COVID-19 Update May 14, 2020

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Notes from Governor Cuomo’s COVID-19 Briefing

Data:
– Hospitalizations and intubations are down
– New COVID Cases 420 as of yesterday
– 157 deaths (121 in hospitals, 36 in nursing homes)

Reopening:
– Not a matter of if we reopen, but when and how
– Check the data on a daily basis; Transparency is key
– NYS will post daily dashboard of relevant local information
– Build Back Better in areas of education, telecommuting, telemedicine, public
transit, and public health

Local Government Management:
– Manage compliance among business and individuals for reopening procedures
– React immediately if numbers change

Federal Assistance:
– We still need federal help to fund schools, hospitals, local governments,
police officers, and firefighters
– President Trump expedited $3.9B to the MTA
– Cap on SALT increases federal taxes on NYers by $12B-$15B
– D.C. must not delay, exclude special interests and not provide corporate
bailouts; If corporation accepts federal funds, they should rehire same amount
of workers

Re-Imagine:
– This experience has taught us we need to make medical equipment in the U.S.
– Initial $3M in grants to businesses to mfg. medical  supplies/equipment in NY

Contact Empire State Development to grow or start medical supply business: www.esd.ny.gov

COVID-Related Illness in Children:
– DOH is investigating 110 cases of what may be rare COVID- related illness in
children with symptoms similar to atypical Kawasaki disease
or toxic shock like syndrome
– Illness has taken lives of 5 year-old boy, 7 year-old boy, and 18 year-old girl
– NYS and DOH are leading national effort to understand and combat new syndrome
– So far, 16 other states, Washington D.C., and six European countries have
reported cases
– While this illness is rare, seek care if child has prolonged fever (more
than five days), abdominal pain, diarrhea, vomiting, bloodshot eyes, skin rash
– NYS issued first-in-the-nation criteria to healthcare professionals defining
this syndrome

Q&A
Reopening:
– Business will reopen while abiding by reopening guidelines for particular regions
which will be enforced by local government.
– According to DeRosa, there will be regional control meetings to ensure regions
are adhering to guidelines
– Social acceptability continues to be left up to individuals
– Religious institutions should adhere to guidelines for large gatherings and
remember the situation in New Rochelle
– There is federal legislation pending regarding liability for businesses that
tests positive for COVID
– Regions will be able to open at 12:01 a.m., so Friday can be a day of business


MSSNY President Submits Testimony on the Impact of the COVID19 Crisis on NY Physician 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 Dr. Litvack. “New York has shouldered the brunt of this crisis and we desperately need fiscal attention.”


5,300 Excess Deaths in New York City May Be Tied to Pandemic, CDC Says
Officials have identified 5,293 excess deaths in New York City that may have been caused by COVID-19 but weren’t included in the official death toll, according to the CDC’s Morbidity and Mortality Weekly Report published May 11.

From March 11 to May 2, a total of 32,107 deaths were reported to the New York City Department of Health and Mental Hygiene. Of those deaths, about 24,172 were found to be in excess of the expected seasonal baseline. Of the 24,172 deaths, 57 percent (13,831) were lab-confirmed COVID-19 deaths and 21 percent (5,048) were probable COVID-19 deaths, leaving 22 percent of deaths (5,293) without an identified cause.

The 5,293 excess deaths may be directly or indirectly due to the pandemic. The deaths could include deaths among people with COVID-19 “who did not access diagnostic testing, tested falsely negative, or became infected after testing negative, died outside of a health care setting, or for whom Covid-19 was not suspected by a health care provider as a cause of death,” according to the CDC. Fear related to the virus could also prompt some to delay seeking or obtaining lifesaving care.

Other findings suggest the true number of national cases and deaths is also likely much higher than reported. (May 13 Becker’s Hospital Review)


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Mount Sinai Health System Launches Center for COVID-19 Recovery
New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease.

The Center for Post-COVID Care, opened May 13, will help patients hospitalized for COVID-19 transition from the hospital to their homes. The center is also open to patients who were never hospitalized but need help during their recovery.

At the center, patients will be offered a personalized treatment plan that will include input from several specialties, including primary care, pulmonary medicine, cardiology, infectious disease and physiatry, as well as social workers and pharmacists. The center will also focus on evaluating the long-term effects of the disease, which are largely unknown. Mount Sinai will create a COVID-19 registry and collect information on sociodemographics, behaviors, underlying conditions, mental health conditions and medications from patients with the disease.

“This center will provide a unique opportunity to follow this population and systematically evaluate the long-term impact of COVID-19,” said Dennis S. Charney, MD, president for academic affairs at Mount Sinai Health System. (Becker’s Hospital Review, 5/15)


MedPage Today: 4.91% of 763 (86% Physicians) Had/Have COVID-19
Of 763 respondents in a MedPage Today survey — 86% of whom were physicians — 4.91% reported they had or currently have COVID-19. The findings come from an ongoing MedPage Today poll conducted every 2 weeks to monitor challenges U.S. healthcare workers face during the COVID-19 pandemic. The most recent survey took place from April 29 to May 3 and was distributed by email and posted on the MedPage Today site.

COVID-19 continues to waylay healthcare workers, the latest findings revealed. Nationally, 20% of respondents said 1% to 5% of their facility’s healthcare workers were out due to COVID-19 illness or exposure. About one in ten put COVID-19 absenteeism at 6% to 10%, and 6% said the virus sidelined 11% or more of their workforce.

The survey also showed:

  • COVID-19 testing still is severely lacking, but trending toward improvement

The majority of respondents, 56%, still rated their access to COVID-19 testing as     fair or poor, representing an improvement from the 67% fair-to-poor rating of 2 weeks ago. “It is still very difficult. We still predominately test if you are being admitted or, now, if you need an elective surgery or admission to a skilled nursing facility. Outpatient is still chaos,” wrote an infectious disease specialist. “Only admitted patients get tested,” noted a cardiologist in New York City. “The hospital is not routinely testing staff workers who want testing,” another New York physician said.

  • About 70% of hospitals lack access to all COVID-19 treatments, including experimental therapies

Only 31% of respondents said their facility could access all therapies including experimental treatments; the same percentage was reported 2 weeks ago. “I cannot get remdesivir yet. Convalescent plasma limited,” one critical care physician wrote. “Stopped using hydroxychloroquine after data was suggesting harm but we had access to it when it was being given more regularly,” an infectious disease specialist noted. “Gilead drug [remdesivir] or IL-6 inhibitors” were not available, a Chicago anesthesiologist wrote, while an Atlanta critical care doctor reported access to “most treatments, including tocilizumab.” 

  • Personal protective equipment (PPE) continues to be a problem

About half (49%) of respondents said their access to PPE was fair or poor, similar to the 51% who said so 2 weeks ago. “We have PPE, but we need to save and reuse our N95 mask,” an emergency medicine doctor in Cleveland remarked. “No N95 is provided unless you can do a mask exchange to have it cleaned and reused,” a nurse practitioner in West Virginia said. “N95 masks and face shields are available only for COVID-confirmed patients,” a cardiologist in northern California noted. “Everything is locked down,” another physician stated. “In order to see a patient in consultation, you have to ask an administrator for an N95 mask. They are available, but barriers are high.”

Most respondents (86%) in this survey were doctors; 4% were nurses, 4% were nurse practitioners, and 3% were physician assistants. Nearly two-thirds (65%) currently worked in a hospital. Specialties included emergency medicine (6%), critical care/ICU (6%), anesthesiology (6%), cardiology (6%), infectious disease (3%), neurology (2%), and pulmonology (2%), among others.

About a quarter of respondents practiced in New York City (17%) or northern New Jersey (8%). Another 10% worked in Los Angeles, 6% in Chicago, 5% in Boston, 4% in Detroit, and 3% in Miami.

A limitation of this poll is that identities of respondents and their locations, license status, and individual responses were not verified independently. Click here for MedPage Today COVID-19 survey results in more detail. (Updated May 12, 2020)


WHO Official: COVID-19 May Never Be Eradicated
A top World Health Organization official said during a May 12 news briefing. “This virus may become just another endemic virus in our communities, and the virus may never go away,” said Mike Ryan, MD, executive director of WHO’s emergencies program. He said HIV has not gone away, but effective therapies and prevention measures have allowed people with HIV to live long, healthy lives. He clarified that he was not comparing the two diseases but emphasized that COVID-19 could be managed if an effective vaccine was globally distributed. (Becker’s Hospital Review, 5/14)


 

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COVID-19 Map – Johns Hopkins Coronavirus Resource Center