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Gadfly has described himself as Maddow’d in respect to coronavirus in nursing homes and other senior-care facilities.

Rachel Maddow was like an early warning sensor beeping the need to more carefully scrutinize conditions in such places accounting for almost 50% of deaths by virus.

Maddow has transitioned a bit as more attention has been focused on these senior sites where “death is waiting to happen.”

See, for instance, this article in today’s Morning Call: Peter Hall, “Auditor general calls for greater transparency, more testing for nursing home coronavirus cases.”

She’s transitioned to focus on jails and food-processing plants.

Death is also waiting to happen in food-processing plants.

See this brutal article in the Wednesday Philadelphia Inquirer provided to Gadfly by Councilwoman Olga Negron: DEADLY RIDE: Pa. poultry workers traveling to their plant in a crowded van were stricken by the virus.

Eight people crammed in a van riding 30 miles to and from work in a plant where people work close together — one passenger dead, the rest sick, all fearful of losing their jobs.

Brutal.

“I am no one of importance,” one says, in regard to what is being done for worker safety.

Heart-wrenching.

Councilwoman Negron is involved through her “day job” because these workers are Latino.

In fact, 35% of the workers in the food-processing industry nation-wide are Latino.

Essential workers.

Councilwoman Negron through her “day job” is in direct contact with the family that lost their dad (Arismendi Bera), and every day she fields phone calls from two or three Latino workers from that plant. Even though the plant is not in Bethlehem, COVID-19 positive workers are sharing her firm’s number, seeking a place to vent their fears to someone in their own language. They need someone to talk to.

It’s easy to say that except for the soul-wearying work performed by day-jobber Negron that this is not a story about Bethlehem.

But we know from her April 8 post that she has been busy fielding calls from local Hispanic/Latinos as well.

Bethlehem is 30% Hispanic/Latino, yet this community accounts for 44% of the cases tested positive for the virus.

Which leads Gadfly — who, of course, knows nothing of such Urban Administration matters — to wonder whether a city with such a substantial block should not have some formal liaison within city government.

The Mayor does have a Latino Advisory Committee.

Why is such liaison left to the Negrons and the non-profits like the Hispanic Center?

But maybe it is best so.

Gadfly just wonders.

“I am no one of importance,” haunts him.

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Pennsylvania Plan for Phased Re-Opening
short version

Process to Reopen Pennsylvania
long version

County of Northampton COVID-19 Information Dashboard

Bethlehem Health Bureau Coronavirus Page
click especially “City of Bethlehem COVID-19 Data”

Covid-19 Dashboard for City of Bethlehem/Lehigh Valley 

Where coronavirus is in Pennsylvania
county and zip code

———–

Important charts by Steve Thode in Bernie O’Hare’s Lehigh Valley Ramblings this morning:

The Big Northeast Might Be Sidelined by Governor Tom Wolf
for Some Time

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Lots of national news on reopening on Friday and now over the weekend.

So using some of the resources in the last post, Gadfly is trying to get a grip on the Pennsylvania reopening plan and how it might affect us.

The following in brief. Consult the resources in the last post to fill in details.

The red-yellow-green plan:

The state will utilize a three-phase matrix to determine when counties and/or regions are ready to begin easing some restrictions on work, congregate settings, and social interactions.

(See Ford Turner, “Wolf says Pennsylvania will use a three-phase approach to emerge from shadow of coronavirus starting May 8.” Morning Call, April 22, 2020.)

The entire state is in the red phase now.

The red phase, which currently applies to the whole state, has the sole purpose of minimizing the spread of COVID-19 through strict social distancing, non-life sustaining business, school closures, and building safety protocols.

As regions or counties move into the yellow phase, some restrictions on work and social interaction will ease while others, such as closures of schools, gyms, and other indoor recreation centers, as well as limitations around large gatherings, remain in place. For example, retail locations will be able to open with forthcoming guidance in place that is substantially similar to the worker safety and building safety order. Otherwise retail will be able to allow for curbside pickup. The purpose of this phase is to begin to power back up the economy while keeping a close eye on the public health data to ensure the spread of disease remains contained to the greatest extent possible.

The green phase eases most restrictions by lifting the stay at home and business closure orders to allow the economy to strategically reopen while continuing to prioritize public health. While this phase will facilitate a return to a “new normal,” it will be equally important to continue to monitor public health indicators and adjust orders and restrictions as necessary to ensure the spread of disease remains at a minimum.

What’s the yellow phase look like?

We’re in the red phase now. Here’s the yellow phase:

• All businesses must follow CDC and DOH guidance for social distancing and cleaning
• Monitor public health indicators, adjust orders and restrictions as necessary

How do we get out of “the red”?

The state is broken into regions. A key metric, but not the only metric for getting out of the red is for a region to have a coronavirus case rate of 50 or fewer per 100,000 residents over stretch of 14 days.

On last Wednesday, Lehigh County’s rate was 643 per 100,000 per the Morning Call.

We are in the Northeast region with such hot spots as Hazelton and Allentown.

Our health director already warned us at Tuesday’s City Council meeting that our reopening fate will be tied to such currently much hotter areas. Note, for instance, this article in this morning’s newspaper:

Andrew Wagaman, “Coronavirus infection rate appears higher in Allentown than Philly and other cities. But why?.” Morning Call, April 24, 2020.

That saying that has “marathon” and “sprint” in it comes to mind.

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Pennsylvania Plan for Phased Re-Opening
short version

Process to Reopen Pennsylvania
long version

County of Northampton COVID-19 Information Dashboard

Bethlehem Health Bureau Coronavirus Page
click especially “City of Bethlehem COVID-19 Data”

Covid-19 Dashboard for City of Bethlehem/Lehigh Valley 

Where coronavirus is in Pennsylvania
county and zip code
————-

Gadfly trying to get a grip on all we need to get a grip on.

Trying to get it all in one spot for easy reference.

Above are links to several web sites with important information as well as numbers, statistics, graphs.

These sites are regularly updated.

So we should refer regularly to such sites for current information.

Let Gadfly know about additions to this list.

Now Gadfly knows 9 uses of the comma but not much about numbers, statistics, and graphs.

What do you see? What should we be keying on? What should we be thinking about?

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Now for some good news about senior facilities!
Click link below the image for video.

The Chandler Estate, 1569 Teels Rd, Pen Argyl, Northampton Co.

Joy Howe, “Pen Argyl personal care home has managed to stay entirely coronavirus free.” WFMZ, April 24, 2020.

PEN ARGYL, Pa. – About six weeks ago, The Chandler Estate in Pen Argyl first got wind that something bad might be coming.

“Immediately we put things into effect,” says Jamie Lemon, director of marketing and admissions, explaining that when the CDC first made recommendations, they went all in to fall in line.

The small personal care home and senior living community shut its doors to everyone, except for their staff of about 30.

Loved ones weren’t allowed to visit inside anymore, and if they dropped off packages, they were disinfected and then set aside for a couple of hours, just in case.

The employees set a benchmark for themselves.

Now 42 days later, not one case of the coronavirus here so far.

Followers know that Gadfly has been focusing on the coronavirus situation in nursing homes. Rachel Maddow last night suggested that local communities support their senior facilities by contacting them to see what help they might need — masks, for instance. A good idea.

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The article below indicates that there are 418 long-term care facilities in the state. Can the state consultant ECRI that we wrote about earlier have much impact on such a great number? The Northampton County long-term care facility infection rate is more than double Lehigh County’s. More than 30 nursing homes and assisted living facilities in the Lehigh Valley have been affected by the coronavirus, but the state Health Department doesn’t list cases by facility. 37 people have died at long-term care facilities in Lehigh County; Northampton County would not release information about coronavirus deaths in its long-term care facilities.

Eugene Tauber, Peter Hall and Anthony Salamone, “New data: Nursing home residents are 7 to 15 times more likely to get coronavirus than others in the Lehigh Valley.”  Morning Call, April 24, 2020.

Nursing home and assisted living residents in the Lehigh Valley and other parts of Pennsylvania are many times more likely to be infected with coronavirus than the rest of the population, an analysis of state Health Department data shows.

In Lehigh County, residents of long-term care facilities were more than seven times as likely to be infected. In Northampton County, the infection rate was more than double Lehigh’s, at 14.5 times the infection rate in other residents.

David Grabowski, a Harvard Medical School expert on aging and long-term care issues, said it’s no surprise that coronavirus infection rates are higher among nursing home and assisted living residents, given the ease of transmission that close quarters with shared living spaces allows.

He cautioned that the higher rates could be a result of more testing among nursing home patients, but said there’s also anecdotal evidence of residents who have died of coronavirus-like symptoms who were never tested.

Nonetheless, Grabowski said the data supports the alarms raised by public health officials on the need for greater efforts to control infections in long-term care facilities.

More than 30 nursing homes and assisted living facilities in the Lehigh Valley have been affected by the coronavirus. Although the state Health Department doesn’t list cases by facility, two operators have acknowledged large numbers of cases in their facilities.

The Lehigh County coroner’s office said that as of noon Friday, 37 people have died at long-term care facilities. Northampton County Coroner Zachary Lysek would not release information about coronavirus deaths in long-term care facilities.

HCR ManorCare Inc., which owns six skilled nursing facilities in the Lehigh Valley, said Friday it had 166 people infected in four of its facilities, up from 108 earlier this week. They included four at ManorCare in Salisbury Township, which the company had not previously reported.

In addition, cases have risen at ManorCare facilities in Palmer Township (89) and at 2021 Westgate Drive, Bethlehem (45). Some 28 people have been listed as positive at a ManorCare in Bethlehem Township. The company is not releasing the number of deaths caused by the virus, said spokeswoman Julie Beckert.

She said not all deaths at ManorCare can be directly linked to the virus, since residents typically have significant underlying health issues or may be in hospice.

With the state preparing to reopen regions with comparatively low infection rates, Sen. Pat Toomey, R-Pa., this week said reopening a county or region should not be delayed if most of the cases are contained at long-term care facilities, arguing that those outbreaks require extra care for residents but do not endanger the broader community.

But Pennsylvania Health Secretary Dr. Rachel Levine said Friday that long-term care facilities will be included in the counts of new cases to determine when to relax mitigation measures. Gov. Tom Wolf and Levine announced this week that the state’s business and social restrictions will be eased only when there are fewer than 50 new cases per 100,000 people in a region over a 14-day period. “Those long-term care living facilities do exist within a county, and the staff go back and forth,” Levine said.

Beckert, the ManorCare spokeswoman, said the company has been moving toward testing throughout a facility when possible and encouraged other facilities to do the same. The company has found residents who test positive without showing symptoms who are then kept in isolation, she said.

Others in the long-term care industry said testing remains scarce. “We feel like we’ve been ignored,” Parkinson said. “Certainly now that the emphasis has gone away from hospitals to where the real battle is taking place in nursing homes, we should be at a priority level one.”

Greater transparency is necessary to understand the full scope of the coronavirus’ impact on nursing homes, he said, adding that many coronavirus cases that begin in nursing homes aren’t being correctly attributed.

The 37 deaths in Lehigh County does not include residents who died after being transferred to a hospital, Coroner Eric D. Minnich said.

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Nursing homes and etcetera still on Gadfly’s mind.

At the Friday April 17 video conference by City staff, we learned that the City was facilitating contact — acting as “liaison” — between our nursing homes and a consultant hired by the state.

That consultant was ECRI.

At the April 21 City Council meeting we learned that there were outbreaks at 3 sites but that one site had transferred the affected residents, so that two sites were the current focus. And we learned that one of those sites had a “virtual call” with ECRI on April 21 and that the City was working to connect the other site as well as the non-affected sites with ECRI.

Gadfly would have liked to have numbers so that he could gauge the severity of the outbreaks.

The Maddow’d Gadfly has said previously that the liaison/facilitator role seemed a bit too “hands-off” to him, as if, and he hopes he is mistaken here, the City was handing off responsibility to the individual nursing homes to contact the consultant. Call ’em if you need ’em.

The press release below doesn’t especially make him feel any better:

1) “ECRI’s experienced patient safety and infection control staff will be on-call twelve hours a day, weekdays”: ECRI is dealing with all the nursing homes in the state. Are they staffed for such a circumstance? They aren’t available on weekends? Will a “Jake from State Farm” always be available in a pinch?

2) “As part of its mission to advance effective, evidence-based healthcare globally, ECRI developed a public-access COVID-19 Resource Center”: Their “selling point” is a resource center. This is a generalized resource and what Gadfly would call a “passive” resource. It’s there for you to use if you want it and if you know what you are looking for. It doesn’t feel an “active” enough resource to Gadfly. Shouldn’t somebody be visiting/inspecting these sites?

“Consultant” doesn’t seem what is needed. Gadfly realizes that most of these sites are private businesses, but in this pandemic it feels like someone with power should be actively investigating the conditions at these sites that are accounting for 50% of the deaths from the virus.

———-

PLYMOUTH MEETING, Pa., April 8, 2020 /PRNewswire/ — Pennsylvania Governor Tom Wolf announced that the Department of Health signed a contract this week with ECRI, an independent nonprofit organization improving the safety, quality, and cost-effectiveness of care across all healthcare settings worldwide, to provide COVID-19 response for long-term care facilities.

“It’s imperative that the state do all that we can to protect all Pennsylvanians, but especially those most vulnerable to COVID-19, and so the Department of Health made the right decision to enlist experts in the field of infection control to help protect those in the state’s long-term care facilities,” said Governor Wolf.

With decades of experience in assisting healthcare providers during outbreaks, ECRI will provide individualized infection control and prevention assistance to long-term care facilities in Pennsylvania as the pandemic continues. ECRI’s experienced patient safety and infection control staff will be on-call twelve hours a day, weekdays. They will coordinate with the Department Operations Center who is currently providing support to those working in coronavirus response.

ECRI will also help the department evaluate personal protective equipment (PPE) and research different ways to maximize available resources.

“ECRI is focused on keeping residents, patients, and healthcare workers safe as the coronavirus pandemic spreads.  Vulnerable populations, like long-term care residents, are increasingly in harm’s way,” says Marcus Schabacker, MD, PhD, president and CEO, ECRI.

For decades, ECRI has worked closely with aging care communities in Pennsylvania and throughout the nation on emergency preparedness, disaster planning, and resident safety.

As part of its mission to advance effective, evidence-based healthcare globally, ECRI developed a public-access COVID-19 Resource Center to help hospitals, ambulatory care, and aging care facilities protect healthcare workers, residents, and patients. The site includes infection control guidance, medical device guidance on PPE, ventilators, and infusion therapies, and clinical evidence assessments on coronavirus-related treatments, therapies, and interventions.

For more information about ECRI, or to request support, visit www.ecri.org, call (610) 825-6000, or e-mail clientservices@ecri.org.

Social Sharing

News: @PAHealthDept signs contract w/ @ECRI_Org to support #ltc facilities w/ #COVID-19 response

About ECRI
ECRI is an independent, nonprofit organization improving the safety, quality, and cost-effectiveness of care across all healthcare settings. With a focus on patient safety, evidence-based medicine, and health technology decision solutions, ECRI is respected and trusted by healthcare leaders and agencies worldwide. Over the past fifty years, ECRI has built its reputation on integrity and disciplined rigor, with an unwavering commitment to independence and strict conflict-of-interest rules.

ECRI is the only organization worldwide to conduct independent medical device evaluations, with labs located in North America and Asia Pacific. ECRI is designated an Evidence-based Practice Center by the U.S. Agency for Healthcare Research and Quality and a federally certified Patient Safety Organization by the U.S. Department of Health and Human Services. In 2020, The Institute for Safe Medication Practices (ISMP) formally became an ECRI Affiliate.

Visit www.ecri.org and follow @ECRI_Org to learn more.

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PRESS RELEASE: City of Bethlehem Health Department April 22, 2020

Mayor Bob Donchez today announced that the City of Bethlehem has been actively working with community partners to ensure that the needs of vulnerable populations, such as the homeless, are addressed during the COVID-19 pandemic. The City recently received additional funding from the Pennsylvania Department of Health to support prevention, preparation and response activities related to COVID-19.

As part of the overall plan, the City’s collaboration with New Bethany Ministries and Comfort Suites Bethlehem will provide hotel rooms for Bethlehem homeless individuals and families in an effort to control the spread of COVID-19 in the community. During this time, New Bethany Ministries will operate an additional transitional housing program to ensure that these families and individuals have a space to socially distance and self-quarantine as well as have access to consistent showers, hand washing and bathroom facilities.

A key goal of this initiative is to not only provide immediate housing to prevent the spread of COVID-19 in Bethlehem, but provide a more stable housing solution for these families and individuals after the pandemic as well.

“It is during trying times like these that we will be judged by how we care for the most vulnerable among us,” said Mayor Donchez. “Helping individuals and families with transitional housing is a priority to ensuring this virus doesn’t spread throughout our most vulnerable populations.”

“The Comfort Suites Bethlehem has always been a strong supporter of the community and we are glad to be able to offer our assistance during this crisis,” stated Dave Urban, General Manager.

If you are a resident of Bethlehem and in need of this service, please contact New Bethany Ministries at (610) 691-5602 ext. 205 for evaluation and referral.

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Tip o’ the hat to Bernie O’Hare for source information.

BLOUGH HEALTH CARE CENTER INC

CEDARBROOK FOUNTAIN HILL ANNEX

COUNTRY MEADOWS NURSING CENTER OF BETHLEHEM

GOOD SHEPHERD HOME-BETHLEHEM

HOLY FAMILY MANOR

KIRKLAND VILLAGE

MANORCARE HEALTH SERVICES-BETHLEHEM (2021)

MANORCARE HEALTH SERVICES-BETHLEHEM (2029)

MORAVIAN VILLAGE OF BETHLEHEM

NORTHAMPTON COUNTY-GRACEDALE

Did Gadfly miss anyone?

Know anything about what’s going on? Any news to share?

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Tip o’ the hat to Bernie O’Hare for source information.

In asking if we should be looking more closely into conditions in nursing homes and senior care facilities, Gadfly does not mean to suspect wrongdoing.

Neither does Maddow.

Neither does Gov. Cuomo, whom I just heard speak on this issue at his daily press briefing.

There may be some problem sites, but the basic situation now is that all such facilities are not prepared for a pandemic.

And they need help.

There should be no “blame game” going on.

The reason for looking into conditions is to see what help they need.

For this is our most vulnerable population, and “deaths are waiting to happen.”

There may be no serious problems now, but it will pay to be prepared.

Northampton County is tracking COVID-19 at all county nursing homes here.

On the menu under the top graph, click on “Nursing Home Data”:

• 295 cases among residents
• 71 cases among employees
• 23 deaths
• 23 deaths is 8% of the resident cases
• 23 deaths is 6% of total number of deaths in nursing homes

Look at the box for “COVID-19 related deaths” on the bottom right.

45 total deaths in Northampton County.

23 deaths in nursing homes = 50% of total number of deaths in Northampton County.

Just as Maddow said.

Which means aid to nursing homes should be an articulated high priority.

Is the City doing enough by what sounded like in the press conferences as simply acting as liaison and kind of handing off to a consulting firm provided by the state?

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Followers know that Gadfly has been “Maddow’d” on the subject of coronavirus and nursing homes (see coronavirus under Topics on the sidebar). Rachel Maddow has made the crucial situation at nursing homes — nearly 50% of all deaths are associated with nursing homes — a subject of consistent concern. Gadfly has provided links in past posts to several of her shows on the subject.

Maddow led with another powerful segment on this subject last night (first 20 minutes), in which she talked about “deaths waiting to happen.”

And then we have this story in the paper this morning.

There is no allegation of poor care, but one can sense “deaths waiting to happen.”

Gadfly, as followers may have sensed, has felt that the subject of nursing homes has been underplayed in City reporting, and wishes that Council members might use their positions to look more deeply into conditions at our potential “hot spots,” if only out of an abundance of caution.

Anthony Salamone and Peter Hall, “ManorCare discloses nearly 100 coronavirus cases, deaths at Lehigh Valley nursing homes.” Morning Call, April 23, 2020.

Amid federal pressure for more transparency about the growing crisis at nursing homes, ManorCare on Wednesday said it is grappling with nearly 100 coronavirus cases and an “unspecified” number of deaths at three facilities it operates in the Lehigh Valley.

Julie Beckert, a spokeswoman for owner HCR ManorCare Inc., said Wednesday that 21 residents have tested positive at ManorCare Health Services-Bethlehem, 2021 Westgate Drive, off Catasauqua Road; 57 at Palmer Township and 21 in Bethlehem Township.

The company owns three other facilities in the Lehigh Valley, two in the Allentown area and one at 2029 Westgate Drive, across from the 2021 Westgate site. Those facilities have had no positive cases, she said.

Beckert said ManorCare has had an unspecified number of patients die during the last six weeks, “but we cannot confirm that it was due to COVID.” She said many patients have significant underlying health issues or are in hospice. “So COVID could be related but not the cause,” she said.

Experts say nursing homes have been ground zero for the virus, and residents of long-term care facilities account for more than half of Pennsylvania’s deaths from the virus. Wednesday’s figures from the state Health Department showed the number of cases in nursing and personal care facilities continue to rise, though the Lehigh Valley’s totals appeared to have steadied.

The state reported among 30 facilities with cases in the Lehigh Valley, there have been 686 infections among residents and staff, with the majority of them residents.

At ManorCare, Beckert said, the company places its senior centers in one of three tiers to “most effectively” treat patients while keeping the environment as safe as possible, Beckert said.

Earlier this week, she said the 2021 Westgate Drive, Palmer and Bethlehem Township facilities are on a “Tier 3” level of care, meaning staff identified coronavirus cases and took steps to isolate the sick. Such measures include installing a dedicated airborne isolation unit. She said those patients are screened, with priority placement given for the highest risk residents.

The home also set up temporary walls with doors and an antechamber for employees to don and remove personal protective equipment, Beckert said. The isolation area allows ManorCare to put “consistent staff” on the unit to care for patients, she said.

Facilities at 2029 Westgate Drive and in Salisbury Township are not on Tier 3, though Beckert declined to say the tier ranking for those two.

Tiers 1 and 2 do not indicate any positive cases, but some Tier 2 centers have COVID-19 tests out and have added airborne isolation to their infection controls, Beckert said.

“We will start to move patients off of isolation since they are recovering and will no longer need to be on airborne isolation,” Beckert said. “The tiered process we have in place for airborne isolation is working at ManorCare.”

Beckert said the company has sufficient staff to care for residents. She said any employee who tests positive would be self-quarantined and able to return to work once cleared of COVID-19 by a health care professional.

“Our caregivers have truly banded together and are working hard to provide compassionate quality care to the patients they serve,” she said. “They are heroes and deserve to be treated as such.”

Beckert said ManorCare is working to make sure people are aware of cases in its facilities, and to prevent people from feeling cut off.

“Our priority is to review our numbers so we can report the most accurate to families,” she said. “We will then post these numbers once families are contacted. We also have systems in place to help families connect with their loved ones during this trying time. We continue to work with the state and the local health department and report daily with any updates in our center.”

New federal regulations could shed additional light on which Pennsylvania facilities have seen cases of COVID-19. The Centers for Medicare & Medicaid Services has announced new reporting requirements that direct nursing homes to inform residents, their families and the federal government about coronavirus infections at their facilities. A CMS spokeswoman said the agency plans to releases data weekly, including names of nursing homes that report information.

Critics have said the move is long overdue. They have called for more aggressive action to track infections in homes and contain outbreaks by helping home operators get greater access to testing and masks, particularly given the vulnerability of elderly patients.

“We don’t know where we should be checking out certain facilities, or the risk part of it is sending staff to a place not knowing if there is a lot of [COVID-19],” said J.R. Reed, executive director of the Lehigh County Office on Aging and Adult Services.

Reed said the state should list the data by facility; currently the Health Department provides a breakdown of the number of cases in each county, without listing specific facilities.

But Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy in Willimantic, Connecticut, said CMS hasn’t issued final regulations yet and questions if those regulations will lead to more transparency in the reporting by care facilities.

“I just think it’s not clear, and they won’t tell you unless it’s in their interest,” Edelman said of nursing homes, whose reporting she characterized thus far as “very spotty.”