May 22 Morning Pennsylvania COVID-19 Update


  • Governor moves 12 counties to yellow, teases more changes
  • Questions abound over DoH long term care facility numbers.
  • Thursday’s COVID-19 data update
  • Levine answers press questions

·        House Committee passes resolution to terminate emergency order

  • FDA fact sheet published re tests and basics

Governor moves 12 counties to yellow, teases more changes Friday
The Governor officially signed an extension of the state’s orders moving 12 counties from red to yellow phase on Friday at 12:01 a.m. 
At the same time, he said he will announce Friday more counties that will move from “red” to “yellow” in his color-coded system of lifting coronavirus restrictions, and — perhaps — the first counties that will move to “green.”
The governor said during a media call on Thursday, “I’ll be announcing a whole range of counties tomorrow moving from red to yellow. The hope is that we’ll also be making some counties that might even be moving from yellow to green tomorrow.”
Data errors mar DoH reports on long term care facilities
Two days after the state released a list of nursing homes where the coronavirus has infected or killed residents or staff, Secretary Levine admitted there are errors in the data.
“I have heard that there were a small number of errors,” Secretary of Health Rachel Levine said Thursday, after being confronted by lawmakers who said facilities in their districts were reporting different numbers of cases than the state had posted on its website. “We’re correcting those.”
The secretary’s comments sought to minimize the extent of the problem, as nursing homeowners and the associations that represent them say the health department’s data is riddled with inaccuracies and, despite knowing about it for days, officials took little action in response.
Provider associations said publishing erroneous data has sown panic and anger among family members, distrust among nursing home staff, and frustration for providers.
The department has been quietly making changes to the data since its release. In perhaps the most egregious examples, the state until Wednesday reported 20 deaths at the Jewish Home of Eastern Pennsylvania and 32 at Saunders House in Montgomery County. But by Thursday, without any notation  or acknowledgment, the state’s data showed no deaths at either facility.
The Pennsylvania Health Care Association first notified the department of inaccuracies Tuesday evening, just hours after the list was posted. On a call with the health department Wednesday, the association asked for the data to be taken down, but health officials refused. The association is now threatening legal action to force the department to remove the information until it can be corrected.
Health department spokesperson Nate Wardle said the nursing home data shared with the public was meant to come directly from the facilities, but not enough providers reported the information in time. Instead, the health department used its electronic disease surveillance system, which matches case information and facility address, to compile its own list.
Nursing home administrators said the health department only requested the data on Friday afternoon with a deadline less than 48 hours later. As they juggle multiple state and federal reporting requirements and caring for residents, that’s simply not enough time, many said.
State officials initially resisted releasing the data, saying it was too messy and that it was protected by a decades-old disease privacy law. But they eventually reversed course following a regulatory change that mandated long-term care facilities report cases to federal officials. The list was first published on the health department’s website Tuesday.
Now, as reports of inaccuracies in the public data pile up, some worry its release is doing more harm than good.
On Thursday, the Department of Health reported that Pennsylvania had reported 980 new confirmed positive cases in the previous 24 hours, for a total of 65,392 confirmed cases.   
The death total rose to 4,869 confirmed COVID-19 deaths, an increase of 102 from  Wednesday’s report, in 53 of the state’s 67 counties.
This includes 4,871 positive cases in health care workers and 14,113 positive cases among residents of 570 long term care facilities.
Just 1.8% of all deaths were among those 30-49, 10.6% were in patients 50-64, 29.2% were among those 65-79, and 58.2% were in those ages 80 and above.
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 Wednesday, 35,909 positive cases (55%) were female and 28,799 (44%) were male. One percent (684)  were unreported or neither. 
By race, 17,102 positives were Caucasian (26%), 7,795 were African-American (12%) and 868 (1%) were Asian, with 356  listed as “Other.”  The vast majority, 39,271 (60% of all cases) remained unreported on the race of the patient. 
On Thursday, 1,654 positive patients were hospitalized. At that time, 347 were using ventilators and 14 were on ECMO machines.  About 1,380 (38%) of the 5,199  intensive care unit (ICU) beds were available, 6,150 general medical beds (45%) were available and 1,389 (53%) of the airborne isolation rooms are still available statewide.  And 1,260 of the state’s 5,393 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. 
Q/As for Dr. Levine
Is the state following CDC guidelines for reopening, and if not, why not?  LEVINE: The CDC guidelines were just released. We’re reviewing them and overall we are following the tenor of the phased guidelines. I’m not sure we’re following each level the way they describe it, but we’re following the general principles of those guidelines.
The owner of a Delaware County barbershop reopened against orders, and said that she wouldn’t have had to do that if her employees had received government relief.  She also said that barbers are trained in infection control. Do you have a response to her statements, and will action be taken to revoke licenses of barbers who reopen against your orders?  LEVINE:  It’s hard for me to talk about that individual circumstance, which I hadn’t heard of before. We’re hoping that barbers and other professionals where there’s hands on care will not open until we are able to get to the green zone.  It’s not that they can’t follow infection control principles and that they cannot keep their clients six feet apart, etc.  but by definition their care is hands on and until they are in a green zone, we are concerned about community spread.
There are CDC guidelines we would want them to follow, and we would want them to follow all of those guidelines.
What can you tell us about the first pediatric death in the state?  Was it a coronavirus case, or a PMIS case? How old was the child and where did it occur? LEVINE:  I cannot give specifics about the individual, but it was a case of COVID-19, not PMIS and the individual was not a resident of Pennsylvania.
Does the state have data on PMIS cases statewide?  LEVINE: We are gathering data and there are two confirmed cases, and several others that are not confirmed.  They are receiving excellent care from our hospitals and especially our children’s hospitals.
What does the Governor think of a bill that would allow restaurants to open with outside seating in yellow zones, and is that feasible if restaurants follow
safety guidelines?
LEVINE: I’ll let the Governor speak for his own feelings.  He has a press briefing coming up.
One year ago today, the Commonwealth declared a hepatitis A outbreak.  How was the curve flattened and is possible we could see a similar curve with COVID this time next year?  LEVINE: That’s a very interesting question, we worked with our county health departments and our community health nurses to work on stemming that outbreak.  The difference is that there is a very safe and effective vaccine for HepA, and we were able to prevent that spread by implementing the vaccine.  There is no vaccine for COVID-19 at this time, and I know that there is a lot of work at the federal level and with educational institutions, research institutes, and when there is a safe and effective vaccine for COVID-19, and distribution of that, I believe we will be able to stem the outbreak of COVID-19.
How closely did you work with legislators on the two bills that would appropriate $500 million to long term care facilities? LEVINE:  As a cabinet member, I do not usually comment on legislation that’s pending in the House or Senate, so I will leave those questions to the Governor and the Governor’s legislative office.
Can you explain in detail the computer problem yesterday?  Can you share what you are doing to prevent this in the future?  LEVINE: It was an IT computer problem, and the IT folks working for the Office of Administration fixed it, and I’m sure we’ll be able to prevent it from happening again.
According to the three day figures on your website, there is an uptick in positive cases in the Northcentral, Northwest and Southwest regions of the state. Does this give you pause or mean that community spread will happen as communities transition to yellow?  LEVINE: We’re watching all those trajectories very closely, and remember it’s only been 3 days’ worth of data and we’re looking at seven day segments.  There is no indication that any of those counties need to go from yellow to red, but we’re going to be watching that very closely, through our testing our case investigations and our contact tracing.
Carbon County goes into the yellow zone tomorrow.  But it’s surrounded by red counties.  Because natural areas like the Lehigh Gorge and Jim Thorpe are tourist destinations, how seriously are you concerned abut spread of the virus from tourists traveling in and out of Carbon County? LEVINE: It’s one of the things we look at very closely, the CMU model has aspects that look at transit through and around counties.  We of course want people in red counties to please stay home.
You’re recommending people don’t go to the Jersey Shore…are you also recommending people don’t take a day trip into the yellow zones?  LEVINE: As we have been saying repeatedly, if you are in a red zone, we want you to stay home.  Now if its nice out and you want to go outside, that’s fine, but we’re really not recommending people take long trips, as the Governor has talked about, to the Jersey shore.
Do you have an update on what criteria will be used to move counties into the green phase?  And do you have any new information on the number of recoveries in the state?  LEVINE:  We’re working on both those pieces of information and we’ll have data very shortly.
Do you expect Governor Wolf to move more counties into the yellow phase tomorrow?  IS there any hope for Dauphin and Lebanon Counties based on the data?  LEVINE:  We’re looking at that today among our team and we’ll make recommendations to the governor and then the Governor will make decisions.
The CDC released its guidance for taverns and restaurants and schools to reopen this week.  Have you seen those and how will PA incorporate those when we go green? LEVINE: We have seen those, and as we release the metrics to go into the green zone, we’re also looking at what life in the green zone would be like, especially for business, restaurants, etc.
What are the acceptable and approved activities for dentists now?  For example, besides emergencies, what else?  LEVINE:  Acceptable activities in yellow and red zones include acute and urgent issues.  Someone might have a toothache or a cavity – that’s not an emergency, but it’s acute.  We’re not recommending cleanings or your regular six month checkups in the red and yellow zones, but that would be for green zones.
The CDC says the novel coronavirus does not spread easily through objects and surfaces.  Does this change any of the guidance for businesses and individuals?  LEVINE:  We’re going to look at that, examine the data it’s based on and then we will consider if there need to be any changes.
A story in The Atlantic is reporting that Pennsylvania is mixing the results of viral and antibody test results in the daily totals of positive cases being reported.  Is this true and why is it appropriate to mix the result of these tests together, as these tests analyze two different things?  LEVINE: When we give you results, there are some that have those antibody test results, but in our own internal data and what we have on the website, we have confirmed cases and probable cases. Antibody tests and considered a probable case, not a confirmed case.  If they get tested for the virus and are confirmed positive, they will move to the confirmed case totals, and if they test negative, then they wouldn’t be included at all.  What’s very important is that we only use confirmed cases when we make decisions on counties going from red to yellow or from yellow to green or any other transition.
What advice do you give in light of the CDC report on surfaces?  For example, do you still suggest people wipe down grocery products that they bring home?  LEVINE:  I would continue to do everything that people have been doing until we learn more about that data and the studies it was based on and give it more time and stay cautious.
Earlier this week, it was announced that a major regional interstate motocross event with thousands of people attending would be held June 1-5 in Greene County.  Why is the state allowing an event like this to be held, but youth baseball, involving just 20-30 people is prohibited?  LEVINE:  I’m not aware of that event, so we’ll have to check with the Governor’s Office to see about the validity of that report.
For the last several weeks, the state has urged health care workers to use the Botelli system which cleans N95 masks for reuse up to 20 time.  But recent reports from doctors and nurses suggest the masks begin to degrade after just 2-3 cleanings.  What advice have you or would you give to health care providers overusing this system?  LEVINE: We have heard great things about this system. I have not seen this report, but we will be checking on it.
One county with just ten reported positive cases said it sent a letter to the state asking to partner with you to work on the metrics to move from yellow to green, but that it had not gotten a response. Is the state open to working with local leaders to establish these policies? Why or why not? LEVINE: We’re always willing to discuss our metrics with local leaders.  We are working on those metrics and will be ready to announce them very soon.  I am unaware of this letter, but we’re always pleased to have discussions.
Do you have any response to concerns that the Department ordered long term care facilities to readmit stable COVID-19 patients on discharge from hospitals?  Critics have said that this action contributed to the spread of the virus in nursing homes.  LEVINE:  We’ve done a deep dive on that, and that guidance actually has come from the federal government from CDC and also from CMS, very specific guidance that if a patient had to be hospitalized and having to go back to the same facility.  A
number of things are important to remember.  That was specifically federal guidance, the same guidance many other states have followed, and for the vast majority of those patients, they contracted the virus in the facility, and the guidance included cohorting them with other patients with the virus.  At the same time, there was significant concern about overwhelming the hospitals, and not wanting patients to just stay in the hospital because of the need to have those patient beds.  So I have no concerns about that initial guidance. We are continuing to look at all of our guidance to see if anything needs to change, but that was the federal guidance at the time which we followed.
Why won’t the state release the names of the food processors with outbreaks of the virus and the number of cases and deaths of each one?  LEVINE:  We have been giving congregate(sic) data on that, they are licensed by the Department of Agriculture, and I’m not sure of their regulations. We can have those discussions but at present I am not releasing them.
What is your response to the fact that there are many reports that the information being made public on your website about long term care homes are incorrect, in some cases where there are no cases, with the facility being reported as having several?  One said they contacted the Department immediately and were told they were aware  there were mistakes and were making changes on this publicly shared information, that this data would be removed, but the information was still on the website this morning.  LEVINE:  That information currently comes from NEDDS, I had heard that there were a few errors on Monday, those have all been fixed, and In the future, the goal is that we will be putting out that data from the surveys we have sent to these facilities, to be consistent with CMS data. This was just requested Sunday, and when we get a full report, we’ll be putting that out.
What information is most crucial when the state considers a request form a county to move from the red to yellow before June 4?  LEVINE:  There are many metrics we’ve been looking at, incidence rates, the model that’s from Carnegie Mellon, the trajectory animations, their hospital and ICU bed capacity,  the capacity to do contact tracing and laboratory testing.
The state has reported results from about 140,000 tests.  The Governor wants weekly reports from nursing homes of about 135,000 tests per week.  How are you going to accomplish this in nursing homes, considering statewide testing is nowhere near that level? LEVINE: Today we announced results of about 13,000 tests, so our testing ability has increased significantly.  We are going to prioritize certain facilities that are impacted, and then we are looking to test of the patients and all of the staff throughout the state. The testing capacity is there to do that.
Tomorrow Beaver County moves to yellow, the last southwestern county to do so. What would you say about the results in the southwest with all of its counties in the yellow phase now? LEVINE: The southwest has been very successful, and Beaver county has done well, and we have every expectation that if that continues, Beaver County will be able to eventually move to green.
Casinos have offered their thoughts on actions they will be taking for when their local counties move into the green.  Have you given any thought to what advice you might give casinos before they can reopen when their counties move to green?  LEVINE:  I’m not sure I have any specific advice for the casino industry, but if they publish recommendations, they will go to our staff and the governor’s staff and we’ll come out with our own recommendations.
Can coronavirus travel through smoke? LEVINE: I don’t know the answer to that question.  We’ll have to look that up and see if anybody knows that. We certainly know that smoking is bad for you and if you have chronic lung disease, that would make you more prone to lung complications due to COVID-19.
Can you talk about the frustration about people who still don’t understand that social distancing and wearing masks is keeping the virus from spreading as much as it could have?  LEVINE:  We will continue to get that message out, That’s why I’m here almost every day repeating those messages, so that people understand it and can follow the guidance.
If the CDC hadn’t made the reporting about where a patient died, why make the change now? Coroners say its confusing to their constituents who want to know who died.  LEVINE: We have always reported it this way, and we have not made any changes. It is different from how Coroners report their deaths according to their regulations and laws.  We’re just trying to explain the difference.
House Committee passes resolution to terminate emergency declaration
A resolution to terminate the current COVID-19 disaster emergency declaration advanced out of the House Veterans’ Affairs and Emergency Preparedness Committee Thursday
The 90-day emergency declaration, issued on March 6, would end in roughly two weeks, but proponents of the resolution, argue there’s nothing to prevent Wolf from renewing that declaration for another 90 days, which he’s done 90 days at a time with regard to his current opioid disaster declaration since he first issued it on Jan. 10, 2018. Wolf on Thursday afternoon said he plans to renew the declaration, though he's not sure how long it would be necessary.
The resolution was advanced by the committee on a party-line vote, a “political divide” Chairman Barrar said he believes was a first for his committee during the last 10 years. Both he and Minority Chair Chris Sainato, D-Lawrence, indicated the members of the committee “are all friends here” and that the vote was simply an example of a rare policy disagreement among the committee’s membership.
While the immediate effort to address the virus outbreak was necessary, HR836 supporters argue what’s happening now isn’t working, and it’s actually making matters worse, while also denying rights the Pennsylvania Constitution does not allow Wolf to suspend or limit.
HR836 prime sponsor Rep. Russ Diamond, R-Lebanon, during Thursday’s committee meeting pointed the committee to a section of the Governor’s March 6 disaster declaration, which states, “WHEREAS, this threat of imminent disaster and emergency situation throughout the Commonwealth is of such magnitude and severity as to render essential the Commonwealth’s supplementation of emergency resources and mutual aid to the county and municipal governments of this Commonwealth and to require the activation of all applicable state, county, and municipal emergency response plans.
Committee Democrats did suggest the current declaration has only about two weeks left to it, and that when it comes time for the Governor to decide if he’ll renew the declaration, then the General Assembly could have a conversation with him and potentially register its opposition to a renewal. Republicans countered that Wolf has not sought legislative approval for anything he’s done thus far, he’s not sought approval for his renewals of the opioid disaster declaration, and his comments about the current situation suggest he has no plan to discontinue the declaration anytime soon, despite the concerns being raised by both health care and economic experts about the growing health and financial costs of the continued quarantine and social isolation of most Pennsylvanians.
When asked about his plans on Thursday afternoon during a conference call with the media, Wolf said it is his intention to renew his disaster declaration, though he indicated that it remains to be seen if it would be needed for another 90 days, and he hoped that would not be the case. He said his decision is due to there being several counties still in the “red” phase of his reopening plan, with thos
e counties under the most stringent mitigation policies because of what the Wolf administration has determined to be a significant, continued presence of the virus.
Concerns were also raised by committee Democrats regarding the potential impact that a termination of the disaster declaration would have on federal CVOID-19 funding, both current and possible additional funding in the future. Wolf echoed those concerns during his media call, suggesting federal dollars would be jeopardized should the declaration be ended.
Republican committee members indicated they have been in contact with federal officials who indicated current funding has already been approved for Pennsylvania, and a cessation of the disaster declaration will have no impact on that. As for future funding, some members suggested that terminating the declaration doesn’t mean the disaster didn’t happen, and wouldn’t likely preclude receiving additional funding for the disaster that’s already occurred; other members added that if it did come down to a choice between future federal funding and ensuring the freedom of Pennsylvanians, they’d tell the federal government to keep its money.
Wolf on Thursday told reporters he has the authority to veto the resolution, which he would do as he said terminating his order would put Pennsylvanians at risk and jeopardize federal disaster funding.
However, others look at the plain wording of Pennsylvania statute, suggesting all that is required to end the declaration is House and Senate approval of the resolution.
When asked about that hypothetical situation, Wolf said he can veto the resolution.