May 4 COVID-19 Update – Pennsylvania American College of Physicians

May 4 Pennsylvania COVID-19 Update

On Friday, the Department of Health reported that Pennsylvania had found 962 new confirmed positive cases in the previous 24 hours, for a total of 49,267 confirmed cases.  The death total rose to 2,444 total confirmed COVID-19 deaths, an increase of 26 from Thursday’s report, all in adult patients.
The state Health Department’s breakout of virus data for long-term care living facilities indicates 1,194 of the state’s deaths, 67 percent, were nursing home residents.  There were 191,374 negative tests in PA as of midnight Thursday night.
At least 3,057 are health care workers – accounting for about six percent of all positive cases; the total figure includes 1,194 workers in nursing homes. And from the department’s website, 9,122 cases – accounting for 18 percent of all cases- are in 492 of the state’s long-term care living facilities in 43 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, 26,763 positive cases (54%) were female and 21,885  (44%) were male. One percent (619)  were unreported or neither.  Among the deaths, 1,262 (52%) were males and 1,171 (48%) were female with 11 unreported by sex.
By race, 10,889 positives were Caucasian (22%), 5,280 were African-American (11%) and 533(1%) were Asian, with 236  listed as “Other.”  The vast majority, 32,306 (66% of all cases) remained unreported on the race of the patient.  A total of 908 deaths were among Caucasian victims, 242 were African American/Black, 28 were Asian and eight were listed as other.  1,258 deaths were not reported by race.
On Sunday at noon,  2,634 positive patients were hospitalized, slightly more than six percent of those testing positive.  At that time, 573 were using ventilators or breathing machines.  About 1,524 (about 39%) of the 5,199  intensive care unit (ICU) beds were available, 7,269 general medical beds (46%) were available and 1,718 (53%) of the airborne isolation rooms are still available statewide.  And 1,400 of the state’s 5,347 ventilators were in use (74% 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. 
Questions for Dr. Levine:
On Saturday, Dr. Levine said that the Department was focused on long term care, skilled nursing facilities, assisted living homes as a serious issue.  She said the state’s Patient Safety Authority is working along with ECRI and DoH.  Noting that Pennsylvania is the only state that requires these facilities to report all cases of harm or potential harm, she said the Department is working to provide consultations to help stop outbreaks.  These congregate living facilities are an “important indicator of community spread.  The employees are subject to exposure from the rest of the community and counties.  That’s why our social distancing measures will continue to be so important,” she said.  “We have to protect and take care of the people caring for our loved ones.”
Dr. Levine took questions from the news media on Saturday:
We’re hearing from personal trainers, barbers, nail salons upset they are not permitted to reopen.  Why scientifically isn’t that possible? LEVINE:  This is a virus that’s transmitted through respiratory droplets in the air and on surfaces.  Even with masks, it’s not 100% safe, and if you’re in close contact with someone for 10 minutes or more it is more likely that there is an opportunity for community spread. Service like massage, barbers and salons doesn’t allow for being six feet away so they won’t be allowed to participate in reopening under yellow.
What do you say to those who feel they are being treated unfairly in the process?  LEVINE:  We don’t feel they are being treated unfairly.  The Governor and I have spoken about this.  We are dealing with an extremely dangerous virus and a global pandemic.  We have taken a measured approach in deciding to move all counties to red, and we’ll take the same measured approach in lifting these restrictions.
To your knowledge has anyone contracted COVID-19 from the rally April 20 in Harrisburg?   LEVINE:  I have no information on that and am not aware of anyone.
Day cares and childcare centers say they are ready to reopen Monday.  Why must they wait until next Friday?  LEVINE:  We feel it’s important to have time to get to reopening. They need that time.
What do you say to those who claim the decisions made on which counties can move are outrageous, because they were done regionally, not on a county by county basis which you said you would do?  LEVINE:  We’ve been extremely consistent.  We said we’d be talking about regions and counties within regions.  For example, there is a county in our northcentral region that can’t move to yellow at this time.  The Governor emphasized that.  When we look at other counties and counties within regions, we won’t stick to any specific schema, including the criteria, metrics, CMU modeling and qualitative factors that go into those decisions.
You said some counties can’t move to yellow because even though those counties have met the benchmarks, they have insufficient testing and contact tracing capabilities. But you haven’t said what those should be?  What are those requirements?  LEVINE:  We put out our testing plan as well as our tracing plan. Those are available on the website.
Looking at Gallup NM and the Navajo reservation outbreak flare up, what can we do to prevent that here in Pennsylvania?  LEVINE:  We’ve said all along that this is a dangerous virus that remains active, and we must be careful to maintain the social distancing measures we talked about.  Contact tracing, isolation of positives will be helpful.  And All of that continues in yellow counties. Retail stores have to use curbside pickup if possible and maintain social distancing inside the stores.  That’s why we won’t let competitive sports continue.  Plus we will continue laboratory testing for symptomatic individuals. 
Allegheny Co Executive Rich Fitzgerald was surprised that population density was among the qualitative factors you used in not allowing the SW counties to move to yellow.  Is this the latest instance in just not communicating your process? Why has the state struggled to clearly communicate the basis on which it makes those decisions and what would you say to those who are frustrated with or distrustful of the process as a result? LEVINE:  What I would say is that Gov Wolf has been extremely clear on the criteria.  We have outlined the role of population density in many of our discussions.  It’s why Philadelphia and New York City have had the problems they have experienced, and there is widespread transmission of a dangerous virus.  These are part of basic public health.  We will continue to do so.
Fitzgerald said yesterday that targets of testing 2% of population should be a goal not a hard and fast requirement.  You appeared to say this was true.  If the number is below 10% does that give Allegheny County any leeway?  LEVINE:  We will continue to talk with the county health department and with any counties going from red to yellow about testing requirements.
Fitzgerald said he’s hopeful the County could get the go ahead next Friday for moving to yellow on the 15th. Is that possible and what’s the timeline?  LEVINE:  We’ll continue to discuss testing plans, tracing plans in different counties, not just Allegheny.  The “Governor said we’ll be looking at
the SW so we will be looking at the Southwest.” We have no specific date, however.
Lafayette College had its first positive COVID-19 case this week. What words do you have for students who are eager to get back to campus. And what will go into decisions on opening colleges and universities?  LEVINE:  It’s hard to talk about the fall when we’ve just entered May, we’ve said all along the virus determines the timeline.  We know it’s very challenging for students in all grades that they are doing remote learning and not having the college experience that’s so valuable.  And that’s all through society with this global pandemic.  It would be dangerous in areas where there is communal spread.  A communal setting like a college is exactly where it would spread very quickly, so we’ll look at the data in the summer and as we approach the fall.
The NY Times reported that the federal government  reporting requirements will lead to identifying nursing facilities with COVID-19 cases by name.  Would you do that before the federal government releases those names?  LEVINE:  We’re looking at that and are weighing all those factors presently.  We’ll have to see what the federal government releases. Then we will have to balance privacy concerns,  as well as laws with transparently.  We are weighing all those factors presently.
Has the Department received complaints about LTC and nursing facilities refusing to release numbers of positives and deaths?  LEVINE:  No, we work with them and have had no challenges in terms of willingness to report.
Do you have concerns about people not practicing social distancing this weekend?  It’s wonderful with the nice weather it is much more spring-like so people can go outside, but its important to still practice social distancing.  You need to be wearing a mask, it’s still the midst of an international pandemic.
As counties prepare to begin reopening. How far off is the yellow phase from Southeast Pennsylvania?  LEVINE:  It’s impossible to say.  I speak with Philadelphia County’s health department director daily. It’s a difficult situation.  But I’m a positive confident person and I believe that will happen.
We’ve been getting reports of people who are clinically diagnosed with COVID-19, but testing negative.  Why is this happening and why the emphasis on testing to stop the spread?  LEVINE:  There are a number or reasons people may test negative.  It could be a mild infection, could be how the sample was obtained, we have false negatives and false positives, and there are other respiratory viruses that the patient may have.  We’re watching those factors carefully.
Can you review the outdoor guidelines as DCNR plans to reopen outdoor spaces? Will people congregate and spread the virus?  LEVINE:  Their plans and our guidance are available on our website.  We have worked with Secretary Dunn so that people don’t come together.  We want people to enjoy the outside, and go to state parks but we still need to practice social distancing.
What progress does Allegheny County need to make to move to the yellow zone?  LEVINE:  Testing and tracing plans, data for the County and other southwest counties, not just on a regional basis.  We will look at the modeling, then we make evaluations and recommendations and the Governor then makes his decisions.
When you said you wouldn’t stick to any specific schema, you seemed to contradict what happened on Friday .  Except for Columbia County it appears you stuck to the Regional schema.  LEVINE:  WE are looking at counties and counties within regions.  Now we’re looking at the southwest and counties near southwest Pennsylvania, to see which counties could go from Red to yellow.
Can you outline what the daily new normal looks like in yellow? LEVINE:  We want them to continue practice Social distancing, and wear masks, but businesses can be open.  We want workers to telework as much as possible, but business has to maintain social distancing, and with retail businesses we prefer curbside pickup but no more than a certain amount of people in a store and no more than 25 people congregating  This will help stimulate the economy in those areas and get people earning paychecks.
What is your reaction to FDA granting approval of remdesivir as a treatment for COFID-19?   LEVINE:  Okay, I can’t pronounce it.  Looking forward to having more and more patients treated and more hospitals obtaining that.  It’s a very positive step, but its not a cure or preventative, and can’t be taken orally, only intravenously.
What have studies shown about COVID-19 and pregnant women?   LEVINE:  I know that some studies have been done on that subject.  The babies have been well, but this data needs to be studied very carefully.
CMS waives rules to boost testing
The agency is encouraging more coronavirus testing in pharmacy parking lots by allowing pharmacists to test people and partner with practitioners to bill Medicare, David reports.
Medicare and Medicaid will also cover certain antibody tests, including lab processing of some FDA-authorized self-test kits for home use. Medicare will pay providers to collect specimens from the program’s beneficiaries.
HHS releases additional funding for hospitals
On Friday, the US Department of Health and Human Services (HHS) announced distribution of $12 billion to 395 hospitals who provided inpatient care for 100 or more COVID-19 patients through April 10, $2 billion of which is being distributed based on their Medicare and Medicaid disproportionate share and uncompensated care payments.
These 395 hospitals accounted for 71 percent of COVID-19 inpatient admissions reported to HHS from nearly 6,000 hospitals around the country. The distribution uses a simple formula to determine what each hospital receives: hospitals are paid a fixed amount per COVID-19 inpatient admission, with an additional amount taking into account their Medicare and Medicaid disproportionate share and uncompensated care payments.
Seventeen Pennsylvania hospitals received funds from this payment account, with the $323,633,599 for inpatient care and an additional $68,458,903 for hospitals treating low-income and uninsured patients.  Of the latter total, $43,442,363 went to hospitals in Philadelphia.
Additionally, rural hospitals, many of which operate on thin margins, have been particularly devastated by this pandemic, as the Governor’s emergency orders prohibited elective services and healthy patients delayed care.  Among the recipients of the $10 billion rural distribution are rural acute care general hospitals and Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), and Community Health Centers in rural areas.
All clinical, non-hospital sites will receive a minimum of at least $100,000, with additional payment based on operating expenses. Rural acute care general hospitals and CAHs will receive a minimum of at least $1 million, with additional payment based on operating expenses.
In Pennsylvania, 156 rural facilities are to receive $231,148,801.
HHS and the Administration are continuing to work rapidly on additional targeted distributions to some providers including skilled nursing facilities, dentists, and providers that solely take Medicaid.
Visit for additional information.
Wolf, other Northeast, Mid-Atlantic state Governors join forces
Gov. Wolf and governors from six other states Sunday pledged to join forces to build manufacturing capacity to make testing kits, PPE and ventilators for the health care system in the fight against covid-19.
“Working together we can combine our strengths to build the capacities we all need. We can explo
it our market size to encourage producers to make what we need, we can exploit our financial strength to give that encouragement added weight, and we can exploit the great research institutions and the brainpower in our region to increase our chances of success,” Wolf said in a phone conference with New York Gov. Andrew Cuomo, New Jersey Gov. Phil Murphy, Connecticut Gov. Ned Lamont, Delaware Gov. John Carney, Rhode Island Gov. Gina Raimondo and Massachusetts Gov. Charlie Baker.
That action is expected to reduce costs and stabilize the supply chain, so that states don’t battle each other for critical supplies, driving up the prices.  Wolf said it is critical for the reopening the economies of the states to instill confidence that people can safely return to work and to reopen schools.
Representatives from Pittsburgh-based UPMC and Allegheny Health Network and Excela Health in Greensburg, have stated they do not have a shortage of protective equipment.
The states will also coordinate policies regarding the inventory of PPE each state’s health care infrastructure should have to prepare for a possible second wave of covid-19, as has been predicted by federal health care officials.  Policies are to be coordinated as to the supplies local governments should have on hand for first responders, and whether any requirements are needed regarding PPE for non-profits and the private sector.