May 8am COVID-19 Update – Pennsylvania American College of Physicians

• Governor extends stay-at-home orders 60 days
• Daily COVID-19 data update
• Q/A’s with Sec. Levine
• Four legislative committees assessing state responses for senior living facilities
• Levine warns about ticks, tick-born illnesses

 
Governor extends stay-at-home orders through June 4
With the April 1 statewide stay-at-home orders set to expire at midnight Thursday, May 7, Governor Tom Wolf and Secretary of Health Dr. Rachel Levine extended the orders for all counties in red, and signed new orders for the 24 counties moving to yellow at 12:01 a.m., May 8.
 
The extended stay-at-home order remains the same as the original statewide stay-at-home order announced on April 1, which was set to expire at midnight and is now extended to June 4. The yellow phase order provides guidance for those counties entering the yellow phase of reopening.
 
The yellow phase order applies to these 24 counties: Bradford, Cameron, Centre, Clarion, Clearfield, Clinton, Crawford, Elk, Erie, Forest, Jefferson, Lawrence, Lycoming, McKean, Mercer, Montour, Northumberland, Potter, Snyder, Sullivan, Tioga, Union, Venango, and Warren.
 
The yellow phase order also addresses the limited reopening of businesses in the yellow phase, detailing those businesses previously deemed non-life-sustaining as being permitted to reopen if they follow the guidance for safety for staff, customers, and facility. The guidance for businesses can be found here.
 
The Governor and Dr. Levine have said there will be an announcement of additional counties moving to the yellow phase in the future, perhaps as soon as Friday, May 8.
 
PA COVID-19 DATA UPDATE
On Thursday, the Department of Health reported that Pennsylvania had found 1,070 new confirmed positive cases in the previous 24 hours, for a total of 52,915 confirmed cases.    
 
The death total rose to 3,416 total confirmed COVID-19 deaths, an increase of  310 from Wednesday’s report, all in adult patients.  This is the result of reconciliation of reports over the past several weeks. The state Health Department’s breakout of virus data for long-term care living facilities indicates 2,355 of the state’s deaths, more than 67 percent, were nursing home residents.  There were 209,873 negative tests in PA as of midnight Wednesday night.
 
At least 3,437 are health care workers – accounting for about six percent of all positive cases; the total figure includes 1,489 workers in nursing homes. And 10,506 cases – accounting for 19 percent of all cases- are in 514 of the state’s long-term care living facilities in 44 counties.  It also includes 2,107 positive cases in workers in the food processing industry in 124 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 Wednesday, 28,844 positive cases (55%) were female and 23,456 (44%) were male. One percent (615)  were unreported or neither.  Among the deaths, 1,704 (50%) were males 1,696 (50%) were female with 16 unreported by sex.
 
By race, 12,349 positives were Caucasian (23%), 5,909 were African-American (11%) and 631 (1%) were Asian, with 264  listed as “Other.”  The vast majority, 33,762 (64% of all cases) remained unreported on the race of the patient.  A total of 1,273 deaths were among Caucasian victims, 356 were African American/Black, 38 were Asian and 11 were listed as other.  1,738 deaths (51%) weren’t reported by race.
 
On Thursday at noon,  2,484 positive patients were hospitalized, about six percent of those testing positive.  At that time, 528 were using ventilators and 21 on ECMO machines.  About 1,315 (39%) of the 5,199  intensive care unit (ICU) beds were available, 6,380 general medical beds (45%) were available and 1,611 (53%) of the airborne isolation rooms are still available statewide.  And 1,421 of the state’s 5,334 ventilators were in use (nearly 73% of ventilators were still available.) 
 
Of the patients who tested positive to date the age breakdown was: less than 1% are aged 0-4; less than 1% are aged 5-12; 1% are aged 13-18; 6% are aged 19-24; 37% are aged 25-49; 26% are aged 50-64; and 27% are aged 65 or older. 
 
QUESTIONS WITH DR. LEVINE:
Are Pennsylvania residents permitted to travel to the Jersey shore beaches that are reopening?  Will there be any enforcement?  LEVINE:  There is no law or regulation that prevents travel within PA and into NJ. My recommendation is to not do that, however.  Going into New Jersey is a risk because that state has had a high incidence of COVID-19.  If you go to the shore, other people will be going to the shore, and it will be difficult to practice social distancing. I recommend people stay at home.
 
If a person is asymptomatic, how likely is it that they will test positive, and that they are contagious? LEVINE: We are still looking at that.  We have recommended all patients that have symptoms get tested. We are not pushing out population testing at this time, which would include these individuals. They can have it and can spread it, but we don’t know how many there are and whether they would spread it.
 
If masks work, why do businesses have to close, and if they don’t, why do people have to wear them?? LEVINE: Well the issue is that masks  work, but not 100%. Masks protect you from me. We are not talking about  N95 masks. Cloth masks are not infallible, so that has led to the mitigation procedures the Governor instituted.  We bent the curve and we have to be careful in the future.  It can surge again and is still prevalent in the northeast and southeast regions  of the state. 
 
The DoH says SCI Huntingdon is reported as having 109 total cases, but Corrections is saying 108 inmates and 32 staff.  Does that mean all of the Huntingdon County cases are from the SCI?  How does that work with moving to yellow? LEVINE:  We are looking at that, but we have always said long term living facilities and prisons do count in a county’s general count of patients.
 
Citizens in Wyoming County have only 27 cases and think they should be treated like Sullivan and Bradford Counties, while Clinton County, which is yellow, never crossed the 50 per 100,000  threshold and is moving to the yellow phase.  Why?  LEVINE:  We are always looking at that data and this week we will present information to the Governor for his decisions. We will do so, and he will have additional recommendations tomorrow.
 
Can you say how many deaths there would have been without the  reconciliation?  LEVINE:  I don’t have that granularity but will send that information to the reporter after the press availability.  We are working daily with Philadelphia, with our personnel and getting IT fixes.  We want the most accurate data possible.
 
There is an extremely high percent of the those tested in Montour county even though it has only 50 cases. Is this because of Geisinger? Are they doing multiple tests?  LEVINE:  I don’t have granularity on that, but assume there is more testing with Geisinger being a level 3 health center.
 
Rite Aid announced it is beginning testing for asymptomatic individuals at its locations.  When will the state do the same?  Should hospitals and others do the same?  LEVINE:  Rite Aid is a partner in our testing program.  We want to make sure testing is available and accessible.  We still have two mass testing sites that go right to the lab in Exton.  Hospitals and health systems are doing the majority of testing and LabCorp and Quest are running samples as are the hospitals.  We are looking to partner with other companies and other pharmacies as well. 
 
Do you have advice for people planni
ng to visit their mom for Mothers’ Day – do you have any guidelines for Mothers’ Day?  LEVINE: My recommendation in red zones is to do it virtually.  In yellow zones, people could do visits, but not to a nursing homes or long term living centers, which are not allowing visitors.  Those congregate care centers still have to be locked down because of the extreme risk
 
Can someone be relocated from a nursing home that has positives to a family home or other nursing facility? And if so, what are the guidelines?  LEVINE:  Well, if a family accepted a nursing home resident, if there were any positive cases in that facility, everyone in the family would need to be quarantined for two weeks. The entire household should quarantine.
 
CDC had developed a detailed guide to reopening that was shelved by the Trump administration. What do you think of that, and does that mean businesses will have less requirements to concern themselves with.in terms of reopening?   LEVINE:  I’m not going to comment on the Trump administration.  We collaborate with them and we use the CDC guidelines, but occasionally we differ.
 
We know DoH wants to expand testing, but if only the sickest are tested, how does the state factor into those decisions now?   LEVINE:  We want more than the sickest people tested now. Even two weeks ago we were applying testing to only those with symptoms over 65, in nursing facilities and hospital and health care workers.  We now have more testing kits, reagents, swabs and we want to expand testing to all symptomatic individuals.
 
How long has the dept been using the GYANT COVID-19 Screener and Emergency Response Assistant (SERA) application and how is it working?  LEVINE:  We’re just in the second day of use, and it’s been great so far.
 
How far along is the Department in deciding on Bluetooth notification technology?  Is the department using Google, Apple, API or some other Bluetooth technology?  LEVINE:  We are getting ready to work out a contract and then we’ll announce that.
 
In Pennsylvania, 84.4% of deaths had 1-4 or more comorbidities. Is it fair to say they died of one of those but were considered COVID-19 deaths because they tested positive? LEVINE:  No, it’s because they had COVID that caused the death and those with comorbidities were more at danger.  We are talking about heart disease, uncontrolled hypertension, diabetes, COPD, and chronic kidney disease. 
 
Today, the number of new positive cases are up.  What is your reaction to that increase Is the trend of decreasing numbers of positives over? LEVINE:  No, we had a data dump from LabCorp and that tends to skew things. So we’ll see what the numbers are tomorrow and over the weekend.  We’ll see how tomorrow’s is.
 
What is your outlook for the fall as far as social distancing? LEVINE: I’m an optimist, and still it’s difficult to predict what the fall will look like. Many experts expect an increase in the fall as the weather gets colder.
 
For the last few days you’ve provided numbers of positive cases for health care workers and also numbers in the food processing industry, nursing homes and their employees.  Are those separate numbers or are they  included in the larger health care workers statistics? LEVINE:  The numbers for nursing home employees are included in the health care workers reports.
 
Some states have opened up drive through testing sites for anyone who wants to get a test.  Why is this not more widespread and why isn’t Pennsylvania doing this?  LEVINE:  We want to make sure we are testing people with symptoms.  We want to get an idea of the total burden, in PA, but get it in a scientific way.
 
Earlier this week, the Monroe Co. Coroner asked for your resignation. What’s your reaction to that?  LEVINE:  I haven’t seen that letter, but we are working with the coroners association and want to be more clear with them. I serve at the pleasure of the Governor and will  continue to as Secretary of Health.
 
Are the Rite Aid tests being included in your statewide results?  LEVINE: Yes.  Rite Aid is doing the tests, obtaining specimens and sending to laboratories and those results are being included in our reports.
 
Will dirt track racing, horse and harness racing like at Presque Isle Downs in Erie be able to open for racing in yellow phase counties?  LEVINE:  I don’t have specific information about those facilities, but I know there is guidance coming out from the Governor’s Office. So we’ll wait to see what that guidance is.
 
The first round of reopening starts tomorrow.  Can you say when the next openings will occur, and will some of the counties be outside or opened  independently of the health district groupings?  LEVINE:  All will be announced tomorrow at the Governor’s press conference.
 
Dentists and dental offices want to know, When will they be able to reopen for normal dental procedures?  LEVINE:  If the state says they can do that opening, we have reviewed OSHA and CDC guidance and are reviewing, discussing that.  We will announce that, probably tomorrow or Saturday.
 
Four Committees looking at state response to COVID-19 and nursing homes
Three separate committee hearings were held this week in the General Assembly and a fourth and fifth are now scheduled to look at how the Wolf Administration has handled the COVID-19 pandemic and its impacts on nursing homes and long term care facilities.  The Senate Aging and Youth and Health and Human Services Committee, Senate Democratic Policy Committee and House Aging and Older Adult Services Committees have held hearings this week on the Wolf Administration’s response, and next week, the House Veterans Affairs and Emergency Preparedness will look at veterans homes and the role of the National Guard in assisting with nursing home issues.
 
With 80 % of new coronavirus deaths in Pennsylvania at nursing and personal care homes, lawmakers of both parties are demanding answers. 
 
Health Department data shows the vast majority of coronavirus deaths are occurring in nursing homes licensed by the Department of Health, and personal care homes which are licensed by the Department of Human Services.  A total of 3,416 coronavirus deaths has been reported statewide through Thursday. Of those, 2,355, or nearly 69%, were associated with nursing or personal care homes.  And in the last week, 76% of all Pennsylvania deaths (850 of 1,124) were at personal care or nursing homes. 
 
Health Secretary Dr. Rachel Levine, testifying Thursday before two Senate committees, said the state focused its response in the early days of the Pennsylvania crisis on hospitals because it wanted to be prepared for a potential surge of patients.  A DoH spokesman said that the Department was not one of the data pieces they have been providing publicly, but Democratic Senator Pam Iovino said the Department told her that 87% of all COVID-19 deaths were in the 65 and older age group.
 
Sen. Andrew Dinniman (D, Chester County) said, The Department of Health has failed our senior citizens.”   Dr. Valerie Arkoosh, a physician who chairs the Montgomery County Board of Commissioners, said her county only learned via numerous calls to 911 and requests to the county for protective equipment that ″there were some really serious problems,” but when the Department of Health could not provide assistance, the County formed teams to visit the homes and purchase PPE for staff.
Chester County was able to buy 3.5 million pieces of protective equipment that it distributed to hospitals and nursing homes there.
 
Sen. John Yudichak (D, Luzerne County), said, “The Department of Health did not act quickly enough and has failed to develop a comprehensive strategic plan for the safety and welfare of not only those nursing home patients, but also the s
taff members that serve them.”  Yudichak and local nonprofits raised more than $500,000 to purchase PPE for local nursing homes when the equipment was unavailable from the Department.
 
Levine insisted that the state has made nursing and personal care homes a priority from the beginning. She said an outside contractor was hired to consult with the facilities about fighting the virus. The mitigation measures put in place by the administration helped many parts of the state and the health care system, Levine said, but could not prevent the spread of the virus into nursing homes.
 
Committee Chairman John DiSanto (R, Dauphin) asked the representatives of nursing homes if they were aware of anyone in the nursing home community that worked with the administration and how their concerns were incorporated into the Administration’s response and guidance.  The present of the Pennsylvania Health Care Association said they did not have a seat at the table and that two weeks ago the state’s relief and recovery plan ignored nursing homes, PCHs, and assisted living communities. 
 
Levine takes time to talk ticks
At the close of her data update, Dr. Levine said, “Pennsylvanians are spending more time outdoors, and that’s great,” but she warned that spending more time outdoors could lead to more instances of tick-borne illnesses such as Lyme disease. 
 
Pennsylvania is among the highest states in the nation for cases of tick-borne diseases. 
 
Levine encouraged Pennsylvanians to use repellents containing DEET to prevent tick bites.