue deficit – are you considering changes to reflect that?  We are looking for ways to stay within the budget set last June.  For the next budget we’ll be working with the legislature with the understanding that revenues will be down
Will local or state buildings in yellow counties or courts reopen?  Yeah, the government offices will reopen but asking them to telework if possible and remotely if possible.  If they don’t, we won’t be able to stay healthy.  As for the courts, they have their own system.  We encourage them to keep people safe.
Why is Centre County, the hardest hit county being transferred to yellow with 100 cases while others with 40 cases remains in red. Center county qualified and they have capacities for testing and contact tracing other counties may not have.  It’s a very complicated issue, and Centre county can do it successfully.
QUESTIONS TO SEC. LEVINE: Little League cancelled the World Series, but they hope little leagues will be able to open. Can they do that in yellow? Organized sports are NOT going to be allowed under yellow – it means caution and it would not be caution to let organized sports play.
Counties have ability to do contact tracing and that a plan is in the works.  What gives you confidence that it will work on the ground?  What about  other counties?  Nurses have already started contact tracing in many of those areas.  We will make sure the case investigations and tracing move forward.  Looking to expand testing so we can do 2% of the population every month in every county.  Expand both and look forward to those counties moving.
Will remdesivir have an impact?  I think it is very positive.  It’s not a cure, but a medicine that can be used to improve outcomes to avoid ICU and ventilator. Public health impact, we’ll have to see.
Will numbers increase with more testing and some counties go back to red?  In central PA?  We are hopeful as the Governor pointed out that those in the yellow will continue to do the right thing, social distance, masks, avoid large gatherings.  Hopefully those counties and towns won’t have to go back to red.  We will try to prevent clusters and prevent them from becoming outbreaks.  Hard to tell you how long that will be. Then we’d go back to yellow.
Are you planning random testing in any of these phases ?  No testing of asymptomatic individuals as this time. However, hospitals and health systems area going to do more nonemergent procedures, and we are recommending they test all individuals before that procedure happens.  AS that rolls out it will provide some very useful data.
In long term care facilities, are COVID positive patients allowed in the same rooms as those who are not positive?  No.  We wouldn’t do that, because it would put those patients at risk.  We would not want someone in the same room as someone who is positive.  We are working to cohort patients that are positive.
Why are retail stores allowed to open but not hair and nail salons?  Those facilities, salons, barber shops, tattoo and massage parlors, no.  It’s impossible to practice social distancing when you have a hands on treatment.  If someone was asymptomatic and working there, they’d see a person an hour, they could expose a whole bunch of people and that’s how we get outbreaks.  They will remain closed until they move to green zone time.
Movie theatres are still closed.  Does this include drive in movie theaters?  If they can keep employees safe and people in their cars, would be able to open.
Are you hiring to do contact tracing? We are taking a measured approach, using nursing services in counties will be the lead, but with local officials, hospitals and health systems, students, all on a county by county basis.
How many does the state now have and how many have been hired?  I don’t have a number, but we will need more as more and more counties go from red to yellow.  Don’t have a specific number and will work with the Governor’s office to make the right decisions.
Allegheny County and the SW have low case rates as well.  Why isn’t Allegheny county and those counties included along with all the others.  We’re taking a very careful measured approach so that normal routines. The southwest isn’t moving from red to yellow because of population density.  We’ve seen the consequences in NYC. We felt it prudent and taking in our ability to do contact tracing and ability and population density, not prudent.
66% of the deaths are in long term care facilities, what scrutiny have you given them?  It is where thousands of individuals have contracted COVID, so in addition to guidance, working to push out PPE, whatever  is necessary.  Significant testing has been done in those facilities, but not asymptomatic individuals.  The staff who are positive will be isolated at home.  For residents, they will stay in facility and we will work to cohort those patients.  We will work to get them the treatment they need.  Our own staff are working with them on procedures and talk with them almost every day. Dedicating staff including our CDC officer to take over that entire project to make sure we’re doing absolutely everything we can.
Studies shown many more than we thought are asymptomatic.  Can this work if so many are? Eventually we want to do population based testing, but on a clinical basis it’s not helpful.  It’s aspirational.  We’ve had extensive discussions what tests, what companies we’d work with, point of care tests, frequently, working with DCED on incentivize those kinds of compan
Are we manufacturing our own tests? PA as a Commonwealth has companies that can do that – incentivize them to do that.  Right now we’re using a whole bunch of different tests, and any platforms we can get reagents for.  Some have developed their own tests, and Quest and LabCorp are doing this too.
Experts say it’s critical for anyone with  symptoms to get tested asap. Do you agree?  We want that testing to be more accessible particularly in those rural counties, and will look at mobile testing sites, etc. We’re not only in those areas but anyone throughout PA to get a diagnosis.
You said PA would be moving regions to yellow as a group, but this doesn’t do that. Why not?  We’re looking at regions and particularly counties. The DoH regions were just an example. We will continue to look at each to see they  meet the metrics and different modeling as well as other factors.  We made recommendations and the Governor made the final decisions.