COVID-19 Update May 6, 2020

Colleagues:

It was the best of times.
It was the worst of times.
And then came Coronavirus.

The year began great. My issue as an OB-GYN is Maternal Mortality. Not long after my inauguration, the legislature passed the law enabling Confidential Maternal Mortality Reviews. I should have quit then.

The rest of year, I sallied forth on such issues as Vaping, Medicaid Redesign (Part Deux), the NY Health Act, the Budget with its OPMC expansion, and, of all things, Measles and Vaccinations.

Nothing, however, prepared me for the Coronavirus Pandemic. Clearly, no one was prepared for the virus which has decimated NY State, both physically and emotionally. My family too suffered a terrible loss. We will all be picking up the pieces for quite some time.

A year goes by very quickly, indeed. Some goals I could not achieve.  I fancied myself a resource for physicians in need. Yet, when PPE supplies ran out, I was sadly unable to assist those doctors who called for help. I tried to break down silos. I might have made a few dents, but my successors will have to finish that job. I just ran out of time.

Dr. Bonnie Litvack, Madame President, now you have the gavel. I know for a fact that our Medical Society of the State of New York is in capable hands. Know that you will always have my support.

So, to my colleagues and to all the MSSNY staff, thank you so very much for all your help.

NY is blessed with so many wonderful physicians, many of whom I am fortunate to call friends.

It has been a privilege.

I leave you now with the inimitable Roy Rogers and Dale Evans

Art Fougner, MD
MSSNY President


INTERIM GUIDANCE FOR REOPENING THE HEALTH CARE SYSTEM & BEST PRACTICES FOR REOPENING FROM COVID-19 AT WWW.MSSNY.ORG


Tomorrow @ 1 P.M. DOH COVID-19 Update
Please join the NYS Department of Health Thursday, May 7th 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:

https://coronavirus.health.ny.gov/weekly-healthcare-provider-update

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


COVID-19 Map – Johns Hopkins Coronavirus Resource Center


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MSSNY Press Release

 Thanks Rep. Carolyn Maloney for Leadership on Legislation to Provide Loan Forgiveness to Frontline Medical Professionals

May 6, 2020, Westbury, NY—MSSNY applauds Representative Carolyn Maloney (D- Manhattan) for introducing legislation (H.R. 6720) that would forgive private, and federal, student loans taken out by physicians, medical residents and a range of other healthcare professionals, caring for COVID-19 patients. The bill also includes researchers working to find a cure and vaccine for the disease. Representative Maloney modeled her proposal after the September 11th Victim Compensation Fund.

“New York physicians have been on the frontlines since the beginning of the COVID-19 crisis, risking their lives to save as many victims of the virus as possible,” said Dr. Art Fougner, President of MSSNY. We are grateful to Rep. Maloney for her leadership in advancing this important bill, as it is a critical step in thanking frontline medical professionals for their service during this unprecedented time.  We urge the US Congress to incorporate these ideas into its next stimulus package that is currently under development.

The bill establishes a commission to work with the Education and Treasury Departments to review applications from borrowers and to determine which frontline applicants are eligible for loan forgiveness.

New York State is the hardest hit in the country with 319,000 confirmed cases and 19,415 deaths, to date


Data from NY State Antibody Study and DOH Fatality Tracker

AGE GROUP MORTALITY RATE MORTALITY RATE
18-24 0.046% 1 out of every 2,163
25-34 0.058% 1 out of every 1,729
35-44 0.181% 1 out of every 552
45-54 0.424% 1 out of every 236
55-64 1.020% 1 out of every 98
65-74 2.236% 1 out of every 45
75+ 4.430% 1 out of every 23

*89.2% of fatalities have at least 1 comorbidity


Advance Payments Boon to NY Physicians
As physicians struggle to stay afloat during the Covid-19 crisis, advance payments from insurers will help.

MSSNY, on Tuesday, applauded Empire BlueCross BlueShield for advancing payments to certain independent primary care physician organizations and multi-specialty groups that include primary care. MSSNY noted that means much needed money to hundreds of groups across the country, beginning this month.

“With physicians reporting dramatic drops in patient visits and revenue in our collective response to the Covid-19 pandemic, we thank Empire Blue Cross for implementing a program to help its network physicians with an advance payment program,” said Dr. Art Fougner, president of MSSNY, in a statement. “It will provide a lifeline to these practices until regular patient visits can resume.”

MSSNY noted that UnitedHealth and CDPHP have also adopted advanced payment programs during the crisis. Fougner urged other insurers to do the same.

Last month, MSSNY reported devastating findings from a physician survey. Some 80% of survey respondents said they had suffered a loss of revenue of more than 50% since the Covid-19 outbreak began. And 83% reported they had experienced a reduction of more than 50% in the volume of patients visiting their practices.

More than a quarter of respondents said they had to lay off or furlough more than half their staff. And the majority had applied for forgivable loans through the Small Business Administration.

“As independent primary care providers play a critical role in our communities, Empire is making advanced payments to certain independent primary care and multi-specialty

organizations that are especially vulnerable financially, as a result of this pandemic,” the insurer said in a statement provided to Crain’s. — Crain’s Health Pulse May 6.


NY Hospitals Get $5B as Feds Target COVID-19 Hot Spots
New York hospitals will get $5 billion from the U.S. Department of Health and Human Services as part of a $12 billion plan to distribute money to COVID-19 hot spots.

The funding will be distributed to 90 hospitals in the state, with New York City facilities receiving $509 million.

The money was designated for facilities with at least 100 COVID-19 patients as of April 10, with a fixed amount given per inpatient admission. Within the fund, $2 billion was set aside for hospitals that treat a greater share of Medicare, Medicaid, and uninsured patients.

The 395 U.S. hospitals given funding accounted for 71% of COVID-19 inpatient admissions, according to HHS. The federal agency said Friday that payments would be made to hospitals within days.

The distribution follows a round of funding that frustrated New York hospitals because it did not account for the areas that have treated the most Covid-19 patients, as well as facilities with high numbers of Medicaid and Medicare Advantage patients. HHS previously distributed $30 billion of the $175 billion allocated for health care providers in the Coronavirus Aid, Relief and Economic Security Act, based on the percentage of Medicare revenue each provider represented. HHS did not announce how much individual hospitals would receive. Crain’s NY Business May 5.


NYC Health and Hospitals Raised $20 Million to Help Healthcare Workers
New York City Health and Hospitals said Friday that it has raised more than $20 million to assist health care workers on the front lines of the Covid-19 crisis. That includes $12.7 million in new funds from nearly a dozen donors.

Goldman Sachs contributed $500,000; BNP Paribas, $400,000; and Advent International, $300,000. The money is being used to purchase scrubs, meals, transportation and hotel rooms for frontline workers, the health system said.

Relief funds also will support an existing Health and Hospitals program that has ramped up in response to the crisis: Helping Healers Heal. The program includes trained peer-to-peer teams of health care.


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Gov. Cuomo: What Businesses Require to Reopen
To open, a business would have to have new safety precautions

  • Adjust workplace hours and shift design as necessary to reduce density in the workplace;
  • Enact social distancing protocols;
  • Restrict non-essential travel for employees;
  • Require all employees and customers to wear masks if in frequent contact with others;
  • Implement strict cleaning and sanitation standards;
  • Enact a continuous health screening process for individuals to enter the workplace;
  • Continue tracing, tracking, and reporting of cases; and
  • Develop liability processes.

The seven criteria to reopening a region

Seven Criteria Chart


These seven criteria will need to be met before each region can reopen.
Here is where they stood on May 4, 2020.
(Photo: Joseph Spector, USA TODAY Network New York)
 

Hospitalization decline

A region has to have at least 14 days of decline in total net hospitalizations or under 15 new hospitalizations in a three-day average.

Decline in hospital deaths

An area would have to show a 14-day decline in hospital deaths or fewer than five deaths over a three-day average.

New hospitalizations

New cases in a hospital would have to stay under 2 people per 100,000 residents, based again on a three-day average.

Total beds available

To be prepared for a potential surge in cases due to reopening, the state’s criteria would require a region’s hospitals to have at least 30% total hospital beds available.

ICU needs

The same 30% threshold of open beds would be needed in intensive care units.

Having enough PPE

A region would also need to have at least 90 days of personal protective equipment stockpiled to ensure enough to give out if cases rises.

Diagnostic Testing Capacity

Each region must have the capacity to conduct 30 diagnostic tests for every 1,000 residents per month.

The state is expanding its ability to add contact tracers to better hunt down where the virus is spreading.


New-Dominant Strain of Coronavirus Appears More Contagious Than Original
A newer strain of the novel coronavirus appears to be even more contagious than the original, according to a study published April 30 on bioRxiv.

Scientists at Santa Fe, N.M.-based Los Alamos Research Laboratory analyzed data from real-time mutation tracking of SARS-CoV-2, the virus that can cause COVID-19. Fourteen different mutations of SARS-CoV-2 spike proteins were identified, with the mutation Spike D614G of “urgent concern,” the researchers wrote. The strain emerged in February in Europe, and by mid-March had spread worldwide, according to the study.

The new strain spreads faster and may make people more vulnerable to reinfection, the study authors wrote.

The study has not yet been peer-reviewed.

(Becker’s Hospital Review, May 6)


Data Suggests Most New Covid-19 Hospitalizations Involve People Staying Home
Gov. Andrew Cuomo is urging New Yorkers to comply with face mask, hand-washing and social distancing orders after early data on new COVID-19 hospitalizations suggests the bulk of those patients have primarily been staying at home.

The governor, who recently required hospitals to report more details on admitted patients, said preliminary findings from 113 hospitals over a three-day period suggest that two-thirds of the 1,200-plus new patients surveyed had been admitted from their homes. By contrast, just 18 percent of new admissions came from people in nursing homes, 2 percent were homeless and less than 1 percent came from jails and prisons.

“Everything is closed down, government has done everything it could, society has done everything it could, now it’s up to you,” he said during a morning news conference today in Manhasset. “Are you wearing a mask? Are you doing the hand sanitizer? … It comes down to personal behavior. This is not a group that we can target with this information, it’s really about personal behavior.”

The preliminary data found that only 17 percent of those being hospitalized for Covid-19 were employed, nearly all — 96 percent — had comorbidities and about three-quarters were aged 51 or older, Cuomo said. Just 4 percent reported using public transportation.

It also suggests that the vast majority of the Covid-19 hospitalizations are occurring downstate, and a disproportionate percentage of the hospitalizations in New York City involve African Americans, Latinos and Asians, he said.

Cuomo has argued that the data on new hospitalizations will allow the state to better target its reopening strategy.

About 600 people were still being admitted to hospitals for treatment of the virus as of Tuesday, down from 900 to 1,000 last week. (Politico Pro, May 5)