Message from Secretary Rachel Levine, Department of Health

Today, Secretary Rachel Levine of the Department of Health held her daily press conference to provide an update on the COVID-19 crisis in Pennsylvania. As of this morning, there have been 1,396 new positive cases of COVID-19 in Pennsylvania, which brings the total number of cases to 45,763 in all 67 counties. Approximately 2,753 cases have been found in healthcare workers. Additionally, there have been 8,112 positive cases of COVID-19 associated with 468 long-term care living facilities, which include nursing homes, personal care homes and congregate setting facilities. Tragically, there have been 2,292 deaths in the state, all of which have been in adult patients. Approximately 2,706 patients are currently hospitalized due to COVID-19, and 562 of those that have been hospitalized have required the use of a ventilator or a breathing machine. Across our healthcare system, approximately 40% of hospital beds, 40% of ICU beds, and 70% of our ventilators are still available in Pennsylvania.

Today, Secretary Levine stated the following:

• The Department continues to work with healthcare providers to make sure that they have all of the PPE that they need in order to care for patients.
• The Department has pushed out PPE to all first responders, in order to care for those in nursing homes, personal care homes, and other congregate settings.
• At the beginning of April, 1,378 shipments of PPE were sent to nursing homes and personal care homes, which included shipments of PPE to 695 Department of Health licensed and skilled nursing facilities, and dozens were sent to congregate living facilities.
• The state has provided healthcare workers and first responders with 4 million N-95 masks, 240,000 hospital gowns, 1.3 million surgical masks, 1.3 million pairs of gloves, and 80,000 face shields.
• The Department asked that, if a business that produces these types of materials has them available for purchase, they can reach out the Department and be part of the Critical Medical Supply Procurement Portal, found at health.pa.gov.
• As the state starts to move to relax social distancing in regions and counties going from the red phase to the yellow phase, the Department must make sure that the health infrastructure has access to PPE, so that healthcare providers can protect themselves and the public from further spread of COVID-19.

Below please find the questions and answers from today's press conference.

Questions asked to and answered by Secretary Levine:

• How did the Department of Health develop the metric of no more than 50 cases per 100,000 residents in a population over a 14 day period?
• We’re looking for a metric, and other metrics, that will provide information about the change in cases over time and over the last 2 weeks of cases in counties and then regions. That is the metric that we decided that we were going to use, but as I’ve said before, that’s not the only consideration. We are going to be looking at other data and looking at other modeling. We are going to take all of that into consideration as we make our decision, so some of that will be quantitative, like a metric, and some of that will be qualitative.

• When the state is ready to move to the green phase, will bars and restaurants have restrictions imposed on them? Or will we be back to business as usual from the beginning? 
• Right now, we are laser focused on certain regions and counties that are going to be transitioning from the red phase to the yellow phase. There are no specific plans to go to the green phase yet.

• Since President Trump has eliminated social distancing guidelines, what will Pennsylvania use moving forward? And will it change based on the three phases of opening?
• The stay-at-home orders that the Governor has issued will remain. There will be changes when counties and regions are to go from the red phase to the yellow phase, and in the future, from the yellow phase to the green phase. Nothing generally changes in terms of the red areas in terms of the stay-at-home orders.

• When an area moves to the yellow phase, is that a signal for all types of businesses to resume? Or will there be some types of businesses that will remain closed?
• We’ve talked about this and decided that some businesses will remain closed, especially those where a large number of people would generally congregate. For example, movie theaters will be closed, restaurants will be closed in the yellow phase (except for curbside pickup), and concerts or other large gatherings. We will be sharing more information about life in the yellow phase tomorrow.

• Does the Department of Health plan on offering testing of asymptomatic residents and staff at nursing homes to prevent outbreaks from occurring at these facilities? And what testing options are there for residents that don’t currently have a positive case?
• We are testing individuals that are symptomatic, but they can be mildly symptomatic. We have been working with long-term care living facilities, including nursing homes and personal care homes, extensively. That involves issuing our state guidance and the CMS federal guidance, having frequent phone calls with our staff, and our contractor, ECRI. Where there have been severe outbreaks, the National Guard medical team has stepped in. We are doing wide spread testing in nursing homes, including symptomatic people. If there is a staff member or a resident, one that is symptomatic, that hasn’t had any previous cases, we will certainly test them. It is a priority of the Department of Health’s and the Governor’s response.

• Yesterday we saw an enormous leap in the number of deaths reported. To your knowledge, are there still large numbers of deaths that occurred weeks ago that are actively being reconciled in the data systems? And should Pennsylvanians expect to see another spike?
• As we’ve talked about for the last several days, we collect data from laboratories, from doctors, from hospitals, from County and Municipal Health Departments, from our coroners, and we work to validate that data. We get data through our NEDS system, and the electronic death reporting system from our Vital Records Department. One of the challenges has been reconciling all of that data to present the accurate death totals to the public. There is a possibility going forward that as we reconcile the data, there will be an increase in cases, but we will explain it that way, if that happens.  

• We believe a Brighton Lakes situation exists in Berks County at Manor Care Sinking Spring. Has the Department engaged with ManorCare about this? And ManorCare West Reading is seeing a high number of cases and deaths.
• We are aware of any situations in these facilities where there are cases or an outbreak of COVID-19. We won’t talk about specific facilities, but we are aware of all of those and we are working with the facilities.

• We’ve spoken with Pennsylvania hospital systems that say that they have the capacity to do more tests, but they are limiting testing to those with coronavirus symptoms. Is the Department aware that hospitals have extra capacity? And should they begin testing asymptomatic patients?
• At the moment, we are recommending testing for symptomatic patients, but we have liberalized our criteria significantly. Previously, we prioritized healthcare workers and seniors over the age of 65 who had symptoms, but we had some specific criteria. We’ve liberalized that to include anyone with symptoms. We are aware that our state laboratory in Exton, as well as other hospitals and health systems have more capacity. That is great because we want to expand testing of symptomatic persons, and recommend that they contact their healthcare provider, arrange for testing there, or at Rite Aid, and we include that in all of our data. The one place where hospitals will be testing asymptomatic people is before elective procedures. In areas that aren’t seeing significant increases in COVID-19, we are encouraging hospitals to start the urgent procedures that have been put on hold for weeks. By testing those individuals, because they are having a procedure, that will be useful to us in terms of surveillance.

• With the reopening of outdoor spaces, what is the Department’s guidance for masking in outdoor settings? And how does it apply to people who are doing athletic activities? Are masks effective when they get sweaty or wet?
• Masks should be effective if a person sweats, but I would assume it is less effective when it is soaked. Our recommendation when going outdoors is to wear a mask if you plan on encountering any other people. However, if you are on a trail, hike, walk, bike ride, and you are not going to encounter anyone, you don't need a mask. It’s very important to have a mask, as my mask protects you and your mask protects me and if everyone wears masks, then it will protect the community.

• Pennsylvania continues to include probable cases of COVID-19 in its count of total cases. In the light of yesterday’s addition of 479 deaths, is Pennsylvania still only counting deaths that involve a positive test for COVID-19? Or have probable deaths been added back into the total?
• Probable deaths have not been added back into the total number of deaths, and we have no plans to re-add them.

• With the help of Senator Yudichak (I - Luzerne), Northeastern Pennsylvania has created a privately funded program to help nursing homes get the proper PPE they need. This comes after advocates for seniors and nursing home unions claim that the state ignored their requests for emergency funds to help deal with the COVID-19 crisis in nursing and personal care homes. Why was their request for additional funds ignored? And what resources are out there for nursing homes that continue to struggle to get the PPE they need for proper care, such as hand sanitizer? 
• We have pushed out many shipments of PPE and other measures to nursing homes and other long-term care living facilities. We had a large pushout of N-95 masks this week, so it’s not so much a fund issue, it’s about having the resources that these facilities need to take care of patients. They are not paying for this PPE. We have federal funds and other CDC funds we are using to help push out this equipment. We are always pleased to have public and private partnerships to help all of our facilities.

• Lycoming County may be one of the first to move to the yellow phase of reopening but only about 1,200 people have been tested, which is roughly only 1% of the county’s population. How do you know that Lycoming County falls under that 50 new cases per 100,000 resident metric, when such a small fraction has been tested for the virus?
• In rural areas, we understand that less people have been tested, and less people have had symptoms. We are going to follow our metrics and other qualitative factors when counties are going from the red phase to the yellow phase. We are looking to expand testing, including to hospitals in Lycoming County, to ensure they have more testing capability than they had several weeks ago, so that is great. If anyone is symptomatic, we want them to contact their health provider, get tested at whichever facility they choose, and we will be watching very carefully for any outbreaks or clusters of COVID-19. We will be using our contact tracers to check on those individual’s contacts and implement isolation and quarantine.

• Some have expressed concern that as testing increases, the number of positive cases will too and that might skew some counties chances for moving into the yellow phase. With that in mind, will there be any float on the 50 new cases per 100,000 residents to account for growth in testing?
• We are not going to change our metric. We will be testing, uniformly, the symptomatic patients across the yellow zone...and even in terms of red zones. There won’t be any sort of skew and please remember that the metric is just one piece of the puzzle. In other words, it is necessary, but not sufficient. We are looking at other qualitative factors to decide which counties will go from the red phase to the yellow phase.

• Is meeting that metric, even though it is not the only factor taken into consideration, is it a mandatory prerequisite?
• It is necessary because we will always be taking other qualitative factors into account. However, if we see a county that has significantly more than 50 new cases per 100,000 residents, it’s much less likely to move into the yellow phase.

• Is Remdesivir, which was the treatment for Ebola, a game changer in the battle against COVID-19? Can you explain what it does more effectively than other remedies to date?
• Remdesivir was developed for treatment of Ebola after the 2014 Ebola outbreak in West Africa. Mind you, it’s a completely different virus, but it has been tested on patients with COVID-19, and there is a study now that it can be effective in patients. A game changer would be promising, but in science and medicine, there is always a need for more studies to be done on how effective it is, what dosage does, what kind of patients it helps, how long it lasts, and all of that still needs to be determined, but it is very promising.

• If there is a resurgence of COVID-19 in the Fall, in what ways might you prepare differently based on the lessons learned this Spring?
• One of the challenges this Spring that was of great difficulty was getting testing from the CDC and the federal government in February and into the beginning of March. We have now expanded testing, we have more capacity at our laboratories, hospitals, health systems, and commercial laboratories all have more capacity. We had a great phone call with the federal government the other day, with the Assistant Secretary of Health from the U.S. Health and Human Services Department, the CDC, and the FDA. We discussed the different components of testing, including the swabs, the media for the viral test tubes, platforms for testing, the extraction, and different aspects of that. They provided us with a lot of information, and they are going to be shipping to us the swabs and test media, and they also provided a lot of information about accessing the other materials for testing. We are very pleased that testing is becoming more available, and we will be using that as we roll out the schema to transition from the red phase to the yellow phase. In the Fall, we are hopeful that we will have more testing available, as we talk with the Governor about that on a regular basis. As far as how we would use that to deal with or prevent a surge of increased cases, we are developing those plans now.

• There is misinformation about Pennsylvania reopening on social media platforms such as Facebook. One post showed what looks to be like official documents from a conceptual plan linked to a State Representative, and listed 40 counties as opening on Monday, May 4th. People continue to believe and share this information, believing it is fact, and everything will reopen and their lives will automatically return to normal. Do you have any advice on how to effectively share the correct information, when so much misinformation is already out there?
• It is challenging, and we know it’s difficult with social media and with the truth of the information that is being shared. I suggest that people check out the Department of Health website to get the accurate information.

• During a state Senate Government Committee hearing today, one of the election directors testified that counties are calling on Governor Wolf to issue an Order regarding polling places needing to be open for the primary election on June 2^nd, so long as there isn’t public health concern preventing it. With nursing homes typically serving as voting locations, those should remain off limits, and schools should be available for voting as usual. Is that something the Governor is planning, willing or able to do?
• I will refer any questions about the election and polling places to the Governor.

• There is an outbreak of cases in two Lycoming County nursing homes. Is the guidance to treat these cases in place at these locations? Or are individuals being moved to isolation rooms at a hospital?
• That depends on what the patient needs in those long-term care living facilities. If they are not critically ill, then they can remain at the facility and be put in isolation. If there are a number of different patients and/or staff with COVID-19, then they should all be cohorted with PPE and the resources they need, as well as having infection control consultations with ECRI. However, if they are severely ill, then they should be taken to the hospital for further intensive medical care.

• Many of our readers ask about the statistics of recovered patients, ones that would not be considered contagious anymore. Is the Department tracking or compiling data of those that have recovered by county?
• We’ve talked about this in the past. Over 45,000 Pennsylvanians contracted COVID-19, and that it just isn’t possible to contact all of those 45,000 patients to see when they recovered. You can do the math in terms of the numbers of patients, and go over the statistics in terms of the 14 days, and they should be better. But we don’t know that, but we have given validated information to the public over a regular basis but we are not able to provide that information about recovered patients.

• Why did the state appoint a temporary manager to run the Brighton Rehabilitation facility? Did the owners ask first? Or did the state say that they were going to come in to support the facility?
• This was a very collaborative decision in terms of appointing a temporary manager to that facility.

• With the state stepping up to help the nursing home in Beaver County, we understand this to be the Brighton Rehab and Wellness facility, by hiring a temporary manager and contracting a consultant to work on infection control, what more is being done to ensure the safety of the residents?
• We have taken those steps, and we will continue to do everything we can to ensure the safety of all of the residents and staff.

• Regarding hosting daily calls with nursing home staff, what have you learned?
• I don't have those granular details with me right now.

• How are healthcare providers and medical facilities following the Department’s mandate of including race and ethnicity data in their tests?
• It is very important, and myself and the Governor have called upon all facilities and laboratories to include all of that data, including race and ethnicity, when they are doing laboratory testing, and then report those results to us. We are doing better in terms of facilities reporting that data, but we are not there yet.

• Have you had to enforce that reporting? And if so, how?
• It’s hard to enforce it when we are calling upon them to do it through press conferences and other forms of communication. Both the Governor and I feel that they will comply. Our data reporting will get better, as it did with lead data reporting previously, but I think we will be successful.

• What is the goal of the temporary manager at the Brighton Rehab and Wellness facility? Is it to bring Brighton Rehab into compliance? Or is it wind down operations and close?
• The temporary manager is there to help the staff in terms of taking care of patients, and preventing further spread of virus and to help those that have it.

• The Secretary of Health in Illinois said recently that existing hospice cases who contract COVID-19 are being classified as a COVID-19 death. Is Pennsylvania doing the same thing? And if so, is it fair to say that COVID-19 is not the primary cause of death? And will the numbers be updated accordingly?        
• I don’t know the answer to that question, but I will look into that and get back to you.

• You mentioned working with hospitals, counties, and municipalities to bolster state contact tracing staff. Will you be hiring many people? And if people are interested in helping with contact tracing, can they do so? Or how can they sign up?
• We are looking to hire people to help with that, and we will have more specific information on that soon.

• Regarding the state loans to hospitals announced today, what impact do you see this money having on health systems? And how quickly? Do you think it will be enough to keep them afloat? Or could there be more state funds needed?
• I think that it is going to be extremely helpful for those hospitals that signed up for that loan program, and there is more money coming from the federal government to hospitals and health systems to keep them afloat. With hospitals that are starting to have elective procedure and operations, which is a large part of their revenue, we are going to be doing everything we can to help our important hospitals and health systems stay afloat and take care of patients.

• Do you have a timeframe for when test kits will be available for nursing home staff and residents?
• We do provide testing for nursing home staff and residents. When you say test kits, the testing is not being done in the facility. The samples are being obtained and run at our state lab in Exton or other commercial labs, so we already do that now.

• Has the Department traced any COVID-19 cases back to the March special elections in Philadelphia, Westmoreland, and Mercer counties?
• I don’t know the answer to that question.

• State Representative Frank Burns (D-Cambria) is calling on Governor Wolf to allow all businesses regardless of size, to offer curbside pickup and delivery following established safety protocols. Since the state wine and spirit stores can operate safely, won’t this work for retail businesses?
• We are going with the schema that the Governor has outlined, where counties and regions will go from the red phase (which is the shutdown we have now) to the yellow phase (where many businesses will be able to do curbside or open following social distancing) and eventually that will lead to the green phase. This is the schema we will be following.

• How often will the state be announcing updates about counties going from the red phase to the yellow phase? Will that be daily or weekly?
• We haven’t determined that yet. We will announce that when those decisions are made for further counties.

• At what time and manner tomorrow does the state plan to release the counties and regions that will be allowed to move to the yellow phase on May 8th?
• I don’t know the exactly time. Many of our press releases are at 12:00 pm, and then we have press conferences at 2:00 pm. That’s my estimate, but I have not been in communication with the Governor’s communication office about what time that will be released tomorrow.

• With the announcement of openings tomorrow, what steps is the Department taking to make openings as safe and effective as possible? Could you elaborate on parts of the process that deem to allow businesses to be open during this time?
• We’re working in terms of the ability to do social distancing, either through curbside business, or for no more than 25 people to be in a business, being 6 feet apart, etc. and making sure that all of the other guidelines are able to be followed. We will be making those announcements tomorrow for the counties on May 8th that will go from the red phase to the yellow phase.

• We’re about a week away from the Governor’s gradual reopening of business. Widespread testing and contact tracing are seen as essential to a safe reopening. Are you concerned that we don’t have that widespread testing and contact tracing in place?
• We do have very extensive testing and contact tracing plans and we will be releasing them either tomorrow or over the weekend, so that the public knows what those plans are. We are very confident in our plan.