May 5 COVID-19 Update – Pennsylvania American College of Physicians

Health Department sets interim guidelines for ending isolation
The Pennsylvania Department of Health (DOH) Monday released updates based on guidance released by the Centers of Disease Control and Prevention (CDC) on May 3, 2020, for discontinuation of isolation for persons with COVID-19 not in healthcare settings.

• Discontinuing home isolation for symptomatic persons with COVID-19 should be based on local circumstances and can be symptom-based or test-based.
• Using the symptom-based strategy, DOH is recommending that persons with COVID-19 under isolation not in healthcare settings be released from isolation after a minimum of 10 days after symptom onset and after 72 hours of being afebrile and feeling well.
• Discontinuing home isolation for asymptomatic persons with COVID-19 should be based on local circumstances and can be time-based or test-based.
• Using the time-based strategy, persons who tested positive for COVID-19 who have not had symptoms may discontinue isolation after 10 days have passed since the date the positive specimen was collected.

This guidance is based on available information about COVID-19 and subject to change as additional information becomes available.
 
PA COVID-19 DATA UPDATE
On Monday, the Department of Health reported that Pennsylvania had found 825 new confirmed positive cases in the previous 24 hours, for a total of 50,092 confirmed cases.  The death total rose to 2,458 total confirmed COVID-19 deaths, an increase of 14 from Sunday’s report, all in adult patients.
 
The state Health Department’s breakout of virus data for long-term care living facilities indicates 1,646 of the state’s deaths, 67 percent, were nursing home residents.  There were 195,498 negative tests in PA as of midnight Sunday night.
 
At least 3,084 are health care workers – accounting for about six percent of all positive cases; the total figure includes 1,224 workers in nursing homes. And from the department’s website, 9,345 cases – accounting for 20 percent of all cases- are in 494 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, 19% were 65-79 and 19% were 80+.  The remainder were unclassified yet per age.
 
Of the total through Sunday, 27,245 positive cases (54%) were female and 22,231  (44%) were male. One percent (616)  were unreported or neither.  Among the deaths, 1,267 (52%) were males and 1,180 (48%) were female with 11 unreported by sex.
 
By race, 11,098 positives were Caucasian (22%), 5,394 were African-American (11%) and 577(1%) were Asian, with 240  listed as “Other.”  The vast majority, 32,783 (65% of all cases) remained unreported on the race of the patient.  A total of 915 deaths were among Caucasian victims, 242 were African American/Black, 28 were Asian and eight were listed as other.  1,265 deaths weren’t reported by race.
 
On Monday at 10 am,  2,689 positive patients were hospitalized, about six percent of those testing positive.  At that time, 553 were using ventilators or breathing machines.  About 1,524 (about 40%) 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 1,402 of the state’s 5,351 ventilators were in use (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; 38% are aged 25-49; 27% are aged 50-64; and 27% are aged 65 or older. 
 
After a news story over the weekend noted that the Governor had let the opioid emergency order expire in March, Levine said that the state has focused on efforts to stop the spread of COVID-19, but noted that opioid substance abuse and crisis hasn’t stopped.  Opioid Use Disorder networks can be very hard to access because of social distancing and patients need treatment without the added stressors.  What hasn’t gone away are our efforts to get them into treatment. She reminded the public to use the state hot line, at 800-662-HELP (4357) to connect directly with substance abuse and treatment services.
 
Levine said, “We were working tirelessly to get additional support for medically assisted treatments for Opioid Use Disorder, warm handoff protocols, and put millions of dollars from the federal government into the system and a robust recovery network. All those efforts continue.“  She also reminded Pennsylvanians that you can visit a pharmacy and get naloxone with the standing prescription she signed 5 years ago.  Please reach out to individuals and see if they need help, she said.
 
“Never underestimate the power of a phone call.  Social distancing can last a lifetime. Know you are not alone,” she said.
 
QUESTIONS FOR SECRETARY LEVINE:
Delaware County officials are asking if they can separate cases from nursing homes from the county, because there are  far more cases since you are basing decisions on all not the general population. Is this something you will do and consider? LEVINE: No we are not separating nursing home cases from rest of the county.  We are all interconnected.  One section of our community impacts the general community and the community impacts them.  It’s very important t to include those and other congregate settings in the counts.
 
Now that there’s a date for the northwest to reopen, when’s the next time for a decision?  LEVINE: We’ll be getting new data starting Tuesdays and new info from CMU, and discussing lab testing and contact tracing, discussion with the Governor starting today.
 
Could it be up to a township or community to decide?  LEVINE: It’s down to them so if there’s a county that didn’t want to go into yellow, we would discuss that.
 
Would restrictions in yellow be able to change in time?  LEVINE: It’s possible, we’ll make those decisions in real time.
 
The stated goal was to prevent hospitals from being overwhelmed, so why not ease mitigation in those areas where this is not an issue?  LEVINE: Our goal was to prevent rise of new cases, and the number of deaths, and we were successful.  We flattened the curve, didn’t see that exponential rise, and the state has stood up very well.  If we release mitigation efforts too soon in areas that still have significant community transmission, we’d be back where we were before.
 
Since most have been nursing homes and +65s, was our initial effort misguided?  LEVINE: No we want to protect the entire population from COVID-19 and its effects.  The basis for the question is correct, but comorbidities and those are the kinds of situations in nursing homes.  There are 695 nursing homes and 1,000 personal care homes.  We have been working hard to protect those homes as much as possible.  It’s a significant issue.
 
Governor Cuomo and other governors have joined in a deal on supplies and reopening.  What does PA get out of it and when does the effort begin?  LEVINE: I don’t have granular details, but the Governor’s  Office will be addressing that.
 
Will workers be required to wear masks in yellow phase businesses? Must the public?  LEVINE: Yes, these are our strong recommendations.  The right thing to do is practice social distancing and wear a mask in public.  We are requesting that.  Those customers should also wear masks.
 
Weeks ago there wasn’t much data then The Governor started a diversity task force.  What’s the status? LEVINE:  It’s very important to get data on sex and race and its required as part of our reporting system.  We know that hospitals and labs are doing it.  The compliance was 10-15%, now we’re up to 33% but it’s still not good enough to get that very important data.
 
What are the Centre and others in yellow now to do?  LEVINE: It’s important to prevent the community spread in those counties – recommend stay at home, but you can go to work,  go out to stores, we are asking people to telecommute, and sell at curbside, but if that’s impossible, to continue all the efforts I discuss every day.  If we all do all of that, areas will be able to go to green.
 
For counties below the threshold, what do they need to do to transition.  LEVINE:  They need to do the same things, and we’ll be looking at data again this week.  They need the ability to expand testing, contact tracing, then we will discuss with the Governor, and he’ll make his decision.
 
How often will counties be moved into next phase?  LEVINE: There is no timeline, we’ll follow the data.
 
Will the Commonwealth prioritize testing around Philadelphia, the economic engine that drives the state?  LEVINE: We’re looking at expanding testing across Pennsylvania.  With Commissioner Bog
an in Allegheny, and expanding testing in yellow zones, and certainly in the suburban Philadelphia counties.  We still have our mass testing site in Montgomery County.
 
Is there a scenario that would allow pools to open this summer?  LEVINE: There is no timeline, and although the weekend was very nice, we haven’t made decisions about pools yet – we will.
 
UPMC doctors have said the pandemic wasn’t as broad or as bad as predicted – what do you say to that?  LEVINE: We were able to bend and straighten the curve, so we didn’t have the surge we were talking about, and that is a success.  We need to continue efforts going forward.
 
Liability issues are popping up in workplaces. Do you have any guidance for the Governor or health care practitioners?   I know those discussions are going on with Governors Office and Office of General Counsel and will defer questions to the Governor.
 
How do you feel when people make comments about you and your personal situation?  LEVINE: I’m working the best I can to get PA through this global pandemic. I know at stressful times, people say things they may not otherwise.  I’m going to remain laser focused on the task at hand.
 
What’s the status of dental effort, and cleanings? LEVINE: We’re working on that and expect to have guidance by the end of the week.
 
Children in daycare and childcare – what are you doing to keep kids safe?  LEVINE: We are working with DHS on that.
 
Why can’t you tell how many county cases are folks diagnosed out-of-state when counting county cases.  LEVINE: That’s how the data system works, so we follow CDC guidelines.
 
Is blood type a factor in this disease?  LEVINE: I have not seen any data on that.
 
Lackawanna county is increasing in its number of cases, but other Northeast counties are decreasing. Do you know why?  LEVINE: We’re going to be doing a deep dive into those numbers.
 
The number of cases vs. tests went from 28% to 25% in last few days. Is that the new expectation?  LEVINE: Each day’s data are dependent on what is coming in at that time.  Sometimes you have to look over time.  Number of positives are doing down and that’s a positive result.  We need to stay focused on preventing community spread.
 
What are you doing to ensure protocols are being respected in nursing facilities?  LEVINE: We do inspections, have had a lot of discussion with these facilities online and by phone, but not routine inspections.  We still do complaint inspections, and we did one this last weekend. I would find it unusual for someone being housed with a positive patient.
 
Many in the public have expressed concern with having symptoms that may be confused with allergies and other similar diseases.  Would it be better to be safe than sorry?  LEVINE: We went any individual with these.  Testing pipeline is much better, and we now have more available. Anyone with symptoms should be tested.  Stuffy nose, runny nose, itchy runny eyes are not the main symptoms of COVID-19 that is  cough, fever and shortness of breath.  Some others very bad sore throat, and chills, etc. Those are different than allergies.  There are very few cases of influenza now so that’s indictive of Covid-19.  Allergies, on a beautiful weekend, like this one, even I have to deal with that.
 
Will you release the names of the nursing homes that have major problems in places like Lackawanna County? Scranton Nursing home facilities have had some problems.  Why don’t Pennsylvanian’ have the right to know these homes?  LEVINE: We have to strike a balance between the facilities rights, patient privacy and the public’s right to know – we will make a decision this week.
 
You have reported 424 deaths in Philadelphia, but Philadelphia is reporting 750 some.  Why haven’t your numbers changed?   LEVINE: Dr. Farley uses a different data system and they are independent – so our corroborating the data takes time.  We are trying to be consistent.
 
We have heard there may be a Second wave in the fall – what have we learned and what will be different?  LEVINE: We’ve heard that from Dr. Fauci and Dr Birx – we need to be prepared for significant increase in cases in the fall – we want widespread testing. Docs offices will have them, they will take just 15 minutes, so we will be able to much more expanded testing.  Antibody testing will be important as well.  We’ll know more about that by then.  We will be working with systems being put into place now, contact tracing, isolation, case investigations, quarantined individuals. At the beginning all the tests were at CDC, now we’ve expanded testing and will be working on that every day.
 
Case counts and deaths appear to be decreasing – is this accurate and positive? LEVINE: Yes, but usually Tuesday is a higher number.  The changes over time are the most important.
Yellow phase rules revised
The Wolf Administration Monday afternoon issued a new set of yellow-zone rules for businesses, including manufacturing and retail operations.  The additional information clears up some major concerns, but significant questions linger.
 
Most importantly, the new information clears up requirements for businesses. They’ll have to meet the same standards that currently open essential businesses are meeting.  That means they’ll have to enforce strict social distancing and masking policies while limiting employee interaction.
 
The new details also solidify the fact that salons, spas, casinos, gyms and theaters won’t reopen because they lead to close personal contact.  But the Governor and Sec. Levine have taken opposite positions on several types of businesses in responding to questions since Friday. 
 
But the new guidance still doesn’t spell out which businesses can open, which leaves businesses like shopping malls in limbo. Retail shops are allowed to open, which would tend to include the mall.  But no building is allowed to have more than 25 people in it, so county officials say the mall must remain closed.
 
The state hasn’t ruled either way. 
 
The 25-person limit also comes with gray areas. Are employees included in the total? Does spacing play a role, or must a large business like the mall remain closed while people pack small boutiques? 
 
SENATE HEARING FOCUSES ON  DECISIONS, REOPENING
The Senate held the first of several COVID-19 related hearings on Monday morning.  Scheduled this week are hearings on the process to reopen Pennsylvania, PA Liquor Control Board reactions to the COVID-19 pandemic; Issues with the state’s Unemployment Compensation program and responses to newly unemployed workers; the impacts of COVID-19 on veterans’ and nursing facilities; and COVID-19 and unsafe construction practices.
 
On Monday, the Senate Veterans Affairs and Emergency Preparedness and the Health and Human Services Committees held a joint public hearing on the Wolf administration’s plan for reopening Pennsylvania.
 
Chairman Scott Martin began by stating that lessons learned from the hearing can be applied to effectively help the state transition during its reopening process. Minority Chairman Haywood stressed that COVID-19 is still a health care emergency and that the conversation has to be about not just when places will be reopened but under what conditions reopening occurs. He expressed concern for issues that COVID-19 made apparent, including health disparities, lack of nursing home oversight, lack of personal protective equipment (PPE) for essential workers, effects on unemployment and childcare centers, and effects of revenue losses on local governments.
 
Secretary of Health Rachel Levine, Secretary of Community and Economic Development Dennis Davin and PEMA Director Randy Padfield were the first panel to appear
. 
 
Chairman Martin asked Dr. Levine for the scientific reasoning behind the 50 new cases per 100,000 people over 14 days metric used in the reopening criteria. Dr. Levine responded that the metric was developed by her team and that it is considered alongside a number of other metrics, including hospital capacity, testing and contact tracing capacity, and other analyses from models, such as Carnegie Mellon University’s model. She stressed that there are both quantitative and qualitative factors that go into the decision-making process and that the 50 new cases per 100,000 people metric is “necessary but not sufficient.”
 
Chairman Martin said that Lancaster County is above the case count metric and asked how much community testing capabilities factor into the process. Sec. Levine responded that Lancaster County has 1,991 cases today and that it still has a “significant rate of community transmission.” She added that the reopening process will not just be influenced by the number of tests but also the number of positive cases. She stressed that if businesses open in an area with community transmission the rate of cases would “skyrocket,” and noted that the number of cases in Lancaster County continues to go up.
 
Chairman Martin stated that more than 80 percent of deaths in Lancaster County related to COVID-19 have occurred in nursing homes and that the strain was not being seen by the health systems. Sec. Levine responded that Lancaster County would continue in the red phase because of its case numbers and the fact that it still has community transmission. While 2/3 of the deaths have been in long term care facilities, and many cases in corrections institutions and food manufacturing plants, she said staff reside in and travel throughout the county. She said many models show the biggest risk factor is opening up too soon and seeing a surge in June or July.
 
Sen. Judy Ward thanked Sec. Levine for the hard work she and her staff have put in but said rural counties are “troubled” by the reopening process. She noted that Blair County has 24 cases and Fulton County has six cases and that some hospitals in the area have actually had to lay people off. She continued that overdose rates have gone up about 1,000 percent and that unemployment is not working out for many people. She asked why the reopening process cannot be looked at on county-by-county basis and when her district should expect to open up. What do I say to them? She asked. We’ve been good soldiers. How do we get answers as to WHY we haven’t been able to open up? Sec. Levine again said that the case count metric is “necessary but not sufficient” and that the decision-making process weighs many factors. She stated that the ability to test and do contact tracing is also key. She remarked that Blair and Fulton Counties have been looked at and that the governor could include them in the next announcement.
 
Sen. Ward said that if the counties do not get moved into the yellow phase, they need to be able to know why, and how to work on getting there.
 
Chairman Haywood noted that a number of studies have shown that stay-at-home orders save lives. He asked what the state is doing to stockpile PPE and prepare for a potential second wave of cases in the fall. Sec. Levine highlighted contributions from DOH and  PEMA saying the state is trying to stockpile PPE as much as it can but that it is still hard to come by. She stressed that PPE is now being prioritized for long-term care living facilities and that they will hopefully be able to stockpile more over the summer. She stated that there is no vaccine on the horizon for the fall so there needs to be “robust” testing and contact tracing. She added that there are aspirational goals to have mass testing and population-based testing in the fall and that the best way to limit community spread is to test, contact trace, and quarantine as much as possible.
 
Chairman Haywood raised the issue of health disparities and asked how the state can prepare so the African-American community is not left out during emergencies like this after noting the Disparity Task Force should have an African-American co-chair.  Dr. Levine said DOH has been working with that task force and that it has a health equity response team of its own. She stressed that vulnerable communities and communities of color deserve to get the care they need.
 
Sen. Bob Mensch asked why Pennsylvania is the only state to not reopen the real estate industry.  Dr. Levine responded that the designation of life-sustaining businesses was a joint effort between DOH, the Department of Community and Economic Development (DCED), PEMA and the governor’s office, and that they decided traditional real estate was not essential and that the industry could wait until counties are in the yellow phase to reopen. Secretary Davin said that the decisions were made based on what they felt was best for Pennsylvania and that it was considered among a number of people from various agencies and the administration.  Mensch said, you do realize that all 49 other states disagree with you, don’t you?
 
Sen. Mensch stated that he does not know what the difference is between someone mowing a park  or their lawn and someone operating a bulldozer on a construction site in terms of social distancing and delaying the opening of construction work.
 
Mensch said Montgomery County is in the red phase but that its density and number of cases differentiate between the eastern and western part of the county. He noted that about 80 percent of deaths in Montgomery County have been among long-term care living facility residents. He asked if that skews the county’s data. Sec. Levine responded that he is correct in that most deaths have been among those in long-term care living facilities and that many deaths have been among those with chronic medical conditions. She noted that staff at those facilities live and travel within those counties. She added that reopening will not be taken down to the zip code because of the amount of traffic that occurs when people go out and go shopping. She confirmed that Montgomery County has 4,645 cases today, which is the second highest number in the state behind Philadelphia County.
 
Sen. Mensch asked why that data is still being used to restrict people’s behaviors if most of the deaths are occurring in long term care living facilities and a small segment of his county. Sec. Levine reiterated that DOH is not primarily looking at death data and that long-term care living facilities are considered a part of counties. She said cases will skyrocket if counties with community transmission begin to open up. She reiterated that the capabilities of the health care systems, population density, and other factors are all considered.
 
Mensch said there should be more local judgment – we are in with counties in a predefined region.  How do we judge a heterogenous population by Long Term Care facilities? Dr. Levine said, people travel between zip codes in the County – traffic makes a difference. Montgomery County has the most cases of any county outside Philadelphia. We’re not being arbitrary at all – trying to be careful because of the risk of skyrocketing spread of the virus, and won’t go zip by zip. Mensch responded, “You don’t want to use arbitrary boundaries  like zip codes, but you are using arbitrary boundaries like counties and arbitrary boundaries like 6 regions.  
 
Sen. Mensch expressed concern for the health care industry, stating that since the Affordable Care Act was implemented hospitals have not been able to maintain adequate inventories. He stressed that going forward there is a real constraint on the processing and supplying of PPE and that hospitals need to have plans for that.
 
Sen. Langerholc began his questions by noting that Montour and Northumberland Counties were permitted to move into the yellow phase despite having case counts higher than 50 per 100,000 people. He asked if Montour having a level-1 trauma center played into t
he decision to reopen the county. Sec. Levine responded that the metric looks at the number of cases over the last 14 days and not the total number of cases. She added that if the majority of cases in a county were in the beginning of the pandemic then it could fit the metric of 50 cases per 100,000 people over 14 days. She continued that trauma centers do not factor into COVID-19 capabilities like intensive care unit beds do. Sen. Langerholc noted that many of the counties he represents have more bed capacity than other counties that have been able to move into the yellow phase. He asked what metric excluded Cambria County from the other 24 that were able to reopen. Sec. Levine reiterated that the southwest region will likely be able to go into the yellow phase soon.
 
Sen. Langerholc asked how many people included in case counts have recovered. Sec. Levine said that with nearly 50,000 positive cases it is impossible to track recovery. She stated that they will begin antibody testing when that is widely available but that it could take weeks or months for someone to test negative after recovery, so it is difficult to track. Sen. Langerholc asked if it is possible for someone to not experience any symptoms and be fully recovered.  Langerholc asked if they would know whether people who have recovered could be donors. Sec. Levine said DOH does not have the ability to do population-based antibody testing, but it will when it is available. She added that she is calling upon the public to contact a hospital to see if they can donate if they have recovered.
 
 
Sen. Langerholc asked what other metrics are used besides the case count metric. Sec. Levine responded that there are a number of factors, including the ability to do testing and contact tracing and the metrics from the Carnegie Mellon analyses. She added that she has “great confidence” that southwest counties will be able to move into the yellow phase soon.
 
Sen. Street asked about DOH’s plans for contact tracing and about support that can be provided to hospitals that are being challenged. Sec. Levine responded that DOH is working in counties that are going into the yellow phase to expand testing and that anyone who has any symptoms should be able to get tested. She stated that there is a metric about how far the average person would have to travel to get tested and that DOH wants to make testing as accessible as possible. She added that for areas in the yellow phase, testing needs to identify positive individuals so they can be isolated and have their contacts investigated. She said that there needs to be “widespread point-of-care testing” and antibody testing.
 
Sen. Street asked if the state is looking to expand testing in red counties and if third-party volunteers could get resources to assist local hospitals and agencies. Sec. Levine responded that there are plans to expand testing in Philadelphia and that it is important to ensure vulnerable communities have access to testing. She added that she would be pleased to work with community organizations and activists to expand testing and meet PPE needs.
 
Randy Padfield, director, PEMA, noted that there is a decontamination system in place that can help clean masks and alleviate some issues with getting masks to constrained areas. He added that there are more than 225 testing sites in Pennsylvania that are able to process about 5,000 to 6,000 tests a day. He noted that Pennsylvania is seventh in the nation in testing and that there are always gap analyses being done to determine underserved areas.
 
Sen. Hutchinson said Butler County reached out to the state to solve issues that were preventing it from moving into the yellow phase, but got no response and that there has been no local input in the process. He asked how resources are getting to critical areas like nursing homes and if DOH can do contact tracing for nursing home staff. After Levine and Padfield discussed PPE supplies and consulting services for nursing homes, Hutchinson again asked what the state is doing for testing and contact tracing in those facilities. Sec. Levine responded that it is an interesting thought but that it would be challenging to test all staff and residents. She noted that staff members at long term care living facilities are not paid well and that there has been staffing issues. She added that there are more than 2,000 long-term care living facilities and that about 500 have been impacted, so it would be a challenge to test and quarantine all of those workers.
 
Chairman Kearney noted issues with testing accuracy and asked how DOH sees metrics for reopening shifting once counties move from one phase to the next. Sec. Levine responded that DOH has been using viral tests from the Centers for Disease Control and Prevention (CDC) and that hospitals and commercial laboratories have their own tests. She noted that testing can be affected by how early a person is tested because a person could have the virus but just not enough of it yet for it to register as a positive test result. She acknowledged that point-of-care testing tends to have a high false negative rate and that it is being considered with the expansion of testing in yellow zones. She added that PPE is being pushed out to long-term care living facilities and hospitals in red zones and hospitals that choose to resume elective procedures will not be allowed to receive PPE.
 
Sen. Muth asked how commuter data factors into the decision-making process. Sec. Levine responded that she does not have that data, but she believes the Carnegie Mellon analyses factor that in. She noted that commuters would be less of an issue in rural counties but that it would be important for the Allegheny and southeast regions.
 
Sen. Muth asked what protections are available for long-term care living facility workers that reach out to raise concerns. Sec. Levine responded that routine visits by DOH staff have been discontinued but that DOH is still investigating complaints that come in. Sen. Muth shared the story of a constituent who was forced to go into work at a nursing home even though she was symptomatic and had tested positive. She noted that the facility told the worker they would lose pay if they did not come into work. Sec. Levine commented that she does not want anyone who is symptomatic to be working and that anyone who tested positive should be isolated. She stated that anonymous reports are still allowed and that it is unacceptable for a facility to require symptomatic staff to work so she would like to hear about that case.
 
Chairman Martin asked what the difference would be for reopening based on region instead of county. Sec. Davin responded that Sec. Levine discussed that. He indicated the state is looking at health regions in reference to strategies and that it is looking at specific counties to determine when they can open. Sec. Levine added that DOH looks at both regional and county data and that she expects more county announcements will be forthcoming. Chairman Martin asked about the reopening of real estate, garden centers and dental offices. Padfield responded that the original closure decision was based on modeling and that mitigation strategies have to be dynamic as models change. He stated that every decision made by DCED, DOH, or the governor’s office has been predicated on how many people could be infected. He added that the restrictions were done with a broad brush to be more conservative and that it has been the guiding principle to be safer.
 
Sen. Ward asked if “low-touch” businesses like real estate, car sales, and dental offices can reopen. Padfield responded that people want to get back to the “new normal” but that having to go back from the yellow phase to the red phase would be worse.
 
Sen. Langerholc asked why the administration has not been transparent about the business waiver process. Padfield responded that he cannot answer that. Sen. Langerholc asked if there were any discussions about the constitutional ramifications of the waiver process. Padfield responded that
the challenge early on was deciding between keeping businesses open and saving lives and that the initial models were “devastating.” Sen. Langerholc asked if any attorneys were consulted. Padfield responded that he cannot speak to that but that the Pennsylvania Supreme Court upheld the decision. Sen. Langerholc asked why the administration chose its own process rather than following national guidelines. Padfield responded that the national guidelines came out after Pennsylvania made its own decision. He stated that decision-making during an emergency has to be swift so the decision can be executed and that the initial decisions were made based on modeling and potential impacts. Sen. Langerholc acknowledged that it is a fluid situation and asked if the administration looked at supplementing the essential businesses list. Padfield responded that there were concerns about being more inclusive, noting that even power plants that continued to operate saw outbreaks among workers. He stated that the goal was to be restrictive early on and that mitigation was “extremely successful.”
 
During the second panel, Dr. Valerie Arkoosh, commissioner, Montgomery County, testified that Montgomery County has diverse populations and businesses. She noted that her goal following the first case on March 7 was to protect first responders, health care workers and essential workers. She stated that the county has started to see case numbers slow and that restrictions have to be relaxed in a way that allows for economic security while continuing to minimize the number of lives lost. She stressed that counties are intertwined, asserting that more than 315,000 workers travel into Montgomery County to work and that more than 200,000 workers travel from Montgomery County to work elsewhere on a normal workday. She urged legislators to work with DCED to get more supplies and grants for businesses and to encourage businesses to offer paid sick leave for their workers. Concluding, she asked for a moratorium on evictions, stating that putting people who lost their jobs onto the streets will only compound the challenges communities face during reopening.
 
Rob Shipp, vice president of quality and population health, Hospital and Healthsystem Association of Pennsylvania, stressed that safety is the top priority in hospitals resuming services. He noted that many elective surgeries have been put on hold, including heart surgeries, joint replacements and colonoscopies, and that it is crucial to reintroduce that needed care in Pennsylvania. He stated that postponement of care can lead to negative health outcomes and that Sec. Levine and DOH released guidance on how hospitals should proceed with elective surgeries. He added that resuming services will have to be gradual in order to mitigate the spread of COVID-19 and that it is important for hospitals to ensure they are prepared to care for all types of patients in their environment.
 
Dr. Michael Ripchinski, chief clinical officer, Penn Medicine Lancaster General Health, discussed the impact of COVID-19 in Lancaster County, noting that the average positive case was 51 years old and that the age range spanned from four months old to 102 years old. He added that 45 patients have died, 83 percent of which were long-term care living facility residents, and that discharged patients range from 19 years old to 89 years old. He stressed that despite having advanced care plans, this pandemic has had a high emotional toll on patients, families and caregivers. He remarked that Lancaster General Health has developed plans to increase its testing capacity and that it has a commitment to do contact tracing as well. He said that Lancaster General Health is prioritizing procedures based on disease and patient factors and that, beyond care, the supply chain continues to be a limiting factor. Concluding, he stated that hospital systems are expecting significant losses in revenue and that estimates will be hard to determine given the uncertainly of this time.
 
Scott Jeffers, vice president of corporate enterprise operations, Quest Diagnostics, testified that Quest has been at the forefront of the country’s response to COVID-19, performing more than 20 percent of all tests nationwide. He noted that Quest has four labs in Pennsylvania and typically has 1.8 million patient encounters a year. He added that Quest worked to expand its testing capacity from the beginning and that throughout its national network it is able to conduct more than 50,000 tests per day with an average turnaround of one to two days. In regard to contact tracing, he stated that he expects to expand Quest’s capacities. He added that the antibody testing may not be used to detect COVID-19 but it can be used to determine who may have been affected and to identify those who may be sources of plasma for other patients.
 
Sen. Ward asked about reliability and availability of testing. Jeffers responded that Quest only launches approved tests and that its antibody test has been validated with specificity at 99.5 percent, which is highly accurate.
 
Sen. Schwank expressed concern for food processing plants and asked what recommendations the panelists had for testing essential workers. Dr. Arkoosh responded that testing pertains to schools, colleges and other workplaces as well. She stated that the goal should be to make workplaces as safe as possible, so rapid testing should be made available. She added that when rapid testing becomes widely available businesses can use it to test their workforce and keep anyone who tests positive at home. She noted that a correctional facility in Montgomery County had 171 of the 944 inmates test positive while not showing any symptoms. She stressed that rapid testing “would go a long way to make the transition as safe as possible.”
 
Dr. Ripchinski commented that businesses will have to implement safety protocols, like universal masking. He added that businesses that struggle to get PPE would have to implement social distancing as much as possible.
 
Sen. Langerholc asked about the difference in testing for coronavirus versus testing specifically for COVID-19. Jeffers responded that he mentioned antibody testing specificity earlier and that it is a key measure in differentiating COVID-19 from other viruses. He stated that the validated antibody testing platform for Quest showed no false positive results in 181 of 182 serum specimen and that Quest only puts out test that are accurate.
 
Sen. Langerholc asked Jeffers if DOH has been in contact with him. Jeffers responded that Quest has public health relationships across many states and that he believes Pennsylvania did contact him.
 
Sen. Langerholc asked if Quest follows up with someone after they have recovered. Jeffers responded that Quest would be part of the testing process but that he is not sure it would be involved in the creation of recovery studies.
 
Chairman Martin noted previous outbreaks of influenza and other viruses. He asked if a shutdown will be the “new normal” with all viral outbreaks. Dr. Ripchinski responded that COVID-19 is twice as contagious as the flu and that infections can occur in a population that does not practice mitigation efforts fast enough. He added that mortality rates have ranged from 52 years old to 96 years old, so it is not just an older age group that is being affected by COVID-19.
 
Dr. Arkoosh commented that the age range with the most positive cases in Montgomery County has been 50 to 59 year olds and that 20 to 29 year olds have almost the same number of cases. She stressed that it is overstated that the virus is only affecting older people and that absences from work are among people of all ages. She added that the state will need to ensure there are enough first responders and hospital beds to meet demands and that mitigation efforts will have to continue until there is a good treatment or vaccine. She continued that “if public health is working, nothing happens” and that the goal of the reopening process should be to not have another shutdown.
 
Chairman Martin asked if elective procedures should be stopped if there seems to be more positive cases. Dr. Ripchinski responded that the reopening process will have to be balanced and that the state will have to monitor hospital utilization. He stated that hospitals will have to look at disease factors and risk for patients in relation to elective procedures. He added that those with chronic conditions need to be protected during their recovery period, so they do not get COVID-19 following surgery. Chairman Martin expressed concerns for health care systems losing revenues.