COVID-19 Update May 22, 2020



Lean on Me: MSSNY Launches COVID Helpline and Recruits Peer Supporters

You just call on me brother, when you need a hand 
We all need somebody to lean on
 
I just might have a problem that you’ll understand
 
We all need somebody to lean on”
  … written and recorded by American singer-songwriter Bill Withers, released in April 1972

Hit songs typically come and go but this song has had enduring longevity.  The lyrics speak to us now touching our soul, expressing exactly how we feel. The music resonates in our heart, mind, and spirit lifting us to another dimension.

Physician stress and moral injury have been plaguing our profession for years and solutions have been a top MSSNY priority.  Our MSSNY committee on Physician Wellness and Resiliency has been working with the AMA and local medical groups and hospital medical staffs on solutions and implementation of a peer to peer support program. The COVID-19 pandemic has added previously unimaginable stressors exacerbating the problem and threatening a professional crisis.  In response, our MSSNY committee jumped into action to accelerate timelines to get needed help to our colleagues.

Last Friday, MSSNY launched the 24/7 Physician COVID Helpline for NYS physicians experiencing COVID 19 related stress.

The Helpline number is: 518-292-0140

Phase Two of the MSSNY Physician Wellness and Resiliency Committee response is the MSSNY Peer to Peer (P2P) support program intended to provide an opportunity for physicians, residents and medical students to talk with a peer about life stressors both work and family related. MSSNY is currently seeking volunteer peer supporters at all career stages who will be trained to listen without judgment, validate feelings and provide support, empathy, and perspective. When needed, peers may also provide a confidential referral for treatment.

Consider volunteering yourself or nominating a colleague. Nominations can be sent to pclancy@mssny.org. More information here.

As we lean on each other, may we all find comfort and peace this Memorial Day Weekend.


HEALTH ADVISORY: Ensuring Access to Health Care Services During COVID-19
Please distribute to the Chief Medical Officer, Family Medicine and Pediatric Departments, Director of Medicine,Director of Nursing and all primary care clinics.


Health Advisory: COVID-19 Updated Guidance for Hospital Operators Regarding Visitation


8 COVID-19-Related Diagnostic Errors to Know
The COVID-19 pandemic could increase the risk of diagnostic errors due to staffing shortages, chaotic work environments and high levels of clinician stress and fatigue, two healthcare quality experts wrote in an article published in the Journal of Hospital Medicine.

The article’s authors are:

  • Tejal Gandhi, MD, chief safety and transformation officer at Press Ganey
  • Hardeep Singh, MD, chief of health policy, quality, and informatics at the Michael E. DeBakey VA Medical Center in Houston.

Drs. Gandhi and Singh identified eight diagnostic errors that may occur in the COVID-19 era based on emerging research and discussions with experts worldwide. The errors are defined below.

  1. Classic: Missed or delayed COVID-19 diagnosis in patients with respiratory symptoms.
  2. Anomalous: Missed or delayed COVID-19 diagnosis in patients who do not have respiratory symptoms.
  3. Anchor: Missed or delayed diagnosis of a different condition because clinicians assume the patient has COVID-19.
  4. Secondary: Missed or delayed diagnosis of a secondary condition in a patient being treated for COVID-19.
  5. Acute collateral: Delayed diagnosis of an acute condition because patients are not seeking care due to fear of contracting COVID-19 in a hospital or emergency department.
  6. Chronic collateral: Delayed diagnosis of ambulatory conditions due to canceled appointments or elective procedures.
  7. Strain: Missed or delayed diagnosis of a different condition because hospitals are overwhelmed, potentially limiting the time and attention clinicians spend on non-COVID-19 patients.
  8. Unintended: Missed or delayed diagnosis because clinicians are using telemedicine more instead of interacting with patients in person.

To view the full article, click here. (Becker’s Hospital May 20)


1 in 5 COVID-19 patients in NYC hospitals were Critically Ill: 5 Things About Them
About 22 percent of COVID-19 patients admitted to two New York City hospitals were critically ill, and nearly all had at least one chronic illness, a new study shows. The study, published in The Lancet, examined the clinical characteristics of critically ill COVID-19 patients admitted to two New York-Presbyterian hospitals affiliated with Columbia University Irving Medical Center in New York City from March 2 to April 1. Of the 1,150 COVID-19 patients admitted to both hospitals, 257 (22 percent) were critically ill.

Five study findings:

  1. The median age of the critically ill patients was 62 years.
  2. Sixty-seven percent were men.
  3. Eighty-two percent of the patients had at least one chronic illness — most commonly hypertension (63 percent) and diabetes (36 percent).
  4. About 46 percent were obese.
  5. Seventy-nine percent of the patients received invasive mechanical ventilation for a median of 18 days.
  6. The researchers conducted a follow-up April 28 and found 39 percent of the patients had died and 37 percent remained hospitalized.

(Becker’s Hospital Review May 20)


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Endocrinologists Share Perspective on Pandemic as Patients with Diabetes Who Contract The Virus Can Face Higher Risk For Hospitalization And Mortality
Endocrine News (5/21) reports, “As the COVID-19 pandemic continues to roil the world’s healthcare systems, endocrinologists may have unique insights that could save lives and improve outcomes in these patients who present with elevated glucose levels and other underlying comorbidities such as obesity and diabetes.”

Endocrine News adds, “Patients with diabetes who contract COVID-19 are at a higher risk for hospitalization and even mortality.” Endocrine News highlights a paper published in Endocrine Reviews last month that examined “how the pathophysiology of diabetes and obesity might intersect with COVID-19 biology and found key shared pathways and mechanisms linked to the development and treatment of” T2D.


Garfunkel Wild Ad


Re-Opening Your Medical Practice in COVID-19 Era; Tuesday, May 26, 12 Noon-1 PM
As physicians are now considering re-opening their practices, they need to appreciate that they cannot simply “go back to normal”.  With furloughs, layoffs, severe limitations of medical services, decreased revenues and office closures, physicians need to consider strategies to maximize the success of their practices going forward.  These include financial analysis and planning, how to best protect and treat patients and employees, and what needs to be done to ensure that their practices operate efficiently, safely, and profitably.  Topics addressed will include:

What you need to consider before re-opening?

  • What financial issues must be considered to better prepare your practice to move forward?
  • How can you ensure your practice operates appropriately as it relates to patients?
  • Is there a continued role for telehealth?
  • What will the new practice culture look like going forward?
  • What reasonable accommodations and workplace safety precautions should be made for employees?
  • What are potential discrimination issues that can arise, including, for example, from a phased re-opening, or gradual return of employees from furlough?
  • Given that employees have had a furlough period, and there may be a backlog of work, can/should employers make changes to or limit their PTO policies for the remainder of the year?
  • How do we handle/resolve employment contract breach issues?

Presented by:
Barry B. Cepelewicz, M.D., Esq.
Partner/Director
Garfunkel Wild, P.C. 

Roy W. Breitenbach, Esq.
Partner/Director
Garfunkel Wild, P.C.


CDC Estimates About One-Third of Coronavirus Patients Don’t Have Symptoms
In new guidance for mathematical modelers and public health officials, the US Centers for Disease Control and Prevention is estimating that about a third of coronavirus infections are asymptomatic. CNN (5/22, Azad) reports that in its “new guidance for mathematical modelers and public health officials,” the CDC “is estimating that about a third of coronavirus infections are asymptomatic.”

The agency also “says its ‘best estimate’ is that 0.4% of people who show symptoms and have Covid-19 will die, and the agency estimates that 40% of coronavirus transmission is occurring before people feel sick.” The CDC “cautions that those numbers are subject to change as more is learned about Covid-19, and it warns that the information is intended for planning purposes.”


Veterans Matters: TBI in Returning Veterans Podcast
Check out MSSNY’s Veterans Matters newest podcast entitled TBI in Returning Veterans.  Dr. David Podwall discusses how to identify and diagnose mild TBI in veterans, along with a discussion on prevention and treatment options. Click here to listen.


COVID-19 Map – Johns Hopkins Coronavirus Resource Center