COVID-19 Update May 15, 2020
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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.
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 Webinar
DATE: May 21, 2020
Time: 7pm
Guest Speaker
Dr. David A. Hirschwerk
Attending-Infectious Diseases
Executive Vice Chair-Dept. of Medicine
North Shore University Hospital/LIJ Medical Center
