COVID-19 Update May 4, 2020

INTERIM GUIDANCE FOR REOPENING THE HEALTH CARE SYSTEM & BEST PRACTICES FOR REOPENING FROM COVID-19


New York State COVID-19 Stats
NYSDOH COVID-19 Tracker – NY.gov


Highlights: Gov. Cuomo’s Press Conference Today
GENERAL:
– Total hospitalizations down (9,647). Net change in hospitalizations also
down; et change in intubations down; Number of new cases daily down (717). Gov says to “take this with a grain of salt” as weekends tend to report lower numbers to begin with; Deaths since May 3: 226. 193 in hospitals, 33 in nursing homes.
– According to the CDC, strains seen in NY originated in Europe and other U.S.
regions. Most flights from Europe landed in NY and NJ.

REOPENING:
– Have seen increased alcoholism, substance abuse, domestic violence since
beginning of shutdown. Need to act ASAP.
– Other areas seeing second waves due to reopening too quickly or
irresponsibly. Dr. Fauci says “we could be in for a bad fall or a bad winter.”
– Unsure when the state will reopen or how. Gov says even experts don’t know
best course of action, important to be prepared for all possibilities.
– Quantifiable formula based on % and rate of hospitalizations + diagnostic
testing rate + contact tracing = R/T – 1.1.
– Gov says we can control the rate of transmission through these
measures (R/T = 1.1 or less); if R/T manageable, we can reopen businesses in phases. This will increase activity level while keeping an eye on transmission rates.
– If R/T goes above 1.1, Gov will  stop or slow reopening.
– Core factors determining when certain regions can reopen include: monitoring
new infections, healthcare capacity, diagnostic testing capacity, and contact
tracing capacity.
– CDC guidelines for reopening:
– Regions must have at least 14 days of decline in total
hospitalizations/deaths on 3-day rolling basis.
– Cannot have 15 new total cases or 5 deaths on 3-day rolling basis.
– Fewer than 2 new cases per 100k residents.
– Regions must have at least 30% total hospital and ICU beds available.
– Hospitals must have at least 90 days of PPE stockpiled.
– PHASE I: construction/manufacturing/some retailers with curbside pick-up.
– PHASE II: professional services, finance/insurance, real estate, etc.
– PHASE III: restaurants and hotels.
– PHASE IV: arts/entertainment/recreation, education.
– Businesses must develop their own safety precautions in compliance with new
social distancing standards.

TESTING:
– 1 million NYers have now been tested.
– CDC recommends 30 tests for every 1k residents in regions in order to reopen.
– National Guard has put together 30,000 testing kits.
– Will be issuing 60,000 tests
– Regions must have baseline of 30 contact tracers for every 100k residents,
additional tracers based on number of cases in the region.
– “Army of tracers” being built in partnership with Mayor Bloomberg.


Contact Tracing Opportunities in NYS
The aim of this initiative will be to call every person diagnosed with COVID-19, establish all contacts of this person, and proceed to call and maintain ongoing communication with every contact. In addition, the team will support the isolation and quarantine of individuals, as appropriate in cooperation with the Local Health Department. This includes virtual needs checks and referral to community resources as needed. This contact tracing initiative is in tandem with statewide-wide efforts to increase testing, improve communication and knowledge of effective strategies to reduce transmission, and implementation of isolation and quarantine. This will fortify efforts to control the pandemic in NYS.

New York State plans to hire a team of 6,400 to 17,000 staff statewide, depending on the projected number of COVID-19 cases, to support the NYS Department of Health (NYSDOH) and Local Health Departments (LHDs) to perform contact tracing in communities across NYS. To meet the scale and scope of this nation-leading program, Bloomberg Philanthropies, Vital Strategies: Resolve to Save Lives and the Johns Hopkins Bloomberg School of Public Health will support building the team through a three-step process: recruitment, interviewing and training.

Our first goal is to help the state identify and recruit a robust Contact Tracing team to be a part of this ambitious and urgent effort. To be considered, candidates must be a New York State resident 18 years of age or older; meet the position description requirement; go through an interview process; and complete a training and certification program.

New York State is looking to immediately fill the following roles:

  • Contact Tracers: reach out to the contacts of anyone diagnosed with COVID-19 to assess symptoms, ensure compliance with quarantine and determine social support needs.
  • Team Supervisors:  lead a team of 20 Contact Tracers, and one Community Support Specialist who are working remotely using digital tools.
  • Community Support Specialists: work with the team and the local health departments to address the physical/mental health, and social/human service needs of those contacted, especially those who are under isolation or quarantine.

Click here if you or someone you know in New York State is interested in applying to be a part of the Contact Tracing team.


Gov. Eliminates Cost Sharing for Mental Health Services for Frontline Essentials
Noting that the “COVID-19 crisis has had an immeasurable impact on all New Yorkers, the impact on essential workers, including health care workers, first responders and other frontline essential employees”, New York Superintendent of Financial Services Linda Lacewell announced this weekend that the New York State DFS issued an emergency regulation following Governor Andrew M. Cuomo’s announcement that DFS will require New York State-regulated health insurers to waive out-of-pocket costs, including cost-sharing, deductibles, copayments and coinsurance, for in-network mental health 
A copy of the DFS circular letter can be found
here.


Faced With 20,000 Dead, Care Homes Seek Shield From Lawsuits
Faced with 20,000 coronavirus deaths and counting, the nation’s nursing homes are pushing back against a potential flood of lawsuits with a sweeping lobbying effort to get states to grant them emergency protection from claims of inadequate care. At least 15 states have enacted laws or governors’ orders that explicitly or apparently provide nursing homes and long-term care facilities some protection from lawsuits arising from the crisis. And in the case of New York, which leads the nation in deaths in such facilities, a lobbying group wrote the first draft of a measure that apparently makes it the only state with specific protection from both civil lawsuits and criminal prosecution. (AP, 5/4)


Physicians Urge CMS to Restart Advance Payment Program
The American Medical Association, sent a letter to CMS urging the agency to restart and expand the Advance Payment Program.

In late March, CMS expanded the payment program to a broader group of healthcare providers to help offset the financial damage caused by the COVID-19 pandemic. The agency suspended the advance Medicare payments to Part B suppliers, including physicians, other medical professionals and durable medical equipment suppliers, on April 26, two days after President Donald Trump signed the Paycheck Protection Program and Health Care Enhancement Act.

In an April 28 letter to CMS Administrator Seema Verma, the AMA asked the agency to quickly reinstate the program with more flexible terms.

“Given the uncertainty facing physician practices as the pandemic is on different surge timelines in communities across the country, we fear physician practices may not resume normal operation in the immediate future and will continue to need access to cash flows to keep their doors open for patients,” the AMA said.

The AMA also urged CMS to expand the program to Medicaid providers.

“While the CARES Act and the recently enacted Paycheck Protection Program and Health Care Enhancement Act may provide much needed financial relief for many physicians, we are concerned that the resources provided may not reach Medicaid practices and providers and that these funds alone may not be sufficient to sustain practices and ensure patient access,” the AMA said.

As of April 26, CMS had approved nearly 24,000 applications advancing $40.4 billion in payments to physicians, other healthcare practitioners and durable medical equipment suppliers. The agency has delivered nearly $60 billion in payments to Part A providers, which includes hospitals. CMS announced on April 26 that it is reevaluating all pending and new applications for accelerated payments to hospitals (Becker’s Hospital Review, May 1)


COVID-19 is 3rd Leading Cause of Death, STAT Analysis Suggests
Updated death projections suggest COVID-19 is the third leading cause of death in the U.S., behind cancer and heart disease, according to an analysis from STAT. STAT first compared COVID-19 death projections to past pandemics and leading causes of death in early April to help Americans get a better sense of the numbers. The previous comparison used projections from the Institute for Health Metrics and Evaluation, which now estimates the death toll will be 72,433 by Aug. 4. IHME previously predicted a death toll of 60,000, which the U.S. surpassed April 29.

For the updated comparison, STAT used a model created by Youyang Gu, an independent data scientist. The model projects 88,217 to 293,381 deaths by early August.

How this projection stacks up to past pandemics and flu seasons:

  1. 1918 flu pandemic: 675,000 deaths
    2. COVID-19 pandemic: 88,217 to 293,381 projected deaths
    3. 2017-18 flu season: 61,000 deaths
    4. 2018-19 flu season: 34,200 deaths
    5. 2009 swine flu pandemic: 12,469 deaths

Note: The CDC does not track individual adult flu deaths and instead estimates seasonal death tolls using mathematical modeling.

How this projection stacks up to the nation’s leading causes of death:

1.Heart disease: 269,583 deaths
2. Cancer: 252,500 deaths (based on 2019 data)
3. COVID-19 pandemic: 88,217 to 293,381 projected deaths
4. Stroke: 60,833 deaths
5. Alzheimer’s disease: 50,417 deaths
6. Drug overdoses: 29,265 deaths
7. Suicide: 19,583 deaths
Note: These figures do not represent annual death counts. COVID-19 models project deaths will fall over the next few weeks, with few occurring past July. To compare death tolls on an equal timeline, STAT calculated death counts for a five-month period for all leading causes of death. All figures are based on 2017 data unless otherwise noted.



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FDA Allows Emergency Use of Drug for Coronavirus
U.S. regulators on Friday allowed emergency use of an experimental drug that appears to help some coronavirus patients recover faster.

It is the first drug shown to help fight COVID-19, which has killed more than 230,000 people worldwide.

The Food and Drug Administration acted after preliminary results from a government-sponsored study showed that Gilead Sciences’ remdesivir shortened the time to recovery by 31%, or about four days on average, for hospitalized COVID-19 patients.

The study of 1,063 patients is the largest and most strict test of the drug and included a comparison group that received just usual care so remdesivir’s effects could be rigorously evaluated.

Those given the drug were able to leave the hospital in 11 days on average versus 15 days for the comparison group. The drug also might be reducing deaths, although that is not certain from the partial results revealed so far.

The National Institutes of Health’s Dr. Anthony Fauci said the drug would become a new standard of care for severely ill COVID-19 patients like those in this study. The drug has not been tested on people with milder illness, and currently is given through an IV in a hospital.

Gilead has said it would donate its currently available stock of the drug and is ramping up production to make more. No drugs are approved now for treating the coronavirus, and remdesivir will still need formal approval. (Modern Healthcare May 1)


CMS: Forming Independent Commission to Assess Nursing Homes
CMS will form an independent commission to assess how nursing homes have responded to the pandemic, upping the scrutiny on the facilities that have become COVID-19 hot spots. The commission will primarily focus on nursing home residents’ safety, strengthening regulations to stem the spread of COVID-19 and enhancing federal and state enforcement strategies to improve compliance with infection-control policies, the agency announced late Thursday. It also aims to better coordinate efforts between federal, state, and local authorities as well as identify best practices that may be incorporated into a larger regulatory framework, CMS said

Homing in on the hard-hit state of New York, 93% of its nursing homes have COVID-19 positive patients. COVID-19 patients make up more than 10% of the residents at nearly half of the state’s nursing homes. There has been a 41% year-over-year increase in COVID-19-related symptoms reported in New York nursing homes, pointing to a potential surge, or surge that has occurred but not yet confirmed due to lack of testing, CarePort researchers found. New York City SNFs alone are short an estimated 1,000 beds.

The commission, which will be made up of nursing home operators, public officials, academics, infection-control specialists, medical ethicists and resident advocates, builds on CMS Administrator Seema Verma’s five-part plan announced last year to ensure safety and quality at nursing homes. Ideally, the commission can come up with recommendations to assist long-term care providers and not just penalize them, but much of Verma’s five-part plan has been punitive in nature, said Brian French, a partner at Nixon Peabody.

The administration also announced Thursday that it will send two shipments of personal protective gear to every nursing home over the next two months, each of which contains a one-week supply. Still, experts blame the administration for not acting quick enough, which contributed to thousands of deaths at nursing homes across the country. Fewer than 10% of nearly 9,000 U.S. nursing homes surveyed said they have the ability to take in new COVID-19 patients, according to a CarePort Health poll conducted from early to mid-April. Prior to the pandemic, SNFs had been paring down their workforces due to a new payment model, exacerbating the crisis. (Modern Healthcare)


AMA Launches Physician Guide for Reopening Medical Practices
CHICAGO – In response to states across the nation revising COVID-19 executive orders to allow elective or non-urgent medical procedures, the American Medical Association (AMA) is announcing a new resource that provides a step-by-step guide for physicians planning to reopen medical practices. This new guide builds on the AMA’s ongoing efforts to ensure physicians and health care professionals have the most up-to-date information and resources necessary to navigate the rapidly changing landscape of the COVID-19 pandemic.

Specifically, the resource offers support and guidance for managing the safe reopening of a medical practice as more routine in-person care resumes, protecting the health of patients, clinicians, staff, and the public. It serves as a one-stop-shop outlining how best to approach the unique challenges that the COVID-19 pandemic brings to the practice reopening process, providing physicians with checklists, supplemental information and helpful links to COVID-19 resources from the AMA, Centers for Disease Control and Prevention (CDC) and other federal agencies.

A summary of practice reopening tools available to physicians includes:

  • Ensuring state and federal government compliance

As states and municipalities modify COVID-19 executive orders detailing the types of medical services permitted, the AMA provides recommendations for closely reviewing and following these individual guidelines while remaining in compliance with federal mandates. This section includes an AMA-developed chart and fact sheet overviewing state-specific resumption of elective or non-urgent procedures.

  • Creating a plan for opening medical practices

This portion of the guideline includes a step-by-step approach to safely and incrementally opening a medical practice. It includes details needed to plan for supplying the office with personal protective equipment (PPE), suggestions for routine disinfecting regimens and staff scheduling protocols. As health experts continue to urge physical distancing as the most effective way to reduce the spread of COVID-19 until a vaccine or effective treatment is available, the resource suggests continuing to gauge whether a telemedicine or in-person appointment would be more appropriate.

  • Instituting new safety measures for patients, clinicians, and staff

Because COVID-19 screening processes designed to reduce community spread of the virus are new territory for physician practices, the guide offers recommendations on how to establish staff, patient and visitor safety protocols to ensure safe physical distancing, minimize interactions and limit the volume of individuals in the practice. Provided is a pre-appointment patient screening script template, designed for staff to inquire via phone about patients’ potential COVID-19 symptoms or exposure ahead of entry to the facility. Consistent with CDC guidance, practices should require all individuals who visit the office to wear a cloth face covering to reduce the risk of virus transmission. In addition, information about monitoring and restricting non-patient visitors, staggering appointment scheduling, designating waiting areas and creating dedicated workstations is included here.

  • Reviewing medical liability, privacy and confidentiality policies related to COVID-19

This page overviews the new legal territory and scenarios related to essential COVID-19 screening of patients, visitors and staff, including how to establish and maintain health-related privacy, confidentiality and data security to protect COVID-19 employee testing results while remaining in compliance with HIPAA rules. It also links to topics related to discussing current coverage with medical liability insurance carriers and the AMA’s advocacy efforts for greater reliance on health care emergency response protections to support physicians amid the COVID-19 pandemic.

The AMA will also continue to release additional information in response to the urgent public health crisis to support physicians and the patients they care for, which can be found on the AMA’s COVID-19 Resource Center.


 

 

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Contact Tracing Opportunities in NYS

Contact Tracing Opportunities in NYS

The aim of this initiative will be to call every person diagnosed with COVID-19, establish all contacts of this person, and proceed to call and maintain ongoing communication with every contact. In addition, the team will support the isolation and quarantine of individuals, as appropriate in cooperation with the Local Health Department. This includes virtual needs checks and referral to community resources as needed. This contact tracing initiative is in tandem with statewide-wide efforts to increase testing, improve communication and knowledge of effective strategies to reduce transmission, and implementation of isolation and quarantine. This will fortify efforts to control the pandemic in NYS.

New York State plans to hire a team of 6,400 to 17,000 staff statewide, depending on the projected number of COVID-19 cases, to support the NYS Department of Health (NYSDOH) and Local Health Departments (LHDs) to perform contact tracing in communities across NYS. To meet the scale and scope of this nation-leading program, Bloomberg Philanthropies, Vital Strategies: Resolve to Save Lives and the Johns Hopkins Bloomberg School of Public Health will support building the team through a three-step process: recruitment, interviewing and training.

Our first goal is to help the state identify and recruit a robust Contact Tracing team to be a part of this ambitious and urgent effort. To be considered, candidates must be a New York State resident 18 years of age or older; meet the position description requirement; go through an interview process; and complete a training and certification program.

New York State is looking to immediately fill the following roles:

  • Contact Tracers: reach out to the contacts of anyone diagnosed with COVID-19 to assess symptoms, ensure compliance with quarantine and determine social support needs.
  • Team Supervisors:  lead a team of 20 Contact Tracers, and one Community Support Specialist who are working remotely using digital tools.
  • Community Support Specialists: work with the team and the local health departments to address the physical/mental health, and social/human service needs of those contacted, especially those who are under isolation or quarantine.

Click here if you or someone you know in New York State is interested in applying to be a part of the Contact Tracing team.