May 7 Pennsylvania COVID-19 Update
- Governor signs limited civil immunity order
- Daily COVID-19 data update
- Q/A’s with Sec. Levine, Governor Wolf
- Governor to launch Civilian Coronavirus Corps
- Free N95 respirator decontamination now available
- DoH updates COVID-19 testing guidance
- Supreme Court rejects request to overturn business closings
Governor signs Executive Order: grants limited civil liability to health care, front line workers
Governor Wolf signed an executive order Wednesday to give some health care practitioners and frontline workers protection against liability for good faith actions taken in response to the call to supplement the health care provider workforce during the COVID-19 pandemic.
During the course of the pandemic and the disaster declaration associated with it, the Wolf Administration has used its authority under the declaration to suspend a significant number of regulations and regulatory statutes to supplement the health care workforce, including facilitating the deployment of retirees and out-of-state health care professionals, expanding scope of practices for numerous health care licensees, bringing in health care professionals who have not previously maintained liability coverage, and calling upon health care providers to perform acts they would not perform in the ordinary course of business.
“As the COVID-19 pandemic has required the Wolf Administration to take broad action to respond to and prepare for Pennsylvanians’ critical health care needs, so too has it required our health care providers to broaden their professional responsibilities and experiences like never before,” Gov. Wolf said. “This Executive Order to Enhance Protections for Health Care Professionals serves to protect the individuals serving on the front lines of the disaster response.”
The executive order:
- Grants immunity to any individual who holds a license, certificate, registration or certification to practice a health care profession or occupation in Pennsylvania and who is engaged in providing COVID-19 medical and health treatment or services during the COVID- 19 disaster emergency response. Immunity does not extend to acts or omissions that constitute a crime, gross negligence, or fraud, malice, or other willful misconduct;
- Extends immunity to those medical professionals in Pennsylvania that provide services in any health care facility as defined by the Health Care Facilities Act, as well as any nursing facility, personal care home, assisted living facility or any alternate care site, community-based testing site or non-congregate care facility used for the purpose of conducting emergency services activities or the provision of disaster services activities related to the Commonwealth's COVID- 19 disaster emergency response;
- Affirms immunity for any person, organization or authority allowing real estate or other premises used for emergency services without compensation in the case of death, injury, or loss or damage to the property of any person who is on the premises for the purpose of those emergency services; and
- Suspends or removes a host of regulatory barriers that would otherwise impede or prevent out-of-state, retired or other qualified practitioners from providing services where needed in the Commonwealth.
The order was written in response to stakeholders like PA-ACP requesting civil immunity for health care practitioners practicing with good judgment under very challenging circumstances during the COVID-19 pandemic. The executive order is in line with actions neighboring states have taken but does not extend immunity to facilities and non-emergency services.
PA COVID-19 DATA UPDATE
On Wednesday, the Department of Health reported that Pennsylvania had found 888 new confirmed positive cases in the previous 24 hours, for a total of 51,845 confirmed cases. This is the first time since March that new positive findings fell below 1,000 for four straight days.
The death total rose to 3,106 total confirmed COVID-19 deaths, an increase of 94 from Tuesday’s report, all in adult patients. The state Health Department’s breakout of virus data for long-term care living facilities indicates 2,108 of the state’s deaths, more than 67 percent, were nursing home residents. There were 204,495 negative tests in PA as of midnight Tuesday night.
At least 3,316 are health care workers – accounting for about six percent of all positive cases; the total figure includes 1,372 workers in nursing homes. And 10,010 cases – accounting for 19 percent of all cases- are in 502 of the state’s long-term care living facilities in 44 counties. It also includes 2,062 positive cases in workers in the food processing industry in 122 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 Tuesday, 28,248 positive cases (54%) were female and 22,987 (44%) were male. One percent (609) were unreported or neither. Among the deaths, 1,562 (50.5%) were males 1,529 (49%) were female with 15 unreported by sex.
By race, 11,937 positives were Caucasian (23%), 5,700 were African-American (11%) and 613 (1%) were Asian, with 254 listed as “Other.” The vast majority, 33,341 (64% of all cases) remained unreported on the race of the patient. A total of 1,147 deaths were among Caucasian victims, 317 were African American/Black, 34 were Asian and 10 were listed as other. 1,598 deaths (52%) weren’t reported by race.
On Wednesday at noon, 2,553 positive patients were hospitalized, about six percent of those testing positive. At that time, 555 were using ventilators and 20 on ECMO machines. About 1,255 (40%) of the 5,199 intensive care unit (ICU) beds were available, 6,217 general medical beds (46%) were available and 1,595 (53%) of the airborne isolation rooms are still available statewide. And 1,417 of the state’s 5,324 ventilators were in use (nearly 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; 27% are aged 50-64; and 27% are aged 65 or older.
QUESTIONS WITH GOV. WOLF AND DR. LEVINE:
New Jersey released its preliminary death totals for last two months. Why hasn’t PA recorded a similar increase? LEVINE: NJ has a completely different death reporting system that we do. We’ve been looking at the data: they had 131,890 positive tested patients in NJ – 8,549 deaths which are approximately 6%. In PA we have had 51,845 positives and 3,106 deaths. That’s approximately 6%, so our numbers in terms of death reporting, approximately the same.
The New York Times is reporting state reporting in Pennsylvania is slower than normal. Why is that? LEVINE: Reporting is a challenge in real time, and recording data every day. We have two death reporting systems, from great coroners NEDDS, and county municipal health departments. Phila has a different system and it has taken time to reconcile that. We are going to be working to reconcile our data daily with Philadelphia to harmonize our NEDDS system and commit to getting most accurate data.
You are now permitting elective surgeries and dental guidance. In what phase can dental offices open? LEVINE: We’ll be having dental guidance by Friday.
Do you believe that local doctors should decide whether a procedure is necessary or not? LEVINE: We agree with that, and in almost all areas of the state, we are allowing elective procedures to start in hospitals and Ambulatory Surgical Facilities. PPE is a different story, both what we have and what we’ve gotten from the feds to hardest areas hit by COVID 19. Our nursing facilities are a priority.
What are respirator decontamination systems? LEVINE: This is a free service, and it’s used to sterilize the N-o5 masks, using aerosolized Hydrogen Peroxide.
What is the timeline for hiring the CCC and how many will you hire? WOLF: I’ll be getting more details as time rolls out. We want this to be a big deal. The point is to create a corps of people trained and ready to help us through the new environment in the post pandemic world.
How will the state pay for it and how will you detail how funds are spent? Do you need legislative approval for this? WOLF: We are trying to get funding from the fed and will share those details when we have them. We do not need legislative approval, and they agree there’s no need.
A photo is circulating that shows a Senate staffer giving haircuts to Senators outside the capitol. What’s your reaction? WOLF: I am not familiar with this. I think that question would be better addressed to whatever staffer did that.
A state Representative said your lack of transparency reminds him of Nazis, and he is by no means the only one saying you are not transparent, and you have not engaged with the legislature. What’s your response? WOLF: I have engaged with legislative leaders, and regularly do so through the legislative affairs department. Our intergovernmental affairs dept is working with local governments. If there’s somewhere we should be working more closely with anybody I’m open to that. I want to be transparent, and we’re trying to fight this disease. There is no excuse for not being as transparent as we possibly can. If there’s something I’m missing, I’m always open for suggestions.
How does the Northeast States Coalition work? WOLF: We occasionally have Zoom meetings. Senior staffers meet twice a week to discuss what we are doing in each state. Recently we announced pooling efforts to get PPE, working with institutes of higher education and research institutes. We want to be sure we are doing everything we can . With 7 states, we have more brain power and buying power.
A company plans to resume bus service from PA to NY and NJ on Monday. Is resuming this bus service a good idea now? WOLF: From what you said, no, no I don’t.
Who can get the free decontamination equipment? WOLF: The free decontamination equipment can go to first responders – they are on the front lines and the ones we really need to be sure they are as protected as they can possibly be.
Will you be granting Long Term Care facilities immunity? WOLF: No – we have been in conversations about health care professionals, particularly those coming back from retirement to serve, giving them additional liability protection. There will be an announcement today on that.
We have reports that some businesses ingare open in spite of your order. What is your reaction to this. Is there a natural dam here - any orders and guidelines on that? WOLF: To the extent the guidelines are ignored, and businesses open and they are not ready, they’ll have trouble inspiring confidence in their customers and employees.
Has the state taken a look at ove
rall death totals, and how this excess death total might impact the full pandemic? LEVINE: I’m aware of some of the calculations and we’ll be looking that.
Delaware has asked that positive cases in nursing facilities be excluded from county data? If there is a way to do that, why not? LEVINE: The majority of deaths are in nursing homes, and also the greatest amount of medical conditions, comorbidities. But they are part of the Community, as are food distribution centers, prisons, etc. Workers in these places are part of the community, that really is part of the mix of a community and they will count.
One state lawmaker is not wearing a mask Is he within his rights given CDC policy? LEVINE: That is incorrect. CDC and federal government, every state in the country – we are recommending wearing a mask when out of your home. Then the community itself is protected.
We were contacted by a reader whose parent had antibodies in December tests. They contacted DoH – would they be included in the DoH numbers? LEVINE: I’m not sure – fi they have antibodies from a reported case in December, that would be interesting.
What role will technology play in contact tracing? LEVINE: We will be using technology. Sera and other companies’ apps – this will be voluntary tracking, other states are starting to use this now.
UPMC physician Steven Shapiro said reopening with coupled cloistering is a workable strategy – your comments? LEVINE: We are looking at different counties, the modeling, as well as quantitative measures to determine which counties go from red to yellow. We will be able to prevent the spread with those.
Why has testing plateaued well short of your goal of 8,500 a day. Why should we believe you on testing tracing going forward if we can’t believe you now? WOLF: We’ve limited the testing. As fewer have the disease, fewer will have the tests, and that’s the rule. I think that could be something of the function of the disease we’re starting to beat.
We are seeing less cases so that’s really good news, trends mean more than any specific day, but we do want to expand testing in areas still affected NE and SE and into areas going yellow in two days now? LEVINE: We’ll be working to do that. You need a doctor’s order to have a test done now, but we are looking for ways to make that easier with hospitals and health systems, and others. Then we’ll consider how and when to do population-based testing. We still want to increase that testing.
Governor Proposes Commonwealth Civilian Coronavirus Corps
On Wednesday, Governor Wolf said he would be creating a Commonwealth Civilian Coronavirus Corps to assist with items such as contact tracing.
“Our highest priority remains protecting public health and safety, but we must also look ahead to see how we can address future needs. To reopen our economy to its maximum potential, we will need to boost our ability to contain this highly transmissible virus,” Governor Wolf said. “The Commonwealth Civilian Coronavirus Corps will serve as a public service program that will expand our ability to conduct contact tracing and testing and mobilize Pennsylvanians to contain COVID-19.”
This will allow Pennsylvanians to effectively monitor and respond to new cases and quantify mitigation efforts. It will help our phased reopening efforts while ensuring that the health care system does not become overwhelmed and that the transmission of disease continues to slow.
As Pennsylvania plans to ramp up these efforts in the coming months, the Commonwealth Civilian Coronavirus Corps would bring these efforts to fruition by:
- Partnering with local public health agencies, community organizations, and the nonprofit community to expand Pennsylvania’s existing testing and contract tracing initiatives;
- Leveraging additional resources to fund testing and contact tracing initiatives;
- Exploring creative ways to recruit experienced Pennsylvanians with health care and public health experience to support this initiative; and
- Coordinating existing resources deployed by the commonwealth, including community health nurses and county health departments who are currently conducting testing and contact tracing throughout the state.
The Commonwealth Civilian Coronavirus Corps will also provide a unique opportunity for Pennsylvania to recruit and train COVID-19-impacted dislocated and unemployed workers into public service, which would address Pennsylvania’s health and economic needs.
To foster this new workforce, the Commonwealth Civilian Coronavirus Corps would:
- Engage partners in the workforce development system, existing allied health training programs, and AmeriCorps programs to build and strengthen a public health workforce across the commonwealth;
- Leverage existing workforce development resources to recruit, train, and connect the public health workforce with employment opportunities; and
- Engage public health and health care employers to connect trained workers with long-term career opportunities.
“We have all made many sacrifices throughout this crisis and all we share a desire to move forward toward a healthier, safer and more prosperous future,” Governor Wolf said. “Through this public service initiative, Pennsylvanians will have opportunities in the months ahead to join a collective effort to ensure that we emerge from this pandemic a stronger commonwealth.”
The Governor said he will continue to unveil aspects of this plan in the coming weeks. How many people would be required, how they would be paid and where the funding would come from were not immediately available. There was little detail provided except for the concept this afternoon.
Free N95 respirator decontamination now available
The Battelle Critical Care Decontamination System (CCDS) was approved by FDA for decontamination and reuse of N95 respirators as needed during a time of crisis. The system uses a vaporous hydrogen peroxide to decontaminate the units.
A single Battelle CCDS site can decontaminate tens of thousands of N95s in a single day. The decontamination process permits the reuse of N95s, and each N95 can be decontaminated up to 20 times before it requires disposal. The US Department of Health and Human Services is funding the operation of multiple Battelle CCDS sites across the country, with one located in Delaware County.
Governor Wolf announced the program on Wednesday for healthcare facilities, first responders, and other eligible organizations with a shortage of the respirators due to limited availability through normal procurement channels.
An eligible organization that wants to use the system for N95 decontamination must register and enter into a use agreement with Battelle, at which time they will receive additional guidance regarding the types of N95s that are allowed and instructions for shipping and delivery. The service is available free of charge for use by eligible organizations – the federal government is absorbing 100% of the cost. The only cost to an eligible organization is for shipping to and from the site.
The Federal Emergency Management Agency and US HHS have determined that eligible organizations include hospitals, urgent care centers, nursing homes, rehabilitation facilities, cancer centers, pharmacies, dialysis centers, assisted living facilities, clinical laboratories, emergency medical services (EMS), and private practice/outpatient facilities. Some situations exist where the following organizations may require use of the Battelle CCDS if experiencing critical shortages of N95 respirators: law enforcement agencies, security firms, fire departments, hazardous materials units, public health departments, public works or utility companies, and emergency management agencies.
Information about the service is being distributed to potentially eligible organizations through the Pennsylvania Emergency Management Agency, PA Department of Health, The Hospital and Healthsystem Association of Pennsylvania (HAP), and other state agencies.
DoH Updates SARS-CoV-2 testing guidance
The Department of Health on Wednesday updated its guidance on SARS-CoV-2 testing, noting that there are no antigen tests authorized under the FDA EUA to date. A copy can be found here.
As of today, there are two different types of SARS-CoV-2 testing. One type is molecular, which detects nucleic acid from SARS-CoV-2. The other type is serology, or antibody testing, which measures SARS-CoV-2 antibodies present in the blood. There is a third type of SARS-CoV-2 test which detects antigens present in the blood. As of today, no antigen tests for SARS-CoV-2 have been authorized by FDA. Such tests will be added to the FDA website when authorized.
Currently, COVID-19 tests are being offered that have been FDA authorized under section 564 of the Federal Food, Drug, and Cosmetic Act (FD&C Act) (these are listed on the FDA website here.) or under the policies outlined in the FDA's Policy for Diagnostic Tests for Coronavirus Disease-2019 (“COVID-19 Test Guidance”). This document discusses policies applicable to testing for COVID-19, including Laboratory Developed Tests (LDTs). “FDA notification” means that the laboratory or manufacturer has provided FDA with notification that it has validated its test as described in the policies outlined in FDA’s COVID-19 Test Guidance and is now listed on the FDA website here.
The guidance delineates which assays offered can be performed by laboratories under each of the CLIA Certificate types. CLIA has four different certificate types, which are Certificate of Waiver, Certificate of Provider-Performed Microscopy Procedures, Certificate of Compliance and Certificate of Accreditation. The required certificate type depends on whether the test was issued an EUA, and if so, the authorized settings included in the Emergency Use Authorization (EUA).
Supreme Court rejects request to lift state shutdown order
The U.S. Supreme Court refused to lift Pennsylvania’s shutdown order, rejecting a request from businesses and a political campaign that said their constitutional rights were being violated.
The challengers included a golf course, laundromat, timber company, real-estate agent and political committee tied to a Republican state legislative candidate. They filed at the Supreme Court after their arguments were rejected by the State Supreme Court. This was the first case taken to the Court over a state pandemic order. There were no noted dissents in the court’s order Wednesday.