COVID-19 Update April 20, 2020

COVID-19 April 20 Statistics
New York reported 14,347 statewide deaths as of Monday, including 478 more fatalities in the past day of New Yorkers who have tested positive for COVID-19. As of Saturday, New York City reported 13,240 deaths of city residents, including “probable” and not just “confirmed” cases. As of Monday, 16,103 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here. Gov. Andrew Cuomo’s April 19 coronavirus presentation is here.

Notes from Governor Cuomo’s COVID-19 Briefing:

– Total hospitalizations 16,103 as of yesterday
– 1,380 new COVID hospitalizations yesterday
– Net change in hospitalizations and intubations is down
– 478 lives lost yesterday (455 in hospitals, 23 in nursing homes)
– – In terms of reopening, let’s use this situation to learn lessons
and reimagine what we want society to be.
– Antibody testing begins today


– Federal government has not funded states to date.
– Federal CARES Act contains zero effort to combat shortfalls
– Renewing bipartisan call for $500 billion in aid to states
– If state government is excluded again schools, local governments,
and hospitals are forecast to be cut by 20% each.
– Hazard pay for frontline workers – they should receive a 50% bonus
(including airline workers)
– 41% of frontline workers are people of color
– 2/3 of front-line workers are women
– 1/3 of front-line workers are from low-income households.


– Over 20 hospitals were using hydroxychloroquine and will send
results to the FDA and CDC today. The DOH will receive a copy.
— Elective surgeries have been suspended in NY, but bed capacity
has increased since start of COVID-19, so this suspension will be reexamined.
– Policy will be announced tomorrow regarding hospital vacancy rate
and COVID-19


– Applications being processed so money should be seen this week.
– People that opt for a debit card instead of direct deposit will wait
longer to receive money.
– DOL launched new form where one application can be filled out to
determine if one is eligible for unemployment insurance and pandemic
unemployment insurance.

NY Physician Practices Struggling to Survive: Survey
Physicians in New York are struggling to stay afloat despite the recent passage of the CARES Act, according to a new survey from the Medical Society of the State of New York.

The bill was meant to address the impact of the Covid-19 pandemic on small businesses, including physician practices, the society said. But more federal support is critical to the survival of those in hard-hit New York.

Some 80% of survey respondents reported that they have suffered a loss of revenue of more than 50% since the Covid-19 outbreak began. And 83% reported they have experienced a reduction of more than 50% in the volume of patients visiting their practices.

Additionally, more than a quarter of respondents said they have had to lay off or furlough more than half their staff, and nearly three-quarters said they have applied for forgivable loans through the Small Business Administration.

Our first priority remains to ensure that our patients through the crisis can continue to receive the care they need, but we need to know if our practices can keep their doors open for patients now and in the future,” said Dr. Art Fougner, president of the medical society, in a statement. “With patients appropriately limiting their trips out of the house, including to their doctor’s offices, along with all elective procedures being suspended, the impact has devastated practices and the hundreds of thousands of New Yorkers they employ.”

Fougner added that one physician commented: “Letting go of my staff, knowing the hardship ahead for them, was one of the most difficult decisions I ever had to make. I pray they will return when this horrible scourge is over.”

The society noted that although the CARES Act provided some funding to make up for deficits, it’s not nearly enough for many physicians across the state.

The group thanked the New York congressional delegation for continued efforts to secure additional relief funds. (Crain’s, April 17)

Survey of Medical Society of State of NY Physicians
A survey of Medical Society of the State of New York members released Thursday found 83 percent of respondents have had a reduction of more than 50 percent in the volume of patients visiting their practices. Also, 80 percent have suffered a loss of revenue of more than 50 percent since the outbreak of COVID-19. More than a quarter have had to layoff, or furlough, more than 50 percent of their staff.

“Very disturbing reports were also received from physician respondents that despite having applied for help as soon as the funds became available, they have received no assistance to date,” the society reported. (Times Union,  April 19)

African Americans Make Up One-Third of All US Coronavirus Cases
As of April 15, African Americans made up about 30 percent of the COVID-19 
cases in the country, according to CDC data.

The CDC released demographic data for coronavirus cases in the U.S. as of April 15 at 4 p.m. CDT. The data is based on 465,995 U.S. cases.

Three insights:

  1. Race is specified for 111,650 of the COVID-19 cases included in the data.
  2. Black people account for about 30 percent of all U.S. COVID-19 cases where race is specified, while white people account for 64 percent and Asians account for 4 percent.
  3. Of the 102,979 cases for which ethnicity was specified, Hispanic/Latinos account for 17 percent of the cases. (Becker’s Hospital Review, April 20)

The Coronavirus Spreads At Least 13 Feet, Travels on Shoes: CDC
The coronavirus can travel through the air at least 13 feet — more than twice as far as social distancing guidelines, according to a report from the Centers for Disease Control and Prevention. Research published in the federal agency’s Emerging Infectious Diseases journal shows the contagion spreading much farther than previous official suggestions — and also getting spread on people’s shoes.

“The aerosol distribution characteristics … indicate that the transmission distance of [COVID-19] might be 4 m,” the report says, translating as more than 13 feet.

“Furthermore, half of the samples from the soles of the ICU medical staff shoes tested positive,” the researchers wrote of samples taken at Huoshenshan Hospital in Wuhan. “Therefore, the soles of medical staff shoes might function as carriers.”

The report, based on research by a team at the Academy of Military Medical Sciences in Beijing, appears to reaffirm fears that the current social distancing guidelines of 6 feet may not be enough.

It also suggests people — especially medical staff on the front lines — could inadvertently be spreading the bug away from its source, recommending stringent disinfecting measures. (WebMD, April 14)


NY Hospital Leadership Regarding Communication and Strategy
Michael Antoniades, EVP and COO, Maimonides Medical Center (NYC) 

Hold virtual town hall meetings with all staff at least weekly. You cannot communicate enough. Be open and transparent with your team.

Robert J. Corona, DO, MBA, FCAP, FASCP, Chief Executive Officer, SUNY Upstate Medical University and Community Hospitals (Syracuse, N.Y.)

Anticipate the unexpected. You are operating in an uncertain environment, and the cavalry is not coming. Reach out to collaborate with organizations promising to help you, but ultimately you’re on your own. Low expectations will lead to less disappointment. You’ll be disappointed by some you thought were good leaders and pleasantly surprised by others. A crisis reveals the essence of people’s leadership skills and their true nature.

At the same time, there are people on the bench waiting to get into the game. You will be surprised by the talent you have right under your nose. Delegate urgent issues to your team so you can focus on the critical. Keep vigilant to threats. You can’t take the typical time to make decisions. As a neuropathologist, I compare it to making a frozen section diagnosis. Time is critical, and you have to make the call with the data you have. Also, start planning now for a rolling recovery and coming out of this crisis as a more resilient organization. Coming out of this crisis only to be the same organization you were before is a lost opportunity. 

Laura Forese, MD, Executive Vice President and COO, New York-Presbyterian 

There is no such thing as overcommunicating. Communicate to your team members at all levels. Every person needs to know what is happening in your organization, how you are thinking about the evolving strategy and that you care about the team.

Ignore all the superfluous and overly sensationalized media “noise.” It’s way too unproductive. Alternatively, stay the course by driving evidenced-based, science-centric decisions. And if the noise gets too loud — turn up the music. 

Bill Lynch, Executive VP/COO, Jamaica Hospital Medical Center (NYC) 

Communicate, communicate and communicate. It’s that critical! Good luck.

fact that decisions need to be made quickly. When doing so, not all decisions will be perfect and the organization needs to be agile enough to adjust quickly.

Another key ingredient in leading through this complex crisis is to ensure that the organization is communicating in a multi-channel way, both internally and externally. Communications need to be built into the organization’s daily rhythm and key messages need to be repeated. As COVID-19 races to adapt to its new environment, so must we. Through courage, cooperation, creativity and most importantly resilience, we will persevere. 

Louis Shapiro, President and CEO, Hospital for Special Surgery (NYC) 

Set up a robust organizational structure as if you were starting a new company at scale. Be forward-looking and think about what you need to do before you need to do it. If you wait, it will be too late. Don’t underestimate the importance of communicating with your workforce. HSS did so in many ways: web-app, daily videos, daily emails, live stream. Visibility, transparency, inspiration and timeliness are all critical. Remember your hidden heroes: environmental services, engineering, supply chain, microbiology. Figure out a way to capture what you learned and make sure you pull it through to the other side. Develop your “return to new normal” plan well before you need it.

Overcommunicate. Make sure communication is timely, transparent, and clearly stated. As the messages are delivered, praise the work for the staff for being flexible, as policies and processes are changing daily. Invite feedback, give them a vehicle with which to respond. Let staff know that you are listening to them because they likely have the answers and you want to know what they are thinking. At no other time have we had the opportunity to connect closer to our frontline staff than now. And it is our responsibility to do so. (Becker’s Hospital Review April 17)

Nearly 60% Of COVID-19 Chest X-Rays Look Normal, Study Shows
Chest X-rays read as “normal” for nearly 60 percent of COVID-19 patients, a new study shows. The study, published in The Journal of Urgent Care Medicine, examined the database of a large urgent care company in the greater New York City area. They examined data for patients with the new coronavirus who also had chest X-rays between March 9 and March 24.

Eleven radiologists reviewed data for 636 chest X-rays among patients with confirmed COVID-19.

Of the 636 chest X-rays, 371, or 58.3 percent, read as normal. Of the 265 chest X-rays that read as abnormal, 195 demonstrated mild disease, 65 demonstrated moderate disease and five demonstrated severe disease. (Becker’s Hospital Review April 17)

NBC/WSJ Poll: People More Concerned About Virus than the Economy
Nearly 60% of Americans say they’re more concerned that loosening stay-at-home measures will cause further spread of the coronavirus than they are about what impact restrictions might have on the US economy, according to a new poll. The NBC News/WSJ poll released Sunday found that 58% of registered voters worry the country will be too quick to lift the restrictions, leading the virus to spread and to more fatalities. By comparison, there was another 32% who are more concerned that the country will take too much time to ease the restrictions, which will take a toll on the economy.

There appeared to be a partisan impact on the responses — with 77% of Democratic respondents and 57% of independents reporting they’re more concerned about the spread of the virus than the economy.

Meanwhile, Republicans were more divided with 39% more worried about the pandemic and 48% reporting that their greatest concern was about the economy, the poll said.

The poll was conducted from April 13 to 15 as some states have begun to talk about how to ease lockdown restrictions.

Pollsters surveyed more than 900 registered voters, more than half of whom were reached by cellphone. (NY Post April 19)

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Coronavirus in Context: Covid-19 Prevalence
WebMD’s Chief Medical Officer, John Whyte, speaks with Justin Silverman, M.D. PhD Assistant Professor, Penn State University Alex Washburne, PhD Research Scientist, Montana State University Nathaniel Hupert M.D. MPH FACP Assistant Professor, Weill Cornell Medicine to discuss Covid-19 Prevalence.

In comparison, as of March 28, the CDC had reported more than 122,000 confirmed cases.

The researchers say their findings are in line with another new study that looked for COVID-19 antibodies in the blood of 3,300 Santa Clara County residents. Based on their tests, researchers estimate that between 2.5% and 4.2% of county residents have antibodies against the virus, a number that translates into 48,000 to 81,000 infections, or 50 to 85 times as high as the number of known cases. That study also has not been peer reviewed.

For their study looking at ILI rates, the researchers looked at several sources of information to determine the infection rate:

  • Every week, about 2,600 U.S. health care providers report the numbers of patients who have ILI to the CDC. These patients have a fever of at least 100 degrees, a sore throat or/or a cough, without a known cause other than flu. Colds, flu, other respiratory viruses, and COVID-19 can all cause these symptoms.
  • The researchers then excluded people who were eventually confirmed to have flu.
  • Of the remaining group, they assumed that those numbers above the season average of the nonflu cases could be attributed to COVID-19.

Study co-author Justin Silverman, MD, PhD, assistant professor of information science and technology at Penn State University, cautions that the data about infection rates needs to be verified yet by other methods, such as testing blood samples and taking swabs. The findings point to the need for more testing, and not just of those showing up at the doctor with symptoms, says Alex Washburne, PhD, co-lead author of the study and a research scientist at Montana State University. What’s needed, he says, is random population testing.

“I would like to see 100 random people in each state on each day” tested, he says, both with swabs and antibody testing. “That would give us a sense of prevalence.”

Ruiyun Li, PhD, a research associate at the Imperial College London, who has studied undocumented COVID-19 infections, agreed that the findings stress the need for more testing. “The finding is important as it indicates the urgent need to improve the testing and detection capability – the more we test, the more cases could be confirmed,” Li says. He also said their approach is interesting because it’s impossible to test everyone. “The estimates based on current ILI surveillance system could help.”

The lack of testing is one of the reasons many countries have employed social distancing measures to prevent the spread of the COVID-19 infection. In the U.S., officials have expressed optimism that ramping up widespread antibody testing may help relax distancing measures. Li echoes the researchers’ caution that the estimates are just that – estimates — and the findings do need to be validated by blood tests to show exactly how many people test positive.

Death Rate Questions

The finding of much more widespread infection suggests the infection to fatality rate from COVID-19 might be less than current estimates, which range from 3% from the World Health Organization to 1.4% reported recently by other experts. But the researchers stop short of estimating a revised death rate from their findings.

Fatality rates also depend heavily on how overwhelmed hospitals get and what percentage of cases are tested. The New York Times reported that China’s estimated death rate was 17% in the first week of January, when Wuhan was in its peak, but only 0.7% by late February.

Washburne says while their findings suggest a lower fatality rate is possible, it’s premature to calculate a death rate from the infection rate the researchers found. Death rate, he says, ”is probably the most important and contentious number for assessing the risk-benefit of costly interventions, such as statewide lockdowns versus more diffuse interventions such as mask wearing.”

One bit of missing information may throw off the estimate of the death rate, Washburne says. “If we’re off by 0.1%, that’s 200,000 deaths.”

Washburne says what they’ve done is added a piece of evidence that suggests the growth rate of the virus is faster but that the number of serious cases is fewer. He hopes he can help guide future models if backed up by other evidence. (WebMD Health News Reviewed by Neha Pathak, MD on April 18, 2020)

Social Distancing May Be Needed Through 2022, Harvard Researchers Say
Social-distancing measures for COVID-19 may need to continue through 2022, according to new projections from Harvard researchers published in Science. 

Researchers from Boston-based Harvard T.H. Chan School of Public Health used mathematical modeling to predict various scenarios for the pandemic.

The researchers projected that the SARS-CoV-2 virus will return every winter, prompting more outbreaks after the initial pandemic wave ends. Prolonged social-distancing strategies could help limit the strain on healthcare systems and make quarantine and contact-tracing a feasible response strategy.

“Intermittent distancing may be required into 2022 unless critical care capacity is increased substantially or a treatment or vaccine becomes available,” the researchers said.

They acknowledged that even intermittent social distancing will have profound economic, social and educational consequences. Even after the “apparent elimination” of COVID-19, viral surveillance should continue through as late as 2024 to prevent an outbreak resurgence, researchers said.

The researchers said their modeling should not be taken as an endorsement of certain response policies, but instead be used to identify helpful interventions and spur new ideas to achieve long-term control of the pandemic.

To view the full study, click here.

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