The coronavirus first entered Pennsylvania with a vengeance in the Philadelphia region. Much of the rest of the state was spared as hospitalizations and deaths mounted here and farther north.

During the summer, the virus concentrated on Pittsburgh and Southwestern Pennsylvania, said Rachel Levine, Pennsylvania’s secretary of health.

Now, maps of infections show a new pattern. “It’s everywhere,” Levine said. Just as the virus has taken off in Midwestern and Western states that had previously seen little infection, it is spreading in Pennsylvania’s rural counties, along with smaller cities and the big metropolitan areas. Only a few sparsely populated counties have still seen little of the virus, she said.

Some of the places with the highest incidence rates — cases per 100,000 in population — are counties that usually don’t make much news: Huntingdon, Bradford, Montour, and Lackawanna. Some smaller Southeastern Pennsylvania counties — Lebanon, Schuylkill, and Berks — also have rates well above the state average. Philadelphia and Delaware Counties are also above the state average incidence rate, while nearby Bucks, Chester and Montgomery are below it.

» READ MORE: In Pennsylvania, COVID-19 is now a rural, urban, and suburban problem

— Stacey Burling

Pregnant women infected with the coronavirus may be at slightly elevated risk of preterm birth, and of severe COVID-19 compared to non-pregnant women, according to two new reports on Monday from the U.S. Centers for Disease Control and Prevention.

CDC researchers analyzed data from more than 5,000 pregnant women who had confirmed coronavirus infections between the end of March and mid-October. Among 3,912 newborns with known gestational ages, almost 13% were born prematurely — higher than the reported 10% for all newborns in the United States.

However, only 54 babies (2.5%) were very or extremely premature–born at 28 weeks or less — when the risks of long term intellectual and developmental disabilities are greatest. Coronavirus infection was also uncommon among the infants. Among 610 with reported test results, less than 3% tested positive. Most previous reports, but not all, also have found a slight increase in preterm birth.

CDC researchers used disease surveillance data to see whether COVID-19 is harder on pregnant women than comparable women who are not pregnant. While the chances of severe illness were relatively low in both groups, pregnant women were more likely to be admitted to intensive care (10.5 versus 3.9 per 1,000 cases), need mechanical ventilation (2.9 versus 1.1 per 1,000 cases), and die (1.5 versus 1.2 per 1,000).

These findings, the researchers wrote in the latest issue of MMWR, might be related to physiological changes in pregnancy, including increased oxygen consumption, decreased lung capacity, immune system alterations, and an increased risk of dangerous blood clots.

“Understanding the risk posed by coronavirus infection in pregnant women can inform clinical practice, risk communication, and medical” preparations, the researchers concluded.

— Marie McCullough

New data from the Kaiser Family Foundation’s COVID-19 tracker show that Black and Hispanic residents are falling ill at disproportionate rates — especially in Pennsylvania.

As of Nov. 2, Black patients made up 21.8% of the state’s COVID cases since the start of the pandemic — even though Pennsylvania’s population is just 10.8% Black. Hispanic patients made up 23.2% of COVID cases, but their share of the population is just 7.6 percent.

While white residents still have the largest share of COVID cases in Pennsylvania, it’s closer in line with their share of the population: 80% of the state’s population is white, and white patients make up 72% of COVID cases.

Pennsylvania was one of just 10 states where the share of COVID cases among Black patients was twice their share of the population, and one of five states where the percentage of cases among Hispanic patients was more than three times their share of the population, said Samantha Artiga, the director of KFF’s Racial Equity and Health Policy Program.

“People of color, including Black people, are at a higher risk for exposure,” she said. They’re more likely to work jobs that can’t be done remotely, or may not have the financial means to take time off work. They may rely on public transportation, which increases exposure, and are more likely to live in more densely populated areas, she said. “We see these combined risks of exposure based on work status, living situations, and transportation.”

Likewise, another KFF report released last week found that nursing homes with a larger share of Black or Hispanic residents generally experienced more severe COVID outbreaks. Those nursing homes were also more likely to experience at least one COVID death, the analysis found.

In Pennsylvania, the analysis found that nursing homes with a larger share of Black residents were significantly more likely — by about 20 percentage points — to have experienced a death at their facility.

“We know communities of color were hit really hard — it’s possible nursing homes in those communities were also more likely to have cases. There’s a pretty high possibility that when communities of color have high rates of cases, those cases bleed into the nursing homes in those communities,” said Priya Chidambaram, a policy analyst with KFF’s Program on Medicaid and the Uninsured.

— Aubrey Whelan

New Jersey coronavirus infections continue to spike, with officials reporting 1,379 new cases and three deaths. The state’s newly reported cases have surpassed 1,000 daily for more than two weeks now, said New Jersey Health Commissioner Judy Persichilli said at a news conference Monday.

The statewide transmission rate is 1.28, meaning each case is resulting in more than one additional infection. The statewide positivity rate from Oct. 29 is 5.29%, a benchmark that epidemiologists say indicates a concerning level of community spread. This number is higher in the southern part of the state, reaching 6.47% positivity, Persichilli said.

There were 1,109 hospitalization as of Nov. 1 and 212 people in intensive care, with 100 people on ventilators. There are no new reports of multi-system inflammatory syndrome in children.

“We’ve been here before, those difficult days in March and April,” Persichilli said. “Back then all of you did the hard work to bring down our case numbers. You took personal responsibility. All of you responded to the call to protect one another from COVID-19. We need to continue vital prevention efforts.”

Officials urged people not to travel this Thanksgiving to contain the spread of the virus in New Jersey.

“We know this won’t be the Thanksgiving we are used to having, but if we all recommit to fighting this virus together we can hope that the state is in a better place in time for the holidays,” Persichilli said. “Our behavior will determine the path forward for the state of New Jersey.”

— Ellie Silverman

Philadelphia announced 941 new cases of the coronavirus Monday, representing test results reported since Friday.

The rate of new cases in the city has been rising in recent weeks, and health officials have warned that the surge in cases could continue through the fall and winter.

The city has had a total of 44,968 confirmed cases of COVID-19 and 1,879 deaths since March. Officials reported three additional deaths Monday.

— Laura McCrystal

As coronavirus cases throughout the United States rise, cases are also growing among the nation’s vulnerable nursing home residents, an industry group said Monday.

Nursing home residents have accounted for 8% of COVID-19 cases but 40% of deaths. Age and chronic illness make the virus especially dangerous for nursing home residents.

Studies have linked cases in nursing homes to community spread within their regions, likely because the virus enters through unknowingly infected staff members.

The new report from the American Health Care Association and National Center for Assisted Living is based on data from Johns Hopkins University and the Centers for Medicare and Medicaid Services.

It found that weekly new cases dropped nationally and in nursing homes from July to Sept. 13. Between that date and Oct. 18, new weekly cases rose 61% in the nation, from 243,692 to 391,527, and 29% in nursing homes, from 5,590 to 7,563. The Midwest, which is now a viral hotspot, accounted for a little more than 10% of new nursing home cases on July 19, but 43% on Oct. 18. The Northeast now accounts for 8% of cases.

According to the Pennsylvania health department, deaths and new cases among nursing home employees have been relatively flat, but cases have been increasing recently. They peaked at about 400 new cases per day in late April, then fell to between 40 and 80 during the summer. They are now around 120.

In a press release, Mark Parkinson, president and CEO of AHCA/NCAL, urged people to wear masks and keep their distance to reduce community spread. He added that facilities need more federal money to combat the virus.

— Stacey Burling

On Monday, the eve of a presidential election in which Pennsylvania could play a pivotal role, the commonwealth added an additional 2,060 confirmed coronavirus cases to its count, Health Secretary Rachel Levine said. On Sunday, Pennsylvania had added 1,909 additional confirmed cases, she added.

Monday marked 28 straight days in which Pennsylvania recorded more than 1,000 new cases of the virus, Levine said.

Six of the past seven days have seen daily tallies of more than 2,000 cases, according to state data.

The percent positivity rate of coronavirus tests has risen to 6% statewide, up from 5% last week, she said, and 40 of Pennsylvania’s 67 counties now have positivity rates of more than 5%, up from 30 counties that were recording that percentage or higher last week. Among them are Delaware County, with a 6.9% positivity rate, according to state data, and Philadelphia County, with a 7.8% positivity rate. Both those counties are considered to have a “substantial level” of community spread, while Bucks, Chester, and Montgomery Counties have “moderate levels,” according to the state.

Hospitalizations have been “steadily climbing” in recent weeks, Levine said, but are not as high as they were in the spring. On Monday, 1,267 people were hospitalized with the virus, the health secretary said, and that number is expected to rise in the coming weeks, as hospitalizations typically lag behind spikes in cases.

“Our healthcare systems are better prepared to address the virus than they were in the spring,” Levine said. “But we all must all do our part to prevent further increases in hospitalizations, particularly as the flu season is here."

With the “fall resurgence” of the virus, the death rate has “increased some, but not to where it was in the spring when we often saw 100 or more deaths per day,” she said. Five additional deaths were reported Sunday, according to state data, and six were reported Monday.

In all, at least 211,996 Pennsylvanians have had confirmed cases of the coronavirus since March and 8,823 have died of virus-related complications.

— Erin McCarthy

While Pennsylvania continues to see a spike in coronavirus cases, an increase in the statewide positivity rate, and a steady climb in coronavirus-related hospitalizations, Health Secretary Rachel Levine said voters should feel safe going to the polls to vote in Tuesday’s presidential election if they have not already done so.

“If you are voting in person, it is safe to vote,” Levine said. Not only should voters wear a mask, she said they should also pack their own blue or black pen and bring hand sanitizer. And “it’s really really helpful to” download the state’s contact tracing app, COVID Alert PA, she said.

She urged Pennsylvanians to vote early and avoid being stuck in long lines when polls close at 8 p.m.

As for people who have been advised by contact tracers to quarantine due to exposure to the coronavirus, she said they should contact the Pennsylvania Department of State and will not be prevented from voting if they have not yet done so. She said she did not know the specifics of how they would be advised to vote safely.

“If someone is in quarantine there are ways that we have that they can vote,” she said. “The Department of State will work out for people who are in quarantine to be able to exercise their right to vote.”

» READ MORE: How to safely vote in person during a pandemic

— Erin McCarthy

Temple University will offer more classes in person for the spring semester, but also will require students to be tested for the coronavirus much more regularly.

The university on Monday said all students who live in residence halls, are enrolled in in-person classes, or are assigned to clinical rotation will be tested twice a week for the virus. The University of Pennsylvania last week also said it would be testing students twice a week.

“It will take effort and sacrifice from each of us to ensure a healthy and safe spring semester, but we know we can count on this community to come together in order to be together,” president Richard M. Englert and provost JoAnne A. Epps said in a campus message.

Temple opened for in-person classes in August, but quickly shut most of them down as coronavirus cases climbed. Temple currently has 69 active cases of the virus, according to its dashboard.

In its announcement, Temple leaders said faculty and staff whose work includes in-person interaction with students would be eligible to be tested twice a week. Students living off campus with a fully online course load will be eligible to be tested once a week, the school said.

The majority of instruction will remain online, but more classes will be in-person than during the fall semester, the school said.

— Susan Snyder

A little more than half of the public received the recommended influenza vaccine during last year’s flu season, with rates varying widely across states, and by age, race, and ethnicity, according to a new analysis by Kaiser Family Foundation.

Pennsylvania’s flu shot rate was 56% percent, and New Jersey’s was 54%.

“The flu vaccine provides a good model for understanding how quickly and broadly a new COVID-19 vaccine could be distributed and administered across the country,” Kaiser said in a news release.

Kaiser warned that vaccinating all or most people living in this country against the new coronavirus “could be a daunting challenge” based on flu shot uptake. However, several factors make it hard to extrapolate:

For the past decade, the flu shot has been recommended for everyone, including infants at least 6 months old. Under the Affordable Care Act, the vaccine is available free of charge to people with insurance, as well as uninsured children through the Vaccines for Children Program.

But the Kaiser analysis found only 52% of the public complied with the recommendation in 2019-2020, well below the federal government’s 70% target vaccination rate. Vaccination rates were highest for seniors and adults with chronic illnesses, two demographic groups at heightened risk of severe illness from flu — and from COVID-19.

In most states, Black and Hispanic people had lower flu vaccination rates compared to their white counterparts, Kaiser found.

“Achieving a high COVID-19 vaccination rate among people of color will be particularly important because they are bearing a heavy, disproportionate burden of the disease, and population immunity is not likely to be reached without high vaccination rates across all communities,” the analysis stated.

» READ MORE: Once a COVID-19 vaccine is here, there will be a new challenge: Convincing people it’s safe

— Marie McCullough

Friendly’s Restaurants, an East Coast dining chain known for its sundaes, is filing for bankruptcy protection.

The company, which runs the restaurants under the parent company FIC Restaurants Inc., will sell substantially all of its assets to Connecticut-based Amici Partners Group.

There are several Friendly’s locations in the Philadelphia area, including locations in Bensalem and across the river in Cinnaminson, Marlton, Voorhees, and Deptford Township.

All 130 of its locations will remain open while it restructures under Chapter 11 bankruptcy protection, the company said late Sunday.

The pandemic has hit the restaurant sector hard, particularly those that rely on people in their dining rooms. At least 10 chains have filed for bankruptcy protection since the pandemic began this year.

— Rob Tornoe and the Associated Press

Officials in Pennsylvania and New Jersey will offer coronavirus updates on Monday. Here’s a schedule of how to watch and stream:

— Rob Tornoe

Private tutoring businesses in New Jersey will be allowed to reopen and mall customers can rent strollers again under a new executive order announced by Gov. Phil Murphy over the weekend.

In addition, the order clarifies that athletes, coaches, referees, and trainers don’t count against capacity limits at sporting events, which are capped at 25% capacity (a maximum of 150 people) indoors and 500 people outdoors.

Among the items in the new COVID-19 order:

— Rob Tornoe

President Donald Trump suggested he might fire Anthony Fauci, the nation’s leading infectious disease expert, after Election Day.

“Don’t tell anybody, but let me wait until a little bit after the election,” Trump told a crowd of supporters as they chanted “Fire Fauci!” at a rally in Florida on Sunday. “I appreciate the advice.”

Later in the speech, Trump called Fauci “a nice guy” but baselessly claimed “he’s been wrong a lot.”

Trump technically doesn’t have the ability to fire Fauci under federal law. But the president could order his political appointees to dismiss Fauci as the director of the National Institute of Allergy and Infectious Diseases, according to CNN. Fauci could appeal the dismissal.

Fauci has said in the past he won’t resign over friction with the Trump administration, and will remain in his current role to oversee the deployment of a COVID-19 vaccine.

» READ MORE: Trump suggests he’ll fire Fauci ‘a little bit after the election’

— Rob Tornoe

Pennsylvania reported 15,374 new COVID-19 cases last week through Saturday, the most of any week during the pandemic and over 3,600 more cases than the week ended Oct. 24 (11,679 cases) as a spike in new infections continued.

A surge in cases in New Jersey also continued to grow last week, while Delaware began to see an uptick in new cases after remaining largely flat throughout October.

Here’s where things stand through Monday, according to an Inquirer analysis of data from each local health department:

» READ MORE: In Pennsylvania, COVID-19 is now a rural, urban, and suburban problem

— Rob Tornoe

The number of COVID-19 hospitalizations also continues to the rise across the region, though numbers remain far below pandemic highs set back in April and death rates have remained relatively stable over the last few months.

Both Pennsylvania and New Jersey have seen the number of COVID-19 hospitalizations more than double in October, while hospitalizations are up 69% in Delaware.

Here’s how hospitalizations look across the tri-state area as of Sunday, according to an Inquirer analysis of data from each local health department:

— Rob Tornoe