COVID-19 Update April 30, 2019

New York State COVID-19 Stats

NYSDOH COVID-19 Tracker – NY.gov


Notes from Governor Cuomo’s COVID-19 Briefing:

  • Hospitalizations and new cases are down.-306 new deaths yesterday – 287 in hospitals / 19 in nursing homes.
  • DATA:– Gov stressed two points about reopening:- Closely monitor the rate of transmission, keep it below 1.1.- Maintain 30% or more available hospital capacity.- The state has collaborated with the federal government to increase testing to 30,000 tests per day. The goal is 40,000.
  • TRANSIT:– NYC Subway conditions have rapidly deteriorated as a result of corvid-19.- MTA employees and NYPD officers are sick, so there are less people available to maintain the subway.- There are less people to provide outreach for homeless people.- The MTA has been cleaning the trains and buses every 72 hours.- Unfortunately, the virus can remain on surfaces for days.- Gov said that trains and buses should be disinfected every 24- The scale of work is unprecedented, but it must be done.

    – The MTA will also disinfect the Metro North and LIRR without

    service disruptions.

    – Overall ridership is down 92%.

    – The slowest hours are from 1:00 a.m. to 5:00 a.m.

  • TRACING:
    – When you get a positive case of COVID-19, you must trace by identifying who they have been in contact within the last 14 days.- Yesterday, there were 4,681 positive cases.- There are too many people to contact at once.- The state needs help tracing people- The state will collaborate with city and county health departments to find tracers- The state is also collaborating with former NYC Mayor- Bloomberg: we must use contact tracing as we relax socialdistancing protocols.

    – He announced partnerships with Johns Hopkins University,

    Vital Strategies, and Resolve to Save Lives, staffing

    organizations, and SUNY/CUNY.

    – These organizations will help with tracing training,

    recruitment, guidance, and app development.

    – Guidelines will be publicly available to provide a model for

    others and spread best practices.

    – There must be 30 contact tracers for every 100,000 cases.

    – Statewide, we will need about 6,000 tracers

    – There will be a tri-state collaboration for contact tracing.

    Q&A:
    CHILDREN:
    – Zucker: COVID-19 infects the lining of blood vessels and lungs.
    – Some kids are having strange, adverse effects to this.
    – Camps are set to open at the end of May.
    – Gov says that the federal government is not providing
    enough funding for schools, rental assistance, etc.


Physicians Offices Should Continue to Submit Requests for PPE through Local Office of Emergency Management (OEM)
Physicians’ offices should continue to submit requests for Personal Protection Equipment (PPE) through their local Office of Emergency Management. Physicians generally need to call the local Department of Health first.  Upon providing their license number and practice address they will be given the private OEM phone number or website address for requesting PPE supplies.   Physicians will need to provide information to the local OEM regarding the amount of PPE needed, license number, and practice location.  In some cases, we have been able to eliminate one step.  IT’S OFTEN A TWO-STEP PROCESS TO REQUEST PPE.

  • Here are contacts for this region:
  • In NYC, EMAIL the OEM directlysupplyrequest@oem.nyc.gov   Make sure you include doctor’s name, complete contact information, and the request.
  • In Nassau, you can go directly to the OEM website (OEM phone number is 516 573-9600)
  • In Suffolk, you can go directly to this website.
  • In Westchester, call the DOH at 1-866-588-0195, Option 2.  A DOH expert will take the request and provide the next step for reaching the OEM

New York State continues to fulfill requests for PPE and provides supplies to the local OEM when there is a request. If your practice is unable to obtain PPE through vendors and local Offices of Emergency Management fail, please let MSSNY know.  MSSNY will need the information that was provided to the local OEM so that we can provide that information back to the state.  MSSNY is in continuous contact with the NYS Department of Health to help address such situations.

For general guidance on the use of PPE in healthcare settings, please refer to CDC guidance entitled “Healthcare Supply of Personal Protective Equipment”.

MSSNY is engaging our county societies statewide to assess the level of difficulty physicians may be encountering in obtaining PPE, to determine if problems being reported are local in nature, or more widespread.

2)  Guidance on steps to take in reopening physician practices is being finalized and will be circulated shortly. 

3)  We are engaged with the Dept of Health and the OPMC on legal changes needed to support confidential peer-to-peer support for physicians during the pandemic and beyond.  Meetings are occurring this week.


HHS: FAQs Posted Regarding Second Tranche
The Department of Health and Human Services (HHS) has posted new Frequently Asked Questions regarding the second tranche of disbursement of the CARES Act Provider Relief Fund. Regarding second Tranche Please note there is conflicting information about whether a provider who has not previously received money from the first round of funding can apply for this round.  The AMA is trying to clarify this and other questions with HHS.


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Paycheck Protection Program (PPP) Update
Have you applied for the PPP small business forgivable loan program yet?  According to SBA.gov as of 5:00 PM yesterday more than 960,000 loans had been approved totaling greater than $90 billion. The total number of lenders involved in processing these transactions has been 5,300 so far. Last week Congress approved an additional $310 billion for the program.

Yesterday, the SBA notified borrowers and lenders that certain provisions would be put in place to favor lending from smaller institutions. The text of the notice:

Paycheck Protection Program (PPP) Lending Operations Update – Wednesday, April 29, 2020

SBA and Treasury value all lenders and their small business customers.

To ensure access to the PPP loan program for the smallest lenders and their small business customers, starting at 4 p.m. yesterday EDT through 11:59 p.m. EDT, SBA systems will only accept loans from lending institutions with asset sizes less than $1 billion.

Please note, lending institutions with asset sizes less than $1 billion will still be able to submit PPP loans outside of this time frame. Please also note that lenders with asset sizes greater than $1 billion will be able to submit loans outside of today’s 4:00 PM -11:59 PM EDT reserved processing time.

Today this reserved processing time applies to April 29, 2020. SBA and Treasury will evaluate whether to create a similar reserved time again in the future.

SBA and Treasury continue to monitor loan system performance and will continue to provide frequent updates to the lending community.


Governor Issues Executive Order to Resume Elective Surgery in 35 Counties, but Only in Hospitals
The Governor issued an Executive Order on April 29 to lift the prohibition on elective surgery in 35 upstate counties based upon meeting certain criteria, but only for hospitals in those counties.  There was an arbitrary exclusion of Ambulatory Surgery Centers and Office-Based surgery locations in these counties from resuming elective surgery.  With many patients facing significant health care issues including pain that require surgical intervention, there is no good reason to exclude these care facilities from the resumption of these elective procedures.  For the benefit of patients, physicians are urged to contact the Governor to lift this restriction by sending a letter from here.

The counties in which hospitals are now eligible are: Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Delaware, Dutchess, Essex, Franklin, Fulton, Genesee, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Niagara, Oneida, Onondaga, Ontario, Orleans, Oswego, Putnam, Saratoga, Schoharie, Schuyler, St. Lawrence, Steuben, Sullivan, Tompkins, Ulster, Wayne, Wyoming and Yates.


NIH Announces $1.5 billion, ‘Shark Tank’-like Initiative to Accelerate Covid-19 testing
The NIH yesterday announced a $1.5 billion initiative aimed at speeding up the availability of diagnostics for Covid-19. The hope is that this endeavor will lead to “millions of tests” being deployed per week by late summer or fall. The initiative will rely on a “national Covid-19 testing challenge,” in which researchers and inventors across the country will compete for a share of $500 million in a “Shark Tank”-style competition to move their proposed inventions forward. The National Institute of Biomedical Imaging and Bioengineering’s director Bruce Tromberg tells STAT’s Lev Facher that the agency, which will be coordinating the initiative, expects to select roughly five winners who will be paired with manufacturers who will mass-produce the new diagnostics.


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NIH: Critical Study of COVID-19 Drug Shows Patients Respond to Treatment
Preliminary data released yesterday from a closely watched, government-run trial of Gilead’s remdesivir showed it was effective in Covid-19 patients. Those who were given remdesivir recovered four days faster than those who were given placebo. The decrease in mortality rate compared to placebo was not statistically significant. Anthony Fauci, the director of NIAID, which is conducting the study, said the data are a “very important proof of concept,” but cautioned they were not a “knockout.”

The preliminary results come after days of conflicting results on remdesivir’s efficacy against Covid-19: While early results from Gilead’s separate trial of the drug in severe Covid-19 patients showed promise, data from a trial in China showed no added benefit. NIAID’s trial results are critical because the drug was tested in a large number of patients and neither the patients nor physicians knew who was getting the drug, which controlled for any unconscious biases. And following NIAID’s preliminary data, the FDA is exploring an emergency use authorization for remdesivir, according to The Wall Street Journal.


 

 

COVID-19 Update April 29, 2020

New York State COVID-19 Stats

NYSDOH COVID-19 Tracker – NY.gov

Deaths: Individual NYS Nursing Homes


Gov. Cuomo Press Conference: What You Need to Know

LAST UPDATED: APRIL 29, 2020 AT 2:45PM

  • Schools and nonessential businesses will stay closed through May 15th.
  • Governor Cuomo issued executive orders 17 and 202.18 requiring all people in New York to wear masks or face coverings in public, including when taking public or private transportation or riding in for-hire vehicles.
  • Governor Cuomo outlined a phased plan to re-open New York starting with construction and manufacturing, implemented in phases based on regional analysis and determinations.
  • 35 counties without a significant risk of a COVID-19 surge in the near term have been approved to resume elective outpatient treatments.
  • Preliminary Phase II results of Antibody Testing Study show 14.9% of the population have COVID-19 antibodies. Find more information and FAQs on antibody testing.
  • New York State is expanding diagnostic testing criteria to allow all FDNY and NYPD officers, first responders, health care workers, transit workers and essential employees to be tested for COVID-19 even if they are not symptomatic.
  • Preliminary results of the FDNY and NYPD antibody testing survey show 17.1% of FDNY officers and EMTs have COVID-19 antibodies, and 10.5% of NYPD officers have COVID-19 antibodies.
  • 1,000 transit workers will be tested for antibodies to further determine the spread of infections among frontline workers.
  • New York State is now conducting 30,000 diagnostic tests for COVID-19 per day.
  • The MTA has been directed to issue a full plan by April 30th, on how it will clean and disinfect trains in response to reported deteriorations of conditions in subways.
  • New Yorkers without health insurance can apply through NY State of Health through May 15, 2020; must apply within 60 days of losing coverage.
  • New Yorkers can call the COVID-19 Emotional Support Hotline at 1-844-863-9314 for mental health counseling.
  • Testing is free for all eligible New Yorkers as ordered by a health care provider.

Gov. Announces 35 NY Counties That Can Resume Outpatient Treatment
Governor Cuomo today announced the 35 counties have been approved to resume elective outpatient treatment, as a follow up to his previous announcement that the state will allow elective outpatient treatments to resume in counties and hospitals without significant risk of COVID-19 surge in the near term.

These counties include: Allegany, Broome, Cattaraugus, Chautauqua, Chenango, Delaware, Dutchess, Essex, Franklin, Fulton, Genesee, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Niagara, Oneida, Onondaga, Ontario, Orleans, Oswego, Putnam, Saratoga, Schoharie, Schuyler, St. Lawrence,  Steuben, Sullivan, Tompkins, Ulster, Wayne, Wyoming and Yates.


Dr. Fauci Touts Clinical Trial of COVID drug as “Quite Good News”
Dr. Anthony Fauci, a key member of the White House coronavirus task force, said results from a COVID-19 clinical trial of a drug for treating the disease showed “quite good news.” Data from a study of remdesivir showed patients recovered quicker when taking the drug, Fauci told reporters at the White House Wednesday, alongside President Trump and Vice President Pence. Remdesivir patients saw a 31 percent improvement over placebo patients, Fauci said.

Although a 31 percent improvement does not seem like a knockout 100 percent, it is a very important proof of concept,” Fauci said. “What it has proven is that a drug can block this virus.”

He added the drug will be “the standard of care.”Remdesivir patients also saw an 8 percent mortality rate, which is slightly lower, but not statistically significant, from the 11.6 percent mortality rate of placebo patients, Fauci said. The drug’s impact on the COVID-19 mortality rate needs further analysis, he said.

The clinical trial, which began in February, evaluated the safety and efficacy of remdesivir, an experimental drug developed by Gilead Sciences, in 1,063 hospitalized adults with COVID-19. The trial was the first in the U.S. to evaluate an experimental treatment for COVID-19.

“We think it’s really opening the door to the fact that we now have the capability of treating [COVID-19],” Fauci said of the results. He said he can “guarantee” the drug will improve as more people, companies and investigators get involved. The study has not yet been published or peer reviewed.

Scientists have had high hopes for remdesivir as a potential COVID-19 treatment. The drug originally developed as a potential treatment for Ebola but was found to be ineffective.

However, the drug has shown promise against coronaviruses in experiments.

Scott Gottlieb, former Food and Drug Administration commissioner under President Trump, said on CNBC Wednesday he thinks the drug is probably not a “home run” treatment for COVID-19, but it could help people avoid worse outcomes. The Hill

Updated at 1:30 p.m.


MSSNY: Community Doctors Should Be Part of Testing Efforts
The Medical Society of the State of New York applauded Gov. Andrew Cuomo’s efforts to increase Covid-19 testing but said community physicians should be at the forefront. The group expressed concern over a new executive order to allow pharmacies to become collection sites for tests.

“In particular, we are concerned that there has not been any specification for how such test results will be shared with the patient’s primary physician or physicians to help explain to the patient what the results mean … as well as what the patient should do,” said Dr. Art Fougner, president of the medical society, in a statement.

The group also questioned the lack of effort to involve community physicians in any statewide testing program and to help them obtain the supplies and personal protective equipment needed to provide Covid-19 tests.

“Not only are community physicians an integral part of New York’s health care system, but many of them have been—unaware to many—working tirelessly to keep the surge of patients from becoming a tsunami, which would have overwhelmed our hospitals,” Fougner said.

People place trust in community physicians, he said, adding that the medical society is urging Cuomo to enlist them to fully expand the state’s testing capacity, which is critical to reopening businesses. ((April 29 Crain’s New York)


Physician Advocacy Orgs Object to Suspension of Medicare Advance Payment
As reported in Med Page, the AMA and other national physician societies joined MSSNY in expressing strong concerns with the decision of the Center for Medicare & Medicaid Services to suspend its program to give physicians and hospitals advance Medicare payments to help them keep their practices open in the wake of COVID-19, suggesting that the program is no longer necessary.

The program had provided nearly $500 million in advance payments to New York Part B providers including physicians and $8.3 billion to Part B providers across the country overall.  It also distributed over $90 billion to Part A providers.

According to a press release issued Sunday, “The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs and in light of the $175 billion recently appropriated for healthcare provider relief payments,”

In a fact sheet update accompanying the announcement, CMS explained that “beginning on April 26, 2020, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through HHS’s Provider Relief Fund. Significant additional funding will continue to be available to hospitals and other healthcare providers through other programs.” The agency noted that the Department of Health and Human Services has already given $30 billion to providers through the CARES Act Provider Relief Fund.

While MSSNY, the AMA and other physician groups had previously taken issue with some of the terms of the Advance Payment program, the program was urged to be continued under more favorable terms. MSSNY is urging the New York Congressional delegation to continue the program in the next stimulus bill to be taken up by Congress.


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Targeted Allocation for Treating the Uninsured
For any physicians who may have treated uninsured patients during this COVID-19 Pandemic,  please review the following link for how you may seek financial help from the Targeted Allocation of the CARES ACT.


HHS: FAQs Posted Regarding Second Tranche
The Department of Health and Human Services (HHS) has posted new Frequently Asked Questions regarding the second tranche of disbursement of the CARES Act Provider Relief Fund. Regarding the second Tranche Please note there is conflicting information about whether a provider who has not previously received money from the first round of funding can apply for this round.  The AMA is trying to clarify this and other questions with HHS.


Gov. Cuomo Orders All NYC Subway Cars Cleaned Every Night
New York Gov. Cuomo on Wednesday ordered that all New York City subway cars be cleaned every night by Metropolitan Transportation Authority (MTA) workers to ensure the safety of essential personnel during the coronavirus pandemic.

“Any essential worker who shows up and gets on a train should know that that train was disinfected the night before,” Cuomo told reporters at his daily coronavirus press briefing.

“Letting them endanger their own life and endanger the lives of others is not helping anyone,” Cuomo said. The governor said that he wants MTA to present to him a plan for the nightly cleanings by Thursday. “It’s realistic. It is essential. How realistic is it? What’s the alternative?” Cuomo said when asked if the state would provide funding to the MTA for the cleaning.

He also commented on reports of the deteriorating state of subway cars during the crisis as the city has allowed homeless people to stay on the cars with their belongings. “No one wants to live their lives on a subway train,” Cuomo said. “We have a higher obligation as a society than to say ‘OK, you can sleep in a subway car.'”

He also announced that starting Wednesday, the state of New York would be offering antibody testing for transit workers to determine if they have contracted or been exposed to COVID-19 and developed the antibodies to fight it. A positive antibody test does not guarantee immunity from the virus, but it does signal that someone may have added protection against the virus moving forward. The Hill 4/29

 

 

Medical Society Proposes “Peer to Peer” Program for Physicians’ Post Traumatic Stress


MSSNY Seal
MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

 

For Immediate Release
April 28, 2020 


Medical Society Proposes “Peer to Peer” Program for Physicians’
Post Traumatic Stress


Statement Attributable to:
Art Fougner, M.D.
President, Medical Society of the State of New York

“The tragic suicide of emergency physician Dr. Lorna Breen is yet one more terrible consequence of the coronavirus pandemic and the leadership of the Medical Society of the State of New York wishes our condolences to her family. We fear that there could be many more physicians and other health care workers who have been on the front lines of treating the unending number of gravely ill patients in New York hospitals who may also be confronting post-traumatic stress and at risk for taking similar action.

To assist these physicians, MSSNY has proposed to create a “Peer to Peer” program similar to programs for veterans and police officers to help these physicians in coping with their post-traumatic stress. However, many physicians in need of this help will not feel comfortable in sharing their experiences unless they know that what they share will be kept strictly in confidence. To that end, MSSNY is working with the New York State Department of Health to approve the parameters of this proposed peer to peer program including ensuring that physician peers providing this greatly needed assistance will not be required to divulge any element of these conversations to any person or governmental body.”

# # #

About the Medical Society of the State of New York
Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

 

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COVID-19 Update April 28, 2020

MSSNY to Develop Recommendations for Re-opening of Physicians Practices
Today, MSSNY President Arthur Fougner, MD and President-Elect, Bonnie Litvack, MD announced that the Medical Society of the State of New York announced that the Committee on Infectious Disease and the Committee on Emergency Preparedness and Disaster/Terrorism Response will work collaboratively to develop recommendations for re-opening office-based practices during the time of the COVID-19 pandemic.

While it is important to note that physician offices are considered “essential” and were not required to be closed, both committees will review issues to ensure safety within the physicians’ practices as the acute phase of the pandemic begins to recede.  These issues include; triage and surge, messaging to patients, telemedicine, office set up to ensure local distancing, mental health of staff and mental health of patients, personal protection equipment, testing, flu season and the administration of other vaccines, possible treatment for Covid 19 and the possible vaccine and, and fiscal issues related to physicians’ practices.  It is anticipated that these recommendations will be available to members for use as a guide.

“We know that office-based physicians have been at the forefront in helping to prevent additional COVID -19 cases from going directly to the hospital and thereby have greatly helped to reduce hospital surge.  We also acknowledge that physicians are willing to care for patients in the new world that we will now live in—but want to ensure their patients safety along with their staff.  Developing recommendations for our office based physicians and their staffs are an important key in keeping the infection rate down,” said Dr. Fougner and Dr. Litvack.  Dr. Fougner and Dr. Litvack encouraged all physicians to use the tools below to assist them in the efforts to combat the virus.

Continuing Medical Education

Physicians are encouraged to register now for MSSNY’s webinar related to the COVID-19 pandemic, Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid on April 29th at 7:30am. Faculty for this program are William Valenti, MD and Craig Katz, MD. Registration is now open for this webinar!

MSSNY also provides to you additional continuing medical education programs through its MSSNY online program at cme.mssny.org.  Physician who are new to the site will need to create an account with a login and password.  If there are any difficulties with the site please contact our support staff at cmesupport@mssny.org  The following coursework is free to all physicians and healthcare providers:

Medical Matters Courses:

· Psychosocial Dimensions of Infectious Outbreaks
· Coronaviruses 2020: COVID-19 An Evolving Story
· Disaster Medicine Every Physician’s Second Specialty
· Doctor Are You Ready?
· The Importance of Resilience After a Disaster
· Principles of Isolation and Quarantine: Epidemiology as a Decision Maker
· Public Health Preparedness 101
· Virtual Drill: Incident Command System & Crisis Communications

Emergency Preparedness:

· Physician’s Electronic Emergency Preparedness Toolkit (Modules 1-4)

Resources:

· Psychological Impact of Disaster and Terrorism Reference Card

Podcasts

Also available are podcasts related to the current COVID-19 pandemic, To listen go here.

COVID 19 Resources/DOH Guidance

Additionally, MSSNY has dedicated resources on its website at www.mssny.org and these resources are available on the homepage and in the blue boxes.  Also, MSSNY is providing to its members a daily update on COVID-19.  If you are not receiving this, and wish to do so, please contact Christina Southard at csouthard@mssny.org.

Practice Financial Support

We want to ensure physicians are aware of two important developments to help physicians with obtaining funds that will cover the significant drop in patient care revenue over the last two months. MSSNY worked together with the American Medical Association (AMA) and many other state and specialty societies to advocate to ensure the availability of these funds.

The Small Business Administration is again accepting applications for the Paycheck Protection forgivable loan Program (PPP), starting Monday, April 27, following the passage of legislation by Congress last week allocating a new $310 billion for the PPP.

Many physicians had reported not being able to get their applications in time prior to the previous allocation being depleted. This pool of funding is also likely to be depleted quickly, so do not delay in getting in your application if you intend to apply. 

For assistance, please contact mauster@mssny.org .

Personal Protective Equipment

Physicians’ offices should continue to submit requests for Personal Protection Equipment (PPE) through their local Office of Emergency Management.  Physicians will need to call their local Department of Health for the OEM phone number and let their local DOH know that they are seeking PPE. They will be directed to the OEM office by phone or by website. Physicians will need to provide information to the local OEM regarding information as to the amount of PPE needed, license number, and practice location.  A listing of local Department of Health offices is here.

New York State continues to fulfill requests for PPE, and provides supplies to the local OEM when there is a request. If all efforts to obtain PPE through vendors and local Office of Emergency Management fail, please contact MSSNY to let us know that the practice is having difficulty in obtaining PPE from the local OEM.  MSSNY will need the information that was provided to the local OEM so we can provide information back to the state about the difficulties the practice is encountering. MSSNY has been in continuous contact with the NYS Department of Health to help address situations when physicians report difficulty with their local OEM. Please contact pclancy@mssny.org if there is difficulty in obtaining PPE from local OEMs. For general guidance on the use of PPE in healthcare settings, please refer to CDC guidance entitled “Healthcare Supply of Personal Protective Equipment”.

MILMIC Insurance Company Checklist

MILMIC Insurance Company has put together a checklist for health practices during the COVID 19 pandemic.  A copy of the checklists can be found HERE.


NYSDOH Info for Physicians


TOP FIVE FROM Gov. Cuomo Today
· CDC Guidelines: Based on CDC recommendations, once a region experiences a 14-day decline in the hospitalization rate they may begin a phased re-opening.

· Industries: Businesses in each region will re-open in phases. Phase one will include opening construction and manufacturing functions with low risk. Phase two will open certain industries based on priority and risk level. Businesses considered “more essential” with inherent low risks of infection in the workplace and to customers will be prioritized, followed by other businesses considered “less essential” or those that present a higher risk of infection spread. Regions must not open attractions or businesses that would draw a large number of visitors from outside the local area.

· Business Precautions: Each business and industry must have a plan to protect employees and consumers, make the physical workspace safer and implement processes that lower risk of infection in the business.

· Building Health Care Capacity: To maintain the phased re-opening plan, each region must have at least 30 percent of hospital beds and ICU beds available after elective surgeries resume.

· Testing Regimen: Regions must implement a testing regimen that prioritizes symptomatic persons and individuals who came into contact with a known COVID-positive person, and conducts frequent tests of frontline and essential workers. Regions must maintain an appropriate number of testing sites to accommodate its population and must fully advertise where and how people can get tested. The region must also use the collected data to track and trace the spread of the virus.


MSSNY Proposes “Peer to Peer” Program for Physicians’ Post Traumatic Stress
“The tragic suicide of emergency physician Dr. Lorna Breen is yet one more terrible consequence of the coronavirus pandemic and the leadership of the Medical Society of the State of New York wishes our condolences to her family. We fear that there could be many more physicians and other health care workers who have been on the front lines of treating the unending number of gravely ill patients in New York hospitals who may also be confronting post-traumatic stress and at risk for taking similar action. To assist these physicians, MSSNY has proposed to create a “Peer to Peer” program similar to programs for veterans and police officers to help these physicians in coping with their post-traumatic stress.

However, many physicians in need of this help will not feel comfortable in sharing their experiences unless they know that what they share will be kept strictly in confidence. To that end, MSSNY is working with the New York State Department of Health to approve the parameters of this proposed peer to peer program including ensuring that physician peers providing this greatly needed assistance will not be required to divulge any element of these conversations to any person or governmental body.”

Statement Attributable to:
Art Fougner, M.D.
President, Medical Society of the State of New York
April 28, 2020


NYS DOH Update for Physicians Thursday, April 30 at 1PM
Please join the NYS Department of Health Thursday, April 30th at 1:00 PM – 2:00 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, our webinar will be streaming via YouTube Live

For audio only, please dial in: 844-512-2950


HHS Posted FAQs re Second Tranche of Disbursement of CARES Act
The Department of Health and Human Services (HHS) has posted new Frequently Asked Questions regarding the second tranche of disbursement of the CARES Act Provider Relief Fund.  Please note there is conflicting information about whether a provider who has not previously received money from the first round of funding can apply for this round. The AMA is trying to clarify this and other questions with HHS.


People Most Comfortable Sharing Info for COVID-19 Research with Doctors
A new survey from PwC finds a majority of people are most comfortable sharing their health information with doctors so the data could be used to help Covid-19 efforts. Here is more from the survey, which looked at consumer behavior as a result of Covid-19:

  • Sharing data: 59% are very willing to share data with doctors, compared to 31% who say the same for university research centers. Almost a third of people say they are unwilling to share information with pharma or other biomedical companies.
  • Health information: Nearly 60% of respondents reported getting information about the pandemic from a local or national news source, while about a quarter said they got it from social media or other internet source.
  • Telehealth: Around 5% of those surveyed they used telemedicine services for the first time. This was especially true for patients with chronic illnesses, 37% of whom reported doing so. (STAT Morning Rounds, 4/28)

WSJ: Pathologists Search for Answers
“Medical researchers are doing detective work to see if the novel coronavirus was in New York before March , undertaking studies of flu swabs and deaths that could challenge the official timeline of the infection’s arrival in the state. Pathologists at Manhattan’s Weill Cornell Medicine are looking at the remains of roughly 20 bodies that were permitted to be autopsied.

These patients died at the hospital in February and March, and researchers are trying to determine whether one of those deaths may have been due to Covid-19, the disease caused by the new coronavirus, said Alain Borczuk, vice chairman and director of anatomic pathology. One case prompted researchers to seek additional testing from the U.S. Centers for Disease Control and Prevention.” (WSJ, April 28)


One in Four in NYC Has Been Exposed to COVID-19
The state released expanded results of its antibody testing study Monday, showing about 1 in 4 New York City residents has been exposed to Covid-19.

New York has now tested 7,500 people for the presence of antibodies that can fight Covid-19, but Gov. Andrew Cuomo sounded a note of caution about whether the state would use the data as it looks to allow businesses to open in certain areas.

Statewide, 14.9% of people tested positive for antibodies, with a 24.7% positive rate in the city, 14.4% on Long Island, 15.1% in Westchester and Rockland counties, and 3.2% elsewhere.

“The antibody does something else for us,” Cuomo said. “One … it tells you [the infection rate] with a two-week lag. Two, it tells you who can donate convalescent plasma.”


Physician Advocacy Orgs Object to Suspension of Medicare Advance Payment
As reported in Med Page today, the AMA and other national physician societies joined MSSNY in expressing strong concerns with the decision of the Center for Medicare & Medicaid Services to suspend its program to give physicians and hospitals advance Medicare payments to help them keep their practices open in the wake of COVID-19, suggesting that the program is no longer necessary.

The program had provided nearly $500 million in advance payments to New York Part B providers including physicians, and $8.3 billion to Part B providers across the country overall.  It also distributed over $90 billion to Part A providers.

According to a press release issued Sunday, “The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs and in light of the $175 billion recently appropriated for healthcare provider relief payments,”

In a fact sheet update accompanying the announcement, CMS explained that “beginning on April 26, 2020, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through HHS’s Provider Relief Fund. Significant additional funding will continue to be available to hospitals and other healthcare providers through other programs.” The agency noted that the Department of Health and Human Services has already given $30 billion to providers through the CARES Act Provider Relief Fund.

While MSSNY, the AMA and other physician groups had previously taken issue with some of the terms of the Advance Payment program, the program was urged to be continued under more favorable terms.  AMA President Dr. Patrice Harris stated: “Physician practices across the country are struggling to keep their doors open.  Advanced payments offer an important lifeline for cash-strapped practices to weather these financially challenging times, and they are always repaid, which distinguishes them from the programs Congress replenished last week.”

MSSNY is urging the New York Congressional delegation to continue the program in the next stimulus bill to be taken up by Congress.


MSSNY: Community Docs Should Be Part of Testing Efforts
The Medical Society of the State of New York applauded Gov. Andrew Cuomo’s efforts to increase Covid-19 testing but said community physicians should be at the forefront.

The group expressed concern over a new executive order to allow pharmacies to become collection sites for tests.

“In particular, we are concerned that there has not been any specification for how such test results will be shared with the patient’s primary physician or physicians to help explain to the patient what the results mean … as well as what the patient should do,” said Dr. Art Fougner, president of the medical society, in a statement.

The group also questioned the lack of effort to involve community physicians in any statewide testing program and to help them obtain the supplies and personal protective equipment needed to provide Covid-19 tests.

“Not only are community physicians an integral part of New York’s health care system, but many of them have been—unaware to many—working tirelessly to keep the surge of patients from becoming a tsunami, which would have overwhelmed our hospitals,” Fougner said.

People place trust in community physicians, he said, adding that the medical society is urging Cuomo to enlist them to fully expand the state’s testing capacity, which is critical to reopening businesses.


CDC: Adds Six Symptoms; Young Patients Dying from Strokes; 8 Updates
COVID-19 cases in the U.S. are soon expected to surpass 1 million, with 965,951 cases and 54,877 deaths reported as of 10 a.m. CDT April 27. Worldwide, 2,990,559 COVID-19 cases and 207,446 deaths have been confirmed, while 875,497 patients have recovered.

Eight updates:

  1. The CDC added six new potential COVID-19 symptoms to its initial three. Originally only listing fever, cough and shortness of breath as virus symptoms, the agency has now added chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell.
  2. “Social distancing will be with us through the summer,” said Deborah Birx, MD, response coordinator for the White House coronavirus task force. On April 26, Dr. Birx told NBC‘s “Meet the Press” social distancing measures will continue to be used in an effort to protect everyone as areas of the U.S. move through the phased reopening.
  3. Young and middle-aged COVID-19 patients with mild symptoms are dying from strokesThe Washington Post reports. Researchers with Philadelphia-based Thomas Jefferson University Hospitals, New York City-based NYU Langone, and New York City-based Mount Sinai Beth Israel Hospital are all intending to publish data regarding COVID-19 patients in their 30s to 40s suffering strokes. Though there are only a few dozen cases per location, the data suggests COVID-19 patients are mostly experiencing large vessel occlusions — the deadliest kind of stroke — which can destroy parts of the brain responsible for movement, speech and decision-making.

Many researchers believe the strokes may be a direct consequence of COVID-19 related blood clots, while others wonder whether they are seeing more young patients because they are more resistant to respiratory problems caused by COVID-19.

The virus appears to result in mild illness for the majority of young adults. However, COVID-19 stroke patients at New York City-based Mount Sinai were an average of 15 years younger than stroke patients without COVID-19, according to J. Mocco, MD, neurosurgeon and researcher.

“These are people among the least likely statistically to have a stroke,” Dr. Mocco told the Post, adding that the link between COVID-19 and stroke “is one of the clearest and most profound correlations I’ve come across.”

  1. The WHO is leading a global initiative to develop new drugs, tests and vaccines for COVID-19, reports STAT. Called the Access to COVID-19 Tools Accelerator, its goal is to ensure low-income countries receive equal access to these medical products. Participating countries and organizations are encouraged to start pledging funds May 4, with the goal of raising $8 billion in initial funding. Nine countries have joined the effort, along with philanthropic organizations like the Wellcome Trust and the Bill and Melinda Gates Foundation. The U.S. has not yet joined the initiative.
  2. There is no evidence that people who’ve recovered from COVID-19 are protected from a second infection, the World Health Organization said in an April 24 guidance on “immunity passports.” Many countries are considering giving these passports to people who have already gotten the virus, allowing them to return to work or other activities. This proposal relies on the assumption that previously infected individuals will be protected by antibodies. However, the WHO said not enough evidence exists to warrant the passports’ use, as it is unknown how much protection COVID-19 antibodies offer and for how long.
  3. New York Gov. Andrew Cuomo outlined on April 26 a phased reopening plan for the state. New York will follow CDC’s recommendation to only reopen once state and regional hospitalization rates fall for two consecutive weeks. The first phase of the plan will reopen construction and manufacturing work. Mr. Cuomo did not share a specific timeline for this reopening, but suggested that some parts of upstate New York could begin to reopen as early as May 15, when his executive order requiring all nonessential workers to stay home ends, according to NBC New York.
  4. Wuhan doesn’t have any more hospitalized COVID-19 patients, Chinese officials said April 26, according to Business Insider.Wuhan, the pandemic’s origin site, has recorded about 46,000 COVID-19 cases since December, or about half of all cases in China. As of April 25, Wuhan had just 12 COVID-19 cases and no new infections. The city ended its lockdown April 8, although some restrictions are still in place and schools remained closed.
  5. The second wave of stimulus payments is set to go out this week, directed at those who recently provided direct-deposit information, the Wall Street Journal reports. Checks are also being sent to people who do not file tax returns but receive Social Security or disability benefits. As of April 17, the IRS has distributed $158 billion of the program’s total $292 billion. It may take months for individuals without direct-deposit information to receive their check, with the government’s check-printing capacity capped at about 5 million a week. (Becker’s Hospital Review, April 27)

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MSSNY Calls on Gov Cuomo to Involve Community Physicians in Statewide Testing Program


MSSNY Seal
MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

 

For Immediate Release
April 27, 2020 


MSSNY CALLS ON GOV CUOMO TO INVOLVE COMMUNITY PHYSICIANS IN STATEWIDE TESTING PROGRAM 


Statement Attributable to:
Art Fougner, M.D.
President, Medical Society of the State of New York

“Physicians across the state share Governor Cuomo’s goal to significantly increase New York’s COVID-19 testing capacity, and applaud his unceasing efforts to confront this pandemic. However, we are very concerned about the Executive Order 202.24 provision to enable pharmacists to become collection sites for these tests without any clear details for how these test collections and results will be coordinated with a physician or hospital.

“In particular, we are concerned that there has not been any specification for how such test results will be shared with the patient’s primary physician or physicians, to help explain to the patient what the results mean regardless of whether there is a positive or negative test finding as well as what the patient should do.

“We also believe that there should be a concerted effort to involve community physicians in any statewide testing program, including helping them with obtaining the necessary medical and protective equipment to help provide these tests. Not only are community physicians an integral part of New York’s healthcare system but many of them have been, unaware to many, working tirelessly to keep the surge of patients from becoming a tsunami which would have overwhelmed our hospitals pushed to the brink.

“New Yorkers place a great deal of trust in these dedicated professionals. We ask Governor Cuomo to enlist these doctors to fully expand New York’s testing capabilities so vital for any reopening.”

# # #

About the Medical Society of the State of New York
Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

 

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COVID-19 Update April 27, 2020

Physicians across the state share Governor Cuomo’s goal to significantly increase New York’s COVID-19 testing capacity and applaud his unceasing efforts to confront this pandemic. However, we are very concerned about the Executive Order 202.24 provision to enable pharmacists to become collection sites for these tests without any clear details for how these test collections and results will be coordinated with a physician or hospital.

“In particular, we are concerned that there has not been any specification for how such test results will be shared with the patient’s primary physician or physicians, to help explain to the patient what the results mean regardless of whether there is a positive or negative test finding as well as what the patient should do.

“We also believe that there should be a concerted effort to involve community physicians in any statewide testing program, including helping them with obtaining the necessary medical and protective equipment to help provide these tests. Not only are community physicians an integral part of New York’s healthcare system but many of them have been, unaware to many, working tirelessly to keep the surge of patients from becoming a tsunami which would have overwhelmed our hospitals pushed to the brink.

“New Yorkers place a great deal of trust in these dedicated professionals. We ask Governor Cuomo to enlist these doctors to fully expand New York’s testing capabilities so vital for any reopening.”

Press Statement Attributable to:
Art Fougner, M.D. President, Medical Society of the State of New Yor


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What Impact Has COVID-19 Had on Outpatient Visits?
The number of visits to ambulatory practices dropped by a whopping 60% in mid-March and continues to be down by at least 50% since early February, according to new data compiled and analyzed by Harvard University and Phreesia, a healthcare technology company.

Phreesia — which helps medical practices with patient registration, insurance verification, and payments — has data on 50,000 providers in all 50 states; in a typical year, Phreesia tracks 50 million outpatient visits.

The report was published online April 23 by The Commonwealth Fund.


HHS General Allocation Fund Portal
Apply for the Paycheck Protection Loan ASAP!

We want to ensure physicians are aware of two important developments to help physicians with obtaining funds that will cover the significant drop in patient care revenue over the last two months.

MSSNY worked together with the American Medical Association (AMA) and many other state and specialty societies to advocate to ensure the availability of these funds.

1) The Small Business Administration will again be accepting applications for the Paycheck Protection forgivable loan Program (PPP), starting at 10:30 AM today, following the passage of legislation by Congress last week allocating a new $310 billion for the PPP.

Many physicians had reported not being able to get their applications in time prior to the previous allocation being depleted. This pool of funding is also likely to be depleted quickly, so do not delay in getting in your application if you intend to apply. 

2) The US Health and Human Services (HHS) has indicated that the application portal is open for physicians to avail themselves of a portion of the $20 billion allocation from the CARES Act Provider Relief Fund.

The AMA has advised that anyone who has a Billing TIN (including a pediatric or obstetric practice) who lost revenue in March and/or can estimate lost revenue in April due to the COVID-19 crisis, should be filling out this portal.

The AMA has also put together this guide to help physicians pull together the information they need to submit to the portal. Here is additional information from HHS regarding the distribution.


Most Asked Question from Physicians Who Filed for Stimulus Check
Q. Why haven’t I gotten my stimulus check yet?
A: The government sent the first wave of payments via direct deposit the week of April 13, and the second will arrive this week. If you did not file your taxes with direct-deposit information, it will take significantly longer to get your paper check. The IRS has added a tool to its website that allows you to add your bank information, which would speed up the process by weeks.


NY Launches Victim Texting Service as Domestic Violence Up 15% Since March
With domestic violence on the rise, New York launches text service for victims

New York has upgraded its domestic violence hotline to allow victims to receive support through a new texting service as the number of reported incidents continues to climb amid the COVID-19 outbreak. Victims in need of support can now text the state or talk with a professional through the state’s Office for the Prevention of Domestic Violence’s website by visiting opdv.ny.gov.

  • All services are confidential and are available 24/7.
  • The number to text is: 844-997-2121.

The new service will allow victims unable to call or help because they are isolated with their abusers to receive services discreetly, Gov. Andrew Cuomo said.

The number of calls to the state’s domestic violence hotline has climbed 30% in April since this time last year, and the number of calls increased by 18% between February and March this year. State Police have also reported a 15% increase in domestic violence incidents for March compared to the same period last year.


Hydroxychloroquine and Chloroquine Should Be Used Only in Hospitals/Trials
The FDA issued a safety warning saying that hydroxychloroquine and chloroquine should only be used in hospitals or as part of clinical trials for the treatment of coronavirus. The FDA warned that the drugs can cause heart problems.


Gov. Cuomo’s Press Conference Yesterday
Gov. Andrew Cuomo said over the weekend that his state’s surge in new hospitalizations from COVID-19 appears to have crested, although a drop-off in new cases is gradual, and the death toll remains high. The governor outlined a plan that could begin a phased easing of shelter-in-place orders upstate after May 15.

Hospitalizations fall again. Yesterday, the total number of hospitalizations fell to 13,839 — returning to the level of March 31. This is a positive trend, but it is still far higher than we would like to see. I am very saddened to say we lost 367 New Yorkers yesterday — down from 437 the previous day. Every day, this is the worst, most devastating news that I must give to New Yorkers.


WHO Raises Concern about “Immunity Passports”
The World Health Organization has emphasized possible concern about the risk for no immunity against a second infection. The WHO was responding to the idea that “immunity passports” could be given to people who have recovered from COVID-19 and have antibodies. The passport could theoretically allow someone to travel or return to work. In a statement, the WHO says, “People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission.”

6 new symptoms: The CDC has added chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell to its list of possible COVID-19 symptoms. These join fever, shortness of breath or difficulty breathing, and cough on the list.


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Essential Workers Will Be Honored Tomorrow (TUESDAY) by Navy’s Blue Angels and Air Force’s Thunderbirds in Metro Fly Over at Noon
New York essential workers will be honored with an air show on Tuesday. The US Navy’s Blue Angels and the Air Force Thunderbirds will fly over the New York Metropolitan area as a tribute to all the workers on the frontlines of this pandemic. “This is our way of showing that we are all in this together and that America’s spirit will prevail,” said Air Force Chief of Staff Gen. David Goldfein and Navy Chief of Naval Operations Adm. Michael Gilday in a joint statement. Air Force Chief of Staff Gen. David Goldfein and Navy Chief of Naval Operations Adm. Michael Gilday said in a joint statement. The flyovers will kick off over New York. The jets will be over the Big Apple and Newark at noon.


WHO Data Leak Shows No Benefit from Gilead Coronavirus Drug
A leading coronavirus drug candidate showed no benefit in results from a hotly anticipated clinical trial that were mistakenly posted to the World Health Organization’s website today. The experimental drug, an antiviral called remdesivir, is being studied in several late-stage trials and has recently drawn praise from President Donald Trump after a sliver of early data from a different clinical trial leaked last week.

The draft documents posted to the WHO website — and then quickly removed — suggest that the drug did not help patients enrolled in a randomized clinical trial in China, and caused significant side effects in several people that led them to end treatment. More participants who received remdesivir died compared to those in the control group, although the difference between the two groups was not statistically significant.

Gilead thinks the results were mischaracterized because the study ended early due to low enrollment, spokesperson Sonia Choi said. “As such, the study results are inconclusive, though trends in the data suggest a potential benefit for remdesivir, particularly among patients treated early in disease.”

“We regret that the WHO prematurely posted information regarding the study,” Choi added.

The Financial Times first reported the mistakenly posted results. Gilead’s stock price dropped more than 7 percent in the hours after the news.

Multiple “phase III” remdesivir studies are still ongoing in the U.S., with early results from some expected this month. (Politico, 4/23)

 

 

MSSNY Applauds Legislation to Replenish Small Business and Health Care Provider Relief Funds


MSSNY Seal
MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

 

For Immediate Release
April 22, 2020

MSSNY Applauds Legislation to Replenish Small Business and Health Care Provider Relief Funds

Statement attributable to:
Art Fougner, MD
President, Medical Society of the State of New York

“MSSNY thanks Senators Schumer and Gillibrand, and the New York Congressional delegation for their efforts to advance legislation to replenish the small business and health care provider relief pools initially passed in the CARES Act. This additional funding stream is critically important to maintaining the availability of physicians to their patients as we continue to manage and begin to recover from this horrific outbreak.

This funding stream is also a critically important lifeline to physicians in their efforts to maintain jobs for the hundreds of thousands of New Yorkers they employ. A MSSNY survey released last week finds that 80% of the physician respondents noted that there had been at least a 50% reduction in patient visits since the beginning of the outbreak, and more than a quarter have had to lay off or furlough at least 50% of their staff.

MSSNY looks forward to the U.S. House passage of these relief funds later this week as well as development of the next stimulus package, which we hope will more fully address the enormous financial consequences to New York’s health care and economic infrastructure, as well as providing a mechanism to ensure both office based and hospital based medical staff have the protective equipment they need.”

# # #

About the Medical Society of the State of New York
Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

MSSNY Contact:
Roseann Raia
Medical Society of the State of New York
516-488-6100 ext 302
rraia@mssny.org

 

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COVID-19 Update April 22, 2020


COVID-19 April 22 Statistics

By the numbers:

* New York reported 15,302 statewide deaths as of Wednesday, including 474 more fatalities in the past day of New Yorkers who have tested positive for COVID-19.

* As of Wednesday, the state reported 10,977 deaths of city residents, or 15,842 deaths if you include “probable” and not just “confirmed” cases.

* As of Wednesday, 15,599 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here.


ALL PHYSICIANS: DO YOU HAVE A STORY TO SHARE? DO YOU HAVE A PHOTO OF YOUR HEALTH CARE HEROES? Email MSSNY at csouthard@mssny.org or call MSSNY at 516-488-6100 ext. 355.


MSSNY President Dr. Art Fougner Holds Up Newsday Centerfold Saluting “HEALTHCARE HEROES.”

MSSNY President Dr. Art Fougner holds up Newsday centerfold saluting “HEALTHCARE HEROES.”


Governor Cuomo’s COVID-19 Briefing Notes

– 15,599 total hospitalizations as of yesterday. “The curve is on the descent.”
– Net change in total hospitalizations and intubations is down
– 1,366 COVID hospitalizations yesterday
– 474 deaths (446 in hospitals, 28 in nursing homes)

White House Visit:

– Visit was productive… was able to put personal politics aside and come to
terms on the federal and state partnership in terms of testing, state
funding, and the state/FEMA match.
– About 40K tests could be done daily if all variables were bought up
to capacity.

Reopening:

– Local leaders are feeling pressure to reopen
– “This is not a time to be stupid.”
– Governor reiterated what happened during the Spanish flu noting that if we
are not prepared a second wave could wreak havoc.
– Governor reiterated that he has no problem taking the blame for any judgements
on the matter.

Q&A:
Reopening:

– Schools will only open if it is known that schools are disinfected and there
are protocols in place for continued disinfecting and social distancing.
– Can’t reopen businesses without reopening schools and transportation.

Nursing Homes:

– Announcement will be made tomorrow on regulations and ensuring safety of staff
– If homes are not providing staff with PPE, they may be put out of business by
the state for noncompliance.

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HealtheConnections Offering COVID-19 Lab Result Data to NYS Physicians
HealtheConnections, a nonprofit organization serving twenty-six counties in New York State, operates our regional health information exchange (HIE). They are offering its free resources tailored to COVID-19 treatment and monitoring to any healthcare provider or public health professional. 

In partnership with the NYS Department of Health, they are offering immediate access to free COVID-19 lab result data and clinical alerting on lab results from anywhere in New York State. Please see this short flyer explaining these services and how to gain access if you feel these might be of benefit to your organization or someone you know working in the healthcare field. 

HealtheConnections is the Regional Health Information Organization (RHIO) for Dutchess County and the entire Hudson Valley region. Their HIE, which creates comprehensive patient medical records from more than 450 care organizations, includes every hospital in our region. 

If you have any additional questions on this data or how to access, please reach out to HealtheConnections directly at support@healtheconnections.org or call 315-671-2241 x5.


DHHS Stimulus Payment Attestation Obligation
Please note that physicians who received a deposit into their bank account from HHSPAYMENT, must attest to the Terms and Conditions within 30 days of receipt and advise whether they accept or reject the payment. The following link will “walk” physicians through this attestation process.


Gov.: Plan for Resuming Elective Surgeries in Certain Parts of Upstate NY
As part of the Governor’s daily press conference yesterday, he announced that elective surgeries could resume in certain “counties and hospitals without significant risk of COVID-19 surge in the near term” across upstate New York. Hospitals will be able to resume performing elective outpatient treatments on April 28, 2020 if

a) the hospital capacity is over 25% for the county and
b) there have been fewer than 10 new hospitalizations of COVID-19 patients in the county over the past 10 days.

If a county or hospital that has resumed elective surgery experiences a decrease in hospital capacity below the 25% threshold or an increase of 10 or more new hospitalizations of COVID-19 patients, elective surgeries must cease. Further, patients must test negative for COVID-19 prior to any elective outpatient treatment. The State Department of Health will issue guidance on resuming elective surgeries.

Restrictions on elective surgery remain in place in Bronx, Queens, Rockland, Nassau, Clinton, Yates, Westchester, Albany, Richmond, Schuyler, Kings, Suffolk, New York, Dutchess,Sullivan, Ulster, Erie, Orange and Rensselaer counties as the state continues to monitor the rate of new COVID-19 infections in the region.


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MSSNY Survey: Please Complete to Gauge Financial Impact of Outbreak and Availability of Relief
The $2 trillion CARES Act became law on Friday, March 27th and was the third stimulus relief package approved by the federal government in less than two months. Among the issues the bill addresses are the impact on small businesses, as well as the healthcare system, and includes $350 billion in forgivable loans and grants, and advanced payments from Medicare.

These resources are already available, but it is unclear how much physicians know about them and whether they are benefiting. Moreover, as MSSNY continues its aggressive advocacy to ensure physicians can obtain needed financial assistance during this crisis, we need information from our members as to the impact on their practice.

To get an idea if funds are getting into the hands of New York physicians, MSSNY’s Governmental Affairs team distributed a survey on Monday, April 13, to all members and other partners, with questions ranging from how aware physicians are of the financial assistance available through the federal government, difficulty in applying for assistance and whether or not physicians are having to layoff, or furlough, staff. For those MSSNY members who may not have taken the survey, please go to this link.

We will keep you updated on our final survey findings and how we plan to use this information, going forward.


Congress, President Announce Agreement to Provide Needed Additional Funding for Small Business and Health Care Relief Pools
As has been reported in several news articles today, Congress and the Trump Administration have agreed on a package to be voted on this week to provide a “replenishment” to various funding pools enacted in the CARES Act last month.  This includes $310 billion to supplement the depleted fund for the Paycheck Protection Program (PPP) for small businesses; $50 billion for the Economic Injury Disaster Loan (EIDL) program; and an additional $75 billion to supplement the $100 billion health care provider pool (of which an initial $30 billion distribution was made last week).

Moreover, the bill allocates $25 billion to assist in developing a national testing program, including a reported $1.5 billion for New York. The US Senate passed the legislation on Tuesday and the US House is expected to take it up Thursday. Each of these funding streams are absolutely essential towards helping physicians maintain their practices and keeping their practices during this crisis period. MSSNY President Dr. Art Fougner praised the New York Congressional delegation for taking this action.


Upstate Escapes the Worst of COVID-19
As of Sunday, the city proper, along with Long Island and its northern suburbs (Dutchess, Orange, Putnam, Rockland and Westchester counties), had recorded almost 14,000 Covid-19 deaths, which was 97 percent of the statewide total and a third of the nationwide toll. The impact on the other 50 counties has been far less severe, with 410 deaths as of Sunday.


We Thank NY Legislators for Replenishing Pool for Relief
“MSSNY thanks Senators Schumer and Gillibrand, and the New York Congressional delegation for their efforts to advance legislation to replenish the small business and health care provider relief pools initially passed in the CARES Act. This additional funding stream is critically important to maintaining the availability of physicians to their patients as we continue to manage and begin to recover from this horrific outbreak.

This funding stream is also a critically important lifeline to physicians in their efforts to maintain jobs for the hundreds of thousands of New Yorkers they employ. A MSSNY survey released last week finds that 80% of the physician respondents noted that there had been at least a 50% reduction in patient visits since the beginning of the outbreak, and more than a quarter have had to lay off or furlough at least 50% of their staff.

MSSNY looks forward to the U.S. House passage of these relief funds later this week as well as development of the next stimulus package, which we hope will more fully address the enormous financial consequences to New York’s health care and economic infrastructure, as well as providing a mechanism to ensure both office based and hospital based medical staff have the protective equipment they need.”


NYC Healthcare Workers Get Coronavirus Antibody Tests
Teams at Columbia University have pushed hard to boost the sensitivity of their in-house COVID-19 antibody testing and are now offering it to healthcare workers returning to the front lines here. While sensitivity is not perfect and questions remain about the clinical significance of SARS-CoV-2 antibodies, teams are moving ahead with the two-fold purpose of providing healthcare workers some peace of mind and collecting data to ultimately improve testing.

After weeks of tweaking their own ELISA assay, Columbia researchers say they’ve managed to bring its sensitivity to 85% — higher than the 50% to 60% they achieved with a commercial assay, according to Steven Spitalnik, MD, director of clinical laboratories at Columbia University Irving Medical Center and NewYork-Presbyterian.

“We know they’ve been diagnosed with the infection, so the majority [of healthcare workers] should test positive with this assay,” Spitalnik told MedPage Today. “That should give them some comfort and lower their stress levels, though we still expect them to use full personal protective equipment.”

Testing will also give Columbia a “biorepository of well curated samples,” he said.
(Med Page, 4/22)


How Many Times Can You Wash Your Mask?
Steam sterilization may work for decontaminating N95 respirators in short supply during the COVID-19 pandemic, researchers reported. N95 masks retained structural integrity and efficacy after three cycles of sterilization, reported Firas Zabaneh, MT, MBA, of Houston Methodist Research Institute, and colleagues in a research letter in Infection Control & Hospital Epidemiology.

Fit testing of the masks on five test subjects checked out after all three rounds compared with baseline. Chemical and biological indicators for every autoclave cycle confirmed absence of contamination on the masks afterward. Reuse is unavoidable, because “the United States will need 3.5 billion N95 masks for healthcare workers during this pandemic, and currently has about 1% of that necessary volume,” the researchers noted.

Decontamination strategies have varied widely from institution to institution in what has been described as a “Wild, Wild West” phase for infection control, with some just waiting out the 72-hour period the coronavirus can live on plastic, stainless steel, and cardboard surfaces and others taking more active measures. The study used immediate-use steam sterilization with a Steris Amsco Evolution HC1500 PreVac Steam Sterilizer autoclave on masks packed in paper-plastic sterilization peel pouches.

While the CDC hasn’t officially endorsed any method for decontamination, it said ultraviolet germicidal irradiation, vaporized hydrogen peroxide, and moist heat — like used in this study — have shown “the most promise” as methods for decontaminating respirators. Also, the FDA indicated it won’t object to use of disinfectant devices, sterilizers, and other approaches for mask decontamination. Subsequently, a study from the National Institute of Allergy and Infectious Diseases determined that the best strategy was vaporized hydrogen peroxide, which worked fast and maintained mask efficacy for three cycles of sterilization.

In that study, ultraviolet light took longer but also kept masks in good shape through three cycles. Dry heat was slow and degraded mask function after two rounds of decontamination. A 70% alcohol saturation did not make it to the second round.

Zabaneh’s group acknowledged the low numbers in their study “to prevent removing N95 masks from clinical settings and to rapidly translate this finding to the greater clinical community.” Follow-up studies in a significantly larger group are planned at Houston Methodist Hospital, with fit testing each day.

Primary Source

Infection Control & Hospital Epidemiology

Source Reference: Carrillo I, et al “Immediate Use Steam Sterilization (IUSS) Sterilizes N95 Masks Without Mask Damage” Infect Control Hosp Epidemiol 2020; DOI: 10.1017/ice.2020.145.


Trump Administration Announces New Nursing Homes COVID-19 Transparency Effort
On April 19, under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) announced new regulatory requirements that will require nursing homes to inform residents, their families, and representatives of COVID-19 cases in their facilities. In addition, as part of President Trump’s Opening Up America, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC).

This information must be reported in accordance with existing privacy regulations and statute. This measure augments longstanding requirements for reporting infectious disease to state and local health departments. Finally, CMS will also require nursing homes to fully cooperate with CDC surveillance efforts around COVID-19 spread.

CDC will be providing a reporting tool to nursing homes that will support federal efforts to collect nationwide data to assist in COVID-19 surveillance and response. This joint effort is a result of the CMS-CDC Work Group on Nursing Home Safety. CMS plans to make the data publicly available. This effort builds on recent recommendations from the American Health Care Association and Leading Age, two large nursing home industry associations, that nursing homes quickly report COVID-19 cases.

This data sharing project is only the most recent in the Trump Administration’s rapid and aggressive response to the COVID-19 pandemic. More details are available in the Press Release and Guidance Memo.

COVID-19 Update April 21, 2020


COVID-19 April 21 Statistics


Notes from Governor Cuomo’s COVID-19 Briefing:

Total hospitalizations is “basically flat” and overall curve is decreasing
– Net change in intubations and net hospitalizations is decreasing
– New COVID hospitalizations 1,308 as of yesterday
– Total hospitalizations by region
– 64% in NYC, 21% in Long Island, 8% in Westchester and Rockland County
– 125 hospital deaths in Erie county yesterday
– 481 total deaths in NY yesterday (452 in hospitals, 29 in nursing homes)

Governor reiterated the need to Do No Harm:
 – Be ready to Surge and Flex support to address local clusters by
moving ventilators and equipment from downstate to upstate.

Elective Treatment:

 – Hospitals will allow elective outpatient treatment in counties
and hospitals without significant risk of COVID-19 surge in near term.
– Westchester and Rockland south, Erie, Albany, Dutchess, and
several other counties are excluded.

Testing and Tracing:

 – National private manufactures of lab equipment sell test and treatment
to labs to 211 labs in NY.
– Governor agrees that states should be in charge of testing however the
federal government should aid in providing tests.

Reopening:
– Decisions to open will be made on regional circumstances.

Q&A:
Testing:

– Meeting with the president will focus on testing.

Regional Reopening:
– Will view hospitalization rate and amount of COVID cases in
addition to infection rates and hospital capacity to determine
when and how reopening is possible.


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Cuomo Commits to Reopening New York State Regionally
“We’re going to make reopening decisions on a regional basis based on that region’s facts and circumstances,” he said during his daily briefing. The briefing was held in Buffalo, his first-time venturing west of Schenectady since the pandemic began.

“Just like some states will reopen before other states because they have a different circumstance when it comes to COVID and their status with COVID, it’s also true across the state,” Cuomo said. “[The] North Country has a totally different situation than New York City. Central New York has a different situation. We operate as one state, but we also have to understand variations, and you do want to get this economy open as soon as possible.”

He provided the first taste of how this regional rollout will work by announcing that some hospitals can resume elective surgeries and treatments. “We’re going to allow elective outpatient treatment, which means the number of beds remain available because the number of people are using those beds is still relatively minimal,” he said. “And we’re going to allow it in those hospitals and counties in the state that do not have a COVID issue.” Cuomo said the policy will exclude hospitals in Westchester, Rockland, Erie, Albany and Dutchess Counties, as well as in New York City, where there still is “a real COVID problem.”

“The economic impact … has taken an extraordinary toll on an already struggling Upstate economy,” Unshackle Upstate Executive Director Michael Kracker said in a statement Monday. “A one-size-fits-all strategy is simply not the best fit for Upstate New York.” (Politico, 4/21)


MSSNY Urges NY-Based Health Insurers to Provide Advance Payment Options for Network Physicians
MSSNY President Dr. Art Fougner has written to the CEOs of several regional health insurers operating in New York State urging that they implement a program to provide “advance payment” options to their network physicians similar to what has been undertaken by the Medicare program.

The letters, written to the CEOs of CDPHP, Excellus, Emblem, Empire Blue Cross, Independent Health and MVP, note that “like many businesses across the state, New York physicians are dealing with the devastating impact on their practices as a result of the suspension of all elective procedures, the lack of availability for needed personal protective equipment (PPE), and patients appropriately limiting their trips out of the house, including to their doctor’s offices.”

The letter also thanks the insurers for “working collaboratively…over the past several weeks to help remove barriers to patients being treated via telemedicine, which has been important to maintaining essential continuity of care for our patients and your insureds collaboration”, but notes that far more needs to be done to preserve their networks in the future given the challenges and limitations of the Paycheck Protection Program established under the CARES Act. A similar program was recently advanced by United Healthcare


COVID-19-Related NY Nursing Home Deaths Surpass 1,000
More than 1,100 New York nursing home and adult care facility residents have died from Covid-19 since the outbreak began more than a month ago, state health officials reported Friday. New data released by the Department of Health found that at least 1,135 people died at nursing home and adult care facilities as of Wednesday. That represents about 9 percent of the state’s death toll so far. The bulk of those deaths occurred at facilities in New York City.  (Politico, April 20)


N.Y. Nurses Sue Montefiore, State Over Dangerous COVID-19 Conditions
The New York State Nurses Association on Monday sued the state, Montefiore Medical Center and Westchester Medical Center, alleging their members weren’t given adequate personal protective equipment and were forced to return to work earlier than advised.

Approximately 161 association nurses at the two health systems have tested positive for coronavirus.

“More than seven in ten of our nurses are reporting exposure to COVID-19 and most are still untested. These lawsuits were filed to protect our nurses, our patients and our communities from grossly inadequate and negligent protections,” NYSNA Executive Director Pat Kane said in a statement. “We cannot allow these dangerous practices to continue.” (4/20 Modern Healthcare)


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Huntington Hospital, Long Island


CMS: Facilities May Begin Performing Elective Procedures; Follow Procedures
Healthcare facilities should be able to begin performing elective procedures again if they follow certain protocols, according to guidelines released Sunday by CMS. Although many hospitals and health systems have quickly set up telehealth services to address non-urgent medical issues, “the reality is that not everything can be addressed by telehealth,” CMS administrator Seema Verma said at a briefing held by the White House’s coronavirus task force, citing breast cancer surgery and cataract surgery as two examples of elective procedures that can’t be put off for too long.

With some hospitals around the country seeing a decline in COVID-19 cases and reporting unused capacity, “we’re issuing guidelines today about how we can re-open the healthcare system; these are recommendations around Phase 1,” Verma said, referring to the administration’s “Guidelines for Opening Up America Again.” That guidance outlines a stepped approach to resuming normal activities based on trajectories of syndromic illnesses, diagnosed cases, need for hospital “crisis care,” and testing availability.

“Every state and local official has to assess the situation on the ground,” she said. “They need to be able to screen patients and healthcare workers for the COVID virus, and we need to make sure that patients feel safe when they come in to seek healthcare services by showing they have the appropriate cleaning in place and that they observe social distancing inside the healthcare facilities.” Verma added that this will be a gradual process in which “healthcare systems across the country need to decide what services should be available. We want to make sure systems are reopening so they can stay open and doing that in a very measured way.”

The new CMS guidelines specify that “non-COVID-19 care should be offered to patients as clinically appropriate and within a state, locality, or facility that has the resources to provide such care and the ability to quickly respond to a surge in COVID-19 cases, if necessary. Decisions should be consistent with public health information and in collaboration with state public health authorities.” (Medpage 4/20)


One in Three N.Y. COVID-19 Patients Required a Ventilator
A large study of hospitalized COVID-19 patients in New York City found 1 in 3 were put on breathing machines. That’s a rate more than 10 times higher than seen in China.

The study’s authors say that of the patients studied, 36% were obese, which may have contributed to severe breathing problems and the need for ventilators.

Published online Friday in the New England Journal of Medicine, the report involves 393 patients admitted to two unidentified hospitals from March 5-27. Patients were aged 62 on average and 60% were men. Almost 40% were white but the report had no other racial breakdown. Overall, 6% were health care workers.

Cough, fever and shortness of breath were the main symptoms, but diarrhea, nausea and vomiting were also common.

Dr. Parag Goyal of Weill Cornell Medicine and the report authors say that compared with China, hospitalization for COVID-19 in the U.S. is generally limited to more severely ill patients, another likely reason for the greater use of ventilators.

The authors say 40 patients or 10% died and 260 were discharged from hospitals. (4/17 Modern Healthcare)


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Private Labs in New York Must Prioritize COVID-19 Testing
Private labs across New York were ordered Friday to coordinate with the state’s Department of Health to mandate coronavirus testing takes priority.

Gov. Andrew Cuomo said Friday he would issue an executive order that mandates all labs—public and private—in the state, who are tasked with carrying out coronavirus diagnostic tests, coordinate with the State’s health department going forward.

There are 301 labs in New York licensed to perform virology testing, Cuomo said.

“How do we get 300 private labs and hospitals to become one system statewide to do testing for COVID? And how do we get them all coordinated? This is something that has never been done before and is going to be a tremendous undertaking,” Cuomo said. (Crain’s New York Business 4/20)


MIPS Credit for Sharing Clinical Data
The CMS on Monday encouraged providers to share clinical data in the Quality Payment Program that could help combat the COVID-19 pandemic.

The agency will give providers credit in the Merit-Based Incentive Payment System if they participate in a clinical trial that uses a drug or biologic to treat COVID-19 and report the data to the CMS. The hope is the increased participation will help improve patient care and find best practices that could curb the virus’ spread.

“The best scientific and medical minds in the world are working night and day to find treatments to combat coronavirus,” CMS Administrator Seema Verma said in a statement. “But without solid data, their efforts are liable to run up against a brick wall.”

Clinical trial participation will earn half of the credit necessary to gain a maximum MIPS improvement activities score, which is 15% of a provider’s total MIPS score.

The CMS highlighted several trials providers could join, including National Institutes of Health trials or a clinical data repository with Oracle.

“Having clinicians use an open source data tool to submit their findings will bring the results of their research to the forefront of healthcare much faster, leading to improvements in care delivery and the ability to treat COVID-19 patients,” the CMS said in a press release. (Modern Healthcare 4/21)


Northwell Awards Front-Line Workers with Cash, Extra PTO
Northwell Health is giving its front-line workers a $2,500 lump-sum payment and a week of paid time off.

The system estimates around 45,000 nurses, physicians, respiratory therapists, housekeepers and other workers are eligible for these benefits.

“Our dedicated staff’s response to the COVID-19 pandemic has been nothing short of heroic. Thanks to the courage and commitment of our front-line caregivers, we answered the call-in service to the patients and communities who entrust us with their care,” said Michael Dowling, Northwell’s CEO. (4/20)


Healthcare Professionals Urge Data re Death among African Americans
Providers are urging the Trump administration to collect more information about what’s causing high rates of COVID-19 infection and death among African Americans and other people of color, according to a joint letter sent Thursday to HHS by three major associations.

The American Hospital Association, American Medical Association and American Nurses Association identified several areas that require more federal attention, including the need for additional information about “comorbidities, the number of patients by race who require ventilators, oxygen support or intubation, and the number who died in their homes.”

“We need the federal government to identify areas where disparities exist and help us immediately address these gaps,” they wrote.

The groups also pushed HHS to work with state and local public health departments to gather and share information to make sure that providers don’t spend valuable time and resources collecting and reporting data that might already be available.

HHS should act to increase access to COVID-19 testing for African Americans by creating testing centers paid for and run by the federal government, according to the letter. Likewise, the Trump administration should make it easier to get a referral for COVID-19 testing since many people of color don’t have health coverage or primary care access.

Hospitals, physicians and nurses also pressed HHS to develop ways to address minority populations’ COVID-19 needs that are culturally relevant.

The Centers for Disease Control and Prevention recently started to collect and report information about COVID-19 patients’ race and ethnicity—including testing, hospitalization and mortality data—after widespread reports that the COVID-19 outbreak was affecting racial and ethnic groups differently. But experts say they need more information to address the problems. Modern Healthcare, April 21)

COVID-19 Update April 20, 2020


COVID-19 April 20 Statistics
New York reported 14,347 statewide deaths as of Monday, including 478 more fatalities in the past day of New Yorkers who have tested positive for COVID-19. As of Saturday, New York City reported 13,240 deaths of city residents, including “probable” and not just “confirmed” cases. As of Monday, 16,103 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here. Gov. Andrew Cuomo’s April 19 coronavirus presentation is here.


Notes from Governor Cuomo’s COVID-19 Briefing:

– Total hospitalizations 16,103 as of yesterday
– 1,380 new COVID hospitalizations yesterday
– Net change in hospitalizations and intubations is down
– 478 lives lost yesterday (455 in hospitals, 23 in nursing homes)
– – In terms of reopening, let’s use this situation to learn lessons
and reimagine what we want society to be.
– Antibody testing begins today

Funding:

– Federal government has not funded states to date.
– Federal CARES Act contains zero effort to combat shortfalls
– Renewing bipartisan call for $500 billion in aid to states
– If state government is excluded again schools, local governments,
and hospitals are forecast to be cut by 20% each.
– Hazard pay for frontline workers – they should receive a 50% bonus
(including airline workers)
– 41% of frontline workers are people of color
– 2/3 of front-line workers are women
– 1/3 of front-line workers are from low-income households.

Q&A:
Hospitals:

– Over 20 hospitals were using hydroxychloroquine and will send
results to the FDA and CDC today. The DOH will receive a copy.
— Elective surgeries have been suspended in NY, but bed capacity
has increased since start of COVID-19, so this suspension will be reexamined.
– Policy will be announced tomorrow regarding hospital vacancy rate
and COVID-19

DOL:

– Applications being processed so money should be seen this week.
– People that opt for a debit card instead of direct deposit will wait
longer to receive money.
– DOL launched new form where one application can be filled out to
determine if one is eligible for unemployment insurance and pandemic
unemployment insurance.

NY Physician Practices Struggling to Survive: Survey
Physicians in New York are struggling to stay afloat despite the recent passage of the CARES Act, according to a new survey from the Medical Society of the State of New York.

The bill was meant to address the impact of the Covid-19 pandemic on small businesses, including physician practices, the society said. But more federal support is critical to the survival of those in hard-hit New York.

Some 80% of survey respondents reported that they have suffered a loss of revenue of more than 50% since the Covid-19 outbreak began. And 83% reported they have experienced a reduction of more than 50% in the volume of patients visiting their practices.

Additionally, more than a quarter of respondents said they have had to lay off or furlough more than half their staff, and nearly three-quarters said they have applied for forgivable loans through the Small Business Administration.

Our first priority remains to ensure that our patients through the crisis can continue to receive the care they need, but we need to know if our practices can keep their doors open for patients now and in the future,” said Dr. Art Fougner, president of the medical society, in a statement. “With patients appropriately limiting their trips out of the house, including to their doctor’s offices, along with all elective procedures being suspended, the impact has devastated practices and the hundreds of thousands of New Yorkers they employ.”

Fougner added that one physician commented: “Letting go of my staff, knowing the hardship ahead for them, was one of the most difficult decisions I ever had to make. I pray they will return when this horrible scourge is over.”

The society noted that although the CARES Act provided some funding to make up for deficits, it’s not nearly enough for many physicians across the state.

The group thanked the New York congressional delegation for continued efforts to secure additional relief funds. (Crain’s, April 17)


Survey of Medical Society of State of NY Physicians
A survey of Medical Society of the State of New York members released Thursday found 83 percent of respondents have had a reduction of more than 50 percent in the volume of patients visiting their practices. Also, 80 percent have suffered a loss of revenue of more than 50 percent since the outbreak of COVID-19. More than a quarter have had to layoff, or furlough, more than 50 percent of their staff.

“Very disturbing reports were also received from physician respondents that despite having applied for help as soon as the funds became available, they have received no assistance to date,” the society reported. (Times Union,  April 19)


African Americans Make Up One-Third of All US Coronavirus Cases
As of April 15, African Americans made up about 30 percent of the COVID-19 
cases in the country, according to CDC data.

The CDC released demographic data for coronavirus cases in the U.S. as of April 15 at 4 p.m. CDT. The data is based on 465,995 U.S. cases.

Three insights:

  1. Race is specified for 111,650 of the COVID-19 cases included in the data.
  2. Black people account for about 30 percent of all U.S. COVID-19 cases where race is specified, while white people account for 64 percent and Asians account for 4 percent.
  3. Of the 102,979 cases for which ethnicity was specified, Hispanic/Latinos account for 17 percent of the cases. (Becker’s Hospital Review, April 20)

The Coronavirus Spreads At Least 13 Feet, Travels on Shoes: CDC
The coronavirus can travel through the air at least 13 feet — more than twice as far as social distancing guidelines, according to a report from the Centers for Disease Control and Prevention. Research published in the federal agency’s Emerging Infectious Diseases journal shows the contagion spreading much farther than previous official suggestions — and also getting spread on people’s shoes.

“The aerosol distribution characteristics … indicate that the transmission distance of [COVID-19] might be 4 m,” the report says, translating as more than 13 feet.

“Furthermore, half of the samples from the soles of the ICU medical staff shoes tested positive,” the researchers wrote of samples taken at Huoshenshan Hospital in Wuhan. “Therefore, the soles of medical staff shoes might function as carriers.”

The report, based on research by a team at the Academy of Military Medical Sciences in Beijing, appears to reaffirm fears that the current social distancing guidelines of 6 feet may not be enough.

It also suggests people — especially medical staff on the front lines — could inadvertently be spreading the bug away from its source, recommending stringent disinfecting measures. (WebMD, April 14)


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NY Hospital Leadership Regarding Communication and Strategy
Michael Antoniades, EVP and COO, Maimonides Medical Center (NYC) 

Hold virtual town hall meetings with all staff at least weekly. You cannot communicate enough. Be open and transparent with your team.

Robert J. Corona, DO, MBA, FCAP, FASCP, Chief Executive Officer, SUNY Upstate Medical University and Community Hospitals (Syracuse, N.Y.)

Anticipate the unexpected. You are operating in an uncertain environment, and the cavalry is not coming. Reach out to collaborate with organizations promising to help you, but ultimately you’re on your own. Low expectations will lead to less disappointment. You’ll be disappointed by some you thought were good leaders and pleasantly surprised by others. A crisis reveals the essence of people’s leadership skills and their true nature.

At the same time, there are people on the bench waiting to get into the game. You will be surprised by the talent you have right under your nose. Delegate urgent issues to your team so you can focus on the critical. Keep vigilant to threats. You can’t take the typical time to make decisions. As a neuropathologist, I compare it to making a frozen section diagnosis. Time is critical, and you have to make the call with the data you have. Also, start planning now for a rolling recovery and coming out of this crisis as a more resilient organization. Coming out of this crisis only to be the same organization you were before is a lost opportunity. 

Laura Forese, MD, Executive Vice President and COO, New York-Presbyterian 

There is no such thing as overcommunicating. Communicate to your team members at all levels. Every person needs to know what is happening in your organization, how you are thinking about the evolving strategy and that you care about the team.

Ignore all the superfluous and overly sensationalized media “noise.” It’s way too unproductive. Alternatively, stay the course by driving evidenced-based, science-centric decisions. And if the noise gets too loud — turn up the music. 

Bill Lynch, Executive VP/COO, Jamaica Hospital Medical Center (NYC) 

Communicate, communicate and communicate. It’s that critical! Good luck.

fact that decisions need to be made quickly. When doing so, not all decisions will be perfect and the organization needs to be agile enough to adjust quickly.

Another key ingredient in leading through this complex crisis is to ensure that the organization is communicating in a multi-channel way, both internally and externally. Communications need to be built into the organization’s daily rhythm and key messages need to be repeated. As COVID-19 races to adapt to its new environment, so must we. Through courage, cooperation, creativity and most importantly resilience, we will persevere. 

Louis Shapiro, President and CEO, Hospital for Special Surgery (NYC) 

Set up a robust organizational structure as if you were starting a new company at scale. Be forward-looking and think about what you need to do before you need to do it. If you wait, it will be too late. Don’t underestimate the importance of communicating with your workforce. HSS did so in many ways: web-app, daily videos, daily emails, live stream. Visibility, transparency, inspiration and timeliness are all critical. Remember your hidden heroes: environmental services, engineering, supply chain, microbiology. Figure out a way to capture what you learned and make sure you pull it through to the other side. Develop your “return to new normal” plan well before you need it.

Overcommunicate. Make sure communication is timely, transparent, and clearly stated. As the messages are delivered, praise the work for the staff for being flexible, as policies and processes are changing daily. Invite feedback, give them a vehicle with which to respond. Let staff know that you are listening to them because they likely have the answers and you want to know what they are thinking. At no other time have we had the opportunity to connect closer to our frontline staff than now. And it is our responsibility to do so. (Becker’s Hospital Review April 17)


Nearly 60% Of COVID-19 Chest X-Rays Look Normal, Study Shows
Chest X-rays read as “normal” for nearly 60 percent of COVID-19 patients, a new study shows. The study, published in The Journal of Urgent Care Medicine, examined the database of a large urgent care company in the greater New York City area. They examined data for patients with the new coronavirus who also had chest X-rays between March 9 and March 24.

Eleven radiologists reviewed data for 636 chest X-rays among patients with confirmed COVID-19.

Of the 636 chest X-rays, 371, or 58.3 percent, read as normal. Of the 265 chest X-rays that read as abnormal, 195 demonstrated mild disease, 65 demonstrated moderate disease and five demonstrated severe disease. (Becker’s Hospital Review April 17)


NBC/WSJ Poll: People More Concerned About Virus than the Economy
Nearly 60% of Americans say they’re more concerned that loosening stay-at-home measures will cause further spread of the coronavirus than they are about what impact restrictions might have on the US economy, according to a new poll. The NBC News/WSJ poll released Sunday found that 58% of registered voters worry the country will be too quick to lift the restrictions, leading the virus to spread and to more fatalities. By comparison, there was another 32% who are more concerned that the country will take too much time to ease the restrictions, which will take a toll on the economy.

There appeared to be a partisan impact on the responses — with 77% of Democratic respondents and 57% of independents reporting they’re more concerned about the spread of the virus than the economy.

Meanwhile, Republicans were more divided with 39% more worried about the pandemic and 48% reporting that their greatest concern was about the economy, the poll said.

The poll was conducted from April 13 to 15 as some states have begun to talk about how to ease lockdown restrictions.

Pollsters surveyed more than 900 registered voters, more than half of whom were reached by cellphone. (NY Post April 19)


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Coronavirus in Context: Covid-19 Prevalence
WebMD’s Chief Medical Officer, John Whyte, speaks with Justin Silverman, M.D. PhD Assistant Professor, Penn State University Alex Washburne, PhD Research Scientist, Montana State University Nathaniel Hupert M.D. MPH FACP Assistant Professor, Weill Cornell Medicine to discuss Covid-19 Prevalence.

In comparison, as of March 28, the CDC had reported more than 122,000 confirmed cases.

The researchers say their findings are in line with another new study that looked for COVID-19 antibodies in the blood of 3,300 Santa Clara County residents. Based on their tests, researchers estimate that between 2.5% and 4.2% of county residents have antibodies against the virus, a number that translates into 48,000 to 81,000 infections, or 50 to 85 times as high as the number of known cases. That study also has not been peer reviewed.

For their study looking at ILI rates, the researchers looked at several sources of information to determine the infection rate:

  • Every week, about 2,600 U.S. health care providers report the numbers of patients who have ILI to the CDC. These patients have a fever of at least 100 degrees, a sore throat or/or a cough, without a known cause other than flu. Colds, flu, other respiratory viruses, and COVID-19 can all cause these symptoms.
  • The researchers then excluded people who were eventually confirmed to have flu.
  • Of the remaining group, they assumed that those numbers above the season average of the nonflu cases could be attributed to COVID-19.

Study co-author Justin Silverman, MD, PhD, assistant professor of information science and technology at Penn State University, cautions that the data about infection rates needs to be verified yet by other methods, such as testing blood samples and taking swabs. The findings point to the need for more testing, and not just of those showing up at the doctor with symptoms, says Alex Washburne, PhD, co-lead author of the study and a research scientist at Montana State University. What’s needed, he says, is random population testing.

“I would like to see 100 random people in each state on each day” tested, he says, both with swabs and antibody testing. “That would give us a sense of prevalence.”

Ruiyun Li, PhD, a research associate at the Imperial College London, who has studied undocumented COVID-19 infections, agreed that the findings stress the need for more testing. “The finding is important as it indicates the urgent need to improve the testing and detection capability – the more we test, the more cases could be confirmed,” Li says. He also said their approach is interesting because it’s impossible to test everyone. “The estimates based on current ILI surveillance system could help.”

The lack of testing is one of the reasons many countries have employed social distancing measures to prevent the spread of the COVID-19 infection. In the U.S., officials have expressed optimism that ramping up widespread antibody testing may help relax distancing measures. Li echoes the researchers’ caution that the estimates are just that – estimates — and the findings do need to be validated by blood tests to show exactly how many people test positive.

Death Rate Questions

The finding of much more widespread infection suggests the infection to fatality rate from COVID-19 might be less than current estimates, which range from 3% from the World Health Organization to 1.4% reported recently by other experts. But the researchers stop short of estimating a revised death rate from their findings.

Fatality rates also depend heavily on how overwhelmed hospitals get and what percentage of cases are tested. The New York Times reported that China’s estimated death rate was 17% in the first week of January, when Wuhan was in its peak, but only 0.7% by late February.

Washburne says while their findings suggest a lower fatality rate is possible, it’s premature to calculate a death rate from the infection rate the researchers found. Death rate, he says, ”is probably the most important and contentious number for assessing the risk-benefit of costly interventions, such as statewide lockdowns versus more diffuse interventions such as mask wearing.”

One bit of missing information may throw off the estimate of the death rate, Washburne says. “If we’re off by 0.1%, that’s 200,000 deaths.”

Washburne says what they’ve done is added a piece of evidence that suggests the growth rate of the virus is faster but that the number of serious cases is fewer. He hopes he can help guide future models if backed up by other evidence. (WebMD Health News Reviewed by Neha Pathak, MD on April 18, 2020)


Social Distancing May Be Needed Through 2022, Harvard Researchers Say
Social-distancing measures for COVID-19 may need to continue through 2022, according to new projections from Harvard researchers published in Science. 

Researchers from Boston-based Harvard T.H. Chan School of Public Health used mathematical modeling to predict various scenarios for the pandemic.

The researchers projected that the SARS-CoV-2 virus will return every winter, prompting more outbreaks after the initial pandemic wave ends. Prolonged social-distancing strategies could help limit the strain on healthcare systems and make quarantine and contact-tracing a feasible response strategy.

“Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available,” the researchers said.

They acknowledged that even intermittent social distancing will have profound economic, social and educational consequences. Even after the “apparent elimination” of COVID-19, viral surveillance should continue through as late as 2024 to prevent an outbreak resurgence, researchers said.

The researchers said their modeling should not be taken as an endorsement of certain response policies, but instead be used to identify helpful interventions and spur new ideas to achieve long-term control of the pandemic.

To view the full study, click here.


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