MSSNY eNews: August 12, 2020 – DFS: You Cannot Charge Patients for PPE

.MS

Reminder: Network Health Care Providers May Not Charge Patients for PPE Costs
As noted in last Friday’s MSSNY e-news, the New York Department of Financial Services (DFS) issued Insurance Circular Letter No. 14 (2020), advising health insurers to immediately notify participating providers that they should not charge insureds fees that are beyond the insureds’ financial responsibility for covered services, such as fees for PPE, and instruct participating providers to refund any such fees to insureds.  It also noted that “Insurers and participating providers should work together to resolve any issues regarding increased costs due to COVID-19, including for PPE, and insureds should be held harmless for such charges.”

MSSNY President Dr. Bonnie Litvack Issued a Statement in Response to Require Health Insurers to Reimburse Health Care Practitioners for PPE Costs
that “MSSNY does not condone health plan-participating health care practitioners charging their patients for the huge jumps in the cost of personal protective equipment (PPE), as state regulations limit the ability of such practitioners to bill patients for these costs.”

However, given the enormous profits of the health insurance industry, MSSNY has urged the DFS to require health insurers to reimburse health care practitioners for these enormous jumps in PPE costs, and the significant difficulty in even obtaining it in the first place. The statement noted a recent MSSNY survey reported that nearly three quarters of the respondents expressed significant difficulty in obtaining PPE altogether, while nearly 40% of the respondents indicated that their PPE costs had gone up by more than 50%.


MSSNY President Testifies at Legislative Hearing Looking at COVID and Hospitals
MSSNY President Dr. Bonnie Litvack presented testimony today at a joint Assembly-Senate legislative hearing examining Covid-19 and hospitals. Dr. Litvack’s testimony raised number of critical issues that impacted and continue to impact physician care from the height of the pandemic, including:

  • Physician wellness, noting MSSNY’s Peer to Peer program
  • Lack of available and affordable PPE
  • Ensuring the ability of patients to receive medically necessary elective surgery in the event of a second surge
  • Ending Executive Order scope of practice changes

Please join the NYS Department of Health Thursday, August 13th at 1-2 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers.

For audio only, please dial in: 844-512-2950 and Access Code: 1166339

News: August 12, 20MLMIC Banner


MSSNY: Restore Physician Supervision for Non-Physician Providers
The Medical Society of the State of New York is calling on the state to restore physician supervision for non-physician health care practitioners following a systemwide approach to reduce Covid-19 infections. Dr. Bonnie Litvack, president of the medical society, said in a statement: “These orders that eliminate essential physician supervision potentially place patients at risk.” (Crain’s, 9/10)


Medicaid/CHP: Deadline Extended to Aug. 28 for Provider Relief Fund
This listserv notice is to remind Medicaid and Child Health Plus (CHP) providers that on July 31, 2020, the U.S. Department of Health and Human Services (HHS) extended the application deadline to August 28, 2020 for the Provider Relief Fund (PRF) for Medicaid and Child Health Plus under the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act.  HHS has reopened its Provider Relief Fund (PRF) Application and Attestation Portal to facilitate this deadline extension.

HHS has been hosting a series of informational webinars to address questions and support providers through the application process. The next provider and provider organization webinar will be held on Thursday, August 13, 2020, at 3:00 PM Eastern. Please visit https://webex.webcasts.com/starthere.jsp?ei=1354695&tp_key=b56041b5d4 to register.

CMS instructions on how to apply for PRF funding are shown below.

To Apply:

All eligible medical, dental, and long-term services and supports (LTSS) providers may begin the application process here. Also available here are Medicaid and CHIP Provider Distribution Instructions and the Medicaid and CHIP Provider Distribution Application Form. It is recommended that you use these documents to help you complete the process through the Enhanced Provider Relief Fund Payment Portal. Visit the CMS website here for additional information.


LabCorp, Quest Diagnostics: “Turnaround Time for COVID-19 Test Results Down to 1-3 Days”
LabCorp and Quest Diagnostics both said their average turnaround times for COVID-19 diagnostic tests now stand between one and three days. LabCorp said it has completed over 10 million COVID-19 tests since March and has a capacity of 180,000 per day with plans to increase further. Its average time to deliver results for COVID-19 diagnostic tests is now one to three days, the lab company said Aug. 10.

LabCorp is prioritizing testing for residents and staff of nursing homes in hot-spot states as well as hospitalized patients. All other tests are performed in the order in which they are received. Quest said its average turnaround time is two to three days as of Aug. 10. It has performed about 11.2 million COVID-19 tests and has a capacity of 150,000 tests per day. Quest said it expects to scale up to 185,000 tests by Labor Day. (Becker’s Hospital Review, Aug. 14)



Neck Gaiters, Bandanas More Harmful than Not Wearing a Mask, Duke Study
Wearing bandanas or neck gaiters as face coverings to protect against COVID-19 may actually do more harm than not wearing a mask at all, a study published in Science Advances found.

Researchers at Durham, N.C.-based Duke University analyzed the effectiveness of 14 face coverings ranging from bandanas to N95 masks. They created a simple device involving a laser and cellphone camera to track individual particles emitted from a person’s mouth when speaking. Researchers had trial participants say the same phrase with and without wearing each mask 10 times.

N95 masks proved the most effective, allowing no droplets to escape. Handmade cotton masks were about as effective as surgical masks, both blocking a substantial amount of droplets. Bandanas and breathable neck gaiters ranked least effective, emitting a higher droplet count than control tests involving no masks.

Bandanas and neck gaiters have more porous fabric, which may break up bigger particles into smaller ones that are more likely to float in the air, hence the higher droplet count, Martin Fischer, PhD, a chemist and physicist who developed the testing device, explained in a video created by Duke and cited by The Washington Post.

Dr. Fischer said these types of coverings are a popular choice among Americans because they are convenient to wear and don’t restrict air, which is also why they’re not offering much protection. “It’s not the case that any mask is better than nothing,” he said in the video. “There are some masks that actually hurt rather than do good.”

To view the full study, click here.(Becker’s Hospital Review, Aug. 14)


P2P Stress Banner


Elegant, Custom Built Home with Unparalleled Craftsmanship – Rhinebeck, NY
Set on 10.6 acres in one of the most sought-after neighborhoods in Rhinebeck, this stunning home borders Drayton Grant Park at Burger Hill (a conservation land and the highest point in Rhinebeck). Features beautifully landscaped gardens with sweeping hilltop views and a well established vegetable garden and barn. This handsome home is generously proportioned throughout, with an inviting foyer entry with tastefully designed staircase, millwork, high ceilings, cherry wood floors and custom windows.

Rhinebeck Estate for SaleA world class kitchen with a marble counter-topped island, enjoys both a cozy fireside seating area perfect for winter evenings, and glass doors in the hexagonal eat-in-kitchen opening onto the expansive stone terrace for three season enjoyment and entertaining.

A luxurious Master suite, with high vaulted ceiling design, his and hers walk-in closets and a gorgeous master bath with cast iron clawfoot tub. The second floor also includes two spacious bedrooms with generous closets and 2 full bathrooms, An additional large sitting room/office could easily make a lovely fourth bedroom. Lower level features a media room, exercise room, bar, wine cellar and full bathroom. Additionally there is a two story barn equipped with water and electricity.

The house is located 7 minutes to the charming center of Rhinebeck village with its many superb restaurants, boutiques & shops. The highly rated Northern Dutchess Hospital, the excellent Rhinebeck schools and the County Fairgrounds, a most desirable venue destination throughout the year, are all nearby. Rhinecliff train station is a mile beyond with Amtrak service south to NYC(1hour 40 minutes) and north to Hudson, Albany, Niagara Falls and Montreal. View full listing Contact Nader Kayal, MD, 845-518-7780 / entdoc53@aol.com or Joshua M. Briggs at Heather Croner RE-Sotheby’s 917 213-9042 / jmb@jmbfineart.com.

Upper East Side Office to Share
Includes waiting room, 2 exam rooms and room for medical assistants. Flexible schedule. Call Bianca at 212-327-1851.

For Sale: 715 Park Avenue
Medical office, 1,800 sq. ft. Rectangular, 11 1/2 ft ceilings, street level access. Private entrance on 70th Street, side of the building. Windows on Park Avenue and 70th Street. Excellent office space for plastic surgeon, dermatologist or dental practice. Central air conditioning, high voltage electric service, two bathrooms. *Sale could include active Cardiac / Medical Practice. Please contact Janet @ 212-288-5468.


Office Space and Quad-A Certified O.R. for Rent
Plastic surgery office and/or quad A – certified operating room available for rent. We welcome you to tour our facility, where safety and luxury are combined in the most prime location on the upper east side. We assure you will be delighted by what you discover. We take pride in our facility, where your patients’ safety and satisfaction are our number one priority.
    • Fully equipped operating room perfect for a board-certified plastic surgeon
  • Pre-op and recovery areas
  • A bright and modern waiting area
  • 3 consultation rooms, administrative room, kitchenette, and 2 bathrooms
  • Full day office rental per week / O.R. rental per case

For inquiries please call 212.737.8700, email polina@specialtyaestheticsurgery.com

Office Space and Quad-A Certified O.R. for Rent


 

 

 

 

 

 

COVID-19 Update May 15, 2020

.

Got PPE?
As physicians we like order and consistency but much in our current reality has been chaotic. Particularly frustrating has been the shortage of essential medical supplies that has plagued us from nearly the first day following the WHO pandemic declaration.  As an organization and a profession, we spoke out early and often about the lack of adequate PPE and the threat it conferred on the health and safety of our doctors, staff and patients in our Emergency Rooms and ICUs.  Thank goodness the crisis has eased in our hospitals and that they are preparing for a possible future surge by re-stocking emergency closets.

In the meantime, our community doctors remain in crisis mode struggling to procure PPE to keep open/reopen their offices.  Our MSSNY was told that local Offices of Emergency Management (OEM) would aid our doctors but sadly, many county warehouses were empty and lists of OEM sources led to dead ends.  This week brings new PPE concerns with the FDA and CDC warning that dozens of tested KN95 masks were defective with some filtering as few as 20% of particles.

The email we sent this week about physician PPE needs yielded about 1000 responses in the first 24 hours.  Clearly, the situation is dire.  Your MSSNY is actively working on a plan to address the PPE acquisition challenges you are facing.  Our physicians are essential to a safe and successful re-opening of New York.  This cannot happen without a reliable supply of protective equipment for our offices.

“Not being heard is no reason for silence.” –Victor Hugo, French novelist.

We will not be silent. Physician offices must GET PPE.

Bonnie Litvack, MD
MSSNY President


Are You Stressed Out from COVID-19? MSSNY Help Line is Live for You!
The Medical Society of the State of New York announced today that it has established a help line NYS physicians that have been experiencing COVID 19 related stress.  The MSSNY helpline is staffed by psychiatrists that will provide one-time support for those in need.

The helpline number is: 518-292-0140

Physicians can call this number 24/7 and will get an answering service who will ask for the individuals name and contact information.   There will be a return call to the individual within an hour of the call being received.

The MSSNY helpline is part of the MSSNY Peer to Peer (P2P) support program which is currently in development by MSSNY.  MSSNY is seek volunteer peer supporters for this program and additional information will be forthcoming within the next several weeks.  Additional information on how to become a volunteer peer support may be obtained by contacting Cayla Lauder at clauder@mssny.org or Pat Clancy at pclancy@mssny.org.


Gov. Cuomo Issues Criteria for Physicians Defining COVID-19 related Inflammatory Illness
Today, Gov. Cuomo has issued the first in the nation criteria for Health Care Professionals defining COVID-19-Related Inflammatory Illness in Children


Notes from Governor Cuomo’s COVID-19 Briefing
Data:

– Hospitalizations and intubations are down

– New COVID Cases 431 as of yesterday, up from 420 May 12

– 132 deaths yesterday

– “We’re where we are when this first started.”

– “Our Curve is down, and the curve in the rest of the nation is up.”

Reopening:

– 5/10 regions will open

– NY on PAUSE is extended to May 28 for regions that do not open today

– If a region hits benchmark between now and then, they can reopen

Phase 1 Reopening

– Retail Business Owner

– Curbside pickup

– In store pickup when curbside is not possible

– Masks must be worn by employees and customers (unless under two

years of age or for medical reasons) and hand sanitizer

will be available

Beaches for Memorial Day

– Agreement has been made with New York, New Jersey, Connecticut, Delaware

to open beaches for Memorial Day

– State and local beaches may open Friday before Memorial Day weekend on

the following conditions:

– No more than 50% capacity with controlled exists/ entrances

– No group activities

– Enforce social distancing measures

– No concessions

– City/town/county beaches can open under same conditions

– Must fully enforce minimum rules and may add additional

Conditions

Q&A

– According to DeRosa, BioReference Lab Core and Quest have been partnered and

30K tests a day are being saved for nursing homes

Reopening:

– Businesses that open today have signed a compliance agreement. If there is a

violation, they can be closed on that basis.

Finances:

– According to Mujica, the Comptroller report coming out today states revenues

are down 14%. He continued noting that the federal government has been

working on a bill that will provide funds to the state.


MSSNY Leglisative Podcast for this Week


Re-Opening Your Medical Practice in the COVID-19 Era on May 26, 12 Noon-1PM
As physicians are now considering re-opening their practices, they need to appreciate that they cannot simply “go back to normal”.  With furloughs, layoffs, severe limitations of medical services, decreased revenues and office closures, physicians need to consider strategies to maximize the success of their practices going forward.

These include financial analysis and planning, how to best protect and treat patients and employees, and what needs to be done to ensure that their practices operate efficiently, safely and profitably.  Topics addressed will include:

What you need to consider before re-opening?

  • What financial issues must be considered to better prepare your practice to move forward?
  • How can you ensure your practice operates appropriately as it relates to patients?
  • Is there a continued role for telehealth?
  • What will the new practice culture look like going forward?
  • What reasonable accommodations and workplace safety precautions should be made for employees?
  • What are potential discrimination issues that can arise, including, for example, from a phased re-opening, or gradual return of employees from furlough?
  • Given that employees have had a furlough period, and there may be a backlog of work, can/should employers make changes to or limit their PTO policies for the remainder of the year?
  • How do we handle/resolve employment contract breach issues?
  • Is there liability to the practices for exposing employees or employees’ family to Coronavirus? Wrongful reopening?

Register in advance for this webinar.

Presented by:

Barry B. Cepelewicz, M.D., Esq.
Partner/Director
Garfunkel Wild, P.C. 

Roy W. Breitenbach, Esq.
Partner/Director
Garfunkel Wild, P.C.


MLMIC Banner


There Are Limits to Coronavirus Antibody Testing, AMA Warns
Physicians and the general public should be cautious about the use of antibody testing for identifying previous COVID-19 infections, and they should especially be cautious of using the tests to determine if a person is immune to the new coronavirus, the American Medical Association warned.

Per a new guidance released by the association May 14, while antibody tests may play a key role in identifying the overall prevalence of COVID-19 in the U.S. population, including among those who do not show symptoms, the testing has inherent limitations.

The limitations include antibody tests currently on the market showing a significant number of false positive results. These tests may also identify antibodies for other coronaviruses, such as those that cause the common cold.

Also, a vast majority of more than 120 tests on the market have not been authorized by the FDA, and the association urges physicians to note the regulatory status of all available coronavirus antibody tests. Thus, the association recommends that “currently available antibody tests not be used as the sole basis of diagnosing COVID-19, and not be offered to individuals as a method of determining immune status.”

The test should not be used to support >decisions on returning to work or ending physical distancing, the association said.


Anyone in NYC with Coronavirus Symptoms Eligible for Testing
Any New Yorker with symptoms of the coronavirus will now be eligible to get tested for Covid-19. The new rules come after weeks where the city refused to test patients unless they were sick enough to be hospitalized. A limited number of vulnerable people, like the elderly in hard-hit neighborhoods, and frontline workers were also deemed eligible.

But now, the city is moving to set up a widespread program to test New Yorkers for the disease and hunt down people they have been in contact with. In the coming months, the effort will be crucial for the city’s plans to gradually lift stay-home restrictions and reopen its economy.

Under the new rules, anyone with a fever, cough, shortness of breath and symptoms like loss of smell and taste can get tested. Anyone who has been in close contact with a confirmed Covid-19 patient is also eligible for testing. Workers in nursing homes, homeless shelters and adult care facilities are eligible as well, regardless of whether they have symptoms.

The city is opening a dozen new testing sites over the next two weeks and will have a total of 23 publicly run sites. Though the eligibility criteria have broadened, there is no guarantee there will be enough tests available to meet demand. Appointments have filled up fast at available sites.

Officials are aiming to do 20,000 tests a day by late May. Next week, test sites will open at the Highbridge Recreation Center in Washington Heights and in Midwood, Brooklyn.

The city has moved its contact tracing program out of the Health Department and into the public hospital system, a move that sparked controversy.

Meanwhile, the number of children suffering from an inflammatory syndrome linked to Covid-19 spiked again on Thursday, reaching 100 confirmed cases.

The city has launched a PSA campaign to warn parents about the disease.

The number of people newly hospitalized for Covid-19, the number of ICU patients in public hospitals, and the share of patients testing positive all declined in the latest data Thursday.

The virus has killed 20,406 people in the city, and there are now 186,293 confirmed cases.


“Practical Considerations in Reopening Your Medical Practice”
By Andrew L. Zwerling

The outbreak of the COVID-19 virus and the response to it, including governmental orders that closed in whole or in part medical practices that performed elective procedures, created a difficult landscape for medical practices to navigate in the effort to remain viable, let alone operationally functional.  As the government slowly lifts stay-at-home orders and bans on elective procedures in New York State, the reopening of medical practices creates its own set of issues and burdens for medical practices to consider and handle.  Lapses in doing so correctly may lead to potentially punishing outcomes.

A threshold issue of significance is ensuring adherence to safety protocols that must be implemented either because they are required by the government or because the failure to implement them may expose a medical practice to future liability should an employee become ill from the COVID-19 virus.

For example, may an employer ask an employee if he or she had COVID-19 or was exposed to anyone who had it or has symptoms of COVID-19?  May an employer require an employee to have his or her temperature taken or submit to a COVID-19 test as a condition of re-entering the workplace?  May an employer require an employee with COVID-19 symptoms to stay home?  May an employer require employees to wear masks and/or gloves?  If so, who should bear the cost?  How does a medical practice social distancing with respect to staff and patients?  Should patients be screened prior to or after their arrival for appointments? What new and different cleaning and sanitation protocols must be implemented in response to COVID-19?  These questions and others should be answered before a medical practice reopens.

A host of employment law issues are also implicated in the reopening. For example, if an employer reduces an employee’s hours and wages does that reduction violate the terms of an employment contract?  If an employer reduces the wages of an exempt employee will that reduction fall below required thresholds and thereby undermine the exempt status of that employee?  If, to compensate for staffing shortages, an exempt employee performs the tasks of a non-exempt employee will that functional change convert the employee to non-exempt status?  If an employer reduces an employee’s salary because he or she is working fewer hours what steps must the employer take – for example, providing the employee with a “Rate of Pay Change” form – in order to avoid costly violations of the New York State Labor Law?

Although the issues related to reopening are many and may seem daunting, they are all susceptible to resolution if an employer conducts the proper due diligence and consults with the legal experts who can assist in providing the requisite guidance.

[1] Andrew L. Zwerling is a Partner-Director at Garfunkel Wild P.C. with over 38 years as a trial and appellate lawyer in State and Federal courts, including his successful argument before the United States Supreme Court.  A member of his firm’s Employment Law Practice Group, he has been advising clients how to respond to COVID-19 issues affecting their practices and businesses.  He may be reached at 516-393-2581 and by email at azwerling@garfunkelwild.com.  


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.

Click here to register for this webinar

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 mhoffman@mssny.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. 


Study Puts U.S. Covid-19 Infection Fatality Rate At 1.3%

KEY TAKEAWAYS

The researchers looked at 116 counties in 33 states and found 40,835 confirmed cases and 1,620 confirmed deaths through April 20. Asymptomatic COVID-19 patients who recovered with no symptoms were not counted in the data, which could have skewed results. The researchers also said they could not estimate age-adjusted IFR-S because the data is not available.

COVID-19 kills 1.3% of symptomatic people and could kill 500,000 Americans in the coming months if as many people contract the highly-contagious virus this year as contracted the seasonal flu last year, according to a caveat-laden estimate published Thursday in Health Affairs.

“After modeling the available national data on cumulative deaths and detected COVID-19 cases in the United States, the IFR-S (Infection Fatality Rate – Symptomatic) from COVID-19 was estimated to be 1.3%,” said the researchers, led by Anirban Basu, Stergachis Family endowed director and professor in the Department of Pharmacy, CHOICE Institute, University of Washington, Seattle.

“This estimated rate is substantially higher than the approximate IFR-S of seasonal influenza, which is about 0.1% (34,200 deaths among 35.5 million patients who got sick with influenza).”


FBI: Hackers Breaking into COVID-19 Research Organizations
China-linked hackers are breaking into American organizations carrying out research into COVID-19, U.S. officials said on Wednesday, warning both scientists and public health officials to be on the lookout for cyber theft. In a joint statement, the Federal Bureau of Investigation and the Department of Homeland Security said the FBI was investigating digital break-ins at U.S. organizations by China-linked “cyber actors” that it had monitored “attempting to identify and illicitly obtain valuable intellectual property (IP) and public health data related to vaccines, treatments, and testing from networks and personnel affiliated with COVID-19-related research.”

The statement offered no further details on the identities of the targets or the hackers. The Chinese Embassy in Washington did not immediately respond to a request for comment. China routinely denies longstanding American allegations of cyberespionage. Coronavirus-related research and data have emerged as a key intelligence priority for hackers of all stripes. Last week Reuters reported that Iran-linked cyberspies had targeted staff at U.S. drugmaker Gilead Sciences Inc., whose antiviral drug remdesivir is the only treatment so far proven to help COVID-19 patients. In March and April, Reuters reported on advanced hackers’ attempts to break into the World Health Organization as the pandemic spread across the globe. (Reuters)


Sanofi: If Successful, Americans Has First to Access Vaccine
Sanofi, the French drug company working with the U.S. Department of Health and Human Services (HHS) to develop a coronavirus vaccine, indicated that Americans will be the first to gain access to the vaccine should the company be successful.

“The U.S. government has the right to the largest pre-order because it’s invested in taking the risk,” Sanofi CEO Paul Hudson told Bloomberg.

HHS announced in February that its Biomedical Advanced Research and Development Authority (BARDA) will provide “expertise and reallocated funds” to Sanofi to develop the vaccine. Hudson said the U.S. expects “that if we’ve helped you manufacture the doses at risk, we expect to get the doses first.”

BARDA has given $30 million to Sanofi so far, according to Bloomberg.

Sanofi also partnered with British pharmaceutical company GlaxoSmithKline on the project and says it could make 600 million doses annually, though Hudson aims to double that projection.

Hudson warned that European countries could be left behind if they do not put in more resources toward vaccine development. “I’ve been campaigning in Europe to say the U.S. will get vaccines first,” Hudson told Bloomberg from his home in Paris. “That’s how it will be because they’ve invested to try and protect their population, to restart their economy.”

The Trump administration is pushing to speed up the development of vaccines through a program dubbed “Operation Warp Speed,” seeking to have millions of doses ready by January, an ambitious timeline that would be significantly faster than any previous vaccine development. Hudson told Bloomberg that Sanofi plans to begin human trials in the second half of this year and aim to have a vaccine available by the second half of 2021.

On Tuesday. the American biotechnology company Moderna announced that the Food and Drug Administration has given them fast-track designation, which is designed to expedite the development of treatments for life-threatening diseases such as COVID-19. (The Hill, May 13)


MSSNY Now Has More Than 50 Podcasts Available
Did you know you can now listen to all of MSSNY’s podcasts at Spotify, iTunes, I Heart Radio or Google Podcast?  Just search “MSSNY” and you will be able to listen to the MSSNY weekly update and messages from the new MSSNY president, Bonnie Litvack, MD.  You will also find podcasts on COVID-19, immunizations, emergency preparedness and veterans matters.  You can also access all of MSSNY’s podcasts by clicking here.


Nassau County Med Society Seal

 

Nassau County Webinar
DATE: May 21, 2020
Time: 7pm

Zoom Webinar Link 

Guest Speaker
Dr. David A. Hirschwerk
Attending-Infectious Diseases
Executive Vice Chair-Dept. of Medicine
North Shore University Hospital/LIJ Medical Center


 

Health Connections Banner


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 14, 2020

.


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)


MLMIC Banner


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)


 

Garfunkel Wild Ad


COVID-19 Map – Johns Hopkins Coronavirus Resource Center


 

 

COVID-19 Update May 12, 2020

.


Notes from Governor Cuomo’s COVID-19 Briefing

Data:
– Hospitalizations and intubations are down
– Deaths 195 (142 in hospitals, 53 in nursing home)

Emerging Issue Among Youth:
– NYS DOH is investigating 100 cases of what may be COVID related illness
in children with symptoms similar to Kawasaki disease and toxic shock-like
syndrome
– Illness has taken lives of 5 year old boy, 7 year old boy, and 18 year old
girl
– Out of 100 cases, 5% of cases are found in those aged 1 or younger,
18% of cases are found in those aged 1-4, 29% is found in those aged 5-9,
28% in kids aged 10-14, 16% in those aged 15-19, and 4% in
those 20-21
– DOH is advising all hospitals to prioritize COVID-19 testing for children
presenting symptoms

Reopening:
– Heed Dr. Fauci’s warnings on risking an outbreak that cannot be controlled
– Learn from others’ mistakes (China, South Korea, Germany)
– Maintain regional management and citizen participation
–  Calibrate/control by monitoring diagnostic testing, antibody testing,
hospitalizations rate and capacity, infection rate
– – Finger Lakes, Mohawk Valley, and Southern Tier meet reopening criteria
– Status of regions will be updated daily and available to view at
forward.ny.gov/regional-monitoring-dashboard

Federal Assistance:
– This is time to pass a smart federal bill
– No time for handouts to corporations, political port, or partisanship
– Bill must fund state and local governments, working families, state testing
and tracing
– NY needs $61B in federal support or we will have to reduce spending
– Schools, local governments, and hospital spending will be cut by
20% each
– Federal bill must also respond to working families with:
– Landlord and renter assistance
– Payroll protection
– Funeral costs
– Repealing of SALT

– “No bailout boondoggles”

– Corporations have already forecasted next scam and will use pandemic
to enact layoffs and not rehire as many employees increasing corporate
profit and stock values on backs of American workers

Nursing Homes
– We now have more testing capacity, so nursing homes should be prioritized

– We will work with regions who do not have the testing capacity to do
two tests per week for staff


Dr. Fauci: Death Toll Higher than Reported
Dr. Anthony Fauci, the Trump administration’s top infectious disease expert, testified Tuesday that the consequence of reopening the country too early could be “really serious” if states don’t have the capability to respond to new coronavirus infections. The warning offered a stark contrast to the case made in recent weeks by President Trump, who has pushed to quickly restart the economy in spite of a mounting death toll and few signs that the months long pandemic is beginning the subside.

“My concern is that we will start to see little spikes that then turn into outbreaks,” Fauci told the Senate HELP Committee during a hearing on how to safely reopen the nation. “The consequences could be really serious.” The vast majority of states have yet to meet the most basic reopening benchmarks set out by the White House by last month, even as most move in stages toward lifting their social distancing guidelines.

That means that new outbreaks are likely as public life resumes, Fauci said, prolonging the coronavirus fight if states are not adequately prepared to respond. Already, more than 80,000 Americans have died from the disease — a figure that most public health experts agree likely undercounts the true toll. “There is no doubt even under the best of circumstances when you pull back on mitigation, you will see some cases appear,” he said.

Fauci added it’s almost certain the death toll is higher than recorded. He said that schools and businesses hoping to open their doors any time soon should not count on therapeutics or vaccines, saying that public safety hinges on the nation’s ability to regularly test Americans. “The idea of having treatments available or a vaccine to facilitate the reentry of students into the fall term would be something that would be a bit of a bridge too far,” he said. (Politico, May 11)


Please Join the NYS DOH in a COVID-19 Update Webinar

Thursday May 14th at 1-2PM for

COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers: 

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


MLMIC Banner


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.

Registration is now open for this webinar

Educational objectives:

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 mhoffman@mssny.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.


NYC’s Death Toll Worse than City and State Figures
New York City’s death toll from the coronavirus may be thousands of fatalities worse than the tally kept by the city and state, according to an analysis released Monday by the U.S. Centers for Disease Control and Prevention.

Some of those excess fatalities could be COVID-19 deaths that went uncounted because a person died at home, or without medical providers realizing they were infected, the researchers at New York City Department of Health and Mental Hygiene said. It might also represent a ripple effect of the health crisis, they wrote. Public fear over contracting the virus and the enormous strain on hospitals might have led to delays in people seeking or receiving lifesaving care for unrelated conditions like heart disease or diabetes.

“Tracking excess mortality is important to understanding the contribution to the death rate from both COVID-19 disease and the lack of availability of care for non-COVID conditions,” the report said.

The report underscored the challenges authorities face in quantifying the human toll of the crisis. Deaths caused by the coronavirus are believed to be undercounted worldwide, due in large part to limits in testing and the different ways countries count the dead.

Through Sunday, New York City had recorded nearly 14,800 deaths confirmed by a lab test and another nearly 5,200 probable deaths where no test was available, but doctors are sure enough to list the virus on the death certificate. In its analysis, the report released Monday said the 5,293 excess deaths were on top of both confirmed and probable fatalities.

Between March 11 and May 2, about 24,000 more people died in the city than researchers would ordinarily expect during that time period, the report said. That is about 5,300 more deaths than were blamed on the coronavirus in official tallies during those weeks. (AP News, March 11)


NY Rolling Out Training for Virus Detectives
New York is poised to launch a training plan for the huge corps of disease detectives it plans to deploy to track people who coronavirus. The effort, seen as a key to keeping the outbreak from flaring again once it is under control, is likely to involve hiring several thousand people who have no background in public health.

Because getting huge groups of people together in one place for a contact-tracing boot camp is not possible, the training is being done through a five- to six-hour online course launching Monday. “There’s all this discussion about using technology in some way. But fundamentally, this is a pretty human activity,” said Josh Sharfstein of the Johns Hopkins Bloomberg School of Public Health, which developed the course with Bloomberg Philanthropies, the charitable foundation of former Mayor Michael Bloomberg.

When someone becomes newly infected with the virus, the tracers will be tasked with figuring out everyone who might have had contact with that person, reaching out to them and advising them how to quarantine themselves until they know for certain they aren’t sick with the virus.

In the video training, actors portray how the tracing interviews—mostly conducted by phone or video chat—are supposed to go. Sharfstein said the training, to be offered on the Coursera website, will be available to anyone, not just those seeking to become contact tracers.

Bloomberg is putting up $10.5 million through his foundation to help the state roll out its tracing plan. Gov. Andrew Cuomo has made hiring at least 30 contact tracers per 100,000 residents requirement for any region of the state to reopen. (Crain’s, May 12)


Garfunkel Wild Banner


NIH to Test Remdesivir in Combo with Eli Lilly Arthritis Drug
The National Institutes of Health announced its sponsorship of a controlled clinical trial of the investigational antiviral drug remdesivir in combination with the anti-inflammatory drug baricitinib to treat COVID-19. The trial is NIH’s second iteration of its Adaptive COVID-19 Treatment Trial, launched Feb. 21.  It tested Gilead Sciences Inc.’s antiviral drug remdesivir in treating COVID-19. Analysis of the trial revealed patients who took remdesivir experienced significantly shorter recovery periods than patients who received placebos.

“ACTT 2 will examine if adding an anti-inflammatory agent to the remdesivir regimen can provide additional benefit for patients, including improving mortality outcomes,” said Anthony S. Fauci, MD, director of the NIH’s National Institute of Allergy and Infectious Diseases. The new trial will incorporate baricitinib, Eli Lilly’s anti-inflammatory drug commonly used to treat rheumatoid arthritis. Baricitinib is expected to inhibit cytokine signaling that causes lung inflammation and shortness of breath among COVID-19 patients.

Investigators will evaluate the recovery times of patients prescribed remdesivir with baricitinib versus those of patients prescribed remdesivir only. ACTT 2 is expected to enroll about 1,000 U.S. hospitalized adults with COVID-19 at 100 sites. (Becker’s Hospital Review, May 11)


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 11, 2020


.


Gov. Cuomo’s Press Conference Today, May 11

Data:

– Total hospitalizations 7,226 as of yesterday

– Net intubations is down

– Lives lost 161 (112 in hospitals, 49 in nursing homes)

– New hospitalizations 488 as of yesterday

Reopening:

– Regions can reopen when numbers show decline in accordance with CDC guidelines

and there is testing/tracing plan in place

– Regions must meet 7 metrics

– 14 day decline in hospitalizations OR under 15 new hospitalizations

(3-day average)

– 14 day decline in hospitalized deaths OR under 5 new (3-day average)

– New hospitalizations – under 2 per1 00K residents (3 day rolling average)

– Share of total beds available (threshold of 30%)

– Share of ICU beds available (threshold of 30%)

– 30 per 1k residents tested monthly (7-day average of new tests per day)

– 30 contact tracers per 100k residents or to meet current infection rate

– Southern tier, Mohawk Valley, and Finger Lakes Regions meet metrics for reopening

Phased Reopening of Businesses:

– Businesses will reopen on a risk vs. reward basis

– Businesses will have to consider:

– Adjusted workplace hours and shift design

– Social distancing

– Non-essential travel restrictions

– Wearing masks if in frequent contact with others

– Strict cleaning and sanitation standards

– Continuous health screenings

– Continuous tracing, tracking, and reporting

– Liability for maintaining processes 

Local Officials:

– Testing – tracing in place

– Monitor infection rate with hospitals

– Communicate with other local governments

– Regional Control room of healthcare professionals and other necessary

personnel to monitor the situation across regions 

Regional Control Rooms:

– Announcing members of regional control rooms to monitor regional metrics today

Looking Back:

– Virus attacked us from Europe in January and February and no one knew

– Projected hospitalizations were 120K


Please join the NYS Department of Health at a COVID-19 Update
Thursday May 14th at 1-2PM for a COVID-19 update for healthcare providers.
To accommodate the large number of participants,
find our webinar streaming via YouTube Live
(and available for viewing immediately thereafter)
on the NYSDOH COVID website for providers.
For audio only, please dial in: 844-512-2950


FDA Approves First Coronavirus Diagnostic Test That Uses CRISPR Technology
The Food and Drug Administration on Thursday authorized the first test to detect the coronavirus using CRISPR technology.

The test, manufactured by genetic engineering company Sherlock Biosciences, provides results in approximately one hour. The test kit works by programming a CRISPR molecule to detect the presence of a genetic signature specific to SARS-CoV-2 in a nasal swab, nasopharyngeal swab, oropharyngeal swab, or broncho-alveolar lavage (BAL) specimen. When the signature is found, the CRISPR enzyme releases a detectable signal. The test is designed for use in high-volume CLIA laboratories and hospitals.

Sherlock is working to rapidly scale the production of the test kit and said it will share plans for distribution and availability in the coming weeks.

“While it has only been a little over a year since the launch of Sherlock Biosciences, today we have made history with the very first FDA-authorized use of CRISPR technology, which will be used to rapidly identify the virus that causes COVID-19,” Sherlock Bio Cofounder, President, and CEO Rahul Dhanda said in a statement. “We are committed to providing this initial wave of testing kits to physicians, laboratory experts, and researchers worldwide to enable them to assist frontline workers leading the charge against this pandemic.”

The company said it is also developing an instrument-free, handheld test that would provide rapid detection of the SARS-CoV-2 virus in a format like an at-home pregnancy test. May 8 Modern Healthcare

This story first appeared in our sister publication, Genomeweb.


Map Shows Communities Vulnerable to Severe Cases of COVID-19
An interactive map created by Experian shows which populations are most at-risk of developing severe cases of COVID-19.The map uses data on the community’s health, such as rates of pre-existing conditions like chronic lung disease or severe asthma, demographic information and social factors like population density and use of public transit to determine a community’s risk.


MLMIC Banner


Estimated Volume Losses for 30 Service Lines
Across all service lines, COVID-19 pushed the number of unique patients who sought hospital care down by an average of 54.5 percent, according to a year-over-year analysis from Strata Decision Technology.

For the analysis, data scientists examined more than 2 million patient visits and procedures from 51 healthcare delivery systems in 40 states. The 228 hospitals represented in the study had varying rates of COVID-19 cases.

Here are the estimated volume losses for 30 service lines for a two-week period in late March-April 2020 compared to the same period a year prior:

Ophthalmology: 81 percent
Spine: 76 percent
Gynecology: 75 percent
Orthopedics: 74 percent
Ear, nose and throat: 72 percent
Endocrine: 68 percent
Dermatology: 67 percent
Gastroenterology: 67 percent
Rheumatology: 66 percent
Neurosciences: 66 percent
General medicine: 64 percent
Urology: 62 percent
Genetics: 60 percent
Vascular: 59 percent
Hepatology: 58 percent
Cardiology: 57 percent
Pulmonology: 56 percent
Breast health: 55 percent
General surgery: 54 percent
Nephrology: 52 percent
Hematology: 49 percent
Allergy and immunology: 48 percent
Behavioral health: 45 percent
Burns and wounds: 44 percent
Cancer: 37 percent
Obstetrics: 30 percent
Infectious disease: 23 percent
Neonatology: 20 percent
Not assigned: 4 percent
Normal newborn: 2 percent
View the full report here. (May 11)


Physicians Rethinking Use of Ventilators for Some COVID-19 Patients
Some COVID-19 patients come to the hospital with low blood oxygen levels — levels that should have them gasping for air — but instead, these patients are awake and talking, resulting in some physicians rethinking the use of ventilators for them, according to The Wall Street Journal.

It is unclear why certain COVID-19 patients are unaffected by low blood oxygen levels and able to tolerate them, but some physicians are now holding off invasive mechanical ventilation for these patients.

Initially during the pandemic, physicians would rush to intubate these patients sooner, afraid of their sudden and swift deterioration. But recently, physicians at Stony Brook (N.Y.) Hospital and Ochsner Medical Center-West Bank Campus in Gretna, La., have put these patients on ventilators less often and are instead using other machines, such as CPAP machines, BiPAP machines or high-flow nasal cannulas.

Scott Weingart, MD, chief of emergency critical care in the department of emergency medicine at Stony Brook Hospital told the Journal about a 42-year-old COVID-19 patient with dangerously low blood oxygen levels, who was able to sit up and talk. Dr. Weingart and his team used a high-flow nasal cannula to increase the patient’s blood oxygen levels and placed the patient on his stomach, called “prone positioning,” which can boost oxygen levels. The patient was discharged without being placed on a ventilator.

The hospitals eschewing the use of ventilators in favor of CPAP and BiPAP machines are also careful to use filters on the masks and keep patients in specially ventilated rooms since these devices could release the virus into the air, they told the Journal.

Ventilators have played a key role in COVID-19 patient care during the pandemic, and as a result, demand for the machines soared. But their use comes with several risks. Studies have shown that many COVID-19 patients placed on ventilators die. A recent study published in the Journal of the American Medical Association showed that of 320 New York state patients who received invasive mechanical ventilation, 88.1 percent died. (Becker’s Hospital Review, May 11)


Northwell Health Surpasses 10,200 COVID-19 Patient Discharges
Northwell Health has discharged 10,210 COVID-19 patients as of May 11, surpassing the threshold of 10,000 patient discharges, the health system told Becker’s Hospital Review.

The state’s largest health system said the milestone comes more than two months after its hospitals saw the first COVID-19 cases and more than 30 days after Northwell experienced the surge’s peak.

“Based on the data we’ve seen, Northwell has treated more COVID-19 patients than any other health system in the nation,” Northwell President and CEO Michael Dowling said in a news release. “Our success is a reflection of the selfless work of both front-line staff and behind-the-scenes innovation that has enabled us to respond to an unprecedented influx of patients.”

Northwell said it has treated more than 41,000 COVID-19 patients since the beginning of the pandemic. This included about 13,000 hospitalized patients on Long Island, in New York City and Westchester County, as well as those seen in emergency departments, urgent care centers and physician offices. (Becker’s Hospital Review, May 11)


 

Garfunkel Wild Banner


COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 7, 2020

Do You Have a Story To Tell or a Photo To Share With Your MSSNY Colleagues? Send to Csouthard@MSSNY.org or Call 516-488-6100 Ext. 355!


COVID-19 Map – Johns Hopkins Coronavirus Resource Center


Gov. Cuomo’s Press Conference Thursday, May 7

GENERAL:
– Total hospitalizations down to ~8,600. Net change also down.
– Intubations are down.
– Number of new cases relatively flat (607). Gov says this has been a slow
downturn.
– Deaths since May 6: 231; 191 in hospitals; 40 in nursing homes.
– Top priority is protecting essential workers. Gov honors their courage and
efforts to take care of society.

TESTING:
– Have been “aggressively” testing essential workers: 25 downstate healthcare
facilities, over 27k employees.
– Found 12% of NYC healthcare workers tested positive (slightly lower
than general population, 19.9%).
– Shows that masks, gloves, and sanitizer have worked.

NOURISH NY:
– Gov said many farms have been particularly impacted by COVID-19, facing waste
and financial loss.
– Launched $25 million Nourish NY Initiative (funds 50 food banks). Wants to
continue this, urged philanthropies/foundations to help.
– Contact covidphilanthropies@exec.ny.gov
– 20,000 households will receive Nourish NY products within the next week.

REOPENING:
– Need to prioritize public health over the economy. No doubts that we will
reopen, Gov just wants to do so safely.
– Gov says leaders making decisions should be willing to participate in
anything they authorize.
– Reiterated that decisions must be made based on facts and data.

Q&A:
FINANCIAL ASSISTANCE:

– PAUSE to expire May 15, then will look at different regions to see where to
begin reopening. Economy will be starting at this point.
– Gov wants to ensure the most vulnerable and financially needy are protected.
He attributed moratorium on evictions, funding food banks, and more as relief
efforts. Hopes extension of moratorium can ease the anxieties of many.
– Gov is working on relief from the banks for landlords, as well as relief for
banks themselves. However, the state’s priority is protecting families from being evicted.
-Have overflow facilities across the state to take nursing home residents
that cannot be cared for.


Is Your Practice in Need of PPE? MSSNY Can Help!
Are you facing challenges obtaining needed PPE for your practice?

If you are a MSSNY member, please let us know if you would like MSSNY’s assistance in obtaining protective equipment, including N95 and KN95 masks.  MSSNY is working with vendors and the New York State Health Department to help physicians meet their PPE needs so that they can get back to treating patients.

Please be aware that some businesses promoting PPE availability have not been properly vetted, have provided substandard products and in some cases have not delivered on the ordered products.  Please contact mauster@mssny.org / pclancy@mssny.org / eskelly@mssny.org if you are a member and require MSSNY’s assistance.


New MSSNY Officers and Councilors Elected May 7, 2020
The Nominating Committee held a meeting on Thursday, January 30, 2020.  After careful consideration of the recommendations submitted by the district branches, county medical societies, the medical student, resident & fellow and young physicians sections, your Committee respectfully submits the following candidates for election on April 25 and 26:

Officers (Each for term of 2020-2021)

President                Bonnie L. Litvack, MD, Westchester
President-Elect        Joseph R. Sellers, MD, Schoharie
Vice-President         Parag H. Mehta, MD, Kings
Secretary                Frank G. Dowling, MD, Suffolk
Assistant Secretary Joshua M. Cohen, MD, New York
Treasurer                Mark J. Adams, MD, Monroe
Assistant Treasurer Howard H. Huang, MD, Jefferson
Speaker                  William R. Latreille, MD, FACP, AME, Franklin
Vice-Speaker          Maria A. Basile, MD, Suffolk

Councilors (Four for term 2020-2023)

First District            Adolph Meyer, MD, Kings
First District            David Jakubowicz, MD, Bronx
Fifth District            Barry Rabin, MD, Onondaga
Seventh District       Janine Fogarty, MD, Monroe

Councilor (One for unexpired term of Edward Bartels to 2021)

Eighth District          Mark Jajkowski, MD, Erie

Resident and Fellow Section Councilor (One-year term 2020-2021) – Raymond Lorenzoni, MD

Medical Student Section Councilor (One-year term 2020-2021) – Shireen Saxena, Monroe

Officers, Councilors and Trustees

Trustees (One Five-Year Term 2020-2025) – Thomas J. Madejski, MD, Orleans


Coronavirus Fear Prompting Avoidance of Healthcare, Poll Finds
Around 29 percent of U.S. adults said they have delayed or avoided seeking medical care due to concerns about contracting COVID-19, a new poll shows.

The poll, conducted by market research firm Morning Consult on behalf of the American College of Emergency Physicians between April 18 and April 20, surveyed a national sample of 2,201 U.S. adults.

Four survey findings:

  1. Sixty-three percent of respondents said they are “very” or at least “somewhat” concerned about wait times at healthcare facilities, and 59 percent expressed concern about receiving adequate care.
  2. Fifty-four percent of adults between 18 and 39 years of age said they have actively delayed or avoided seeking care due to COVID-19 concerns, compared to 59 percent of adults, ages 40 to 74 years.
  3. Around 80 percent of respondents said they are concerned about contracting COVID-19 from another patient or visitor if they need to go to an emergency room.
  4. Most respondents (73 percent) are concerned about overstressing the health care system when considering a trip to the emergency department. (Becker’s Hospital Review, Ap 29)

Look Out for COVID-19 Scams Directed at Physicians
Unfortunately, scammers are using the COVID-19 pandemic to try to steal your Medicare Number, personal information, and money. And they are using robocalls, social media posts, and emails to do it.

Remember, if anyone reaches out to get your Medicare Number or personal information in exchange for something, you can bet it is a scam.

·  Be on the lookout, so you can stop scams before they happen. Here are recent Coronavirus scams to watch for:

·  Robocalls offering you respiratory masks they will never send

·  Social media posts fraudulently seeking donations for non-existent charities, or claiming to give you stimulus funds if you enter your bank account information

·  Fake testing kits, cures, “immunity” pills, and offers for protective equipment

Remember this:

·  Medicare will never contact you for your Medicare Number or other personal information unless you have given them permission in advance.

·  Medicare will never call you to sell you anything.

·  Visit Medicare.gov/fraud for more information and tips on preventing Medicare scams and fraud.


Hackers Targeting Healthcare to Steal COVID-19 Info, U.S., U.K. Warn
Sophisticated hackers are targeting healthcare and medical research organizations to gain information about the novel coronavirus, according to U.S. and U.K. cybersecurity agencies.

The Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency and the U.K.’s National Cyber Security Centre in a joint alert issued Tuesday said they have found evidence that “(advanced persistent threat) actors are actively targeting organizations involved in both national and international COVID-19 responses.”

APT groups typically comprise hackers backed by a nation state. The CISA and the NCSC did not say whether the attacks they have identified were linked with specific countries.

Hospitals have already seen an uptick in cyber attacks trying to take advantage of the COVID-19 outbreak to spread malware. But the attacks warned of by the U.S. and U.K. cybersecurity agencies this week differ in that APT groups are frequently looking to steal intellectual property or sensitive data related to COVID-19 research.

Hackers affiliated with APT groups have looked to exploit healthcare organizations’ weak password practices, according to the agencies.

The CISA and the NCSC are investigating “large-scale password spraying campaigns” that have targeted healthcare entities in the U.S. and the U.K., as well as international healthcare organizations. In a password spraying campaign, a hacker will try to enter different commonly used passwords into many accounts to try to break into them.

“These attacks are successful because, for any given large set of users, there will likely be some with common passwords,” the alert reads.

Hackers have also been taking advantage of the shift to remote work by searching out vulnerabilities in virtual private network, better known as VPN, products.

The CISA and the NCSC warned that they are investigating multiple attacks against organizations involved in COVID-19 research, including against pharmaceutical companies, medical research organizations and universities. Those attacks may have been perpetrated to “steal sensitive research data and intellectual property for commercial and state benefit,” the agencies said.

To protect against cyberthreats, the CISA and the NCSC recommended organizations implement multi-factor authentication, update VPNs and set up security monitoring capabilities, among other mitigation tactics. (Modern Healthcare, May 6)


Q & A: What About Mild or Asymptomatic Cases of COVID-19?
Asymptomatic transmission has not only been confirmed in China, but recent modeling data found that mild or asymptomatic cases that went undetected (“undocumented”) accounted for 85% of total infections in the earliest stages of the outbreak. The study found these cases were less infectious on a per-contact basis, but because those individuals were not isolated, they infected more people in total.

The big unknown, however, is how common it may be for people to become infected but with symptoms too mild to seek treatment. Currently, detection is based on molecular testing, which is performed only on individuals who come into contact with the healthcare system. The prevalence of such mild or asymptomatic infections will not be known until an inexpensive serological test, detecting antibodies to the virus that signal previous exposure, is available for use with routine blood draws. Thus, the extent of exposure in the population may not be known for years.

How do you contract COVID-19?

Research points to droplet and fomite transmission, with recent data suggesting the virus can survive on surfaces such as plastic and stainless steel for up to several days. It can also survive in the air for a few hours, indicating it may also potentially be aerosol transmissible.

The virus may also be transmitted through the fecal-oral route, with research suggesting some patients develop gastrointestinal symptoms, and that the virus is shed through stool.

A small cohort study in China found the virus present in two patients’ tears, indicating it might be transmissible through eye secretions.

How infectious is the COVID-19 coronavirus?

Research from China found a similar viral load in symptomatic and asymptomatic patients, which may suggest patients can transmit the virus whether they have mild or severe disease.

Latest data from the World Health Organization estimated the “R0” as 2.0 to 2.5, meaning infected individuals transmit it to 2-2.5 others on average. By contrast, the R0 for measles is 12-18, while for seasonal influenza it is a little over 1.

How virulent is COVID-19?

According to JAMA, global mortality for COVID-19 is reported to be 4.7%, and about 1.7% of patients died in the first 141,000 cases in the U.S., though the authors emphasized this was not an accurate case-fatality rate due to the uncertain denominator.

CDC examined the first 4,200 U.S. cases, and found 508 (12%) of patients were hospitalized, and of those, 121 were known to be admitted to an intensive care unit, and 44 patients died. Similar to China, both hospitalization and mortality rates increased with increasing age, though this data indicated 20% of hospitalized patients and 12% of patients admitted to an ICU were ages 20-44. Nine patients ages 20-44 died, though in the entire group most deaths were among adults ages 65 and older.

Notably, however, mortality rates vary dramatically from one country to another, raising more questions about case-finding and record-keeping than there are answers.

What are the early symptoms of COVID-19?

In addition to fever, cough and shortness of breath, CDC now lists several other symptoms: chills, repeated shaking with chills, new loss of taste or smell, muscle aches, headache and sore throat.

Examining data from patients admitted in New York City, prior to respiratory symptoms, including about three-quarters presented with cough or fever, and almost 60% with shortness of breath. Gastrointestinal symptoms seem to be more common in U.S. patients, with about a quarter reporting diarrhea and 20% reporting vomiting.

It appears not all patients present with symptoms, with research out of Germany in February finding patients testing positive for COVID-19 despite being afebrile and otherwise normal-seeming.

How is COVID-19 diagnosed?

A patient is swabbed, then the sample is tested via reverse transcription polymerase chain reaction (RT-PCR) to determine presence of viral RNA.

The FDA recently authorized the first serology test to detect IgM and IgG antibodies under Emergency Use Authorization, for diagnosing COVID-19 infection in combination with other clinical and lab data.

What are the risk factors for more severe disease?

Reports from China indicate disease is much more severe in older patients, with the highest mortality rate among adults age 80 and older. Patients with other comorbidities are also the most at risk, with U.S. data finding hypertension and obesity were the most common chronic medical conditions among patients hospitalized with COVID-19, followed by chronic lung conditions, diabetes and cardiovascular disease.

Data out of New York City found obesity as a risk factor for mechanical ventilation. Patients requiring mechanical ventilation were also more likely to need vasopressors, and experienced other complications such as atrial arrhythmias and new renal replacement therapy.

What does severe disease look like?

JAMA detailed 21 patients from Washington state, 15 of whom needed mechanical ventilation. All 15 had acute respiratory distress syndrome, and eight developed severe ARDS by 72 hours. Vasopressors were used for 14 patients, though most patients did not present with evidence of shock, and seven patients developed cardiomyopathy. Mortality among this group was 67%, 24% remained critically ill and 9.5% were discharged from the ICU, as of March 17.

In New York City, a third of patients required intubation, and of these, 30% did not get supplemental oxygen, meaning they deteriorated quickly.

However, U.K. research indicated a lower proportion of COVID-19 patients in the critical care unit survived compared to patients with non-COVID-19 viral pneumonia (52.1% vs 77.8%, respectively).

How is the disease treated?

Treatment mainly consists of supportive care, according to CDC recommendations. The most common complications of severe disease include pneumonia, hypoxemic respiratory failure/ARDS, shock, multiorgan failure. Since pneumonia is common, IV antibiotic use has been widely reported, along with supplemental oxygen, with anecdotal reports of proning and ultimately, mechanical ventilation, including some patients who receive extra corporeal membrane oxygenation (ECMO).

Although corticosteroids were widely used in China, the CDC generally recommends against them except in patients with steroid-responsive comorbidities such as septic shock. “[P]atients with MERS-CoV or influenza who were given corticosteroids were more likely to have prolonged viral replication, receive mechanical ventilation, and have higher mortality,” whereas reports from China in COVID-19 were uncontrolled and observational, the CDC explained. Research indicates patients hospitalized with COVID-19 often develop blood clots, leading some international societies to call for patients to receive prophylactic anticoagulant treatment to prevent this complication.

What are the potential therapeutic options for treating the virus?

There are currently no approved therapies to treat COVID-19. The NIH released treatment guidelines, which noted both insufficient clinical data to recommend for or against use of both remedisivir and hydroxychloroquine and chloroquine. Specifically, the agency noted monitoring patients who receive HCQ for adverse effects, especially prolonged QTc interval. The FDA recently issued a warning about the heart risks of the drug. NIH also said there is insufficient clinical data to recommend use of convalescent plasma or hyperimmune globulin, as well as interleukin-6 inhibitors and interleukin-1 inhibitors. The agency recommended against the use of hydroxychloroquine plus azithromycin, lopinavir/ritonavir (Kaletra) or other HIV protease inhibitors, interferons and Janus kinase inhibitors.

What is the status of clinical trials for these potential therapies?

Remdesivir has been available for compassionate use. An interim analysis of a formal trial from the National Institute of Allergy and Infectious Diseases including data from U.S. patients found remdesivir met its primary endpoint in severe COVID-19 patients, significantly faster time to recovery versus controls, and trended towards a survival benefit. Manufacturer Gilead Sciences also reported topline results from a phase III trial comparing two dosing regimens in severe cases, but without a usual-care control group, showing a trend favoring a 5- versus 10-day treatment period.

Many hospitals have begun to use hydroxychloroquine or chloroquine, which is most commonly used to treat patients with malaria, as well as arthritis and systemic lupus erythematosus, although the supporting evidence is anecdotal at best. The FDA has issued an Emergency Use Authorization for hydroxychloroquine held in the National Strategic Stockpile, although that does not make COVID-19 an approved indication. Latest data from the U.S. found no difference in risk of ventilation the drug in male veterans with severe COVID-19.

A small case series in China found three of five patients treated with convalescent plasma were later discharged from the hospital, though questions about scaling this as a potential therapy remain. Some centers have also tried anti-cytokine agents such as tocilizumab (Actemra) but evidence of benefit over standard treatment remains scant. Controlled trials with tocilizumab are now underway, including one sponsored by drugmaker Genentech/Roche.

Sanofi and Regeneron announced a phase II/III trial for sarilumab (Kevzara), another anti-interleukin-6 agent, for patients with severe COVID-19.The Milken Institute has collated currently ongoing trials for COVID-19 interventions on its website.

What are the vaccine prospects?

Several companies and public health agencies have vaccines in development, including the National Institute of Allergy and Infectious Diseases. Phase I trials with vaccines are underway, with a timeline of 12-18 months for a vaccine to be ready for wide-scale deployment.

As of April 21, the Milken Institute counted 115 vaccine candidates in development, including six in phase I and five in phase I-II safety and efficacy studies in humans.

What is the prognosis for patients with COVID-19?

Older patients and those with other comorbidities are the most at risk, whereas the disease appears to be less severe among younger patients. U.S. data seems to indicate fewer children contract severe disease than adults, and hospitalization in this population is most common among infants and children with underlying conditions.

Research is starting to come from China that COVID-19 vertical transmission from mother to baby is possible, given several isolated case reports.

What are some potential complications of COVID-19?

Data from New York City indicated ST-segment elevation on the EKG was complex, and confirmed COVID-19 cases were complicated by ST-segment elevation, which could have indicated potential acute MI.

Neurologic complications have been reported, with limited case reports from Italy linking COVID-19 infection to Guillain-Barré syndrome. And in China, more than a third of confirmed COVID-19 cases had neurologic symptoms, such as acute cerebrovascular events, impaired consciousness and muscle injury, which were more common among patients who required mechanical ventilation.

What are the long-term sequelae of COVID-19?

It is unclear whether or how often COVID-19 survivors will experience persistent pulmonary or other problems, or for how long. Many patients have remained hospitalized with the illness for weeks outside of China, out of an abundance of caution and for public health reasons.

Researchers from China pointed to cardiovascular system abnormalities in nearly half of a small group of SARS patients in a 12-year follow-up cohort, as well as about two-thirds with high lipids and 60% with glucose metabolism problems. They suggested COVID-19 may also cause chronic damage to the cardiovascular system, as the virus has a similar structure to SARS. Last Updated May 07, 2020.


COVID-19 Info and Advice for All Physicians
COVID-19 presents new challenges for everyone. However, healthcare professionals are facing unique personal and professional challenges within the context of this rapidly shifting landscape.

Individuals may find themselves managing multiple new challenges at once. Some medical professions, such as anesthesiology, emergency medicine, or intensive care, incur greater risks for contamination as they perform intubation procedures on hospitalized COVID-19 patients.

Healthcare clinicians wearing full-body PPE in the hospital are faced with physical barriers to self-care during shifts: eating, drinking, and lavatory visits may be delayed or eliminated, leading to depletion in personal reserves.

Craig Spencer, MD, MPH, director of Global Health in Emergency Medicine and an ER physician at New York-Presbyterian/Columbia University Medical Center in New York City, is on the front lines of managing the COVID-19 patient surge. In a Washington Post op-ed and a Twitter thread, he wrote about his daily experience of navigating the compounding stressors of the patient surge; managing patient life support with limited ventilators; being unable to attend to personal needs during long shifts; and, to protect his family, vigilant decontamination before leaving work and again once he arrives home. Other healthcare clinicians report quarantining themselves in sections of the home to limit the risks of contaminating family members.

These new and daunting circumstances require careful attention to self-care, stress management, and wellness practices to best ensure continued health and performance in a time of great need.


COVID-19 Strategies for Coping and Wellness

1. Take stock. As routines drastically change, health choices may falter. Ask yourself how you are doing in regard to daily health behaviors: the quantity and quality of sleep, exercise, nutrition, and hydration.

2. Stabilize yourself with good health behaviors. After taking stock, choose one area for improvement and set a goal. Examples of concrete goals are maybe 30 minutes of daily exercise, limiting evening screen time in the hours before bed, and eating three servings of vegetables daily.

COVID-19 brings a high degree of uncertainty, and feelings of loss of control are common. Setting a self-care goal can help keep you grounded and focused on things you can control. Good self-care will ensure that your immune system is best supported and able to fight illness. Remember too that when you are well cared for yourself, you can be of best service to others.

3. Observe your stress level. Stress manifests mentally, emotionally, and physically. Observe the tension level in your muscles, the frequency and intensity of any difficult emotions, and potential physical effects such as headaches, upset stomach, or difficulty sleeping.

4. Identify your emotions. Anxiety, sadness, fear, anger, and frustration may all be common. Acknowledge these emotions as they arise. Often, they are temporary and observing them without judgment can allow them to dissipate quicker.

5. Employ stress reduction techniques. Stress activates the sympathetic nervous system and keeps you in a state of “high alert.” Even low-grade prolonged stress can have negative impacts on sleep, mood, blood pressure, cortisol — all of which reduce your tolerance to future stressors. Ongoing stress can also promote unhelpful choices, like using alcohol for stress relief, and further deplete sleep, mood, and energy. In this time of COVID-19, stress mitigation is key, and calming your nervous system is medicinal.

If you have a favorite stress reduction tool, ask yourself if you are using it frequently enough. If you do not have a favorite stress reduction tool, these are some good options to try:

·       Shine: Calm Anxiety & Stress offers a special toolkit for COVID-19 anxiety, with a free app that offers guided relaxation and meditations, daily motivational messages, and an “ask an expert” section

·       Headspace is a stress, meditation, relaxation, and sleep app, free with NPI provider number

·       The UCLA Mindful: Meditations for Well-Being app includes recorded mindfulness meditations of varying lengths and a weekly podcast

·       The Society for Health Psychology, a division of the American Psychological Association, offers a wide range of recommended wellness tools, including a sleep app and resources to address trauma

·       Calm Your Nervous System is a free, stream able, 20-minute guided relaxation audio file. Using headphones or earbuds allows background binaural technology to deepen your relaxation response

Use your favorite tool daily or as needed throughout the day to de-stress, interrupt any unhelpful thought patterns, and as a general wellness practice.

6. Have compassion for yourself and others. Recognize that everyone is doing their best in this time of crisis, including yourself. Remind yourself that everyone is navigating unchartered territory without a playbook. Anchor yourself and avoid reacting to the emotional instability of others. Use any of the calming tools listed above or another you may love.

7. Stay socially connected. Social connection is certainly different with “physical distancing” — and it may be more important than ever. Reach out to others by phone, email, text, or various social media platforms. Check in with older adults, anyone you know to be socially isolated, and daily friends and colleagues that you do not have contact with now due to quarantine or shelter-in-place orders.

8. Find personal space in isolation. Paradoxically, physical distancing is forcing people and families in close proximity for extended periods of time. During a stable time of emotional neutrality, discuss individual needs for personal space and develop a plan.

9. Set a timer and limit your access to the news. Reports of mounting disease and death counts can be distressing and anxiety-provoking. The volatility of the stock market and loss of investment and retirement income may represent a personal threat to security and trigger anxiety or despair. While staying informed is important, limiting news and screen time can support stress management and mental health. If you find yourself constantly scanning the news, consider containing your news-checking to twice daily and for a defined and brief period.

10. Gratitude and positivity. Daily, find a positive story in the news that illustrates resilience and positivity amidst challenge. Allow yourself to reflect on one personal gratitude each day.

Resources and Guidelines by Specialty

Below, the MedPage Today staff has compiled a list of COVID-19 resources for physicians and other healthcare professionals. We will be updating this list frequently to ensure it remains a collection of the latest guidelines, resources, and best practices in dealing with COVID-19 both personally and professionally. You can track the U.S. COVID-19 outbreak on a real time dashboard, by state and by county.

Anesthesiology
American Society of Anesthesiologists library

Cardiology
American College of Cardiology – ACC’s COVID-19 Hub
ASNC/SNMM – Guidance and Best Practices for Nuclear Cardiology Laboratories
European Society of Cardiology – COVID-19 and Cardiology
American Heart Association- COVID-19 Resources
Society for Cardiovascular Angiography and Interventions – Considerations for the Cath Lab Considerations for Cardiac Catheterization Laboratory Procedures During the COVID-19 Pandemic

Dermatology
American Academy of Dermatology

Emergency Medicine
American College of Emergency Physicians
American Academy of Emergency Medicine
American College of Surgeons – How to Set Up a Regional Medical Operations Center to Manage the COVID-19 Pandemic

Endocrinology
American Association of Clinical Endocrinologists – AACE Position Statement: Coronavirus (COVID-19) and People with Diabetes – The American Association of Clinical Endocrinologists’ (AACE) guidance on helping people with diabetes prepare for and prevent the spread of COVID-19. Some precautions for this high-risk population include staying home as much as possible, washing hands regularly, and stocking up on prescriptions. The guidance also advises people with diabetes to check with each individual states’ department of health website to see if he or she is able to purchase an additional 30-day supply of insulin or other diabetes medication.

ENT
American Academy of Otolaryngology-Head and Neck Surgery

Ethics
AMA Journal of Ethics – COVID-19 Ethics Resource Center

Gastroenterology
American Gastroenterological Association
American College of Gastroenterology
SAGES (gastroenterology surgeons)

General
Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic
American Medical Association – Guide to telemedicine
American Medical Association – CMS payment policies and flexibilities

Geriatrics
CDC – COVID-19 Guidance for Older Adults
American Geriatrics Society – information hub and article in Journal of the American Geriatrics Society

Health Policy
CDC – Evaluating and Testing For COVID-19
CDC – Healthcare Infection Control Guidance
CDC – Guidance for Emergency Medical Care Services
CDC – Healthcare Personnel with Potential Exposure Guidance
CDC – Inpatient Obstetric Care Guidance
AMA – COVID-19 Resource Center for Physicians – Includes a physician’s guide to COVID-19 along with information from JAMA and other resources.
AMA – COVID-19 FAQ – Addresses what to tell patients, how to manage PPE, and other practice issues.
National Institutes of Health – Coronavirus (COVID-19)
CDC – Clinician Outreach and Community Activity Call CDC: Contact Tracing Not Needed for HCPs Exposed to COVID-19

Hepatology
American Association for the Study of Liver Diseases

Infectious Disease
Infectious Diseases Society of America
American Society of Microbiology – Novel Coronavirus (COVID-19) resources
The Lancet – COVID-19 Resource Center
New England Journal of Medicine – Coronavirus (COVID-19)

Nephrology
National Kidney Foundation regarding dialysis
American Society of Nephrology regarding dialysis and hospitalized patients with kidney failure

Neurology
American Academy of Neurology- COVID-19 resources
National MS Society – Disease-Modifying Treatment Guidelines for COVID-19 – Recommendations of the National MS Society’s National Medical Advisory Committee
American Headache Society – Headache Clinic Workflows During the COVID-19 Pandemic – Telemedicine and precaution to treat patients
Movement Disorders Society – MDS Statement, References, and Resources for the COVID-19 Pandemic
American Epilepsy Society – COVID-19 Resources for Epilepsy Clinicians – Patient management, medications, and more

Nursing
American Association of Critical-Care Nurses – Resources
American Association of Critical-Care Nurses – Online course on pulmonary, ARDS, and ventilator resources
American Nursing Association
Oncology Nursing Society – Interim Guidance During the COVID-19 Pandemic

OB/GYN
American College for Obstetricians and Gynecologists: COVID-19 Guidelines
CDC – Considerations for Inpatient Obstetric Healthcare Settings
Society for Maternal-Fetal Medicine

Ophthalmology
American Academy of Ophthalmology – Important Coronavirus Updates for Ophthalmologists

Oncology
MedPage Today – COVID-19 Poses Special Challenges to Cancer Care – While having an unprecedented impact on all aspects of the nation’s healthcare system, the COVID-19 pandemic created unique circumstances and challenges for cancer care, according to authors of a review from the early U.S. epicenter in metropolitan Seattle. ASCO – ASCO recommendations
Oncology Nursing Society – COVID-19 Resource Page – Links for providers and patients, Nat’l Comprehensive Cancer Network – COVID-19 Resource Page – Links for providers of cancer care:
American Cancer Society Answers to Common Questions – Oriented toward patients, caregivers

Pathology
College of American Pathologists
American Society of Clinical Pathologists

Pain Management
ASIPP – Statement from ASIPP on COVID-19
American Association of Pain Management – Managing Pain and Related Symptoms during Coronavirus
ASRA – Recommendations on Chronic Pain Practice during the Pandemic
DEA – Coronavirus Guidance

Pediatrics
American Academy of Pediatrics – Management of Infants Born to Mothers with Suspected or Confirmed COVID-19

Primary Care
American Academy of Family Physicians
American College of Physicians

Psychiatry and Psychology
American Psychiatric Association: COVID-19 mental health impacts
Interagency Standing Committee: mental health and psychosocial aspects of COVID-19
The Lancet: The psychological impact of quarantine and how to reduce it
CDC: Mental Health and Coping During COVID-19

Public Health
CDC – Manage Anxiety & Stress

Pulmonology/Critical Care
CHEST
Society for Critical Care Medicine
American Thoracic Society

Radiology
American College of Radiology (ACR) on nuclear-med ventilation scans
ACR on CT scans
Society for Interventional Radiologists

Rheumatology
American College of Rheumatology – COVID-19 Resources
EULAR

Sleep
American Academy of Sleep Medicine – COVID-19: FAQs for Sleep Medicine

Surgery
American College of Surgeons (ACS) general information and directory
ACS: elective case triage
ACS: review committees for triage decision-making
SAGES (gastrointestinal surgeons)
American Association of Neurological Surgeons


 


MLMIC Banner


 

 

 

 

 


Garfunkel Wild Banner


 

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


MLMIC Banner


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.


NYEC Banner


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)

 

COVID-19 Update May 5, 2020

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


COVID-19 Map – Johns Hopkins Coronavirus Resource Center


 


CMS Announces Pay Parity for Audio-Only Telephone Visits
The Centers for Medicare & Medicaid Services said it will bump up payments for audio-only telephone consultations to match payments made for office and outpatients visits.

The new rule would increase payments for audio-only telephone consultations from $14-$41 to about $46-$110, CMS said in a media release.

The rule change was part of a broad package of waivers and rules shifts that were brought forward Thursday by CMS in to facilitate testing and expand access to telehealth.


Over 1,600 Undisclosed Deaths Reported at NY Nursing Homes
New Health Department statistics released late Monday included the previously undisclosed deaths of more than 1,600 people who were presumed to have died of the virus at nursing homes but who had not received a confirmed diagnosis. By May 3, according to the new data, 4,813 people had died of the virus at nursing homes. The new data did not include nursing home residents who died in hospitals.

The number of deaths of nursing home residents, either at homes or in hospitals, was 3,025 on April 28, and approximately 100 more people died at nursing homes from April 29 to May 2, according to state figures.

Gary Holmes, a Health Department spokesman, said officials had revised the state’s system for gathering and evaluating data from homes and that figures would probably continue to be revised. “This crisis and our response to it continues to evolve,” he said. “And the unprecedented amount and specificity of data we are providing to the public will continue to evolve with it.”

David C. Grabowski, a Harvard University researcher who studies nursing homes, said that when the final data is in, nursing homes will probably account for about half of all of the Covid-19 deaths in every state, as they already do in Massachusetts, New Jersey and Pennsylvania, among others.

In New York State, even with the new presumed deaths added, nursing homes account for about 25 percent of the state’s fatalities. The homes hit the hardest have been in New York City and its suburbs. Homes in the Bronx had 215 confirmed virus deaths and 446 deaths the virus was presumed to have caused. In Queens, the new numbers showed 358 confirmed deaths and 476 presumed deaths.

Nursing homes had fought the release of death counts for individual facilities, arguing that a large toll might not indicate poor infection control and might scare families unnecessarily. (NYT, 5/5)


Empire Advancing Payments to Certain Independent Primary Care Physicians
To support these essential providers during the COVID-19 crisis, Empire is advancing payments to certain independent primary care physician organizations and multi-specialty groups that include primary care. Empire (and Anthem) will offer these payments to hundreds of physician organizations across the country, beginning in May.

Dr. Art Fougner, President of the Medical Society of the State of New York, applauds Empire and Anthem, its parent company, for this action for physicians during the pandemic.

“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. It will provide a lifeline to these practices until regular patient visits can resume.

“We are also aware that United and CDPHP have, importantly, also adopted advance programs.  We urge other health insurers to similarly work with their network physicians to implement advance payment programs.”

Statement Attributable to:
Art Fougner, M.D.
President, Medical Society of the State of New York


Pandemic Hurting Primary Care Practices
The coronavirus pandemic has ravaged primary-care practices and physicians are saying they may have to close or sell their practices without more financial relief. The pandemic has highlighted existing disparities in primary-care reimbursement, and expanded telehealth options have not compensated for a massive drop in volume.

Primary-care physicians also complain that they have been disadvantaged by an important federal grant funding formula and CMS recently cut off a loan program designed to help with cash flow. Restrictions on nonemergency procedures and care have decimated in-person volumes, and providers are concerned that patients may be hesitant to return to practices even after restrictions are lifted.

Atrius Health delivers care to 745,000 patients across 31 practices in Massachusetts. The group averaged about 22,000 encounters per week in its internal medicine and pediatrics departments in 2019. Last week, the group logged 4,000 video and 9,600 in-person visits, for a 38% drop in volume. But that is an improvement from mid-March, when video visits were “almost zero. “Telehealth is helping restore some revenue, but reimbursement varies by medium, state and payer. Some practices have struggled to make the sudden transition with outdated equipment.

Most practices have gotten some grant money from the $50 billion HHS distributed from the Coronavirus Aid, Relief, and Economic Security Act’s provider relief fund. But the funding allocation is based on the “net patient revenue” metric in cost reports, which experts say favors specialists who demand higher reimbursement rates than primary-care providers. Some practices also took advantage of Medicare advance payments to help them maintain cash flow, but the loans must be repaid. CMS begins recouping the funds after four months by garnishing Medicare reimbursement. If the loan is not fully repaid in seven months, then the loans begin to accrue interest far higher than market rates.

CMS suddenly suspended the Medicare advance payment program April 16, though it is still accepting applications for Medicare Part A providers. The agency said it distributed more than $40 billion to nearly 24,000 Medicare Part B providers and suppliers and was pulling back on the program because “of historical direct payments made available” through the CARES Act. “Significant additional funding will continue to be available to hospitals and other healthcare providers through other programs,” the agency noted in a fact sheet.

Primary-care advocates are also pushing to allow CMS to pay family medicine practices in monthly, per-patient installments. (Modern Healthcare,5/2)


NYT: Projects Steady Increase in COVID-19 Cases This Month
An internal White House document obtained by The New York Times projects a steady increase in COVID-19 cases this month, with the daily death toll hitting about 3,000 by June 1. At present, about 1,750 COVID-19 deaths are occurring each day. The document also projects about 200,000 new cases daily by the end of May, a large jump from the roughly 25,000 daily cases occurring now.

A researcher at Baltimore-based Johns Hopkins University conducted the preliminary analysis and shared it with FEMA “to aid in scenario planning — not to be used as forecasts,” Joshua Sharfstein, MD, the school’s vice dean of public health practice, told Bloomberg. The White House has distanced itself from the analysis, which was dated May 1 and contains seals for both HHS and the Department of Homeland Security.

“This is not a White House document, nor has it been presented to the Coronavirus Task Force or gone through interagency vetting,” Judd Deere, a spokesperson for the White House, said in a statement to Bloomberg. “This data is not reflective of any of the modeling done by the task force or data that the task force has analyzed.”


DOH: New Guidance for Medicaid Physicians re Use of Telehealth
The Department of Health has released updated guidance for Medicaid providers regarding the use of Telehealth, including Telephonic, services during the COVID-19 State of Emergency. The accompanying Frequently Asked Questions document has also been updated. These documents are available on the Department of Health website here or via the links below.

Medicaid Update

Frequently Asked Questions

A summary of the changes is provided below.

  • Clarification regarding payment parity for telehealth and telephonic services
  • Provides additional details regarding billing and coding instructions, including POS and Modifier codes to use in each of the telephonic billing lanes
  • Clarifies definitions of telehealth, telemedicine, and telephonic services.
  • Clarifies billing rules for Article 28 services with a Professional Component
  • Revises billing rules for FQHCs to allow wrap payments for licensed practitioners providing services via telehealth or telephone
  • Clarifies requirements for Medicaid Managed Care Plans
  • Provides additional links to other resources

The intent of this guidance is to provide broad expansion for the ability of all Medicaid providers in all situations to use a wide variety of communication methods to deliver services remotely during the COVID-19 State of Emergency, to the extent it is appropriate for the care of the member.

Telehealth services will be reimbursed at parity with existing off-site visit payments (clinics) or face-to-face visits (i.e., 100% of Medicaid payment rates). This guidance relaxes rules on the types of clinicians, facilities, and services eligible for billing under telehealth rules.



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.

 

Registration is now open for this webinar.

To view the companion pieces to this webinar, 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.

 

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.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. 

COVID-19 Update May 4, 2020

INTERIM GUIDANCE FOR REOPENING THE HEALTH CARE SYSTEM & BEST PRACTICES FOR REOPENING FROM COVID-19


New York State COVID-19 Stats
NYSDOH COVID-19 Tracker – NY.gov


Highlights: Gov. Cuomo’s Press Conference Today
GENERAL:
– Total hospitalizations down (9,647). Net change in hospitalizations also
down; et change in intubations down; Number of new cases daily down (717). Gov says to “take this with a grain of salt” as weekends tend to report lower numbers to begin with; Deaths since May 3: 226. 193 in hospitals, 33 in nursing homes.
– According to the CDC, strains seen in NY originated in Europe and other U.S.
regions. Most flights from Europe landed in NY and NJ.

REOPENING:
– Have seen increased alcoholism, substance abuse, domestic violence since
beginning of shutdown. Need to act ASAP.
– Other areas seeing second waves due to reopening too quickly or
irresponsibly. Dr. Fauci says “we could be in for a bad fall or a bad winter.”
– Unsure when the state will reopen or how. Gov says even experts don’t know
best course of action, important to be prepared for all possibilities.
– Quantifiable formula based on % and rate of hospitalizations + diagnostic
testing rate + contact tracing = R/T – 1.1.
– Gov says we can control the rate of transmission through these
measures (R/T = 1.1 or less); if R/T manageable, we can reopen businesses in phases. This will increase activity level while keeping an eye on transmission rates.
– If R/T goes above 1.1, Gov will  stop or slow reopening.
– Core factors determining when certain regions can reopen include: monitoring
new infections, healthcare capacity, diagnostic testing capacity, and contact
tracing capacity.
– CDC guidelines for reopening:
– Regions must have at least 14 days of decline in total
hospitalizations/deaths on 3-day rolling basis.
– Cannot have 15 new total cases or 5 deaths on 3-day rolling basis.
– Fewer than 2 new cases per 100k residents.
– Regions must have at least 30% total hospital and ICU beds available.
– Hospitals must have at least 90 days of PPE stockpiled.
– PHASE I: construction/manufacturing/some retailers with curbside pick-up.
– PHASE II: professional services, finance/insurance, real estate, etc.
– PHASE III: restaurants and hotels.
– PHASE IV: arts/entertainment/recreation, education.
– Businesses must develop their own safety precautions in compliance with new
social distancing standards.

TESTING:
– 1 million NYers have now been tested.
– CDC recommends 30 tests for every 1k residents in regions in order to reopen.
– National Guard has put together 30,000 testing kits.
– Will be issuing 60,000 tests
– Regions must have baseline of 30 contact tracers for every 100k residents,
additional tracers based on number of cases in the region.
– “Army of tracers” being built in partnership with Mayor Bloomberg.


Contact Tracing Opportunities in NYS
The aim of this initiative will be to call every person diagnosed with COVID-19, establish all contacts of this person, and proceed to call and maintain ongoing communication with every contact. In addition, the team will support the isolation and quarantine of individuals, as appropriate in cooperation with the Local Health Department. This includes virtual needs checks and referral to community resources as needed. This contact tracing initiative is in tandem with statewide-wide efforts to increase testing, improve communication and knowledge of effective strategies to reduce transmission, and implementation of isolation and quarantine. This will fortify efforts to control the pandemic in NYS.

New York State plans to hire a team of 6,400 to 17,000 staff statewide, depending on the projected number of COVID-19 cases, to support the NYS Department of Health (NYSDOH) and Local Health Departments (LHDs) to perform contact tracing in communities across NYS. To meet the scale and scope of this nation-leading program, Bloomberg Philanthropies, Vital Strategies: Resolve to Save Lives and the Johns Hopkins Bloomberg School of Public Health will support building the team through a three-step process: recruitment, interviewing and training.

Our first goal is to help the state identify and recruit a robust Contact Tracing team to be a part of this ambitious and urgent effort. To be considered, candidates must be a New York State resident 18 years of age or older; meet the position description requirement; go through an interview process; and complete a training and certification program.

New York State is looking to immediately fill the following roles:

  • Contact Tracers: reach out to the contacts of anyone diagnosed with COVID-19 to assess symptoms, ensure compliance with quarantine and determine social support needs.
  • Team Supervisors:  lead a team of 20 Contact Tracers, and one Community Support Specialist who are working remotely using digital tools.
  • Community Support Specialists: work with the team and the local health departments to address the physical/mental health, and social/human service needs of those contacted, especially those who are under isolation or quarantine.

Click here if you or someone you know in New York State is interested in applying to be a part of the Contact Tracing team.


Gov. Eliminates Cost Sharing for Mental Health Services for Frontline Essentials
Noting that the “COVID-19 crisis has had an immeasurable impact on all New Yorkers, the impact on essential workers, including health care workers, first responders and other frontline essential employees”, New York Superintendent of Financial Services Linda Lacewell announced this weekend that the New York State DFS issued an emergency regulation following Governor Andrew M. Cuomo’s announcement that DFS will require New York State-regulated health insurers to waive out-of-pocket costs, including cost-sharing, deductibles, copayments and coinsurance, for in-network mental health 
A copy of the DFS circular letter can be found
here.


Faced With 20,000 Dead, Care Homes Seek Shield From Lawsuits
Faced with 20,000 coronavirus deaths and counting, the nation’s nursing homes are pushing back against a potential flood of lawsuits with a sweeping lobbying effort to get states to grant them emergency protection from claims of inadequate care. At least 15 states have enacted laws or governors’ orders that explicitly or apparently provide nursing homes and long-term care facilities some protection from lawsuits arising from the crisis. And in the case of New York, which leads the nation in deaths in such facilities, a lobbying group wrote the first draft of a measure that apparently makes it the only state with specific protection from both civil lawsuits and criminal prosecution. (AP, 5/4)


Physicians Urge CMS to Restart Advance Payment Program
The American Medical Association, sent a letter to CMS urging the agency to restart and expand the Advance Payment Program.

In late March, CMS expanded the payment program to a broader group of healthcare providers to help offset the financial damage caused by the COVID-19 pandemic. The agency suspended the advance Medicare payments to Part B suppliers, including physicians, other medical professionals and durable medical equipment suppliers, on April 26, two days after President Donald Trump signed the Paycheck Protection Program and Health Care Enhancement Act.

In an April 28 letter to CMS Administrator Seema Verma, the AMA asked the agency to quickly reinstate the program with more flexible terms.

“Given the uncertainty facing physician practices as the pandemic is on different surge timelines in communities across the country, we fear physician practices may not resume normal operation in the immediate future and will continue to need access to cash flows to keep their doors open for patients,” the AMA said.

The AMA also urged CMS to expand the program to Medicaid providers.

“While the CARES Act and the recently enacted Paycheck Protection Program and Health Care Enhancement Act may provide much needed financial relief for many physicians, we are concerned that the resources provided may not reach Medicaid practices and providers and that these funds alone may not be sufficient to sustain practices and ensure patient access,” the AMA said.

As of April 26, CMS had approved nearly 24,000 applications advancing $40.4 billion in payments to physicians, other healthcare practitioners and durable medical equipment suppliers. The agency has delivered nearly $60 billion in payments to Part A providers, which includes hospitals. CMS announced on April 26 that it is reevaluating all pending and new applications for accelerated payments to hospitals (Becker’s Hospital Review, May 1)


COVID-19 is 3rd Leading Cause of Death, STAT Analysis Suggests
Updated death projections suggest COVID-19 is the third leading cause of death in the U.S., behind cancer and heart disease, according to an analysis from STAT. STAT first compared COVID-19 death projections to past pandemics and leading causes of death in early April to help Americans get a better sense of the numbers. The previous comparison used projections from the Institute for Health Metrics and Evaluation, which now estimates the death toll will be 72,433 by Aug. 4. IHME previously predicted a death toll of 60,000, which the U.S. surpassed April 29.

For the updated comparison, STAT used a model created by Youyang Gu, an independent data scientist. The model projects 88,217 to 293,381 deaths by early August.

How this projection stacks up to past pandemics and flu seasons:

  1. 1918 flu pandemic: 675,000 deaths
    2. COVID-19 pandemic: 88,217 to 293,381 projected deaths
    3. 2017-18 flu season: 61,000 deaths
    4. 2018-19 flu season: 34,200 deaths
    5. 2009 swine flu pandemic: 12,469 deaths

Note: The CDC does not track individual adult flu deaths and instead estimates seasonal death tolls using mathematical modeling.

How this projection stacks up to the nation’s leading causes of death:

1.Heart disease: 269,583 deaths
2. Cancer: 252,500 deaths (based on 2019 data)
3. COVID-19 pandemic: 88,217 to 293,381 projected deaths
4. Stroke: 60,833 deaths
5. Alzheimer’s disease: 50,417 deaths
6. Drug overdoses: 29,265 deaths
7. Suicide: 19,583 deaths
Note: These figures do not represent annual death counts. COVID-19 models project deaths will fall over the next few weeks, with few occurring past July. To compare death tolls on an equal timeline, STAT calculated death counts for a five-month period for all leading causes of death. All figures are based on 2017 data unless otherwise noted.



MLMIC Banner


FDA Allows Emergency Use of Drug for Coronavirus
U.S. regulators on Friday allowed emergency use of an experimental drug that appears to help some coronavirus patients recover faster.

It is the first drug shown to help fight COVID-19, which has killed more than 230,000 people worldwide.

The Food and Drug Administration acted after preliminary results from a government-sponsored study showed that Gilead Sciences’ remdesivir shortened the time to recovery by 31%, or about four days on average, for hospitalized COVID-19 patients.

The study of 1,063 patients is the largest and most strict test of the drug and included a comparison group that received just usual care so remdesivir’s effects could be rigorously evaluated.

Those given the drug were able to leave the hospital in 11 days on average versus 15 days for the comparison group. The drug also might be reducing deaths, although that is not certain from the partial results revealed so far.

The National Institutes of Health’s Dr. Anthony Fauci said the drug would become a new standard of care for severely ill COVID-19 patients like those in this study. The drug has not been tested on people with milder illness, and currently is given through an IV in a hospital.

Gilead has said it would donate its currently available stock of the drug and is ramping up production to make more. No drugs are approved now for treating the coronavirus, and remdesivir will still need formal approval. (Modern Healthcare May 1)


CMS: Forming Independent Commission to Assess Nursing Homes
CMS will form an independent commission to assess how nursing homes have responded to the pandemic, upping the scrutiny on the facilities that have become COVID-19 hot spots. The commission will primarily focus on nursing home residents’ safety, strengthening regulations to stem the spread of COVID-19 and enhancing federal and state enforcement strategies to improve compliance with infection-control policies, the agency announced late Thursday. It also aims to better coordinate efforts between federal, state, and local authorities as well as identify best practices that may be incorporated into a larger regulatory framework, CMS said

Homing in on the hard-hit state of New York, 93% of its nursing homes have COVID-19 positive patients. COVID-19 patients make up more than 10% of the residents at nearly half of the state’s nursing homes. There has been a 41% year-over-year increase in COVID-19-related symptoms reported in New York nursing homes, pointing to a potential surge, or surge that has occurred but not yet confirmed due to lack of testing, CarePort researchers found. New York City SNFs alone are short an estimated 1,000 beds.

The commission, which will be made up of nursing home operators, public officials, academics, infection-control specialists, medical ethicists and resident advocates, builds on CMS Administrator Seema Verma’s five-part plan announced last year to ensure safety and quality at nursing homes. Ideally, the commission can come up with recommendations to assist long-term care providers and not just penalize them, but much of Verma’s five-part plan has been punitive in nature, said Brian French, a partner at Nixon Peabody.

The administration also announced Thursday that it will send two shipments of personal protective gear to every nursing home over the next two months, each of which contains a one-week supply. Still, experts blame the administration for not acting quick enough, which contributed to thousands of deaths at nursing homes across the country. Fewer than 10% of nearly 9,000 U.S. nursing homes surveyed said they have the ability to take in new COVID-19 patients, according to a CarePort Health poll conducted from early to mid-April. Prior to the pandemic, SNFs had been paring down their workforces due to a new payment model, exacerbating the crisis. (Modern Healthcare)


AMA Launches Physician Guide for Reopening Medical Practices
CHICAGO – In response to states across the nation revising COVID-19 executive orders to allow elective or non-urgent medical procedures, the American Medical Association (AMA) is announcing a new resource that provides a step-by-step guide for physicians planning to reopen medical practices. This new guide builds on the AMA’s ongoing efforts to ensure physicians and health care professionals have the most up-to-date information and resources necessary to navigate the rapidly changing landscape of the COVID-19 pandemic.

Specifically, the resource offers support and guidance for managing the safe reopening of a medical practice as more routine in-person care resumes, protecting the health of patients, clinicians, staff, and the public. It serves as a one-stop-shop outlining how best to approach the unique challenges that the COVID-19 pandemic brings to the practice reopening process, providing physicians with checklists, supplemental information and helpful links to COVID-19 resources from the AMA, Centers for Disease Control and Prevention (CDC) and other federal agencies.

A summary of practice reopening tools available to physicians includes:

  • Ensuring state and federal government compliance

As states and municipalities modify COVID-19 executive orders detailing the types of medical services permitted, the AMA provides recommendations for closely reviewing and following these individual guidelines while remaining in compliance with federal mandates. This section includes an AMA-developed chart and fact sheet overviewing state-specific resumption of elective or non-urgent procedures.

  • Creating a plan for opening medical practices

This portion of the guideline includes a step-by-step approach to safely and incrementally opening a medical practice. It includes details needed to plan for supplying the office with personal protective equipment (PPE), suggestions for routine disinfecting regimens and staff scheduling protocols. As health experts continue to urge physical distancing as the most effective way to reduce the spread of COVID-19 until a vaccine or effective treatment is available, the resource suggests continuing to gauge whether a telemedicine or in-person appointment would be more appropriate.

  • Instituting new safety measures for patients, clinicians, and staff

Because COVID-19 screening processes designed to reduce community spread of the virus are new territory for physician practices, the guide offers recommendations on how to establish staff, patient and visitor safety protocols to ensure safe physical distancing, minimize interactions and limit the volume of individuals in the practice. Provided is a pre-appointment patient screening script template, designed for staff to inquire via phone about patients’ potential COVID-19 symptoms or exposure ahead of entry to the facility. Consistent with CDC guidance, practices should require all individuals who visit the office to wear a cloth face covering to reduce the risk of virus transmission. In addition, information about monitoring and restricting non-patient visitors, staggering appointment scheduling, designating waiting areas and creating dedicated workstations is included here.

  • Reviewing medical liability, privacy and confidentiality policies related to COVID-19

This page overviews the new legal territory and scenarios related to essential COVID-19 screening of patients, visitors and staff, including how to establish and maintain health-related privacy, confidentiality and data security to protect COVID-19 employee testing results while remaining in compliance with HIPAA rules. It also links to topics related to discussing current coverage with medical liability insurance carriers and the AMA’s advocacy efforts for greater reliance on health care emergency response protections to support physicians amid the COVID-19 pandemic.

The AMA will also continue to release additional information in response to the urgent public health crisis to support physicians and the patients they care for, which can be found on the AMA’s COVID-19 Resource Center.


 

 

Health Connections Banner

 

 

COVID-19 Update May 1, 2020

MSSNY Legislative Podcast


New York State COVID-19 Stats

NYSDOH COVID-19 Tracker – NY.gov


Highlights: Gov. Cuomo’s Press Conference Today

  • New York reported 289 deaths related to COVID-19 in the past 24 hours. The rate of hospitalizations and net change of hospitalizations continue to trend downward, while the number of new COVID-19 patients remains flat.
  • Overall hospitalizations in the state have been well below original projections made at the outset of the pandemic. Cuomo said, by practicing social distancing, New Yorkers likely helped save close to 100,000 lives.
  • The next steps the state will need to take involve addressing the new daily cases – which have hovered between 950-1,100 for several days.
  • The majority of new cases are in the downstate region.
  • Schools across New York will remain closed for the remainder of the academic year.
  • K-12 and college facilities will continue to provide distance learning for rest of academic year
  • The governor says schools will still be required to execute meal provision plans, as well as assist in childcare options for essential workers.
  • Schools and colleges will be required to come up with plans to eventually reopen in ways that do not put students and essential workers at risk; those plans will need to be approved by the state before they can be carried out.
  • It is not yet clear when a decision will be made on the 2020-2021 academic year, but he added that schools should start planning sooner than later.
  • Some businesses may be able to reopen in some regions of the state depending on specific factors, such as the virus’ local impact, around May 15.

Gov. Permits Limited Resumption of “Elective” Surgeries; MSSNY Objects to ASC Exclusion
Governor Cuomo put forth an Executive Order this week permitting the resumption of elective surgery in 35 counties across upstate New York, where there is less of a chance of a coronavirus surge, including Monroe and Onondaga counties.  Of particular concern was the limitation on resumption of elective surgery in these counties to hospitals only, not Ambulatory Surgery Centers and office-based surgery locations that are often owned by physicians.

MSSNY President Dr. Art Fougner was quoted in the Utica Observer-Dispatch about the adverse impact of this limitation on patients obtaining needed care across Central New York, and issued a statement today (LINK) calling for this arbitrary exclusion to be eliminated so that patients have a choice in these counties as to where they can receive these needed surgeries.  Physicians can send a letter to the Governor expressing their concerns here: https://p2a.co/WOOJcvS

The guidance from DOH permitting the limited resumption of elective surgeries does provide important clarification to perhaps address some confusion as to what specifically was prohibited.  The guidance notes that the prohibition does not prevent hospitals, ASCs and OBS from performing surgeries and procedures related to the diagnosis of cancer such as lumpectomies and biopsies, the treatment of intractable pain, or other diagnostic and treatment services for highly symptomatic patients. It also includes a grid of examples to help guide treatment or delay decisions.


Medicare to Increase Payments for Audio-Only Telehealth
In response to advocacy by organized medicine, the Centers for Medicare & Medicaid Services (CMS) announced this week that it will be increasing payments for audio-only telephone visits between Medicare beneficiaries and their physicians to match payments for similar office and outpatient visits.

According to the American Medical Association (AMA), this would increase payments for these services from a range of about $14-$41 to about $46-$110, and the payments are retroactive to March 1, 2020.  This is a major victory for organized medicine that will enable physicians to care for their patients, especially their elderly patients with chronic conditions who may not have access to audio-visual technology or high-speed Internet.


NYSDOH Weekly Update for Physicians on YOUTUBE
April 30: Weekly Update to Healthcare Providers

Watch the webinar on YouTube.

Purpose: The purpose of this weekly publication is to provide healthcare providers in New York State with a consolidated update of guidance released by the New York State Department of Health (NYSDOH) related to the COVID-19 pandemic response. This will show only current guidance for any given topic and will be updated to reflect new guidance.

As a reminder, all advisories and informational messages (including webinar invitations) are distributed through the Integrated Health Alerting Network System (IHANS), an application housed on the Health Commerce System (HCS). If you are not receiving IHANS notifications, please work with your site’s HCS coordinator. Additional COVID-19 resources may be found on the NYSDOH webpage under Information for Healthcare Providers.

Recordings of COVID-19 Weekly Healthcare Provider Updates are also available on the NYSDOH


Paycheck Protection Program (PPP) Update
Have you applied for the PPP small business forgivable loan program yet?  According to SBA.gov as of 5:00 PM yesterday more than 960,000 loans had been approved totaling greater than $90 billion. The total number of lenders involved in processing these transactions has been 5,300 so far. Last week Congress approved an additional $310 billion for the program.

Yesterday, the SBA notified borrowers and lenders that certain provisions would be put in place to favor lending from smaller institutions. The text of the notice:

Paycheck Protection Program (PPP) Lending Operations Update – Wednesday, April 29, 2020

SBA and Treasury value all lenders and their small business customers.

To ensure access to the PPP loan program for the smallest lenders and their small business customers, starting at 4 p.m. today EDT through 11:59 p.m. EDT, SBA systems will only accept loans from lending institutions with asset sizes less than $1 billion.

Please note, lending institutions with asset sizes less than $1 billion will still be able to submit PPP loans outside of this time frame. Please also note that lenders with asset sizes greater than $1 billion will be able to submit loans outside of today’s 4:00 PM -11:59 PM EDT reserved processing time.

This reserved processing time applies today April 29, 2020. SBA and Treasury will evaluate whether to create a similar reserved time again in the future.

SBA and Treasury continue to monitor loan system performance and will continue to provide frequent updates to the lending community.


MLMIC Banner


Garfunkel Wild One-Hour Webinar: The Enforceability of Employment Contracts During the COVID-19 Pandemic on Monday May 4 @12 noon-1pm

Speakers:  Andrew L. Zwerling and Roy W. Breitenbach

Garfunkel Wild’s Andrew L. Zwerling and Roy W. Breitenbach will present the webinar “The Enforceability of Employment Contracts During The COVID-19 Pandemic” on May 4, 2020.

Among the many impacts of the COVID-19 pandemic has been the steep rise in concern over the viability of employment contracts. Businesses of all types, in all industries, have experienced business and financial disruption of profound magnitude that has compelled them to take action of various types that, on their face, violate the plain language of employment contracts of which they are a part.

Salary reductions, work reductions, terminations without requisite notice, job furloughs and similar actions that on their face violate contractual obligations have become commonplace as businesses try to stay viable, if not operationally functional, during the COVID-19 crisis. This raises certain obvious questions: despite running afoul of the plain language in employment contracts, are such actions nonetheless proper given the impact of the pandemic? Are parties obligated to perform their obligations under employment contracts given the constraints imposed by governmental orders and other fallout from the pandemic or are they discharged from such obligations? Does it matter that there is a force majeure provision in my contract? What happens if the employment contract does not have a force majeure clause?

We will conduct a webinar that will address these issues and others, including the applicability of doctrines of impossibility of performance, impracticability of performance and frustration of performance, and the effect of force majeure clauses.

Click Here To Register


When States Ordered Nursing Homes to Take COVID-19 PTs, Many Put in Danger
On March 29, as New York and other states began ordering nursing homes to admit medically stable residents infected with the coronavirus, national trade groups warned it could unnecessarily cost more lives.

The health directives put “frail and older adults who reside in nursing homes at risk” and would “result in more people going to the hospital and more deaths,” the American Health Care Association and affiliates said at the time. A month later, it appears government officials should have heeded the dire call to pursue different pandemic emergency plans.

The deadly virus has spread like wildfire through many nursing homes across the Northeast, and state officials are scrambling to better protect those most vulnerable to COVID-19, the disease caused by the virus.

The death toll is devastating, according to interviews with nursing-home officials, patients’ families, health-care advocates, government officials and from an examination of state records by the USA Today Network Atlantic Group, a consortium of 37 Gannett-owned daily newspapers across the Northeast.

  • At least 3,043 people have died inside New York nursing homes due to COVID-19 complications, or about 17% of the state’s 18,015 deaths as of Wednesday.
  • In Pennsylvania, about 65% of coronavirus deaths were nursing-home residents, and New Jersey had 3,200 residents of long-term care homes die due to complications from the virus, about 40% of the statewide total.
  • About 58% of the deaths in Delaware lived in nursing homes, and 46% of the fatalities in Maryland were at nursing homes, prompting Gov. Larry Hogan to order residents and staff members at nursing homes be tested for coronavirus.

Meanwhile, advocates and residents’ relatives have criticized state and federal officials, as well as some nursing homes, for failing to address the crisis as deaths mounted.

“To have a mandate that nursing homes accept COVID-19 patients has put many people in grave danger,” said Richard Mollot, executive director of the Long Term Care Community Coalition in New York. (LoHud, May 1)


Cuomo to Order Insurers to Offer Free Mental Health Services for Essential Workers
Essential workers in New York can soon access free mental health services through their insurance plans, Gov. Andrew Cuomo said today.

The governor said he is directing all insurers to waive any cost sharing, co-pay and deductibles for frontline workers seeking mental health services during the Covid-19 pandemic.

“Too many people, too many families have said to me, ‘Well, I would go for services but I don’t want to pay the cost, I can’t afford it,’” Cuomo said at a morning news conference. “That’s gone. There is no cost to get mental health services. Just wipe that reason away and get the help that you need.”

Cuomo also announced a new emotional support hotline for essential workers. If you need support, call the New York State Emotional Support Hotline at 1-844-863-9314.


NYSDOH Mirrors CDC’s Guidance for Healthcare Facilities’ Employees
On March 16, 2020, the Centers for Disease Control and Prevention (CDC) issued guidance to address employees of healthcare facilities, including nursing homes, suspected of or confirmed to be positive for the COVID-19 virus (Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)). Under the CDC guidance workers could return to work at a nursing home:

  • “At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
  • At least 7 days have passed since symptoms first appeared.”

The CDC updated their guidance to address asymptomatic workers thereafter.

New York State Department of Health’s guidance mirrored the CDC’s position – however, going forward we will no longer adhere to CDC’s standard on this issue, and will instead require that nursing home employees who test positive for COVID-19 but remained asymptomatic are not eligible to return to work for 14 days from first positive test date in any situation and will no longer adhere to the shorter CDC timeframe. Symptomatic nursing home employees may not return to work until 14 days after the onset of symptoms, provided at least 3 days (72 hours) have passed since resolution of fever without the use of fever-reducing medications and respiratory symptoms are improving. PDF here

Nursing homes must only accept and retain those residents for whom the facility can provide adequate care. 


 

NYEC Banner AD


New York to Hire ‘Army of Tracers’ to Combat Coronavirus
New York will hire up to 17,000 contact tracers as part of a statewide effort to combat the novel coronavirus pandemic by tracking down people who have gone near those infected by Covid-19. New York Gov. Andrew Cuomo said at a Thursday press conference that the state needs at least 30 tracers for every 100,000 people to follow the path of those infected and determine whether their contacts should be isolated. (WSJ 4/30)

Articles:

·       Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic https://jamanetwork.com/journals/jama/fullarticle/2764380

 

 

1 2 3 4