COVID-19 Update April 28, 2020

MSSNY to Develop Recommendations for Re-opening of Physicians Practices
Today, MSSNY President Arthur Fougner, MD and President-Elect, Bonnie Litvack, MD announced that the Medical Society of the State of New York announced that the Committee on Infectious Disease and the Committee on Emergency Preparedness and Disaster/Terrorism Response will work collaboratively to develop recommendations for re-opening office-based practices during the time of the COVID-19 pandemic.

While it is important to note that physician offices are considered “essential” and were not required to be closed, both committees will review issues to ensure safety within the physicians’ practices as the acute phase of the pandemic begins to recede.  These issues include; triage and surge, messaging to patients, telemedicine, office set up to ensure local distancing, mental health of staff and mental health of patients, personal protection equipment, testing, flu season and the administration of other vaccines, possible treatment for Covid 19 and the possible vaccine and, and fiscal issues related to physicians’ practices.  It is anticipated that these recommendations will be available to members for use as a guide.

“We know that office-based physicians have been at the forefront in helping to prevent additional COVID -19 cases from going directly to the hospital and thereby have greatly helped to reduce hospital surge.  We also acknowledge that physicians are willing to care for patients in the new world that we will now live in—but want to ensure their patients safety along with their staff.  Developing recommendations for our office based physicians and their staffs are an important key in keeping the infection rate down,” said Dr. Fougner and Dr. Litvack.  Dr. Fougner and Dr. Litvack encouraged all physicians to use the tools below to assist them in the efforts to combat the virus.

Continuing Medical Education

Physicians are encouraged to register now for MSSNY’s webinar related to the COVID-19 pandemic, Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge & Psychological First Aid on April 29th at 7:30am. Faculty for this program are William Valenti, MD and Craig Katz, MD. Registration is now open for this webinar!

MSSNY also provides to you additional continuing medical education programs through its MSSNY online program at cme.mssny.org.  Physician who are new to the site will need to create an account with a login and password.  If there are any difficulties with the site please contact our support staff at cmesupport@mssny.org  The following coursework is free to all physicians and healthcare providers:

Medical Matters Courses:

· Psychosocial Dimensions of Infectious Outbreaks
· Coronaviruses 2020: COVID-19 An Evolving Story
· Disaster Medicine Every Physician’s Second Specialty
· Doctor Are You Ready?
· The Importance of Resilience After a Disaster
· Principles of Isolation and Quarantine: Epidemiology as a Decision Maker
· Public Health Preparedness 101
· Virtual Drill: Incident Command System & Crisis Communications

Emergency Preparedness:

· Physician’s Electronic Emergency Preparedness Toolkit (Modules 1-4)

Resources:

· Psychological Impact of Disaster and Terrorism Reference Card

Podcasts

Also available are podcasts related to the current COVID-19 pandemic, To listen go here.

COVID 19 Resources/DOH Guidance

Additionally, MSSNY has dedicated resources on its website at www.mssny.org and these resources are available on the homepage and in the blue boxes.  Also, MSSNY is providing to its members a daily update on COVID-19.  If you are not receiving this, and wish to do so, please contact Christina Southard at csouthard@mssny.org.

Practice Financial Support

We want to ensure physicians are aware of two important developments to help physicians with obtaining funds that will cover the significant drop in patient care revenue over the last two months. MSSNY worked together with the American Medical Association (AMA) and many other state and specialty societies to advocate to ensure the availability of these funds.

The Small Business Administration is again accepting applications for the Paycheck Protection forgivable loan Program (PPP), starting Monday, April 27, following the passage of legislation by Congress last week allocating a new $310 billion for the PPP.

Many physicians had reported not being able to get their applications in time prior to the previous allocation being depleted. This pool of funding is also likely to be depleted quickly, so do not delay in getting in your application if you intend to apply. 

For assistance, please contact mauster@mssny.org .

Personal Protective Equipment

Physicians’ offices should continue to submit requests for Personal Protection Equipment (PPE) through their local Office of Emergency Management.  Physicians will need to call their local Department of Health for the OEM phone number and let their local DOH know that they are seeking PPE. They will be directed to the OEM office by phone or by website. Physicians will need to provide information to the local OEM regarding information as to the amount of PPE needed, license number, and practice location.  A listing of local Department of Health offices is here.

New York State continues to fulfill requests for PPE, and provides supplies to the local OEM when there is a request. If all efforts to obtain PPE through vendors and local Office of Emergency Management fail, please contact MSSNY to let us know that the practice is having difficulty in obtaining PPE from the local OEM.  MSSNY will need the information that was provided to the local OEM so we can provide information back to the state about the difficulties the practice is encountering. MSSNY has been in continuous contact with the NYS Department of Health to help address situations when physicians report difficulty with their local OEM. Please contact pclancy@mssny.org if there is difficulty in obtaining PPE from local OEMs. For general guidance on the use of PPE in healthcare settings, please refer to CDC guidance entitled “Healthcare Supply of Personal Protective Equipment”.

MILMIC Insurance Company Checklist

MILMIC Insurance Company has put together a checklist for health practices during the COVID 19 pandemic.  A copy of the checklists can be found HERE.


NYSDOH Info for Physicians


TOP FIVE FROM Gov. Cuomo Today
· CDC Guidelines: Based on CDC recommendations, once a region experiences a 14-day decline in the hospitalization rate they may begin a phased re-opening.

· Industries: Businesses in each region will re-open in phases. Phase one will include opening construction and manufacturing functions with low risk. Phase two will open certain industries based on priority and risk level. Businesses considered “more essential” with inherent low risks of infection in the workplace and to customers will be prioritized, followed by other businesses considered “less essential” or those that present a higher risk of infection spread. Regions must not open attractions or businesses that would draw a large number of visitors from outside the local area.

· Business Precautions: Each business and industry must have a plan to protect employees and consumers, make the physical workspace safer and implement processes that lower risk of infection in the business.

· Building Health Care Capacity: To maintain the phased re-opening plan, each region must have at least 30 percent of hospital beds and ICU beds available after elective surgeries resume.

· Testing Regimen: Regions must implement a testing regimen that prioritizes symptomatic persons and individuals who came into contact with a known COVID-positive person, and conducts frequent tests of frontline and essential workers. Regions must maintain an appropriate number of testing sites to accommodate its population and must fully advertise where and how people can get tested. The region must also use the collected data to track and trace the spread of the virus.


MSSNY Proposes “Peer to Peer” Program for Physicians’ Post Traumatic Stress
“The tragic suicide of emergency physician Dr. Lorna Breen is yet one more terrible consequence of the coronavirus pandemic and the leadership of the Medical Society of the State of New York wishes our condolences to her family. We fear that there could be many more physicians and other health care workers who have been on the front lines of treating the unending number of gravely ill patients in New York hospitals who may also be confronting post-traumatic stress and at risk for taking similar action. To assist these physicians, MSSNY has proposed to create a “Peer to Peer” program similar to programs for veterans and police officers to help these physicians in coping with their post-traumatic stress.

However, many physicians in need of this help will not feel comfortable in sharing their experiences unless they know that what they share will be kept strictly in confidence. To that end, MSSNY is working with the New York State Department of Health to approve the parameters of this proposed peer to peer program including ensuring that physician peers providing this greatly needed assistance will not be required to divulge any element of these conversations to any person or governmental body.”

Statement Attributable to:
Art Fougner, M.D.
President, Medical Society of the State of New York
April 28, 2020


NYS DOH Update for Physicians Thursday, April 30 at 1PM
Please join the NYS Department of Health Thursday, April 30th at 1:00 PM – 2:00 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, our webinar will be streaming via YouTube Live

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


HHS Posted FAQs re Second Tranche of Disbursement of CARES Act
The Department of Health and Human Services (HHS) has posted new Frequently Asked Questions regarding the second tranche of disbursement of the CARES Act Provider Relief Fund.  Please note there is conflicting information about whether a provider who has not previously received money from the first round of funding can apply for this round. The AMA is trying to clarify this and other questions with HHS.


People Most Comfortable Sharing Info for COVID-19 Research with Doctors
A new survey from PwC finds a majority of people are most comfortable sharing their health information with doctors so the data could be used to help Covid-19 efforts. Here is more from the survey, which looked at consumer behavior as a result of Covid-19:

  • Sharing data: 59% are very willing to share data with doctors, compared to 31% who say the same for university research centers. Almost a third of people say they are unwilling to share information with pharma or other biomedical companies.
  • Health information: Nearly 60% of respondents reported getting information about the pandemic from a local or national news source, while about a quarter said they got it from social media or other internet source.
  • Telehealth: Around 5% of those surveyed they used telemedicine services for the first time. This was especially true for patients with chronic illnesses, 37% of whom reported doing so. (STAT Morning Rounds, 4/28)

WSJ: Pathologists Search for Answers
“Medical researchers are doing detective work to see if the novel coronavirus was in New York before March , undertaking studies of flu swabs and deaths that could challenge the official timeline of the infection’s arrival in the state. Pathologists at Manhattan’s Weill Cornell Medicine are looking at the remains of roughly 20 bodies that were permitted to be autopsied.

These patients died at the hospital in February and March, and researchers are trying to determine whether one of those deaths may have been due to Covid-19, the disease caused by the new coronavirus, said Alain Borczuk, vice chairman and director of anatomic pathology. One case prompted researchers to seek additional testing from the U.S. Centers for Disease Control and Prevention.” (WSJ, April 28)


One in Four in NYC Has Been Exposed to COVID-19
The state released expanded results of its antibody testing study Monday, showing about 1 in 4 New York City residents has been exposed to Covid-19.

New York has now tested 7,500 people for the presence of antibodies that can fight Covid-19, but Gov. Andrew Cuomo sounded a note of caution about whether the state would use the data as it looks to allow businesses to open in certain areas.

Statewide, 14.9% of people tested positive for antibodies, with a 24.7% positive rate in the city, 14.4% on Long Island, 15.1% in Westchester and Rockland counties, and 3.2% elsewhere.

“The antibody does something else for us,” Cuomo said. “One … it tells you [the infection rate] with a two-week lag. Two, it tells you who can donate convalescent plasma.”


Physician Advocacy Orgs Object to Suspension of Medicare Advance Payment
As reported in Med Page today, the AMA and other national physician societies joined MSSNY in expressing strong concerns with the decision of the Center for Medicare & Medicaid Services to suspend its program to give physicians and hospitals advance Medicare payments to help them keep their practices open in the wake of COVID-19, suggesting that the program is no longer necessary.

The program had provided nearly $500 million in advance payments to New York Part B providers including physicians, and $8.3 billion to Part B providers across the country overall.  It also distributed over $90 billion to Part A providers.

According to a press release issued Sunday, “The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs and in light of the $175 billion recently appropriated for healthcare provider relief payments,”

In a fact sheet update accompanying the announcement, CMS explained that “beginning on April 26, 2020, CMS will not be accepting any new applications for the Advance Payment Program, and CMS will be reevaluating all pending and new applications for Accelerated Payments in light of historical direct payments made available through HHS’s Provider Relief Fund. Significant additional funding will continue to be available to hospitals and other healthcare providers through other programs.” The agency noted that the Department of Health and Human Services has already given $30 billion to providers through the CARES Act Provider Relief Fund.

While MSSNY, the AMA and other physician groups had previously taken issue with some of the terms of the Advance Payment program, the program was urged to be continued under more favorable terms.  AMA President Dr. Patrice Harris stated: “Physician practices across the country are struggling to keep their doors open.  Advanced payments offer an important lifeline for cash-strapped practices to weather these financially challenging times, and they are always repaid, which distinguishes them from the programs Congress replenished last week.”

MSSNY is urging the New York Congressional delegation to continue the program in the next stimulus bill to be taken up by Congress.


MSSNY: Community Docs Should Be Part of Testing Efforts
The Medical Society of the State of New York applauded Gov. Andrew Cuomo’s efforts to increase Covid-19 testing but said community physicians should be at the forefront.

The group expressed concern over a new executive order to allow pharmacies to become collection sites for tests.

“In particular, we are concerned that there has not been any specification for how such test results will be shared with the patient’s primary physician or physicians to help explain to the patient what the results mean … as well as what the patient should do,” said Dr. Art Fougner, president of the medical society, in a statement.

The group also questioned the lack of effort to involve community physicians in any statewide testing program and to help them obtain the supplies and personal protective equipment needed to provide Covid-19 tests.

“Not only are community physicians an integral part of New York’s health care system, but many of them have been—unaware to many—working tirelessly to keep the surge of patients from becoming a tsunami, which would have overwhelmed our hospitals,” Fougner said.

People place trust in community physicians, he said, adding that the medical society is urging Cuomo to enlist them to fully expand the state’s testing capacity, which is critical to reopening businesses.


CDC: Adds Six Symptoms; Young Patients Dying from Strokes; 8 Updates
COVID-19 cases in the U.S. are soon expected to surpass 1 million, with 965,951 cases and 54,877 deaths reported as of 10 a.m. CDT April 27. Worldwide, 2,990,559 COVID-19 cases and 207,446 deaths have been confirmed, while 875,497 patients have recovered.

Eight updates:

  1. The CDC added six new potential COVID-19 symptoms to its initial three. Originally only listing fever, cough and shortness of breath as virus symptoms, the agency has now added chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell.
  2. “Social distancing will be with us through the summer,” said Deborah Birx, MD, response coordinator for the White House coronavirus task force. On April 26, Dr. Birx told NBC‘s “Meet the Press” social distancing measures will continue to be used in an effort to protect everyone as areas of the U.S. move through the phased reopening.
  3. Young and middle-aged COVID-19 patients with mild symptoms are dying from strokesThe Washington Post reports. Researchers with Philadelphia-based Thomas Jefferson University Hospitals, New York City-based NYU Langone, and New York City-based Mount Sinai Beth Israel Hospital are all intending to publish data regarding COVID-19 patients in their 30s to 40s suffering strokes. Though there are only a few dozen cases per location, the data suggests COVID-19 patients are mostly experiencing large vessel occlusions — the deadliest kind of stroke — which can destroy parts of the brain responsible for movement, speech and decision-making.

Many researchers believe the strokes may be a direct consequence of COVID-19 related blood clots, while others wonder whether they are seeing more young patients because they are more resistant to respiratory problems caused by COVID-19.

The virus appears to result in mild illness for the majority of young adults. However, COVID-19 stroke patients at New York City-based Mount Sinai were an average of 15 years younger than stroke patients without COVID-19, according to J. Mocco, MD, neurosurgeon and researcher.

“These are people among the least likely statistically to have a stroke,” Dr. Mocco told the Post, adding that the link between COVID-19 and stroke “is one of the clearest and most profound correlations I’ve come across.”

  1. The WHO is leading a global initiative to develop new drugs, tests and vaccines for COVID-19, reports STAT. Called the Access to COVID-19 Tools Accelerator, its goal is to ensure low-income countries receive equal access to these medical products. Participating countries and organizations are encouraged to start pledging funds May 4, with the goal of raising $8 billion in initial funding. Nine countries have joined the effort, along with philanthropic organizations like the Wellcome Trust and the Bill and Melinda Gates Foundation. The U.S. has not yet joined the initiative.
  2. There is no evidence that people who’ve recovered from COVID-19 are protected from a second infection, the World Health Organization said in an April 24 guidance on “immunity passports.” Many countries are considering giving these passports to people who have already gotten the virus, allowing them to return to work or other activities. This proposal relies on the assumption that previously infected individuals will be protected by antibodies. However, the WHO said not enough evidence exists to warrant the passports’ use, as it is unknown how much protection COVID-19 antibodies offer and for how long.
  3. New York Gov. Andrew Cuomo outlined on April 26 a phased reopening plan for the state. New York will follow CDC’s recommendation to only reopen once state and regional hospitalization rates fall for two consecutive weeks. The first phase of the plan will reopen construction and manufacturing work. Mr. Cuomo did not share a specific timeline for this reopening, but suggested that some parts of upstate New York could begin to reopen as early as May 15, when his executive order requiring all nonessential workers to stay home ends, according to NBC New York.
  4. Wuhan doesn’t have any more hospitalized COVID-19 patients, Chinese officials said April 26, according to Business Insider.Wuhan, the pandemic’s origin site, has recorded about 46,000 COVID-19 cases since December, or about half of all cases in China. As of April 25, Wuhan had just 12 COVID-19 cases and no new infections. The city ended its lockdown April 8, although some restrictions are still in place and schools remained closed.
  5. The second wave of stimulus payments is set to go out this week, directed at those who recently provided direct-deposit information, the Wall Street Journal reports. Checks are also being sent to people who do not file tax returns but receive Social Security or disability benefits. As of April 17, the IRS has distributed $158 billion of the program’s total $292 billion. It may take months for individuals without direct-deposit information to receive their check, with the government’s check-printing capacity capped at about 5 million a week. (Becker’s Hospital Review, April 27)

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