COVID-19 Update May 13, 2020
Notes from Governor Cuomo’s COVID-19 Briefing
– Hospitalizations and intubations are down
– New COVID Cases is 416 as of yesterday, up from 401 May 11
– 166 deaths (122 in hospitals, 44 in nursing homes)
– “We’re just about where we are when we started this painful situation.”
Testing for Essential Workers:
– Antibody Test Results for essential workers are testing positive at lower rates
than other groups
– Downstate transit workers 14.2%
– Downstate healthcare workers 12.2%
– NYC General Population tested positive at 19.9%
– Elective surgeries to continue in 12 more counties
– Albany, Cayuga, Chemung, Columbia, Clinton, Cortland, Montgomery,
Orange, Otsego, Rensselaer, Schenectady, Warren
– Finger Lakes, Mohawk Valley, North County, and Southern Tier meet metrics
– The governor reiterated Dr. Fauci’s warning about reopening too soon
– Calibrate/control by monitoring diagnostic testing, antibody testing,
hospitalizations rate and capacity, infection rate
Children and COVID-19:
– DOH is investigating 102 cases of what may be rare COVID- related illness in
children with symptoms similar to Kawasaki disease or toxic shock like syndrome
– Illness has taken lives of 5-year-old boy, 7-year-old boy, and an 18-year-old girl
– 60% of children with symptoms tested positive for COVID-19 and 40% tested
positive for the antibodies (14% positive for both). 71% of cases end up in ICU.
– 14 other states (California, Connecticut, Delaware, Georgia, Illinois, Kentucky,
Louisiana, Massachusetts, Mississippi, New Jersey, Ohio, Pennsylvania, Utah,
Washington) Washington D.C, and Spain, France, England, Italy, and Switzerland
have reported cases as well
– Hospitals have been directed by DOH to prioritize COVID-19 testing for children
– No corporate giveaways for layoffs
– Gov. Washington Op-Ed: “Make sure subsidies are tied to worker protections.”
– Americans First Law: No corporate bailout if workers will be laid off
– Will be introduced by congressional delegation
– According to DeRosa, testing parameters came from Dr. Burke and the White
House task force and these parameters provide confidence in North Country
to have enough testing capacity to reopen
Gov.: 12 More Counties Now Eligible to Resume Elective Surgeries
Ambulatory Surgical Centers in These 47 Counties Will Also Be Able to Resume Elective Surgeries
Amid the ongoing COVID-19 pandemic, Governor Andrew M. Cuomo today announced 12 more counties are now eligible to resume elective surgeries. The Governor previously announced that the state will allow elective outpatient treatments to resume in counties and hospitals without significant risk of COVID-19 surge in the near term, and a total of 47 counties can now resume elective surgeries:
Ambulatory surgical centers in these 47 counties will also be able to resume elective surgeries. Additionally, the State Department of Health clarified that these centers may continue providing certain diagnostic or screening procedures such as for cancer. Empire State Development Corporation also clarified that doctors’ visits continue to be permitted and remain open as essential businesses.
MSSNY Thanks Gov: Ambulatory Surgery Center Can Resume Elective Surgery
“We thank Governor Cuomo and the New York State Health Department for designating Ambulatory Surgery Centers as an additional clinical location that can resume performing elective surgery for patients in the 47 counties in which such surgeries are permitted. We also appreciate the reminder to the public that physician offices have and remain open to deliver needed patient care.
We of course still have much to do to continue to confront the Covid-19 pandemic and to work together to protect against a second surge of infections, but this action today will assist countless patients across New York State to receive urgently needed treatment that had been delayed to help prioritize health care resources towards those most immediately in need.
We look forward to continuing to work with the Governor and the NYS DOH on taking those steps which will enable the rest of New York’s health care system to more fully resume providing needed patient care.”
MSSNY Pres. Submits Testimony on Impact of COVID19 Crisis on NY Practices
May 13, 2020, Westbury, NY— Dr. Bonnie Litvack, MD, a Westchester radiologist and President of the Medical Society of the State of New York (MSSNY), today submitted testimony to the Joint Legislative Committee Hearing on Small Businesses, describing the impact of the COVID19 crisis on physician practices delivering patient care across the state of New York.
“Like many small businesses across the state, New York physicians have faced devastating consequences for their practices as a result of the coronavirus outbreak,” said Dr. Litvack. “Our first priority is, of course, to ensure that our patients, through the crisis and after, can continue to receive the care they need. However, physicians need to be assured that our practices can keep our doors open for patients now and in the future.”
To learn details about the impact, MSSNY conducted two surveys of its membership over the last month. Key takeaways from MSSNY’s most recent survey include:
- 79% have seen a reduction of more than 50% in the volume of patients visiting their practices.
- Nearly 3/4 had a greater than 50% drop in practice revenue.
- More than a quarter had to lay off or furlough more than 50% of their staff, and 40% had to lay off or furlough at least 25% of their staff.
However, the bad news from the second survey was mixed with some modestly positive news that more physicians have received a small business Paycheck Protection Program loan. The CARES Act has provided some funding to help make up for some of the enormous deficits suffered by physician practices. However, it is not nearly enough to ensure the survival of many physician practices across the state.
Dr. Litvack’s testimony provided recommendations for how Congress and the New York State legislature can support physicians going forward including “advance” payments by commercial insurers to physicians and requiring health insurers to make bonus payments to their network physicians to account for the costs associated with additional Personal Protective Equipment (PPE) and the mark-up in price, that will be essential as practices begin to open up.
MSSNY also continues to work with the New York Congressional delegation to press for needed additional funding in future stimulus packages to help further offset the devastation to these practices. Physicians also need assurance that existing funding streams in previous stimulus packages will continue to be made available to community physicians so they may continue to provide patient care.
MSSNY will continue to urge the necessity of additional funding to New York State to prevent potentially devastating cuts.
“New York’s health care system, including physicians, shouldn’t have to face financial ruin, while working around the clock to save lives,” said Litvack. “New York has shouldered the brunt of this crisis and we desperately need fiscal attention.”
CDC Guidance More Restrictive Than White House’s Plan
Advice from the top U.S. disease control experts on how to safely reopen businesses and institutions during the coronavirus pandemic was more detailed and restrictive than the plan released by the White House last month.
The guidance, which was shelved by Trump administration officials, also offered recommendations to help communities decide when to shut facilities down again during future flareups of COVID-19.
The Associated Press obtained a 63-page document that is more detailed than other, previously reported segments of the shelved guidance from the U.S. Centers for Disease Control and Prevention. It shows how the thinking of the CDC infection control experts differs from those in the White House managing the pandemic response.
The White House’s “Opening Up America Again” plan that was released April 17 included some of the CDC’s approach, but made clear that the onus for reopening decisions was solely on state governors and local officials.
By contrast, the organizational tool created by the CDC advocates for a coordinated national response to give community leaders step-by-step instructions to “help Americans re-enter civic life,” with the idea that there would be resurgences of the virus and lots of customization needed. The White House said last week that the document was a draft and not ready for release.
It contains the kinds of specifics that officials need to make informed decisions, some experts said.
From the start, CDC staffers working on the guidance were uncomfortable tying it specifically to reopening, and voiced their objections to the White House officials tasked with approving the guidance for release, according to a CDC official granted anonymity because they were not cleared to speak with the press.
The CDC’s detailed guidance was eventually shelved by the administration April 30, according to internal government emails and CDC sources who were granted anonymity because they were not cleared to speak to the press. After the AP reported about the burying of the guidance last week, the White House asked the CDC to revive parts of it, which were sent back for approval, according to emails and interviews.
On Tuesday, CDC Director Robert Redfield testified before a U.S. Senate committee that the recommendations would be released “soon.” He provided no further details.
The shelved CDC guide advises communities to avoid all nonessential travel in phases of reopening until the last one, when cases are at the lowest levels. Even then, the CDC is cautious and advises only a “consideration” of the resumption of nonessential travel after 42 continuous days of declining cases of COVID-19.
The White House plan, by contrast, recommends that communities “minimize” travel in Phase 1, and that in Phase 2, after 28 consecutive days of decline, “Non-essential travel can resume.”
As of Tuesday, CDC’s web page on travel guidance during the pandemic still linked to the White House plan. The stricter guidance is not there.
Another stark difference in the final White House plan and that designed by epidemiologists at the CDC is the latter’s acknowledgment that COVID-19 cases will likely surge after states reopen, and that local governments need to continuously monitor their communities closely.
(Modern Healthcare, May 13)
Registration Now Open Mental Health and COVID-19 for Health Professionals May 20, 2020 @ 7:30am Medical Matters CME Webinar
As health professionals, we are at great psychological risk simply by virtue of our “exposure” to the reality of COVID-19. Registration is now open for MSSNY’s next Medical Matters webinar related to the COVID-19 pandemic, Medical Matters: Mental Health and COVID-19 for Health Professionals. Faculty for this program is Craig Katz, MD.
- Better understand the mental health risks posed by COVID-19 for physicians
- Review the possible range of psychological and psychiatric responses to the pandemic
- Discuss principles and interventions for helping ourselves, our families, and our colleagues
To view MSSNY’s other COVID-19 related programs, be sure to go here and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020, Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020 and Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge and Psychological First Aid recorded on April 29, 2020. You can also listen to MSSNY’s podcasts related to COVID-19 by going here.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at email@example.com.
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
25 Hospitals Getting Biggest Slice of $12B Federal Bailout Fund
HHS has released new details on the latest payments to hospitals from the $175 billion in relief aid Congress allocated to cover expenses or lost revenues tied to the COVID-19 pandemic.
The first $50 billion in funding from the Coronavirus Aid, Relief and Economic Security Act was delivered to hospitals in April. HHS distributed $30 billion based on Medicare fee-for-service reimbursements and another $20 billion based on hospitals’ share of net patient revenue.
HHS announced May 1 that it is sending $12 billion to 395 hospitals that provided inpatient care for 100 or more COVID-19 patients through April 10. The agency said those hospitals accounted for 71 percent of COVID-19 inpatient admissions reported to HHS from 6,000 hospitals across the U.S.
HHS released new data May 8, sharing where the $12 billion in funding went. Below are the 25 hospitals that received the most funding.
- Long Island Jewish Medical Center (New Hyde Park, N.Y.): $277.7 million
- Holy Name Medical Center (Teaneck, N.J.): $213.4 million
- Tisch Hospital (New York City): $203.2 million
- Montefiore Hospital-Moses Campus (New York City): $156.7 million
- Columbia University Irving Medical Center (New York City): $152.7 million
- NewYork-Presbyterian Queens (New York City): $143.3 million
- Mount Sinai Medical Center (New York City): $140.8 million
- Sandra Atlas Bass Heart Hospital (Manhasset, N.Y.): $137.5 million
- Maimonides Medical Center (New York City): $131.5 million
- Weill Cornell Medical Center (New York City): $118.6 million
- New York City Health + Hospitals/Elmhurst: $111.3 million
- NYU Winthrop Hospital (Mineola, N.Y.): $108 million
- Hackensack (N.J.) University Medical Center: $98.1 million
- BronxCare Hospital Center-Fulton Campus (New York City): $91.5 million
- Staten Island University Hospital-South Campus (New York City): $91.4 million
- Ochsner Medical Center-West Bank Campus (Gretna, La.): $91.3 million
- Montefiore Hospital-Einstein Campus (New York City): $89.2 million
- St. Joseph’s University Medical Center (Paterson, N.J.): $88.2 million
- NewYork-Presbyterian Brooklyn Methodist Hospital (New York City): $87 million
- New York City Health + Hospitals/Bellevue: $86.7 million
- Stony Brook University Hospital (New York City): $83.3 million
- New York City Health + Hospitals/Kings County: $78.9 million
- New York-Presbyterian Allen Hospital (New York City): $76.9 million
- New York City Health + Hospitals/Lincoln: $76.1 million
- Jamaica Hospital Medical Center (New York City): $75.9 million
(Becker’s Hospital CFO Report. May 11)
Long Island CEOs Take Pay Cuts to Businesses Going
Dr. Raj Raina, president, CEO, and owner of Medical Associates, based in Hauppauge, has been taking care of patients — and his practice.
A primary care doctor who runs the six-site, multispecialty practice, he has kept Medical Associates’ doctors, nurses, and staff busy treating COVID-19 patients as he puts his own pay on pause. And he is not alone among doctors in private practice on Long Island who are making sacrifices to keep their doors open. “I personally have not taken a paycheck for the last couple of paychecks; I’m living off my savings,” Dr. Raina says, noting that his wife, a nurse, is receiving a paycheck for helping to run the COVID-19 test center at Jones Beach State Park. “Once they opened in Jones Beach, she was one of the first to be there. She’s a coleader there, scheduling patients.”
While healthcare providers and hospitals are on the front lines of the COVID-19 crisis, physicians without the resources of hospitals are facing financial and medical challenges, sometimes making financial sacrifices. “We’re living right now on income we produced in the past, hoping the government gives us some help,” Dr. Raina says, saying that his 79-person practice didn’t get help from the first tranche of funds. “It’s very hard in our industry to train people.”
Many physician practices face financial troubles, according to a survey by the Medical Society of the State of New York (MSSNY). The society says 83 percent of respondents saw patient volume drop by more than half, while 80 percent’s revenue fell by at least half since the COVID-19 outbreak. More than a quarter had to lay off or furlough more than half of their employees and about two thirds applied for forgivable loans, but most hadn’t received help before the first round of funding closed.“
Other healthcare providers, also considered essential, are taking steps to keep producing, as CEOs reduce or suspend their compensation or pay employees who are unable to work.
The federal government, meanwhile, made it easier for physicians to do virtual visits, increasing patient and provider safety, but Raina said that typically leads to $50 reimbursements.
“We’re mostly getting patients who have COVID-19 infection,” Dr. Raina says, adding that most are virtual visits. “Our revenue came mostly from stress tests, echocardiograms, and allergy tests.” Dr. Raina is still getting funds from previous work since insurer payments typically lag two months behind.
“I don’t want to lose employees,” Dr. Raina says. “They know what they’re doing. I would not want to start again. I’ve tried to keep everyone going. If I go through this year without a loss, I will think it is a good thing for me. I’m not sure that’s going to happen, though.” Note: Dr. Raina is a MSSNY member. (LI Press May 11)
COVID-19: Risk Calculator / Choir Practice Super-Spreading Event
See some of the latest news on novel coronavirus disease (COVID-19):
Risk calculator: Researchers have developed a web-based risk calculator to estimate the probability that a COVID-19 patient will develop critical illness, defined as intensive care unit admission, invasive ventilation, or death. Reporting in JAMA Internal Medicine, the researchers examined the hospital records of nearly 1600 patients in China and assessed 72 potential risk factors. They found that the following 10 variables at admission were associated with increased risk for critical illness: chest radiographic abnormality, age, hemoptysis, dyspnea, unconsciousness, number of comorbidities, cancer history, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and direct bilirubin. (Try the calculator at the second link below.)
Choir practice: Roughly 87% of 60 members of a Washington State choir became ill with confirmed or probable COVID-19 following a 2.5-hour practice that was also attended by a symptomatic person, according to an MMWR study. Two attendees died. The authors say that the act of singing may have contributed to viral transmission.