Daily Press Conference COVID-19 Update

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 are 543 new positive cases of COVID-19 in Pennsylvania, which brings the total number of cases to 57,154 in all 67 counties. This includes 3,790 positive cases in healthcare workers, and 11,801 positive cases of COVID-19 among 540 long-term care living facilities, which includes nursing homes and personal care homes. Tragically, that brings the statewide total to 3,731 patients who tested positive for COVID-19 and have passed away, and to date, all of those deaths have been in adult patients. 

Today, Secretary Levine stated the following:

• Many have heard that both her and the Governor have talked about the importance of testing of persons with symptoms, which helps the Department to identify outbreaks, and continue to make accessible and available testing sites across the state.
• Rite Aid, a local Pennsylvania company, has done excellent work to increase testing access for Pennsylvanians.
• Starting today, there are 9 drive-thru testing sites at various Rite Aid locations throughout Eastern Pennsylvania, and there are an additional 6 testing sites across the entire state.
• Everyone can get tested for free. People will need to make an appointment at www.riteaid.com. A map with all of the testing locations can be found at the Department of Health’s website.
• In order to know whether or not you need to be tested, you can do the following:
• Go to the Department’s website, and click on the “Symptoms and Testing” section, which gives great tools to see if you should be tested.
• There is also a symptom checker tool from the CDC for your convenience.
• Symptoms include: fever, cough, shortness of breath, chills, repeated shaking with chills, diarrhea, muscle pain, headache, a significant sore throat, and/or a new symptom, which is the loss of taste or smell.
• For those counties moving from the red phase to the yellow phase, the Department asks for everyone to continue to practice social distancing and wearing masks. 

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

Questions asked to and answered by Secretary Levine:

• Is the State stepping up license inspections of nursing homes and personal care homes in the wake of the increased numbers of COVID deaths in those facilities?

• The Department of Health regulates nursing homes, and the Department of Human Services regulates personal care homes. At the order of the CMS, Center for Medicaid and Medicaid Services, we are not doing the routine inspections that are done every year by one of our Departments for those facilities. But we are continuing to investigate any complaints or concerns regarding the care at the facilities, and we can do that virtually rather than have the team go to the facility.

What is the role of the National Guard assigned to Brighton Rehab? Will the facility be evacuated? And the management’s handling of patients during the pandemic be investigated?

• Today, we have placed a temporary manager at Brighton that is being paid for by civil monetary protection funds from the Department of Health. The manager is Allure Health Systems of New Jersey and we are doing this at the agreement of all of the parties. The National Guard is there to provide direct care support, and they will be there until May 18th. On May 18th, staff contracted by the facility will be on-site to care for a patient, and it will be direct patient care that the National Guard will be participating in. We do not have any intentions to evacuate the facility. That is why we have put in a temporary manager who is arriving there today, as well as the National Guard. We will take whatever means are necessary to protect the health and safety of the staff that is active authority. Right now, we are looking forward to all of that work happening and making sure that the patients are taken care of.

The National Guard says Brighton Rehabilitation is the 9^th nursing home it has provided this kind of support to. Why isn’t it the first nursing home to get support, as it has long been the worst nursing home outbreak in the state?

• Unfortunately, as you know, nursing homes in long-term care living facilities are one of most challenging situations we are dealing with in Pennsylvania, and really throughout the nation. I'm looking at the responses in New York, New Jersey, Maryland, Illinois, Massachusetts, and other states, and this has really been a challenging situation for all of us. There have been nursing homes that have had significant issues in terms of staffing throughout the state, and that helped to make the determination that the National Guard had to be in other places, and now is in Brighton.

There is a State statute which gives the State power to impose a manager at a facility within the state. The statute says there are two options which are as follows: 1) A manager can be imposed either when a healthcare provider has failed to bring the facility into compliance within the time specified by the Department or Health; 2) A facility has demonstrated that it is unwilling or unable to achieve compliance, such as convincing a reasonable person that any correction violations can be unlikely to be maintained. Which of these 2 options is the reason the State is imposing a temporary manager at Brighton?

• According to our legal experts on our legal team, those are imposed if the facility refuses to work with us in terms of a temporary manager. But as I said, the temporary manager is being instituted by agreement of all of the parties, and that is how the temporary manager is starting at Brighton.

Given that New Jersey and New York are releasing facility level data on long-term care infections and deaths, why has Pennsylvania refused? Considering that aggregate data does not violate privacy of residents, what is the value of not releasing this infection data to the public?

• As I said last week, we are awaiting the CMS guidance to be released about that data. We've been working on that plan, and that data will be released later this week. 

• You’ve said that the Department of Health is continuing to discuss outbreaks in nursing homes, and whether more information should be released publicly. Are those conversations ongoing? And will more information be released about specific homes with cases?  

• As I just stated, we will be releasing that information by the end of the week.

• What did Bucks County Officials say to you on Saturday during your Skype meeting regarding reopening? And did it change your mind?

• We had a very good discussion with the County Commissioners, including the Philadelphia County Health Commissioner, and our staff about Bucks County in terms of the number of cases and the locations of cases. We will be working with them, and all of the other counties in the Southeast, on a plan for what metrics we will be using and how we are looking at the Southeast to eventually move into the yellow phase. We did not come to any specific conclusions, but we all agreed that we will continue those discussions. 

• What advice do you have for childcare centers moving into the yellow phase on Friday, May 15th?

• That information can be found on our Frequently Asked Question document on our website, and the Department of Human Services determines those guidelines. 

• Please provide more details regarding your discussions with Philadelphia leadership and that of the Southeast Pennsylvania counties, regarding an opening plan tailored towards their specific challenges.

• We have had discussions with Philadelphia, Montgomery, Bucks, and other counties. We're going to continue all of those discussions about the metrics that we would use, the data that we will use, and other considerations that we will use for the Southeast is to go from the red phase to the yellow phase. Those conversations will be continuing this week. 

• What message do you have for counties that are defying the Governor’s Orders and moving themselves into the yellow phase? How could their reopening affect neighboring counties?

• The Governor had addressed that earlier. We are concerned about counties going from the red phase to the yellow phase before they are ready, from a public health perspective. We are looking at all of the different data because we want to make sure that we don’t precipitate any outbreaks of COVID-19.

Do you have a response to State Senator Doug Mastriano (R-Franklin) who today was at the Capitol in Harrisburg calling for your resignation?

• I have no response for Senator Mastriano, I serve as Secretary of Health for the Governor and the Governor answered that question.   

• Any update on that specific criteria to send a yellow phase county into the green phase?

• We have not determined what the exact criteria would be for counties to go from the yellow phase to the green phase. Of course, the first counties just went from the red phase to the yellow phase this past Friday, and that was 24 counties. We have 13 more counties going to transition to the yellow phase this Friday, May 15th. We are working on other criteria for counties to go from the red phase to the yellow phase, and as we're working on that, we will start to think about what would be necessary to transition to the green phase. 

• Do all Pennsylvania counties have to be in the yellow phase before any counties can move into the green phase?

• We haven't made any of those determinations at the present time. 

• Are residents expected to help enforce the new rules in the yellow phase? If so, to whom should they direct their reporting – police, 911, or the Department of Health?

• I would not call 911 unless there is some kind of an emergency. But I think that if they're concerned about businesses operating in their county, then they should contact their local authorities. I believe that there is also a business line that people can call or check the Department’s website to reach out to additional personnel. 

• Your daily numbers include 2% of people hospitalized are ages 0-29. What are the ages of the youngest diagnosed cases? And the youngest hospitalized patients?

• I do not have that granular data with me, so we will have to check and get back to you. 

• At this morning’s news conference, Governor Wolf said that counties defying State Orders will not receive discretionary funding from Pennsylvania. A short time ago, the Governor tweeted that he would announce consequences for counties defying State Orders. Will there be additional consequences beyond the loss of discretional funding? And can you elaborate?

• No, I’m going to leave that to the Governor. 

• What are some of the health consequences for counties that move into the yellow phase before both you and the Governor say that it’s okay?

• It's more than just the Governor and I saying that it's okay. We have an expert team in which includes our epidemiologists and public health officials, who are looking at all of the data, and different ways to depict the data such as the trajectory animations that are available on our website. In addition, we have different models that we are looking at, including the model from Carnegie Mellon University and others. We go over public health impacts and then discuss those concerns with the Governor's Office including the social impacts, political impact, and specifically the economic impact. All of those factors have to be taken into consideration when we make our recommendations, and then the Governor makes his decisions. 

• Johns Hopkins University started enrollment today for an online training course to become a contact tracer. Since there is now a push for contact tracing in Pennsylvania, would you recommend people take this training course?

• There are a number of different courses that are available, and I think training courses are great. However, I don't have a specific preference for one or the other, but John Hopkins is a fantastic University with a great public high school. 

• Will the Department of Health release hospitalization rates and discharges by county? How about revised daily death counts?

• We are working on all of our death data, and I will talk to our team about how granular we can get. 

• Some people in Pennsylvania who have a COVID-19 antibody test, have been told that if their results are positive, they would be given to the Department of Health and would be considered a presumed COVID case. Is that true? And has the Department of Health been reporting that number in its daily count? Or will that be reported soon in a separate category?

• We have been getting that data, and no we are not reporting it in a separate or different count. 

• If a county begins moving to the yellow phase and doing so causes infections, how long would it take for the Department to realize that? And how do you plan to monitor that situation?

• As we've been discussing, expanding testing in those areas, our ability to do case investigations and contact tracing, responding to any outbreak with the patient being isolated, and then the contacts being quarantined. The incubation period has to be taken into consideration, as the incubation period ranges from 2 days to 14 days, with an average of 5 days. In order for us to know, it would be at least 5 to 7 days if there is an increase in cases, and then possibly two weeks or more. 

• The Northeast region saw its fewest cases today than it has seen in a least 2 weeks. Does that suggest that community spread is slowing down in Northeast Pennsylvania? And does it open up the potential for the region to move into the yellow phase?

• It's a very positive finding, but again…one day’s data is not as meaningful as trends in data, so we will watch that very carefully. A trend in data with a decreasing number of cases will be very positive, and we will be taking that into consideration as we consider all the variables for counties to transition from the red phase to the yellow phase. 

• Rite Aid says it would provide testing to asymptomatic people, in keeping with Federal guidelines from the Department of Health and Human Services. Can you please clarify the role that the Pennsylvania Department of Health guidelines play in determining which residents in Pennsylvania get tests?

• We have been prioritizing the testing of symptomatic individuals; however, I have no problem if Rite Aid tests asymptomatic individuals as well, but our priority is symptomatic individuals. As we announced today, they are going to be expanding their sites so anyone can register to get a free test. Overall, we really want to expand testing as much as possible throughout Pennsylvania. 

• If Rite Aid can administer tests more widely, what stops other healthcare providers from rushing ahead of State guidelines to test asymptomatic patients?

• I don't have an objection if providers want to do that. We are going to be in prioritizing testing in terms of symptomatic individuals, but we want to get to the point where we are doing that type of population-based surveillance type testing, so we are going to continue to work towards that. 

• Could the Department of Health work with Rite Aid to direct their supply of tests to nursing homes or other congregate settings, that would benefit from universal testing?

• We will work with all testing facilities, whether it is Rite Aid, hospitals, health systems, or our own State lab, to prioritize testing for nursing homes and personal care homes. 

• New York has ordered testing of all nursing home staff twice per week. Does Pennsylvania have plans to issue a similar Order?

• We are working on those plans, and we plan to announce more information about that later this week. 

• If a person receives several negative tests because they are given a test each time they go to a medical facility, are those counted as separate negative tests? Or is each test counted as negative?

• Each test would be counted as negative. 

• Can you please describe in as much detail as possible, what contact tracing currently looks like in the yellow phased counties? Including how many Department of Health personnel are conducting contact tracing, the capacity to test no contacts, and any plans to increase tracer capacity?

• We are working on our plans to increase capacity. We are doing really well, but I don’t have granular detail about specific numbers. I will have to get back to you on that, but we have a whole team working on that so I think we are doing pretty well.

The Governor gave his reaction to counties moving from the red phase to the yellow phase without permission, what is your reaction to those counties defying the Order?

• I have no further comments beyond what the Governor stated.

• This is the fewest number of single-day new cases since March 28th, is that promising or is it a function of less intense reporting over the weekend?

• We have noticed that there tends to be a decrease for reporting on the weekend, especially on holidays, and yesterday was Mother's Day. So we are going to have to see as the data comes in this week if that is one day's reporting or if it's a continued trend.

• Why is the State paying for the temporary manager? Shouldn’t Brighton pay that fee?

• Usually when we put in a temporary manager they report to us, so we pay the fee for the temporary manager.

• Why did the Lycoming County case numbers increase by 1 today? While the nursing home case count increased by 3? Is that a statistical reconciliation issue?

• I'm not exactly sure in terms of the granularity of data. If someone is a resident of another state or another county, they count towards that county or state, but I'm not specifically sure.

• Has the Carnegie Mellon University (CMU) model been completed? And will it be made public?

• The CMU model is already public, and it’s available on our website. It's not just one completion however, they actually update it every week.

• Can you list some of the variables factored into the red, yellow and green phases? For example, have you factored in that there will be some people who aren’t compliant? And there will be some people with other high risk behaviors?

• The models that we look at do factor in behavior in terms of compliance, with the stay-at-home recommendations for red phased counties.

• With 65% of COVID-19 deaths in Pennsylvania occurring in nursing or personal care homes, going forward…what measures are you taking to ensure the wellbeing of those patients and healthcare workers?

• I said before that the well-being, safety, and health of individuals in long-term care living facilities, such as nursing homes and personal care homes are really a top priority. We have collaborated between the Pennsylvania Department of Health, as well as PEMA, and working with the facilities themselves in terms of working towards that goal. We have infection control and public health experts at the Department of Health and they have also been working with the facilities, and we have worked with 100% of the facilities that have cases of COVID-19. In addition, we have contracted with our consultant ECRI to do further infection control work with the facilities, and we have had the National Guard go in to provide staffing for this facilities. The Department also has pushed out well over 1,500 different specific pushes to all the nursing homes for personal protective equipment, such as N-95 masks and the other types of resources they need to take care of patients, and we will be continuing to do that. Over the last number of weeks, since the hospitals have been doing somewhat better, our absolute priority has been pushing out the PPE towards our long-term care living facilities. We are going to be working on all of this specific data regarding nursing homes and cases later this week, and we will continue to do absolutely everything we can to protect the staff and residents of long-term care living facilities.

• Can you elaborate as to why you are not reporting antibody test results?

• We are reporting the antibody test results, and we are not reporting them separately than any other results.