The following is the latest COVID-19 information from the state government as 3:00 p.m. on Wednesday, December 9.

Governor Wolf

Governor Wolf has tested positive for COVID-19.  It was diagnosed in a routine test and he is quarantining at home.  See a news release from the governor’s office with further information.

 Department of Health

The Department of Health has issued guidance to hospitals on how to identify and report COVID-19 outbreaks originating within the facility.  The department wants this guidance to be used to supplement other relevant guidance documents and to guide the implementation of public health expectations for hospitals.

Key messages included in the guidance:

• COVID-19 surveillance procedures must be outlined via written policy and implemented in a way that can systematically identify clusters.
• Outbreak Definition:
  • ≥2 cases of confirmed COVID-19 in a patient seven or more days after admission for a non-COVID condition, with epi-linkage; or
  • ≥3 cases of confirmed COVID-19 in HCP with epi-linkage AND no other more likely sources of exposure for at least two of the cases.
• Outbreaks fitting the definition outlined in this advisory must be reported through the Pennsylvania Patient Safety Reporting System (PA-PSRS) as an infrastructure failure.  This does not replace reporting of COVID-19 cases or capacity data in other state or federal systems.

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

The following is the latest COVID-19 information from the state and federal governments as of 2:45 p.m. on Wednesday, December 2.

Pennsylvania Update

Governor Wolf

• Governor Wolf has renewed his COVID-19 public health emergency declaration.  See the announcement of the renewal here and go here to see the declaration itself.
• On Tuesday the governor posted a message on Twitter stating that “PA is projected to run out of ICU beds this month.”
• Governor Wolf and the Department of Health have extended the state’s contract with a vendor to perform COVID-19 testing throughout the state.  Over the next 12 weeks, five teams will provide testing in 61 counties – counties without their own health departments; the six counties not receiving this testing have their own health departments that perform testing.  Work begins immediately, with testing available from December 2 through December 6 in Bedford, Mifflin, Tioga, and Northampton counties and from December 4 through December 8 in Butler County.  Learn more about this new testing initiative in this news release from the governor’s office.

Department of Health

The Department of Health has updated its interim guidance for skilled nursing facilities to incorporate new state and federal guidance issued since the last update on October 13, 2020.

The Department of Health issued a health advisory with guidance for long-term-care facilities on testing and managing residents with acute respiratory illness symptoms when COVID-19 and influenza viruses are both circulating.

Department of Health – by the numbers

• Pennsylvania’s number of COVID-19 cases today surpassed 375,000.
• More than 10,500 Pennsylvanians have now died from COVID-19.  The past two days have had the two highest single-day death totals in the state since the pandemic began.
• More than 36,000 residents of long-term-care facilities and more than 6800 people who work in those facilities have contracted COVID-19.  Those figures encompass 1289 facilities in 65 of Pennsylvania’s 67 counties.
• More than 14,800 health care workers in the state have contracted COVID-19.
• The number of people currently hospitalized with COVID-19 has doubled since November 16.  The Department of Health reports that “Most of the patients hospitalized are ages 65 or older…”
• The number of COVID-19 patients currently breathing with the help of a ventilator has doubled since November 17.
• More than 1000 Pennsylvanians are currently in hospital adult intensive care units being treated for COVID-19.
• 16 percent of hospital adult ICU beds are currently unoccupied, as are 15 percent of medical/surgical beds, 41 percent of pediatric beds, 17 percent of pediatric ICU beds, and 32 percent of airborne isolation unit beds.
• The state-wide positivity rate on COVID-19 tests rose from 11.1 percent two weeks ago to 11.7 percent last week, according to the early warning dashboard released weekly by the governor and Department of Health.  Sixty-six of Pennsylvania’s 67 counties have positivity rates greater than five percent; five counties – Juniata, Mifflin, Bedford, Somerset, and Tioga – had positivity rates greater than 20 percent.
• A positivity rate greater than five percent is considered “concerning,” Department of Health Secretary Levine has explained in the past.
• That same dashboard shows that 66 of the state’s 67 counties exhibited “substantial levels of community transmission” last week, up from 59 of 67 counties the previous week.
• In light of the growing number of COVID-19 cases, the Department of Health is now prioritizing case investigations.  As a result, the number of successful contract-tracing efforts was 22 percent last week, up from 10 percent the previous week.
• Of the confirmed cases reported between November 15 and November 21 in which contact tracing was successful, only one percent said they visited a business establishment 14 days prior to the onset of symptoms (down from 13 percent two weeks ago).  Drilling down on this data, the dashboard reports that

Compared to data reported on November 23, this week’s data indicated an increase for people who reported going to a restaurant (51 percent vs. 48 percent last week), going to a salon/barbershop (8 percent vs. 7 percent last week), and slight increases for those going to some other business (24.5 percent vs. 24 percent last week) and going to a bar (15.3 percent vs. 15 percent last week). The data saw a decrease for people who reported going to a gym/fitness center (10 percent vs. 14 percent last week). The number of those who attended a mass gathering or other large event decreased to 13 percent from 16.3 percent last week.

In addition, 16 percent of respondents said they had attended a mass gathering or other large event 14 days prior to onset of symptoms; two weeks ago, that figure was nearly 19 percent.

Around the State

• The Philadelphia Inquirer reported on Monday that “788 patients with COVID-19 were hospitalized in Philadelphia as of Monday… up 48% since Nov. 18, when 530 coronavirus patients were in the hospital.  69 patients were on ventilators.”
• Across the state, the Pittsburgh Tribune-Review reported late last week that “A staggering rise in new covid-19 cases in Allegheny County means fewer people will receive calls from case investigators who have been overwhelmed with the rapid increase, Allegheny County Health Director Dr. Debra Bogen said Friday.  On Thursday and Friday, the county recorded a combined 1,642 new cases – more than the total number of new cases in May and June combined.”
• In response, Pittsburgh’s public safety department has formed a task force to enforce new state COVID-19 restrictions.  The Tribune-Review reports that according to a policy spokesperson, the task force, requested by the city’s mayor, will “…conduct random, unannounced compliance checks at various businesses…  All violations will be documented.  In addition, police officers on regular patrol will respond to all complaints for violations of the Governor’s order.”
• During a Monday news briefing, according to the Pennsylvania Capital-Star, “State Health Secretary Dr. Rachel Levine said the number of hospitalized individuals was a record, higher than totals in spring.”

Department of Human Services

• DHS has published guidelines describing steps providers of in-home services can take to mitigate the possible transmission of COVID-19.
• DHS’s Office of Long-Term Living and Office of Developmental Programs have updated their guidance on COVID-19 for personal care homes, assisted living residences, and intermediate care facilities.
• DHS’s Office of Developmental Programs has published guidance for agencies and facilities providing life-sharing services during the COVID-19 pandemic.

Department of State

The Department of State has extended until 90 days after the governor’s COVID-19 emergency declaration ends all temporary practice permits issued by the State Board of Nursing for RNs and PNs (licensees from other states who may or may not still need to be examined) and graduate temporary permits for RNs and PNs (graduates of nursing education programs who have yet to be examined) that were in effect on March 6, 2020 unless (1) the temporary practice permit holder was subsequently issued a license after March 6, 2020 or (2) the temporary practice permit holder subsequently failed the licensure examination after March 6, 2020.  See the Department of State’s notice here.

Federal Update

Centers for Medicare & Medicaid Services

• CMS has announced the introduction of two new Medicare condition codes that will take effect for claims received on or after February 1, 2021:  one to enable providers to report when a service is provided as part of Expanded Access approval and another to enable providers to report when the service is provided as part of an Emergency Use Authorization.  Find an article about the new codes here in MLN Matters, CMS’s online publication.
• CMS has updated its compendium of COVID-19 emergency declaration of blanket waivers for health care providers with new information about its Medicare ground ambulance data collection system; see page 31 for details.
• CMS has updated its COVID-19 FAQs on Medicare fee-for-service billing with a new section for Indian Health Services hospitals (see pages 150-151).

Department of Health and Human Services

• HHS’s Office of the Assistant Secretary for Preparedness and Response has compiled a new hospital operations toolkit for COVID-19.  It covers capacity, patient care policies and processes, infection prevention and control, and administration.
• HHS’s Office of the Assistant Secretary for Preparedness and Response will host a webinar titled “Crisis Standard of Care and COVID-19:  What’s Working and What Isn’t” on Thursday, December 3 at noon (eastern).  Speakers will discuss clinical consultation versus triage support, systems-level information sharing, coalition-level coordination activities, and recent publications/resources to help with COVID-19 planning efforts.  Go here to learn more about the webinar and how to register for it.

Food and Drug Administration

• The FDA has reissued its August 23, 2020 emergency use authorization (EUA) for the emergency use of COVID-19 convalescent plasma for the treatment of hospitalized patients with COVID-19.

Centers for Disease Control and Prevention

• The CDC has updated its guidance on appropriate periods of time to quarantine for people who believe they have been exposed to individuals with suspected or confirmed COVID-19.  The new guidance calls for briefer quarantine periods.
• The CDC’s Advisory Committee on Immunization Practices (ACIP) has adopted the following resolution (scroll down to find it) about the administration of COVID-19 vaccines:

When a COVID-19 vaccine is authorized by FDA and recommended by ACIP, vaccination in the initial phase of the COVID-19 vaccination program (Phase 1a) should be offered to both 1) health care personnel and 2) residents of long-term care facilities.

• The CDC has updated its information on managing pregnant patients with confirmed or suspected COVID-19.
• The CDC has updated its guidance on assessing COVID-19 risk factors and why risk factors matter.
• The CDC has updated its data on COVID-19-related cases, hospitalizations, and deaths by race and ethnicity.
• The CDC has updated its guidance for expanded testing to help reduce the spread of COVID-19.
• The CDC has updated its information with guidance and resources for laboratories that perform COVID-19 tests.
• The CDC has published a new edition of its COVID-19 Science Update.

National Institutes of Health

• The NIH has updated its guidelines on the testing, treatment, and management of COVID-19 patients.

Government Accountability Office

• The GAO has examined the federal response to the COVID-19 public health emergency, describing the impact of the pandemic and the government’s response to it while identifying shortcomings in that response and recommending ways to address those shortcomings.  Learn more from the GAO report “COVID-19:  Urgent Actions Needed to Better Ensure an Effective Federal Response.”

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ

The following is the latest COVID-19 information from the state and federal governments as of 2:30 p.m. on Tuesday, November 24.

Pennsylvania Update

Governor Wolf/Department of Health

Citing modeling that projects 22,000 new COVID-19 cases a day in Pennsylvania in December, Governor Wolf and Department of Health Secretary Levine have introduced new mitigation efforts.  The governor’s news release announcing these new efforts noted that “In the past week, the number of COVID-19 attributable deaths has quadrupled, and the average daily case count is 7 times higher than it was two months ago.”

The news release also explained that “The new measures include revamped school safety attestation, targeted business and gathering restrictions, and a new enforcement plan that includes liability protection for businesses enforcing the Secretary of Health’s strengthened mask-wearing order.”

The new mitigation effort also addresses elective procedures performed in acute-care hospitals.  The order establishes criteria under which the Department of Health may order hospitals to reduce by 50 percent the number of elective procedures performed in their facilities for a period of seven days.  Orders to reduce elective procedures can be triggered based on hospital staffing levels, COVID-19 surges, and available bed capacity.  Such orders will apply to all acute-care hospitals in any region that meets two of the three metrics and will be in effect for seven days, with renewal possible depending on conditions within the region; regions are defined in the executive order.  The order takes effect on November 30.  See Secretary Levine’s order addressing required reduction of elective procedures in regions with low acute-care treatment capacity.

Department of Health

• The Department of Health announced that the federal government will be distributing supplies of the investigational monoclonal antibody therapy bamlanivimab to Pennsylvania hospitals.  The state will decide which hospitals receive supplies, and in what quantities, based on county COVID-19 case counts.  See the department’s news release for further information.
• The Department of Health has compiled answers to frequently asked questions on COVID-19 laboratory testing.
• The Department of Health strongly encourages the use of a COVID-19 safety pledge for nursing home residents who participate in non-medical outings during the holiday season.  The pledge is meant to be a tool to educate residents, families, and friends about the additional risk of exposure when visiting the community.

Department of Health – by the numbers

• Pennsylvania’s number of COVID-19 cases today surpassed 321,000.
• In three of the past ten days Pennsylvania has set a new single-day high for the number of new cases.
• Nearly 10,000 Pennsylvanians have now died from COVID-19.
• More than 32,000 residents of long-term-care facilities and more than 6000 people who work in those facilities have contracted COVID-19.  Those figures encompass 1244 facilities in 64 of Pennsylvania’s 67 counties.
• More than 14,000 health care workers in the state have contracted COVID-19.
• The number of people currently hospitalized with COVID-19 has doubled in the past two weeks.
• The number of COVID-19 patients currently breathing with the help of a ventilator has doubled since November 5.
• Nearly 826 Pennsylvanians are currently in hospital intensive care units being treated for COVID-19; that is a 43 percent increase in the past week.
• 17 percent of hospital adult ICU beds are currently unoccupied, as are 17 percent of medical/surgical beds, 39 percent of pediatric beds, 19 percent of pediatric ICU beds, and 34 percent of airborne isolation unit beds.  There are now more COVID-19 patients in adult ICU beds in Pennsylvania than there are currently unoccupied adult ICU beds in the state.
• The state-wide positivity rate on COVID-19 tests rose from 9.6 percent two weeks ago to 11.1 percent last week, according to the early warning dashboard released weekly by the governor and Department of Health.  Sixty-six of Pennsylvania’s 67 counties have positivity rates greater than five percent.
• A positivity rate greater than five percent is considered “concerning,” Department of Health Secretary Levine has explained in the past.
• That same dashboard shows that 59 of the state’s 67 counties exhibited “substantial levels of community transmission” last week, down from 63 of 67 counties the previous week.
• In light of the growing number of COVID-19 cases, the Department of Health is now prioritizing case investigations.  As a result, the number of successful contract-tracing efforts was down to 10 percent last week; it was 21 percent the previous week.
• Of the confirmed cases reported between November 8 and November 14 in which contact tracing was successful, 13 percent said they visited a business establishment 14 days prior to onset of symptoms (down from 19 percent two weeks ago).  Among them:
  • 48 percent reported going to a restaurant
  • 24 percent reported going to some other business establishment
  • 15 percent reported going to a bar
  • 14 percent reported going to a gym/fitness center
  • seven percent reported going to a salon/barbershop

In addition, 16 percent of respondents said they had attended a mass gathering or other large event 14 days prior to the onset of symptoms; two weeks ago, that figure was nearly 19 percent.

Federal Update

Provider Relief Fund

The Provider Relief Fund web page has been updated with the following notice:

The application deadline for the Provider Relief Fund Phase 3 General Distribution was Nov. 6, 2020. You must have submitted your Taxpayer Identification Number (TIN) for validation by 11:59 p.m. ET on Nov. 6, 2020 for Phase 3 relief funds. If you submitted your TIN for validation by the deadline and your TIN is validated by Nov. 13, you will be able to proceed with submitting your revenue documentation to complete your application by 11:59 p.m. ET on Nov. 27, 2020.

Department of Health and Human Services

• HHS has announced plans to allocate doses of the investigational monoclonal antibody therapeutics casirivimab and imdevimab for treatment of non-hospitalized patients with mild or moderate confirmed cases of COVID-19 at high risk of hospitalization; this is often referred to publicly as the Regeneron antibody cocktail.  HHS will allocate 300,000 federally-purchased doses to state and territorial health departments that will determine which health care facilities receive the infusion drug.  Weekly allocations of the drug will be proportionally based on confirmed COVID-19 cases in each state and territory over the previous seven days based on data that hospitals and state health departments enter into the HHS Protect data collection platform.  Learn more from HHS’s announcement about the allocation plan.  Find additional information about allocation here.
• HHS has published a Request for Information notice in which it seeks to “…gather information on effective innovative approaches and best practices in health care in response to the COVID-19 pandemic by non-HHS health care systems and providers.”  Comments are due by December 24.  Go here to see the brief notice.
• HHS’s Office of the Assistant Secretary for Preparedness and Response has posted a paper on the designation of individual hospitals as COVID-19 hospitals within health systems or geographic areas.
• HHS’s Office of the Assistant Secretary for Preparedness and Response has posted a report on crisis standards of care and patient surge management for COVID-19.
• HHS’s Office of the Assistant Secretary for Preparedness and Response has posted a presentation with information on the use of point-of-care tests for the diagnosis of COVID-19.

Centers for Medicare & Medicaid Services

• CMS has posted the first episode in a series of short podcasts for frontline nursing home staff.  The series, “CMS Beyond the Policy:  Nursing Home Series for Frontline Clinicians and Staff,” is designed to reinforce training and infection control practices in nursing homes to help combat the spread of COVID-19.  To listen to the podcast, go here.

Food and Drug Administration

• The FDA has issued emergency use authorization for emergency use of baricitinib (Olumiant), in combination with remdesivir (Veklury), for use by health care professionals in the treatment of suspected or laboratory-confirmed COVID-19 in certain hospitalized patients requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).  See the FDA’s letter authorizing the drug’s use in this manner, a fact sheet for providers, and an FAQ on the emergency use of baricitinib in combination with remdesivir.
• The FDA has issued an EUA for casirivimab and imdevimab to be administered together for the treatment of mild to moderate COVID-19 in adults and pediatric patients (12 years of age or older weighing at least 88 pounds) with confirmed cases of COVID-19 and who are at high risk for progressing to severe COVID-19.  The FDA also posted an FAQ on the use of this combination of drugs.
• The FDA has approved an abbreviated new drug application for succinylcholine chloride injection, which can be used to facilitate tracheal intubation and provide skeletal muscle relaxation during mechanical ventilation for COVID-19 patients.

Centers for Disease Control and Prevention

• The CDC’s weekly morbidity and mortality report addresses the deliberations of the agency’s Advisory Committee on Immunization Practices’ ethical principles for the allocation of initial supplies of COVID-19 vaccine.
• The CDC has updated its information about strategies for optimizing providers’ supplies of N95 respirators.
• The CDC has updated its FAQs for laboratories that perform COVID-19 tests.
• The CDC has updated its guidance on infection control for nursing homes.
• The CDC also has updated its infection control assessment tool for nursing homes.

Department of Labor

• The Department of Labor’s Occupational Safety and Health Administration (OSHA) has updated its FAQ on the use of cloth face coverings as personal protective equipment.

Resources to Consult

Pennsylvania Department of Human Services

Main COVID-19 Page

COVID-19 Provider Resources

Press Releases

Pennsylvania Department of Health

Main COVID-19 Page

PA Health Alert Network

Centers for Disease Control and Prevention

Main COVID-19 Page

FAQ