Dr. Rachel Levine signs PPE requirement order for long-term care facilities

A new state order for Pennsylvania’s long-term care facilities mandates all organizations to provide pre-approved personal protective equipment to all staff working directly with COVID-19 positive residents by Aug. 27.

Secretary of Health Rachel Levine issued the order Monday.

While many long-term care facilities have worked diligently against the spread of the virus, she said the order is a response to safety concerns from nurses and staff of facilities across the country.

“The order requires that the necessary steps are in place to deliver a safer environment to continue providing high-quality care during these challenging times,” Levine said in a press release.

As part of the order, facilities must provide respirators, such as N95 masks, to any staff working directly with COVID-19 positive patients. The respirators need to be approved by either the National Institute of Occupational Safety and Health or the Food and Drug Administration.

These facilities may find that they won’t be able to comply with the order in just a week’s time thanks to continued shortages in the supply chain that have created gaps in PPE procurement for most health care providers. The shortages have left some independent physicians with only a week’s worth of equipment.

Adam Marles, president and CEO of LeadingAge PA, said the nonprofit trade association supports efforts to protect residents in long-term care facilities, but that state funding doesn’t cover the costs for PPE or Pennsylvania’s testing requirements for facilities.

“We have additional concern that personal care homes and assisted living residences, in particular, will have difficulty complying given they are only just beginning to receive CARES Act funding, and it will likely not be enough to cover universal testing,” he said.

Long-term care providers began receiving CARES Act funding through Act 24 of 2020, signed by Gov. Wolf in June. The Act included $457 million in relief funds for providers of long-term living programs.

Marles added that the Mechanicsburg-based nonprofit will be looking to work forward with the administration and lawmakers to address critical funding needs among its members.

For independent physicians, obtaining PPE is an ongoing struggle

Maintaining personal protection equipment for patients and staff has become a full-time job for independent health care providers who have not received the help from the state that their counterparts in health care systems have.

Facing a potential second wave to the COVID-19 pandemic, Jackson Siegelbaum Gastroenterology in East Pennsboro Township, Cumberland County, created a four-person team to monitor the stock of PPE at its offices and laboratory.

Through the inventory management team, the gastroenterology clinic maintains its supply of PPE and calculates a burn rate that tells management how long the facilities will be able to operate if supply chains fail.

Since the beginning of the pandemic, Gov. Tom Wolf’s office and the state Department of Health distributed over 5.2 million N95 masks, 621,000 gowns, 4,782,000 gloves and more to hospitals, long-term care facilities, first responders and other providers in need of PPE. But the state has yet to provide the same equipment to independent physicians, instead encouraging them to seek PPE through their own vendors, health care coalitions or the state’s COVID-19 PPE and supplies business to business portals.

However, PPE continues to be difficult to obtain for providers, 20% of whom have only a one week supply in stock, according to a survey of 983 physicians conducted in late April by the Pennsylvania Medical Society (PAMED).

Since the April survey, the stream of PPE to providers has continued to be slow moving.

“Hospitals got what they needed but for practices to open up and keep patients out of the hospitals, we need more PPE,” said Dr. David Talenti, vice president at PAMED and a gastroenterologist at Wayne County-based Northern Gastroenterology Associates.

To ensure that its members have the PPE they need to stay open safely, PAMED purchases provisions through Action PPE, a collaborative bulk PPE supplier launched by the Charleston County Medical Society in South Carolina. The collaborative allows PAMED to increase its buying power and access more PPE than a single office. But, even with the increased buying power, some equipment is still hard to find.

“There are some things that we are scraping by with,” he said. “We have K95 respirator masks that expose our providers to a higher risk of infection. The N95’s were stockpiled by larger systems and the K95 respirator doesn’t seal properly.”

Jackson Siegelbaum Gastroenterology is using PAMED’s access to Action PPE in concert with its own management team and has been able to stock more than a month of PPE.

“When you are a smaller practice, you are really reliant on your own internal resources and relationships with vendors to get the necessary equipment,” said Dr. Wilson Jackson, a partner at Jackson Siegelbaum. “The society helped us get access but we’ve also worked really hard to get access to what we needed.”

Talenti’s office has also been stuck by the lack of provisions. He noted that the facility has one staff member on the phone contacting between 20 to 25 suppliers daily just to ensure that the clinic continues to have a supply.

If there is a large second wave of the virus and the state elects to pause elective surgeries as it did earlier in the pandemic, gastroenterology clinics such as Jackson Siegelbaum and Northern Gastroenterology would close, he said. Jackson said a more pressing concern will be if the pandemic continues to smolder and the practice needs to continue to stock PPE in the way it is now.

In late April, PAMED sent a letter to the Governor asking the state to make a percentage of the PPE stockpile available to independent providers. In the letter, Dr. Lawrence John, the society’s president, said that the lack of PPE in private practices could result in a closure of practices and an increased stress on local hospitals.

“These private practitioners are keeping patients away from emergency departments so that health systems can effectively treat COVID-19 patients, yet they cannot obtain PPEs,” John wrote. “Daily we are hearing of practices closing or indicating that they are within days of ceasing life sustaining care and treatments. Without help from private practitioners, patients will have no choice but to go to hospitals for care.”

Neither the DOH or Governor Wolf’s office have responded to the letter.

PA to award $10 million in grants for COVID-19 vaccine, treatment and therapy research

The state is now accepting applications for $10 million in grant funding through its COVID-19 Vaccines, Treatments and Therapies program to support advancement in new methods to combat the COVID-19 pandemic.

Applications for the program end July 24 and are open for colleges and universities, for-profit companies, academic medical centers, nonprofit research institutions and economic development organizations.

Grants will be awarded to entities that demonstrate both a financial need and a well-defined pathway to accelerating the commercialization of a vaccine, treatment or therapy against COVID-19, the Governor’s office wrote in a press release.

“Our commonwealth is home to some of the most brilliant minds and institutions and has a history of being a leader in developing groundbreaking science and advancing new, life-sustaining technologies,” said Gov. Tom Wolf, who announced the grants on Thursday. “As we continue to take mitigation efforts seriously, we want to support groups that can move Pennsylvania forward in the development of treatments that can halt the spread of COVID-19 and protect our families, friends, and communities for the long-term.”

The program will be administered by the Pennsylvania Department of Community and Economic Development’s Office of Technology and Innovation.

CDC commends Pa.’s reduction of COVID-19 positive cases

Pennsylvania is one of three states of the country that have had a downward trajectory of COVID-19 cases for more than 42 days, Gov. Tom Wolf announced during a press conference on Wednesday.

Montana, Hawaii and Pennsylvania have had the most consistent drop in positive cases of the virus since the pandemic began, according to a new report Wolf referenced by the Centers for Disease Control.

As of Wednesday afternoon, Pennsylvania has had 79,818 cases of COVID-19— approximately 335 more cases than the day before, according to data reported by the state Department of Health. The number of daily positive cases has continued to decrease since numbers reached as high as 1,599 in late April.

Wolf added that 24 states have seen an increase in cases as Pennsylvania’s continued to drop, which he attributed to the state’s reopening plan.

“We know our decline in cases is because of our choices because half of the states are experiencing an increase in COVID-19 cases as reopening begins,” Gov. Wolf said. “Many of these states are experiencing significant case increases tied to reopening too soon or too much. Pennsylvania is not. We have remained focused on balancing economic interests with public health.”

The state’s focus on continuing to enforce the wearing of masks even in green phase counties was another reason why the state has led in its reduction of cases, according to Wolf.

“Pennsylvanians have done an excellent job at demonstrating how to balance business and public health,” Gov. Wolf said. “If we keep this up, we can continue to be a model to other states and a leader at saving lives and livelihoods during this pandemic.”

Levine orders new regulations for Pa. hospitals

The Pennsylvania Department of Health issued an order that calls on hospitals to create to implement new safety measures by next week to make facilities safer for staff and patients.

Comments given to the department from nurses and staff working in the state helped to inform which regulations were included in the order, said state Health Secretary Dr. Rachel Levine.

“Across Pennsylvania, nurses and other front-line workers are treating patients around the clock in hospitals fighting the COVID-19 pandemic,” Levine said. “I have heard from nurses and staff, and this order responds directly to many of their safety concerns. It ensures that the necessary steps are in place to deliver a safer environment so these workers can continue providing high-quality care during these extraordinary times.”

The order requires all hospitals:

  • Notify hospital staff members who have been in close-contact with a confirmed or probable COVID-19 case within 24 hours of the known contact and provide instruction for quarantine and work exclusion for those staff members.
  • Test both symptomatic and asymptomatic hospital staff who received notice of a close contact with a COVID-19 positive patient.
  • Distribute respirators to hospital staff members when the staff member determines the mask is soiled, damaged or ineffective in any way.
  • Require universal masking for all individuals entering the facility except for visitors under the age of two or if the mask would create a further health risk.

Pa. hospitals may resume elective surgeries under new DOH guidance

Pennsylvania Department of Health Secretary Dr. Rachel Levine speaks during a press conference in March. FILE

Hospitals in the commonwealth can resume their elective surgeries and procedures if they follow new guidance released by the Pennsylvania Department of Health.

Secretary of Health Dr. Rachel Levine announced in a press conference on Monday that health care providers across the state can now continue their elective surgeries and procedures through new updated guidance from the state, if they follow a series of rules meant to continue to contain COVID-19.

Earlier this month, the department issued called on hospitals and ambulatory surgical facilities to postpone or cancel elective surgeries until further notice.

“We know many Pennsylvanians have had to delay important procedures and operations but it was necessary to ensure that our hospital system had enough capacity in case it became overwhelmed with patients with COVID-19,” said Levine.

The department is allowing elective surgeries and procedures as long as they don’t jeopardize the safety of patients and staff or hamper a facility’s response to COVID-19.

Hospitals and surgical centers that reinstate elective surgeries must ensure they have enough personal protective equipment to prepare for any surge in COVID-19 cases. They should also have a plan in place to handle any surge in COVID-19 cases without having to prioritize care, Levine said.

“Facilities have to have enough trained and educated staff to be able to handle the procedures themselves but also a potential surge in hospital patients,” she said. “This guidance puts forth ways for hospitals and ambulatory surgical facilities to do that while making sure that we stayed prepared for a resurgence in COVID-19 in those areas.”

If a hospital or surgical center decides to begin elective surgeries and procedures, they will need to update their emergency preparedness plans to reflect that change.

The updated guidance also makes changes in the department’s guidance on visitor policies during the pandemic, which previously asked hospitals to limit visitor access to vulnerable populations.

“The department strongly encourages that a hospital’s visitor policy allow for a patient support person at the patient’s bedside for patients in labor and delivery; pediatric patients; and patients for whom the hospital determines a support person is essential to the care of the patient, including patients with intellectual and/or developmental disabilities and patients with cognitive impairments such as dementia,” the department wrote in its guidance.

DOH mask mandate allows for homemade masks

A statewide order compelling employers to require all employees and customers to wear masks in their facilities will not be postponed despite a lack of available supplies.

Pennsylvania Health Secretary Dr. Rachel Levine signed the order on April 15. The requirement goes into effect on Sunday. Failure to comply could result in fines and citations.

It is unclear how aggressively the state’s departments will enforce the order. In a phone call with press on Thursday, Gov. Tom Wolf referred to the order as a set of guidelines when asked if the order would be enforced by the Pennsylvania State Police.

“Businesses are responsible for ensuring that customers abide by the protocols pertaining to customers, and the appropriate enforcement agencies are responsible for ensuring that employers abide by the protocols pertaining to employers and employees,” said Elizabeth Rementer, deputy press secretary for the Office of the Governor. “Law enforcement has been tasked with ensuring that businesses are aware that the order exists and notifying businesses that a complaint of noncompliance was received.”

During a press conference on Thursday, Levine said she would not delay the start date past April 19 for any industry.

“We recommend that if someone comes to a retailer or a grocery store and doesn’t have a mask, that they be asked to go back home and get a mask,” Levine said. “If the store has extra masks they can certainly give one and that would be great.”

The Department of Health has since released further guidance on the order, noting that masks can be obtained or made by employers or employees but must be approved by the employer in accordance with department guidelines.

Masks can be non-medical-grade and when masks aren’t available, the department also recommends using a scarf or bandana.

Levine’s order also specifies that if an employee contracts COVID-19, businesses must implement temperature screenings before employees can enter the business prior. When asked what a business should do if they purchase no-contact thermometers that cannot be delivered before Sunday, Levine said they can reach out to the department for support.

Local distillery to make hand sanitizer for COVID-19 effort

Midstate Distillery in Harrisburg will be one of first three distilleries in the state to prepare alcohol-based hand sanitizer in partnership with the Pennsylvania Department of Health.

The Philadelphia-based Pennsylvania Distillers Guild announced on Wednesday that it has partnered with the state Department of Health to mobilize the state’s distilleries to make hand sanitizer products to be used in the fight against further spread of coronavirus.

Through the state funded program, the department has already ordered 100,000 units of hand sanitizer to be filled by Midstate Distillery as well as New Liberty Distillery in Philadelphia and Pennsylvania Pure Distilleries in Pittsburgh.

After the first order of 100,000 units is filled, the guild said it will be mobilizing two to four additional distilleries every 48 hours to fulfill any other orders sent through the program.

Other distilleries across the state have launched similar efforts to sell hand sanitizer made from alcohol.

“The herculean lift from the distilleries across the state of Pennsylvania is a testament to the resourcefulness and dedication of all involved,” said Dan Healy, co-owner and head distiller of Midstate Distillery. “Even those distilleries not yet directly involved in this specific endeavor are dedicating man hours to providing support to their local communities through sanitizer production. Many of these business owners work full time jobs in addition to running their production facilities, and the fact that we as an industry are able to contribute this small bit of help to the overall effort is inspiring.”

When it isn’t producing hand sanitizer, Midstate manufactures vodka, rum, gin, coffee liqueur and whiskies.

Lebanon added to Pennsylvania ‘stay-at-home’ orders

Lebanon County was one of seven counties to receive stay-at-home orders from Gov. Tom Wolf and Secretary of Health Dr. Rachel Levine on Tuesday.

Positive cases of COVID-19 are growing every day, causing the state to continue to issue stay-at-home orders for an increasing list of counties.

On Tuesday, Wolf and Levine announced that the list will now include Cameron, Crawford, Forest, Franklin, Lawrence, Lebanon and Somerset counties, bringing the total number of counties to 33.

The order allows for people to leave their homes to maintain their health and safety or that of family members, if they need necessary supplies or services or for necessary travel such as caring for an elderly family member or for non-residents to return to their homes.

Businesses deemed non-life-sustaining must be closed as a part of the order. Life-sustaining businesses like restaurants can continue to offer take-out services.

The orders are to take effect at 8 p.m. and will continue until April 30.

Wolf announced on Monday that Cumberland and Dauphin would be added to the list, and expanded the end date for the orders past April 6.

The counties under stay-at-home orders now include: Allegheny, Beaver, Berks, Bucks, Butler, Cameron, Carbon, Centre, Chester, Crawford, Cumberland, Dauphin, Delaware, Erie, Forest, Franklin, Lackawanna, Lancaster, Lawrence, Lebanon, Lehigh, Luzerne, Monroe, Montgomery, Northampton, Philadelphia, Pike, Schuylkill, Somerset, Washington, Wayne, Westmoreland and York counties.

Wolf also said on Monday that he would be continuing the closures of schools and non-life-sustaining businesses until further notice.

Cumberland, Dauphin added to Pennsylvania ‘stay-at-home’ orders

Four more counties, including Cumberland and Dauphin have been given stay at home orders until April 30, and Pennsylvania’s schools and non-life-sustaining businesses are to stay closed until further notice, Gov. Tom Wolf said during a press conference on Monday.

Residents of Carbon, Cumberland, Dauphin and Schuylkill counties will be joining the state’s 22 counties already covered by the order, which has been expanding as positive cases of COVID-19 continue to.

“If you are living in one of the 26 counties in my stay at home order, you should only leave your house if it is absolutely necessary,” Wolf said.

Wolf also announced that Pennsylvania schools and non-life-sustaining businesses will remain closed until further notice. Previously Wolf had suspended operations for the entities for two weeks.

“Our business and school closures will no longer have a set date to resume operations,” Wolf said. “I am going to leave the date indefinite. We will keep our schools and businesses as long as we need to keep them closed.”

While the stay-at-home orders were previously set to end on April 6, Wolf said that he is extending the order until April 30, to coincide with President Donald Trump’s extension of the country’s social distancing guidelines to the same date.

On Saturday, Wolf announced that Beaver, Centre and Washington counties would be added to the list.

The 26 counties now included in the Governor’s order include: Allegheny, Beaver, Berks, Bucks, Butler, Carbon, Centre, Chester, Cumberland, Dauphin, Delaware, Erie, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Northampton, Philadelphia, Pike, Schuylkill, Washington, Wayne, Westmoreland and York counties.

As of Monday afternoon, Pennsylvania’s positive cases of COVID-19 are at 4,087.

Pennsylvania tells hospitals to implement COVID-19 emergency plans today

The Pennsylvania Department of Health has given the state’s hospitals until midnight Thursday to implement their COVID-19 emergency plans, including limits on elective surgeries.

“We are working to try and stop elective surgeries and elective procedures,” said State Health Department Secretary Dr. Rachel Levine. “That’s always a decision between a patient and a doctor. Those decisions are being asked to be made.”

If the state’s hospitals agree with the department’s request, prioritizing essential surgeries would free up spaces for patients as positive cases of coronavirus surge and would limit the amount of protective equipment used, Levine said.

Penn State Health announced on Wednesday that it set its own plan in place to suspend non-essential surgeries and asked its surgeons to review their operating room schedules and cancel all elective procedures. The department has also pulled back its regulations regarding the addition of new beds, allowing any Pennsylvania hospital to add additional regular care and ICU beds as needed.

Levine warned that daily counts of the virus continue to increase rapidly, suggesting that community spread of coronavirus is already happening. She asked hospitals and health systems to prepare for a continued surge of the virus in the coming weeks.

Pa. announces first two cases of coronavirus

Gov. Tom Wolf announced two presumptive cases of coronavirus – one in Delaware County and the other in Wayne County. Tests are being sent to the Centers for Disease Control and Prevention for a second opinion.

The individuals, both adults, are currently self-quarantined in their homes.

“We anticipated this very scenario and have been preparing for Pennsylvanians to become impacted by this virus,” Wolf said. “This is not the first rapidly-spreading virus we have faced in our commonwealth and it will not be the last. We are prepared to mitigate the spread of this virus.”

Pennsylvania began testing potential samples of coronavirus last week after the CDC shipped tests to the states. The state is referring to these first two cases as “presumptive” until it can get a second opinion from the CDC.

The state has yet to say how either individual contracted the virus, but noted that the adult in Delaware County recently traveled to an area of the country where the virus has been reported.

“Further spread of this virus throughout the nation will likely occur,” said Secretary of Health Dr. Rachel Levine. “We encourage people to prepare for potential life disruptions. The same family emergency plans and kits that we use to prepare for flu or norovirus, and even snowstorms and floods, are important now. Pennsylvanians should continue to help stop the spread of viruses by washing your hands, covering coughs and sneezes, cleaning surfaces and staying home if you are sick.”

There are currently 100,000 cases of the virus worldwide, including more than 3,300 deaths. In the U.S., there have been 233 confirmed cases and 12 deaths.