COVID-19 Update – April 8, 2020

Health Care Workers Needed to Volunteer in NYC!


NY Statistics for COVID-19
New York State accounts for 36% of the country’s 337,971 COVID-19 cases, according to data as of Monday morning from Johns Hopkins University. About three-quarters of New York State residents are concerned the coronavirus crisis will cause them serious financial problems, according to a new poll released Monday.

The virus has led to closure of nonessential businesses in the state. The state’s Department of Labor processed more than 369,000 initial unemployment applications in the week that ended March 28, representing a 2,674% increase compared with the same week last year. (WSJ, April 8)


Notes from Governor Cuomo’s COVID-19 Briefing:

-NY PAUSE and social distancing have been working to flatten the curve for the
moment. The Governor said stopping such measures could change numbers
and result in an increase in cases.
– Number of patients hospitalized is down, 3-day average trend down, large
hospital systems reporting higher levels of releases than intakes.
– Have managed to increase capacity and share equipment among hospitals.
The Governor said if hospitalization rate continues to decrease, the system
should be able to stabilize over the next couple of weeks and reduce the need
for overflow systems.
– Must continue social distancing to achieve this.
BAD NEWS: Highest single death toll, 779 people, seen overnight. Number
of deaths will continue to rise as those hospitalized for a longer amount of time
pass.
– For perspective, the Governor said 2,753 lives were lost in 9/11 and 6,268
have passed from COVID-19.
– Flags will be set at half-staff in honor of the lives lost.
– Need to learn and develop a “new normal” through public health preparedness
and increasing hospital capacity. Additionally, have found new ways of using
technology (celebrated the development of a virtual court system, telehealth,
working from home, and online education).
– Still have to develop a testing capacity. Those who are negative or developed
antibodies will be able to return to work from this testing.
– Will be conducting more testing in minority populations to better understand
disparities. Research and testing to be conducted by SUNY Albany’s Dr. Havidan
Rodriguez and DOH/Northwell Health. The Governor said this will begin soon.
– Will be issuing an additional $600 payment to all unemployed NYers; the State
expects to be reimbursed by the Federal government at some point.
– Unemployment benefits will be expanded for an additional 13 weeks
(totaling 39 weeks).
– By executive order, absentee ballots will be allowed for the June 23rd primaries.
– Mercury Medical donated 2,400 BiPap machines, which were flown to NY from
Florida for free courtesy of Jet Blue. He also thanked Oregon, Washington, and
California for helping with ventilators.
– Commended the efforts of public health workers and first responders.
– Will be starting new social media campaign, “Who Are You Staying Home For?”
– Examples include healthcare workers, public health, family members.
– Social distancing violation fines have been doubled, as previously mentioned.
– PASSOVER: Wished the Jewish community a Happy Passover,
noted previous anti-Semitic events from earlier in the year. Used Passover
as an example for how to improve, explaining that it is based on analyzing the past
and determining the future.

NEWS SUMMARY

1. President Donald Trump said the U.S. may end funding to the World Health Organization. Trump later clarified that his administration has not yet decided to end funding for the agency but will be looking into it. The U.S. has provided $893 million during WHO’s current two-year funding period, nearly 15 percent of its total funding, according to the organization’s website, cited by STAT. 

2. Black people appear to be dying from COVID-19 at disproportionately high rates across the U.S., though many states and officials haven’t been tracking or reporting racial data, USA Today reports. Emerging studies found that black people accounted for 29 percent of confirmed cases and 41 percent of deaths in Illinois as of April 6, despite only making up 15 percent of Illinois’ population, according to STAT. Similar trends appear in Michigan and Wisconsin.

The White House, civil rights groups and lawmakers have urged federal health officials to publish racial data as deaths soar in cities with significant black populations, such as Detroit, New Orleans and New York, according to USA Today.

3. Ventilators may be being overused for COVID-19 patients, some physicians say, according to STAT. Many critical care physicians are reevaluating the widespread use of ventilators after observing that some COVID-19 patients with fatally low blood oxygen levels aren’t gasping for air. That, as well as noting that these patients’ hearts are not racing and their brains don’t show signs of oxygen deficiency, is making some physicians suspect that blood oxygen levels might be misleading care for COVID-19 patients and perhaps numerous patients could instead be treated with less intensive respiratory support.

4. The Drug Enforcement Administration will increase production quotas for several drugs in high demand amid the pandemic, according to an April 7 announcement. The agency is increasing quotas for pharmaceutical manufacturers producing medications in high demand, as well as increasing imports of necessary medications for patients on ventilators.

5. New York City reported 731 COVID-19 deaths in one day, along with an ‘unusually high’ increase in related cases and hospitalizations between April 6-7. The spike is due to both a lag in reports from labs and a large transfer of data from patients hospitalized before April 6. New data from New York state also revealed that 61 percent of 5,489 COVID-19 deaths in the state were among men, and 86 percent of the deaths were among individuals with underlying illnesses. Additionally, 63 percent of deaths were among those 70 years and older.

6. General Motors will build 30,000 ventilators for the national stockpile under a $489.4 million contract with the federal government. The company will deliver the first 6,123 ventilators by June 1, according to the contract invoked under the Defense Production Act.

(Becker’s Hospital Review, April 8)

Worldwide, 1,446,242 COVID-19 cases and 83,424 deaths have been reported, while 308,146 people have recovered from the illness as of 8:30 a.m. CDT April 8.


A Breakdown of Six of the Most Promising COVID-19 Treatments
Hundreds of drugs are being tested to treat COVID-19, the disease caused by the novel coronavirus. Below are six of the most promising treatments, according to Business Insider:

  1. Remdesivir— Gilead’s drug, already tested on other viruses, remdesivir has been a front-runner as a possible COVID-19 treatment. The World Health Organization has called it “the most promising candidate,” and there are five active clinical trials testing its effectiveness against COVID-19 taking place in China, the U.S. and South Korea, according to Business Insider.
  2. Kaletra— Kaletra is an HIV drug made by AbbVie. Although a study published March 18 in the New England Journal of Medicine said Kaletra didn’t show benefits in COVID-19 patients, the WHO said it will conduct a global study on four experimental treatments, including Kaletra, according to Business Insider.
  3. Actemra and Kevzara— Actemra, made by Roche, and Kevzara, made by Regeneron and Sanofi, are both classified as IL-6 inhibitors and may work by stopping a biological mechanism that causes overactive inflammatory responses in patients’ lungs, according to Business Insider. Both drugs are being tested in late-stage clinical trials.
  4. Convalescent plasma— Convalescent plasma is blood plasma taken from COVID-19 patients who have recovered from the disease. That plasma contains antibodies that could help sick patients and boost their immune response, according to Business Insider. So far, two trials have shown promising results.
  5. Chloroquine and hydroxychloroquine— Chloroquine and hydroxychloroquine are both antimalarial drugs. President Donald Trump has expressed hope for chloroquine’s potential in treating COVID-19. The scientific community has not yet definitively confirmed its clinical effectiveness for this virus.
  6. Avigan— Avigan is a flu drug made by Japan-based Fujifilm Toyama Chemical. A trial conducted in China showed Avigan helped patients recover seven days faster than patients on another antiviral drug called arbidol, and it also reduced the frequency of symptoms like coughing and fever, according to Business Insider. However, the drug is not approved in the U.S.  Read the full article here. (Becker’s Hospital Review, April 8)

Worldwide, 1,446,242 COVID-19 cases and 83,424 deaths have been reported, while 308,146 people have recovered from the illness as of 8:30 a.m. CDT April 8. (Becker’s Hospital Review, April 8)


The Four Benchmarks Needed to End Social Distancing
Until there is a vaccine or effective treatment against COVID-19, states should direct efforts toward four major criteria that will help determine local progress, according to a report cited by The New York Times.

The report was written by Scott Gottlieb, MD, former FDA commissioner; Caitlin Rivers, PhD, assistant professor at Baltimore-based Johns Hopkins Center for Health Security; Mark McClellan, MD, PhD, director of the Robert J. Margolis Center for Health Policy and professor at Durham, N.C.-based Duke University; Lauren Silvis, former FDA chief of staff; and Dr. Crystal Watson, senior scholar and assistant professor at Johns Hopkins Center for Health Security. 

Criteria that will determine if and when areas can come out of lockdown:

  1. Hospitals must be able to safely treat all patients needing hospitalization without resorting to crisis standards of care. This is the first standard to meet and the focus of most health officials, according to the authors. Currently, there’s no reason to believe any area meets this criteria, and many local outbreaks aren’t predicted to peak for weeks.
  2. A state needs to be able to test at least everyone with symptoms. Nationwide, about 750,000 tests would be needed a week, and that’s not including areas with major outbreaks. On a smaller scale, states would need to test every person who may be infected and receive the results in a timely manner. The third requirement cannot be achieved until the second occurs.
  3. The state can monitor confirmed cases and contacts. A robust system of contact-tracing and isolation is the only thing that can prevent outbreaks and sequential lockdowns, the authors write. Scaling up some areas’ public health systems to handle such a task would take significant time and money, NYT notes. Other countries have used cellphone-tracking technology to determine who people have been near, but it’s unclear if the U.S. would allow such a tactic.
  4. Cases must continue to decrease for 14 days. It can take up to two weeks for COVID-19 symptoms to emerge, so if the number of cases drops steadily for that much time, officials can be reasonably sure suppression has been achieved, or that every infected person is infecting fewer than one other. (Becker’s Hospital Review, April 8)

NYC First Responders: Dwindling PPE and Many Out Sick
New York City’s first responders — paramedics, EMTs, firefighters, and police officers — continue to man the front lines of the COVID-19 epidemic, despite dwindling amounts of protective equipment and an increasing proportion of their workforce out sick. They are struggling to avoid getting sick, while working increasingly demanding shifts and managing call volume surges. Vincent Variale, president of the Uniformed EMS Union Local 3261 in New York, said that normal medical call volume is about 4,000 calls a day. Now, EMS providers are responding to more than 6,500 calls daily. They’re also managing longer workdays, rationing protective gear, and following guidelines that continue to change as hospitals overcrowd with patients.

Last week, for instance, New York City enacted new guidelines for patients in cardiac arrest. If paramedics and EMTs cannot save a patient who is in cardiac arrest in the field, they are being instructed not to take them to the hospital. In New York, this shortage of masks has prompted instructions to firefighters that they use N95 masks only during procedures that might generate aerosols, including intubation, asthma treatment, and cardiac arrest care. (Medpage, April 8)


Comfort Will Be Able to Treat 500 COVID-19 Patients
Gov. Cuomo told reporters on Tuesday the Comfort will be able to treat up to 500 COVID-19 patients, about half of its original expected capacity. The governor said the shift from non-COVID-19 patients to coronavirus cases led to the elimination of 500 beds. The military-run hospitals at the Javits Center and onboard the USNS Comfort remain mostly empty — so far treating only 110 patients between them.


Hospitals: “Fed Gov. Seizing Medical Supplies, Leaving Doctors in Dark”
The Los Angeles Times (4/7) reports that although the President “has directed states and hospitals to secure what supplies they can, the federal government is quietly seizing orders, leaving medical providers across the country in the dark about where the material is going and how they can get what they need to deal with the coronavirus pandemic.” Hospital and clinic officials in seven states “described the seizures in interviews over the past week.”

The Federal Emergency Management Agency “is not publicly reporting the acquisitions, despite the outlay of millions of dollars of taxpayer money, nor has the administration detailed how it decides which supplies to seize and where to reroute them.”


Researchers Say Diabetes Does Not Increase Risk of Coronavirus Infection but is Tied to Higher Mortality Among the Infected
Healio (4/7) reports researchers examined data from China and Italy and concluded that while “adults with diabetes are no more likely to contract” coronavirus “than people without diabetes,” they “could be up to twice as likely to die from complications” tied to the infection.

The researchers wrote a letter to the Journal of Endocrinological Investigation sharing their findings. Gian P. Fadini, MD, PhD, an associate professor of endocrinology at the University of Padova in Italy and one of the letter’s authors, said, “Diabetes does not increase the risk of new coronavirus infection, but it can worsen the outcome of COVID-19. People with diabetes can be reassured they are not at higher risk for becoming infected, but they have to pay additional attention to symptoms and signs of disease progression.”


MEDICAL ECONOMICS

WC Board Extends Formulary Deadline for Prescription Renewals to Jan 1, 2021
In response to widespread health care industry challenges due to COVID-19, the Chair of the New York State Workers’ Compensation Board (Board) has modified the New York Workers’ Compensation Drug Formulary (NY WC Formulary) regulation (12 NYCRR 441.3(a)(2)) to extend the deadline by which all health care providers must obtain prior authorization for renewals of non-formulary medications from June 5, 2020, to January 1, 2021.

The six-month extension to January 1, 2021 will:

· Reduce the impact that the COVID-19 emergency may have on health care providers’ ability to implement the requirement.

· Provide more time to health care providers to ensure that prescription renewals are consistent with the NY WC Formulary.

· Ensure that the current health crisis does not negatively affect injured workers, especially those who are on certain medications that are non-formulary agents.

This extension also aligns with the expected implementation of the first phase of the Board’s Business Information System (BIS) Project. In the first phase, the Board will roll out a new web-based portal through which providers can request and manage prior authorization and variance requests related to treating injured workers, taking common forms (MG-1, MG-2, and C4-Auths) and related processes online.

The new portal will promote greater access for health care providers, quicker response times for prior authorization requests, and greater system reliability – resulting in the improved delivery of care to injured workers. For more information, please visit the Board’s website at wcb.ny.gov.


CMS OKs $34B for Providers with Accelerated/Advance Payment in One Week
CMS has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.

The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks.  In a little over a week, CMS has received over 25,000 requests from health care providers and suppliers for accelerated and advance payments and have already approved over 17,000 of those requests in the last week.

The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.

The advance and accelerated payments are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement. Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively.

It is important to note, this funding is separate from the $100 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act appropriation is a payment that does not need to be repaid. The Department of Health and Human Services (HHS) will be providing additional information on how healthcare providers and suppliers can access CARES Act funds in the coming weeks.

The fact sheet on the accelerated/advance payment process and how to submit a request can be found here: Fact Sheet Providers can also contact their Medicare Administrative Contractor for any questions.


CMS Office Hours on COVID-19
You are invited to CMS “Office Hours” on COVID-19, Thursday, April 9th from 5:00 – 6:00 PM EST, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

·        Increase Hospital Capacity – CMS Hospitals Without Walls;

·        Rapidly Expand the Healthcare Workforce;

·        Put Patients Over Paperwork; and

·        Further Promote Telehealth in Medicare

We encourage you to submit questions in advance to partnership@cms.hhs.gov, including “Office Hours” in the subject line. There will also be live Q&A.

Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

Toll-Free Attendee Dial In: 833-614-0820

Event Plus Passcode: 1881716