USDA Secretary Sonny Perdue announced the Coronavirus Food Assistance program on April 17, 2020. CFAP will use funding and authorities provided in the Coronavirus Aid, Relief, and Economic Security Act, the Families First Coronavirus Response Act, and other USDA existing authorities. This $19 billion immediate relief program includes direct support to agricultural producers as well as the Food Box Distribution Program. This webpage has more information on the direct support for farmers and ranchers, which include:

• CFAP will provide direct support based on actual losses for agricultural producers where prices and market supply chains have been impacted.
• CFAP will assist producers with additional adjustment and marketing costs resulting from lost demand and short-term oversupply for the 2020 marketing year caused by COVID-19.

USDA has hosted webinars to provide basic information on how producers can prepare for the upcoming signup for the Coronavirus Food Assistance Program. This includes information on how to apply once signup opens and how to initiate contact with FSA.

More information can be found at their website.

Pennsylvania Department of Community and Economic Development (DCED) Secretary Dennis Davin has reminded all Pennsylvanians to be a good neighbor and respond to the 2020 Census.

This year marks the 22nd year of the United States Census, and commonwealth residents began receiving invitations to fill out the 2020 Census in the beginning of March. All households should have already received their initial invitation.

Taking time to respond to the 2020 Census now means a Census taker will not need to visit your home later. Beginning May 13, 2020, Census takers will begin a phased restart of on-field operations in the commonwealth by dropping off 2020 Census invitation packets at the front doors of households in areas where the majority of households do not receive mail at their home.

The deadline to respond has been extended from August 14, 2020, to October 31, 2020.

Pennsylvania Governor Tom Wolf proclaimed Friday, May 22, the 143rd day of the year, as 1-4-3 Day, a statewide day of kindness in honor of Pennsylvania native Fred Rogers. Fred Rogers, best known from his beloved television series, Mister Rogers’ Neighborhood, exemplified compassion and regularly used 1-4-3 as another way of saying “I love you,” with 1-4-3 representing the number of letters in each word.

As the state continues to navigate the COVID-19 crisis, Governor Wolf is encouraging all Pennsylvanians to spread even more kindness, more love, and more generosity to essential workers and neighbors on 1-4-3 Day.

The Pennsylvania Department of Agriculture has outlined the order of enforcement actions that would be taken against restaurants offering dine-in services to patrons in violation of Governor Tom Wolf’s March 19 business closure Executive Order to slow the spread of COVID-19 in the commonwealth.

The Department of Agriculture’s Bureau of Food Safety will enforce this order for retail food facilities under the department’s jurisdiction that are re-opening and offering dine-in services. In Governor Wolf’s plan to reopen Pennsylvania, restaurants in counties in both the red and yellow phases are prohibited from offering dine-in service and are limited to take-out and delivery options only.

Food safety inspectors will follow up on reports of restaurants offering dine-in service in violation of the order. Once confirmed, the following actions will be taken by the department:

• Warning letter from the Departments of Agriculture and Health;
• Follow up inspection;
• If still in violation of the order at follow up inspection, adjudication to suspend the businesses retail food license;
• If the business continues to operate after license is revoked, citations will be filed with the magisterial district judge;
• The department may pursue civil penalties of up to $10,000 per day of violation.

The department will work with the Pennsylvania Department of Health and collaboratively across other agencies – such as with the Pennsylvania State Police, and Pennsylvania Liquor Control Board – to report and follow up on violations.

“We know that people dining together in a restaurant puts many people at risk of exposure, including patrons and employees,” Secretary of Health Dr. Rachel Levine said. “It is essential that restaurants comply with guidance and continue with carry-out and delivery options at this time. Social distancing is a primary tool to fight this virus, and we must stay the course.”

Restaurants under the department’s jurisdiction that are inspected as a result of such complaints will have public reports with details of violations filed in Pennsylvania’s restaurant inspection database, publicly accessibly via the department’s website or the free EatSafePA mobile app for both Apple and Android devices.

Reports related to food safety concerns or restaurants offering dine-in services can be made online through the department’s Food Safety Complaint Form.

Pennsylvania Department of Agriculture Secretary Russell Redding and Pennsylvania Department of Aging Secretary Robert Torres today penned a letter to Pennsylvania’s congressional delegation urging legislative action to enable Pennsylvania’s older adults to access the Senior Farmers Market Nutrition Program during the mitigation effort.

Typically, the Senior Farmers Market Nutrition program application and eligibility verification is completed at a senior center or at one of Pennsylvania’s 52 Area Agencies on Aging. Distribution of the vouchers also takes place at these locations.  However, since these locations are currently closed to the public, older adults would have difficulty directly accessing this program.

The proposed temporary waiver would allow eligible older adults to complete their application over the phone or electronically, with vouchers mailed directly to their homes.

In addition to advocating for contact-free eligibility verification, the administration asked for additional administrative funds to cover banking costs incurred by farmers and partner agencies with increased costs for mailing vouchers and other required materials. At a time when budgets have been put under increasing financial strains, the provision of these administrative funds would relieve some of the additional costs incurred in carrying out this program.

For more on food security in Pennsylvania, visit agriculture.pa.gov/foodsecurity.

New tool provides innovative solutions for states and facilities to protect our nation’s vulnerable nursing home residents during emergency

On May 14, 2020, under the direction of President Trump, CMS released a new toolkit developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes. The toolkit builds upon previous actions taken by the Centers for Medicare & Medicaid Services (CMS), which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

 

“The coronavirus presents a unique challenge for nursing homes. CMS is using every tool at our disposal to protect our nation’s most vulnerable citizens and aid the facilities that care for them. This toolkit will support state, local leaders and nursing homes in identifying best practices to protect our vulnerable elderly in nursing homes” said CMS Administrator Seema Verma.  

 

The toolkit provides detailed resources and direction for quality improvement assistance and can help in the creation and implementation of strategies and interventions intended to manage and prevent the spread of COVID-19 within nursing homes. The toolkit outlines best practices for a variety of subjects ranging from infection control to workforce and staffing. It also provides contact information for organizations who stand ready to assist with the unique challenges posed by caring for individuals in long-term care settings. Each state was involved in the creation of this toolkit, resulting in a robust resource that may be leveraged by a variety of entities serving this vulnerable population.

 

Additionally, CMS has contracted with 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with providers, community partners, beneficiaries and caregivers on data-driven quality improvement initiatives designed to improve the quality of care for beneficiaries across the United States. The QIN-QIOs are reaching out to nursing homes across the country to provide virtual technical assistance for homes that have an opportunity for improvement based on an analysis of previous citations for infection control deficiencies using publicly available data found on Nursing Home Compare.

 

This effort augments CMS Administrator Seema Verma’s five-part plan to ensure safety and quality in America’s nursing homes, which was announced in April 2019, and recent agency efforts to combat the spread of COVID-19 within these facilities. Since February, CMS has taken unprecedented action to address COVID-19 within nursing homes. On February 6, CMS took action to prepare the United States for COVID-19 by reissuing longstanding infection control guidelines. CMS then moved quickly to address the rapid spread of infection by issuing guidance on new screening processes for facilities, on the use of personal protective equipment (PPE), and on temporary restrictions on non-essential medical staff and visitors in March. CMS immediately followed these actions by prioritizing inspections to conduct targeted surveys for infection control and complaints triaged at the Immediate Jeopardy level.

 

The Agency also issued a call to action for nursing homes and state and local governments as a means of reinforcing infection control responsibilities and urging leaders to work closely with facilities to determine needs for testing and PPE. Recently, CMS announced payment increases for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 cases. Finally, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC) and inform residents and their families and representatives of COVID-19 cases within their facilities in an effort to improve transparency.

 

To keep up with the important and ongoing work of the White House Coronavirus Task Force in response to COVID-19, visit www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

Pennsylvania Governor Tom Wolf has announced that the U.S. Department of Education (USDE) has approved Pennsylvania’s application for $523.8 million in one-time federal emergency funds to help schools respond to COVID-19 impacts. The Pennsylvania Department of Education (PDE) submitted its Elementary and Secondary School Emergency Relief (ESSER) Fund application to USDE last week. Beginning today, local education agencies (LEAs) can apply to PDE to receive their allocation of the funding and can expect to start receiving funds within the next several weeks.

LEAs may use ESSER funding for a wide range of purposes, including food service, professional training, technology purchases, sanitization and cleaning supplies, summer and after-school programs, and mental health supports. Funds must be used by September 2022. PDE is urging school entities to prioritize investments for vulnerable students and families, including those living in the deepest poverty, students with disabilities, English learners, migrant students, students experiencing homelessness, and children in foster care. View a list of what each school district and charter school will receive in ESSER funds.

Pennsylvania Secretary of Agriculture Russell Redding reminded Pennsylvanians the importance of mutual respect when patronizing Pennsylvania’s essential businesses – whether it be a grocery store, farmers market, restaurant, or hardware store. Business operators and their employees are working hard to protect each other and their consumers in a safe, clean environment.

The secretary’s order asks that businesses require customers to wear masks on premises in order to help protect workers in life-sustaining businesses. Customers at supermarkets and pharmacies must wear masks to enter the store, unless they have a medical condition that prevents them from wearing a mask. If the customer does not wish to wear a mask, these stores must provide an alternate means of delivering goods.

“Essential workers see many people each day. We can minimize their risk if we all work together to follow this simple guidance: wear a mask and stay 6 feet away from one another,” Redding said. “Privately owned stores have both followed guidance and orders from the state, and voluntarily implemented their own policies to keep everyone safe and as comfortable as possible. We applaud businesses that early in this crisis, committed to staying open, and offered special hours for vulnerable shoppers, outdoor shelter for those waiting in line to get into the store, and other extra measures. It shows how thoughtful businesses have been about public health.”

While so many shoppers have been respectful, some have ignored simple actions businesses have requested of customers, such as wearing a mask, following one-way arrows through the store, and keeping 6 feet apart from other shoppers and workers.

The Pennsylvania Department of Human Services (DHS) is reminding Pennsylvanians that while all county assistance offices (CAOs) statewide remain closed to the public, online services remain available.

CAOs in counties moving to the yellow phase will reopen following adjustments to facilities necessary to keep staff and clients safe. Pennsylvanians are encouraged to use DHS’ online applications and resources to apply for benefits or submit paperwork as necessary.

The following key services can be accessed online through COMPASS and the myCOMPASS PA mobile app without going into the CAO:

• Apply for Medical Assistance, cash assistance, SNAP or LIHEAP (only on COMPASS)
• Submit benefit renewal information
• Review benefits and case record information
• Report a change in case information
• Upload verification documents

DHS administers public assistance programs that helps Pennsylvanians maintain access to health care, food, and other essential needs when people need extra help and during periods of economic uncertainty like what we currently face. Applications for benefits and renewals can be submitted online at www.compass.state.pa.us.

A rural town’s prescription for a nation weighing what’s next

Washington Post, Todd C. Frankel, May 12, 2020 at 9:23 a.m. EDT

DANVILLE, Pa. — The pathologist stood in the kitchen on his 40-acre farm and cut the crust from a ham and cheese sandwich for his 7-year-old son’s packed lunch. He took a swig of his morning coffee. He’d been up late answering calls, hustling to launch a clinical trial to test blood plasma as a possible treatment for covid-19, hashing out the details between rides on his Peloton stationary bike and taking rifle shots at nuisance groundhogs.
Now, he needed to get to the hospital, along with his son.

“Hey, Damien, we’ve got to go, bud,” Gustaaf de Ridder said as they headed toward his GMC Denali.

De Ridder had his feet in two worlds, living in a small town with a huge hospital — a rural community that is the unlikely home to one of the highest concentrations of hospital workers in the nation. Social distancing comes easy in these parts, and with just 50 COVID-19 cases and zero deaths, there is little apparent need to mobilize forcefully against the virus.

Yet almost everyone here is bracing for a medical battle, akin to the feeling of a military town on war-footing.

This rare combination shows how the push to reopen the economy and the need to control a deadly virus can coexist, with fewer of the tensions that have popped up across the country, such as an anti-quarantine protest that drew hundreds to Harrisburg, Pa., just 65 miles away. And President Trump, who won 62 percent of the vote in surrounding Montour County, tried to add more pressure to the situation Monday with a tweet accusing the state’s Democratic leadership of being too slow to reopen and claiming, “The great people of Pennsylvania want their freedom now, and they are fully aware of what that entails.”

“Health-care workers seem to have gone from heroes to the enemy because it’s like we’re making people wear masks,” said Mary Jane Reed, a critical care surgeon in Danville. “But I haven’t seen that here.”

“It might sound strange,” de Ridder said, “but it helps when you have so many health-care workers in the region giving the message directly. There’s less resistance. Less suspicion. Because we want this to go right, too.”

De Ridder, 40, runs the blood transfusion lab at Geisinger Medical Center. His wife works for the hospital’s supplier of protective face masks. With schools closed, his son was going to the hospital, too, to attend a day camp where children wear face masks decorated with bears.

Life in Danville has always seemed to revolve around what some locals call the “Big G,” the hospital on the hill that employs more than 10,000 people in a borough of 4,600, with as many medical evacuation helicopters at its disposal (nine) as Danville has stoplights.

Farmers and machine shop workers are neighbors to doctors and nurses. They all shop at Beiter’s Department Store. Many of their kids take piano lessons from the same teacher.

The pandemic had only intensified those connections, as virtually everything but the two covid-19 wings of the hospital shut down in preparation for the pandemic. One Geisinger doctor turned spare vacuum bags into respirator face masks; medical residents spent their free time cutting protective gowns out of surgical drapes; hundreds of volunteers sewed masks for home health nurses.

As parts of Pennsylvania, including Danville, took steps toward reopening some businesses on Friday, locals see the low caseload as evidence their efforts paid off.

“We’ve weathered this shockingly well,” said Sandy Green, a cardiologist who lives on a farm with his family just outside of town. “It would be much better if the rest of the world handled it like this.”

The hospital has been in Danville for more than a century, founded by the widow of an iron mining magnate in 1915 and forced to open its doors two weeks early to deal with a typhoid outbreak. It has grown over the years to become the flagship teaching hospital for one of the nation’s largest rural health-care networks, serving 3 million patients over parts of Pennsylvania and New Jersey.

Today, the hospital born into one infectious outbreak aims to face down another.

Signs of change

De Ridder’s morning commute shows how much has changed.

He drove his pickup past a billboard for Knoebels, an amusement park that had gone from delaying its regular April opening to postponing it indefinitely. A Perkins restaurant posted a handwritten sign, “We are open to go,” and Unida Pizza promoted “Takeout only.”

He continued past the mural proclaiming Danville “Home of the T-Rail” — a nod to its long-ago starring role in iron manufacturing.  The marquee outside Danville Area High School still read “Go Ironmen” — despite classes being canceled weeks ago.

De Ridder pulled up next to a Geisinger office building. He and his son were checked for fever. Damien retrieved the mask he’d been using for the week. The plastic cords looping over his ears annoyed him. He preferred his dad’s N95 respirator face mask.

As de Ridder jumped into his truck and pulled away, a woman in a mask ran after him.  “You forgot your son’s lunch!”  “I was up all night,” he explained, finding the lunch in his truck. “I’m a little tired.”

The hospital was quiet. The parking lots were mostly empty. The only signs of life were the few staff members milling outside white tents serving as temporary screening areas for the coronavirus before patients enter the hospital. It was the kind of languid scene that inspired online videos aimed at driving claims that the pandemic was overblown. One video had been shot at another Geisinger hospital in northern Pennsylvania.

The medical center was empty because elective surgeries had been canceled for weeks to prepare for the virus. Routine checkups and cancer follow-ups were delayed. The bulk of the hospital’s regular business was shut down. Visitors were discouraged.

Geisinger has resumed some medical procedures, but it has suffered financially. The hospital’s top executives announced they’d take a pay cut. But the hospital has so far avoided layoffs or furloughs.

The hospital’s steady employment normally inoculates the region against economic downturns and keeps unemployment lower here than in surrounding counties, said Fred Gaffney, president of the Columbia Montour Chamber of Commerce. But the pandemic’s economic pain was all around them.

In late April, almost every storefront was closed along Mill Street, in the town’s commercial heart. The governor shuttered most nonessential businesses, and even some businesses that could have stayed open locked their doors. Beiter’s owner Tom Beiter said he voluntarily closed his variety store because the virus made his employees fearful about coming to work. He is talking to his workers and planning to hold a soft reopening to see how it goes.

Andy Bower, owner of the Cherokee Tap Room, said his business was down 70 percent since it was forced to move to takeout-only — restrictions that would not change under the governor’s plan. He was growing increasingly anxious to reopen, but he said he and other business owners needed to do so with caution. It’d take time. The blow was softened by his wife’s job as a Geisinger physician assistant.

It’s not an unusual situation. “It’s hard not to know someone who works at Geisinger,” Bower said.

Geisinger has kept doctors on staff despite few patients to see and little to do. Green, the cardiologist, had most of his schedule cleared by the coronavirus. Same for his wife, Jamie Green, a kidney specialist. “They’re really trying to preserve their base” of health-care workers, Sandy Green said of the hospital. He knew that when the emergency passed, he and the other doctors would be expected to work hard to clear a backlog of patients.

He also knew Geisinger might need him and his wife sooner.

They were the specialists who would be called on first to replace critical care doctors sickened by the coronavirus.

Masks from vacuum filters

Karen Korzick saw the hospital’s supply of face masks and protective gowns was tight in March, just as the pandemic began.  She’s co-director of Geisinger’s critical care program — in charge of caring for covid-19 patients. In her rare off-hours, Korzick tried to craft her own supplies. She knew how to sew. She noticed her canister vacuum cleaner had a HEPA-filter bag. She went to work, cutting and stitching. She made her own N95 respirator mask using the vacuum bag. She conducted fit testing to make sure the mask seals were tight. It seemed to work.  Sandy Green, also worried about shortages, struck a deal with Korzick. She’d help engineer the gear. He’d raise funds and find volunteers to help.

They each contributed $4,000 of their own money. Jaime Green pitched in. They launched a GoFundMe campaign, raising more than $24,000. They found 300 volunteers to sew masks offering different levels of protection. Local businesses signed up to help.

They branched out, making protective gowns from old surgical drapes. Green hunted down contacts among the region’s manufacturers and middlemen, buying up surplus N95s and hospital masks. They started a project with Geisinger staff members and nearby Bucknell University professors to engineer a reusable respirator face mask using 3-D printers. They printed face shields.

Korzick’s basement was transformed into a staging area for volunteer efforts.

In one corner, dozens of bottles of bleach were stored in case Geisinger ran out of the disinfectant wipes used to clean covid-19 patient rooms.  In another, three medical residents cut the surgical drapes into shapes seamstresses could stitch into gowns. Plastic drop cloths were cut so they could cover COVID-19 patients when hospital workers needed to get extremely close — like during emergency CPR. The plastic cloths already were being used in crash carts at the hospital.

The three residents said they knew they were living through history. They wanted to be part of it in any way they could. The COVID-19 pandemic would become their war story — the kind older doctors love to tell young residents. “That’s the story we’ll tell,” said Miya McKnight, an internal medicine resident.

The volunteer project has pushed masks out to people who need them the most. Home health aides. Cancer patients. People on dialysis. Nursing home staff. Ambulance crews. The staff at a nuclear power plant 30 miles away. “Can you imagine if all those workers got sick?” Sandy Green said. “Whose is going to run it then?”

Green said he does not expect the supply-making effort to end even if the pandemic fades. He wants to keep it going as a nonprofit foundation so the community won’t need to look to outsiders for help during the next medical crisis.

Especially if the next crisis is like this one, with a virus that had everyone spooked — especially those who saw it up close at the hospital.

Reed and Korzick talked about what they would do if one of them got the virus. It felt like it was just a matter of time before a doctor or nurse got sick and was put on a ventilator. These two critical care doctors saw death frequently. But this pandemic was showing them something new.

They talked about the lives they’d led and their lack of fear about what was ahead. This was the job, Korzick said, voluntarily dedicating yourself to meeting the needs of others.

“You don’t want your friend who you’ve worked with for 10 years to feel bad if they can’t save you,” Reed said.

Getting ahead of the surge

De Ridder was working the same problem from another angle. He hoped to find a way to prevent patients from needing a ventilator.

The plasma of patients recovered from the infection should be rich in protective antibodies, the result of the body’s natural reaction to fighting the virus. Giving that plasma to an ill person should boost their immune system.

But it wasn’t a clear cure. During his medical residency at Duke University in Durham, N.C., de Ridder had been involved in a trial using plasma to treat influenza. That failed. But he believed it was worth a shot with the coronavirus. Big institutions like the Mayo Clinic and Johns Hopkins were trying it. He thought it could help people here.  He just needed a donor.

He found one in Patrick Konitzer, a Geisinger anesthesiologist. Konitzer believed he was infected returning home from a March trip to Dublin with his family. Trump had just announced American citizens in Europe should return home. Konitzer was stuck in a long airport line with people around him coughing.  He got sick a few days later. So did his daughter and his fiancee — a Geisinger nurse — along with her daughter.  They all recovered.

Konitzer’s plasma donation was scheduled to start at 1 p.m. at a blood bank about an hour away.  De Ridder later learned other recovered patients in the Geisinger system had donated plasma. Soon he had just enough plasma to give it to every COVID-19 patient who needed it.

At day’s end, de Ridder picked up Damien at camp. He asked his son about his homework and marveled at the construction paper flower he’d made.  They drove home — this time passing near the town’s Memorial Park, filled with monuments to the soldiers of past wars.

His wife, Rupa Ray, who has a doctorate in microbiology, was working from home. Normal dinner table talk was about immunology or diseases like sickle cell anemia.

But this night, they sat at the dining room table, covered by a 1,000-piece puzzle of a library painting. Damien said he didn’t feel like going to his taekwondo class via Zoom videoconferencing. He read a graphic novel while his parents talked.

De Ridder mentioned the anesthesiologist and how he hoped it was the start of something big, a way to change the course of this disease.

“Oh,” Ray said, “did he donate?”

“Yeah,” he said. “It went fine.”

It was just the beginning.