COVID-19 Update June 5, 2020

Colleagues:

This week as our nation attempts to heal from a global pandemic that has disrupted the lives of all and taken the lives of many, recent events around the country and in our own state have forced us to confront other intolerable, insidious evils in our society–the longstanding pandemic of racism and a developing culture of indifference to human suffering.

Our Medical Society believes that all forms of racism and discrimination must be eradicated. We stand in support of the right of individuals to peacefully protest George Floyd’s death and against violence in all forms. George Floyd’s death has left this state and country reeling at a time when people are already feeling stressed, fearful, isolated and lonely due to COVID-19.   The all too familiar tragedy playing out on our streets has again highlighted the need for this country to address the prevalence of endemic racism.

Many members of the law enforcement community across the country and in our state have expressed their outrage for the hateful and unlawful behavior by some in their ranks. However, much more needs to happen to ensure that violence against people of color perpetrated in the name of law and order stops and that the right to peacefully protest is upheld and supported without violence and our citizens are treated universally with dignity and fairness. The responsibility for change falls upon us all. We as a Medical Society stand unified in the call to action that Mr. Floyd’s death has ignited and we will stand with those individuals who are calling for change – change that is an essential component of our very democracy.

Racism and injustice must be condemned.  As physicians, we believe this nation has the ability to finally halt the systematic racism and begin the healing process by listening to the voices of all that are grieving and crying out for justice.

As we move forward, let us do so in a compassionate and loving way for all.

“Now is the time to make real the promises of democracy. Now is the time to rise from the dark and desolate valley of segregation to the sunlit path of racial justice. Now is the time to lift our nation from the quick sands of racial injustice to the solid rock of brotherhood…”

Martin Luther King, Jr

From the “I Have A Dream” speech” delivered August 28, 1963, at the Lincoln Memorial, Washington D.C.

Bonnie Litvack MD
MSSNY President


This Week’s MSSNY Update Podcast


News & Highlights from the Governor’s Daily Briefing
GENERAL:
– Day 97 of COVID-19 pandemic, Day 12 of civil unrest.
– Gov played videos showing police shoving citizens in Buffalo and NYC, with no
threat to the officer shown. Said such actions were “offensive… frightening.”

REFORM:
– Gov proposed “Say Their Name” Reform Agenda in NY, inspired by the history
of black lives lost to police brutality. Four cornerstones:
– Transparency of prior disciplinary records (50-a).
– No chokeholds.
– False race-based 911 reports should be a hate crime.
– AG as independent prosecutor for police murders.
– Argued reforms worked to vindicate the overwhelming majority of good police.
Said the community-police relationship must heal for progress to occur.
– Gov claimed societal change is possible, as seen with the COVID-19 pandemic.

COVID-19:
– Deaths 6/4: 42 (new low, number was 800 just 8 weeks ago).
– Lowest number of hospitalizations to date.

Q&A:

BUFFALO:
– Gov said he was “sick to [his] stomach” after seeing the clip of a man being
shoved by police in Niagara Square and supported Mayor Brown’s decision to
suspend the officers responsible.
– Believes DA should review the incident for criminal charges.

POLICE:
– Argued police officers are aware of being filmed during protests so they are
not attempting to “get away” with anything.
– Gov believes use of body cameras would be helpful.


Congress Enacts Legislation to Provide Physicians Flexibility with PPP Awards
The President has signed into law legislation passed by the US Senate this week to provide greater flexibility over the spending of Paycheck Protection Program (PPP) funds after having been passed by the US House of Representatives last week.  The new law will enable up to 40% of PPP forgivable loan proceeds to be spent on non-payroll costs (instead of the current 25% limitation).

This is particularly important for small businesses including physician offices located in high rent areas such as downstate New York.  The legislation also extends from 8 to 24 weeks the period of time for the proceeds to cover, as well as extend to 5 years the re-payment time period.  MSSNY has been working with the AMA and other physician societies in support of reform and expansion of various stimulus programs, including the PPP.  More information here.


NY Businesses Can Refuse Entry to People Not Wearing a Mask
Gov. Cuomo tweeted May 29, “People don’t have a right to jeopardize other people’s health.” Another tweet from the day before reads, “No Mask – No Entry.”



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Study Shows 76% Of Coronavirus Patients Improve after Plasma Transfusion
Plasma from recovered COVID-19 cases is transfused to critically ill COVID-19 patients, with the hope that the antibodies will help the patient fight or neutralize the disease. Study authors say the treatment method has been used to treat microbial infections for more than 100 years. Other doctors began voicing optimism for the plasma transfusions in COVID-19 patients earlier in the pandemic when some cases improved. The Houston study was published May 26 in The American Journal of Pathology.

The study’s outcomes focused on safety and the potential benefit of transfusing convalescent plasma to patients with severe coronavirus. Noting several other studies that suggest plasma donations are an effective treatment strategy for COVID-19, the Houston reachers wanted to offer more data on initial clinical observations.

“The data indicate that administration of convalescent plasma is a safe treatment option for those with severe COVID-19 disease,” study authors wrote.

A week after transfusion, 36 percent of patients showed clinical improvement. Another seven days later, a total of 76 percent, or 19 patients, improved or were discharged from the hospital.

Study authors described the therapy, which was one transfusion of 300 mL of plasma, as “well-tolerated,” and said that “no transfusion-related adverse events were observed.”


New Reporting COVID-19 Guidelines Require Race and Age Data
New COVID-19 test reporting guidelines require labs to provide additional data such as patients’ race and age HHS said June 4. The newly required information will be used to monitor disease incidence and trends by initiating epidemiologic case investigations, assist with contact tracing, assess availability of testing resources, and anticipate potential supply chain issues, according to the HHS release. “The requirement to include demographic data like race, ethnicity, age, and sex will enable us to ensure that all groups have equitable access to testing, and allow us to accurately determine the burden of infection on vulnerable groups,” said Assistant Secretary for Health Adm. Brett Giroir, MD. (Becker’s Hospital Review, June 5)


N95 Mask Reuse and Failure Rates
A small, cross-sectional study in JAMA reports that duckbill N95 masks had a high rate of fit test failure (71%) among healthcare workers who were using their masks for extended periods. Dome-shaped N95 masks had a 28% failure rate. For the dome-shaped masks, failure was more likely with increasing duration of use. The authors of the research letter write: “Based on these preliminary data, health systems should closely evaluate N95 fit during extended use or reuse and limit duckbill


Sen. Passes Bill to Give Flexibility for Small Business Coronavirus Aid Program
The Senate passed legislation on Wednesday to provide more flexibility for the Paycheck Protection Program (PPP), which provides help for small businesses amid the steep economic impact of the coronavirus.

“Today we’re passing another piece of legislation that makes a few targeted changes to the program,” Senate Majority Leader Mitch McConnell (R-Ky.) announced from the floor. “I’m proud the Senate is sending it on to the president’s desk to become law.”

The bill, which would extend the window for businesses to be able to spend loans granted under the program, passed the Senate by unanimous consent. The bill already passed the House last month, meaning it now goes to President Trump‘s desk.

Under the March $2.2 trillion coronavirus package, businesses were given eight weeks to spend PPP funds. The bill passed by the Senate on Thursday would extend it to 24 weeks.

It would also change a 75-25 divide included in the March bill — which required businesses to spend 75 percent of the loan on payroll and 25 percent on other fixed costs such as rent and utilities — to a 60-40 ratio.

Negotiations on expanding the PPP’s flexibility have been ongoing for weeks after the Senate left town for the Memorial Day recess without being able to pass its own version of the House legislation.

“I’m glad our Republican friends have relented and passed the bill here as we are about to close session for this week. It passed the House. We Democrats have been pushing to get it done for the last three days,” said Senate Minority Leader Charles Schumer (D-N.Y.).

The passage of the bill comes only hours after Democrats tried to pass it earlier Wednesday, but Sen. Ron Johnson (R-Wis.) objected.

Johnson said at the time that he was objecting because language in the bill could be misinterpreted to let businesses apply for the PPP loans through the end of the year instead of through the end of June.

“I reached out to Democrat leaders saying we’re very close. I think we’ll probably be able to pass the House bill with assurances by unanimous consent, just not at this moment,” Johnson said.

Johnson was asking for committee leaders and Senate leadership to sign a “letter of intent” that the PPP not be automatically reauthorized through the end of the year.

“Put that letter in the Congressional Record so that we are certain that we’re not reauthorizing this or authorizing it through Dec. 31, that the authorization does end June 30,” Johnson said.

McConnell on Wednesday evening submitted a letter into the Congressional Record. Spokespeople for McConnell directed a question about the letter to spokesmen for Johnson, who didn’t immediately respond to a request for comment. But Schumer thanked Johnson shortly before the bill passed, saying they had talked on the phone “repeatedly.” This is an improvement that’s much needed and comes at the last minute,” he added, “Eight weeks will expire so soon, and now it’s extended to 24 weeks.” (The Hill, June 3)


Fauci Weighs Pros and Cons of Reopening Schools This Fall Amid COVID-19

The idea of keeping schools closed in the fall because of safety concerns for children might be “a bit of a reach,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. In a phone interview with CNN Wednesday, Fauci noted that children tend to have milder symptoms or even no symptoms when they are infected with COVID-19. (CNN.com International | June 3, 2020)


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Major Study on Hydroxychloroquine Retracted from Lancet
A major study on the effects of hydroxychloroquine on COVID-19 patients was retracted from a leading medical journal Thursday after doctors and scientists raised questions about the validity of the data. The study that was withdrawn had concluded patients taking the anti-malaria drug had a higher risk of death than those who were not taking the medication.

The three authors of the study, led by Mandeep R. Mehra of Harvard Medical School and published in late May, retracted their study from the Lancet because independent peer reviewers could not access the data used for the analysis. The source of the data was Surgisphere Corporation, which told peer reviewers it would not transfer the full dataset used for the study because it would violate client agreements and confidentiality requirements.

“We all entered this collaboration to contribute in good faith and at a time of great need during the COVID-19 pandemic,” the authors wrote in a statement Thursday. “We deeply apologize to you, the editors, and the journal readership for any embarrassment or inconvenience that this may have caused.” The study focused on more than 96,000 hospitalized COVID-19 patients at 671 hospitals on six continents, using hospital records obtained by Surgisphere Corporation, a little-known data company.

The Lancet wrote in a statement that it “takes issues of scientific integrity extremely seriously” and that there are “many outstanding questions about Surgisphere and the data that were allegedly included in this study.” (The Hill 6/4)


AstraZeneca Found Partners to Manufacture/Distribute COVID-19 Vaccine
The drug giant AstraZeneca said Thursday that it has found partners to manufacture and distribute 2 billion doses of the experimental Covid-19 vaccine created by Oxford University, inking a seriesof deals with non-government organizations and another manufacturer.


Support Health Equity Initiatives Through David & Donna Marie Meza Health Equity Fund
The David and Donna Marie Meza Health Equity Fundwas established by Thomas Madejski, MD, and Sandra Madejski to support health equity initiatives through the AMA Foundation. Support from this fund is focused on the AMA’s Center for Health Equity and the Foundation’s Community Health Program. 

Eligible initiatives must demonstrate a commitment to addressing health disparities and promoting health equity in diverse, economically disadvantaged environments. Preference shall be given to initiatives that support health literacy and self-management.

You can make a tax-deductible donation in direct support of this fund using the form here.


Invite to Join Global Physicians Network Foundation from Dr. Malhotra
I wanted to share with you about Global Physicians Network Foundation’s (GPNF) wellness initiative; programs for frontline healthcare workers and communities impacted by COVID-19. GPNF is a community based 501(c)(3) not-for-profit organization.

During the pandemic, GPNF volunteers created and distributed over 700 wellness bags to 20 hospitals in all the five boroughs of NYC.  We especially targeted the residents and fellows working tirelessly in the hardest hit areas.  We were also able to support nurses in several hospitals during ‘Nurses Week’.

The bags and its contents were very much appreciated by all. The feedback was extremely positive, and many commented on how it had boosted their morale and supported their needs.  This was made possible because of the generous contributions of donors, supporters, volunteers, and several companies all coming together.  We have posted some pictures on the instagram@gpnfoundation and the gofundme link.

We are honored that MSSNY shared the media coverage and have attached the link to the recent article on some of the work we have been doing.

Our wellness initiative continues with a targeted series of Wellness discussions and peer support for the frontline physicians, residents, fellows, medical students, and healthcare professionals. We are thrilled to invite MSSNY members and your team to the upcoming complimentary interdisciplinary Wellness Discussion Series.  The first session has been created to provide space for dialogue regarding the tragic and painful current events.  Attached is the flyer which can be forwarded to the members of your team. Please share with your residents, fellows, and students. Here is the link for Registration.

We look forward to your participation in the upcoming programs.  Please do not hesitate to contact me, if you have any questions.

Sandhya Malhotra MD
GPNF Team
718-938-560
www.gpnfoundation.org


Veterans Matters Podcasts
Check out MSSNY’s Veterans Matters podcast series on Veterans’ healthcare topics including PTSD in Returning Veterans, TBI in Returning Veterans, Substance Use in Veterans, Suicide in Veterans, The Special Mental Health Needs of Women Veterans and Military Culture: Everything Physicians Need to Know about Veterans as Patients.

Click here to listen to Part 1 of PTSD in Returning Veterans with Dr. Frank Dowling.

Click here to listen to Part 2 of PTSD in Returning Veterans with Dr. Frank Dowling.

Click here to listen to TBI in Returning Veterans with Dr. David Podwall.

Click here to listen to Substance Use Disorders with Dr. Thomas Madejski.

Click here to listen to Suicide in Veterans podcast with Dr. Jack McIntyre.

Click here to listen to The Special Mental Health Needs of Women Veterans with Dr. Malene Ingram, Colonel, U.S. Army Reserves and Retired Chief Master Sergeant, U.S. Air Force, Marcelle Leis.

Click here to listen to Military Culture: Everything Physicians Need to Know about Veterans as Patients with Retired Lieutenant Colonel, U.S. Army, Lance Allen Wang and Retired Chief Master Sergeant, U.S. Air Force, Marcelle Leis.


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