COVID-19 Update: May 18, 2020

COVID-19 update for Monday, May 18 as of 2:30 p.m.

Pennsylvania Update

Department of Health

Pennsylvania State Map The Department of Health issued revised guidance for health care providers that have not already received guidance on how to reopen elective procedures. The guidance would not apply to hospitals, ambulatory surgical facilities, dental practices, and any others operating under separate department guidance.

The department issued additional clarification late Friday about Secretary Levine’s order for nursing homes to report information about COVID-19 patients to the Department of Health.

Because of the serious implications that COVID-19 has had and is having for the residents and staff of nursing homes, and the surrounding communities, and because of the need for the most timely and accurate data the Department of Health is able to obtain, the Secretary of Health has chosen to exercise her public health authority and issue an Order requiring the reporting in question. The Department of Health has provided instructions today to all skilled nursing facilities regarding how to report into its system for this purpose. The Department is requiring facilities to report daily, even over weekends and holidays, precisely because of the serious consequences that spread of the virus has for nursing home residents, its ability to spread asymptomatically, and the need for the most current, timely and accurate data to inform the Commonwealth’s response.

Information provided to skilled nursing facilities by the Department today did also include a letter reminding them of their obligations under CMS’ new regulations. This letter, while intended to be a timely reminder of those federal regulatory obligations, was not intended to define their obligations under the Secretary’s public health Order. The Secretary’s Order stands separate and apart from requirements mandated by CMS and is authorized by her authority to protect the health of the people of this Commonwealth, and to determine and employ the most efficient and practical means for the prevention and suppression of disease. Therefore, the letter detailing federal requirements relating to CMS should be disregarded for purposes of complying with the Secretary’s Order. The Department is not taking the issuance of this Order as a regulatory step, but as a public health imperative.

Department of Health Daily Briefing

More than 13,600 residents of long-term-care facilities and more than 2000 people who work at such facilities have tested positive for COVID-19. Those cases are spread over 561 facilities in 44 counties.
Nearly 69 percent of all COVID-19-related deaths in Pennsylvania have been people who resided in long-term-care facilities.
Nearly 4500 health care workers have tested positive for COVID-19, as have more than 2400 people employed in the food industry in 159 different facilities.
Secretary Levine explained that the state is now using a new death reporting system. When publicly reporting long-term care deaths, they will be reported based on the county of the facility. When reporting overall deaths, patients who passed away in long-term-care facilities – and those who do so in hospitals as well – will be reported based on their county of residence, not the county where the long-term-care facility or hospital was located.
More testing at long-term-care facilities will be introduced this week but it will not necessarily be weekly testing. The frequency of testing will be based on the situations of the individual facilities.
Case and mortality data for individual long-term-care facilities will be publicly reported beginning tomorrow.
Secretary Levine reported that the state is still seeking to acquire COVID-19 antibody testing for state labs and hopes to have it by the end of the month but some hospitals, as well as LabCorp and Quest, already have this capacity. She warned that the value of such tests is still not entirely clear.

Federal Update

Centers for Medicare & Medicaid Services

CMS has posted a compendium of COVID-19-related flexibilities it has authorized for ambulance services during the COVID-19 crisis.
CMS has updated its collections of COVID-19-related waiver flexibilities for several types of health care providers.
- For health care providers, a new section on ambulance services and the Medicare ground ambulance data collection system (p. 29).
- For hospitals, new provisions addressing specific life safety code matters for hospitals (p. 3); expanded ability for hospitals to offer long-term-care services (swing beds) (p. 6); hospitals classified as sole-community hospitals (p. 7); and hospitals classified as Medicare-dependent small rural hospitals (p. 7).
- For teaching hospitals, teaching physicians, and medical residents, new sections on the expanded ability of hospitals to offer long-term-care services (swing beds) for patients who do not require acute care but do meet the skilled nursing facility level-of-care criteria (p. 5) and its waiving of certain physical requirements under the Medicare conditions of participation to allow for increased flexibilities for surge capacity and patient quarantine at hospitals, psychiatric hospitals, and critical hospitals as a result of COVID-19 (p. 6).
- For long-term-care facilities (skilled nursing facilities or nursing facilities), a new section on the training required for paid feeding assistants (p. 11).
- For home health agencies, a new provision that permits occupational therapists, physical therapists, and speech language pathologists to perform initial and comprehensive assessments for all patients and not only for patients for whom physical therapy has been ordered (see page 4).
- For end-stage renal disease facilities, new information about the requirement that facilities furnish dialysis services on the main premises (p. 5).

CMS Weekly Stakeholder Calls

COVID-19: Office Hours Call — May 19

Tuesdays and Thursdays from 5 to 6 pm ET

Hospitals, health systems, and providers: Ask CMS questions about its temporary actions.

To Participate on May 19:

Conference lines are limited but you also can join via audio webcast
Or, call 833-614-0820; Access Passcode: 9984433

Target Audience: Physicians and other clinicians

COVID-19: Home Health and Hospice Call — May 19

Tuesdays from 3 to 3:30 pm ET

These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.

To Participate on May 19:

Conference lines are limited but you also can join via audio webcast
Or, call 833-614-0820; Access Passcode: 6477704

COVID-19: Nursing Home Call — May 20

Wednesdays from 4:30 to 5 pm ET

These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.

To Participate on May 20:

Conference lines are limited but you also can join via audio webcast
Or, call 833-614-0820; Access Passcode: 4879622

COVID-19: Dialysis Organization Call — May 20

Wednesdays from 5:30 to 6 pm ET

These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.

To Participate on May 20:

Conference lines are limited but you also can join via audio webcast
Or, call 833-614-0820; Access Passcode: 3287645

COVID-19: Nurses Call — May 21

Thursdays from 3 to 3:30 pm ET

These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.

To Participate on May 21:

Conference lines are limited but you also can join via audio webcast
Or, call 833-614-0820; Access Passcode: 2874976

COVID-19: Office Hours Call — May 21

Tuesdays and Thursdays from 5 to 6 pm ET

Hospitals, health systems, and providers: Ask CMS questions about its temporary actions.

To Participate on May 21:

Conference lines are limited but you also can join via audio webcast
Or, call 833-614-0820; Access Passcode: 9984433

Target Audience: Physicians and other clinicians

COVID-19: Lessons from the Front Lines Call — May 22

Fridays from 12:30 to 2 pm ET

These weekly calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians: Share your experience, ideas, strategies, and insights related to your COVID-19 response. There is an opportunity to ask questions.

To Participate on May 22:

Conference lines are limited but you also can join via audio webcast
Or, call 877-251-0301; Access Code: 6086125

To catch up on past calls, go here for transcripts and podcasts.

Department of Health and Human Services

ASPR TRACIE, sponsored by HHS’s Office of the Assistant Secretary for Preparedness and Response (ASPR) to provide Technical Resources, Assistance Center, and Information Exchange (TRACIE) services, has published a summary on funding for alternative care sites for helping to increase hospital surge capacity in communities overwhelmed by patients diagnosed with COVID-19. In particular, see the charts on pages 3 and 4.
HHS will be distributing another large quantity of the drug remdesivir to state health departments later this week. Those state health departments, in turn, will distribute the drug to their states’ hospitals as they believe appropriate. This distribution is about the same size as last week’s. Another, smaller distribution is expected next week.

Neither this week’s nor next week’s distributions require any action by hospitals; they do not have to provide any data through the COVID-19 teletracking portal.

Gilead, manufacturer of remdesivir, is expected to donate more than 300,000 additional vials to the federal government in early June. Hospitals will be asked to input their COVID-19 data through the teletracking portal in early June as that next donation draws closer.

Centers for Disease Control and Prevention

The CDC updated its information for pediatric health care providers on multi-system inflammatory syndrome in children (MIS-C).

Food and Drug Administration

The FDA has issued an emergency use authorization (EUA) for an at-home sample collection kit that can then be sent to specified laboratories for COVID-19 diagnostic testing.

The FDA has issued an EUA for a commercial device to be used for remote monitoring of cardiograms among COVID-19 patients whose hearts may be susceptible to cardiac arrhythmias when taking certain prescription drugs.
The FDA has updated its guidance document on conducting clinical trials of medical products during the COVID-19 emergency.