By Jim Harvey, Rural Health Farm Worker Protection Safety Specialist, Pennsylvania Office of Rural Health

The Novel Coronavirus Disease, known as COVID-19, is a highly infectious respiratory disease caused by a new typPreview (opens in a new tab)e of the common coronavirus. The disease was discovered in China in December 2019 and has since spread around the world. On March 11, 2020, the World Health Organization declared COVID-19 as a worldwide pandemic, meaning that it is a disease that is taking place over a very large geographic area and affecting an extremely large number of people. Although the disease started in China, it is not associated with any specific country and in America, it is not a result of any political action.

People who are infected with COVID-19 may experience a runny nose, a sore throat, a dry cough, fever, and in severe cases, difficulty breathing. They may start having these symptoms between 2 and 14 days after being exposed to someone or something that has the virus. The disease can be very mild or severe.

COVID-19 can spread easily from person-to-person through respiratory droplets from an infected person who coughs or sneezes. It also can be spread by touching a surface or object that has the virus on it and then touching your face. While everyone can get COVID-19, those who have a greater chance of getting it are older people and people of all ages who have ongoing medical conditions.

The response to COVID-19 is something that most people have never encountered. As we brave this new world together, but at a distance, here are some tips to take care of you and your family.

Protect yourself by thoroughly washing your hands often and stay six feet from another person.  Do not be in groups of 10 or more people and do not shake hands. If you are sick, stay home except to get medical treatment, and stay away from other people in your home. Use a tissue to cover your mouth and nose when you cough or sneeze or cough and sneeze into your elbow. Do not share personal household items and clean all surfaces in your house.

Products that have been approved by the government to clean areas potentially containing the coronavirus include ammonia, hydrogen peroxide, and peroxyacetic acid.

Holmes Morton, MD, founder of the Clinic for Special Children in Strasburg in Strasburg, PA and founder and medical director of the Central PA Clinic in Belleville, PA, is worried about the COVID-19 infections and crowd. “A gathering of hundreds of people at a fund-raising dinner or benefit auction could easily become the source of an outbreak of COVID-19 in the [Amish and Mennonite] community,” noted Morton.

According to Morton, each person who is infected and attends an event will pass the infection to an additional three to five people. The onset of symptoms for those who contract the illness at that event will be, on-average, 4.5 days later the event. Those who become ill, require hospitalization and intensive care, and survive will have prolonged and expensive hospital stays. Death and long hospital stays will happen most often in children and adults with underlying chronic diseases and in the elderly. For those who do not survive the illness, the median time from the start of the disease to death will be 12.5 days.

If you think that you might have COVID-19, you can get tested through local Clinics. Call your doctor or nurse for instructions BEFORE you go to their office and before you go to the hospital.

The Central PA Clinic in Belleville may soon be able to test for COVID-19 through CSI Labs in Huntingdon PA. For more information and to ask about the clinic’s testing services, call the clinic at 717-935-2065.

You also can call the Pennsylvania COVID-19 hotline at 1-877-PA-HEALTH (1-877-724-3258) if you are worried that you might have the disease or if you think you may need to be tested

COVID-19 is a very serious disease.  Do what you can to help stop the spread.

Other resources include:

Lancaster Online

Mennonite Church USA

Anabaptist Mennonite Biblical Seminary Library

On March 20, 2020, the Centers for Medicare & Medicaid Services (CMS) released two comprehensive toolkits on telehealth that are specific to general practitioners as well as providers treating patients with End-Stage Renal Disease (ESRD).

Under President Trump’s leadership to respond to the need to limit the spread of COVID-19, CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020.  A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. These benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19 are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.

Each toolkit contains electronic links to reliable sources of information on telehealth and telemedicine, which will reduce the amount of time providers spend searching for answers and increase their time with patients. Many of these links will help providers choose learn about the general concept of telehealth, choose telemedicine vendors, initiate a telemedicine program, monitor patients remotely, and develop documentation tools. Additionally, the information contained within each toolkit will also outline temporary virtual services that could be used to treat patients during this specific period of time.

You can find the Telehealth Toolkit for General Practitioners Here:  https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf

You can find the End-Stage Renal Disease Providers Toolkit Here: https://www.cms.gov/files/document/esrd-provider-telehealth-telemedicine-toolkit.pdf

CMS continues to monitor the developing COVID-19 situation and assess options to bring relief to clinicians. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov. For complete and updated information specific to CMS, please visit the Current Emergencies Website.

Free rural health COVID-19 “Call First” Communications Toolkit Available

As rural health leaders, the National Rural Health Association (NRHA) knows that you’ve been working diligently on communications regarding important issues such as social distancing, handwashing and overall messaging around practices to flatten the curve. An additional concern is taking all steps possible to not overburden our rural health facilities, while demonstrating leadership in our communities to promote a sense of vigilance, but also an environment of security and calmness.

In this spirit, NRHA through donated services of partner Legato Healthcare Marketing, is providing NRHA members free access to a communications toolkit with messaging focused on:

• Calling first to determine if you should be seen
• Your rural hospital/clinic is taking a leadership role to protect your community

Toolkit components – designed to allow customization and branding for your facility — include items such as print and digital ads, radio scripts, social media posts and media materials. Legato is donating its services not only for the production and use of these materials, based on CDC messaging and input from a rural health taskforce, but also for complimentary assistance in helping to download materials. Visit here. When entering this site, you will be asked to provide your email so that updates to the toolkit can be sent to you immediately, allowing you to respond promptly to this ever-changing situation.

Access Toolkit

March 20, 2020

Harrisburg, PA – The Department of Human Services (DHS) released guidance for its employment and training (E&T) programs in coordination with Governor Wolf’s mitigation guidance regarding COVID-19. Because closure of non-essential services will affect program operations, people participating in employment and training programs to meet a work participation requirement should participate remotely or be excused for the period that E&T programs are unable to operate. 

“The health and safety of our clients is our number one priority, so to that end we are encouraging people who feel ill, including people who are in our employment and training programs, to stay home. We will work with you to determine how to meet your E&T requirements and needs,” said Secretary Teresa Miller. “No one should fear losing their benefits due to circumstances beyond their control, and we are working with our E&T providers to excuse program participants during this period.”

No sanctions associated with COVID-19 should take place. If a program is closed, participants will remain enrolled in the program until it reopens. E&T providers have been instructed to be flexible and offer, to the extent possible, remote additives to keep individuals actively engaged. 

Individuals should not physically bring anything verifying their employment hours to their local county assistance offices (CAOs), which will be closed to the public until April 1 at the earliest. MyCOMPASS PA, the mobile app for benefits issued by the CAO, can be used by participants to send in verifications. Additionally, forms can be faxed/emailed/mailed directly to providers.

Visit the PA Department of Health’s dedicated Coronavirus webpage for the most up-to-date information regarding COVID-19.

Guidance to DHS providers related to COVID-19 is available here. 

MEDIA CONTACT: Erin James, 717-425-7606

Free Lookup Tool Available To See Your Local Situation

The rapidly increasing number of national COVID-19 cases is raising alarm among experts and state and local officials about health systems’ capacity to treat patients effectively and revealing the uneven geographic distribution of the country’s health care resources.

A special report by KFF’s Kaiser Health News (KHN) shows that more than half the counties in the United States have no intensive care unit (ICU) beds, which poses a particular danger to patients age 60 or older who fall victim to the coronavirus. Hospital ICUs have sophisticated equipment, such as bedside machines to monitor a patient’s heart rate and ventilators to help them breathe ― trouble breathing is a common symptom among seriously ill COVID-19 patients. Even in communities that do have ICU beds, the numbers vary wildly ― with some having just one bed available for thousands of senior residents.

KHN’s coverage includes a 50-state map that shows which counties have no lCU beds as well as which lack a hospital altogether. Thirty seven million Americans reside in such counties. An online “lookup” tool lets readers check the ICU bed capacity near their homes or in surrounding counties.

This report is part of KFF’s continuing efforts on the coronavirus outbreak. The national story also ran in USA Today and, as always, KHN content is available to republish free of charge. News organizations can request localized data by contacting Chris Lee.

On March 6, 2020, Pennsylvania Governor Wolf issued a disaster declaration in response to the presence of the COVID-19 coronavirus in Pennsylvania. Pursuant to this disaster declaration, the Office of Medical Assistance Programs (OMAP) in the Pennsylvania Department of Human Services (DHS) is issuing guidance to hospitals and community providers regarding submitting claims for services provided in alternative screening sites for COVID-19.

On March 9, CMS issued a Memorandum regarding “Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019 (COVID-19), which applies to both Medicare and Medicaid providers.

The memorandum discussed a hospitals options to mitigate exposure to COVID-19 and set up alternative screening sites both on and off the hospital campus.

The Pennsylvania Department of Health, the entity licensing hospitals in the state, issued guidance on the ability of hospitals to set up alternate screening sites for COVID-19. The guidance can be found here.

Hospitals do not need to enroll their on-campus or off-campus temporary screening sites separately in the Medical Assistance (MA) program. The Department of Human Services understands the Department of Health considers these sites part of the hospital and the areas are set up as part of the hospital’s emergency preparedness plan. Thus, hospitals should use their existing acute care hospital enrollment (01-010) or a hospital outpatient unit (01-183) to submit claims for services performed at these on or off campus screening sites.

Community Screening Sites Not Under the Control of a Hospital

Other non-hospital community providers may choose to set up COVID-19 screening sites. Community screening sites not under the control of a hospital and being conducted by a health care provider, such as an independent clinic, federally qualified health care center, rural health center, physician or physician office, laboratory or certified registered nurse practitioner, also do not need to enroll these sites separately.

As these sites are temporary in nature, providers should bill from office or clinic sites already enrolled in MA using a place of service that best describes where the service was provided.

This guidance will remain in effect for 90 days or while a valid disaster declaration authorized by the Governor related to the COVID-19 virus remains in effect, whichever is earlier. OMAP may re-issue these guidelines as appropriate.

Additional information about EMTALA requirements and COVID-19 can be found here.

Additional information is also available on the CDC website and through CMS.

Information on MA Program coverage related to COVID-19, including an FAQ document and instructions regarding the procedure codes to use for COVID-19 lab screenings, can be found on the Department of Human Services website here.

The Pennsylvania Department of Health has a dedicated page for COVID-19 that provides regular updates.

Click here for the most up to date information regarding COVID-19.

As part of National Institute for Occupational Safety and Health’s (NIOSH) efforts to keep our stakeholders up to date on the CDC and NIOSH COVID-19 response, below is a summary of new information posted this week for workers.

General 

• Guidance on Preparing Workplaces for COVID-19
  This document helps guide employers to implement engineering, administrative, and work practice controls and personal protective equipment (PPE), as well as considerations for doing so. It is intended for planning purposes. Employers and workers should use this guidance to help identify risk levels in workplace settings and to determine any appropriate control measures to implement. Additional guidance may be needed as COVID-19 outbreak conditions change, including as new information about the virus, its transmission, and impacts, becomes available.

Healthcare Worker Resources

• Return to Work for Healthcare Personnel
  New criteria for return to work for healthcare personnel (HCP) with confirmed or suspected COVID-19 is now available on the CDC website. This guidance is for occupational health programs and public health officials making decisions about return to work for HCP with confirmed COVID-19, or who have suspected COVID-19 (e.g., developed symptoms of a respiratory infection [e.g., cough, sore throat, shortness of breath, fever] but did not get tested for COVID-19).
• Clinician Toolkit
  CDC’s Prepare to Care for COVID-19 is a resource with practical tools clinicians can use to care for patients with COVID-19. This resource will be regularly updated to help clinicians adapt as the outbreak unfolds.
• New NIOSH Science Blog: Proper N95 Respirator Use for Respiratory Protection Preparedness
  Healthcare facilities should ensure that healthcare workers who may be called to care for COVID-19 patients are prepared to use respiratory protection, among other personal protective equipment. Healthcare facilities should make sure their healthcare workers are fit tested, if possible, medically evaluated, and receive ongoing training in proper use. This resource has reminders and illustrations about proper respiratory use.

To stay up to date on the response please visit the COVID-19 webpage or sign up for the COVID-19 newsletter

The National Multiple Sclerosis Society is focused on the needs of people living with MS and that the health and safety of them and their families are their first priority as we move through the COVID-19 pandemic together. To protect the well-being of our communities, the society will not gather for in-person events, programs or advocacy activities through May 17. Instead, they are reimagining how to ensure everyone in the MS movement feels connected, supported and informed. They want everyone to reach out to the people they know in the MS movement – no matter where they are. And they are here to provide the tools and support needed to raise awareness and funds. they know that times of uncertainty can isolate us from each other. By connecting, we strengthen each other. The society has gathered information and resources below to keep you up to date on COVID-19 and what you can do. Stay tuned to the Coronavirus Resource Page for the latest updates and information.