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Posted Wednesday, May 13, 2020

From Secretary Rachel Levine. Department of Health

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 707 new positive cases of COVID-19 in Pennsylvania, which brings the total number of cases to 58,698 in all 67 counties. This includes 4,066 positive cases in healthcare workers, and 12,408 positive cases of COVID-19 among 543 long-term care living facilities, which includes nursing homes and personal care homes. Tragically, this brings the statewide total to 3,943 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:

  • Yesterday, Pennsylvania received its first shipment of Remdesivir, which is the medication to treat patients who have contracted COVID-19.
    • The State received 1,200 doses to treat severely ill patients that have COVID-19, and by this morning there were 51 hospitals across the state that received their supply of this medication.
      • These hospitals were chosen to receive the first shipments of Remdesivir based on the numbers of patients that they have in their facility over a period of 7 days, as well as the severity of the illness in the patient.
  • The State’s supply is managed by the U.S. Department of Human Services, and they assured that more medication will be shipped to Pennsylvania on a weekly basis over the next number of weeks.
  • The Secretary cautioned that Remdesivir is not a cure for COVID-19, as there is limited information on the safety and effectiveness for treating COVID-19, but was shown in recent clinical trials to shorten the lifespan of the virus over time.
    • The FDA authorized the emergency use of this medication only as treatment of severely ill COVID-19 patients.
    • The medication is given intravenously once a day, and there are two ways that the medication can be given:
      • One regimen is a 5 day course with 6 doses;
      • And another regimen is a 10 day course with 11 doses for more severely ill patients.
        • Ultimately the regimens are determined on a case-by-case basis.
    • According to the FDA, the medication may decrease the amount of the coronavirus in the body, in order to get better faster.
  • The Secretary stated that the Department of Health will continue to provide as many tools for healthcare providers to battle the dangerous COVID-19 virus. 

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

 Questions asked to and answered by Secretary Levine: 

  • What is the latest information in Pennsylvania on the Inflammatory Syndrome in children that is related to COVID-19?
    • There was a recently described syndrome in children, most of whom have tested positive for COVID-19, and these reports have been coming from New York City. This is an inflammatory condition of the blood vessels, it resembles other conditions that have been reported in children called Toxic Shock Syndrome, or another one called Kawasaki’ Disease, which is an atypical disease. These children are very ill, and they often require intensive care and fluid support, and some even need to use a ventilator or breathing machine. Tragically, there have been a number of deaths in New York City, and we have already asked hospitals to report any cases of this syndrome to the Department, but to date there are no reports in Pennsylvania. However, we have been reaching out to our 6 Children’s Hospitals across Pennsylvania to find out more information, or to see if they have any of these cases. 
  • Both Luzerne and Carbon County are reaching out to Governor Wolf’s Administration to see if they can transition into the Yellow phase. Would the State consider transitioning both counties into this phase before June 4th?
    • We are looking at all of our data over the next 2 days, which includes all of our metrics, data reports, and modeling specifically from Carnegie Mellon University. There are other models as well that we take into consideration which are the University of Pittsburgh School of Public Health, the Children’s Hospital of Philadelphia Data Lab, the new model from Wharton School of Business of Pennsylvania, and the University of Washington, which the Federal Government has been relying upon. There are lots of different modeling that we are following, we will make our recommendations to the Governor about what counties should transition from the Red phase to the Yellow phase, and ultimately he will make the final decision. 
  • How will collecting information on gender identity and sexual orientation help in the fight against COVID-19?
    • Overall, we want to collect as much demographic information as possible about patients, and the populations that have contracted COVID-19. We have previously discussed gathering race and ethnicity data through the State’s NEDS data system, and we are getting somewhat better in terms of getting that information, but there have been challenges in terms of the reporting. We are now adding sexual orientation and gender identity to that system…so we would like as much demographic information as possible for those who have contracted this disease.

 Is there any concern that this information could be compromised, putting Pennsylvania residents at risk of persecution?

    • No, our NEDS data system is completely confidential within the Department of Health and the agencies that we work with. 
  • What are the dangers of PPE litter? How important is it for people to properly dispose of PPE, especially as we move to the Yellow phase and see more people out & about?
    • We have to describe what we mean as PPE at the Department of Health versus what the public believes we are describing. What the Department describes as PPE is the type of equipment that we send to healthcare providers, hospitals, long-term care living facilities, EMTs, ambulance drivers, etc., and that equipment would be the N-95 masks, surgical masks, surgical gowns and gloves. If those healthcare providers are in contact with patients with COVID, that PPE used will need to be disposed of in the red biological waste bags and then disposed of in the way that all biological waste bags are disposed of. If they happened to be in contact with a person who might have COVID-19, those materials could have an active virus on them for a period of time. However, the cloth masks (non-disposable) that the public have been using, we recommend that people wash them everyday when they are out and about, and when they take them off they should use hand sanitizer, as well as wash their hands. For those that have disposable masks, we ask that people please dispose of them in the trash and wash their hands. 
  • What are your thoughts on Schuylkill County backing off from its self-declaration of the Yellow status? What communications occurred with the county? And what will happen now?
    • I will leave those discussions for the Governor and the Governor’s office.

 Do you think the Governor went too far in calling County Officials ‘cowardly’ in his official statement?

    • No, I support the Governor and the Governor’s statements. 
  • Please explain the role of plasma in the treatment of COVID-19.
    • There are studies that show that plasma, which is the part of blood that contains white blood cells and other immune factors, from recovered patients of COVID-19 (after being processed by blood banks) can be used to treat severely ill patients with COVID-19. Those type of plasma transfusions are just one of our “arsenals” in order to treat severely ill hospitalized patients with COVID-19. 
  • This week you called for testing in all Pennsylvania nursing homes. Can you give us more specific targets…such as who gets tested, how often the tests are administered, and when will we have the testing capacity to accomplish this?
    • Yes, we have called for the testing of all of the patients and all of the staff in these long-term care living facilities, such as nursing homes, personal care homes and other assisted living facilities. We know that if you test once, that is not conclusive, because you could test negative on one day, and then test positive on a different day. However, in this case the re-testing will need to be individualized to the number of cases in the facility. For example, if there is a facility with no cases versus a facility with a few or many cases, they will be running on a much different testing schedule. We will be working with them to facilitate the testing and work with them in terms of their testing schedule…in fact I heard that our staff will probably be holding a webinar for the facilities, and outline those different measures. Finally, we do have the lab capacity to be able to do that, and we started piloting it last week and we have the capacity to roll that out. We are working on a timeline for the Governor in terms of how that will roll out with the many facilities, as there are approximately 693 nursing homes, and approximately 1,200 or more personal care homes and other congregate facilities, so it will take some time to roll out. 
  • Today was the deadline that Bucks County Officials gave the State to let them know when the county would be moved into the Yellow phase. Did you send them a date for when they can move to Yellow? And if so, what was that date? And if not, when do you plan to do so?
    • As I mentioned earlier, we are looking at all of our data, metrics, and models right now…then we will be pleased to work with the counties, the Governor will work with the counties, and we will have more information this week. 
  • The State’s reopening plans say that in order for a region to reopen, there needs to be enough testing available for individuals with symptoms and target populations, such as those at high risk, healthcare personnel, and first responders. How are you defining a high risk in this context?
    • Those that are at high risk are our vulnerable populations, which are residents in our long-term care living facilities. Other high risk individuals include seniors who are 65 or older that suffer from comorbid medical conditions, such as high blood pressure, heart disease, lung disease, etc. 
  • The White House’s plan for reopening says that states should set up sentinel surveillance sites to screen for asymptomatic cases. What are sentinel surveillance sites? And where are they located in Pennsylvania?
    • A sentinel site would be a site like our mass testing sites that we have in Montgomery and Luzerne County that are still open, and the previous one in Philadelphia. However, they would be screening only asymptomatic individuals. There are lots of ways to do that type of surveillance, and we are going to be working on that, but we don’t have the lab capacity to do that right now. We do have the lab capacity to do the type of testing I mentioned before in long-term care living facilities, like nursing homes. In terms of that population-based surveillance testing, we will need to continue to increase our lab capacity to do that. I think what would be best to get to that point, would be to have a rapid and simple point of care test that healthcare providers could rapidly process in  15 to 20 minutes, or an at-home test that could be done with good accuracy, simplicity and specificity…however that’s not available yet. I know that there are laboratories and other companies that are actively working on that, and that would aid that type of populated based screening greatly. 
  • Columbia County’s Commissioners declared that they would move their county to the Yellow phase on May 15th, if the Governor has not declared by then that the county will move to the Yellow phase on May 22nd. Do the county’s numbers support their move? Or are there concerns that you specifically have about Columbia County?  
    • As I mentioned earlier, we are looking at all of our data, metrics, and models right now…and we are working to make our determinations and recommendations to the Governor presently. 
  • Many people are feeling uncomfortable with Allegheny County moving to Yellow phase, and are asking for specific justifications why it is at this time? What information can you provide to “evaporate” their concerns?
    • We feel very comfortable with Allegheny County moving from the Red to the Yellow Phase. In terms of the number of cases they have, rate of change of their cases, the different modeling and metrics we are looking at…and with all of that information, we did announce last Friday, that Allegheny County will be able to open Friday, May 15th, along with additional Southwest counties that can move from the Red phase to the Yellow phase. We also discussed this extensively with the Health Commissioner of Allegheny County, Dr. Bogen, who is doing an excellent job, as we speak with her regularly, so we all feel very comfortable with this. However, we all need to be vigilant as every county moves into the Yellow phase and make sure that there is enough testing, contact tracing, and watching for any clusters that could lead to an outbreak of more cases. I am aware that Dr. Bogen has all of that taken care of. 
  • Is broad surveillance level testing a goal in Pennsylvania? If so, what will it take to get there? And when might it become available?
    • It is an aspirational goal to be able to do broad population-based surveillance testing. In order to do so, we will need more testing capacity, and what would be most effective would be a rapid point of care test that is very accurate, and very sensitive and specific. That test could possibly be done by a healthcare provider, a mass testing site, or in someone’s home, that can be done within 20 to 30 minutes. 
  • Are youth or high school sports allowed to hold practices and games once counties enter the Green phase of the reopening plan?   
    • A goal in the Green phase is that that would be possible, but we have not set any criteria yet to go from the Yellow phase to the Green phase…since it has only been 5 days since counties moved into the Yellow phase. However, we will be setting that criteria in the future, and that will be a goal. But we still need to be vigilant, be careful, and protect ourselves from this dangerous virus. 
  • School districts are already weighing their back-to-school options. Does the State anticipate making a blanket decision for schools that are in the Red or Yellow zones about being allowed to open? Or does the State anticipate leaving that to the schools? And what criteria might go into decision making in the return to traditional school?
    • Secretary Rivera from the Pennsylvania Department of Education (PDE), had a Senate hearing about this a few days ago and our goal is that schools will be able to open in the fall. However, in order to do so, we need to make sure for all of metrics and models that we look at allow that to be done safely. I’m also sure that the PDE will be having further discussions with all of the school districts in terms of that opening. 
  • Could you please review what a probable case of COVID-19 means? Additionally, if someone is believed to be a probable case, why are they not being tested to confirm whether or not they have COVID-19? And if they are tested…does the State continue to include their information in the zip code data, or does that number shift to the positive or negative category, depending on test result?
    • A probable case is someone who lives in a household with other confirmed positive cases of COVID-19, and they have symptoms consistent with COVID-19. With the limited lab capacity that we had before, we needed to prioritize our lab capacity and we did recommend those people being tested. However, now we are very pleased for anyone to get tested that is showing symptoms similar to COVID-19.  I guess a reason why someone might not be tested, would be because of other family members being sick and it could be very difficult to come out of their house and go to a testing site, doctor’s office, or Rite Aid…as we talked about before. However, if they did come out and test positive then that would be a confirmed test, and if they tested negative then it would be counted towards the negative count. 
  • Some high schools have spoken about plans for in-person graduation ceremonies. If they employ social distancing guidelines, will they receive any resistance from the State?
    • We are not recommending large gatherings in either the Red or Yellow zones given how contagious this virus is. Even with practicing social distancing, it is not 100% effective and there is still a possibility of transmitting the virus, so we would not recommend any large gathering such as graduation ceremonies. 
  • In Allegheny County where the population is 1.26 million, .12% of the population has been sick, and .01% have died. Obviously any death is tragic, but how do you use and consider these percentages of people impacted, when you are looking at the pace of re-opening?
    • I sometime find specific data hard to calculate when being put on the spot, but as I’ve said before…we are looking at all of our data, metrics, the rate of change of that data, and models for determining which counties will go from the Red to the Yellow phase. By looking at all of that and collaborating with the Commissioner, we feel comfortable about the county moving to the Yellow phase on Friday. 
  • Can you tell us about the various restrictions that will be put in place in parks and areas that move into the Yellow phase?
    • That type of guidance is available on the website for the Department of Conservation and Natural Resources, and our staff have worked with Secretary Dunn and her staff in terms of social distancing guidelines in our fantastic State parks. 
  • It appears that there will still be some mitigation efforts in place, even when areas move into the Green phase. Can you tell us what communities might expect in the Green phase and what will happen at that point?
    • We haven’t specifically gone over the criteria yet for moving into the Green phase. There is some general guidance on our website about life in the Green zone versus the Yellow and the Red zone. Of course, we will still need to vigilant in terms of hand washing. I still think it would be useful to wear masks, especially if you are in a setting with a lot of other people. We will have to vigilant because this virus will not be gone, even when we go into the Green zones and we want to make sure it does not have a resurgence. 
  • Yesterday you referred to the nursing home testing advisory as a universal testing strategy, but the advisory says nursing homes should consider testing every resident within the limitations of testing supplies. Can you explain the discrepancy? And can you say, with certainty, that there are enough testing supplies to test every Pennsylvania nursing home resident and staffing member?
    • We feel comfortable that there are enough resources to do that, but looking forward we know that you can’t just test once, there has to be a testing on certain schedule. It is possible in the future that there might be further limitations on supplies that we receive from the Federal Government, or labs,  and companies that create those supplies, so that is why that type of statement was added. 
  • With the total number of confirmed cases of COVID-19 at 58,698 since the outbreak began, is there a way to distinguish the number of those who recovered from the virus, from the number who are actively infection, since it has an infectious period of about 2 weeks?
    • We’ve been asked that question a lot, and unfortunately it’s impossible to contact all of those patients to see when, or if they recovered. But there are some statistical and epidemiological techniques that we can use to do that, so we are researching how to do that, as well as reaching out to other states to see how they are doing that and calculating that data. We recognize that that is important to the population and we are going to work to try to have some estimate of that hopefully by the end of next week. 
  • During a hearing today, a State Senator said that her understanding is that no county will move to the Green phase if there are still counties in Pennsylvania that are in the Red phase. Is that true?
    • We have not made that determination at all. In fact, I was on a call with the Governor and the Leadership of the House and the Senate today and discussed that very question. We have not determined that type of criteria at all. In fact, we have not yet determined the criteria to move from Yellow to Green because it was only 5 days ago that any county in the state went from Red to Yellow. 
  • Can you explain why the State adopted a policy of cohorting at nursing homes? Do you think this contributed to the spread of the virus in nursing homes?
    • We have tried to individualize the recommendations to the people in the nursing homes, including how many beds they have, how many staff they have, how many positive cases they, how many rooms they have, etc. We have tried to handle that on a case-by-case basis, dependent upon the circumstances in specific nursing homes. 
  • Why didn’t the National Guard come to Brighton Rehabilitation Center earlier than they did? Why did they go to 8 other nursing homes first?
    • Brighton has been very challenged, but other nursing homes have been very challenged as well. What the National Guard is doing when they are going into nursing homes is supplementing specifically for staff shortages. At the right time earlier this week, the National Guard came to Brighton, as well as the installation of the temporary manager who reports to the Department of Health and paid by us. 
  • Since hospitals have beds available, should more nursing home patients who test positive for COVID-19 be moved to hospitals, so nursing home staff can focus on the rest of their residents?
    • It isn’t possible to cohort positive patients who don’t medically need to be in the hospital in a hospital setting, so we are not able to do that. 
  • If supermarkets and many big box stores are safe for customers, why can’t smaller retail stores open in Red counties, even if they operate only with curb-side pickup?
    • What we have tried to do in terms of the businesses is to have essential businesses open. It is essential for people to get food, so grocery stores have been open. Other smaller food stores have been open. It is essential for people to get medication they might need, thus pharmacies have been open. In terms of home repair, it is essential that if something at home, like a toilet, breaks, that people are able to get the supplies to fix that, and this is why those types of stores are open. 
  • The data suggests that nearly 70% of deaths are in nursing homes, and an even higher percentage is among the elderly. Some thing this data should mandate a shift in strategy to more strongly mitigate long-term care living facilities and people with dangerous pre-existing conditions, but ease restrictions elsewhere. In the final analysis, shouldn’t students in Elk County and other lightly affected counties, be in school right now?
    • We have been focused on long-term care living facilities, and our new plan was outlined yesterday. One of our main focuses is on the vulnerable population, which includes those living in long-term care living facilities and seniors over 65 with comorbidities. However, those facilities are in the communities of those counties, and the staff go in-and-out, and back and forth in terms of returning to their homes and running local errands. But as we started to transition into the Yellow phase last week and as we continue to do so moving forward, counties moving from the Red phase to Yellow phase…which includes Elk County…the Governor did closed those schools to mitigate the spread of COVID-19. 
  • Why is Pennsylvania the only state that prohibits Real Estate statewide? Every other state is allowing realtors to practice following the CISA and CDC guidelines.
    • After discussion with our Department, the Department of Community & Economic Development, and the Governor’s Office, we made the decision to protect the public health and not have Real Estate offices be open. 
  • Can an employer require an employee to have their temperature checked everyday before work? Does the employee have the right to decline?
    • That’s more a legal issue, so I will decline that question and refer it to the Office of General Counsel. 
  • If a county has only had 1 case in the last 9 weeks, is that good enough to go to the Green phase?
    • Right now, we are only working on counties that are going from the Red phase to the Yellow phase, but eventually we will work on the criteria for counties to go from the Yellow phase to the Green phase. Remember that the incubation period is on average 5 days but up to 14 days, and it’s only been 5 days since any counties have moved to the Yellow phase…so it is way too soon for any county to move to the Green phase. We will be looking at that and when that determination has been made by the Governor, then we will announce it.   
  • Can you explain whether the Administration has any authority to compel nursing homes to implement surveillance testing? Also, does the Department of Health expect long-term care living facilities to bear the cost of doing so?  
    • We are going to be working on the cost, but we have received funding from the Federal Government specifically for testing so that is our plan at this time. Do we have the authority to compel them? Again, that is more of a legal question, but the Department of Health regulates and licenses nursing homes, and the Department of Human Services regulates and licenses personal care homes…so I believe we do. But I don’t see us having any of those specific challenges working with these facilities in terms of rolling out the testing, we don’t anticipate that.