On May 14, the PCMS Public Health Committee held a Q&A regarding COVID-19. You can listen to the session below, with a transcript written underneath.
Eileen Ryan (PCMS): Hello, can everyone hear me?
Dr. Walter Tsou: Yes.
Jessica Caum (PDPH): Yeah.
E: Hey, thank you, I appreciate it very much. We’re going to open up the meeting with Jessica Caum who is going to give us an update. She is Program Manager of Bioterrorism and Public Health Preparedness, Philadelphia Department of Health and Jessica, it’s all yours.
J: Thank you Eileen. Hi everyone, thanks for having me again this week. I do have the list of questions that Eileen provided, so I think I’ll run down that list. I am going to start with question number five, since I think that provides a good background for the rest of the call and the question number five is: What are the latest statistics as well as mortality? I’ll give you the update from yesterday. As of yesterday, there’s been 63,253 tests conducted overall. Of those tests, 18,779 were positive, so that’s our case number. And then there have been 986 deaths attributed to COVID-19. So those are the updates as of yesterday. And for everyone’s awareness on this call, this is data that’s published on our website every day usually around 1 PM. Today’s data hasn’t been updated yet, but I think after this call I’d like to follow up with you Eileen and just provide the web address so that folks, if they’re interested, can check on this data as regularly as they’d like to and actually a few of the other questions that were submitted were also addressed with some of the data that’s being reported on that site. I will make sure I distribute that information after today’s call.
The first question was, do we have information regarding specific zip codes where virus breakouts are happening? And yes, we do have that information and the website that I was just mentioning actually has some maps that show a couple of different ways of looking at this: by zip code, by residents—I think per cases per 10,000—and so there are a couple of different maps that you can look at that will show you by shading where the most cases seem to be occurring. So again, I think visually it’s probably the best way to look at it because you can really get a better sense of the geographic distribution. There are also some other data sets that are available on that site as well that you can look into a little bit further for anyone who’s interested.
The second question is, can you talk a little bit more about the plan for contact tracing? There are a couple questions here about contact tracing so I think I’ll just give you an update about where we are right now, and where that is right now is that we do have a new staff member who has come on board to lead the contact tracing unit. She actually is a veteran employee of the city and has come back to lead this group. So that group is in the process of making some decisions about the technology that will be used, what the staffing structure will be, what the staffing cadres will be, so we have a lot of offers from volunteers, students and other organizations who would like to participate in this and so all of that is ongoing right now.
I understand some decisions were made this week as to what technology will be used and I think some things are still being worked out with our IT department to protect security and all that, so I don’t want to get into too many details here just in case it changes. But I do think the group has settled on the technology that they’ll be using and now there is a plan in place to do some rapid hiring to bring some additional supervisors on board who will then organize these different groups of contact tracers. I would expect that physicians will be appearing and we’ll be doing some rapid hiring. So that is the plan right now.
We still are pretty focused on outbreak management given the number of cases that we’re still seeing per day. Which is variable; since yesterday it was around 300 something, I think today it was a little bit higher than that. So, we’re definitely still seeing fewer cases than we were seeing a few weeks ago but it’s still a substantial number of cases per day. We still are pretty focused on outbreak management and then contact tracing in those higher risk settings like among healthcare workers. But as the number of cases go down, we will become much more aggressive in contact tracing. The current focus right now is just to get organized and to get enough staff and volunteers involved who will be able to assist with that effort.
E: Jessica, hi, it’s Eileen again. Don’t want to put you on the spot, but I guess depending on the amount of individuals in the city, yesterday the mayor and Dr. Farley talked about and tried to explain—because it is very difficult to try to explain—just where do we have to be in order to try to open up the city. And so, it’s a twofold question. Are they discussing, or do you have any idea about the number of people that we will need to hire as contact tracers in order to get the job done, and maybe you don’t even have a number yet? And do you have the information regarding how many cases we need to see over a fourteen-day span in order for us to get into a better place to open? So that’s pretty much a two-fold question to you.
J: Okay, so I think that also leads us into question number four, about the criteria for the city reopening, or going to the yellow phase. This is under discussion right now, there’s been a lot of communication between the city and the governor’s office about what this means for Philadelphia and I don’t think this has been fully realized yet as to exactly what that criteria needs to be. I’ve heard the number fifty cases over a fourteen-day period. I don’t know if that’s exactly what’s been settled on but I have seen that in some of the correspondence and some of the documentation and guidance that’s been circulated. I think this is an ongoing discussion and so I’m not able to say much more about this today. It’s something that’s being worked out at the highest levels of the executive leadership to make these decisions for what’s appropriate for the city.
But as to the question about the number of staff it will take to do contact tracing, I think we’re talking probably, potentially about hundreds of people. Will they all be paid or hired staff? Possibly not. There have been a lot of conversations with schools, some of our academic institutions, as well as other volunteer organizations, as to how they might contribute to this effort. We’re certainly not going to be hiring hundreds of people, but I think what’s being explored right now is the potential for being able to utilize some of these other potential staffing resources in a voluntary capacity in order to really expand our capacity. So, I don’t know exactly the number of people who will be formally hired to do this. I think the focus right now is really on hiring supervisors who will be able to oversee different units within contact tracing. I don’t have an exact number but I think that’s where we’re headed.
E: That’s great, that’s a great answer but I just want everyone on this phone call to have a better understanding of where we are today and that means we certainly still have a way to go before we can get to that fifty or fifty-five per day in Philadelphia over a fourteen day period of cases. Do you agree?
J: A lot more needs to happen before it is going to be safe to reopen the city and to get into that yellow phase.
E: Right. Thank you.
J: Headed in the right direction certainly, but a lot more still has to happen before it’s safe.
E: Okay. Thank you. Good.
J: Question number three I think also fits in here and that was, should everyone who works or lives in Philadelphia be tested before reopening the city? And I would say, I don’t think that would be the department’s position. I think as everyone is aware, there are a lot of limitations still with testing, as well as availability and a negative test on one day doesn’t necessarily mean something for two or three days from now. People could be exposed, become positive, and so I don’t know that that would really help us. What we’re continuing to do, and the expanded criteria to do this is to really focus on those folks who are symptomatic, so we have expanded the criteria to be broader than it was previously as more testing supplies become available, as lab capacity is increased. I just don’t think there would ever be a position where we would want to test everyone in Philadelphia, but who knows, that could change, I could be wrong. But I don’t think we’re there yet.
But getting then into question number six was about the city’s expansion of testing, and is it because there are more testing kits or more labs? And I think it’s a combination of a lot of things. One is that testing has just become more available because there are more supplies available to the commercial labs. Which means that a lot of other sites have been able to do testing so, as you may know, over the last several weeks, a lot of the FQHCs have been offering expanded testing and I think they get some help from the commercial labs here. But we’re also able to supply some materials in order to be able to do that and so I think that having more supplies, having more lab capacity certainly enables greater expansion of testing and certainly enables more sites to come online and be able to do that. So, I think we’ve seen a lot of progress in the last few weeks, but again there’s a lot more to do.
We still need to do more expansion, and I’m not sure if everyone on the call would be aware of this, and Eileen I can send this out to you after the call, but we actually have put out a request for proposal earlier this week looking for organizations that might be interested and capable of doing a community-based testing program. And so there are stipulations in the RFP that have to do with the ability to bill for insurance, for testing and to do some other administrative tasks, but that was posted on the city’s website a few days ago and I can send the RFP around if that would be of interest to circulate among your networks. But we definitely are looking for other ways to expand testing and would like to be able to support other community-based organizations to expand testing and particularly to get to into some areas of the city where geographically testing is less accessible. We’re looking forward to seeing some applications there and hopefully being able to be supportive to organizations that want to do that work. At the moment there’s not a dedicated funding stream for that but we are optimistic that there will be and hopefully our expectations will be met.
So, there was another question about our position on sampling asymptomatic people to understand prevalence. I assume that this is speaking to zero prevalence studies, and I think there is interest now in doing some serology studies to better understand how prevalent—we haven’t formalized anything yet, I think some of our academic institutions are also looking into this, and I think we do have an interest here but haven’t really settled on a methodology for doing this. But it could be very helpful in understanding where the disease has been and I think it could be a useful tool for us, but we’re not quite there yet and hopefully by the next time we talk I’ll have some more information about where that might be headed.
E: Jessica, on that same line I just received a question that I’m not sure you could answer, but at least this is for next time. It’s very similar: What is the thought about doing antibody test on staff and patients who have not been diagnosed with the disease as a way to determine the exposure and possible protective status for going back into society and to work? So, I’ll send you that one, do you want to make any comment regarding that question? We can certainly leave it for next time.
J: I would say the interest for serology right now would definitely be in, possibly among healthcare workers, I would say also in congregate facilities so, long term care facilities, perhaps shelters, so better understanding who has been exposed or who might have had the disease. I think there still isn’t great understanding about whether or not having had the disease conveys long term immunity or short-term immunity. There are a lot of question about that, what it actually means, that we’d like to learn more about, but certainly I think that serology testing could be a very useful tool in some of those settings where there have been extensive outbreaks and understanding who might have some protection and can safely work would be a very useful thing to know. So, I hope that answers the question.
E: Thank you.
J: Okay, there was also a related question about the current policy for testing everyone at nursing homes, prisons, other confined spaces. There definitely is an interest in expanding testing in some of these congregate types of settings where we know that there is high likelihood of exposure, where we’ve seen a lot of outbreaks. I think the state health department has issued some guidance earlier this week about universal testing in nursing homes. Depending on who you’re talking to, it’s not entirely clear if that’s a recommendation or a mandate, and I think some of the nursing homes definitely have questions about this. I think there definitely is interest in really focusing testing on these places where they’re having these outbreaks and I think there’s probably more to come on that, but I wouldn’t say there’s a defined policy yet that we are able to fully support.
The other issue is that universal testing in certain types of facilities could be challenging given supplies. Even though supplies have improved, suddenly there are policies that mandate testing, let’s say among long term care facilities, residents and staff, and if that’s something that has to be conducted on a weekly, or whatever the regular basis is, that will quickly deplete supplies. We’re still in a situation where, we’re in a better place for supplies, certainly the commercial labs are, but our ability to get supplies in the health department is still very challenging. So, I think there is another consideration there as to using the testing in a way that can reduce risk or reduce exposure or help to make decisions about cohorting or other infection control policies. And if that’s a good reason, then to use testing in that manner. A lot of our physicians right now are thinking through this and again, more to come on this topic.
J: Question number nine is about information if someone wants to take a course to be a contact tracer. What I understand is that ASTHO has a good general course about what it entails to be a contact tracer and I can send information about that course if that’s something that anybody wants to disseminate further.
E: Great, in case the question is asked, that’s terrific, thank you.
J: We have not created our own course for this yet, and I haven’t seen this ASTHO course for myself but I’ve heard it’s good and comprehensive and would give anyone a good background, baseline for contact tracing. So, I think we already discussed hiring of contact tracers. Question eleven is about recommendations for how long a close contact needs to be quarantined before they can return to work. We do have some guidance for essential businesses and organizations that have been posted on our website again. Typically, what our recommendation is would be that employees who are household contacts of the confirmed case and don’t become ill should stay at home and self-isolate for fourteen days after isolation has been discontinued for the ill household member. It probably would be most beneficial if I just sent out this guidance around because there are a lot of nuances here and there’s some variations so it’s pretty detailed, it’s probably about six pages long and so I’d like to just circulate that document for anyone who’s interested in taking a closer look at that.
Okay, what protections are being implemented in health centers, urgent care centers, and are you expanding testing at these locations? So yes, we have expanded testing at the federally qualified health centers. Urgent care centers have also been able to expand testing and now, not all of them but some in particular are offering testing. The city will actually be putting a map up, I hope by the end of the week, that will indicate all of the testing centers that are available throughout the city and quite a few of them now are urgent health centers. So that map will be, I’m hoping, available by the end of this week. That will provide a lot of information as to location, whether or not a telehealth appointment is required in advance, what the phone number is to call, if there are any restrictions on who can be tested. I think that will be a useful tool to be able to gauge the availability of testing and the differences in testing that are happening in different places.
As far as protections, I can’t speak globally to every location, but for the FQHCs that we’ve been working with to expand testing, we’ve been providing PPEs to locations that need it. We have a pretty standard PPE that we offer for anyone who’s conducting testing and that’s what we’ve been offering to any of the organizations that need that assistance. I assume that masking, if there are patients being seen, that masking is still in place. I think a lot of locations, from what I understand, among health centers, and I think this is true of urgent care centers also, are really encouraging the telehealth visit, and trying to conduct a lot of business that way. So that should really help to minimize exposure that might be happening in those settings, and then of course, as I said for the testing sites that are FQHCs, we’re providing PPE to meet whatever their needs are.
J: The next question is about protections that are being implemented at the Holiday Inn quarantine location. Not quite sure what the word protections refers to, I assume that’s also for PPE and some other strategies that have been put into place there. I can tell you that there is a pretty extensive intake process for anyone who is being referred to the Holiday Inn. That requires a medical chart review that the health department does, and there is a lot of background that happens before patients are able to be referred there. For the staff who are working there, they are of course in PPE if they are in any areas where they’re potentially going to come into contact with someone who’s been referred. Referrals at the Holiday Inn of course, that’s for people who either have already tested positive or are there pending testing results. So we have been very cautious about providing the appropriate PPE, training staff to use it depending on what area they’re working in, and then there has been some other measures in place to minimize contact between anyone who is there waiting for a test result or has already tested positive, just to minimize any exposure that’s happening.
And the last question I have on the list is, does the health department stock or allocate PPE and remdesivir? And the answer to the PPE is, yes we do have a modest supply of PPE, most of it is going out to FQHCs and to long term care facilities who we have also been providing PPE to as we understand that that’s a severe need among a lot of the long term care facilities. We’ve also been distributing PPE to our other congregate settings like shelters, and have been working on distribution to some of the other sites in Philadelphia that might also benefit from PPE: places like inpatient behavioral health facilities, personal care homes. We’ve been working along several lines of effort over the last six weeks or so to allocate the PPE as we get it, make sure that it’s getting out, make sure that it’s going to places that really need it. We’ve been doing these global distributions in concert with the office of emergency management, and then of course through our own call center and our own interactions with long term care facilities or other places where we’re also fulfilling urgent needs for PPE.
Unfortunately, I think I said this on the last call and I’ll just say this again, gowns are still impossible to get. We have not received any new gowns since I last said that we were experiencing a severe shortage of gowns, although my understanding is that there were deliveries that were happening through FEMA at the end of last week and into the weekend to allocate a good amount of PPE including gowns to a lot of the long term care facilities. That was really good to hear as we know that they have been struggling with their PPE supplies.
For remdesivir, no we are not stocking that but my understanding is that many of the acute care facilities have recently received a supply of it across Philadelphia and so they should have it in their supply, and I believe that also is coming from FEMA and I would expect that maybe there will be more to come after that. I don’t have a lot more information about that, except that I understand that this distribution was happening over the last couple of days and so hopefully those acute care facilities have received those supplies. So I think that’s everything I have on my question list. I don’t know if there was anything that Rona wanted to talk about related to some inquiries about mental health and behavioral health support for our frontline workers?
Rona Cooper, MPH: Yeah, Eileen and Walter and I had briefly discussed that. I did send that list of resources that I’d accumulated that are specific to healthcare workers. I have not vetted the portion that has to do with direct teletherapy. However, what I can say is that it was offered free to healthcare providers so I would call your attention to that, but I can’t be responsible necessarily for quality or ongoing work with therapists. However, the resource is there. And then the other portions of that document really talk a lot about self-care in this environment, so there’s that. And then as you reminded me, the mental health initiative that Mayor Kenney had announced was the collaboration with Independence Blue Cross, and there is a website, and Eileen I hope you will push out the address of that website.
E: Sure, yeah, I’ll do that commercial break right now. If everyone has paper and pencil, it’s an excellent, excellent website that deals with everything that’s going on with mental health and wellbeing and the initiative, as she had said is called Mindful Together and it’s brand new, it was just announced Monday as Rona said. So, the website you should go to is: healthymindsphilly.org, and the other website, same thing, Mindful Together, mindphltogether.com. If you go to both of those websites, you will get all of the information you need on how to get these free services. Thank you so much Rona. Again, I’ll repeat it: healthymindsphilly.org or mindphltogether.com. Thanks Rona.
E: Dr. Walter Tsou, the chair of the Public Health Committee is on and Jessica, can you still stay on with us for a couple minutes?
J: I have about one minute left before I need to get onto another call.
E: Okay, gotcha. We completely understand and want to be respectful of your time, that’s for sure. We thank you so much. If anyone on the call right now has a quick question for Jessica, please unmute your phone. Dr. Tsou, are you there?
W: Yeah, I’m here, and I also want to thank Jessica for her time and I want to give credit to Eileen for organizing this, and I want to know if there’s any other questions from anybody else. I think Jessica has to go right now, so we should let her go.
J: Yeah, sorry about that, I do need to jump on another call, but just for closing, I will follow up with you Eileen to provide the website addresses for some of the data that I referred to and I’ll provide information about that after training.
E: That’s terrific Jessica, I’ll talk to you real soon. Thank you again so much. We’re still on the call everyone, if everyone is still on. We’re still here. Thank you, Jessica.
J: Okay, thank you, bye-bye.
E: Does anyone have any questions for Dr. Walter Tsou or myself, that is on this call right now? Are there any issues that need to be addressed at our next meeting? We will be having another update just as this for you to submit your questions. We appreciate it, but Dr. Walter Tsou and I are very happy to take any of your thoughts or concerns at this time.
W: Well sounds good, like nobody’s there.
E: I know, did we lose everyone? Ha ha. If you wish to adjourn, Dr. Tsou, that’s fine by me.
W: Did I hear someone ask a question? Well if not, I want to thank you Eileen for all your time for helping set everything up and we’ll have more of these calls again with the health department. I found this very informative, personally. I also want to thank Rona Cooper, if she’s still there, for helping set this up on behalf of the health department. So, thank you all for joining us today, and I guess we are adjourned.
E: Thank you, we will be in touch with you all. Thank you again.