Process to Reopen Pennsylvania

The 2019 Novel Coronavirus (COVID-19) pandemic is an unprecedented event that has impacted every part of the globe. Pennsylvania has seen a similar unprecedented burden of COVID-19 and has taken equally unprecedented measures to save lives and reduce morbidity of the COVID-19 virus.

The commonwealth has responded aggressively to the spread of COVID-19, first by working to contain the virus through contact tracing and quarantines for residents who came in contact with someone who tested positive for the virus to slow sustained community spread. When sustained community spread was established, the commonwealth moved to mitigation efforts early in the response by issuing orders to close schools and non-life-sustaining businesses; and to restrict large gatherings. This decision to respond aggressively has proven to be an essential and effective measure to reduce the spread of COVID-19 and ultimately save an unrealized number of Pennsylvanians’ lives.

Mitigation efforts have helped to curtail the spread of COVID-19 so our hospitals can treat patients without overwhelming our limited supplies of personal protective equipment (PPE), ventilators, or beds. Throughout the pandemic, we have closely monitored our hospital system capacity through the creation of a public dashboard, and we have built and distributed millions of goods and materials to help our health care system manage the influx of patients.

PA DOH and PEMA have worked together to develop plans and stand up alternative care sites in the northeast and southeast so when our health care system becomes overwhelmed, we can load balance patients and supplies by keeping patient safety top of mind. At this point, alternative care sites have been identified in other areas of the commonwealth and can quickly stand up should there be a surge in other areas of the state.

As the situation stabilizes, we are planning a measured and strategic approach to allowing Pennsylvanians to return to work safely to prevent a resurgence of the virus. This must be done in the most effective, efficient, and risk-adverse method possible to balance our return to economic stability, while at the same time continuing to keep Pennsylvanians safe by controlling the spread of disease.

We are planning for the days and weeks ahead when we will not only safely return Pennsylvanians to work but return to a different and more resilient Pennsylvania. While we cannot be certain of the future path of this disease, our decisions will be driven first by prioritizing the health and safety of all Pennsylvanians.

To that end, the commonwealth is partnering with Carnegie Mellon University (CMU) to create a data-driven decision support tool that will enable a balance between maximizing the results of our economy while minimizing public health risks. This tool will help better understand the current health and economic status, as well as the inherent risks and benefits to easing restrictions by sector and region.

In consultation with Team PA, PA DOH, PEMA, the Department of Community and Economic Development, the Department of Labor & Industry, and others, the administration will develop guidance for businesses, local governments, workers, and customers with the goal of guiding a safe and iterative reopening process.

Pennsylvania plans to proceed with returning to work cautiously. Broad reopenings or reopenings that are not structured around ongoing social distancing, universal masking, or other public health guidance would likely result in a spike of cases and new stay-at-home and closure orders.

Throughout this process, the administration will have guidance in place to support best public health practices. This guidance will reinforce and build on existing worker and building safety orders. It will also be able to adapt to the changing nature of the pandemic, as well as lessons learned from communities that return to work strategically.

Discussed in greater detail below, the administration 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.

The red phase 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.

safety protocols.

Red Phase
Work & Congregate Setting Restrictions
Life Sustaining Businesses OnlyMasks Are Required in BusinessesCongregate Care and Prison Restrictions in PlaceSchools (for in-person instruction) and Most Child Care Facilities Closed
Social Restrictions
Stay at Home Orders in PlaceLarge Gatherings ProhibitedMasks Are Required in all Public SpacesRestaurants and Bars Limited to Carry-Out and Delivery OnlyOnly Travel for Life-Sustaining Purposes Encouraged

• Reiterate and reinforce safety guidance for businesses, workers, individuals, facilities, update if necessary
• Monitor public health indicators, adjust orders and restrictions as necessary

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, hair and nail salons, 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.

Yellow Phase
Work & Congregate Setting Restrictions
Telework Must Continue Where FeasibleBusinesses with In-Person Operations Must Follow Business and Building Safety OrdersMasks Are Required in BusinessesChild Care May Open Complying with GuidanceCongregate Care and Prison Restrictions in PlaceSchools may provide in-person instruction only in accordance with Department of Education guidance.
Social Restrictions
Stay at Home Order Lifted for Aggressive MitigationLarge Gatherings of More Than 25 ProhibitedMasks Are Required in all Public SpacesIn-Person Retail Allowable, Curbside and Delivery PreferableIndoor Recreation, Health and Wellness Facilities and Personal Care Services (such as gyms, spas, hair salons, nail salons and other entities that provide massage therapy), and all Entertainment (such as casinos, theaters) Remain ClosedRestaurants and Bars May Open Outdoor Dining, in Addition to Carry-Out and Delivery (effective 6/5/2020)

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

After a county transitions to the yellow phase, we will closely monitor for increased risk, such as significant outbreaks. If overall risk remains mitigated for fourteen days, we will transition the county to the green phase.

The green phase eases most restrictions with the continued suspension of 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.

Green Phase
Work & Congregate Setting Restrictions
Telework Must Continue Where FeasibleBusinesses with In-Person Operations Must Follow Updated Business and Building Safety RequirementsAll Businesses Operating at 50% Occupancy in the Yellow Phase May Increase to 75% Occupancy, Except Where Noted for Bars and RestaurantsMasks Are Required in BusinessesChild Care May Open Complying with GuidanceCongregate Care Restrictions in PlacePrison and Hospital Restrictions Determined by Individual FacilitiesSchools Subject to CDC and Commonwealth Guidance
Social Restrictions
Gathering Limits Determined Using Maximum Occupancy CalculatorMasks Are Required in all Public SpacesSelf-certified Restaurants May Open at 50% Capacity for Indoor DiningOn-premises Alcohol Consumption Prohibited Unless Part of a Meal; Cocktails-to-go and Carryout Beverages are AllowedServing Alcohol for on-site Consumption Must End at 11:00 PM and All Alcoholic Beverages Must Be Removed From Patrons by MidnightPersonal Care Services (including hair salons and barbershops) Open at 50% Occupancy and by Appointment OnlyIndoor Recreation and Health and Wellness Facilities (such as gyms and spas) Open at 50% Occupancy with Appointments Strongly Encouraged; Fitness Facilities Are Directed to Prioritize Outdoor Fitness ActivitiesAll Entertainment (such as casinos, theaters, and shopping malls) Open at 50% OccupancyConstruction Activity May Return to Full Capacity with Continued Implementation of Protocols

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

History

The first confirmed case of the 2019 novel coronavirus in the United States was reported in Washington state on January 21; on January 30, the World Health Organization declared the virus a global health emergency.

The Pennsylvania Department of Health (PA DOH) began daily leadership meetings on January 26, to carefully track the disease, prepare a response, and coordinate with federal and hospital partners.

On February 1, PA DOH stood up its DOC, or Department Operations Center, on a 12 hour, 7 days a week activation status at the Pennsylvania Emergency Management Agency (PEMA). Staffed by PA DOH epidemiologists, public health nurses, physicians, logistical, planning and communication support, the Pennsylvania Department of Human Services and PEMA to closely monitor the spread of the disease, and begin containment strategies in furtherance of the state’s preparedness plans.

On March 4, due to the continued spread of the virus throughout the United States, PEMA partially activated its Commonwealth Response Coordination Center (CRCC) to provide planning and logistical support for PA DOH and to coordinate situational awareness across state agencies and all 67 counties within the commonwealth.

On March 6, Pennsylvania recorded its first two cases of COVID-19 and Governor Tom Wolf signed a Disaster Declaration to ensure the state had the resources and authority to plan the process of containment and mitigation in Pennsylvania, assuring Pennsylvanians that the commonwealth was prepared to face this crisis.

On March 7, PEMA elevated the activation level of its CRCC to a full activation during daylight hours to provide for additional support for PA DOH and to coordinate planning and response operations across state agencies and federal, state, and local jurisdictions.

From the beginning of the pandemic, the administration undertook a measured, regional strategy to mitigation and containment, and protecting Pennsylvanians with the assurance that they could receive testing and treatment for COVID-19 without any financial burden. Decisions and actions were taken on a state, county, and regional basis in coordination with local elected officials, public health experts, and other stakeholders.

On March 10, PEMA, with assistance from PA DOH, conducted a COVID-19 planning workshop and tabletop exercise for all state agencies to discuss preparations, potential impacts, and agency Continuity of Operations Plans (COOP) related to operations during a pandemic.

On March 12, with cases rising in Montgomery County, Governor Wolf closed schools and adult day centers there for 14 days, requesting that non-essential businesses close and county residents limit travel. He also imposed limited visitation in nursing homes and correctional facilities. The mitigations would prove to be vital as cases increased in the Southeast over the next week.

On March 13, Governor Wolf announced that mitigation efforts would be extended to Delaware County and all Pennsylvania schools would be closed for 10 days beginning March 16. Additionally, on March 13 the President of the United States issued a National Emergency, which included Emergency Disaster Declarations for all 50 states for emergency protective measures for COVID-19 response operations that was retroactive to January 20.

On March 14, with cases in Pennsylvania nearing 50, Governor Wolf announced additional closures in Bucks and Chester counties.

On March 16, because of the continued spread of the virus across the commonwealth and increasing case counts, PEMA began 24/7 operations of its CRCC in support of PA DOH and to maintain situational awareness, coordinate resource support, and provide planning support across the state agencies and federal, state, and local jurisdictions.

Under guidance from Health Secretary Dr. Rachel Levine, Governor Wolf ordered all Allegheny, Bucks, Chester, Delaware, and Montgomery county bars and restaurants to cease dine-in operations beginning March 16 for 14 days.

On March 18, PA DOH announced the first death from COVID-19 in the state.

On March 19, Governor Wolf ordered all non-life-sustaining businesses to close across the commonwealth to help stop the spread of the virus. The administration provided guidance, refined parameters, and designed an exemption process that could allow some businesses to remain open under strict guidance from the state. Additionally, on March 19 the governor received notification of approval of his request for a Small Business Administration (SBA) disaster declaration for the Economic Injury Disaster Loan (EIDL) program to provide much-needed aid to businesses impacted by the COVID-19 mitigation procedures.

On March 23, Governor Wolf and Dr. Levine began the process of issuing additional stay-at-home orders based on county cases and modeling of the possible spread.

Timeline of County Stay-at-Home Orders:

• March 23 Allegheny, Bucks, Chester, Delaware, Monroe, Montgomery, and Philadelphia counties;
• March 24 Erie County;
• March 25 Lehigh and Northampton counties;
• March 27 Berks, Butler, Lackawanna, Lancaster, Luzerne, Pike, Wayne, Westmoreland and York counties;
• March 28 Beaver, Centre, Washington counties;
• March 30 Carbon, Cumberland, Dauphin and Schuylkill counties;
• March 31 Cameron, Crawford, Forest, Franklin, Lawrence, Lebanon, Somerset counties; and
• April 1 Statewide Stay-at-Home Order.

As the administration issued stay-at-home orders, it also moved to make more materials available to health care systems by working with the legislature to invest $50 million in support for hospitals and health systems. The administration also worked with the legislature to move the primary election from April 28 to June 2.

Federal support and aid have been critical in the state’s response. On March 29, to seek all available aid, Governor Wolf requested a federal major disaster declaration. On March 31, the federal government granted approval. Beginning with early assurances that COVID-19 testing and treatment would be covered for all Pennsylvanians at no cost, Governor Wolf took additional steps to ensure everyone in the state was treated fairly and without discrimination amid the pandemic.

On April 3, to reinforce mitigation and safety surrounding the COVID-19 pandemic, Governor Wolf called for universal masking and requested that religious leaders consider alternate forms of worship.

Additionally, on April 3, Pennsylvania was one of the first states to receive statewide approval from the Federal Emergency Management Agency (FEMA) to conduct non-congregate sheltering in response to the COVID-19 emergency in the commonwealth.

On April 5, Governor Wolf announced that Dr. Levine issued an Order to make the buildings Pennsylvanians work in safer.

To successfully mitigate a surge that could overwhelm the state’s health care system, the administration sought information, capabilities, and needs from manufacturers that could ramp up to supply necessary personal protective equipment (PPE) and others supplies. In addition, health care facilities began the process of transferring supplies to help secure preparedness for those areas with greater needs. The state issued an order for the ability to transfer supplies around the commonwealth, as necessary to load balance the system.

On April 9, Governor Wolf announced the closure of schools through the end of the academic year and a temporary reprieve program for non-violent state correctional facility inmates amid Department of Corrections plans to keep inmates safe while incarcerated.

Communication and collaboration with other states have been vital as people typically travel between neighboring states for work, to visit family, and to vacation under non-pandemic circumstances. On April 13, Governor Wolf joined six other governors (NY, NJ, CT, RI, DE, MA) in a council to plan how states can work together to safely reopen and begin the process of recovery.

On April 15, the Secretary of Health issued an Order requiring safety measures in all businesses permitted to maintain in-person, physical operations except for health care providers. These measures included standards for cleaning and disinfecting high-touch areas, establishing protocols for businesses exposed to a probable or confirmed case of COVID-19, limiting the numbers of employees and customers on the premises, ensuring that employees have access to soap, sanitizer, and face masks, and that patrons wear face masks.

On April 17, Pennsylvania was the first state to have a Memorandum of Understanding (MOU) accepted by FEMA for purchasing and distributing food through established Food Banks in the commonwealth.

Also, on April 17, Governor Wolf outlined the standards the administration will use for reopening and on April 20, Governor Wolf announced a target date of May 8 for the beginning of phased reopening and easing of restrictions.

Our approach will be data driven and reliant upon quantifiable criteria to drive a targeted, evidence-based, regional approach to reopenings in Pennsylvania.

To help inform decisions about what regions to reopen, and on what timeline, the commonwealth has partnered with Carnegie Mellon University and other institutions of higher education, to develop a data dashboard. This dashboard, as well as demographic and health criteria described further below, such as population density, mobility, availability of testing, and health care resources will inform formal recommendations made jointly by the Secretary of Health, the PEMA Director, and the Secretary of the Department of Community and Economic Development to the governor regarding when a region may safely move from one phase of reopening to the next. In preparing recommendations, the secretaries and PEMA director will meet to review the data sources described more fully below, balance risks to public health, and benefits to the economy, and agree unanimously as to the phase in which each region should safely be categorized.

First, DOH, in coordination with PEMA, other commonwealth agencies, and stakeholders in the areas of public health, economics, and emergency management, has developed criteria that will help guide decisions about reopenings and the easing of restrictions.

A target goal for reopening was initially set at having fewer than 50 new confirmed cases per 100,000 population reported to DOH in the previous 14 days.

So, for example, an area with a population of 800,000 people would need to have fewer than 400 new confirmed cases reported in the past 14 days to meet the target. An assessment then determines if the target goal has been met, and the administration works closely with county and local governments to enable the communities to reopen and transition back to work.

With the commonwealth dramatically increasing its testing capacity, as of May 22, the fewer-than-50 new cases per 100,000 population measure will be considered, but it will be reviewed in the context of various other factors that are indicative of risk.

Additionally, the commonwealth must ensure there is:

• Enough testing available for individuals with symptoms and target populations, such as those at high risk, health care personnel, and first responders.
• Robust case investigation and contact tracing infrastructure is in place to facilitate early identification of any cluster outbreaks and to issue proper isolation and quarantine orders.
• Identification of area’s high-risk settings, including correctional institutions, personal care homes, skilled nursing facilities, and other congregate care settings, and assurance that facilities have adequate safeguards in place such as staff training, employee screening, visitor procedures and screening, and adequate supplies of PPE to support continued operations.

View CMU Risk-Based Decision Support Tools PDF (November 19, 2020).

Second, the commonwealth will use a modeling dashboard under development and evaluation by Carnegie Mellon University to take a regional and sector-based approach to reopenings, the easing of restrictions, and response.

The administration will use this data-driven decision support tool to better understand the current health and economic status, as well as the inherent risks and benefits to reopening certain businesses and industry areas. Using data that considers worker exposure and spread risks, health care capacity, economic impact, and supply chain impact, we will prioritize reopening where it has the potential for the most positive impact on the economy for workers and businesses while mitigating risk to public health and safety.

In order to arrive at results through this dashboard, the Commonwealth of Pennsylvania is providing access to data from several commonwealth agencies including the Departments of Labor & Industry, Human Services, Community and Economic Development, Revenue, and Health.

The dashboard will help with questions such as: What will be the likely public health and economic implications associated with opening an industry? What impact might reopening have on vulnerable workers and businesses? The data from the dashboard will also provide insights and recommendations at the industry and county level to inform state policy decisions.

The analysis will link data sources together to build an understanding of the current and real time state of Pennsylvania’s economy and the impact of the spread of COVID-19. The model will help to predict and understand what types of individuals, businesses, and industries will be more at risk, most vulnerable, and impacted by COVID-19. The model will apply what-if scenarios that will allow the state to understand the impact of potential re-opening decisions. The analysis will allow the commonwealth to monitor changes over time and the impact of decisions. The purpose is not to make decisions but rather to inform decision makers. For example, all indicators could point to opening a specific county, but other factors such as population density around a hotspot, availability of supplies to ensure workers are protected, either PA DOH criteria or proximity to a hotspot in another county could make the county unfit to open.

Regions

Just as the administration took a measured, county-by-county approach to the Stay at Home order before expanding the order statewide, it will do the same to ease restrictions and reopen the state.

As regions meet the measures described earlier, the commonwealth will ease restrictions with the goal of broad reopenings as soon and as safely as possible. Certain regions have seen less case density than others. In these regions, it is important to account for hospital capacity as reopenings and the easing of restrictions begin. This information is part of the data and modeling project. For example, in the north central region there is less population density and fewer cases, but there is less hospital capacity if cases and hospitalizations were to surge. These factors will be considered on an ongoing basis and employers will be responsible for developing and demonstrating compliance with criteria in consultation with PA DOH and other relevant state agencies. At any point, the Governor, in consultation with PA DOH and PEMA may revise reopening standards to adjust for the spread of disease.

Industries

The reopening and the easing of restriction approach will primarily focus on regions, however certain industries are more susceptible to the spread of COVID-19. Other industries are more vulnerable to changing economic conditions. These factors are also part of the data and modeling project and will be closely considered as part of the reopening and the easing of restriction process. The first or “Yellow” phase of reopening will focus on businesses with low and moderate risk profiles, including those with low worker density, those that take place in outdoor settings, and those that can successfully implement the Governor and Secretary of Health’s Worker Safety and Building Safety Orders, while encouraging those who can telework to continue to do so (see later section on “Phases”). When reopened, these businesses will have to adhere to strict guidelines for density and procedures. The administration will work with stakeholders in various industry sectors, as well as labor representatives and health professionals to craft guidance with tailored and appropriate safeguards in place.

We will put forth guidance and recommendations for employers, individuals, and health care facilities and providers for assured accountability as we reopen.

Since the beginning of the pandemic, the Wolf Administration has provided general safety guidance for businesses, organizations, and individuals. As the administration begins the reopening and the easing of restriction process, this guidance will be refined and strengthened so businesses and organizations can continue to prioritize public health and safety while attracting new business and getting the economy back on track.

All Pennsylvanians should continue to maintain social distancing even as the reopening and easing of restriction process begins. With few exceptions, Pennsylvanians should maintain a distance of six feet from each other, gatherings of more than 25 people will be prohibited, and non-essential travel should be avoided. In addition, individuals should engage in frequent hand washing and sanitizing, and surfaces should be disinfected as often as possible.

For employers, remote or telework should be the primary option if possible. Employers should expand technology where possible to provide remote or telework options. If remote or telework are not possible, employers must follow the guidance developed by the commonwealth in order to reduce the risk of coronavirus spread and to ensure workers are kept safe.

Guidance

Working across agencies, the commonwealth provided broad guidance for businesses and individuals that will enable employers to use their own expertise to decide what is best for their business while reporting on outcomes to the commonwealth. This guidance re-emphasizes and builds on existing orders previously issued to protect employees and customers, specifically the building safety and workers’ safety orders. The guidance formalizes and builds on CDC recommendations and other best practices in states across the country.

Communicating COVID-19 Safety Procedures to Employees and Customers

Organizations will be required to make employees and customers aware of the guidance provided by the commonwealth to keep people at their establishment safe. Similar to Workers’ Compensation or OSHA regulations, the commonwealth will require commonwealth-created “COVID-19 Safety Procedures for Businesses” flyer to be clearly displayed at workplaces, along with publicly posted acknowledgement by the employer that the guidance is being followed. There is also a requirement to name a “Pandemic Safety Officer” who would be in charge of carrying out the COVID-19 safety procedures set forth in this guidance.

The business reopening guidance will provide more information about expectations for communicating safety procedures to employees and customers.

Supplier Directory

The administration recognizes the difficulty of procuring materials businesses need to safely resume operations. In order to address this concern, the Department of Community and Economic Development created a supplier directory for protective materials.

Reopening necessitates that adequate personal protective equipment and diagnostic testing are available.

Personal Protective Materials and Hospital Stockpiles

Ensuring adequate supplies of Personal Protective Equipment (PPE) and other supplies needed to conduct diagnostic testing, care for COVID-19 patients, and support other normal health care functions is critical to resuming normal operations. The global nature of the COVID-19 pandemic has adversely impacted the normal supply chain for these materials as the demand has significantly outpaced the ability to produce or acquire the PPE and supplies needed. Since early March the Wolf Administration has worked tirelessly to procure and distribute PPE and other supplies to hospital systems, long-term care facilities, first responders and emergency management agencies throughout the commonwealth to respond to the COVID-19 crisis

As of April 22, the Wolf Administration has distributed 3 million N95 masks, approximately 231,000 gowns, approximately 1.36 million procedure masks, more than 1.32 million gloves, more than 68,000 face shields, and more than 5,300 coveralls to more than 900 unique places.

The Wolf Administration continues to monitor PPE and stockpile levels at our health systems, and takes that information into consideration as it makes decisions.

Diagnostic Testing

As of April 21, 2020, over 163,000 Pennsylvanians have been tested for COVID-19 at 67 unique testing sites, including our own State Public Health laboratory and two county public health labs. Over 700 tests a day can be done at the PA DOH State Public Health laboratory and PA DOH has deployed 14 rapid testing machines to vulnerable congregate settings including correctional facilities and health care and state hospitals. Additionally, during the course of the pandemic, the Wolf Administration supported the establishment of three community-based testing sites which were located in Montgomery, Philadelphia, and Luzerne counties. The Luzerne County site is currently open and can test up to 250 people per day.

As the administration takes steps toward reopenings and the easing of restrictions, diagnostic testing capacity will be a critical factor in early identification of new infections or cluster outbreaks, changes in the spread of the virus, the extent of virus spread throughout the commonwealth, and whether healthy individuals who were previously exposed to the virus have developed immunity.

The commonwealth’s testing plan consist of a multilayered approach comprised of the following components:

1. Community based testing available through:
   1. Existing health care institutions;
   2. State managed, locally executed community based or mass testing sites; and,
   3. Corporate managed and supported testing sites such as those available through commercial pharmacies and other providers.
2. Point of Care (POC) testing available through:
   1. Primary Care Physicians (PCP);
   2. Hospital Emergency Departments, urgent care, or other acute care centers;
   3. County health departments;
   4. Institutions with congregate care settings that have their own health care capability; and,
   5. Outbreak response teams responding to congregate care settings to identify spread of virus within institutions.
3. Serology testing as it becomes commercially available to determine the extent of the population that may have been exposed to COVID-19 and have developed antibodies to the virus and potentially have immunity.

The testing strategy also includes a plan to test underserved populations and those that have limited availability of transportation by employing a mobile community-based testing strategy as applicable.

Reopening requires a monitoring and surveillance program that allows the commonwealth to deploy swift actions for containment or mitigation.

The administration will use the data and modeling tools available as well as other indicators to determine if changes in the reopening and the easing of restriction process must take place.

Robust surveillance, case investigation, contact tracing, and isolation of positive cases or quarantine of close contacts can slow and stop the transmission of COVID-19. Pennsylvania’s public health infrastructure of epidemiologists, community health nurses, and county and municipal health departments are the backbone of this work. These public health professionals are supported by surveillance and case management technology tools to track, manage, and evaluate efforts.

To scale our surveillance and monitoring infrastructure the commonwealth has:

• Partnered with Department of Human Service’s eHealth Authority and the regional Health Information Exchange to monitor rate of emergency department visits and inpatient admissions.
• Established alerts from EpiCenter, Pennsylvania’s syndromic surveillance system, for early identification of an increase in disease activity.
• Provided county-level and zip code level data through a public facing dashboard.
• Daily detailed analysis of surveillance data related to cases and test results, analysis of geospatial clusters of cases.
• Twice weekly reconciliation with surveillance data and electronic death data to provide more accurate counting of deaths related to COVID-19.
• Improving access to testing and timeliness for reporting for symptomatic close contacts in regions where this containment strategy is being implemented.

As counties return to work the department will use these tools and the complete case investigation and contact tracing plan of positive cases to stamp out disease transmission. Positive cases will be isolated, and their close contacts counseled and quarantined. The department will continue to conduct investigations of outbreaks at businesses, correctional facilities, and long-term or other congregate care facilities. This work will be done in partnership with local health departments and other health care infrastructure in the region. Existing public health systems and new technology tools will be utilized to support these boots on the ground efforts.

Protections for vulnerable populations must remain steadfast throughout the reopening process, such as limitations on visitors to congregate care facilities and prisons.

Pennsylvanians in congregate care and prisons are especially vulnerable to outbreaks. Until the pandemic is controlled, the commonwealth must continue measures designed to protect outbreaks in facilities like nursing homes, long-term care facilities, residential treatment facilities, and prisons. As the commonwealth reopens and eases restrictions on a regional basis, restrictions on visitors in congregate care settings and prisons will remain in place. These restrictions will be among the last restrictions eased to ensure resident health and safety. We are committed to alternative means of communication for residents with their family, friends, community members, and advocates while we take necessary health and safety precautions.

While the administration has needed to take unprecedented action in limiting visitation for vulnerable populations in congregate care settings, we are doing all we can to create new opportunities for social connectedness. For example, the Department of Aging through its Office of the Long-Term Care Ombudsman has developed a strategic partnership with the AARP to re-establish lines of communication with nursing home residents in targeted facilities throughout the commonwealth. As this disaster emergency continues over the next weeks and months, this critical technology, when strategically placed, will help meet the psychosocial needs of these already vulnerable individuals.

Congregate Care Facilities

On March 16, the Department of Human Services closed LIFE day centers to avoid congregate settings and to practice social distancing. The closure applies to the day center portion only. LIFE Provider Organizations should continue to use discretion when utilizing the clinic and therapy areas to see participants. FAQs are provided here.

On March 18, PA DOH issued guidance for nursing facilities on COVID-19 mitigation. This guidance required visitor limitations, personnel restrictions, and other measures to reduce the spread of COVID-19 in nursing facilities. This guidance will continue.

On March 29, the Department of Human Services issued guidance restricting all visitations in Personal Care Homes and Assisted Living Residences except for medically necessary visits and compassionate care situations, such as end-of-life situations. 

On March 31, the Department of Human Services issued guidance for residential providers under the Office of Mental Health and Substance Abuse Services including Long-Term Structured Residences, Community Residential Rehabilitation Services, Residential Treatment Facilities, and Crisis Residences recommending all providers develop temporary modifications to their visitation policies that prohibit all non-employee visitors unless it is a medical necessity, required by court order, adult protective services or older adult protective services staff as outlined in guidance issued under applicable protective services laws. At the discretion of the facility director, additional exceptions may be made where a visit is deemed to be necessary. This guidance will continue.

On April 4, the Department of Human Services temporarily suspended all transfers to state-run juvenile justice facilities. This step was taken to allow staff to create two ten-bed intake units to mitigate risk of spread at the state-run facilities. Youth awaiting transfer to the state-run juvenile justice system will be admitted to the intake unit on the same day and remain in the unit for 14 days until they are cleared for entry into their designated program. If any youth test positive for COVID-19 during this 14-day period, they will be moved into isolation and the youth who are in the intake unit will restart their 14 days in the unit to make sure that they do not develop symptoms of COVID-19. Youth in the intake unit will have access to a counselor, psychological and medical services, physical activity, and other individualized recreational activities. Social distancing will be enforced, and youth will be able to maintain contact with their family through phone calls, video conferencing, and letters.

On April 7, the Department of Human Services issued procedures that must be followed for admission of an individual to one of the department’s state facilities. Requirements include individuals be screened for COVID-19 prior to admission to state operated psychiatric hospitals, the long-term care facility (South Mountain Restoration Center), state centers, and Youth Development Centers or Youth Forestry Camps. Any individual who meets screening criteria for indication of infection but does not have documentation of a negative test result for COVID-19, may not be admitted. A medical clearance attestation from a physician within 72 hours prior to the requested admission date is acceptable for admission if the individual was screened with a negative result. If there was a positive screening, regardless of a COVID-19 test result, the individual must not be admitted until 7 days have passed since symptom onset, and 3 days (72 hours) after the resolution of fever without fever reducing medicines and improvement of other symptoms. If an individual has had a close contact with someone suspected to have, or diagnosed with, COVID-19, the individual should quarantine for 14 days from the last admission to a facility should not occur until after the 14-day quarantine is complete.

State Correction Institutions

On March 12, the DOC started their mitigation efforts by screening all staff across the state and canceled in person visitation before statewide mitigation was ordered. On March 28, the DOC shifted all new inmate intakes to one centralized location at SCI Retreat to allow for a period of quarantine before assigning their home institution.

At 10 p.m. on March 29, the DOC began a statewide inmate quarantine in response to the COVID-19 pandemic.

Since the quarantine began, inmates have been fed in their cells, and afforded out-of-cell time only for video visits, phone calls, access to the law library, as well as in-cell programming. All inmate movement is controlled to conform to social distancing recommendations. This guidance will continue.

To expand inmate interaction with their loved ones, video visits are being held seven days a week. To date, DOC has conducted almost 16,000 video visits with more scheduled every day. This number will continue to increase due to daily scheduling happening at state prisons. In addition, DOC officials have begun reducing the population where they can. Steps taken include:

• Furloughing paroled individuals from centers to home plans;
• Working with the parole board to maximize parole releases; and,
• Reviewing parole detainers for individuals in county jails and state prisons.

On April 10th, the governor issued reprieves for inmates who met criteria for the Temporary Program to Reprieve Sentences of Incarceration.

Limitations on large gatherings unrelated to occupations should remain in place for the duration of the reopening process.

At this time, the commonwealth continues to follow federal guidance on restrictions on large gatherings. The CDC continues to recommend against larger gatherings of people, particularly gatherings where vulnerable populations may be present. This guidance will stay in place for the duration of the reopening process until there is robust testing, community-wide surveillance, contact tracing, or other means to mitigate the spread of the virus.

Support Systems

As reopenings and easing of restrictions begin, we need to provide adequate support systems for workers. That includes reopening of programs that support individuals’ ability to return to work such as schools, child care facilities, adult day facilities, summer camps and afterschool programs, community recreational facilities, and more.

Child Care

The COVID-19 related school closure has created a gap in child care that may not have existed just a few months ago. We know this gap may potentially be a barrier for many Pennsylvanians preparing to transition back to work outside of the home. To address this barrier, the Departments of Education and Human Services are working with stakeholders to identify child care and school age care needs across the commonwealth. A primary focus will be exploring and creating options that will work best for families within their community. We will also look to our many partners to help us design a realistic plan that not only re-opens and expands these services if necessary, but also creates a restored sense of confidence in these environments as safe and healthy options when caregivers return to work.

K-12 Schools

On April 9, Governor Wolf and the Pennsylvania Department of Education announced that school buildings would be closed for the remainder of the 2019-2020 academic year. The Department of Education worked with Intermediate Units (IUs) and the Pennsylvania Training and Technical Assistance Network (PATTAN) to develop guidance and evidence-based resources around continuity of education to ensure all schools provide continuity of education for all students in the most accessible and appropriate ways possible. Working with the General Assembly, the Governor signed Act 13 of 2020 to waive the School Code requirement for a minimum 180-day school term, an action that builds on the administration’s earlier commitment that no district or school would be penalized for falling short of the 180-day school term requirement.

In addition, Pennsylvania sought and received approvals from the federal government to allow schools the option to distribute meals to children age 18 and under at no cost while schools are closed. Although not required, participating schools are strongly encouraged to continue distributing and/or delivering school meals during breaks.

Higher Education

On April 9, the Governor and the Pennsylvania Department of Education announced that all postsecondary institutions in Pennsylvania must suspend in-person instruction at least through the end of the spring 2020 term. Postsecondary institutions may not resume in-person instruction until the governor permits them to open or lifts the closure of non-life-sustaining businesses.

Government Services

Local Government

Since the beginning of the COVID-19 outbreak, the Governor’s Office has been in close collaboration with local leadership at the county and municipal level. Early on, the Governor’s Office consulted with and informed county commissioners and municipal leadership about starting mitigation efforts in their jurisdictions. The Governor’s Office shared public health concerns and information and took local feedback into account when making decisions around mitigation. This collaboration led to a strong, coordinated effort to prevent the spread of COVID-19 across the commonwealth.

As we look to reopen regions of the commonwealth, the Governor’s Office will be undertaking that same coordinated approach to relaxing the governor’s mitigation efforts. Local feedback, knowledge, and expertise will be critical as we move through all phases of reopening. The Governor’s Office will continue to coordinate with local officials directly, when appropriate, and through their statewide representative organizations.

In the 10 jurisdictions with local county or municipal health departments, PA DOH will continue to coordinate closely with local health officials to ensure that there is a shared understanding of the public health rationale behind reopening decisions. In the remaining areas without countywide health departments, PA DOH will continue to discuss public health realities directly with county commissioners.

The shared goal of the state and local governments is, and should continue to be, a united front in which all levels of government are prepared to lead the citizens of Pennsylvania through this pandemic and to a safe, efficient, and effective reopening.

State Government

The COVID-19 global pandemic has created an unprecedented situation within our workforce. The Commonwealth is not excluded from this as it is the second-largest employer in the state. Throughout the COVID-19 crisis, state workers have continued to provide essential services to ensure public safety and the public health of all Pennsylvanians, specifically our most vulnerable populations. Roughly 43,000 employees continue to report onsite daily to perform vital work while roughly 18,000 employees remain teleworking in a full-time capacity.

As the state looks to reopen, it will do so in a phased approach in consultation with PA DOH. Bringing back our workforce and reopening public-facing offices at the appropriate time will be done through cooperation with state agencies, employees, and our unions. The staff that is already teleworking will be encouraged to do so where appropriate. Social distancing and facility cleaning measures will be in place to protect both staff and customers. Staff working onsite will be required to wear a mask.

Phases

As we progress through the process of reopening and the easing of restrictions, we will work in phases, taking a regional approach, with the expectation that this will not necessarily be a linear process. If indicators and criteria point to a spike in cases, the commonwealth, in coordination with local officials, will need to revert to previous restrictions and orders. Throughout all phases, there must be strict guidance in place to encourage social distancing.

Throughout this process, the commonwealth will remain flexible and respond to the conditions on the ground in specific areas. The commonwealth will work with local governments to help inform and make decisions that are best for their communities.

The phases were developed through the commonwealth’s six standards for reopening as well as the federal government’s Opening Up America Guidelines. The phases are intentionally expansive to allow for flexibility and decisions will be driven by health indicators as well as the Carnegie Mellon University data tool and metrics from the Department of Health to determine safety for regions and industries taking into account economic vulnerability. *Within each of these phases there could be additional actions, orders, or guidance depending on the public health and economic conditions facing regions or counties.*

Red Phase
Work & Congregate Setting Restrictions
Life Sustaining Businesses OnlyMasks Are Required in BusinessesCongregate Care and Prison Restrictions in PlaceSchools (for in-person instruction) and Most Child Care Facilities Closed
Social Restrictions
Stay at Home Orders in PlaceLarge Gatherings ProhibitedMasks Are Required in all Public SpacesRestaurants and Bars Limited to Carry-Out and Delivery OnlyOnly Travel for Life-Sustaining Purposes Encouraged

• Reiterate and reinforce safety guidance for businesses, workers, individuals, facilities, update if necessary
• Monitor public health indicators, adjust orders and restrictions as necessary

Yellow Phase
Work & Congregate Setting Restrictions
Telework Must Continue Where FeasibleBusinesses with In-Person Operations Must Follow Business and Building Safety OrdersMasks Are Required in BusinessesChild Care May Open Complying with GuidanceCongregate Care and Prison Restrictions in PlaceSchools may provide in-person instruction only in accordance with Department of Education guidance.
Social Restrictions
Stay at Home Order Lifted for Aggressive MitigationLarge Gatherings of More Than 25 ProhibitedMasks Are Required in all Public SpacesIn-Person Retail Allowable, Curbside and Delivery PreferableIndoor Recreation, Health and Wellness Facilities and Personal Care Services (such as gyms, spas, hair salons, nail salons and other entities that provide massage therapy), and all Entertainment (such as casinos, theaters) Remain ClosedRestaurants and Bars May Open Outdoor Dining, in Addition to Carry-Out and Delivery (effective 6/5/2020)

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

Green Phase
Work & Congregate Setting Restrictions
Telework Must Continue Where FeasibleBusinesses with In-Person Operations Must Follow Updated Business and Building Safety RequirementsAll Businesses Operating at 50% Occupancy in the Yellow Phase May Increase to 75% Occupancy, Except Where Noted for Bars and RestaurantsMasks Are Required in BusinessesChild Care May Open Complying with GuidanceCongregate Care Restrictions in PlacePrison and Hospital Restrictions Determined by Individual FacilitiesSchools Subject to CDC and Commonwealth Guidance
Social Restrictions
Gathering Limits Determined Using Maximum Occupancy CalculatorMasks Are Required in all Public SpacesSelf-certified Restaurants May Open at 50% Capacity for Indoor DiningOn-premises Alcohol Consumption Prohibited Unless Part of a Meal; Cocktails-to-go and Carryout Beverages are AllowedServing Alcohol for on-site Consumption Must End at 11:00 PM and All Alcoholic Beverages Must Be Removed From Patrons by MidnightPersonal Care Services (including hair salons and barbershops) Open at 50% Occupancy and by Appointment OnlyIndoor Recreation and Health and Wellness Facilities (such as gyms and spas) Open at 50% Occupancy with Appointments Strongly Encouraged; Fitness Facilities Are Directed to Prioritize Outdoor Fitness ActivitiesAll Entertainment (such as casinos, theaters, and shopping malls) Open at 50% OccupancyConstruction Activity May Return to Full Capacity with Continued Implementation of Protocols

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