COVID-19 Update April 21, 2020


COVID-19 April 21 Statistics


Notes from Governor Cuomo’s COVID-19 Briefing:

Total hospitalizations is “basically flat” and overall curve is decreasing
– Net change in intubations and net hospitalizations is decreasing
– New COVID hospitalizations 1,308 as of yesterday
– Total hospitalizations by region
– 64% in NYC, 21% in Long Island, 8% in Westchester and Rockland County
– 125 hospital deaths in Erie county yesterday
– 481 total deaths in NY yesterday (452 in hospitals, 29 in nursing homes)

Governor reiterated the need to Do No Harm:
 – Be ready to Surge and Flex support to address local clusters by
moving ventilators and equipment from downstate to upstate.

Elective Treatment:

 – Hospitals will allow elective outpatient treatment in counties
and hospitals without significant risk of COVID-19 surge in near term.
– Westchester and Rockland south, Erie, Albany, Dutchess, and
several other counties are excluded.

Testing and Tracing:

 – National private manufactures of lab equipment sell test and treatment
to labs to 211 labs in NY.
– Governor agrees that states should be in charge of testing however the
federal government should aid in providing tests.

Reopening:
– Decisions to open will be made on regional circumstances.

Q&A:
Testing:

– Meeting with the president will focus on testing.

Regional Reopening:
– Will view hospitalization rate and amount of COVID cases in
addition to infection rates and hospital capacity to determine
when and how reopening is possible.


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Cuomo Commits to Reopening New York State Regionally
“We’re going to make reopening decisions on a regional basis based on that region’s facts and circumstances,” he said during his daily briefing. The briefing was held in Buffalo, his first-time venturing west of Schenectady since the pandemic began.

“Just like some states will reopen before other states because they have a different circumstance when it comes to COVID and their status with COVID, it’s also true across the state,” Cuomo said. “[The] North Country has a totally different situation than New York City. Central New York has a different situation. We operate as one state, but we also have to understand variations, and you do want to get this economy open as soon as possible.”

He provided the first taste of how this regional rollout will work by announcing that some hospitals can resume elective surgeries and treatments. “We’re going to allow elective outpatient treatment, which means the number of beds remain available because the number of people are using those beds is still relatively minimal,” he said. “And we’re going to allow it in those hospitals and counties in the state that do not have a COVID issue.” Cuomo said the policy will exclude hospitals in Westchester, Rockland, Erie, Albany and Dutchess Counties, as well as in New York City, where there still is “a real COVID problem.”

“The economic impact … has taken an extraordinary toll on an already struggling Upstate economy,” Unshackle Upstate Executive Director Michael Kracker said in a statement Monday. “A one-size-fits-all strategy is simply not the best fit for Upstate New York.” (Politico, 4/21)


MSSNY Urges NY-Based Health Insurers to Provide Advance Payment Options for Network Physicians
MSSNY President Dr. Art Fougner has written to the CEOs of several regional health insurers operating in New York State urging that they implement a program to provide “advance payment” options to their network physicians similar to what has been undertaken by the Medicare program.

The letters, written to the CEOs of CDPHP, Excellus, Emblem, Empire Blue Cross, Independent Health and MVP, note that “like many businesses across the state, New York physicians are dealing with the devastating impact on their practices as a result of the suspension of all elective procedures, the lack of availability for needed personal protective equipment (PPE), and patients appropriately limiting their trips out of the house, including to their doctor’s offices.”

The letter also thanks the insurers for “working collaboratively…over the past several weeks to help remove barriers to patients being treated via telemedicine, which has been important to maintaining essential continuity of care for our patients and your insureds collaboration”, but notes that far more needs to be done to preserve their networks in the future given the challenges and limitations of the Paycheck Protection Program established under the CARES Act. A similar program was recently advanced by United Healthcare


COVID-19-Related NY Nursing Home Deaths Surpass 1,000
More than 1,100 New York nursing home and adult care facility residents have died from Covid-19 since the outbreak began more than a month ago, state health officials reported Friday. New data released by the Department of Health found that at least 1,135 people died at nursing home and adult care facilities as of Wednesday. That represents about 9 percent of the state’s death toll so far. The bulk of those deaths occurred at facilities in New York City.  (Politico, April 20)


N.Y. Nurses Sue Montefiore, State Over Dangerous COVID-19 Conditions
The New York State Nurses Association on Monday sued the state, Montefiore Medical Center and Westchester Medical Center, alleging their members weren’t given adequate personal protective equipment and were forced to return to work earlier than advised.

Approximately 161 association nurses at the two health systems have tested positive for coronavirus.

“More than seven in ten of our nurses are reporting exposure to COVID-19 and most are still untested. These lawsuits were filed to protect our nurses, our patients and our communities from grossly inadequate and negligent protections,” NYSNA Executive Director Pat Kane said in a statement. “We cannot allow these dangerous practices to continue.” (4/20 Modern Healthcare)


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Huntington Hospital, Long Island

CMS: Facilities May Begin Performing Elective Procedures; Follow Procedures
Healthcare facilities should be able to begin performing elective procedures again if they follow certain protocols, according to guidelines released Sunday by CMS. Although many hospitals and health systems have quickly set up telehealth services to address non-urgent medical issues, “the reality is that not everything can be addressed by telehealth,” CMS administrator Seema Verma said at a briefing held by the White House’s coronavirus task force, citing breast cancer surgery and cataract surgery as two examples of elective procedures that can’t be put off for too long.

With some hospitals around the country seeing a decline in COVID-19 cases and reporting unused capacity, “we’re issuing guidelines today about how we can re-open the healthcare system; these are recommendations around Phase 1,” Verma said, referring to the administration’s “Guidelines for Opening Up America Again.” That guidance outlines a stepped approach to resuming normal activities based on trajectories of syndromic illnesses, diagnosed cases, need for hospital “crisis care,” and testing availability.

“Every state and local official has to assess the situation on the ground,” she said. “They need to be able to screen patients and healthcare workers for the COVID virus, and we need to make sure that patients feel safe when they come in to seek healthcare services by showing they have the appropriate cleaning in place and that they observe social distancing inside the healthcare facilities.” Verma added that this will be a gradual process in which “healthcare systems across the country need to decide what services should be available. We want to make sure systems are reopening so they can stay open and doing that in a very measured way.”

The new CMS guidelines specify that “non-COVID-19 care should be offered to patients as clinically appropriate and within a state, locality, or facility that has the resources to provide such care and the ability to quickly respond to a surge in COVID-19 cases, if necessary. Decisions should be consistent with public health information and in collaboration with state public health authorities.” (Medpage 4/20)


One in Three N.Y. COVID-19 Patients Required a Ventilator
A large study of hospitalized COVID-19 patients in New York City found 1 in 3 were put on breathing machines. That’s a rate more than 10 times higher than seen in China.

The study’s authors say that of the patients studied, 36% were obese, which may have contributed to severe breathing problems and the need for ventilators.

Published online Friday in the New England Journal of Medicine, the report involves 393 patients admitted to two unidentified hospitals from March 5-27. Patients were aged 62 on average and 60% were men. Almost 40% were white but the report had no other racial breakdown. Overall, 6% were health care workers.

Cough, fever and shortness of breath were the main symptoms, but diarrhea, nausea and vomiting were also common.

Dr. Parag Goyal of Weill Cornell Medicine and the report authors say that compared with China, hospitalization for COVID-19 in the U.S. is generally limited to more severely ill patients, another likely reason for the greater use of ventilators.

The authors say 40 patients or 10% died and 260 were discharged from hospitals. (4/17 Modern Healthcare)


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Private Labs in New York Must Prioritize COVID-19 Testing
Private labs across New York were ordered Friday to coordinate with the state’s Department of Health to mandate coronavirus testing takes priority.

Gov. Andrew Cuomo said Friday he would issue an executive order that mandates all labs—public and private—in the state, who are tasked with carrying out coronavirus diagnostic tests, coordinate with the State’s health department going forward.

There are 301 labs in New York licensed to perform virology testing, Cuomo said.

“How do we get 300 private labs and hospitals to become one system statewide to do testing for COVID? And how do we get them all coordinated? This is something that has never been done before and is going to be a tremendous undertaking,” Cuomo said. (Crain’s New York Business 4/20)


MIPS Credit for Sharing Clinical Data
The CMS on Monday encouraged providers to share clinical data in the Quality Payment Program that could help combat the COVID-19 pandemic.

The agency will give providers credit in the Merit-Based Incentive Payment System if they participate in a clinical trial that uses a drug or biologic to treat COVID-19 and report the data to the CMS. The hope is the increased participation will help improve patient care and find best practices that could curb the virus’ spread.

“The best scientific and medical minds in the world are working night and day to find treatments to combat coronavirus,” CMS Administrator Seema Verma said in a statement. “But without solid data, their efforts are liable to run up against a brick wall.”

Clinical trial participation will earn half of the credit necessary to gain a maximum MIPS improvement activities score, which is 15% of a provider’s total MIPS score.

The CMS highlighted several trials providers could join, including National Institutes of Health trials or a clinical data repository with Oracle.

“Having clinicians use an open source data tool to submit their findings will bring the results of their research to the forefront of healthcare much faster, leading to improvements in care delivery and the ability to treat COVID-19 patients,” the CMS said in a press release. (Modern Healthcare 4/21)


Northwell Awards Front-Line Workers with Cash, Extra PTO
Northwell Health is giving its front-line workers a $2,500 lump-sum payment and a week of paid time off.

The system estimates around 45,000 nurses, physicians, respiratory therapists, housekeepers and other workers are eligible for these benefits.

“Our dedicated staff’s response to the COVID-19 pandemic has been nothing short of heroic. Thanks to the courage and commitment of our front-line caregivers, we answered the call-in service to the patients and communities who entrust us with their care,” said Michael Dowling, Northwell’s CEO. (4/20)


Healthcare Professionals Urge Data re Death among African Americans
Providers are urging the Trump administration to collect more information about what’s causing high rates of COVID-19 infection and death among African Americans and other people of color, according to a joint letter sent Thursday to HHS by three major associations.

The American Hospital Association, American Medical Association and American Nurses Association identified several areas that require more federal attention, including the need for additional information about “comorbidities, the number of patients by race who require ventilators, oxygen support or intubation, and the number who died in their homes.”

“We need the federal government to identify areas where disparities exist and help us immediately address these gaps,” they wrote.

The groups also pushed HHS to work with state and local public health departments to gather and share information to make sure that providers don’t spend valuable time and resources collecting and reporting data that might already be available.

HHS should act to increase access to COVID-19 testing for African Americans by creating testing centers paid for and run by the federal government, according to the letter. Likewise, the Trump administration should make it easier to get a referral for COVID-19 testing since many people of color don’t have health coverage or primary care access.

Hospitals, physicians and nurses also pressed HHS to develop ways to address minority populations’ COVID-19 needs that are culturally relevant.

The Centers for Disease Control and Prevention recently started to collect and report information about COVID-19 patients’ race and ethnicity—including testing, hospitalization and mortality data—after widespread reports that the COVID-19 outbreak was affecting racial and ethnic groups differently. But experts say they need more information to address the problems. Modern Healthcare, April 21)