Medicare provided extra time for people to pay their Medicare premiums because of the Coronavirus Disease 2019 (COVID-19) public health emergency.  This extra time ends on September 30, 2020.  Letters were sent to impacted people with Medicare last month.  Please see the attached sample letter.  This message is a reminder that the deadline to pay any owed Medicare premiums is approaching at the end of this month.

People with Medicare who owe past due Medicare premiums must pay the full amount owed before September 30, 2020, to keep their Medicare coverage. If there are people with Medicare who are unable to pay their past-due premiums in full by the end of September, they should contact their local Social Security Office as soon as possible to see if they are eligible for a payment plan with the Social Security Administration.

A Message from Pennsylvania Secretary of Health, Rachel Levine, MD

Technology connects us to resources and plays a powerful role in our lives. And at no time is technology more important than during the COVID-19 pandemic.

Pennsylvanians listen to our press briefings, gather data from our enhanced statewide and early warning monitoring dashboards, and follow us on Facebook and Twitter for the most up-to-date information.

Still, COVID-19 continues to impact our state. Nearly 142,885 Pennsylvanians have been diagnosed with COVID-19 so far, and we are still seeing cases increase each day.

It is upon each of us to help mitigate the spread of COVID-19. Here in Pennsylvania, we are adding another tool in the toolbox residents can use to protect themselves and their loved ones:  COVID Alert PA, an app that uses Bluetooth technology to notify you of a potential COVID-19 exposure.

This app uses Bluetooth technology, the same technology that helps your phone connect with your car to play music or use wireless headphones. This technology does not track or collect any location data or personal data from your phone – only your phone’s proximity to other phones with the app enabled. It is strictly designed to notify you if you may have been in close contact with someone who tested positive for the virus. If you test positive for the virus, and you choose to confirm that information into the app, it will notify those that may have been in close contact with you.

Often, it can be difficult for someone to either name or even know all the close contacts they were exposed to while they were infectious — like a person you spoke to for 15 minutes at the bar or someone you sat next to on the bus. This is where COVID Alert PA becomes extremely useful and augments value to the state’s contact tracing efforts.

When an individual tests positive for COVID-19, a public health professional from the Pennsylvania Department of Health or a county and municipal health department contacts them to begin a case investigation. During the investigation the individual learns about their test results and is asked to recall who they have been in close contact with during their infectious period.

The public health professional also will encourage the COVID-19 positive individual to open the COVID Alert PA and enter a six-digit validation code. After the validation is complete, the app will alert other individuals who were within six feet of the COVID-19 positive individual for at least 15 minutes.

Anyone getting an exposure alert is provided with public health advice and resources to talk to a public health professional about next steps or how to find the nearest testing site.  People with a confirmed exposure are bound to have questions and concerns, and we want to provide the information people need to make informed decisions about their health and the health of the people closest to them.

Remember, all this is done through Bluetooth technology, which means no personal or identifying information will be collected through the app. The person notified will not know the identity of the person to whom they were exposed.

The Wolf Administration has taken additional measures to ensure the safety and well-being of Pennsylvanians. Now that the state is reopened, though mitigation efforts remain in place, there is still an opportunity for COVID-19 to spread, so we need to prepare ourselves by washing hands, wearing masks, practicing social distancing and downloading the COVID Alert PA app. The more people who download the app, the better our chances are of preventing an outbreak and keeping our communities healthy.

When the app is available later this month, please download it through the Google Play or Apple App Store and add your phone to the fight to help stop the spread of COVID-19.

Together, we can help ourselves, our loved ones and our neighbors across the commonwealth stay safe.

USA Today

Pennsylvania doctors who treat child abuse say they are seeing a wave of more serious injuries in younger victims.  It’s part of a disturbing trend they first observed in the spring: as the coronavirus continues to spread across the state, so does the number of severe injuries in abused children.

The virus didn’t recede in the summer as anticipated, nor did the abuse.

Penn State Children’s Hospital saw a wave of serious injuries that began in mid-June, according to Dr. Lori Frasier, chief of the hospital’s child abuse pediatrics division.  “We’re seeing a surge of some kind,” she said last month.  The hospital doesn’t provide specific patient numbers, but it is “seeing pretty serious physical abuse injuries,” Frasier said.

The children range in age from “young to very young,” she said, and often end up in critical condition in the intensive care unit.  “What really kills kids is head and abdominal trauma,” Frasier said. “That’s what they die from in those early 1- to 7-day periods.”

Fatal and nearly fatal

At least 155 children died or nearly died this year in Pennsylvania as a result of suspected child abuse or neglect, according to state data from Jan. 1 to July 15.  Those cases were referred to child welfare investigators, according to Ali Fogarty, communications director at the state Department of Human Services.  There were 144 children who died or nearly died in all of 2019 because of substantiated abuse or neglect, according to state data.  But, to clarify, measuring the differences between suspected cases and substantiated cases is not an apples-to-apples comparison.

In the cases last year, most abuse came at the hands of a parent, according to state data. The majority of victims were younger than 4 years old.  Overall, there were more than 5,200 substantiated cases of child abuse in Pennsylvania last year, with more than 40 percent of those cases attributed to sexual abuse. The rate of abuse in rural counties was more than double the rate in urban counties.  During the past five years, the number of fatalities and near fatalities in children has steadily increased from 95 in 2015 to 144 in 2019.

Waves of trauma

Penn State Children’s Hospital has seen waves of child abuse trauma in the past, even before a public health crisis changed American life.   But families are facing added pressure as the virus has a systemic effect in Pennsylvania, and that’s leading to more abuse, Frasier said.  Unemployment or having one parent at home to take care of the kids is a big source of stress, she said.  “They don’t feel like the pandemic has passed,” Frasier said.

There were 835 additional positive cases of Covid-19 and 20 deaths reported in Pennsylvania on Friday, bringing the statewide total to nearly 132,000. More than 7,600 state residents have died.  The state can track the number of positive cases and deaths, but the overall effect the virus is having on vulnerable children is unclear.   I don’t think we’ll have the full picture for a year,” Frasier said. “We’re right in the middle of it.”

‘A lot of stress’

St. Christopher’s Hospital for Children in Philadelphia saw an increase in severe injuries in the spring.  In July, Dr. Norrell Atkinson, section chief of the child protection program at the Level 1 trauma and burn center, started seeing an increase of toxic ingestions in young children.   “They come in with illegal substances in their system — opiates, marijuana, amphetamines,” she said.   Close to a third of the hospital’s cases are ingestions, and the patients are generally younger than 5 years old, Atkinson said.   “I’ve been at this hospital for two years,” she said, “and I haven’t seen a cluster like this.”

In most cases, the child lives in a home where the drugs are present and they are left unsupervised long enough to ingest the substances.  During June and July, the hospital saw cases often in which there were “supervision issues, and (parents and guardians) were more stressed and medicating differently,” Atkinson said.  The hospital doesn’t disclose the number child trauma cases treated, but all of the ingestion patients have survived, she said.  “We’re busier this year, and that could be due to a variety of factors, including the pandemic,” Atkinson said. “We’re not seeing decreased rates of abuse or neglect. We see a lot of stress.

Hidden dangers

The trend in Pennsylvania is in line with what’s occurring nationwide.  Doctors across the country are seeing more severe injuries in children in a week than they’re used to seeing in a month, according to medical providers at the American College of Emergency Physicians.  “The current pandemic is changing all of our lives in ways we can see, but the unseen may be even more vital than the seen,” said Dr. Jacque Johnsen, vice chair of the American College of Emergency Physicians. “Knowing additional risks to the most vulnerable patient populations at this time may save even more lives.”

The U.S. Centers for Disease Control and Prevention cited safety issues among its reasons that students should return to school in the fall.  “Extended school closures deprive children who live in unsafe homes and neighborhoods of an important layer of protection from neglect as well as physical, sexual, and emotional maltreatment and abuse,” the CDC reported.  Teachers and educational staff report suspected child abuse more than any other type of mandated reporter, according to state and federal data.

When students weren’t in classrooms in the spring, child abuse reports decreased. But severe child injuries increased, according to emergency room doctors.  The CDC cited an example of that in Washington, D.C.: The Washington, D.C. Child and Family Services Agency recorded a 62 percent decrease in child abuse reporting calls between mid-March and April this year compared to the same time period in 2019, but saw more severe presentation of child abuse cases in emergency rooms.

In Pennsylvania, Frasier said she’s “hoping against hope” the trend changes soon.  “I hope families reach out to resources and know they’re not alone,” she said. “I don’t want families to feel so isolated and stressed.”  And she doesn’t want to see another child with an injury that can’t be healed.

Candy Woodall is a reporter for the USA Today Network. She can be reached at 717-480-1783 or on Twitter at @candynotcandace.

Pennsylvania Governor Wolf and the Office of Child Development and Early Learning (OCDEL) announced the distribution of $116 million in CARES funding to nearly 7,000 child care providers throughout Pennsylvania. This round of funding is the third distribution allocated to sustaining the child care sector during the current health crisis, with a total investment of $220 million, $104 million of which was distributed earlier this summer. The latest round of funding was largely based on findings from a research study undertaken by Penn State Harrisburg’s Institute of State and Regional Affairs, which studied the impact of the COVID-19 pandemic on Pennsylvania’s child care industry.

As part of his fall legislative agenda, Governor Wolf last week announced a proposed a $250 million investment in the child care sector to help families in need of child care for school-aged children due to hybrid K-12 programs in the 2020-21 school year. Wolf also proposed $27 million to expand access to child care deserts in Pennsylvania, or areas where few providers exist. Finally, $50 million in grants also was proposed for programs serving low-income communities and offering part-day school-age care.

OCDEL has also offered guidance for families and child care centers to ensure school-age children have access to reliable child care. The announcement provides guidance to non-licensed community-based entities and individuals planning to care for groups for school-age children during the 2020-21 school year. Additionally, OCDEL is directing an entity or person operating a non-licensed part-day school-age child care (SACC) program or Learning Pod to notify the Department of Human Services (DHS) and OCDEL if they intend to care for more than six school-age children for the school year.

A new change to child care subsidy payments recently announced by OCDEL also took effect this week. Due to the pandemic, OCDEL was making child care subsidy payments to providers based on the provider’s subsidy enrollment in March 2020. However, effective September 1^st, OCDEL returned to pre-pandemic procedures, now basing subsidy payments on actual attendance.

Continuing to help students learn during the pandemic, Pennsylvania Governor Tom Wolf is dedicating $15 million for schools to secure broadband, mobile hot spots, and other platforms that increase equitable access to remote learning.

“The COVID-19 pandemic has forced our schools to rethink and rework how to provide instruction to students who are learning completely at home or in a hybrid model,” said Gov. Wolf. “As schools reopen this fall, students need Internet connectivity, computers and other technology, and access to remote-learning platforms. This funding will help our students as we enter the new school year.”

The Coronavirus Aid, Relief and Economic Security (CARES) Act authorizes governors to determine the educational use of Governor’s Emergency Education Relief (GEER) Funds.

The initiative will employ a multi-pronged approach that includes the use of state library networks and other partnerships, including the Pennsylvania Technical Training and Assistance Network (PaTTAN).

Specifically, the funding will be used to:

• Enable public libraries to coordinate work with the Internet Disaster Recovery Center to expand Internet connectivity in targeted county-wide geographic service areas identified as most in need. Expand the inventory of Wi-Fi hot spots and lendable technology through public libraries and addressing the technology deficit among libraries (estimated $1.4 million).
• Strengthen and expand the existing 24/7 online homework help through the POWER Library Chat with a Librarian service and additional electronic resources (estimated $100,000).
• Create and deploy Open Educational Resources (OER) for students and educators (estimated $500,000). OERs give students access to a wider range of instructional materials, including textbooks, videos and research, free of charge.
• Establish a statewide datacasting initiative with Pennsylvania PBS to connect students to learning content who don’t have access to the Internet (estimated $8 million). Datacasting uses over-the-air TV signals to deliver educational content that can be used on computers without having to access the Internet. Using a datacasting antenna, students can download lesson plans, videos, and worksheets from their schools.
• Distribute devices to be used in conjunction with datacasting technology for households without a connection to the Internet (e.g. datacasting antenna, laptops), and provide the technical supports and professional development to connect students to learning (estimated $3 million).
• Distribute accessible/assistive technology, including but not limited to software, tablets, tablet mounts, screens, smart pens, hotspots, devices, for K-12 students with exceptionalities in collaboration with the PaTTAN system (estimated $2 million).

“In response to the pandemic, PDE and others have created new partnerships and strengthened existing ones to ensure Pennsylvania’s students continue to be served, whether that is academically, nutritionally, or socially and emotionally,” said Secretary of Education Pedro A. Rivera. “This new initiative is another way in which communities are working together to benefit our students.”

This initiative builds on the Department of Education’s efforts to support schools’ efforts to implement continuity of education plans during the 2019-20 academic year when schools closed unexpectantly as a result of COVID-19, which included Equity Grants and a partnership with Pennsylvania’s PBS stations to air standards-aligned programming across the state.

To date, the Wolf Administration has awarded $102.5 million in GEER funding to help keep students and educators safe and meet the unique challenges of COVID-19. In addition to the $15 million for connectivity, the Wolf Administration has directed $17 million for schools designated for Additional Targeted Support and Improvement under the federal Every Student Succeeds Act; $15 million for special education; $28 million to postsecondary institutions and adult basic education providers; $14 million to K-12 schools to support equity in continuity of education; $10.5 million to Career and Technical Education Centers; and $3 million for Preschool Early Intervention Programs.

As part of NIOSH’s efforts to keep stakeholders up to date on the CDC and NIOSH coronavirus disease 2019 (COVID-19) response, below is a summary of new information posted this week.

General Resources

Two New NIOSH Science Blogs are Now Available on Respiratory Protection

• The Blog, Respiratory Protection vs. Source Control – What’s the Difference?, helps readers understand the difference between respiratory protection, which protects the wearer, and source control, which protects others.
• The Blog, Supplementing the Supply of N95s With Reusable Elastomeric Half Mask Respirators, discusses the use of reusable elastomeric half mask respirators (EHMRs) as a substitute for N95 respirators. This comes as organizations rely on other types of respiratory protection due to the high demand and limited supply of N95 respirators during the COVID-19 pandemic.

Industry-Specific Resources

Update to Wildland Firefighter FAQs   

Updates to the Wildland Firefighter FAQs webpage address new concerns, clarify that testing recommendations are relevant to prevent infection and the spread of COVID-19 regardless of test result or exposures, and update the screening terminology to be consistent across the CDC website.

Limiting Workplace Violence Infographic Translated

The webpage Limiting Workplace Violence Associated With COVID-19 Prevention Policies in Retail and Services Businesses has a newly translated infographic. “Basic dos and don’ts for EMPLOYEES to prevent workplace violence” has been translated into eight languages: Chinese, Korean, Vietnamese, French, Haitian-Creole, Portuguese, Spanish, and Russian.

New Fact Sheets

CDC recently published fact sheets for two additional groups that provide suggestions for preventing the spread of COVID-19

• Hotel, resort, and lodge employees and employers
• Paratransit operator employees and employers

President Trump and the U.S. Department of Health and Human Services (HHS), through the Assistant Secretary for Health, issued guidance under the Public Readiness and Emergency Preparedness Act (PREP Act) to expand access to safe and effective COVID-19 vaccines when they are made available. This guidance authorizes state-licensed pharmacists to order and administer, and state-licensed or registered pharmacy interns acting under the supervision of the qualified pharmacist to administer, COVID-19 vaccinations to persons ages 3 or older, subject to certain requirements.

“This action builds upon our Administration’s progress toward delivering a safe, effective, and widely available vaccine by 2021,” said Assistant Secretary for Health ADM Brett P. Giroir, M.D. “Allowing pharmacists to order and administer COVID-19 vaccines will greatly expand convenient access for the American people.”

The authorization preempts any state and local laws that prohibit or effectively prohibits those who satisfy these requirements from ordering or administering COVID-19 vaccines as set forth above. The authorization does not preempt state and local laws that permit additional individuals to administer COVID-19 vaccines to additional persons.

Access a copy of the guidance – PDF*

Information on Operation Warp Speed

Clinical resources on vaccines, including continuing education training on best practices

Pennsylvania Governor Tom Wolf announced that restaurants may increase indoor occupancy to 50 percent starting September 21. To ensure that these businesses operate safely as Pennsylvania continues to mitigate the spread of COVID-19, and to instill customers and employees with confidence knowing that they can dine safely, restaurants will ​commit to strictly complying to all public health safety guidelines and orders through a self-certification process.

“While our aggressive and appropriate mitigation efforts have kept case counts low, we must continue to take important steps to protect public health and safety as we head into the fall. At the same time, we must also support the retail food services industry that has struggled throughout this pandemic,” Gov. Wolf said. “The self-certification ensures that ​restaurants can expand indoor operations and commit to all appropriate orders so that employees and customers alike can be confident they are properly protected.”

Restaurants that self-certify will appear in the Open & Certified Pennsylvania searchable online database of certified restaurants across the commonwealth. Consumers will be able to access this database and find certified businesses in their area, ensuring that consumers can make more informed choices about the food establishments they are looking to patronize.

The self-certification documents and information about the Open & Certified Pennsylvania program can be found online starting September 21 and will contain the following:

• A list of requirements contained in the current restaurant industry guidance and enforcement efforts;
• A statement that the owner has reviewed and agrees to follow these requirements;
• The business’ maximum indoor occupancy number based on the fire code; and
• A statement that the owner understands that the certification is subject to penalties for unsworn falsification to authorities.

Any restaurant that wishes to ​increase to 50 percent indoor capacity on September 21 must complete the online self-certification process by October 5. Business owners should keep a copy of the self-certification confirmation they will receive by e-mail. Social distancing, masking and other mitigation measures must be employed to protect workers and patrons. Further, starting September 21 restaurants that have alcohol sales will close alcohol sales at 10:00 PM.

Additionally, restaurants that self-certify will be mailed Open & Certified Pennsylvania branded materials, such as window clings and other signage designating their certification, which they can display for customers and employees.

The self-certification will be used as part of ongoing enforcement efforts conducted by Department of Agriculture and Pennsylvania State Police Bureau of Liquor Control Enforcement, and will be shared with the departments of State, Labor & Industry and Health, and other enforcement agencies. Restaurants operating at 50 percent capacity will have their self-certification status checked as part of ongoing enforcement by these agencies starting on October 5, and will focus on educating businesses. The commonwealth will continue its measured approach to easing restrictions, keeping the rest of the targeted mitigation tactics specific to the food retail industry in place as restaurants increase capacity to 50 percent.

Further, a restaurant’s listing in the Open & Certified Pennsylvania restaurant database shows it cares about its customers, employees, community and the economic future of the state.

The self-certification process is modeled after a similar mitigation effort in Connecticut, and the alcohol sales limitation is modelled after a similar mitigation effort in Ohio.

Boosting consumer confidence is critical for restaurants, as according to the most recent Longwoods International tracking study of American travelers, only 40 percent of Americans are comfortable dining in local restaurants.

“We recognize the impact that the COVID-19 pandemic has had on Pennsylvania’s small businesses, especially on our restaurants,” added Gov. Wolf. “Through this self-certification process, our commonwealth’s restaurant industry will ensure the safety and well-being of both employees and patrons alike, and will be able to begin a return to normal operations and financial recovery.”

Restaurant owners with additional questions about the self-certification program can contact covidselfcert@pa.gov.

In July, following the recommendations of the federal government and in response to a rise in COVID-19 cases, Governor Wolf and Secretary of Health Dr. Rachel Levine signed orders for targeted mitigation efforts for all Pennsylvania businesses in the food services industry, including restaurants, wineries, breweries, private clubs and bars. Commonwealth and local agencies continued and even increased appropriate enforcement measures.

The governor has urged the General Assembly to support his plan to provide additional recovery for small businesses, including proposing $100 million in forgivable loans and grants for the hospitality, leisure and service industries.

The governor has also urged Congress to quickly provide financial relief to the nation’s restaurants by passing the Real Economic Support That Acknowledges Unique Restaurant Assistance Needed to Survive (RESTAURANTS) Act. The bipartisan bill in Congress provides $120 billion to help independent restaurants with the economic challenges created by the COVID-19 pandemic.

The administration of Pennsylvania Governor Wolf released frequently asked questions for restaurant owners to reference following the newly announced self-certification process.

This new process, Open & Certified Pennsylvania, ensures that customers and employees know that they can dine safely at restaurants ​committed to strictly complying with all public health safety guidelines and orders as we work to mitigate the spread of COVID-19 in the commonwealth.

“The novel coronavirus has created new challenges for Pennsylvania businesses, and it is critical that we provide avenues of support for our restaurants, which have been disproportionately impacted,” Department of Community and Economic Development Secretary Dennis Davin.

“Open & Certified Pennsylvania will instill consumer faith and allow our small businesses to recover more quickly, and we want to make the process as simple and easy as possible. The list of frequently asked questions we are releasing today will help ensure that this transition goes as smoothly as possible for Pennsylvania businesses.”

Any restaurant that wishes to ​increase to 50 percent indoor capacity on September 21 must complete the online self-certification process by October 5.

Restaurant owners with additional questions about the self-certification program can contact covidselfcert@pa.gov.

Becker’s Hospital Review reported on the 14 rural hospitals that have closed this year. It is worth noting that eight closures occurred during the COVID-19 pandemic, a time when access to health care services is more important than ever before. Additionally, local reporting in Georgia confirms that two more rural hospitals are slated for closure in October. Last year set the record for the greatest number of rural hospital closures in a single year at 18; 2020 is on pace to smash that record.