Daily Press Conference COVID-19 Update

Today, Secretary Rachel Levine of the Department of Health and Randy Padfield, Executive Director of the Pennsylvania Emergency Management Agency (PEMA) held their daily press conference to provide an update on the COVID-19 crisis in Pennsylvania. As of this morning, there are 837 new positive cases of COVID-19 in Pennsylvania, which brings the total number of cases to 57,991 in all 67 counties. This includes 3,923 positive cases in healthcare workers, and 12,130 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 3,806 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:

• Governor Wolf stated yesterday that the common enemy is the virus, and it has continued to impact our communities, especially those resident in long-term care living facilities - such as nursing homes and personal care homes.
• Since the start of the COVID-19 pandemic, the Department focused its efforts on those living in these facilities by ensuring resident safety, preventing and mitigating outbreaks, and working in partnership with local agencies, state health departments, and long-term care living facility operators across the Commonwealth.
• The Wolf Administration has worked with several state agencies in this regard including the Department of Health, the Department of Human Services, the Department of Aging, the Pennsylvania Emergency Management Agency, and the Pennsylvania National Guard to slow the spread of COVID-19 in these facilities.
• The Department has provided education and training to all nursing home staff, using the best available clinical information from the CDC, including how to help stop the transmission among residents, universal screening, and the use of personal protective equipment for staff treating patients.
• The Department has leveraged their existing expertise and resources to provide consultations to nursing home operators to help them prevent and control existing outbreaks.
• This has including staff from the Department’s nursing home licensure program, and the Department’s healthcare acquired infection program.
• Additionally, the Department has contracted with their consultant ECRI for additional support, received educational support and clinical coaching program partners through the Department of Human Services, and the independent State agency – the Patient Safety Authority.
• The state has gotten approval from the Federal Government to allow more flexibility so that more nursing home operators can hire additional staff, and the Department of State waived and suspended several license regulations in order to alleviate barriers for healthcare system providers during this pandemic.
• When necessary, the Department facilitated direct staffing of the facilities that are in crisis. The Pennsylvania National Guard has provided direct care, education and training, and clinical consultations to support for now 10 facilities.
• Additionally, the Department sent 1,700 shipments of PPE directly to personal care homes and nursing homes to make sure that they have the right equipment to protect both the staff and residents.
• Testing is another essential piece of their efforts, and today the Department announced their robust universal testing strategy for all staff and residents in long-term care living facilities, by stating that they are focusing on ensuring that testing is accessible, available, and adaptable to the evolving landscape of this virus. This strategy will focus on the following factors:
• If a patient was hospitalized for COVID-19 and has to return to the facility, that resident must be tested for COVID at that hospital before returning to the nursing home, as this information is valuable to the facility in order for them to take the proper precautions to stop the spread of the virus, and to monitor their condition to ensure that they have the care that they need.
• A health alert network advisory was also sent to all long-term care living facilities, which outlined this process of when and how to re-test residents. That alert also outlines how nursing homes can manage patients by cohorting patients until a test result is received.
• To accomplish all of this, the testing swabs will be provided by the Federal Government for facilities that do not have adequate supplies, as well as testing resources available at the State’s laboratory in Exton and commercial laboratories as well.
• The National Guard also is mobilizing to provide a mobile testing option for facilities that cannot do the testing on their own, and Director Randy Padfield will provide more information on that.
• To ensure that Pennsylvania is in line with Federal guidance released late this week from the Center for Medicare and Medicaid Services (CMS), today the Secretary is ordering nursing homes to report deaths, cases and tests that are performed through the same system that hospitals are currently using. Those nursing homes will be required to report that information starting on May 17^th, and that information will be reported publicly through the Department’s daily press conferences and through their website.
• By testing all residents and staff in every nursing home across the state, this will allow the Department to be able to pinpoint who has contracted COVID-19, who has been exposed and hasn’t shown symptoms, and cohort positive cases to prevent any further spread of COVID-19. Ultimately this will provide a clearer picture of the extensive outbreaks in nursing homes, and a head start at stopping them.
• She asked that Pennsylvanians continue to maintain social distancing, no matter what stage of reopening a county is currently in. She stated that the Department is aware that the virus didn’t suddenly appear in a nursing home, but rather it had to come from the staff that moves in and out of the facilities. Pennsylvanians need to work together to protect these vulnerable people in these facilities.  
• She acknowledge that it may be hard to do the right thing when the sacrifice seems greater than the reward, but she, the Governor and his Administration is committed to doing everything they can to make Pennsylvanians safe.

Today, Director Randy Padfield stated the following:

• He stated that his goal was to provide additional context regarding the support and role that the Pennsylvania Emergency Management Agency (PEMA) has taken throughout the course of the pandemic.  
• PEMA has been working hand-in-hand with the Department of Health since the beginning of the COVID-19 crisis, and they have served the role as cross-agency collaborators, and working to leverage the strength of multiple state agencies to bear the complex problems that that Commonwealth is facing, like those in long-term care facilities.
• He stated that one of the major partners of PEMA is the National Guard, and the work that they do with PEMA is apart of is a tiered response, as they have coordinated across counties and multiple levels of government such as local and county health departments and emergency managers are actively engaged in the process with long-term care living facilities.
• What he referred to as the State’s “strike team,” he referred to the county health nurses and aging personnel who have been providing initial inspections of nursing homes, providing information on the proper use of PPE, or providing additional resources as needed in the form of PPE.
• He stated that many counties are engaged with their medical reserve core, who have already been providing onsite assessments and additional support to these vulnerable facilities as Dr. Levine stated previously.
• The National Guard have been key response partners since the very beginning by providing support across multiple avenues and venues…one of those ways is by providing personnel to be able to assist in operational planning teams.
• They have been instrumental in long-term care living facilities by working in a layered approach for consultations and providing on-site assessments to be able to verify the information that PEMA is receiving through the consultations with those facilities that provide key information and guidance to be able to protect those that are most vulnerable.
• They have also provided medical support, with 150 guardsmen throughout the state that have medical training and are actively working since early April.
• They also work to provide general support regarding cleaning, hygiene and any other support needed for facilities that have been, and still are facing staffing challenges due to the virus. The key is to stabilize these facilities when and where possible in order to revive them of the support that they need to continue to function, and limit further spread of COVID-19 in the facilities.
• PEMA is going to embark with the National Guard on mass testing in a lot of these facilities as well, as they are very well positioned and trained to provide these services and operationalize this plan to test individuals throughout the facilities in the state.
• He stated that the most complex issues that they are currently dealing with in long-term care living facilities are related to staffing, and PEMA realizes that National Guard may become engaged with these facilities for a longer period of time to be able to augment the staff.  
• PEMA is looking to leverage additional contracted support throughout the Commonwealth, as well as looking at Federal support that can potentially be provided through the National Disaster Medical System, and other support that may be available through the Emergency Management Assistance Compact through other states and mutual aid.
• The ultimate challenge is that this effects not only Pennsylvania, but many other states and a lot of medical personnel are committed to their state of residency, but with leveraging the capabilities across multiple agencies and the expertise that is within the National Guard, state agencies, local agencies, medical reserve core, and county health departments, PEMA is addressing these issues as they come up on a regular basis.

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

Questions asked to and answered by Secretary Levine:

• We’ve heard that you moved your mother from a nursing home and to a hotel. What message does that send to the thousands of Pennsylvanians whose parents are in nursing homes, but may be unable to move them out…when the person in charge of nursing homes and is in charge of the State’s response to COVID-19 moves out their own parent?
• My mother is actually a resident of a personal care home, not a nursing home, and that is regulated by the Department of Human Services…not the Department of Health. My mother requested, and my sister and I as her children complied, to move her to another location during the COVID-19 outbreak. My mother is 95 years old and is very intelligent and more than competent to make her own decisions. I will be committed to protecting residents of Pennsylvania wherever they live and wherever they go, whether it is in a facility I regulate, or a home in the communities, and whether or not they agree with our strategies.

• With 70% of the state’s COVID-19 deaths coming from nursing homes and long-term care living facilities, where is our greatest need for improvement in these facilities? Do we need better and more testing? And how long will it take to get us to where we need to be?
• We are continuing to do all of the outreach that we have made with these facilities, and we now have the capability in Pennsylvania to do the mass testing that we hope to do. I started this last week, and we are continuing to roll that out this week through many of the mechanisms that we discussed. Some of those tests can be done at the state laboratory, and many will be done at commercial laboratories. I want to test all of the staff and residents in these facilities and take care of them and their impact of COVID-19 in the way they need to be taken care of.

• How many tests a day or a week do you expect the personal care home testing will require? How much will the program cost? And who will pay for it?
• We have released an advisory team that we issued to nursing homes. Today that helps them develop a testing schedule based upon their current situation. For example, if a facility has zero cases, it’s testing strategy will be geared to detect any early cases. On the other hand, if there is an ongoing outbreak, then initial testing will occur and then more frequent testing will be needed. It will have to be individualized for each facility.

• Under the long-term care testing plan, what is considered a long-term care facility?
• We’re talking about congregate facilities such as personal care homes, nursing homes, and assisted living facilities.

• Regarding the testing in long-term care living facilities, how long will this weekly testing go on for? And how much is budgeted to fund this?
• We will be doing this as long as it is necessary. The funding will come from our resources, especially if it is done in our laboratories. There are additional Federal resources through the CDC, resources dedicated by Congress and signed by the President of the United States, and from FEMA given the disaster declaration.

• Why did Pennsylvania wait until now to implement such a testing plan?
• Until the last week or so, we did not have the testing capabilities in Pennsylvania to perform this. However, in the last approximately 2 and a half weeks, it’s been extremely challenging to get the supplies and the swabs needed to be able to perform this significant amount of testing. We are now better resourced through the Federal Government, as well as through the testing companies. We have more resources at the Pennsylvania Department of Health, commercial laboratories, and hospital laboratories to perform that testing.

• Would it be more effective to focus on protecting nursing homes, instead of continuing a broad based shutdown of the economy? And have the state’s efforts to protect nursing home residents failed?
• One of the things that we have been emphasizing all along…and what the Governor has emphasized is that we are all interconnected, given the scope of this global pandemic. Nursing homes reside in communities, the staff that are taking care of residents reside in communities, and the staff leave and go home to their families, go to the grocery store, go to the pharmacy to pick up medications, etc. We are all interconnected. We are working, we have been working, and we will continue to work to protect the vulnerable residents and staff that reside in these facilities. They are part of the community, so that is why they’re included in the county’s case numbers, and why this has to be an integrated strategy.

• Will state inspections take infection control violations more seriously moving forward? Right now, the vast majority of these violations are categorized as minimal harm or no harm.
• We have been taking it seriously, and what is even more important than exactly how we categorize it in the report, is what we’re doing about it. We have infection control experts and public health experts in our Department that have reached out to every single facility, nursing home, personal care home, etc. All of those who have had cases. We have continued consultations, and then we have our consultant ECRI do you further consultations as needed. As was outlined in my remarks and the Director’s remarks, for facilities that are most strained in terms of staff, we now have the National Guard on their 10^th mission to help these facilities, and we will continue to do whatever we can to help them.

• The nursing home industry says that it was left behind in the early days of COVID-19, with the focus being on hospitals. Is that true? And can you provide specifics about what supplies went to each healthcare facility in the state?
• We have had over 1,700 shipments of personal protective equipment sent to these congregate facilities. I would respectfully disagree with any of the organizations that are saying that they were left behind because they were not. We were focusing on all of these facilities from the beginning, as well as focusing on hospitals and making sure that they were not overwhelmed by patients with COVID-19. Overall, we have been working to balance that in terms of all of our work and we have done so.

• Can you clarify the benefits of population-based testing in facilities such as nursing homes, or prisons and jails? What purpose does that serve considering the lag between testing and the results, could lead to more infections than what was initially tested?
• What we are trying to do is find people who are asymptomatic, because we have been testing symptomatic patients this entire time. As we are learning in terms of this novel coronavirus, is that many patients don’t show any signs or symptoms, or rather that they may be transferring the virus before any symptoms develop. By testing people only when they start to show the health symptoms, we are missing the people that potentially have the virus. We now have the testing capability to do this population-based testing within the facilities, and that’s why we are implementing it.

• What data points will be made public about long-term care living facilities? And if the Department will include assisted living personal care homes?
• We are working to provide all of the data that is in the CMS guidelines in terms of the facility and the number of patients, etc. Whatever is in their guidelines, we will provide on our website to be consistent with the CMS guidelines in their reporting strategies as well. We are working with the Department of Human Services because they regulate the personal care homes and assisted living facilities, and we will work with them to provide the same type of data.

• It seems the Department of Health is on the verge of releasing specific nursing home data of COVID-19 cases and deaths. Why have we waited 2 months into the pandemic to release this information, when many other states have had from here on out? Will this level of disclosure be the standard that you will use?
• All along, we have wanted to be very transparent. We were waiting for the Federal Government’s guidance about what exactly their recommendations were in terms of the data that is released…and now we are going to implement those recommendations.

• A lot of backlash with Brighton Rehabilitation Center have some calling for a Federal investigation. What is your reaction? And what was the delay in getting extra help into the facility, including the temporary manager and the National Guard?
• We have been working with the Brighton facility since their first case, we have been working to provide infection control guidance, healthcare-acquired infection guidance, etc. There was a consultant in place weeks ago, but because of continued issues with infection and continued cases, we installed a temporary manager. We are paying for that manager, as they report to us, and the National Guard stepped in.

• Montgomery County says there was some confusion about what agency was supposed to help long-term care living facilities in the early days of COVID-19. Whose job was it to make sure nursing homes were prepared for the virus?
• It’s all of our collective responsibilities. As we have been outlining, this is a collaborative effort against this dangerous and contagious virus. It’s the state’s responsibility including the Department of Health and Department of Human Services for the facilities that they licensed and regulated. The Department of Aging is also responsible because the vast majority of the patients are seniors, and we have been working collaboratively with Director Padfield at PEMA from the beginning. Now the latest additional is the National Guard. The counties that have a county municipal health department often have been the ones to lead on many of facilities, and we’re working with them as well. It’s through true collaboration that we will be successful in defeating this dangerous virus.