COVID-19 Update May 28, 2020

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Gov. Cuomo’s Daily Press Conference Highlights

-Total hospitalizations and intubations is down
– 163 new COVD cases as of yesterday
– 74 lives lost yesterday (52 in hospitals, 22 in nursing homes)

Governor’s Opinion:
– I understand what states and Governors must do, but what is Washington going
to do?
– Analysis from May 4 shows that NYS only received about $24K per positive
COVID case, compared to Kentucky who received about $338K per positive case
– – Governor reiterated that corporations that accept federal aid, must rehire
the same amount employees that were fired

Reopening NYC:
– Contact Tracing needs to be worked on before reopening
– Focus on troubled areas
– More cases are coming from outer-borough, minority, lower income
communities with people who are currently unemployed

– NYS is partnering with Northwell Health to bring more healthcare
services to impacted communities
– There are more than 225 testing sites in NYC, but many are being underused
– 1M masks will be delivered to hard hit communities
– Executive order will be signed today authorizing businesses to deny entry to those
who do not wear face mask or coverings

Q&A:
Federal Aid:
– According to DeRosa, the state will realize a savings through a hiring freeze,
a voluntary pay increase deferment from unionized labor as well as from
management confidential employees

Testing & PPE:
– Perez commended today’s executive order stating that it will help decrease
instances in which conflict/anxiety occurs due to some customers not wearing masks
– According to DeRosa, only 10 states are currently providing probable and confirmed
death data


There Were 364,965 Confirmed COVID-19 Cases in New York as of Wednesday.


MSSNY President Voices Support for Bill to Curb Price Gouging of Essential Medical Supplies
MSSNY President, Dr. Bonnie Litvack, MD, voiced support for the passage of A.10270 (Rozic)/S.8189 (Hoylman), which would expand New York’s anti-“price gouging” statute to include “unconscionably excessive” prices charged by vendors for essential medical supplies used by physicians every day in their practices, such as PPE and hand sanitizer.  The bill passed the Senate and Assembly during its legislative session this week. “Even though the COVID19 acute crisis has begun to subside around the state, New York physicians still face enormous challenges as they work to fully reopen their practices to treat their patients,” said Dr. Bonnie Litvack, MD, President of the Medical Society of the State of New York (MSSNY).

“Chief among those challenges is the dangerous shortage of Personal Protective Equipment (PPE) due to a variety of factors including refusal by some suppliers to sell to smaller physician practices and/or charging enormously marked-up prices. This legislation sets forth important steps to better ensure that PPE sellers will deal more fairly with community physicians and other care providers to enable them to get the critical supplies they need to get back to treating their patients and serving the communities where they live.” (CARY, AUSTER)


Legislature Passes Measure to Expand Whistleblower Protections for Healthcare Workers
The Senate and Assembly passed a measure this week (S.8397-A, Savino/A.10326-A. Reyes), which would provide New York healthcare workers with greater “whistleblower” protections to reduce the risk of employers penalizing employees for filing complaints against them.

New York’s Labor Law provides healthcare workers with some whistleblower protections but does not specifically address disclosures to the public made via new platforms like social media. This legislation would provide medical professionals with greater legal protections against employer retaliation regarding public reports raising concerns with workplace safety conditions.   The sponsor’s memo in support of this legislation notes that the legislation is in response to concerns raised by many healthcare professionals during the pandemic that the institution where they practiced did not provide them sufficient PPE.

If signed into law by the Governor, the law would take effect immediately.
(CARY, AUSTER)


Legislature Passes Measure to Expand Medicaid Coverage for Audio-Only Telehealth
The Senate and Assembly passed a measure this week (A.10404-A, Rosenthal/S.8416) that permanently expands coverage for telemedicine in Medicaid and the Child Health Plus Insurance program to include “audio-only” services. Given the importance of making sure patients with limited access to video technological services could maintain continuity of care with their physician, Medicaid has been covering audio-only telehealth services since mid-March.  MSSNY President Dr. Bonnie Litvack issued a statement praising the legislation and urging that it be continued as well for all forms of insurance coverage.

“We applaud Senator Metzger and Assemblymember Rosenthal for advancing their legislation (A.10404-A/S.8416) to expand Medicaid and CHIP coverage for telehealth to include “audio-only” services.  During this pandemic, telemedicine availability has been an absolutely essential modality for our patients to continue to receive needed medical services from their physicians.

The Cuomo Administration, through the New York State Department of Health (DOH) and Department of Financial Services (DFS), took critically important steps in mid-March to remove barriers to telehealth coverage for commercial and state-sponsored insurance programs, including ensuring that telephone conversations between patients and their physicians were covered.

This is particularly important for many of our patients who do not possess adequate video-enabled technology to conduct audio-visual telehealth visits with their physicians.  Recognizing this concern, CMS also took the step of expanding audio-only telehealth coverage for our senior patients covered by Medicare.

As we enter a new phase in confronting the pandemic, and preventing against a second “surge”, MSSNY has been urging that this expanded coverage for telehealth be continued across the health insurance coverage spectrum.  This legislation would ensure that this expanded coverage continues for the Medicaid and CHIP programs, a standard which we would also urge DFS to continue to require of state-regulated commercial health insurance plans.” (AUSTER)


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Research Indicates Five-Day Course of Remdesivir Works as Well As 10-Day Course for Patients with Severe COVID-19
Reuters reports that “Gilead Sciences Inc, which has suggested that a shorter treatment duration could extend limited supplies of its drug remdesivir,” has “published results of a study showing no significant difference in outcomes between 5-and 10-day courses of the drug for patients with severe COVID-19.” The findings were published in the New England Journal of Medicine.


“2nd Wave ‘Is Not Inevitable,” Dr. Fauci Says; CDC Clarifies Message on Virus Transmission — 5 Covid-19 Updates
Reported U.S. deaths related to COVID-19 have surpassed 100,000, with 100,442 deaths and 1,699,933 COVID-19 cases reported as of 7:45 a.m. CDT May 28. Globally, there have been 5,716,570 reported cases and 356,131 deaths, while 2,367,292 have recovered.


Five Updates:

  1. The coronavirus can spread by touching a contaminated surface and then touching the mouth, nose or eyes, though this isn’t thought to be the main form of transmission, according to the CDC. The clarification comes after the agency updated its website last week to say that the virus doesn’t spread easily via surface transmission. The update was “to make it easier to read, and was not a result of any new science,” according to the CDC. The primary and most significant mode of transmission is close contact with others, the agency reiterated.
  2. A second wave “could happen but is not inevitable,” Anthony Fauci, MD, said during a May 27 interview on CNN‘s “Newsroom.” The nation’s top infectious disease physician said broad efforts to identify and isolate COVID-19 patients through contact tracing could help prevent the virus’s resurgence this fall. Dr. Fauci also commented on the use of the antimalarial drug hydroxychloroquine as a potential COVID-19 treatment during the interview. “The scientific data is really quite evident now about the lack of efficacy for it,” he told CNN.
  3. The WHO Foundation was created to broaden the World Health Organization’s donor base and achieve ‘sustainable and predictable’ funding, according to a May 27 announcement. The entity is legally separate from WHO and will facilitate contributions from the public, individual major donors, and corporate partners. After President Donald Trump said May 18 that he may pull all WHO funding from the U.S., agency officials voiced concern regarding emergency programs. The WHO Foundation will initially focus on emergencies and response to the pandemic.
  4. “The jury is still very much out” on whether COVID-19 antibodies provide immunity against reinfection, Mike Ryan, MD, executive director of the WHO’s emergencies program, said. May 26. Scientists are still learning about the virus SARS-CoV-2 and the disease COVID-19, including how immune systems respond once a person is exposed to the virus, according to WHO officials.
  5. More than 2.1 million Americans filed for unemployment last week, according to new data from the U.S. Department of Labor. This marks the eighth consecutive week of decline in unemployment figures, although the number of people seeking financial assistance is still about 10 times higher than before lockdowns started in March, according to The Wall Street Journal (Becker’s Hospital Review May 28)

Cuomo to Sign Executive Order Allowing Businesses to Deny Entry to Customers Without Masks
New York Gov. Andrew Cuomo said today he will sign an executive order allowing private businesses to deny entry to customers who are not wearing face coverings.

“We made them mandatory in public settings, public transportation etc., but when we’re talking about reopening stores and places of business, we’re giving the store owners the right to say, ‘if you’re not wearing a mask, you can’t come in,” Cuomo said during his daily press briefing.

Store owners have a right to protect themselves and other patrons, he said.

“You don’t want to wear a mask? Fine, but you don’t have a right to then go into that store if that store owner doesn’t want you to,” the governor added.


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MSSNY COVID-19 Update – May 28, 2020 (Latest Alerts, SBA Loans, Health & Safety)

Physicians are required to report suspect cases to their local department of health.

Jump to: Alerts; Health; Finance; Volunteering and Donations; Testing; Telehealth; Patient Information; Statistics; Webinars; Fraud; Research; Additional Information;


MSSNY Helpline for Physicians Experiencing
COVID-19 Related Stress
518-292-0140


Coronavirus Magnified

Alerts and Notifications


Please join the NYS Department of Health 

Thursday May 28th at 1-2PM for

COVID-19 update for healthcare providers.

To accommodate the large number of participants,

find our webinar streaming via YouTube Live (and available for viewing immediately thereafter)

on the NYSDOH COVID website for providers 

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


COVID-19 Updated Guidance for Hospital Operators Regarding Visitation


Contact Tracing Opportunities in NYS

Interim Guidance for Reopening the Health Care System & Best Practices for Reopening From COVID-19

CDC Weekly Key Messages (Updated May 1)

COVID-19 update for healthcare providers (Recorded)

MSSNY 2020 House of Delegates in Tarrytown Postponed (Updated April 21)

Physician’s Resource Page (Updated)


Health and Safety

Interim Guidance on Executive Orders 202.17 and 202.18 Requiring Face Coverings in Public During the COVID-19 Outbreak

Requiring Face Coverings for Public and Private Employees Interacting with the Public

COVID-19 and the Use of Cloth Face Coverings

Ensuring the Safety of Our Direct Caregivers

Nursing Home COVID-19 Preparedness Self-Assessment Checklist

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

Advance Care Planning Recommendations During COVID-19


Finance

Applications for SBA Loans

FAQs on Medicare Fee-for-Service (FFS) Billing

CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week

Request for Accelerated/Advance Payment

With $349 Billion in Emergency Small Business Capital Cleared, SBA and Treasury Begin Unprecedented Public-Private Mobilization Effort to Distribute Funds

Social Security Benefits Will be Paid on Time and Other Updates Related to the COVID-19 Pandemic

Trump Administration Provides Financial Relief for Medicare Providers

Trump Administration Approves 34th State Request for Medicaid Emergency Waivers

Special Coding Advice During the COVID-19 Crises

Tax Day now July 15: Treasury, IRS extends filing deadline and federal tax payments regardless of amount owed


Volunteering and Donations

Healthcare Workers! New York City Needs You Now!

Nasopharyngeal Swabs Urgent Appeal!

Do You Have Medical Services or Equipment to Donate?

PPE shortage – How to make a request, and steps to preserve equipment

Additional Qualified Health Professionals Needed


Testing

Guidance for Private Physician Practices Operating Specimen Collection Sites

Should ibuprofen be Used to Treat COVID-19?


Telehealth

How to Set Up Free Telemedicine for Your Patients (Video)

If you’re using Zoom for teleconferencing, read this FBI report on “zoom-bombing” which is on the increase.

Frequently Asked Questions Regarding Use of Telehealth Including
Telephonic Services During the COVID-19 State of Emergency

Humana Telehealth Update

Emergency Medical Aid and Telemedicine

Comprehensive Guidance Regarding Use of Telehealth 

Expansion of Medicare coverage for telehealth (so it is no longer limited to rural areas)

Assuring physicians can use Facetime and Skype for telehealth without worrying about HIPA

COVID-19 Physical, Occupational and Speech Therapy Telehealth

Telehealth Insurance Circular Letter No. 6 (2020)
Reminder that private insurers must cover telehealth services for patients (including those provided through a smartphone) and without patient cost-sharing.

COVID-19 Telephonic Communication Services
Since Medicare still requires telemedicine to be provided only to patients in a rural setting, you should look at “virtual check-in” services under codes  G2010, G2012, 99421, 99422 and 99423.

State regulated insurers re: required telehealth coverage for all health care services without patient cost-sharing “including technology commonly available on smartphones and other devices”.

Telehealth Benefits in Medicare are  a Lifeline for Patients During Coronavirus


May 27 Statistics

New York State: 364,965 confirmed cases, 23,643 deaths. New York City: 197,351 confirmed cases; 16,650 deaths; 40,034 Nassau; 39,258 Suffolk; 33,186 Westchester; 13,047 Rockland; 1,796 Albany. For a complete NYS county list, click here.

United States: 1,703,789 confirmed; 100,651 deaths; 70,337 recovered. World Count: 5,731,837 confirmed; 356,606 deaths.


SBL Frauds and Scams 

FBI Sees Rise in Fraud Schemes Related to the Coronavirus Pandemic

Small Business Scams and Fraud

New funding for Coronavirus SBA loans attracts scammers


Research

Authorization of Licensed Pharmacists to order COVID-19 Tests

Pediatric Multi-System Inflammatory Syndrome Temporally Associated with COVID-19 Interim Case Definition in New York State

Pediatric Multi-System Inflammatory Syndrome Potentially Associated with Coronavirus Disease (COVID-19) in Children


Webinars/Podcasts

Re-Opening Your Medical Practice in COVID-19 Era (Prerecorded)

Registration Now Open for Veterans Matters CME Webinar – June 3, 2020

Veterans Matters: PTSD in Returning Veterans Podcast Part I

Veterans Matters: PTSD in Returning Veterans Podcast Part II


Additional Information

Stimulus Package Passed by Congress Provided Several Programs to Aid Physicians Through this Crisis
As reported in an AMA summary of the $2 trillion stimulus package enacted into law last Friday, here are some of the key provisions to benefit physicians:

Small business loans. Small businesses, including physician practices, with no more than 500 employees are eligible to apply for the Small Business Administration’s (SBA) section 7(a) Payroll Protection Program. For more information on how physicians can access this program, click here.

This allows a small business to apply to an SBA-approved lender for a loan of up to 250% of the business’ average monthly payroll costs to cover 8 weeks of payroll as well as help with other expenses like rent, mortgage payments, and utilities. The maximum loan amount is $10 million. Sole-proprietors, independent contractors, and other self-employed individuals are eligible.

A loan can be forgiven based on maintaining employee and salary levels. For any portion of the loan that is not forgiven, the terms include a maximum term of 10 years, a maximum interest rate of four percent. Small businesses and organizations will be able to apply if they were harmed by COVID-19 between February 15, 2020 and June 30, 2020. This program is retroactive to February 15, 2020andare available through June 30, 2020.

Emergency loans.  Moreover, there was also Authorization for $10 billion in “emergency” Economic Injury Disaster Loan (EIDL) to eligible entities with not more than 500 employees. Allows an eligible entity that has applied for an EIDL loan to request an advance on that loan, of not more than $10,000, which the SBA must distribute within 3 days. Advance payments may be used for providing paid sick leave to employees, maintaining payroll, meeting increased costs to obtain materials, making rent or mortgage payments, and repaying obligations that cannot be met due to revenue losses

Financial support for hospitals, physicians, and others. Provides $100 billion through the Public Health and Social Services Emergency Fund to provide immediate financial relief by covering non-reimbursable expenses attributable to COVID-19. Health care entities, including physician practices, that provide health care, diagnoses, or testing are eligible. Non-reimbursable expenses attributable to COVID-19 qualify for funding.

Examples include increased staffing or training, personal protective equipment, and lost revenue. HHS is instructed to review applications and make payments on a rolling basis to get money into the health system as quickly as possible. HHS is given significant flexibility in determining how the funds are allocated and is expected to release guidance on the application process shortly.


Business Loan Forgiveness Included in CARES Act
Within the Coronavirus Aid, Recovery and Economic Security (CARES) Act that President Trump signed yesterday is a $350 billion Paycheck Protection Program that will allow businesses and nonprofits with fewer than 500 employees to apply for loans up to $10 million each to cover losses caused by the COVID-19 pandemic. 

What makes this relief even more significant is the possibility of loan forgiveness, which is available to employers who retain their workforce levels through the crisis. If you follow the guidelines carefully, you can essentially convert your business loan to a grant – even if you’ve already laid off employees.

Loan Forgiveness Requirements

Loans may be forgiven if businesses use the money to pay for payroll costs, salaries, benefits, mortgage interest, rent and/or utilities.  The forgiven amount would be equal to the amount actually paid for these expenses during the eight weeks following disbursement of the loan. Additional wages paid to tipped employees under Section 3(m)(2)(A) of the Fair Labor Standard Acts may also be forgiven.

Forgiveness will be scaled back if the business has a reduction in employees, salaries or wages. Reductions in workforce, salaries and wages that occur from February 15, 2020 to April 26, 2020 will be disregarded for purposes of reducing the forgiveness amount, as long as the reductions are eliminated by June 30, 2020.

For purposes of the loan forgiveness, a reduction in workforce and salary or wages will be calculated as follows:

  • Workforce reductions will be calculated by the initial forgiven amount multiplied by the quotient of average full-time equivalents (FTEs) during the eight-week period, divided by the average FTEs for the period from February 15, 2019 through June 30, 2019 or January 1, 2020 through February 29, 2020, as determined by the loan recipient.
  • Salary or wage reductions will be determined by the amount of any salary or wage decrease in excess of 25 percent of the total salary or wages during the most recent full quarter such employee was employed before the eight-week period. Only employees who did not receive, during any single pay period during 2019, wages or salary at an annualized rate of pay in excess of $100,000 are included in this calculation.

Advance Medicare Payments to Help Physicians Through this Period
Moreover, CMS announced over the weekend a process for physicians to receive 100% of predicted Medicare payments for a 3-month period ( Fact Sheet: Advanced Payment Program During COVID-19 Emergency).  Here is a recommended process for applying for these advanced payments shared with MSSNY by a medical practice, as well as some of the particulars of this program:
Process:

1. Go to your National Government Services (NGS) website and fill in, sign, and submit an Accelerated / Advance Payment request form for your practice.

2. Can request up to 100% of Medicare payment for a 3-month period.

3. Check box 2 (“Delay in provider/supplier billing process of an isolated temporary nature beyond the provider’s/supplier’s normal billing cycle and not attributable to other third-party payers or private patients.”); and

3. State that the request is for an accelerated/advance payment due to the COVID-19 pandemic

4. Will receive payment within seven calendar days from the request.

5. Recoupment will begin 120 days after payment issuance date.

 Eligibility:

1.     Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form,

2.     Not be in bankruptcy,

3.     Not be under active medical review or program integrity investigation, and

4.     Not have any outstanding delinquent Medicare overpayments.

For further information, contact Regina McNally, VP of MSSNY’s Socio-Economic

Division at 516-488-6100 ext.332 or email rmcnally@mssny.org.



Questions:

• NYS has a coronavirus hotline at 1-888-364-3065.
• The New York State Department of Health has established a provider email account for physicians to ask questions about COVID-19: Covidproviderinfo@health.ny.gov

COVID-19 Update May 27, 2020


Please Join NYSDOH Update for Physicians Tomorrow 1-2 PM 

For audio only, please dial in: 844-512-2950
Please share with your healthcare provider members- 

Please join the NYS Department of Health 

Thursday May 28th at 1-2PM forCOVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers:

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


48% of Americans Delayed Care in Pandemic; Tests May Be Wrong Half the Time
The U.S. has reported 1,681,418 COVID-19 cases and 98,929 related deaths as of 7:45 a.m. CDT May 27. Globally, there have been 5,614,458 reported cases and 350,958 deaths, while 2,307,510 have recovered.


Five COVID-19 Updates:

1. COVID-19 antibody tests are wrong nearly half the time, according to the CDC. Serologic tests meant to measure past COVID-19 exposure or infection are not accurate enough to use to make policy decisions, the CDC said. Healthcare providers should use the most accurate antibody test available and may need to test people twice. If only a small percent of people being tested have been exposed to the virus, even a small margin of error can be significant — if 5 percent of the population tested has the virus, a test with more than 90 percent accuracy could still fail to detect half the cases.

2. Forty-eight percent of Americans said they or someone in their household have postponed or skipped medical care due to the pandemic, according to a poll by Kaiser Family Foundation. The phone survey was conducted May 13-18 among 1,189 U.S. adults. As restrictions ease, many (68 percent of those who delayed care; 32 percent of all adults) expect to receive the care they delayed over the next three months.

3. New cases are increasing in about a dozen states, according to The New York Times, at least half of these states — including Alabama, Florida, Georgia, South Carolina, and Tennessee — started reopening in late April and early May. NYT said the new cases could reflect increased testing capacity in some areas. Former FDA Commissioner Scott Gottlieb noted during an interview with CNBC‘s “Squawk Box” there is also “a small uptick” in hospitalizations that “is probably the result of reopening.”

“I’m concerned that there are people who think that this is the all-clear,” he said.

4. One-third of Americans show signs of clinical anxiety or depression, according to a U.S. Census Bureau survey cited by The Washington Post.The agency polled adults from more than 42,000 households between May 7-12. Twenty-four percent of Americans showed clinically significant symptoms of major depressive disorder and 30 percent had symptoms of generalized anxiety disorder. These figures demonstrate a large jump from depression and anxiety rates seen before the pandemic.

5. The CDC shared a new guidance on when confirmed or suspected COVID-19 patients can end self-isolation practices. Patients can be around others if they have gone three days with no fever, their symptoms have improved, and it has been 10 days since symptoms first appeared. Asymptomatic patients who tested positive for COVID-19 can be around others after 10 days. (Becker’s Hospital Review, May 27)


WHO Warns Of ‘Second Peak’ Before Second Wave
The world could see a “second peak” of COVID-19 cases before a presumed second wave comes this fall, Dr. Mike Ryan, executive director of the World Health Organization’s emergencies program, said during a May 25 media briefing.

Dr. Ryan said the world is still in the middle of the first wave, citing areas like Africa and South Asia where cases are steadily rising. He warned against making any assumptions about the pandemic’s trajectory just because cases are falling in some areas. Countries cannot assume they will have a few months to get ready for a second wave, Dr. Ryan said.

“We need to be cognizant of the fact that the disease can jump up at any time,” he said. “We may get a second peak in this wave… It is crucial for countries to implement a comprehensive strategy involving testing, surveillance, and other public health measures to “ensure we continue to have an immediate downward trajectory” in cases, Dr. Ryan concluded.

To view the full media briefing, click here. (Becker’s Hospital Review, May 26)


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Webinar: Re-Opening Your Medical Practice in COVID-19 Era
On June 4, MLMIC and HANYS will host “Emerging From COVID-19: Guidelines for Re-opening Healthcare.” This webinar will provide a strategic roadmap to help medical practices safely and efficiently return to normal operations. Read more at MLMIC.com


Zocdoc Concerns MSSNY Physicians, Again
Recently, the MSSNY leadership had a few meetings; whereby, many physician members expressed much dismay seeing their names on Zocdoc’s website/database.  MSSNY addressed a similar problem last year.  Many physicians who have no agreement with Zocdoc do NOT want to be listed on the Zocdoc website.

It is considered by many physicians to be inappropriate and misleading to the patient community.  MSSNY contacted Zocdoc to urge correction of this misleading information.  Physicians without a Zocdoc agreement should be removed from the website/database.  The statement that the physician has no online appointments available is misleading since the statement is used when a physician does not participate with Zocdoc.  Patients have no idea if a doctor has appointments outside of Zocdoc and may not take further steps to contact the physician.

Zocdoc has advised that they would remove individual pages at the applicable physician’s request.  Any physician who would prefer their page removed from Zocdoc’s website can contact Zocdoc, directly at service@zocdoc.com

Zocdoc will work directly with the physician to remove the physician’s page.

On a related note, MSSNY’s Task Force on Telemedicine is currently in the process of vetting vendors to partner with to offer a statewide telemedicine platform for our members.


Physicians, Do You Use Telemedicine?
CMS has asked MSSNY for a listing of physicians who do Telemedicine. They have heard from a numbers of community health care groups for seniors that some patients are hesitant about calling their physicians about needed appointments since they are fearful of having to go to the doctor’s office.

CMS is asking for MSSNY’s assistance for two reasons:

The first is to alert patients in communities which physicians can provide virtual care during this pandemic.

Second, regarding forward thinking, it would be helpful for CMS to know which and how many physicians can provide telemedicine. This information would be useful in making the argument of continuing the expanded telemedicine coverage in a post pandemic future.

If you are capable of providing telemedicine, please provide MSSNY with your name, address, specialty, phone and NPI number. This information will be added to MSSNY’s website and shared with your county societies.  CMS would also help in disseminating the information to the patient community.


New York Pharmacist Arrested in N95 Profiteering Scheme
Richard Schirripa, a licensed pharmacist in New York City, was charged May 26 with violating the Defense Production Act by allegedly hoarding and hiking the price of thousands of N95 masks.  Mr. Schirripa allegedly bought $200,000 worth of N95 masks from the black market between February and April and sold thousands of them at severely inflated prices.

He often sold them out of his car and charged up to $25 for a mask that cost about $1.27, the U.S. Justice Department alleged. When the Defense Production Act was invoked March 25, it made it a crime to hoard or price gouge N95 masks. In a separate charge, Mr. Schirripa was also accused of falsely billing Medicare and Medicaid for thousands of doses of controlled substances that he kept for himself before closing his pharmacy in New York City earlier this year.

Mr. Schirripa is charged with violating the Defense Production Act, committing healthcare fraud, aggravated identity theft and exploiting the personal information of his pharmacy’s customers to fill prescriptions. Read the Justice Department’s full news release here.


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COVID-19 IN CHILDREN:  They Have Lower Levels of ACE2 Gene Expression
Mount Sinai Health System said Friday that a group of its researchers have found that children have lower levels of ACE2 gene expression than adults, which may explain children’s lower risk of Covid-19 infection and mortality. The virus that causes Covid-19 uses ACE2, which is found on the surface of certain cells in the body, to enter victims, Mount Sinai said. A new study on the findings was published in JAMA. (Crain’s Pulse, May 27)


 

 

 

 

 

 

COVID-19 Update May 20, 2020


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Please Join NYS DOH’s Webinar Update on COVID-19 Tomorrow!
Please join the NYS Department of Health Thursday May 21st at 1:00 PM – 2:00 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers:

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


PPE Source for MSSNY Members Only!
MSSNY is now able to provide members with access to a PPE supply chain, in a collaborative effort with the American Society of Plastic Surgeons.

Items available range from N95 masks and face shields to hand sanitizer and alcohol wipes. New items are consistently being added and restocked.  Shipment times may vary from several days to several weeks. Some orders may be fulfilled by outside vendors with longer shipping times.

MSSNY members have been sent details on linking to the ASPS, where they can see available supplies and create an account to purchase items.  If you are not currently a MSSNY member you can renew for 2020 or apply online here.

MSSNY is proud to offer this benefit to our members and grateful to ASPS for extending this opportunity to help medical practices and patients in our state resume practice swiftly and safely.


NYSDOH Reducing Medicaid by 1.5% Effective for Service after April 2
As a practical matter, with a 1% cut having already been imposed for claims with dates of service between January 1, 2020 and April 1, 2020, physicians can expect that their payments will be 0.5% less for claims with dates of service 4/2/20 and after, when compared to claims with dates of service between 1/1/20-4/1/20.

The announcement from DOH notes the cuts are not applicable to physician administered drugs. These cuts are one way New York State is seeking to address its enormous revenue shortfall as a result of the Covid-19 pandemic.   MSSNY has been working together with the federation of medicine in support of legislation before Congress that would, among many other provisions, provide additional Medicaid funding to states to prevent against further Medicaid cuts.


HEALTH ADVISORY: Ensuring Access to Health Care Services During COVID-19
It is critical to maintain access to health care services during the COVID-19 public health emergency, including routine preventive care and follow-up services. • Healthcare providers should continue to ensure infection prevention and control measures are in place to prevent the spread of COVID-19. Healthcare providers should contact patients who may have missed routine preventive care or follow-up appointments during the COVID-19 public health emergency, including ensuring children, adolescents, and adults receive doses of recommended vaccines they may have otherwise missed.


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Re-Opening Your Medical Practice in the COVID-19 Era on 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?
  • Is there liability to the practices for exposing employees or employees’ family to Coronavirus? Wrongful reopening?

Register in advance for this webinar: https://mssny.zoom.us/webinar/register/WN_8YjCTCssTq6fVgwn404Bw

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

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


Tomorrow, Thursday, May 21 Nassau County Medical Society Webinar @ 7PM

DATE: May 21, 2020
Time:   7pm

Zoom Webinar Link https://us02web.zoom.us/webinar/register/WN_sPTtUWRVSxqJrZqKWBumFA

Guest Speaker: Dr. David A. Hirschwerk
                          Attending-Infectious Diseases
                          Executive Vice Chair-Dept. of Medicine
                         North Shore University Hospital/LIJ Medical Center


May 28 Webinar: Leading Causes of Million-Dollar Claims in NYS!
On Thursday, May 28, at 7:30 a.m., MLMIC will host “Million Dollar Claims: A Closer Look,” a complimentary webinar examining major causes of million-dollar claims in New York State. As the State’s leading medical professional liability carrier, MLMIC is well-positioned to provide guidance to medical organizations on reducing the risk of high-exposure claims. These recommendations and strategies are informed by an analysis of factors contributing to $1,000,000 claims over a five-year period.

Presenters Joyce McCormack, a MLMIC risk management consultant and registered professional nurse, and Danielle Mikalajunas Fogel, a medical malpractice litigation expert with Fager Amsler Keller & Schoppmann, will educate participants on:

  • identifying the leading causes of loss in million-dollar claims;
  • analyzing the key factors leading to significant payments in these claims;
  • recognizing the chief medical factors identified in these files; and
  • implementing risk management strategies to lessen the risks of high-exposure professional liability claims within your organization.

Policyholders can sign up for this event via the webinar registration form.

This webinar is designed to offer risk management perspectives to physicians and other healthcare providers, risk managers, quality improvement managers, medical directors, office practice administrators/managers, office practice staff, nurse administrators, patient safety officers and healthcare counsel.

MLMIC is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians and designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Registration Now Open for Veterans Matters CME Webinar PTSD in Returning
Veterans on June 3, 2020 @ 8:30 am

The Medical Society of the State of New York, along with Cobleskill Regional Hospital are hosting a CME live webinar entitled Veterans Matters: PTSD in Returning Veterans on Wednesday, June 3, 2020.

Click here to register for the webinar

Adolph Meyer, MD will serve as faculty for this program and the educational objectives are:

  • Identify diagnostic criteria for PTSD
  • Discuss medical and psychiatric comorbidities of military related PTSD
  • Discuss evidence based treatment modalities for PTSD including medications and psychotherapy
  • Discuss strategies to help veterans overcome stigma to seek and accept treatment for military related trauma

For more information, contact Jangmu Sherpa at jsherpa@mssny.org  or call (518) 465-8085.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians 

The Medical Society of the State of New York designates each of these live activities for a maximum of 1.0 AMA PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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Surgeon/Colleagues Make N95 Mask Disinfection Facility for Under $15,000
VCU Health shares step-by-step instructions, quality controls, and blueprints for an innovation it created to disinfect and reuse up to 12,000 masks a day.

DOCTORS CREATE

KEY TAKEAWAYS

  • A VCU Health orthopaedic surgeon and his colleagues created this innovation.
  • The rack system enables the high throughput necessary to disinfect thousands of masks daily
  • Other health systems can replicate this initiative for about $15,000. While other methods exist to sterilize the masks, VCU Health chose UV-C light because it relies on electricity rather than supplies that might run short during the pandemic.

The COVID-19 crisis has spawned a new era of innovation at hospitals and health systems to adapt to changing demands. Inspiration comes from many sources.

In Richmond, Virginia, an anticipated N95 mask shortage at VCU health sent orthopaedic surgeon Stephen Kates, MD, into his personal machine shop, where he has fabricated items for the operating room, his car, and even parts for a friend’s old Ford tractor. This time, working with an anesthesiologist, two residents, and two PhDs from Virginia Commonwealth University, the professor and chairman of orthopaedic surgery produced a trellis rack to hang and sterilize masks with UV-C light. The design amplifies an already proven sterilization process, enabling high throughput. The health system is now using the system to decontaminate and reuse up to 12,000 N95 masks a day.

The process is based on a concept from the University of Nebraska and adheres to Centers for Disease Control and Prevention guidelines. It involves a commonly used UV-C light robot that VCU already had on hand to decontaminate hospital rooms and employs materials which the VCU team sourced from The Home Depot, Lowe’s, and a tractor supply store.

To help other health systems replicate this initiative, Richmond, Virginia–based VCU Health, which includes an academic medical center and is affiliated with Virginia Commonwealth University, offers a free 28-page downloadable instruction manual. The booklet outlines each step in the process, including quality controls with pictures and a video link providing added details. Kates estimates a similar system can be fabricated for as little as $15,000, provided a facility already has a proper UV-C light source that can be redeployed for this purpose.

Kates was called into action by a group from the university, which had produced a white paper on the topic of disinfecting N95 masks. While other methods exist to sterilize the masks, including hydrogen peroxide vapor, VCU Health chose UV-C light because it relies on electricity rather than supplies that might run short during the pandemic. In addition, exposure to the light source does not structurally degrade the mask as quickly as other methods, Kates says.

“The concept of sterilizing things with UV lights is not new; we didn’t come up with that,” says Kates. “The question was, ‘How to you actualize it and make it work?’ ” he says. “How do we have a high throughput process that can deal with a surge of patients that otherwise is overwhelming health systems across the country?”

“Making stuff out of metal is a hobby of mine, so I went to work on it that day and made a sample,” he says. “Everyone liked the appearance of it, so the next day we made seven more. Once we found a good design, we had local welders and machinists fabricate the rest of them.”

RAMPING UP PRODUCTION

N95 Masks

Photo Courtesy of VCU Health

VCU created a mask decontamination facility in a building adjacent to the hospital and painted the treatment room with reflective white paint at the recommendation of its UV-C robot manufacturer to facilitate light measurement.

The final design includes six racks on wheels, each containing 42 masks. The racks are arranged in a hexagonal pattern around the robot.

 

 

 


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 19, 2020


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PPE SOURCE FOR MSSNY MEMBERS ONLY!
MSSNY is now able to provide members with access to a PPE supply chain, in a collaborative effort with the American Society of Plastic Surgeons.

Items available range from N95 masks and face shields to hand sanitizer and alcohol wipes. New items are consistently being added and restocked.  Shipment times may vary from several days to several weeks. Some orders may be fulfilled by outside vendors with longer shipping times.

MSSNY members have been sent details on linking to the ASPS, where they can see available supplies and create an account to purchase items.  If you are not currently a MSSNY member you can renew for 2020 or apply online here.

MSSNY is proud to offer this benefit to our members and grateful to ASPS for extending this opportunity to help medical practices and patients in our state resume practice swiftly and safely.


Physicians: Join NYSDOH for COVID-19 Update 1-2 PM

Please join the NYS Department of Health Thursday May 21st at 1:00 PM – 2:00 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers: 

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


Guidance for Office Based Surgery Practices
This Guidance is directed at Ambulatory Surgery Centers (ASC) Office Based Surgery practices (OBS), and Diagnostic and Treatment Centers (DTC) that are in counties without a significant risk of COVID-19 surge and are deemed eligible to perform Deferred Procedures, (i.e., elective surgeries and non-urgent procedures).

These centers and practices are required to meet the same provisions required of hospitals in these eligible counties that are also resuming deferred procedures.

Any ASC, OBS, or DTC that fails to comply with this Guidance may be subject to civil penalties. The guidance from the NYS Department of Health regarding the resumption of elective surgery in the 49 counties across the State where such surgery has been permitted, including in ASCs and OBS.


Moderna Releases Positive Data on Early COVID-19 Vaccine Trial
Moderna reported May 18 that its COVID-19 vaccine, the first of its kind to test human subjects, safely creates an immune response against coronavirus, according to The New York Times. The vaccine stimulates the creation of antibodies that can stop coronavirus from replicating, and the levels of those neutralizing antibodies were found to match the levels in recovered COVID-19 patients. The biotech company’s findings are based on results from the first trial beginning in March, in which eight volunteers each received two doses.

The Food and Drug Administration approved Moderna’s second phase of the trial, which will begin soon and involve 600 people. A third phase is planned for July and is slated to include thousands of volunteers. Depending on the success of the coming trials, the vaccine could become available for widespread use by the year’s end or early 2021. (Becker’s Hospital Review) May 18.


US Reopening Doesn’t Hinge on Coronavirus Vaccine, HHS Chief Says
Echoing President Donald Trump’s recent comments that the U.S. will reopen whether a COVID-19 vaccine is available or not, HHS Secretary Alex Azar said “everything does not depend on a vaccine,” according to CNN.

Mr. Azar said that while the White House is committed to delivering a vaccine, it is only one part of a “multi-factorial response program,” during a CNN interview.

Other parts of the plan include testing symptomatic people, broader surveillance of cases, containing surges and therapeutics, Mr. Azar said.

On May 15, President Trump and HHS unveiled a vaccine effort called Operation Warp Speed, a program designed to drastically reduce the time it takes to get a COVID-19 vaccine to U.S. residents. The program is a collaboration between HHS, the U.S. Defense Department, private firms, and other federal agencies, including the U.S. Department of Agriculture, the U.S. Energy Department, and the U.S. Department of Veterans Affairs. Read HHS’ full news release here.(Becker’s Hospital Review Leadership & Management May 18)


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Trump Inks Deal to Create Nation’s First Strategic Stockpile of COVID-19 Drugs
President Donald Trump signed a four-year $345 million contract with Richmond, Va.-based drugmaker Phlow Corp. May 19 to create a national COVID-19 medication stockpile, according to The New York Times. The Biomedical Advanced Research and Development Authority awarded Phlow with the contract to manufacture the raw pharmaceutical ingredients needed to make popular generics and drugs that treat COVID-19, most of which are now produced in India and China.

The contract “will not only help bring our essential medicines home but actually do so in a way that is cost competitive with the sweatshops and pollution havens of the world,” said Peter Navarro, Mr. Trump’s trade advisor. Phlow has partnered with nonprofit drugmaker Civica Rx to produce the stockpile. They will first focus on manufacturing critical care medicine for COVID-19 patients, such as antibiotics and medicines used for ventilator support and pain, according to Eric Edwards, MD, PhD, CEO, and president of Phlow. (May 19, Becker’s Hospital Review)


AMA Answers Questions re CARES Act Provider Relief Fund
The AMA has received many questions from physicians and medical societies related to the CARES Act Provider Relief Fund, and we have been in touch with senior HHS officials about them. Certain formulas that were previously on the HHS website led some physicians to believe they may have received more money from this fund than they were supposed to, and they were worried that it will be recouped by HHS. Because the AMA informed the administration of the concerns and alarm the previous formulas and language about overpayments were causing many physicians, HHS removed it from the website.

HHS was concerned that many physicians were using the formulas to calculate for themselves what they thought HHS intended for them to receive from the CARES Act Provider Relief Fund, and then deciding on the basis of their own calculations that they were going to be in trouble. HHS has asked for people to provide documentation of certain revenue information so that it can make the calculations specific to each TIN (Taxpayer Identification Number).

HHS removed the formula and overpayments language from the portal last week to allay concerns from physicians who had done their own estimates and reached conclusions about potential overpayments instead of relying on HHS to do the calculations. Unfortunately, in some cases these changes with formulas appearing and disappearing from the website heightened rather than allayed concerns. On Friday, May 15th, HHS posted revised FAQs on the Provider Relief Fund General Distribution Portal.

Several of the FAQs are dated May 14th, and seek to clarify some of the recent confusion, particularly these two questions: 

How Did HHS Determine the Additional Payments Under the General Distribution?

HHS is distributing an additional $20 billion of the General Distribution to providers to augment their initial allocation so that $50 billion is allocated proportional to providers’ share of 2018 net patient revenue. The allocation methodology is designed to provide relief to providers, who bill Medicare fee-for-service, with at least 2% of that provider’s net patient revenue regardless of the provider’s payer mix.

Payments are determined based on the lesser of 2% of a provider’s 2018 (or most recent complete tax year) net patient revenue or the sum of incurred losses for March and April. If the initial General Distribution payment you received between April 10 and April 17 was determined to be at least 2% of your annual patient revenue, you will not receive additional General Distribution payments. 

How Can I Estimate 2% Of Patient Revenue to Determine My Approximate General Distribution Payment? (Added 5/14/2020)

In general, providers can estimate payments from the General Distribution of approximately 2% of 2018 (or most recent complete tax year) patient revenue. To estimate your payment, use this equation:

  • (Individual Provider Revenues/$2.5 Trillion) X $50 Billion = Expected Combined General Distribution.
  • To estimate your payment, you may need to use “Gross Receipts or Sales” or “Program Service Revenue.” Providers should work with a tax professional for accurate submission.

This includes any payments under the first $30 billion general distribution as well as under the $20 billion general distribution allocations. Providers may not receive a second distribution payment if the provider received a first distribution payment of equal to or more than 2% of patient revenue.

Additional information that has recently been added notes that HHS is making a list publicly available of the providers who have received and accepted money from the Provider Relief Fund here.

Other questions have arisen regarding what HHS views as the appropriate use of the CARES Act funds. We have not seen additional guidance beyond that provided on the website and we think it would be difficult for HHS to craft language in a way that would be relevant to each practice’s individual needs.

We believe that the key thing is that each practice is able to clearly document the revenue losses and expenses it is incurring that are directly due to COVID-19, which could include losses related to social distancing (such as cancellation of visits and procedures, Part B drugs that have passed their expiration date), costs of new infection control practices, PPE, digital health equipment, etc., and that are not reimbursable from other sources (excluding loans that have to be repaid).



Registration Now Open for Veterans Matters CME Webinar PTSD in Returning
Veterans on June 3, 2020 @ 8:30 am

The Medical Society of the State of New York, along with Cobleskill Regional Hospital are hosting a CME live webinar entitled Veterans Matters: PTSD in Returning Veterans on Wednesday, June 3, 2020.

Click here to register for the webinar

Adolph Meyer, MD will serve as faculty for this program and the educational objectives are:

  • Identify diagnostic criteria for PTSD
  • Discuss medical and psychiatric comorbidities of military related PTSD
  • Discuss evidence based treatment modalities for PTSD including medications and psychotherapy
  • Discuss strategies to help veterans overcome stigma to seek and accept treatment for military related trauma

For more information, contact Jangmu Sherpa at jsherpa@mssny.org  or call (518) 465-8085.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians 

The Medical Society of the State of New York designates each of these live activities for a maximum of 1.0 AMA PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 18, 2020


.
From the Governor’s Office Today 

  • Westchester and Suffolk Counties are Now Eligible to Resume Elective Surgeries and Ambulatory Care including in ambulatory care settings such as ASCs and Office based surgery locations.
  • Confirms 2,419 Additional Coronavirus Cases in New York State – Bringing Statewide Total to 348,232; New Cases in 52 Counties
  • Calls on U.S. Senate to Pass Coronavirus Relief Bill

Gov.: Over 700 locations Where New Yorkers Can Get Diagnostic Testing

  1. New Yorkers can visit a new website — health.ny.gov/find-test-site-near-you — and enter their address to view a list and a map view of the nearest testing sites. The state has also partnered with Google Maps to display testing site results. New Yorkers can search “COVID testing near me” on Google Maps to easily find the nearest testing sites. Please remember you must always schedule an appointment to get a COVID-19 diagnostic test by calling 1-888-364-3065 or your healthcare provider.
  2. New York State is partnering with CVS to bring testing to more than 60 CVS pharmacies across the state. Each site will be able to conduct 50 or more tests per day.
  3. The number of total COVID hospitalizations continues to drop. Total hospitalizations fell to 5,897, from 6,220 the day before. The number of new COVID hospitalizations also dropped to 374, from 400 the day before. Tragically, we lost 139 New Yorkers to the virus yesterday.
    4. A reminder that there are mental health resources available to those who need it. The past few months have been hard for everyone. If you need emotional support, call the New York State Emotional Support Hotline at 1-844-863-9314 to schedule a free appointment with a mental health professional. New Yorkers can access additional mental health resources at headspace.com/ny.

Webinar: Re-Opening Your Medical Practice in the COVID-19 Era on 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 relate 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?
  • Is there liability to the practices for exposing employees or employees’ family to Coronavirus? Wrongful reopening?

Click Here to Register

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

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


Study Shows How Long Speech-Generated Droplets Can Stay in Air
A research team comprised of scientists from the National Institute of Health and the University of Pennsylvania have found that the coronavirus can stay airborne for anywhere between eight and 14 minutes after conversation.

Previously, scientists have researched how cough or sneeze generated droplets carried the virus. They used the phrase “stay healthy” for 25 seconds into an open end of a cardboard box. The inside was lit with lasers that could measure the droplet spray the speaker produced. Researchers admitted that the controlled setting, a stagnant air environment, could vary greatly from well ventilated room. (Modern Healthcare 5/18)


Majority Want Stay-At-Home Orders Lifted Within Month
More than six in 10 providers want stay-at-home restrictions to be lifted in the next month or sooner, according to a new survey. CHG Healthcare surveyed 1,200 physicians, physician assistants and nurse practitioners about their workloads, COVID-19 restrictions and anxiety levels. While 60% said they are still working full-time or part-time, 74% of those said their hours have been reduced. Nearly three out of four providers want elective care to start back up in the next month. (Modern Healthcare 5/14)


Right Ventricular Dilation Could Indicate High-Risk COVID-19 Cases
Right ventricular dilation, where the right side of the heart enlarges and doesn’t function correctly, may indicate worse outcomes in hospitalized COVID-19 patients, according to a study in the Journal of the American College of Cardiology: Cardiovascular Imaging. Researchers analyzed records of 105 patients and found right ventricular dilation was the only factor that significantly correlated with increased mortality.

Though the reason for the correlation is unknown, researchers say there could be multiple factors, including possible clots, lung damage, low blood oxygen level or heart damage. “Echocardiography is a readily available bedside tool that yields essential diagnostic and prognostic information in these patients,” said Dr. Edgar Argulian, an author of the study. “Clinicians can use bedside echocardiography as a readily available tool to identify patients with COVID-19 infection at the highest risk of adverse hospital outcomes.” (Modern Healthcare 5/18)


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State Health Officials Sending Thousands of Test Kits to Nursing Homes
State health officials are sending thousands of test kits to nursing homes and are securing new lab capacity to help the facilities meet new staff testing requirements, Gov. Andrew Cuomo said Monday during his daily briefing. The governor said his administration is connecting nursing homes and adult care facilities with private labs that have reserved at least 35,000 tests per day to help them comply with new regulations requiring all staff to be tested twice a week. It is also sending 320,000 test kits to nursing homes and adult care facilities across the state, he said.

Cuomo, who has faced criticism over his handling of Covid-19 in nursing homes as well as his new staff testing requirement , stressed that while facility operators “are not happy” about the policy, it’s needed to reduce the spread of the virus. The governor added that many testing sites across the state are being underutilized and have the capacity to perform these tests.

Covid-19 has killed or is presumed to have killed more than 5,000 nursing home and adult care residents in New York. (Politico, May 18)


Clinic Pushes Inhaled Stem Cell Tx, Delivered to Your Door: Taking Advantage of COVID-19 Fears
In the age of social distancing, one stem cell clinic has decided to make its products — which it strongly suggests can prevent COVID-19 — available for home delivery. No injections are required: instead, a nebulizer allows patients to inhale exosomes directly into their lungs, according to a YouTube video posted by the Los Angeles-based Novus Center that has since been taken down (though a text-only version persists on Google Cache).

“This procedure was invented during the coronavirus outbreak so patients could get the full benefit of exosome vapor to repair their lungs, strengthen their immune systems, and interrupt ‘virus multiplication’ WITHOUT risking a trip to their local clinic or hospital (where they could end up catching COVID-19),” the text below the video reads.

Stem cell companies have been using the coronavirus pandemic to push their dubious products in many ways, according to a new paper by Turner about to be published in Cell: Stem Cell (it’s currently posted as a “pre-proof” on the journal’s website).

Clinics in ColoradoPennsylvaniaDelawareArizona, and Florida are all selling stem cell or exosome treatments that they claim can boost immunity, enhance lung health, and inhibit viral replication — making strong suggestions about a place in COVID-19 prevention. The Arizona clinic even cites a South China Morning Post article about a 65-year-old woman in China who had COVID-19 but was healed thanks to stem cells.

Other players in the direct-to-consumer stem cell industry have seized on coronavirus-related opportunities for promoting their products. Biobanks have urged healthy clients to store their own stem cells for future use if they develop COVID-19, Turner reported, though the YouTube and Facebook posts he cited have since been removed.

Two organizations that promote stem cells — the American Academy of Stem Cell Physicians and the American Society for Interventional Pain Physicians — have issued public messaging about stem cells, which Turner says “risks spreading the misrepresentation that a substantial body of evidence already supports the safe and efficacious use of stem cell products in the care of individuals with COVID-19.”

Regulators have started to warn stem cell companies playing to coronavirus fears; starting in April, the FDA has sent warning letters to Dynamic Stem Cell Therapy, the Stem Cell Center of New JerseyKimera Labs, and Sparrow Health & Performance. The Federal Trade Commission issued warning letters to Absolute Health ClinicAmerican Medical Aesthetics, the Center for Regenerative Cell MedicineStemedix, and Vidaful Medicine.

The FDA has long been trying to get a handle on unapproved stem cell therapies. In 2017, the agency issued guidance on regenerative medicine products, with a November 2020 deadline for full compliance. It has since sent numerous warning letters to companies, though many continue to push therapies ahead of the fall deadline. (Medpage, May 15)


 

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COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 15, 2020

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Got PPE?
As physicians we like order and consistency but much in our current reality has been chaotic. Particularly frustrating has been the shortage of essential medical supplies that has plagued us from nearly the first day following the WHO pandemic declaration.  As an organization and a profession, we spoke out early and often about the lack of adequate PPE and the threat it conferred on the health and safety of our doctors, staff and patients in our Emergency Rooms and ICUs.  Thank goodness the crisis has eased in our hospitals and that they are preparing for a possible future surge by re-stocking emergency closets.

In the meantime, our community doctors remain in crisis mode struggling to procure PPE to keep open/reopen their offices.  Our MSSNY was told that local Offices of Emergency Management (OEM) would aid our doctors but sadly, many county warehouses were empty and lists of OEM sources led to dead ends.  This week brings new PPE concerns with the FDA and CDC warning that dozens of tested KN95 masks were defective with some filtering as few as 20% of particles.

The email we sent this week about physician PPE needs yielded about 1000 responses in the first 24 hours.  Clearly, the situation is dire.  Your MSSNY is actively working on a plan to address the PPE acquisition challenges you are facing.  Our physicians are essential to a safe and successful re-opening of New York.  This cannot happen without a reliable supply of protective equipment for our offices.

“Not being heard is no reason for silence.” –Victor Hugo, French novelist.

We will not be silent. Physician offices must GET PPE.

Bonnie Litvack, MD
MSSNY President


Are You Stressed Out from COVID-19? MSSNY Help Line is Live for You!
The Medical Society of the State of New York announced today that it has established a help line NYS physicians that have been experiencing COVID 19 related stress.  The MSSNY helpline is staffed by psychiatrists that will provide one-time support for those in need.

The helpline number is: 518-292-0140

Physicians can call this number 24/7 and will get an answering service who will ask for the individuals name and contact information.   There will be a return call to the individual within an hour of the call being received.

The MSSNY helpline is part of the MSSNY Peer to Peer (P2P) support program which is currently in development by MSSNY.  MSSNY is seek volunteer peer supporters for this program and additional information will be forthcoming within the next several weeks.  Additional information on how to become a volunteer peer support may be obtained by contacting Cayla Lauder at clauder@mssny.org or Pat Clancy at pclancy@mssny.org.


Gov. Cuomo Issues Criteria for Physicians Defining COVID-19 related Inflammatory Illness
Today, Gov. Cuomo has issued the first in the nation criteria for Health Care Professionals defining COVID-19-Related Inflammatory Illness in Children


Notes from Governor Cuomo’s COVID-19 Briefing
Data:

– Hospitalizations and intubations are down

– New COVID Cases 431 as of yesterday, up from 420 May 12

– 132 deaths yesterday

– “We’re where we are when this first started.”

– “Our Curve is down, and the curve in the rest of the nation is up.”

Reopening:

– 5/10 regions will open

– NY on PAUSE is extended to May 28 for regions that do not open today

– If a region hits benchmark between now and then, they can reopen

Phase 1 Reopening

– Retail Business Owner

– Curbside pickup

– In store pickup when curbside is not possible

– Masks must be worn by employees and customers (unless under two

years of age or for medical reasons) and hand sanitizer

will be available

Beaches for Memorial Day

– Agreement has been made with New York, New Jersey, Connecticut, Delaware

to open beaches for Memorial Day

– State and local beaches may open Friday before Memorial Day weekend on

the following conditions:

– No more than 50% capacity with controlled exists/ entrances

– No group activities

– Enforce social distancing measures

– No concessions

– City/town/county beaches can open under same conditions

– Must fully enforce minimum rules and may add additional

Conditions

Q&A

– According to DeRosa, BioReference Lab Core and Quest have been partnered and

30K tests a day are being saved for nursing homes

Reopening:

– Businesses that open today have signed a compliance agreement. If there is a

violation, they can be closed on that basis.

Finances:

– According to Mujica, the Comptroller report coming out today states revenues

are down 14%. He continued noting that the federal government has been

working on a bill that will provide funds to the state.


MSSNY Leglisative Podcast for this Week


Re-Opening Your Medical Practice in the COVID-19 Era on May 26, 12 Noon-1PM
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?
  • Is there liability to the practices for exposing employees or employees’ family to Coronavirus? Wrongful reopening?

Register in advance for this webinar.

Presented by:

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

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


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There Are Limits to Coronavirus Antibody Testing, AMA Warns
Physicians and the general public should be cautious about the use of antibody testing for identifying previous COVID-19 infections, and they should especially be cautious of using the tests to determine if a person is immune to the new coronavirus, the American Medical Association warned.

Per a new guidance released by the association May 14, while antibody tests may play a key role in identifying the overall prevalence of COVID-19 in the U.S. population, including among those who do not show symptoms, the testing has inherent limitations.

The limitations include antibody tests currently on the market showing a significant number of false positive results. These tests may also identify antibodies for other coronaviruses, such as those that cause the common cold.

Also, a vast majority of more than 120 tests on the market have not been authorized by the FDA, and the association urges physicians to note the regulatory status of all available coronavirus antibody tests. Thus, the association recommends that “currently available antibody tests not be used as the sole basis of diagnosing COVID-19, and not be offered to individuals as a method of determining immune status.”

The test should not be used to support >decisions on returning to work or ending physical distancing, the association said.


Anyone in NYC with Coronavirus Symptoms Eligible for Testing
Any New Yorker with symptoms of the coronavirus will now be eligible to get tested for Covid-19. The new rules come after weeks where the city refused to test patients unless they were sick enough to be hospitalized. A limited number of vulnerable people, like the elderly in hard-hit neighborhoods, and frontline workers were also deemed eligible.

But now, the city is moving to set up a widespread program to test New Yorkers for the disease and hunt down people they have been in contact with. In the coming months, the effort will be crucial for the city’s plans to gradually lift stay-home restrictions and reopen its economy.

Under the new rules, anyone with a fever, cough, shortness of breath and symptoms like loss of smell and taste can get tested. Anyone who has been in close contact with a confirmed Covid-19 patient is also eligible for testing. Workers in nursing homes, homeless shelters and adult care facilities are eligible as well, regardless of whether they have symptoms.

The city is opening a dozen new testing sites over the next two weeks and will have a total of 23 publicly run sites. Though the eligibility criteria have broadened, there is no guarantee there will be enough tests available to meet demand. Appointments have filled up fast at available sites.

Officials are aiming to do 20,000 tests a day by late May. Next week, test sites will open at the Highbridge Recreation Center in Washington Heights and in Midwood, Brooklyn.

The city has moved its contact tracing program out of the Health Department and into the public hospital system, a move that sparked controversy.

Meanwhile, the number of children suffering from an inflammatory syndrome linked to Covid-19 spiked again on Thursday, reaching 100 confirmed cases.

The city has launched a PSA campaign to warn parents about the disease.

The number of people newly hospitalized for Covid-19, the number of ICU patients in public hospitals, and the share of patients testing positive all declined in the latest data Thursday.

The virus has killed 20,406 people in the city, and there are now 186,293 confirmed cases.


“Practical Considerations in Reopening Your Medical Practice”
By Andrew L. Zwerling

The outbreak of the COVID-19 virus and the response to it, including governmental orders that closed in whole or in part medical practices that performed elective procedures, created a difficult landscape for medical practices to navigate in the effort to remain viable, let alone operationally functional.  As the government slowly lifts stay-at-home orders and bans on elective procedures in New York State, the reopening of medical practices creates its own set of issues and burdens for medical practices to consider and handle.  Lapses in doing so correctly may lead to potentially punishing outcomes.

A threshold issue of significance is ensuring adherence to safety protocols that must be implemented either because they are required by the government or because the failure to implement them may expose a medical practice to future liability should an employee become ill from the COVID-19 virus.

For example, may an employer ask an employee if he or she had COVID-19 or was exposed to anyone who had it or has symptoms of COVID-19?  May an employer require an employee to have his or her temperature taken or submit to a COVID-19 test as a condition of re-entering the workplace?  May an employer require an employee with COVID-19 symptoms to stay home?  May an employer require employees to wear masks and/or gloves?  If so, who should bear the cost?  How does a medical practice social distancing with respect to staff and patients?  Should patients be screened prior to or after their arrival for appointments? What new and different cleaning and sanitation protocols must be implemented in response to COVID-19?  These questions and others should be answered before a medical practice reopens.

A host of employment law issues are also implicated in the reopening. For example, if an employer reduces an employee’s hours and wages does that reduction violate the terms of an employment contract?  If an employer reduces the wages of an exempt employee will that reduction fall below required thresholds and thereby undermine the exempt status of that employee?  If, to compensate for staffing shortages, an exempt employee performs the tasks of a non-exempt employee will that functional change convert the employee to non-exempt status?  If an employer reduces an employee’s salary because he or she is working fewer hours what steps must the employer take – for example, providing the employee with a “Rate of Pay Change” form – in order to avoid costly violations of the New York State Labor Law?

Although the issues related to reopening are many and may seem daunting, they are all susceptible to resolution if an employer conducts the proper due diligence and consults with the legal experts who can assist in providing the requisite guidance.

[1] Andrew L. Zwerling is a Partner-Director at Garfunkel Wild P.C. with over 38 years as a trial and appellate lawyer in State and Federal courts, including his successful argument before the United States Supreme Court.  A member of his firm’s Employment Law Practice Group, he has been advising clients how to respond to COVID-19 issues affecting their practices and businesses.  He may be reached at 516-393-2581 and by email at azwerling@garfunkelwild.com.  


May 20, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open
Mental Health and COVID-19 for Health Professionals

Register now for MSSNY’s next webinar related to the COVID-19 pandemic, Medical Matters:: Mental Health and COVID-19 for Health Professionals.  Just like we need to take extra precautions to protect ourselves from the risk of being infected by COVID-19, we also need to be concerned about psychological risks for health professionals. Faculty for this program is Craig Katz, MD.

Click here to register for this webinar

To view the companion pieces to this webinar, be sure to go to https://cme.mssny.org and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020, Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020 and Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge and Psychological First Aid recorded on April 29, 2020.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 


Study Puts U.S. Covid-19 Infection Fatality Rate At 1.3%

KEY TAKEAWAYS

The researchers looked at 116 counties in 33 states and found 40,835 confirmed cases and 1,620 confirmed deaths through April 20. Asymptomatic COVID-19 patients who recovered with no symptoms were not counted in the data, which could have skewed results. The researchers also said they could not estimate age-adjusted IFR-S because the data is not available.

COVID-19 kills 1.3% of symptomatic people and could kill 500,000 Americans in the coming months if as many people contract the highly-contagious virus this year as contracted the seasonal flu last year, according to a caveat-laden estimate published Thursday in Health Affairs.

“After modeling the available national data on cumulative deaths and detected COVID-19 cases in the United States, the IFR-S (Infection Fatality Rate – Symptomatic) from COVID-19 was estimated to be 1.3%,” said the researchers, led by Anirban Basu, Stergachis Family endowed director and professor in the Department of Pharmacy, CHOICE Institute, University of Washington, Seattle.

“This estimated rate is substantially higher than the approximate IFR-S of seasonal influenza, which is about 0.1% (34,200 deaths among 35.5 million patients who got sick with influenza).”


FBI: Hackers Breaking into COVID-19 Research Organizations
China-linked hackers are breaking into American organizations carrying out research into COVID-19, U.S. officials said on Wednesday, warning both scientists and public health officials to be on the lookout for cyber theft. In a joint statement, the Federal Bureau of Investigation and the Department of Homeland Security said the FBI was investigating digital break-ins at U.S. organizations by China-linked “cyber actors” that it had monitored “attempting to identify and illicitly obtain valuable intellectual property (IP) and public health data related to vaccines, treatments, and testing from networks and personnel affiliated with COVID-19-related research.”

The statement offered no further details on the identities of the targets or the hackers. The Chinese Embassy in Washington did not immediately respond to a request for comment. China routinely denies longstanding American allegations of cyberespionage. Coronavirus-related research and data have emerged as a key intelligence priority for hackers of all stripes. Last week Reuters reported that Iran-linked cyberspies had targeted staff at U.S. drugmaker Gilead Sciences Inc., whose antiviral drug remdesivir is the only treatment so far proven to help COVID-19 patients. In March and April, Reuters reported on advanced hackers’ attempts to break into the World Health Organization as the pandemic spread across the globe. (Reuters)


Sanofi: If Successful, Americans Has First to Access Vaccine
Sanofi, the French drug company working with the U.S. Department of Health and Human Services (HHS) to develop a coronavirus vaccine, indicated that Americans will be the first to gain access to the vaccine should the company be successful.

“The U.S. government has the right to the largest pre-order because it’s invested in taking the risk,” Sanofi CEO Paul Hudson told Bloomberg.

HHS announced in February that its Biomedical Advanced Research and Development Authority (BARDA) will provide “expertise and reallocated funds” to Sanofi to develop the vaccine. Hudson said the U.S. expects “that if we’ve helped you manufacture the doses at risk, we expect to get the doses first.”

BARDA has given $30 million to Sanofi so far, according to Bloomberg.

Sanofi also partnered with British pharmaceutical company GlaxoSmithKline on the project and says it could make 600 million doses annually, though Hudson aims to double that projection.

Hudson warned that European countries could be left behind if they do not put in more resources toward vaccine development. “I’ve been campaigning in Europe to say the U.S. will get vaccines first,” Hudson told Bloomberg from his home in Paris. “That’s how it will be because they’ve invested to try and protect their population, to restart their economy.”

The Trump administration is pushing to speed up the development of vaccines through a program dubbed “Operation Warp Speed,” seeking to have millions of doses ready by January, an ambitious timeline that would be significantly faster than any previous vaccine development. Hudson told Bloomberg that Sanofi plans to begin human trials in the second half of this year and aim to have a vaccine available by the second half of 2021.

On Tuesday. the American biotechnology company Moderna announced that the Food and Drug Administration has given them fast-track designation, which is designed to expedite the development of treatments for life-threatening diseases such as COVID-19. (The Hill, May 13)


MSSNY Now Has More Than 50 Podcasts Available
Did you know you can now listen to all of MSSNY’s podcasts at Spotify, iTunes, I Heart Radio or Google Podcast?  Just search “MSSNY” and you will be able to listen to the MSSNY weekly update and messages from the new MSSNY president, Bonnie Litvack, MD.  You will also find podcasts on COVID-19, immunizations, emergency preparedness and veterans matters.  You can also access all of MSSNY’s podcasts by clicking here.


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Nassau County Webinar
DATE: May 21, 2020
Time: 7pm

Zoom Webinar Link 

Guest Speaker
Dr. David A. Hirschwerk
Attending-Infectious Diseases
Executive Vice Chair-Dept. of Medicine
North Shore University Hospital/LIJ Medical Center


 

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COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 14, 2020

.


Notes from Governor Cuomo’s COVID-19 Briefing

Data:
– Hospitalizations and intubations are down
– New COVID Cases 420 as of yesterday
– 157 deaths (121 in hospitals, 36 in nursing homes)

Reopening:
– Not a matter of if we reopen, but when and how
– Check the data on a daily basis; Transparency is key
– NYS will post daily dashboard of relevant local information
– Build Back Better in areas of education, telecommuting, telemedicine, public
transit, and public health

Local Government Management:
– Manage compliance among business and individuals for reopening procedures
– React immediately if numbers change

Federal Assistance:
– We still need federal help to fund schools, hospitals, local governments,
police officers, and firefighters
– President Trump expedited $3.9B to the MTA
– Cap on SALT increases federal taxes on NYers by $12B-$15B
– D.C. must not delay, exclude special interests and not provide corporate
bailouts; If corporation accepts federal funds, they should rehire same amount
of workers

Re-Imagine:
– This experience has taught us we need to make medical equipment in the U.S.
– Initial $3M in grants to businesses to mfg. medical  supplies/equipment in NY

Contact Empire State Development to grow or start medical supply business: www.esd.ny.gov

COVID-Related Illness in Children:
– DOH is investigating 110 cases of what may be rare COVID- related illness in
children with symptoms similar to atypical Kawasaki disease
or toxic shock like syndrome
– Illness has taken lives of 5 year-old boy, 7 year-old boy, and 18 year-old girl
– NYS and DOH are leading national effort to understand and combat new syndrome
– So far, 16 other states, Washington D.C., and six European countries have
reported cases
– While this illness is rare, seek care if child has prolonged fever (more
than five days), abdominal pain, diarrhea, vomiting, bloodshot eyes, skin rash
– NYS issued first-in-the-nation criteria to healthcare professionals defining
this syndrome

Q&A
Reopening:
– Business will reopen while abiding by reopening guidelines for particular regions
which will be enforced by local government.
– According to DeRosa, there will be regional control meetings to ensure regions
are adhering to guidelines
– Social acceptability continues to be left up to individuals
– Religious institutions should adhere to guidelines for large gatherings and
remember the situation in New Rochelle
– There is federal legislation pending regarding liability for businesses that
tests positive for COVID
– Regions will be able to open at 12:01 a.m., so Friday can be a day of business


MSSNY President Submits Testimony on the Impact of the COVID19 Crisis on NY Physician Practices
May 13, 2020, Westbury, NY— Dr. Bonnie Litvack, MD, a Westchester radiologist and President of the Medical Society of the State of New York (MSSNY), today submitted testimony to the Joint Legislative Committee Hearing on Small Businesses, describing the impact of the COVID19 crisis on physician practices delivering patient care across the state of New York.

“Like many small businesses across the state, New York physicians have faced devastating consequences for their practices as a result of the coronavirus outbreak,” said Dr. Litvack. “Our first priority is, of course, to ensure that our patients, through the crisis and after, can continue to receive the care they need. However, physicians need to be assured that our practices can keep our doors open for patients now and in the future.”

To learn details about the impact, MSSNY conducted two surveys of its membership over the last month. Key takeaways from MSSNY’s most recent survey include:

  • 79% have seen a reduction of more than 50% in the volume of patients visiting their practices.
  • Nearly 3/4 had a greater than 50% drop in practice revenue.
  • More than a quarter had to lay off or furlough more than 50% of their staff, and 40% had to lay off or furlough at least 25% of their staff.

However, the bad news from the second survey was mixed with some modestly positive news that more physicians have received a small business Paycheck Protection Program loan. The CARES Act has provided some funding to help make up for some of the enormous deficits suffered by physician practices. However, it is not nearly enough to ensure the survival of many physician practices across the state.

Dr. Litvack’s testimony provided recommendations for how Congress and the New York State legislature can support physicians going forward including “advance” payments by commercial insurers to physicians and requiring health insurers to make bonus payments to their network physicians to account for the costs associated with additional Personal Protective Equipment (PPE) and the mark-up in price, that will be essential as practices begin to open up.

MSSNY also continues to work with the New York Congressional delegation to press for needed additional funding in future stimulus packages to help further offset the devastation to these practices. Physicians also need assurance that existing funding streams in previous stimulus packages will continue to be made available to community physicians so they may continue to provide patient care.

MSSNY will continue to urge the necessity of additional funding to New York State to prevent potentially devastating cuts.

“New York’s health care system, including physicians, shouldn’t have to face financial ruin, while working around the clock to save lives,” said Dr. Litvack. “New York has shouldered the brunt of this crisis and we desperately need fiscal attention.”


5,300 Excess Deaths in New York City May Be Tied to Pandemic, CDC Says
Officials have identified 5,293 excess deaths in New York City that may have been caused by COVID-19 but weren’t included in the official death toll, according to the CDC’s Morbidity and Mortality Weekly Report published May 11.

From March 11 to May 2, a total of 32,107 deaths were reported to the New York City Department of Health and Mental Hygiene. Of those deaths, about 24,172 were found to be in excess of the expected seasonal baseline. Of the 24,172 deaths, 57 percent (13,831) were lab-confirmed COVID-19 deaths and 21 percent (5,048) were probable COVID-19 deaths, leaving 22 percent of deaths (5,293) without an identified cause.

The 5,293 excess deaths may be directly or indirectly due to the pandemic. The deaths could include deaths among people with COVID-19 “who did not access diagnostic testing, tested falsely negative, or became infected after testing negative, died outside of a health care setting, or for whom Covid-19 was not suspected by a health care provider as a cause of death,” according to the CDC. Fear related to the virus could also prompt some to delay seeking or obtaining lifesaving care.

Other findings suggest the true number of national cases and deaths is also likely much higher than reported. (May 13 Becker’s Hospital Review)


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Mount Sinai Health System Launches Center for COVID-19 Recovery
New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease.

The Center for Post-COVID Care, opened May 13, will help patients hospitalized for COVID-19 transition from the hospital to their homes. The center is also open to patients who were never hospitalized but need help during their recovery.

At the center, patients will be offered a personalized treatment plan that will include input from several specialties, including primary care, pulmonary medicine, cardiology, infectious disease and physiatry, as well as social workers and pharmacists. The center will also focus on evaluating the long-term effects of the disease, which are largely unknown. Mount Sinai will create a COVID-19 registry and collect information on sociodemographics, behaviors, underlying conditions, mental health conditions and medications from patients with the disease.

“This center will provide a unique opportunity to follow this population and systematically evaluate the long-term impact of COVID-19,” said Dennis S. Charney, MD, president for academic affairs at Mount Sinai Health System. (Becker’s Hospital Review, 5/15)


MedPage Today: 4.91% of 763 (86% Physicians) Had/Have COVID-19
Of 763 respondents in a MedPage Today survey — 86% of whom were physicians — 4.91% reported they had or currently have COVID-19. The findings come from an ongoing MedPage Today poll conducted every 2 weeks to monitor challenges U.S. healthcare workers face during the COVID-19 pandemic. The most recent survey took place from April 29 to May 3 and was distributed by email and posted on the MedPage Today site.

COVID-19 continues to waylay healthcare workers, the latest findings revealed. Nationally, 20% of respondents said 1% to 5% of their facility’s healthcare workers were out due to COVID-19 illness or exposure. About one in ten put COVID-19 absenteeism at 6% to 10%, and 6% said the virus sidelined 11% or more of their workforce.

The survey also showed:

  • COVID-19 testing still is severely lacking, but trending toward improvement

The majority of respondents, 56%, still rated their access to COVID-19 testing as     fair or poor, representing an improvement from the 67% fair-to-poor rating of 2 weeks ago. “It is still very difficult. We still predominately test if you are being admitted or, now, if you need an elective surgery or admission to a skilled nursing facility. Outpatient is still chaos,” wrote an infectious disease specialist. “Only admitted patients get tested,” noted a cardiologist in New York City. “The hospital is not routinely testing staff workers who want testing,” another New York physician said.

  • About 70% of hospitals lack access to all COVID-19 treatments, including experimental therapies

Only 31% of respondents said their facility could access all therapies including experimental treatments; the same percentage was reported 2 weeks ago. “I cannot get remdesivir yet. Convalescent plasma limited,” one critical care physician wrote. “Stopped using hydroxychloroquine after data was suggesting harm but we had access to it when it was being given more regularly,” an infectious disease specialist noted. “Gilead drug [remdesivir] or IL-6 inhibitors” were not available, a Chicago anesthesiologist wrote, while an Atlanta critical care doctor reported access to “most treatments, including tocilizumab.” 

  • Personal protective equipment (PPE) continues to be a problem

About half (49%) of respondents said their access to PPE was fair or poor, similar to the 51% who said so 2 weeks ago. “We have PPE, but we need to save and reuse our N95 mask,” an emergency medicine doctor in Cleveland remarked. “No N95 is provided unless you can do a mask exchange to have it cleaned and reused,” a nurse practitioner in West Virginia said. “N95 masks and face shields are available only for COVID-confirmed patients,” a cardiologist in northern California noted. “Everything is locked down,” another physician stated. “In order to see a patient in consultation, you have to ask an administrator for an N95 mask. They are available, but barriers are high.”

Most respondents (86%) in this survey were doctors; 4% were nurses, 4% were nurse practitioners, and 3% were physician assistants. Nearly two-thirds (65%) currently worked in a hospital. Specialties included emergency medicine (6%), critical care/ICU (6%), anesthesiology (6%), cardiology (6%), infectious disease (3%), neurology (2%), and pulmonology (2%), among others.

About a quarter of respondents practiced in New York City (17%) or northern New Jersey (8%). Another 10% worked in Los Angeles, 6% in Chicago, 5% in Boston, 4% in Detroit, and 3% in Miami.

A limitation of this poll is that identities of respondents and their locations, license status, and individual responses were not verified independently. Click here for MedPage Today COVID-19 survey results in more detail. (Updated May 12, 2020)


WHO Official: COVID-19 May Never Be Eradicated
A top World Health Organization official said during a May 12 news briefing. “This virus may become just another endemic virus in our communities, and the virus may never go away,” said Mike Ryan, MD, executive director of WHO’s emergencies program. He said HIV has not gone away, but effective therapies and prevention measures have allowed people with HIV to live long, healthy lives. He clarified that he was not comparing the two diseases but emphasized that COVID-19 could be managed if an effective vaccine was globally distributed. (Becker’s Hospital Review, 5/14)


 

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COVID-19 Map – Johns Hopkins Coronavirus Resource Center


 

 

COVID-19 Update May 13, 2020

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Notes from Governor Cuomo’s COVID-19 Briefing

Data:

– Hospitalizations and intubations are down

– New COVID Cases is 416 as of yesterday, up from 401 May 11

– 166 deaths (122 in hospitals, 44 in nursing homes)

– “We’re just about where we are when we started this painful situation.”

Testing for Essential Workers:

– Antibody Test Results for essential workers are testing positive at lower rates

than other groups

– Downstate transit workers 14.2%

– Downstate healthcare workers 12.2%

– NYC General Population tested positive at 19.9%

Hospitals:

Elective surgeries to continue in 12 more counties

        – Albany, Cayuga, Chemung, Columbia, Clinton, Cortland, Montgomery,

          Orange, Otsego, Rensselaer, Schenectady, Warren

Reopening:

– Finger Lakes, Mohawk Valley, North County, and Southern Tier meet metrics

  for reopening

– The governor reiterated Dr. Fauci’s warning about reopening too soon

– Calibrate/control by monitoring diagnostic testing, antibody testing,

hospitalizations rate and capacity, infection rate

Children and COVID-19:

– DOH is investigating 102 cases of what may be rare COVID- related illness in

children with symptoms similar to Kawasaki disease or toxic shock like syndrome

– Illness has taken lives of 5-year-old boy, 7-year-old boy, and an 18-year-old girl

– 60% of children with symptoms tested positive for COVID-19 and 40% tested

positive for the antibodies (14% positive for both). 71% of cases end up in ICU.

– 14 other states (California, Connecticut, Delaware, Georgia, Illinois, Kentucky,

Louisiana, Massachusetts, Mississippi, New Jersey, Ohio, Pennsylvania, Utah,

Washington) Washington D.C, and Spain, France, England, Italy, and Switzerland

have reported cases as well

– Hospitals have been directed by DOH to prioritize COVID-19 testing for children

presenting symptoms

Federal Assistance:

– No corporate giveaways for layoffs

– Gov. Washington Op-Ed: “Make sure subsidies are tied to worker protections.”

– Americans First Law: No corporate bailout if workers will be laid off

– Will be introduced by congressional delegation

Q&A

Reopening:

– According to DeRosa, testing parameters came from Dr. Burke and the White

House task force and these parameters provide confidence in North Country

to have enough testing capacity to reopen

Testing:

– We will provide aid to ensure that testing can be done twice a week in nursing home facilities


Gov.: 12 More Counties Now Eligible to Resume Elective Surgeries
Ambulatory Surgical Centers in These 47 Counties Will Also Be Able to Resume Elective Surgeries

Amid the ongoing COVID-19 pandemic, Governor Andrew M. Cuomo today announced 12 more counties are now eligible to resume elective surgeries. 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, and a total of 47 counties can now resume elective surgeries:

Albany Genesee Putnam
Allegany Herkimer Rensselaer
Broome Jefferson Saratoga
Cattaraugus Lewis Schenectady
Cayuga Livingston Schoharie
Chautauqua Madison Schuyler
Chemung Monroe St. Lawrence
Chenango Montgomery Steuben
Clinton Niagara Sullivan
Columbia Oneida Tompkins
Cortland Onondaga Ulster
Delaware Ontario Warren
Dutchess Orange Wayne
Essex Orleans Wyoming
Franklin Oswego Yates
Fulton Otsego

Ambulatory surgical centers in these 47 counties will also be able to resume elective surgeries. Additionally, the State Department of Health clarified that these centers may continue providing certain diagnostic or screening procedures such as for cancer. Empire State Development Corporation also clarified that doctors’ visits continue to be permitted and remain open as essential businesses.


MSSNY Thanks Gov: Ambulatory Surgery Center Can Resume Elective Surgery
“We thank Governor Cuomo and the New York State Health Department for designating Ambulatory Surgery Centers as an additional clinical location that can resume performing elective surgery for patients in the 47 counties in which such surgeries are permitted.  We also appreciate the reminder to the public that physician offices have and remain open to deliver needed patient care. 

We of course still have much to do to continue to confront the Covid-19 pandemic and to work together to protect against a second surge of infections, but this action today will assist countless patients across New York State to receive urgently needed treatment that had been delayed to help prioritize health care resources towards those most immediately in need.

We look forward to continuing to work with the Governor and the NYS DOH on taking those steps which will enable the rest of New York’s health care system to more fully resume providing needed patient care.”


MSSNY Pres. Submits Testimony on Impact of COVID19 Crisis on NY Practices
May 13, 2020, Westbury, NY— Dr. Bonnie Litvack, MD, a Westchester radiologist and President of the Medical Society of the State of New York (MSSNY), today submitted testimony to the Joint Legislative Committee Hearing on Small Businesses, describing the impact of the COVID19 crisis on physician practices delivering patient care across the state of New York.

“Like many small businesses across the state, New York physicians have faced devastating consequences for their practices as a result of the coronavirus outbreak,” said Dr. Litvack. “Our first priority is, of course, to ensure that our patients, through the crisis and after, can continue to receive the care they need. However, physicians need to be assured that our practices can keep our doors open for patients now and in the future.”

To learn details about the impact, MSSNY conducted two surveys of its membership over the last month. Key takeaways from MSSNY’s most recent survey include:

  • 79% have seen a reduction of more than 50% in the volume of patients visiting their practices.
  • Nearly 3/4 had a greater than 50% drop in practice revenue.
  • More than a quarter had to lay off or furlough more than 50% of their staff, and 40% had to lay off or furlough at least 25% of their staff.

However, the bad news from the second survey was mixed with some modestly positive news that more physicians have received a small business Paycheck Protection Program loan. The CARES Act has provided some funding to help make up for some of the enormous deficits suffered by physician practices. However, it is not nearly enough to ensure the survival of many physician practices across the state.

Dr. Litvack’s testimony provided recommendations for how Congress and the New York State legislature can support physicians going forward including “advance” payments by commercial insurers to physicians and requiring health insurers to make bonus payments to their network physicians to account for the costs associated with additional Personal Protective Equipment (PPE) and the mark-up in price, that will be essential as practices begin to open up.

MSSNY also continues to work with the New York Congressional delegation to press for needed additional funding in future stimulus packages to help further offset the devastation to these practices. Physicians also need assurance that existing funding streams in previous stimulus packages will continue to be made available to community physicians so they may continue to provide patient care.

MSSNY will continue to urge the necessity of additional funding to New York State to prevent potentially devastating cuts.

“New York’s health care system, including physicians, shouldn’t have to face financial ruin, while working around the clock to save lives,” said Litvack. “New York has shouldered the brunt of this crisis and we desperately need fiscal attention.”


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CDC Guidance More Restrictive Than White House’s Plan
Advice from the top U.S. disease control experts on how to safely reopen businesses and institutions during the coronavirus pandemic was more detailed and restrictive than the plan released by the White House last month.

The guidance, which was shelved by Trump administration officials, also offered recommendations to help communities decide when to shut facilities down again during future flareups of COVID-19.

The Associated Press obtained a 63-page document that is more detailed than other, previously reported segments of the shelved guidance from the U.S. Centers for Disease Control and Prevention. It shows how the thinking of the CDC infection control experts differs from those in the White House managing the pandemic response.

The White House’s “Opening Up America Again” plan that was released April 17 included some of the CDC’s approach, but made clear that the onus for reopening decisions was solely on state governors and local officials.

By contrast, the organizational tool created by the CDC advocates for a coordinated national response to give community leaders step-by-step instructions to “help Americans re-enter civic life,” with the idea that there would be resurgences of the virus and lots of customization needed. The White House said last week that the document was a draft and not ready for release.

It contains the kinds of specifics that officials need to make informed decisions, some experts said.

From the start, CDC staffers working on the guidance were uncomfortable tying it specifically to reopening, and voiced their objections to the White House officials tasked with approving the guidance for release, according to a CDC official granted anonymity because they were not cleared to speak with the press.

The CDC’s detailed guidance was eventually shelved by the administration April 30, according to internal government emails and CDC sources who were granted anonymity because they were not cleared to speak to the press. After the AP reported about the burying of the guidance last week, the White House asked the CDC to revive parts of it, which were sent back for approval, according to emails and interviews.

On Tuesday, CDC Director Robert Redfield testified before a U.S. Senate committee that the recommendations would be released “soon.” He provided no further details.

The shelved CDC guide advises communities to avoid all nonessential travel in phases of reopening until the last one, when cases are at the lowest levels. Even then, the CDC is cautious and advises only a “consideration” of the resumption of nonessential travel after 42 continuous days of declining cases of COVID-19.

The White House plan, by contrast, recommends that communities “minimize” travel in Phase 1, and that in Phase 2, after 28 consecutive days of decline, “Non-essential travel can resume.”

As of Tuesday, CDC’s web page on travel guidance during the pandemic still linked to the White House plan. The stricter guidance is not there.

Another stark difference in the final White House plan and that designed by epidemiologists at the CDC is the latter’s acknowledgment that COVID-19 cases will likely surge after states reopen, and that local governments need to continuously monitor their communities closely.

(Modern Healthcare, May 13)


Registration Now Open Mental Health and COVID-19 for Health Professionals May 20, 2020 @ 7:30am Medical Matters CME Webinar

As health professionals, we are at great psychological risk simply by virtue of our “exposure” to the reality of COVID-19.  Registration is now open for MSSNY’s next Medical Matters webinar related to the COVID-19 pandemic, Medical Matters: Mental Health and COVID-19 for Health Professionals. Faculty for this program is Craig Katz, MD.

Registration is now open for this webinar 

Educational objectives:

  • Better understand the mental health risks posed by COVID-19 for physicians
  • Review the possible range of psychological and psychiatric responses to the pandemic
  • Discuss principles and interventions for helping ourselves, our families, and our colleagues

To view MSSNY’s other COVID-19 related programs, be sure to go here and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020, Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020 and Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge and Psychological First Aid recorded on April 29, 2020.  You can also listen to MSSNY’s podcasts related to COVID-19 by going here.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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25 Hospitals Getting Biggest Slice of $12B Federal Bailout Fund
HHS has released new details on the latest payments to hospitals from the $175 billion in relief aid Congress allocated to cover expenses or lost revenues tied to the COVID-19 pandemic.

The first $50 billion in funding from the Coronavirus Aid, Relief and Economic Security Act was delivered to hospitals in April. HHS distributed $30 billion based on Medicare fee-for-service reimbursements and another $20 billion based on hospitals’ share of net patient revenue.

HHS announced May 1 that it is sending $12 billion to 395 hospitals that provided inpatient care for 100 or more COVID-19 patients through April 10. The agency said those hospitals accounted for 71 percent of COVID-19 inpatient admissions reported to HHS from 6,000 hospitals across the U.S.

HHS released new data May 8, sharing where the $12 billion in funding went. Below are the 25 hospitals that received the most funding.

  1. Long Island Jewish Medical Center (New Hyde Park, N.Y.): $277.7 million
  2. Holy Name Medical Center (Teaneck, N.J.): $213.4 million
  3. Tisch Hospital (New York City): $203.2 million
  4. Montefiore Hospital-Moses Campus (New York City): $156.7 million
  5. Columbia University Irving Medical Center (New York City): $152.7 million
  6. NewYork-Presbyterian Queens (New York City): $143.3 million
  7. Mount Sinai Medical Center (New York City): $140.8 million
  8. Sandra Atlas Bass Heart Hospital (Manhasset, N.Y.): $137.5 million
  9. Maimonides Medical Center (New York City): $131.5 million
  10. Weill Cornell Medical Center (New York City): $118.6 million
  11. New York City Health + Hospitals/Elmhurst: $111.3 million
  12. NYU Winthrop Hospital (Mineola, N.Y.): $108 million
  13. Hackensack (N.J.) University Medical Center: $98.1 million
  14. BronxCare Hospital Center-Fulton Campus (New York City): $91.5 million
  15. Staten Island University Hospital-South Campus (New York City): $91.4 million
  16. Ochsner Medical Center-West Bank Campus (Gretna, La.): $91.3 million
  17. Montefiore Hospital-Einstein Campus (New York City): $89.2 million
  18. St. Joseph’s University Medical Center (Paterson, N.J.): $88.2 million
  19. NewYork-Presbyterian Brooklyn Methodist Hospital (New York City): $87 million
  20. New York City Health + Hospitals/Bellevue: $86.7 million
  21. Stony Brook University Hospital (New York City): $83.3 million
  22. New York City Health + Hospitals/Kings County: $78.9 million
  23. New York-Presbyterian Allen Hospital (New York City): $76.9 million
  24. New York City Health + Hospitals/Lincoln: $76.1 million
  25. Jamaica Hospital Medical Center (New York City): $75.9 million
    (Becker’s Hospital CFO Report. May 11) 

Long Island CEOs Take Pay Cuts to Businesses Going
Dr. Raj Raina, president, CEO, and owner of Medical Associates, based in Hauppauge, has been taking care of patients — and his practice.

A primary care doctor who runs the six-site, multispecialty practice, he has kept Medical Associates’ doctors, nurses, and staff busy treating COVID-19 patients as he puts his own pay on pause. And he is not alone among doctors in private practice on Long Island who are making sacrifices to keep their doors open. “I personally have not taken a paycheck for the last couple of paychecks; I’m living off my savings,” Dr. Raina says, noting that his wife, a nurse, is receiving a paycheck for helping to run the COVID-19 test center at Jones Beach State Park. “Once they opened in Jones Beach, she was one of the first to be there. She’s a coleader there, scheduling patients.”

While healthcare providers and hospitals are on the front lines of the COVID-19 crisis, physicians without the resources of hospitals are facing financial and medical challenges, sometimes making financial sacrifices. “We’re living right now on income we produced in the past, hoping the government gives us some help,” Dr. Raina says, saying that his 79-person practice didn’t get help from the first tranche of funds. “It’s very hard in our industry to train people.”

Many physician practices face financial troubles, according to a survey by the Medical Society of the State of New York (MSSNY). The society says 83 percent of respondents saw patient volume drop by more than half, while 80 percent’s revenue fell by at least half since the COVID-19 outbreak. More than a quarter had to lay off or furlough more than half of their employees and about two thirds applied for forgivable loans, but most hadn’t received help before the first round of funding closed.“

Other healthcare providers, also considered essential, are taking steps to keep producing, as CEOs reduce or suspend their compensation or pay employees who are unable to work.

The federal government, meanwhile, made it easier for physicians to do virtual visits, increasing patient and provider safety, but Raina said that typically leads to $50 reimbursements.

“We’re mostly getting patients who have COVID-19 infection,” Dr. Raina says, adding that most are virtual visits. “Our revenue came mostly from stress tests, echocardiograms, and allergy tests.” Dr. Raina is still getting funds from previous work since insurer payments typically lag two months behind.

“I don’t want to lose employees,” Dr. Raina says. “They know what they’re doing. I would not want to start again. I’ve tried to keep everyone going. If I go through this year without a loss, I will think it is a good thing for me. I’m not sure that’s going to happen, though.”  Note: Dr. Raina is a MSSNY member. (LI Press May 11)


COVID-19: Risk Calculator / Choir Practice Super-Spreading Event
See some of the latest news on novel coronavirus disease (COVID-19):

Risk calculator: Researchers have developed a web-based risk calculator to estimate the probability that a COVID-19 patient will develop critical illness, defined as intensive care unit admission, invasive ventilation, or death. Reporting in JAMA Internal Medicine, the researchers examined the hospital records of nearly 1600 patients in China and assessed 72 potential risk factors. They found that the following 10 variables at admission were associated with increased risk for critical illness: chest radiographic abnormality, age, hemoptysis, dyspnea, unconsciousness, number of comorbidities, cancer history, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and direct bilirubin. (Try the calculator at the second link below.)

Choir practice: Roughly 87% of 60 members of a Washington State choir became ill with confirmed or probable COVID-19 following a 2.5-hour practice that was also attended by a symptomatic person, according to an MMWR study. Two attendees died. The authors say that the act of singing may have contributed to viral transmission.

Risk score study in JAMA Internal Medicine
Web-based risk calculator
Choir study in MMWR
NEJM Journal Watch COVID-19 page
NEJM COVID-19 page
FO Report. May 11)


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 12, 2020

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Notes from Governor Cuomo’s COVID-19 Briefing

Data:
– Hospitalizations and intubations are down
– Deaths 195 (142 in hospitals, 53 in nursing home)

Emerging Issue Among Youth:
– NYS DOH is investigating 100 cases of what may be COVID related illness
in children with symptoms similar to Kawasaki disease and toxic shock-like
syndrome
– Illness has taken lives of 5 year old boy, 7 year old boy, and 18 year old
girl
– Out of 100 cases, 5% of cases are found in those aged 1 or younger,
18% of cases are found in those aged 1-4, 29% is found in those aged 5-9,
28% in kids aged 10-14, 16% in those aged 15-19, and 4% in
those 20-21
– DOH is advising all hospitals to prioritize COVID-19 testing for children
presenting symptoms

Reopening:
– Heed Dr. Fauci’s warnings on risking an outbreak that cannot be controlled
– Learn from others’ mistakes (China, South Korea, Germany)
– Maintain regional management and citizen participation
–  Calibrate/control by monitoring diagnostic testing, antibody testing,
hospitalizations rate and capacity, infection rate
– – Finger Lakes, Mohawk Valley, and Southern Tier meet reopening criteria
– Status of regions will be updated daily and available to view at
forward.ny.gov/regional-monitoring-dashboard

Federal Assistance:
– This is time to pass a smart federal bill
– No time for handouts to corporations, political port, or partisanship
– Bill must fund state and local governments, working families, state testing
and tracing
– NY needs $61B in federal support or we will have to reduce spending
– Schools, local governments, and hospital spending will be cut by
20% each
– Federal bill must also respond to working families with:
– Landlord and renter assistance
– Payroll protection
– Funeral costs
– Repealing of SALT

– “No bailout boondoggles”

– Corporations have already forecasted next scam and will use pandemic
to enact layoffs and not rehire as many employees increasing corporate
profit and stock values on backs of American workers

Nursing Homes
– We now have more testing capacity, so nursing homes should be prioritized

– We will work with regions who do not have the testing capacity to do
two tests per week for staff


Dr. Fauci: Death Toll Higher than Reported
Dr. Anthony Fauci, the Trump administration’s top infectious disease expert, testified Tuesday that the consequence of reopening the country too early could be “really serious” if states don’t have the capability to respond to new coronavirus infections. The warning offered a stark contrast to the case made in recent weeks by President Trump, who has pushed to quickly restart the economy in spite of a mounting death toll and few signs that the months long pandemic is beginning the subside.

“My concern is that we will start to see little spikes that then turn into outbreaks,” Fauci told the Senate HELP Committee during a hearing on how to safely reopen the nation. “The consequences could be really serious.” The vast majority of states have yet to meet the most basic reopening benchmarks set out by the White House by last month, even as most move in stages toward lifting their social distancing guidelines.

That means that new outbreaks are likely as public life resumes, Fauci said, prolonging the coronavirus fight if states are not adequately prepared to respond. Already, more than 80,000 Americans have died from the disease — a figure that most public health experts agree likely undercounts the true toll. “There is no doubt even under the best of circumstances when you pull back on mitigation, you will see some cases appear,” he said.

Fauci added it’s almost certain the death toll is higher than recorded. He said that schools and businesses hoping to open their doors any time soon should not count on therapeutics or vaccines, saying that public safety hinges on the nation’s ability to regularly test Americans. “The idea of having treatments available or a vaccine to facilitate the reentry of students into the fall term would be something that would be a bit of a bridge too far,” he said. (Politico, May 11)


Please Join the NYS DOH in a COVID-19 Update Webinar

Thursday May 14th at 1-2PM for

COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers: 

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


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Registration Now Open Mental Health and COVID-19 for Health Professionals May 20, 2020 @ 7:30am Medical Matters CME Webinar
As health professionals, we are at great psychological risk simply by virtue of our “exposure” to the reality of COVID-19.  Registration is now open for MSSNY’s next Medical Matters webinar related to the COVID-19 pandemic, Medical Matters: Mental Health and COVID-19 for Health Professionals. Faculty for this program is Craig Katz, MD.

Registration is now open for this webinar

Educational objectives:

Better understand the mental health risks posed by COVID-19 for physicians
Review the possible range of psychological and psychiatric responses to the pandemic
Discuss principles and interventions for helping ourselves, our families, and our colleagues

To view MSSNY’s other COVID-19 related programs, be sure to go here and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020, Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020 and Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge and Psychological First Aid recorded on April 29, 2020.  You can also listen to MSSNY’s podcasts related to COVID-19 by going here.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.


NYC’s Death Toll Worse than City and State Figures
New York City’s death toll from the coronavirus may be thousands of fatalities worse than the tally kept by the city and state, according to an analysis released Monday by the U.S. Centers for Disease Control and Prevention.

Some of those excess fatalities could be COVID-19 deaths that went uncounted because a person died at home, or without medical providers realizing they were infected, the researchers at New York City Department of Health and Mental Hygiene said. It might also represent a ripple effect of the health crisis, they wrote. Public fear over contracting the virus and the enormous strain on hospitals might have led to delays in people seeking or receiving lifesaving care for unrelated conditions like heart disease or diabetes.

“Tracking excess mortality is important to understanding the contribution to the death rate from both COVID-19 disease and the lack of availability of care for non-COVID conditions,” the report said.

The report underscored the challenges authorities face in quantifying the human toll of the crisis. Deaths caused by the coronavirus are believed to be undercounted worldwide, due in large part to limits in testing and the different ways countries count the dead.

Through Sunday, New York City had recorded nearly 14,800 deaths confirmed by a lab test and another nearly 5,200 probable deaths where no test was available, but doctors are sure enough to list the virus on the death certificate. In its analysis, the report released Monday said the 5,293 excess deaths were on top of both confirmed and probable fatalities.

Between March 11 and May 2, about 24,000 more people died in the city than researchers would ordinarily expect during that time period, the report said. That is about 5,300 more deaths than were blamed on the coronavirus in official tallies during those weeks. (AP News, March 11)


NY Rolling Out Training for Virus Detectives
New York is poised to launch a training plan for the huge corps of disease detectives it plans to deploy to track people who coronavirus. The effort, seen as a key to keeping the outbreak from flaring again once it is under control, is likely to involve hiring several thousand people who have no background in public health.

Because getting huge groups of people together in one place for a contact-tracing boot camp is not possible, the training is being done through a five- to six-hour online course launching Monday. “There’s all this discussion about using technology in some way. But fundamentally, this is a pretty human activity,” said Josh Sharfstein of the Johns Hopkins Bloomberg School of Public Health, which developed the course with Bloomberg Philanthropies, the charitable foundation of former Mayor Michael Bloomberg.

When someone becomes newly infected with the virus, the tracers will be tasked with figuring out everyone who might have had contact with that person, reaching out to them and advising them how to quarantine themselves until they know for certain they aren’t sick with the virus.

In the video training, actors portray how the tracing interviews—mostly conducted by phone or video chat—are supposed to go. Sharfstein said the training, to be offered on the Coursera website, will be available to anyone, not just those seeking to become contact tracers.

Bloomberg is putting up $10.5 million through his foundation to help the state roll out its tracing plan. Gov. Andrew Cuomo has made hiring at least 30 contact tracers per 100,000 residents requirement for any region of the state to reopen. (Crain’s, May 12)


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NIH to Test Remdesivir in Combo with Eli Lilly Arthritis Drug
The National Institutes of Health announced its sponsorship of a controlled clinical trial of the investigational antiviral drug remdesivir in combination with the anti-inflammatory drug baricitinib to treat COVID-19. The trial is NIH’s second iteration of its Adaptive COVID-19 Treatment Trial, launched Feb. 21.  It tested Gilead Sciences Inc.’s antiviral drug remdesivir in treating COVID-19. Analysis of the trial revealed patients who took remdesivir experienced significantly shorter recovery periods than patients who received placebos.

“ACTT 2 will examine if adding an anti-inflammatory agent to the remdesivir regimen can provide additional benefit for patients, including improving mortality outcomes,” said Anthony S. Fauci, MD, director of the NIH’s National Institute of Allergy and Infectious Diseases. The new trial will incorporate baricitinib, Eli Lilly’s anti-inflammatory drug commonly used to treat rheumatoid arthritis. Baricitinib is expected to inhibit cytokine signaling that causes lung inflammation and shortness of breath among COVID-19 patients.

Investigators will evaluate the recovery times of patients prescribed remdesivir with baricitinib versus those of patients prescribed remdesivir only. ACTT 2 is expected to enroll about 1,000 U.S. hospitalized adults with COVID-19 at 100 sites. (Becker’s Hospital Review, May 11)


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

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