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Hospitals OK’d to resume electives

Hospitals will soon be able to resume nonemergency procedures. Additionally, starting Friday, golf courses, marinas and privately owned campgrounds can open and guided fishing tours can resume, state officials announced Monday.

All will need to follow rules, including social distancing, to limit the spread of the coronavirus.

State park campgrounds will remain closed through May 14.

The state Department of Health on Monday released guidance so hospitals can resume nonemergency surgeries and procedures that the state ordered to be stopped several weeks ago to ensure the hospitals had enough resources to handle a potential surge of coronavirus-infected patients.

The guidance is in line with those of the American Hospital Association and various other national organizations, said Health Secretary Dr. Rachel Levine on the department’s daily webcast.

“I know Pennsylvanians have had to delay important elective procedures and operations,” Levine said. “(But) that was necessary to ensure that hospitals had enough capacity in case they were overwhelmed.”

Hospitals in the Philadelphia area have been “stressed” — a stress relieved with the help of resources provided by other hospitals based on mutual aid agreements — but no hospitals in the state have been overwhelmed, Levine said over the weekend.

Hospitals can now “move forward,” provided they don’t jeopardize patient safety and provided they have the resources to handle any future surge of COVID-19 patients, according to Levine.

The release of restrictions should help hospitals financially, based on findings by the Hospital and Healthsystem Association of Pennsylvania that the crisis reduced revenues by about 40 percent, largely because of the loss of the well-paying elective procedures, HAP CEO Andy Carter said earlier this month.

HAP supports the decision to release the new guidance, Carter said, as quoted in a HAP news release Monday.

“HAP and its members look forward to continuing to work together with the Wolf administration to ensure we are achieving the right balance between reducing COVID-19’s incidence and expanding access for Pennsylvania patients to essential health care services, including nonemergent surgeries and procedures,” Carter stated in the news release.

A week ago, UPMC announced that it was preparing to resume “essential,” but nonemergency care, with the help of universal testing of the patients receiving that care, as a means of ensuring safety and reassuring the patients.

“We are pleased with the guidelines announced by the state,” wrote UPMC spokeswoman Danielle Sampsell in an email. “UPMC will safely reopen for elective cases in compliance with these and CMS guidelines.”

The email didn’t mention UPMC’s unilateral advance last week.

“We are aware of the guidelines, we are well-positioned to meet them, and we will be communicating our plans around elective surgery to our patients and the community very soon,” said Conemaugh Health System spokeswoman Emily Korns. “Conemaugh will be keeping patient and staff safety at the forefront in these decisions.”

Reopening mixed

The state continues to offer mixed-signals on the controversy over the regional configuration for its phased societal and economic reopening, a reopening that will be based on “health districts” formed in the 1960s.

The configuration has become controversial because the plan calls for all counties in a region to have new-case counts under 50 per 100,000 people over the previous 14 days. Some counties that are well within that threshold — including Blair and Cambria — are grouped with others, far distant, that are well above it, promising delays in their reopenings.

Blair-based state lawmakers last week called for a revision in the state’s plan, and two Cambria County commissioners on Monday called for Cambria County to stand alone.

Blair, with a case concentration Sunday of 11, is grouped with seven other counties that are over the threshold, while Cambria, with a concentration Sunday of 6, is grouped with other counties around Pittsburgh that have experienced much more serious outbreaks.

“We’re glad to take any requests,” Levine said on her webcast. The plan is “not specifically held to regions on the map,” she said.

The state isn’t “tied to any arbitrary definition of county or region,” Gov. Tom Wolf said in a teleconference with Lt. Gov. John Fetterman principally dedicated to a Fetterman-led task force to investigate inequities in health care.

And yet, when asked later in the webcast why the state doesn’t phase out the restrictions like it phased them in — county-by-county — Levine said counties are in regions and that reopening would not be based only on counties.

Later, after the webcast, a department spokesman reiterated that the health districts would remain the basis for the plan.

“The Wolf administration felt (the district map) is the most useful for handling,” the spokeswoman wrote.

“(Still) we don’t want to emphasize the metric too much,” Levine said during the webcast.

In addition to the threshold concentration of recent infections in a region, the department will also consider a region’s capacity for handling an outbreak and its capacity for expanded testing, case investigation and contact tracing, Levine said.

The state is working on developing capacity for the contact tracing, according to Levine.

The department’s community health nurses will take the lead, but the department will also be relying on county and municipal health departments and on hospital and health systems — Geisinger in particular — plus volunteers and new department hirees, Levine said.

The department is working with The MITRE Corp. on the tracing plans, she said.

With MITRE’s Sara Alert, individuals can “enter their symptoms into the tool daily, providing public health officials with real-time insights,” according to the corporation website.

“By tracking potential cases, state and local public health departments can rapidly and safely arrange health care and prevent further spread of the infection,” the website states.

The department is also hoping to take advantage of a partnership between Apple and Google, she said.

Pennsylvania is also talking to other states about the contact tracing, Wolf said.

Maintaining privacy is one of the main concerns, according to the governor.

Disparity concerns

The state is urging medical professionals to fulfill a COVID-19 reporting obligation that most have ignored — adding information on the race of patients.

The information is missing on 70 percent of the reports received by the Department of Health, Wolf and Fetterman said.

Reportedly, people in minority groups, especially black people, have been hurt disproportionately by the pandemic, but “we lack the statistics needed to see the severity,” Wolf said.

Better information would enable the state to target efforts to ensure that everyone has the same level of access to testing and treatment, Wolf said.

The state wants people in minority communities to get better information about testing locations and hours and doesn’t want a lack of vehicles, prior medical care or relationships with a doctor to be obstacles to testing and treatment, according to Wolf and Fetterman.

The additional information will help the state to identify hard-to-detect cases, according to the news release.

The state additionally hopes that something “durable” will come out of the effort, “when we’re past this crisis,” Fetterman said.

Mirror Staff Writer William Kibler is at 949-7038.

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