COVID-19 Update June 9, 2020


COVID-19 Testing Survey
MSSNY is conducting a short survey to ensure community physicians’ ability to test their patients for COVID-19. This information will be used by MSSNY leadership and staff to advocate to ensure community physicians’ offices have the ability to conduct this testing as we move forward in confronting this pandemic.

Please take just a few minutes to complete the survey.

Highlights from Governor Cuomo’s Daily Briefing:
– 101 days since first COVID case in NY
– Day 16 of civil unrest

NYS Police Reform:
– NYS Will Pass Aggressive Reform
– Banning of chokeholds
– False race-based 911 reports prohibited
– Gov. applauded Legislature for beginning to pass reforms yesterday
– Gov. stated he will sign these into law, hopefully this week

– Westchester/Rockland/Hudson Valley reopening today
– “NY had the worst situation and we handled it the best.”
– As we continue to reopen, Metro-North is taking steps to be safe
– Deploying 500K masks and 10K gallons and 100K 2oz bottles of hand
– Masks are mandatory when riding on public transportation systems
– Stay six feet apart when possible
– Long Island will enter Phase II tomorrow
NYC reopened yesterday
– 19.9% positive cases in all of NYC
NYS Testing Network
– 800+ testing sites in NY

– Daily testing will be biggest indicator of progress reiterating that 50K
are administered daily
– Governor stressed the need to be smart, citing a Wall Street Journal article on
COVID cases accelerating in more than a dozen states

– In response to a question on what percentage increase is considered a spike,
Governor stated that, “it depends”
– If those who tested positive can be  traced back to one event/workplace
then it is considered a hotspot not a spike
– Governor continued stating that if a specific connection cannot be found
then it is a spike
– Dr. Zucker added that the rate of transmission is also taken into
consideration and that as total number of cases drop it will make the
percentage of higher cases seem higher

AMA: Relief Pool for Physicians Who Participate in Medicaid and CHIP
Important information from the AMA about the next release of funds from the HHS Provider Relief pool, specifically to those physicians that participate in Medicaid and CHIP, and who did not receive a payment in the first 2 rounds.

The AMA has continued to press HHS to swiftly distribute funds to assist those physicians who have not previously received any money from the Provider Relief Fund. We are pleased the Department announced it is moving forward to provide some relief. HHS expects to distribute approximately $15 billion to eligible physicians and organizations that participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Allocation. Starting June 10, HHS plans to launch a portal that will allow eligible physicians and organizations to report their annual patient revenue data and other necessary information to receive a payment equal to at least 2 percent of reported gross revenues from patient care.

Nassau County Medical Society Seminar “Reopening Healthcare” June 11
Emerging From COVID-19: Guidelines for Re-opening Healthcare at 7PM

Whether you work in a hospital, ambulatory surgery center, or a physician office practice, you have faced the unprecedented and rapidly evolving challenges associated with the coronavirus disease 2019 (COVID-19) pandemic.

As the pandemic begins to recede, questions will arise about how best to return to your normal operations. The unprecedented nature of the COVID-19 outbreak might make navigating this process confusing and stressful.

Join us as Elizabeth Moy a Risk Management Consultant from MLMIC Insurance Company and Will Hassett, an attorney from Fager Amsler Keller & Schoppmann, LLP discuss the evolving changes to state and federal law associated the pandemic, and provide a strategic roadmap towards safely resuming previously suspended operations.

At the end of this presentation, the participant will be able to:

1. Understand the current legal updates associated with COVID-19.
2. Determine the resources necessary to safely reopen.
3. Create new workflows and effectively manage patient backlog.
4. Identify areas of need in anticipation for a future surge.

Target audience: Physicians of all specialties

Register Here 

NYC Small Business Loans Program: Up to $75K Zero-Interest
Applications for the city’s small-business loan program, which offers zero-interest loans up to $75,000 to businesses affected by Covid-19, went live on June 5. City businesses in operation for two years or more with fewer than 100 employees across all locations are eligible to apply. They must be able to prove 25% or more in revenue lost as a result of the crisis, have no outstanding tax liens or legal judgments against them, and show they are able to pay off the loan. (Crain’s Business

Astrazeneca Plans to Distribute Up to 2 Billion COVID-19 Vaccines Doses
AstraZeneca said June 4 it has partnered with several organizations to help manufacture and distribute up to 2 billion doses of the experimental COVID-19 vaccine it is developing with Oxford University.

The U.K.-based drugmaker has partnered with the Coalition for Epidemic Preparedness Innovations, or CEPI, and Gavi, a public–private global health partnership with the goal of increasing access to vaccines in poor countries, STAT reported.

Under the partnership, the companies will spend $750 million to manufacture and distribute 300 million doses of the vaccine by the end of 2020, assuming it is proven safe and effective, according to STAT. Data on the vaccine isn’t expected before August.

The partnership between AstraZeneca, CEPI and Gavi is the first made through the Access to COVID-19 Tools (act) Accelerator, a program co-chaired by the Bill and Melinda Gates Foundation and the World Health Organization designed to ensure the fair allocation and distribution of the vaccine across the world.

AstraZeneca said CEPI will lead development and manufacturing of the vaccine, and Gavi will lead the procurement.

AstraZeneca also reached a licensing agreement with the Serum Institute of India to supply 1 billion doses of the vaccine to low and middle-income countries. The institute committed to providing 700 million doses of the vaccine before the end of the year, STAT reported.

AstraZeneca also previously announced plans to ship 100 million doses of the vaccine to the U.K. and 200 million to the U.S. (Becker’s, June 5)

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Probable Coronavirus Cases and Deaths Reported by Fewer Than Half of States
The Washington Post (6/8) reports, “Fewer than half the states are following federal recommendations to report probable coronavirus cases and deaths, marking what experts say is an unusual break with public health practices that leads to inconsistent data collection and undercounts of the disease’s impact.”

A review by the Washington Post “found that the states not disclosing probable cases and deaths include some of the largest: California, Florida, North Carolina and New York.” This “is one reason government officials and public health experts say the virus’s true toll is above the U.S. tally as of Sunday of about 1.9 million coronavirus cases and 109,000 deaths – benchmarks that shape policymaking and public opinion on the pandemic.

New Report Finds Low Levels of Teenage Well-Being in The U.S.
A new report on teen well-being in the U.S. finds that 60% of those ages 13-18 are not flourishing — defined as experiencing positive emotions as well as positive emotional and social functioning. Teens are also reporting higher stress levels than older adults, the majority of which is due to mass shootings, concern about peers with anxiety and depression, and rising suicide rates.

Majorities of teens have also been discriminated against, and almost all report hearing the word “gay” used disparagingly at school. The report also identifies 47 action items that policymakers at local, state, and national levels can take to improve the well-being of teens. These items range from engaging with social media platforms and influencers to promote more content that encourages teens to spend time helping others in their community to encouraging lawmakers to design budgets with teenage well-being in mind.

ED Visits Down 49% Since January, Analysis Reveals
Emergency department volume fell 49 percent between January and April, with facilities in urban areas seeing the largest drop, according to an analysis from the Emergency Department Benchmarking Alliance.

The analysis includes self-reported comparative ED volume data for the first four months of 2019 and 2020 from EDBA members representing 2,240 EDs nationwide. EDBA examined trends in overall ED volume, along with volume differences based on facility type and location. ED volume rose 7 percent year over year in January and 4 percent in February, likely due to flu season.

“We started off the year with a positive increase in volume from the previous year across the board,” Mike Gibbons, RN, executive director of EDBA, told Becker’s. “That’s been kind of consistent in what’s going on in emergency medicine. Year-over-year, there is about a 2.5 percent annual increase in volume.”

However, ED volume fell 19 percent year over year in March, when COVID-19 spurred nationwide lockdowns. By April, ED volume was down 48 percent. This figure depicts a larger hit to EDs compared to a recent CDC analysis, which found that average weekly ED visits fell 42 percent year over year in April.

“The most surprising thing to me is the drastic reduction in pediatric emergency departments,” Mr. Gibbons said, noting that the analysis includes data from 24 pediatric EDs — a relatively small sample size.

These facilities saw a 71 percent decrease in volume between January and April — the largest drop of all ED types. Freestanding EDs had a 49 percent drop in use over the same time period, while general EDs saw a 50 percent drop. When sorted by location, facilities in urban areas had the largest drop in volume. Urban EDs went from treating an average of 128 patients daily in January to just 56 daily in April.

“This suggests that urban centers in major metropolitan areas were affected more from a volume decrease than in community hospitals and suburban settings,” Mr. Gibbons said. (Becker’s Hospital Review, June 9)


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COVID-19 Update June 8, 2020


MSSNY Members Win Two Leadership Slots at AMA
Two MSSNY members were elected Sunday to key leadership positions at the American Medical Association’s first virtual meeting.

Former MSSNY president Thomas Madejski MD of Albion, NY was elected to a four-year term on the AMA’s Board of Trustee while Erick Eiting MD from Manhattan was elected to the AMA’s Council on Medical Service for a four-year term.

Dr. Madejski served as MSSNY president in 2018.  And has been an AMA member for 35 years.  He has also served as chair of the Empire State Medical, Scientific and Scientific Foundation and previously was a member of the AMA’s Council on Medical Service.   He received a pharmacy degree from SUNY Buffalo and his MD from the SUNY Health Science Center in Syracuse. A board-certified IM, his practice is focused on geriatrics, hospice, and palliative care.  Dr. Madejski said, “I am honored and humbled to be selected by the HOD to serve on the Board of Trustees. I will work tirelessly to improve health care for our patients and the practice of medicine and bring equity to our healthcare system and our country.”

Dr. Erick Eiting is Vice Chair of Operations for Emergency Medicine at Mt. Sinai Beth Israel Hospital in Manhattan. Certified by the American Board of Emergency Medicine, Dr. Eiting received his Medical Degree from SUNY Downstate.

Gov.: “NYC Is Eligible to Resume Elective Surgeries and Ambulatory Care”
As New York City enters phase one of reopening today, Governor Andrew M. Cuomo announced that New York City is now eligible to resume elective surgeries and ambulatory care. The Governor previously announced 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.

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DFS Releases NY Insurers Requested Premium Increases for 2021
The NY DFS has released a chart of NY-health insurer requested premium increases for 2021, ranging from +1.4% to 29.1% in the group market, and -3.7% to +19.1% in the individual market.

Staten Island Amazon Employees Sue after Contracting Coronavirus-19
Three employees at Amazon‘s JFK8 fulfillment center in Staten Island and family members of the workers have filed a lawsuit against the company for allegedly mandating work conditions that led to at least one employee contracting the new coronavirus.

The lawsuit claims that the employee then transmitted the virus to multiple family members, including one who died. The lawsuit alleges that Amazon made the warehouse a “place of danger” by obstructing efforts intended to prevent the new coronavirus’ spread at the facility and instead prioritize productivity over safety. According to Reuters, Amazon said the company has followed guidance from health authorities and experts on workplace safety since the new coronavirus pandemic began, but the company did not comment on the lawsuit (Reuters, 6/3).


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Severe Complications Seen in All Stages of COVID-19, Including Recovery
More than half of COVID-19 patients admitted to two hospitals in Spain developed some form of neurologic symptoms, a retrospective, observational study showed.

Neurologic manifestations were seen in 57.4% of 841 patients hospitalized with COVID-19 in March, reported Carlos Manuel Romero-Sanchez, MD, of Complejo Hospitalario Universitario de Albacete in Spain, and co-authors in Neurology.

In 4.1% of COVID-19 deaths in the study, neurologic complications were considered the fundamental cause.

This is the largest hospital-based study of COVID-19 patients to analyze neurologic symptoms systematically, the researchers noted. Neurologic symptoms emerged throughout all phases of COVID-19 infection. Potentially severe conditions, like stroke and inflammatory diseases, appeared in late COVID stages, Romero-Sanchez said.

“We would like to raise awareness that neurological complications may arise in the recovery phase of COVID-19, including cerebrovascular and dysimmune,” he told MedPage Today. “Optic neuritis and acute inflammatory demyelinating polyradiculoneuropathy are two examples.”

In the study, one in five patients (19.6%) hospitalized with COVID-19 had disorders of consciousness. “Disorders of consciousness were associated with severe COVID, older age, higher creatine kinase levels, and lower lymphocyte count,” Romero-Sanchez noted.

Disorders of consciousness were nearly twice as high (38.9%) among patients with severe COVID-19 (with severity defined by 2007 Infectious Diseases Society of America/American Thoracic Society criteria). Most cases of altered consciousness were secondary to severe hypoxemia, the researchers noted. Of patients with severe COVID-19, 14.9% had delirium and 9.4% had coma.

Across all 841 hospitalized COVID-19 patients, myopathy (3.1%), dysautonomia (2.5%), cerebrovascular diseases (1.7%), seizures (0.7%), and hyperkinetic movement disorders (0.7%) occurred. Cerebrovascular diseases included 11 patients (1.3%) with ischemic stroke and three patients (0.4%) with intracranial hemorrhage.

“More than one-third of ischemic strokes involved posterior arterial territories, an unusual proportion,” Romero-Sanchez pointed out.

“Moreover, we had some cases of otherwise unexplained vertebro-basilar dissection and also one case of multiple cortical hemorrhages associated with brain MRI pattern resembling posterior reversible encephalopathy syndrome,” he added. “Although our study is mainly descriptive, we hypothesize that SARS-CoV-2 [the virus that causes COVID-19] may carry special tropism towards posterior circulation and endotheliopathy may be suggested.”

In the study, nonspecific symptoms such as myalgias (17.2%), headache (14.1%), and dizziness (6.1%) were common. Anosmia (4.9%) and dysgeusia (6.2%) tended to occur early — 60% of the time they occurred, they were the first clinical manifestation of COVID-19 — and were more frequent in less severe cases. One case each of encephalitis, Guillain-Barré syndrome, and optic neuritis emerged.

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The analysis was a systematic review of all patients diagnosed with COVID-19 in the AlbaCOVID registry. Patients had been admitted to two Spanish hospitals, Complejo Hospitalario Universitario de Albacete and Hospital General de Almansa, from March 1 to April 1, 2020. They had a confirmed laboratory diagnosis of COVID-19, either with a positive result for IgG/IgM antibodies against SARS-CoV-2 in a blood test or through detection of SARS-CoV-2 RNA with a real-time reverse transcription-polymerase chain reaction of throat swab samples.

In total, 329 patients (39%) had severe COVID-19. Seventy-seven patients were admitted to the ICU, and 197 patients died during the course of their hospital admission. Neurologic complications were considered the fundamental cause of patient death in eight cases (4.1% of total deaths).

Overall, patients were an average age of 66 and 56% were men. Those with severe disease were older than those with mild disease (71 years vs 63 years; P<0.001). Sex was not a risk factor for severe prognosis.

Hypertension (55.2%), obesity (44.5%), dyslipidemia (43.3%), tobacco smoking (36%), diabetes mellitus (25.1%), and heart disease (18.8%) were the most common systemic comorbidities. In multivariate analysis, obesity was the only independent predictor for severe COVID-19 (OR 3.06, 95% CI 1.41-6.67, P=0.005).

The researchers were unable to demonstrate direct invasion of the central nervous system (CNS) in this study; all CNS analyses were negative for viral RNA. They could not determine whether neurologic problems stemmed from SARS-CoV-2 infection or other factors like cross-immunity, inflammatory reaction, or side effects of treatment.

The pandemic context prevented a full neurologic exam of every hospitalized COVID-19 patient and selection bias may have occurred, Romero-Sanchez and co-authors noted. They added that the study is hospital-based and does not reflect the incidence of neurologic complications of COVID-19 patients in the community. (MedPage Today June 5, 2020)

Primary Source

Neurology: Source Reference: Romero-Sánchez CM, et al “Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry” Neurology 2020; DOI: 10.1212/WNL.0000000000009937.



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