COVID-19 Update May 8, 2020
After literal and figurative March and April showers, we are ready for those May flowers! We have been living in what should be the realm of science fiction. This global pandemic has hit our house of medicine hard physically, emotionally, and financially. My thoughts and prayers are with all of you. I wish those that are sick a speedy recovery and those that have suffered the loss of a loved one my heartfelt sympathy.
During these trying times the ethics, courage, strength, ingenuity, and resilience of the physicians of New York have not waivered nor have the efforts of our medical society. We have spoken out about everything from needed equipment, needed protections both physical and legal to needed funding. We have come together as a profession and rapidly mobilized, disseminated needed information, and helped our practices adapt to the current reality. This has been in no small part due to the strong leadership and tireless efforts on the part of Dr. Art Fougner whose inspiring quotes and stories have been a light in the darkness.
As I humbly take the torch from Art, the seeds of change are beginning to take hold. The talk is of re-imagining healthcare in our state. It is time to change– medical malpractice reform, an end to bureaucratic paperwork and hassles and a time for collective negotiation for physicians. As we start this new decade it is time to end to health disparities and prioritize healthy equity. Let us imagine New York with a new distinction as the healthiest place to live and to practice medicine.
May the roses bloom in our gardens this year! Happy Mother’s Day to all.
Governor Cuomo’s COVID-19 Briefing Notes for Today
-Hospitalizations down to 8,196.
– Intubations down (-330).
– New hospitalizations flat (604), have been flat for a few days.
– IHME Projection model show cases decreasing over time, but still expects a
few hundred in June.
– Deaths since May 7: 216. 171 in hospitals, 45 in nursing homes
– 3 Million Europeans flew into NY from December to March, none were screened
for the virus.
– Reiterated argument that an outbreak in one nation can be assumed to exist
in other regions as well.
UPDATES ON COVID-19:
– There are doubts of immunity despite the existence of antibodies, though
information continues to be updated.
– 73 reported cases of children with symptoms similar to Kawasaki disease.
– On Thursday, a 5-year old boy passed away from COVID-related
complications and other cases are being investigated as well.
– Gov urged parents to seek care if their child has a prolonged fever,
difficulty feeding, severe abdominal pain/diarrhea/vomiting, change in skin
color (pale, patchy, or blue), trouble breathing, chest pain, decreased amount
or frequency of urine, lethargy, irritability, or confusion.
– Infection rate is higher in minorities, affecting Hispanic/Latinos and
African-Americans the most.
– Have asked hospitals to provide information on new cases as a way
to better target state efforts.
– Majority of new cases are coming from minority communities. Gov says
this inequity will be addressed immediately, with new information to be
released in a couple of days.
CHILD VICTIMS ACT:
– Because of reduction in court services, window will be extended an additional
five months (Jan. 14).
– Gov feels we are ahead of the virus and “in control of our own destiny.”
Attributes success to distancing protocols. Again, urged for responsible
reopenings to ensure numbers continue to go down.
– Gov says “nicest surprise” when reopening would be acting responsibly.
Reiterated a focus on factual data to best determine reopening and the actions
to be taken. Doesn’t believe downstate numbers will change enough in the next
few days to reopen.
– Gov wants to avoid any potential deaths from “responding to politics.”
– On a remark that many jobs were lost, Gov, claimed to understand the
struggles many New Yorkers are facing now. “We have to get through,” he said. Gov
reiterated previous statement that health is most important.
– Said we will “figure out” the economics once the situation becomes more
– DeRosa urged applicants to take matters online and only use the phone system
if there is a lack of access to internet. Granted $6.8 billion to 1.6 million
people in the last seven weeks.
– DeRosa reiterated that upgrades to the system were not necessary prior to
the outbreak, as well as the point that NYS has done more than other states to
help the unemployed.
– “Unemployment forfeit” days: DeRosa said this has come to their attention in
the last week and the state is working to fix the issue.
– Antibody testing is used as an indicator of infection rates. No action is
being taken after testing, Gov says data is used for statistical purposes.
– DOH Commissioner Zucker: Working with hospitals to develop tests and confirm quality of tests. Also added that NYS’s antibody test stands six standard deviations out, making it more accurate.
SMALL BUSINESS LOANS FOR PHYSICIANS
In late April, Congress approved an additional $310 billion dollars for the Paycheck Protection forgivable loan Program (PPP) to assist small businesses, including physician practices. To date, the program has approved assistance to nearly 250,000 New York businesses in two different rounds of application periods.
The Congressional package also provided $75 billion more for the CARES Act Health Provider Relief Pool, to assist hospitals and physicians. This is in addition to $30 billion dedicated to physicians and hospitals, in early April, based on 2019 Medicare payments, and $20 billion was just made available to physicians and hospitals based on 2018 total patient revenue.
As with our first survey, MSSNY wants to gather data to determine how much New York physicians are benefiting from these new resources, to better guide our advocacy for further stimulus bills. Please help us evaluate this by taking a few minutes to fill out and submit the following Survey Monkey questionnaire.
HHS Extends Attestation Time Period for CARES Act Relief Pool
The US Department of Health and Human Services (HHS) has extended the deadline for physicians and other healthcare providers to attest to receipt of payments from the CARES Act Provider Relief Fund and accept the Terms and Conditions. Physicians will now have 45 days, increased from 30 days, from the date they receive a payment to attest and accept the Terms and Conditions or return the funds. The AMA gives the example that, the initial 30-day deadline for providers who received payment on April 10, 2020, is extended to May 24 from May 9, 2020. With the extension, not returning the payment within 45 days of receipt of payment will be viewed as acceptance of the Terms and Conditions. For physicians, this is referring to payments from the $30 billion in Round 1 from this fund and $20 billion in Round 2 from this CARES Act relief fund (not the PPP).
More Details Regarding Empire BCBS Advance Physician Payment Program
As reported in the MSSNY e-news and Crain’s Health Pulse earlier this week, Empire BCBS (Anthem) is initiating a program to provide advance care payments to many of its network independent primary care and specialty care physician practices in New York State and across the country. The goal of the program is to help these practices through this difficult period to remain available for patient care as we begin to transition back to a more regular schedule of patient care visits. Advance payments would be paid back over a period of time. Empire has begun outreach to physician groups that meet the criteria to be eligible for this program. Further questions can be directed to Empire’s provider relations department (https://www.empireblue.com/provider/)
Malaria Drug Shows No Benefit in New Coronavirus Study
A new study finds no evidence of benefit from a malaria drug widely promoted as a treatment for coronavirus infection. Hydroxychloroquine did not lower the risk of dying or needing a breathing tube in a comparison that involved nearly 1,400 patients treated at Columbia University in New York, researchers reported Thursday in the New England Journal of Medicine.
Although the study is observational rather than a rigorous experiment, it gives valuable information for a decision that hundreds of thousands of COVID-19 patients have already had to make without clear evidence about the drug’s risks and benefits, some journal editors and other doctors wrote in an editorial. “It is disappointing that several months into the pandemic, we do not yet have results” from any strict tests of the drug, they wrote. Still, the new study “suggests that this treatment is not a panacea.”
President Donald Trump repeatedly urged the use of hydroxychloroquine, which is used now for lupus and rheumatoid arthritis. It has potentially serious side effects, including altering the heartbeat in a way that could lead to sudden death.
The U.S. Food and Drug Administration has warned against its use for coronavirus infections except in formal studies. Doctors at Columbia tracked how 565 patients who did not get the drug fared compared to 811 others who received hydroxychloroquine with or without the antibiotic azithromycin, a combo Trump also has touted.
In all, 180 patients required breathing tubes and 232 died, and the drug did not seem to affect the odds of either. Patients given hydroxychloroquine were generally sicker than the others, but widely accepted methods were used to take that into account and still no benefit was seen for the drug.
Its use started within two days of admission for nearly all who received it. Some critics of earlier studies have said treatment may have started too late to do any good.
The study was funded by the National Institutes of Health, which has launched two of its own trials comparing hydroxychloroquine to placebo — the gold standard for establishing safety and effectiveness.
One study involves COVID-19 patients, and the other aims to see whether the drug can help prevent infections in health care workers exposed to the virus. Both got started in April. (Modern Healthcare, May 8)
Hospitals and Doctors: Need $60 Billion in Direct Funding
New York state said Thursday that it needs at least an additional $60 billion in direct federal funding along with millions of dollars more from Medicaid and FEMA formula changes in the next coronavirus aid package being crafted in Congress.
New York’s massive request, which is part of the National Governors Association’s bid for $500 billion for all states and territories, would be spread over three fiscal years, unrestricted and could be used for revenue shortfalls, according to the association.
New York hospitals need additional direct federal funding, targeted to “hot spots” such as New York state, to meet the high cost of treating patients with COVID-19 amid huge revenue losses, the Healthcare Association of New York State said.
A top priority is to bolster New York State’s finances so that it does not have to cut state Medicaid funding by as much as 20% to 30%.The association seeks changes in formulas used to distribute health care funding, including tweaks to Medicare and Medicaid payment systems, that could be worth billions of dollars.
Meanwhile, doctors with private practices need greater access to small business loans and medical school loan debts should be forgiven for young physicians and residents, especially for those who have pitched in to treat the infected patients, said the Medical Society of the State of New York. (Newsday, Updated May 7)
Symptomatic Spread of SARS-CoV-2 in a Nursing Home
Neil M. Ampel, MD reviewing Arons MM et al. N Engl J Med 2020 Apr 24 Gandhi M et al. N Engl J Med 2020 Apr 24
More than half the residents who tested positive were asymptomatic at testing.
Nursing homes are now recognized as niduses of infection with SARS-CoV-2. On February 29, 2020, because of known COVID-19 in their area, a nursing home in King County, Washington, instituted enhanced infection control measures and soon identified a resident and staff member who were infected. This prompted a larger study culminating in two point-prevalence surveys of the residents. Full-time staff were also tested.
On the initial screen of 76 residents, 23 (30%) were positive on nasopharyngeal swab for SARS-CoV-2. Among those testing positive, 12 (52%) were asymptomatic. One week later, 49 who were initially negative were retested. Of these, 24 (49%) were positive and 15 (63%) were without symptoms. Of the 27 residents testing positive without symptoms, 24 (89%) later developed symptoms. Among 138 full-time staff, 26 (19%) tested positive. The doubling time of infection was 3.5 days. Fifteen residents (26%) died. There was no difference in the viral load of SARS-CoV-2 in samples from those with symptoms and those without symptoms. Viable virus was isolated from 6 days before to 9 days after symptoms developed.
This paper has multiple important takeaways. First, infection can spread rapidly and efficiently in a nursing home environment. Second, infection control methods that focus only on those with symptoms are inadequate, since there is likely ongoing transmission from patients without symptoms as well as from staff. As the editorialists point out, this asymptomatic transmission distinguishes SARS-CoV-2 from the related SARS-CoV-1. Last, early and repeated viral testing of residents and staff, particularly those without symptoms, is the key to control. CITATION(S):
Arons MM et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. N Engl J Med 2020 Apr 24; [e-pub]. (https://doi.org/10.1056/NEJMoa2008457)
May 20, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open Mental Health and COVID-19 for Health Professionals
Register now for MSSNY’s next webinar related to the COVID-19 pandemic, Medical Matters: Mental Health and COVID-19 for Health Professionals. Just like we need to take extra precautions to protect ourselves from the risk of being infected by COVID-19, we also need to be concerned about psychological risks for health professionals. Faculty for this program is Craig Katz, MD.
To view the companion pieces to this webinar, be sure to go to https://cme.mssny.org 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.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at firstname.lastname@example.org.
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.
Health Care Workers Dealing With ‘Medical Burnout’ Amid Exhausting Pandemic
The pandemic has taken its toll on health care workers, leading many to experience medical burnout. Northwell cardiologist Dr. Evelina Grayver, who works in a COVID-19 ICU, says the trauma and stress can take a toll on medical staff. She says burnout has always- been a bullet to dodge, but the coronavirus has made it even tougher.
“At a certain point, we allow ourselves to be human and allow ourselves to feel the fear and the helplessness and the sense of desperation,” says Grayver. “Because if we don’t deal with it head-on, we are going into an era of anxiety depression, insomnia, post-traumatic stress disorder.”
Northwell Health has set up several resources for its medical providers who are feeling burned out, including outreach programs, counseling and setting up tranquility spaces where staff can take a few moments to regroup.
“We have ramped up our support services because everybody knows that people are under an enormous amount of stress and anxiety,” says Northwell Health Senior Vice President Dr. David Battinelli.
Along With support from clinicians, Northwell Health psychiatrist and Director of CPH, Dr. Jeff Selzer. says the signs of support from the community and sense of teamwork is keeping health care professionals emotionally strong.
Veterans Matters: Substance Use Disorder in Veterans Podcast
Check out MSSNY’s Veterans Matters newest podcast entitled Substance Use Disorders (SUDs) in Veterans. Dr. Thomas Madejski, Immediate Past President of MSSNY, discusses how to identify and diagnose substance use in veterans. Click here to listen.
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