COVID-19 Update April 22, 2020
COVID-19 April 22 Statistics
By the numbers:
* New York reported 15,302 statewide deaths as of Wednesday, including 474 more fatalities in the past day of New Yorkers who have tested positive for COVID-19.
* As of Wednesday, the state reported 10,977 deaths of city residents, or 15,842 deaths if you include “probable” and not just “confirmed” cases.
* As of Wednesday, 15,599 New Yorkers were hospitalized with the coronavirus. For more numbers, including the latest statewide and borough-by-borough statistics, click here.
- Andrew Cuomo’s April 22 coronavirus presentation is here.
- Johns Hopkins COVID-19 map
- Medical Society of the State of New York website: mssny.org
- NYS DOH COVID-19 Map
MSSNY President Dr. Art Fougner Holds Up Newsday Centerfold Saluting “HEALTHCARE HEROES.”
Governor Cuomo’s COVID-19 Briefing Notes
– Net change in total hospitalizations and intubations is down
– 1,366 COVID hospitalizations yesterday
– 474 deaths (446 in hospitals, 28 in nursing homes)
White House Visit:
terms on the federal and state partnership in terms of testing, state
funding, and the state/FEMA match.
– About 40K tests could be done daily if all variables were bought up
– “This is not a time to be stupid.”
– Governor reiterated what happened during the Spanish flu noting that if we
are not prepared a second wave could wreak havoc.
– Governor reiterated that he has no problem taking the blame for any judgements
on the matter.
are protocols in place for continued disinfecting and social distancing.
– Can’t reopen businesses without reopening schools and transportation.
– If homes are not providing staff with PPE, they may be put out of business by
the state for noncompliance.
HealtheConnections Offering COVID-19 Lab Result Data to NYS Physicians
HealtheConnections, a nonprofit organization serving twenty-six counties in New York State, operates our regional health information exchange (HIE). They are offering its free resources tailored to COVID-19 treatment and monitoring to any healthcare provider or public health professional.
In partnership with the NYS Department of Health, they are offering immediate access to free COVID-19 lab result data and clinical alerting on lab results from anywhere in New York State. Please see this short flyer explaining these services and how to gain access if you feel these might be of benefit to your organization or someone you know working in the healthcare field.
HealtheConnections is the Regional Health Information Organization (RHIO) for Dutchess County and the entire Hudson Valley region. Their HIE, which creates comprehensive patient medical records from more than 450 care organizations, includes every hospital in our region.
If you have any additional questions on this data or how to access, please reach out to HealtheConnections directly at firstname.lastname@example.org or call 315-671-2241 x5.
DHHS Stimulus Payment Attestation Obligation
Please note that physicians who received a deposit into their bank account from HHSPAYMENT, must attest to the Terms and Conditions within 30 days of receipt and advise whether they accept or reject the payment. The following link will “walk” physicians through this attestation process.
Gov.: Plan for Resuming Elective Surgeries in Certain Parts of Upstate NY
As part of the Governor’s daily press conference yesterday, he announced that elective surgeries could resume in certain “counties and hospitals without significant risk of COVID-19 surge in the near term” across upstate New York. Hospitals will be able to resume performing elective outpatient treatments on April 28, 2020 if
a) the hospital capacity is over 25% for the county and
b) there have been fewer than 10 new hospitalizations of COVID-19 patients in the county over the past 10 days.
If a county or hospital that has resumed elective surgery experiences a decrease in hospital capacity below the 25% threshold or an increase of 10 or more new hospitalizations of COVID-19 patients, elective surgeries must cease. Further, patients must test negative for COVID-19 prior to any elective outpatient treatment. The State Department of Health will issue guidance on resuming elective surgeries.
Restrictions on elective surgery remain in place in Bronx, Queens, Rockland, Nassau, Clinton, Yates, Westchester, Albany, Richmond, Schuyler, Kings, Suffolk, New York, Dutchess,Sullivan, Ulster, Erie, Orange and Rensselaer counties as the state continues to monitor the rate of new COVID-19 infections in the region.
MSSNY Survey: Please Complete to Gauge Financial Impact of Outbreak and Availability of Relief
The $2 trillion CARES Act became law on Friday, March 27th and was the third stimulus relief package approved by the federal government in less than two months. Among the issues the bill addresses are the impact on small businesses, as well as the healthcare system, and includes $350 billion in forgivable loans and grants, and advanced payments from Medicare.
These resources are already available, but it is unclear how much physicians know about them and whether they are benefiting. Moreover, as MSSNY continues its aggressive advocacy to ensure physicians can obtain needed financial assistance during this crisis, we need information from our members as to the impact on their practice.
To get an idea if funds are getting into the hands of New York physicians, MSSNY’s Governmental Affairs team distributed a survey on Monday, April 13, to all members and other partners, with questions ranging from how aware physicians are of the financial assistance available through the federal government, difficulty in applying for assistance and whether or not physicians are having to layoff, or furlough, staff. For those MSSNY members who may not have taken the survey, please go to this link.
Congress, President Announce Agreement to Provide Needed Additional Funding for Small Business and Health Care Relief Pools
As has been reported in several news articles today, Congress and the Trump Administration have agreed on a package to be voted on this week to provide a “replenishment” to various funding pools enacted in the CARES Act last month. This includes $310 billion to supplement the depleted fund for the Paycheck Protection Program (PPP) for small businesses; $50 billion for the Economic Injury Disaster Loan (EIDL) program; and an additional $75 billion to supplement the $100 billion health care provider pool (of which an initial $30 billion distribution was made last week).
Moreover, the bill allocates $25 billion to assist in developing a national testing program, including a reported $1.5 billion for New York. The US Senate passed the legislation on Tuesday and the US House is expected to take it up Thursday. Each of these funding streams are absolutely essential towards helping physicians maintain their practices and keeping their practices during this crisis period. MSSNY President Dr. Art Fougner praised the New York Congressional delegation for taking this action.
Upstate Escapes the Worst of COVID-19
As of Sunday, the city proper, along with Long Island and its northern suburbs (Dutchess, Orange, Putnam, Rockland and Westchester counties), had recorded almost 14,000 Covid-19 deaths, which was 97 percent of the statewide total and a third of the nationwide toll. The impact on the other 50 counties has been far less severe, with 410 deaths as of Sunday.
We Thank NY Legislators for Replenishing Pool for Relief
“MSSNY thanks Senators Schumer and Gillibrand, and the New York Congressional delegation for their efforts to advance legislation to replenish the small business and health care provider relief pools initially passed in the CARES Act. This additional funding stream is critically important to maintaining the availability of physicians to their patients as we continue to manage and begin to recover from this horrific outbreak.
This funding stream is also a critically important lifeline to physicians in their efforts to maintain jobs for the hundreds of thousands of New Yorkers they employ. A MSSNY survey released last week finds that 80% of the physician respondents noted that there had been at least a 50% reduction in patient visits since the beginning of the outbreak, and more than a quarter have had to lay off or furlough at least 50% of their staff.
MSSNY looks forward to the U.S. House passage of these relief funds later this week as well as development of the next stimulus package, which we hope will more fully address the enormous financial consequences to New York’s health care and economic infrastructure, as well as providing a mechanism to ensure both office based and hospital based medical staff have the protective equipment they need.”
NYC Healthcare Workers Get Coronavirus Antibody Tests
Teams at Columbia University have pushed hard to boost the sensitivity of their in-house COVID-19 antibody testing and are now offering it to healthcare workers returning to the front lines here. While sensitivity is not perfect and questions remain about the clinical significance of SARS-CoV-2 antibodies, teams are moving ahead with the two-fold purpose of providing healthcare workers some peace of mind and collecting data to ultimately improve testing.
After weeks of tweaking their own ELISA assay, Columbia researchers say they’ve managed to bring its sensitivity to 85% — higher than the 50% to 60% they achieved with a commercial assay, according to Steven Spitalnik, MD, director of clinical laboratories at Columbia University Irving Medical Center and NewYork-Presbyterian.
“We know they’ve been diagnosed with the infection, so the majority [of healthcare workers] should test positive with this assay,” Spitalnik told MedPage Today. “That should give them some comfort and lower their stress levels, though we still expect them to use full personal protective equipment.”
Testing will also give Columbia a “biorepository of well curated samples,” he said.
(Med Page, 4/22)
How Many Times Can You Wash Your Mask?
Steam sterilization may work for decontaminating N95 respirators in short supply during the COVID-19 pandemic, researchers reported. N95 masks retained structural integrity and efficacy after three cycles of sterilization, reported Firas Zabaneh, MT, MBA, of Houston Methodist Research Institute, and colleagues in a research letter in Infection Control & Hospital Epidemiology.
Fit testing of the masks on five test subjects checked out after all three rounds compared with baseline. Chemical and biological indicators for every autoclave cycle confirmed absence of contamination on the masks afterward. Reuse is unavoidable, because “the United States will need 3.5 billion N95 masks for healthcare workers during this pandemic, and currently has about 1% of that necessary volume,” the researchers noted.
Decontamination strategies have varied widely from institution to institution in what has been described as a “Wild, Wild West” phase for infection control, with some just waiting out the 72-hour period the coronavirus can live on plastic, stainless steel, and cardboard surfaces and others taking more active measures. The study used immediate-use steam sterilization with a Steris Amsco Evolution HC1500 PreVac Steam Sterilizer autoclave on masks packed in paper-plastic sterilization peel pouches.
While the CDC hasn’t officially endorsed any method for decontamination, it said ultraviolet germicidal irradiation, vaporized hydrogen peroxide, and moist heat — like used in this study — have shown “the most promise” as methods for decontaminating respirators. Also, the FDA indicated it won’t object to use of disinfectant devices, sterilizers, and other approaches for mask decontamination. Subsequently, a study from the National Institute of Allergy and Infectious Diseases determined that the best strategy was vaporized hydrogen peroxide, which worked fast and maintained mask efficacy for three cycles of sterilization.
In that study, ultraviolet light took longer but also kept masks in good shape through three cycles. Dry heat was slow and degraded mask function after two rounds of decontamination. A 70% alcohol saturation did not make it to the second round.
Zabaneh’s group acknowledged the low numbers in their study “to prevent removing N95 masks from clinical settings and to rapidly translate this finding to the greater clinical community.” Follow-up studies in a significantly larger group are planned at Houston Methodist Hospital, with fit testing each day.
Infection Control & Hospital Epidemiology
Trump Administration Announces New Nursing Homes COVID-19 Transparency Effort
On April 19, under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) announced new regulatory requirements that will require nursing homes to inform residents, their families, and representatives of COVID-19 cases in their facilities. In addition, as part of President Trump’s Opening Up America, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC).
This information must be reported in accordance with existing privacy regulations and statute. This measure augments longstanding requirements for reporting infectious disease to state and local health departments. Finally, CMS will also require nursing homes to fully cooperate with CDC surveillance efforts around COVID-19 spread.
CDC will be providing a reporting tool to nursing homes that will support federal efforts to collect nationwide data to assist in COVID-19 surveillance and response. This joint effort is a result of the CMS-CDC Work Group on Nursing Home Safety. CMS plans to make the data publicly available. This effort builds on recent recommendations from the American Health Care Association and Leading Age, two large nursing home industry associations, that nursing homes quickly report COVID-19 cases.
This data sharing project is only the most recent in the Trump Administration’s rapid and aggressive response to the COVID-19 pandemic. More details are available in the Press Release and Guidance Memo.