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Posted Monday, May 18, 2020

From the 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 822 new positive cases of COVID-19 in Pennsylvania, which brings the total number of cases to 63,056 in all 67 counties. This includes 4,479 positive cases in healthcare workers, and 14,626 positive cases of COVID-19 among 561 long-term care living facilities, which includes nursing homes and personal care homes. Additionally, 2,422 workers in the food industry across 159 facilities have tested positive for COVID-19. Tragically, that brings the statewide total to 4,405 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:

  • We’ve done a lot of work to analyze all the data, as it usually takes several months to analyze this amount of data. The epidemiologist and data analyst teams have done extensive and excellent work.
  • We have made a push to report the data in a timely way and are now reconciling data with Philadelphia daily.
  • Pennsylvania’s reporting system (NEDS) is extremely effective at reporting disease outbreaks, but it was not ready for a disease like this.
  • Today's data report regarding deaths will now look different because we have transitioned to the Electronic Death Reporting System (EDRS) to get as close to real-time information regarding deaths.
    • For example, if a person died of COVID-19 in a congregate care facility, but was a resident in a different county, the CDC instructed the Department to report the death in their county of residence, while coroner's report is based on the county they died in.
  • The county coroners have differences in regulations, so they may report differently.
  • There will be two different sets of data that will be reported.
    • The first is in the county of their legal residence, which may not be the same county as the nursing home.
    • The second is in the county attributed to the facility, and we are not double reporting.
      • The total death count and the long-term care living facilities death count might not match up because of this.
  • We worked to add more demographics (race, age, ethnicity, gender, and comorbidity) to the data, which will be reported on a weekly basis. 

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

 Questions asked to and answered by Secretary Levine:

 

  • When are you going to release the plan to do mass testing at long-term care living facilities on residents and staff on a weekly basis? What are some specific details, such as will 100% percent of the staff and residents be tested weekly Will there be re-tests? And how will the Department determine which long-term providers will be doing the testing?
    • We will roll out that plan this week, and not every facility will be tested weekly. It will be individualized to the specific facility, depending on how many cases of COVID-19 they have. We have some facilities with a significant amount of COVID-19 cases that will be tested differently from facilities with few to no cases. We will work on individualized testing strategies for those facilities.

 

  • When are you going to release the Department's early plan to battle the COVID-19 virus in long-term care living facilities that was not previously implemented?
    • A lot of that was discussed by the Governor and Director Padfield in their press briefing earlier. We have talked about having teams go out to nursing facilities to help with infection control and staffing. We have already implemented that strategy with the PA National Guard, and the CDC teams will be announced soon. We will also be working on further strike teams, it was that strike team plan that was in our original drafts, which was delayed…but will be rolled out soon.

 

  • According to your Office, the collection of specific data from certain nursing homes in the State only started yesterday. There was some confusion that those numbers were to be reported last week. Did something change in that process?
    • Yes, there was some hope that we could report that information last week. The collection did start yesterday, and we will start those reports tomorrow.

 

  • Your Office also said that the deadline for the facilities to cooperate is today. What happens if they don't?
    • If they don't, we will contact them and ask them to cooperate. This is the same data they're required to report to the Federal Government and the Center for Medicare and Medicaid Services (CMS). However, we did wait on our data reporting plan, so that our data system would be consistent with CMS's.

 

  • Why does the Department need additional time to release the facility level long-term care infection and death data? Your Department says it started collecting it on May 17th. Hasn't it been collecting it all along? And if so, why has it been delaying releasing information?
    • We have been collecting information, but in a completely different way. We have different internal data reporting systems, so we wanted to make sure ours was consistent with CMS's. We waited for the CMS guidance, which came about 10 days ago, we worked on it last week, and we will start to report it tomorrow.

 

  • Do you see improvements in nursing homes since the new testing strategy was released?
    • I think we are seeing progress with all of the different measures we have in place, such as the infectious disease consultants, the work by the Patient Safety Authority, the National Guard, etc. I don't want to underestimate the challenges because seniors, many of those with chronic medical conditions, live in these congregate settings. Many states such as New York, New Jersey, Massachusetts, Illinois, etc., have had significant challenges with these facilities. We will continue to do everything we can to protect the staff and residents of these facilities.

 

  • This morning the State's website reported 38 deaths in Westmoreland County, while the County Coroners reported 32. Can you offer any information about what led to this discrepancy?
    • I don't know in terms of the specific county, but we can look into it. There will be some differences in reporting because of transitioning systems. 
  • What is the current suicide rate since the shutdown? And what has it been since the stay-at-home Order first began?
    • Suicide rates are hard to get. We get the information from the County Coroners, but these reports can be delayed while they are investigating. Unfortunately, we don't have specific numbers, but we have concerns for people who feel depressed, anxious, or isolated and might be at risk for suicide. We also are concerned about substance abuse, specifically opioid abuse, and these are all things we will be working in collaboration with the Department of Human Services and the Department of Drug and Alcohol Program.   
  • What has the overdose rate been since stay-at-home Orders came in effect? 
    • I don't have those numbers because it takes a while for those numbers to come in. However, we are very concerned in terms of opioid abuse and overdose deaths. 
  • During the last month or so, a trend has emerged between Lackawanna and Luzerne counties. Initially, the amount of new cases being reported in Luzerne County was substantial. Since then, new cases in Luzerne have sharply declined, while the number of cases in Lackawanna County appear static. Is this also a trend observed by the Department of Health? And are there insights to explain why new cases have been dropping in Luzerne, but have remained steady in Lackawanna?
    • I don't have specific granular details, but my team can do a deep dive into the data and report back. 
  • The death toll in Lackawanna County dropped substantially today, with smaller decreases in Luzerne and Pike counties. Do you have any idea what happened? And would it be due to the switch in the reporting system?
    • Yes, it would be due to the transition in reporting systems. It was most likely due to individuals who passed away in a hospital or congregate care facilities in those counties, but their county of residence was a different county. The coroners report it as their county of death, while we have to report it as their county of residence per the CDC standards. 
  • The data you gathered for Speaker Turzai indicates an age breakdown showing almost 88% of deaths were 65 or older. Are you surprised by the magnitude? And what does the data about comorbidity tell you?
    • I'm not surprised. Clearly, the data from Pennsylvania, other states, and other countries show that seniors are the most at risk for having severe complications to COVID-19 and passing away, especially those with other types of medical comorbidities. That could include heart disease, lung disease, kidney disease, diabetes, hypertension, etc. There are others at risk, who have a much lower death rate, but significant rates of illness, which includes young to middle-aged adults, and we now know that children are at risk for the new multi-system inflammatory condition. 
  • If, and when will youth be allowed to resume participation in organized sports and other activities? Is there evidence to suggest that the virus could spread amongst them asymptomatically and spread it to their parents or grandparents? Are youth being found less likely to contract the virus altogether? 
    • We are still learning a lot of information. In general, youth are less likely to have symptoms and be asymptomatic or have mild symptoms. The multi-system inflammatory disease is post-infectious that seems to be an inflammatory response to the virus weeks after the COVID-19 infection, and is a separate issue.

 

  • Can you give an update on antibody testing in the State? Is it widely available? And can Pennsylvania easily access it at a low cost?
    • We are working on getting that laboratory testing at our State laboratory by the end of the month, but I know that some hospitals are doing antibody testing, and Quest and LabCorp are also doing antibody testing. This is a blood test to look for antibodies, but what we don't know is how long those antibodies last and how much immunity they provide. We look to have that information over the summer.

 

  • Why is the National Guard leaving Brighton tomorrow? And what goal did they achieve?
    • They achieved a significant amount of progress in terms of staffing and infection control, and there is now other staffing coming to Brighton Rehab to allow the Guard to leave for their next mission. 
  • Can you explain what the new death data dashboard is showing, specifically what the percentage column is showing? How is it different than what we saw before?
    • This data is from a different system, the electronic death reporting system, so it was obtained in a different way. One thing we will have to deal with is the difference between where a person passes away, where they reside, and how it gets reported. 
  • The State is reporting 87 new deaths, but a close look at the data reveals that death counts for a handful of counties have dropped overnight. Why doesn't the Health Department's message today in emails and on the official website, reflect the full scope of what is happening?
    • I believe we are reflecting the full scope as we are reporting it in several different ways. 
  • Any update on the recovery tracking? When will the public be able to see that data?
    • We will have that available this week. 
  • Instead of bringing recovering Coronavirus patients to nursing homes, is the State exploring other options to care for these elderly individuals and keep residents safe?
    • We want to do everything we can to keep residents safe. Unfortunately nothing has been easy, but we will explore every opportunity. 
  • There have been some changes in death rates. Montour County no longer has any deaths, Snyder County now has 1 instead of 2, and Northumberland County now has 2. Any insights into these changes? 
    • This is what we have been talking about, this is where someone passed away, but it may not have been in the county that they are a resident of. Moving forward, the data will be consistent because this is how we will be reporting deaths. 
  • Will clubs like American Legion or VFW be allowed to open? They could wear masks, gloves, social distance, etc. They support many community endeavors, not just socialization. 
    • Not in the Red Phase, but we will look at the Yellow phase guidance, and we are developing the Green Phase guidance next week. 
  • Our county had 1 death and now has zero, and we do not have any nursing home cases. A neighboring county had 1 death and now is reporting 2. Could our case be counted in another county?
    • I'm not sure which county you are in, but yes. 
  • The new weekly death report says that the place of death is reported by the Medical Certifier. Does that mean if a person who lives in one county is taken to a hospital that is located in a different county, they will be counted for the hospital's county? 
    • That's how the coroners would list the patients because of their guidelines. Our guidance from the CDC is to list them by the county of residence. 
  • Would the Department consider subtracting long-term care living facility cases from the counties total, in deterring the 50 cases per 100,000 residents benchmark? We realize that employees at the facility come and go from outside of the facility, but a majority of the cases are residents who are confined. Some suggest that those cases could or should be counted separately. 
    • We discussed this before in terms of how public health officials and epidemiologists look at counties. Hospitals, long-term care facilities, food manufacturers, and State or County prisons are all part of the county, so they are all included in the county's numbers. 
  • Have death statistics been adjusted retroactively?
    • I'm not sure, so we will have to get back to you. 
  • It is EMS week. Can you offer a comment on EMS services across the Commonwealth this week? 
    • Our EMS technicians and staff have been doing an absolutely fantastic job, we owe them a debt of gratitude for their heroism and bravery.