May 6 COVID-19 Update – Pennsylvania American College of Physicians

Below:

• Levine Q/As from Tuesday
• Governor talks southwest PA
• Altman writes Congress
• House passes COVID-19 testing and RTK bills

 
PA COVID-19 DATA UPDATE
On Tuesday, the Department of Health reported that Pennsylvania had found 865 new confirmed positive cases in the previous 24 hours, for a total of 50,957 confirmed cases.  The death total rose to 3,012 total confirmed COVID-19 deaths, an increase of  554 from Monday’s report, all in adult patients. The numbers of deaths today are over two weeks and partially due to a reconciliation of data with other sources, including the Philadelphia Health Department.
 
The state Health Department’s breakout of virus data for long-term care living facilities indicates 2,029 of the state’s deaths, more than 67 percent, were nursing home residents.  There were 199,925 negative tests in PA as of midnight Monday night.
 
At least 3,204 are health care workers – accounting for about six percent of all positive cases; the total figure includes 1,284 workers in nursing homes. And 9,625 cases – accounting for 19 percent of all cases- are in 495 of the state’s long-term care living facilities in 43 counties.  It also includes 2,032 positive cases in workers in the food processing industry in 120 facilities statewide.
 
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 Monday, 27,713 positive cases (54%) were female and 22,634  (44%) were male. One percent (610)  were unreported or neither.  Among the deaths, 1,522 (50.5%) were males and 1,473 (49%) were female with 17 unreported by sex.
 
By race, 11,498 positives were Caucasian (23%), 5,548 were African-American (11%) and 592 (1%) were Asian, with 243  listed as “Other.”  The vast majority, 33,076 (65% of all cases) remained unreported on the race of the patient.  A total of 1,099 deaths were among Caucasian victims, 312 were African American/Black, 34 were Asian and 10 were listed as other.  1,557 deaths (52%) weren’t reported by race.
 
On Tuesday at noon,  2,580 positive patients were hospitalized, about six percent of those testing positive.  At that time, 542 were using ventilators and 19 on ECMO machines.  About 1,247 (39%) of the 5,199  intensive care unit (ICU) beds were available, 6,168 general medical beds (46%) were available and 1,589 (53%) of the airborne isolation rooms are still available statewide.  And 1,386 of the state’s 5,344 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. 
 
Levine said 1,259 individuals have been tested at Mohegan Sun and that they have significant capacity left .  She encouraged those with any symptoms to register online or by calling the Department at 1-877 PA HEALTH.  She said a Symptoms and Testing page with a symptom checker tool from the CDC available on the health.pa.gov website as is a map of testing locations throughout the commonwealth.
QUESTIONS WITH DR. LEVINE:
You testified that Lancaster County had community spread. Could you be more specific?  LEVINE: That means there are individuals with COVID-19 in the community and it is spreading from person to person in a widespread way.  For instance, we reported 2,018 cases have been tested positive in Lancaster County.  That includes nursing homes.  453 residents of nursing homes  have tested positive but far more have been tested positive in the general populations.
 
Today we saw a report that nursing homes are taking in COVID-infected residents. If you can’t test daily,  What about weekly testing for those facilities?  LEVINE: We  This has been one of our biggest challenging situations with COVID 19 and seniors.  We know there are individuals who are positive and others who might have been hospitalized and then returned.  We have been working with those congregate facilities and are working with them on policies, procedures, PPE and how to use it.  At severely affected homes, we have actually had the National Guard go in.  We have ideas on how to improve testing in those homes and will do everything we possibly can.
 
The U of Washington modeling recently revised its projections on positives and death upward, because their original estimates were based on keeping everyone at home through May 30.  Have you seen those numbers and what is your reaction?  LEVINE:  We have seen those models, and we think they highlight the significant risks of opening too quickly.  That’s why we believe the Governor has done the right thing with his measured, iterative response.  Will be done in a careful, data driven fashion county by county. Data-driven way
 
Since model now predicts more than 8,600 deaths in PA are you making a mistake by what you are doing and loosening restrictions and lifting the stay at home orders?  LEVINE: It is concerning, and It shows the risk of going too fast and underscores the importance of a careful phased reopening like the Governor has chosen.
 
We continue to see the numbers of positives below 1,000, but death increase is over 500. Is this good news or bad news?  LEVINE: We get less case reports over the weekend, and the fact that we got less than 1,000 on a Tuesday is a good thing.  The death number is representing deaths over several weeks, and is a reconciliation, and shows that this is challenging in terms of regularity of data.  We are putting changes in to try to reconcile the data on a daily basis to have a smoother way to do that.
 
Why is the state not releasing the ages of people who have died of COVID-19?  LEVINE: The majority are those over 65 and with other chronic diseases, like COPD and diabetes.  We haven’t put out exact numbers, and we’re always putting out more information.
 
There are more than 23,000 cases across Lackawanna and Luzerne Counties.  Are you concerned that the testing at Mohegan Sun are low?  LEVINE: The purpose of my mentioning it today is to help get people to come and be tested if they have any symptoms.
 
Patients and  family members tell us the conditions aren’t the best, especially when a patient is suffering with the virus. What is the Department doing?  LEVINE: We are working with the homes and their patients are most at risk.  We have been interacting with them with guidance, regular phone conversations, virtual conversations, Considering other ways of testing on a pilot basis.
 
Several of our listeners are concerned about the status at homes where their loved ones are living.  They are having a difficult time getting information from the facilities.  Will the Department continue to not release this information and leave families with members in a nursing home in the dark about their situation? LEVINE: First, it is the responsibility of the facility to notify family members of any situation in that facility, but we understand that has not always been the case.  The right to privacy vs. the loved one and public’s right to know. We’ll have an answer this week.
 
Why, giving it  had a low case count and is bordered by three counties that are moving to yellow on Friday was Mifflin County not able to move to yellow on Friday?  LEVINE: We’re looking at that data and have a new run of data today and we’ll be looking at that this afternoon, and on Thursday, reviewing the CMU data this week and making recommendations to the Governor about ways counties can move forward.
 
A local gym has opened in defiance of the order, owner says he’ll remain open despite two citations.  What do you say to that?  LEVINE: I wasn’t aware of that, and disagree with it.  And I think it’s not the right thing to do, particularly in red zones.  When detected, they are reported t
o DCED for enforcement work group and then local authorities can be contacted.
 
What have the science and health communities learned about the warmer temperatures, and COPVID as temps rise in May, any promise?  LEVINE: It’s been episodic in PA, but suggestions that the virus is transmitted less in warmer temperatures, but it’s hopeful and we’ll have to see what happens in Pennsylvania in warmer times.
 
The Board of Pharmacy discussed a letter from the Deans of Pharmacy Schools asked to have the two year lab requirement waived so more pharmacies could give the tests so all Pennsylvanians could be within 45 miles of a testing site. Any consideration given to that request?  LEVINE: I’m not familiar with the proceedings of the Board of Pharmacy.  We consider all requests – in the end, that’s the responsibility of the Pharmacy Board and the Department of State to take up those considerations.
 
During Monday’s briefing, you indicated wearing a mask was not mandatory in yellow areas, but it was instead highly recommended If masking is not mandatory, will businesses be able to deny entry or service if someone doesn’t wear a mask?  LEVINE: I want to clarify, we strongly feel that masks are an important part of social distancing for communities  whether in green, red or yellow zones, we expect Pennsylvanians to do the right thing.  The right thing to do is to wear a mask.
 
Do you plan to do universal testing at SCI Huntingdon to get a true handle on the number of positive cases with 51  inmates and 24 staff tested positive?  LEVINE: Yes, we’ll be discussing whatever’s necessary to protect everyone there with Sec. Wetzel.
 
SCI Huntingdon had a spike recently.  With state prison inmates and staff spiking totals will these counties be able to go to yellow? If so, why does it impact those counties, and some like Mifflin, but not others bordering Huntingdon County like Centre County?  LEVINE: It’s a long term care facility, and like food processing plants or nursing homes, it’s part of the county and contributes to possible community spread. What happens in one county won’t necessarily influence the counties next door to it.
 
Can we expect any counties to move to green as long as other counties in the state are still in red?  LEVINE: We haven’t begun to discuss that with only 24 counties on Friday.  We’ll make other determinations in time, but as to when and how counties will go from yellow to green hasn’t been discussed because we’re not there yet.
 
Several counties with low numbers of cases are not being moved to yellow.– is the state worried about businesses defying that order and opening on their own?  And what would the consequences be?  LEVINE: We are certainly concerned and it is very challenging in terms of the economy and businesses and we’re going to be working with the Governor about counties going from red to yellow and we’re counting on all Pennsylvanians to do the right thing and follow the guidelines.
 
Pennsylvania has more confirmed cases among meat production workers than any other state according to the CDC.  How is the state tracking those workers and is the state plans to publicly release information about plants with these outbreaks in order to protect workers and consumers?  LEVINE: We are working very diligently among every level of govt and the ag industry on food processing industry – regular discussions even today with Sec. Redding and discussions with processors and manufacturers, food safety inspectors from PDA advising on on-site measures, and we are working with an interagency way to protect these facilities.
 
The public is watching the raw total numbers you  put out and making its own assumptions.  Has the Department considered putting out more information (breakdown as to when tests were taken) to give more context to the information? LEVINE: I really feel we have been very transparent.  We’ve been very transparent. It’s unprecedented in terms of the amount of data we’re putting out on the daily basis. We always took to improve, and will continue to do so.
 
Counties in the NE region with low numbers of cases, but remaining in the red now.  We know lawmakers have sent letters asking for those specific counties be allowed to reopen.  Are you considering actions to allow such reopening by county even when other counties in the region remain in the red zone?  LEVINE: The Governor has always said we will not be beholden to any schema, and we always take seriously any letters we receive from the legislature.
 
Since 4/21, Butler has had 22 new cases with a pop of 180,000. This trend was apparent when the first round of changes came around.  What has been holding back allowing Butler County and others like it? Is it the border with Beaver County?  LEVINE: We used the metrics we described a\using data from CMU and testing, tracing abilities to make the decisions for the 24 counties.  We will continue to look at new data, both ours and those with CMU and working with local authorities in terms of testing capability and then make recommendations to the Governor for decisions on additional counties as well.
 
National Guard started helping out at Graystone in Lehigh County?  What other homes are they working at? Will they be available to help at private nursing homes, as in NJ?   LEVINE: They are available to help, and I don’t have specific information on where they have gone into, but they are available to go in anywhere help is needed.
 
Pfizer Labs began testing multiple versions of a vaccine on young persons this week with a stated goal to have a vaccine available for high risk groups by the fall.  Is that realistically possible?  LEVINE: I don’t have the information have heard they started testing.  and we all wish them success, don’t know what the timetable is, but I the sooner the better!
 
The Department is not supplying PPE to hospitals going back to elective procedures.  Why not?  LEVINE: If they are doing those procedures, and if they are able to do those non-urgent procedures, they have enough PPE to do that.  We want to prioritize our PPE to facilities that have large amounts of COVID 19 patients (such as Philadelphia, the collar counties, and nursing homes who definitely need PPE, so we will prioritize to them.
 
Remdesivir as a treatment – is there anything new?  LEVINE: Looking for more standardized tests and results. It has shown promise with patients with an IV preparation and that’s great, but we’ll wait and see what other types of medications may be available.
 
When is the Mohegan Sun site expected to close? LEVINE: We want more and more patients to be tested there.  T’s met our expectations, but we would like it to exceed our expectations.  I have no timetable for when it may close.
 
Currently there are 50,957 positive cases, and 2,580 in the hospital  Does that mean that 48,377 cases have recovered?  LEVINE: I’m going to have trouble with data and calculations in my head.  The majority of those patients have recovered, but we cannot contact all 50,000. We are very pleased that the majority have recovered.
 
Wolf says southwest can expect an announcement soon
Gov. Tom Wolf said the southwest region can expect an announcement on moving from the red to yellow phase “soon.” On a conference call with reporters Tuesday, Wolf said. “As I said last week, southwestern Pennsylvania is doing a really good job. We’re doing the best we can to keep people safe within the constraints of this deadly virus.”
 
Gov. Wolf says Southwestern PA doing “good job” controlling Coronavirus and expects to make an announcement on moving from red to yellow phase “soon.”
 
Allegheny County and the rest of the region easily met the governor’s criteria of new cases, staying under 50 per 100,
000 over 14 days. Allegheny has had less than 30, and the region has had about 33.  Area hospitals have never been stressed, and Allegheny County says its testing and tracing of those who have come in contact with infected people has allowed it to isolate and contain spikes.  Only Beaver County in southwestern PA is significantly over the threshold metric.  The rest of the southwest, and several southcentral counties also meet the 50 new cases per 100,000 population metrics.
 
Altman writes Congressional delegation re: insurance fixes
State Insurance Commissioner Jessica Altman has written the state’s Congressional delegation recommending federal actions to provide stability and affordability to the insurance market. The letter identified steps Congress could take to help individuals and families struggling to acquire or pay for coverage today and in the future.
 
The letter outlined the potential impact of COVID-19 on premiums beyond 2020, as 2021 insurance products are about to be filed with PID.  To prevent COVID-19 from increasing premiums, the letter recommends implementing a reinsurance program to cover high-cost claims as insurers attempt to forecast for 2021. She also asked Congress to consider covering the cost of vaccine or treatments developed in the future, to help prevent these costs from being priced into 2021 premium rates.
 
The commissioner requested advance premium tax credit flexibility to account for income fluctuations due to layoffs and the additional unemployment compensation millions of Americans have filed for.
 
The department also asked Congress to consider: 

• Addressing the “Family Glitch” in the ACA that prevents families from qualifying for premium tax credits when those tax credits are very much needed. 
• Subsidizing COBRA premiums until the end of the current plan year; open a special enrollment period for individuals whose employer coverage plan does not align with marketplace coverage. 
• Passing balance billing legislation to protect consumers from surprise medical bills during these uncertain financial times. 
• Instituting a special enrollment period for the federal marketplace allowing uninsured Americans an opportunity to purchase comprehensive health coverage.

 
House unanimously passes bills requiring reopening of Right to Know offices, testing plans
The State House on Tuesday unanimously passed (202-0) legislation that would require Commonwealth agencies’ Right to Know Offices to be open and provide access to public records.  The General Assembly has been growing more frustrated daily with being unable to access information from the Wolf Administration about decisions and decision making during the COVID-19 emergency declaration.
 
Following last week’s efforts to amend language to require Gov. Wolf to present his statewide plan for COVID-19 testing, the House also passed by an almost unanimous vote (201-1) legislation that would  require the Governor to present that plan and give local health departments greater latitude to implement coronavirus testing that meets FDA guidelines. 
 
The bill’s sponsor, John Lawrence of Chester County, said after learning Chester County purchased thousands of COVID-19 test kits, red tape at the state Department of Health blocked the county from using the tests to screen first responders and medical professionals for the coronavirus.
 
The House also passed legislation sponsored by Rep. Tom Murt (R-Montgomery/Philadelphia) that requires insurance companies show the Insurance Department that they are offering mental health coverage with the same parity as they do coverage for physical illness.
 
The federal Mental Health Parity and Addiction Equity Act requires large group mental health insurance policies to provide mental health/substance use disorder benefits at parity with medical and surgical benefits.  The bill would require insurers file an annual report with the PID detailing how they offer mental health coverage at the same level as medical and surgical benefits.