MSSNY eNews: April 14, 2021 – CDC and NYS DOH Info on Johnson & Johnson Vaccine
Message from NYS Health Commissioner Dr. Howard Zucker re: Johnson & Johnson COVID-19 Vaccine
New York State is following the CDC and FDA recommendation by immediately halting the use of the Johnson & Johnson vaccine statewide at all vaccine provider locations while federal health and safety agencies evaluate next steps. If you are scheduled to administer Johnson & Johnson vaccine, you should not do so until further notice. At this time, please retain any Johnson & Johnson vaccine doses you have in proper storage conditions. We will update you as soon as we have additional information.
At this time, due to the continued limited supply of COVID-19 vaccine, there is no supply of Pfizer or Moderna vaccine to replace the Johnson & Johnson doses. Thank you for your participation in the vaccination program and for your patience while the CDC and FDA determine next steps.
US House Passes Legislation to Prevent 2% Medicare Cut Until 2022
Yesterday the US House of Representatives overwhelmingly approved legislation to extend until the end of the year the 2% Medicare sequester moratorium that had expired on April 1. This bill to prevent ill-timed Medicare cuts to physicians and other care providers had previously passed the US Senate in late March and President Biden is expected to sign it into law.
The Centers for Medicare & Medicaid Services has been holding off on processing April Medicare claims to avoid making payments with reduced amounts. Prevention of these cuts was a significant focus in the meetings that MSSNY physician leadership had with the New York Congressional delegation in late February.
CDC Health Alert: Cases of Cerebral Venous Sinus Thrombosis with Thrombocytopenia after Receipt of the Johnson & Johnson COVID-19 Vaccine
As of April 12, 2021, approximately 6.85 million doses of the Johnson & Johnson (J&J) COVID-19 vaccine (Janssen) have been administered in the United States. The Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) are reviewing data involving six U.S. cases of a rare type of blood clot in individuals after receiving the J&J COVID-19 vaccine that were reported to the Vaccine Adverse Events Reporting System (VAERS). In these cases, a type of blood clot called cerebral venous sinus thrombosis (CVST) was seen in combination with low levels of blood platelets (thrombocytopenia).
All six cases occurred among women aged 18–48 years. The interval from vaccine receipt to symptom onset ranged from 6–13 days. One patient died. Providers should maintain a high index of suspension for symptoms that might represent serious thrombotic events or thrombocytopenia in patients who have recently received the J&J COVID-19 vaccine. When these specific type of blood clots are observed following J&J COVID-19 vaccination, treatment is different from the treatment that might typically be administered for blood clots.
Based on studies conducted among the patients diagnosed with immune thrombotic thrombocytopenia after the AstraZeneca COVID-19 vaccine in Europe, the pathogenesis of these rare and unusual adverse events after vaccination may be associated with platelet-activating antibodies against platelet factor-4 (PF4), a type of protein. Usually, the anticoagulant drug called heparin is used to treat blood clots. In this setting, the use of heparin may be harmful, and alternative treatments need to be given.
CDC will convene an emergency meeting of the Advisory Committee on Immunization Practices (ACIP) on Wednesday, April 14, 2021, to further review these cases and assess potential implications on vaccine policy. FDA will review that analysis as it also investigates these cases. Until that process is complete, CDC and FDA are recommending a pause in the use of the J&J COVID-19 vaccine out of an abundance of caution. The purpose of this Health Alert is, in part, to ensure that the healthcare provider community is aware of the potential for these adverse events and can provide proper management due to the unique treatment required with this type of blood clot.
VAERS is a national passive surveillance system jointly managed by CDC and FDA that monitors adverse events after vaccinations. The six patients (after 6.85 million vaccine doses administered) described in these VAERS reports came to attention in the latter half of March and early April of 2021 and developed symptoms a median of 9 days (range = 6–13 days) after receiving the J&J COVID-19 vaccine. Initial presenting symptoms were notable for headache in five of six patients, and back pain in the sixth who subsequently developed a headache. One patient also had abdominal pain, nausea, and vomiting. Four developed focal neurological symptoms (focal weakness, aphasia, visual disturbance) prompting presentation for emergency care.
The median days from vaccination to hospital admission was 15 days (range = 10–17 days). All were eventually diagnosed with CVST by intracranial imaging; two patients were also diagnosed with splanchnic* and portal vein thrombosis. Unusual for patients presenting with thrombotic events, all six patients showed evidence of thrombocytopenia (<150,000 platelets per microliter of blood), consistent with a condition known as thrombotic thrombocytopenia, with platelet nadir counts ranging from 10,000 to 127,000 during their hospitalizations.
Four patients developed intraparenchymal brain hemorrhage and one subsequently died. All data presented in this HAN are preliminary and investigations of these VAERS reports are ongoing. The Clinical Immunization Safety Assessment (CISA) project which includes experts in infectious disease and hematology are also reviewing these cases. To date, VAERS has received no reports of CVST with thrombocytopenia among persons who received either of the two mRNA-based COVID-19 vaccines.
These reports following the J&J COVID-19 vaccine are similar to reports of thrombotic events with thrombocytopenia after receipt of the AstraZeneca COVID-19 vaccine in Europe. Both vaccines contain replication-incompetent adenoviral vectors (human [Ad26.COV2.S] for J&J and chimpanzee [ChAdOx1] for AstraZeneca) that encode the spike glycoprotein of SARS-CoV-2, the virus that causes COVID-19. Based on studies conducted among the patients diagnosed with immune thrombotic thrombocytopenia after the AstraZeneca COVID-19 vaccine in Europe, the pathogenesis of these rare and unusual adverse events may be associated with platelet-activating antibodies against platelet factor 4 (PF4).
Anti-PF4, also known as heparin-PF4 antibody, can induce thrombotic thrombocytopenia in a small percentage of persons exposed to heparin. However, none of the cases reported from Europe had recent heparin exposure. As with heparin-induced thrombocytopenia, the administration of the anticoagulant heparin should be avoided in patients with potential vaccine-associated immune thrombotic thrombocytopenia (VITT), unless heparin-induced thrombocytopenia (HIT) testing is negative. Non-heparin anticoagulants and high-dose intravenous immune globulin should be considered in treatment of patients who present with immune-mediated thrombotic events with thrombocytopenia after J&J COVID-19 vaccination. Consultation with hematology specialists is strongly recommended.
* The term ‘splanchnic circulation’ describes the blood flow to the abdominal gastrointestinal organs including the stomach, liver, spleen, pancreas, small intestine, and large intestine.
- Pause the use of the J&J COVID-19 vaccine until the ACIP is able to further review these CVST cases in the context of thrombocytopenia and assess their potential significance.
- Maintain a high index of suspension for symptoms that might represent serious thrombotic events or thrombocytopenia in patients who have recently received the J&J COVID-19 vaccine, including severe headache, backache, new neurologic symptoms, severe abdominal pain, shortness of breath, leg swelling, petechiae (tiny red spots on the skin), or new or easy bruising. Obtain platelet counts and screen for evidence of immune thrombotic thrombocytopenia.
- In patients with a thrombotic event and thrombocytopenia after the J&J COVID-19 vaccine, evaluate initially with a screening PF4 enzyme-linked immunosorbent (ELISA) assay as would be performed for autoimmune HIT. Consultation with a hematologist is strongly recommended.
- Do not treat patients with thrombotic events and thrombocytopenia following receipt of J&J COVID-19 vaccine with heparin, unless HIT testing is negative.
- If HIT testing is positive or unable to be performed in patient with thrombotic events and thrombocytopenia following receipt of J&J COVID-19 vaccine, non-heparin anticoagulants and high-dose intravenous immune globulin should be strongly considered.
- Report adverse events to VAERS, including serious and life-threatening adverse events and deaths in patients following receipt of COVID-19 vaccines as required under the Emergency Use Authorizations for COVID-19 vaccines.
For Public Health
- Pause the use of the J&J COVID-19 vaccine in public health clinics until the ACIP is able to further review these CVST cases in the context of thrombocytopenia and assess their potential significance.
- Encourage healthcare providers and the public to report all serious and life-threatening adverse events and deaths following receipt of COVID-19 vaccines to VAERS as required under the EUAs for COVID-19 vaccines.
- Disseminate this alert to healthcare providers in your jurisdictions.
For the Public
- If you have received the J&J COVID-19 vaccine and develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination, contact your healthcare provider, or seek medical care.
- Report adverse events following receipt of any COVID-19 vaccine to VAERS.
- If you are scheduled to receive the J&J vaccine, please contact your healthcare provider, vaccination location, or clinic to learn about additional vaccine availability.
Do You Know an Outstanding Physician? MSSNY Now Accepting Nominations for the Albion O. Bernstein, MD Award
“…the physician, surgeon or scientist who shall have made the most widely beneficial discovery or developed the most useful method in medicine, surgery or in the prevention of disease in the twelve months prior to December, 2020.”
This award was endowed by the late Morris J. Bernstein in memory of his son, a physician who died in an accident while answering a hospital call in November, 1940.
The $2,000 award will be presented to the recipient during a MSSNY Council Meeting.
Nominations must be submitted on an official application form and must include the nominator’s narrative description of the significance of the candidate’s achievements as well as the candidate’s curriculum vitae, including a list of publications or other contributions.
Deadline for applications is June 9, 2021. To request an application, please contact:
Committee on Continuing Medical Education
Miriam Hardin, PhD, Manager, Continuing Medical Education
Medical Society of the State of New York
99 Washington Avenue, Suite 408
Albany, NY 12210
MSSNY’s Women Physicians Committee Offers Volunteer Virtual Homework Assistance
MSSNY has volunteer homework assistants! If you have school age children (K – 12) who could use a virtual helping hand with homework, let us know.
The MSSNY Women Physicians Committee, recognizing the considerable additional responsibility that has fallen on our physician families with school age children due to the Covid-19 pandemic, has launched a Virtual Volunteer Homework Assistance Program. This is a MSSNY members only program.
Contact firstname.lastname@example.org and tell us in which subject(s) your child is in need of support. We will match your child with a helper as best we can. You can then make the arrangements that work best for all.
Please remember that our homework assistants are members’ children who have volunteered (i.e. not professionals tutors and not vetted) and that MSSNY is not responsible for scholastic outcomes.
With our thanks,
NYS Department of Health COVID-19 Update for Healthcare Providers: Thursday, April 15th, 1-2 PM
To accommodate the large number of participants, find the webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers: https://coronavirus.health.ny.gov/weekly-healthcare-provider-update
Audio number and code: 844-512-2950 Access code 3386015#
Info Blocking Rule Examples Needed: Take the AMA Survey
The AMA is conducting an informal survey to collect members’ perspectives, stories, and examples of patient harm as it relates to the release of protected health information (PHI). This information will inform AMA’s policy and advocacy efforts. The Office of the National Coordinator for Health Information Technology (ONC) recently implemented regulations that require physicians to make available a variety of medical information (e.g., lab tests, clinical notes, medications, etc.) to entities or individuals requesting that information for or on behalf of the patient. Physicians interfering or imposing any delays in the access, exchange, or use of that information would likely implicate new rules aimed to prevent information blocking.
ONC’s guidance is directing physicians to immediately release information to patients—in many cases, prior to the physician reviewing the information and without regard to whether such release could be mentally or emotionally distressing to the patient. For example, a radiology report of a CT scan indicating a “malignancy could not be ruled out” must be sent to the patient’s portal or smartphone application even if the oncologist has yet to view the study or read the report. If this report were sent to a parent of an infant ahead of a holiday weekend, the parent could unnecessarily spend days in deep emotional distress before being able to talk to the infant’s physician.
Another example pertains to adolescent medical records, particularly in states where minors do not have specific privacy protections, allowing parents to access their adolescent’s health information. Adolescents often confide in their clinicians as a “safe space” and the release of information against their wishes could provoke significant emotional or psychological distress, even in scenarios where the adolescent may not fear physical abuse. While patients accessing their medical information is an important part of patient-centered care and the AMA strongly supports patient access and engagement, there are a variety of ethical, professional, and practical concerns with automatically and immediately releasing all reports and office notes.
We are interested in real-world examples, scenarios, and instances where the release of reports or notes without vital physician context or review with the patient could or has caused emotional or mental harm. The AMA is advocating for OCR to revise its subregulatory guidance on “harm” to include emotional and mental distress. This would facilitate ONC’s ability to create additional flexibility. Your information will help inform the AMA’s efforts to address unintended consequences of OCR’s current policy and ONC’s information blocking regulations. Please send your examples to Ela Cameron Ela.Cameron@ama-assn.org by April 30th.
DATE CHANGE: Social Media in Medicine is Now Wednesday, May 5 at 6 PM ET
MSSNY Vice President Parag H. Mehta, MD and MSSNY YPS Chair Daniel E. Choi, MD present Social Media in Medicine: A Beginners Guide for Physicians.
When: May 5, 2021 at 6:00 PM Eastern Time
After registering, you will receive a confirmation email containing information about joining the meeting.
- Introduction to popular social media physician communities: #MedTwitter,
Instagram, YouTube, TikTok
- How to establish a social media presence and grow your audience
- Common terminology e.g. Twitter handle, hashtag
- Scheduling posts
- How social media can be harnessed for effective patient education, practice growth, and advocacy
- Best ways to connect with patients and colleagues on social media
- Pitfalls of social media as a physician
- What not to do on social media
Updates for Accelerated and Advanced Payments Program
During this session, we will review the revised repayment and recoupment process and provide the latest updates on the Accelerated and Advanced Payments program. If your facility received an accelerated or advanced payment from Medicare due to the COVID-19 public health emergency, then attending this webinar will provide the most current information from CMS.
Medicare Part B
Apr 15, 2021 10:00 a.m ET – 11:00 a.m ET
COVID-19 Medicare Part B Advanced Payment, Repayment and Recoupment Process
If you requested accelerated or advanced payments from Medicare due to the COVID-19 public health emergency, this learning session is for you. CMS expanded the accelerated and advance payment program for financial hardship relief during the COVID-19 public health emergency. Accelerated or advanced payments need to be repaid to the Medicare Trust Fund. During this webinar, we will review the repayment and recoupment process and address your questions.
MSSNY Medical Matters Program on Mental Health of Children and Teens During COVID
Registration now open
Medical Matters: COVID-19 & Mental Health of Children and Teens
Date: April 21, 2021 @ 7:30am
The COVID-19 pandemic has affected the mental health of the entire population. Learn more about how children and teens have been affected by registering for Medical Matters: COVID-19 & Mental Health of Children and Teens. This webinar will take place on Wednesday, April 21st at 7:30 am. Linda Chokroverty, MD will serve as faculty for this program. Click here to register for this webinar.
- Identify normal stressors impacting children and teens and those that have resulted from the COVID-19 pandemic
- Examine what is known so far about the mental health impact of COVID-19 on children and teens
- Describe resources to assist children and teens during the COVID-19 pandemic
- Appraise the scope of COVID-19’s long term mental health impact on children and teens
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. (HOFFMAN)
Veterans Matters: Military Culture: Everything Physicians Need to Know about Veterans as Patients Webinar
Registration Now Open
Thursday, April 22nd @ 7:30 am
The Medical Society of the State of New York is hosting a Continuing Medical Education (CME) program entitled Veterans Matters: Military Culture: Everything Physicians Need to Know about Veterans as Patients live webinar on Thursday, April 22, 2021 at 7:30 am.
When: April 22, 2021 at 7:30 am
Faculty: Lt. Colonel Lance Allen Wang (Ret.) & Sharran Chambers-Murphy, Desert Storm-era Veteran
- Describe the unique aspects of military culture and how they impact patients who are veterans;
- Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality; and
- Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back to civilian life.
For more information, contact Jangmu Sherpa at email@example.com or call (518) 465-8085.
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. (SHERPA)
Webinar for Physicians Applying to PCF Model on April 31
Physicians considering applying for the PCF model to start in 2022 are invited to register now for a webinar to be offered Tuesday, April 13, from 6:00-7:00 pm ET by the American Medical Association, American College of Physicians, American Academy of Family Physicians, and the CMS Innovation Center. PCF is open to medical practices that provide primary care services in 26 regions across the country, with an application deadline of April 31, 2021.
The live webinar will allow participants to hear from CMS and medical society experts about the model and how participation could affect their practice revenues. Additional details, including the request for applications, a map of the 26 regions, and lists of the practices and other payors that are participating as part of the 2021 cohort are available on the CMS Primary Care First website.
Classified Ads Available for:
Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate
For help, information or to place your ad, call Christina Southard 516-488-6100 x355 • fax 516-488-2188
-Separate reception area -Consultation room -1-3 exam rooms -Free Valet Parking
-Designated physician parking spot. Contact Dr. Nir Somekh (516) 662-1232
340 E. 49TH St. (Ground Floor -Handicap Accessible) 1-3 Lanes Wed/Fri/Sat/Sun Full use of: VF / OCT /Pachymeter/ Autorefractor /Autolensometer / Argon / YAG Lasers
Please contact Scott Weissman MD.firstname.lastname@example.org. 914-772-5581
Two Offices Available for Rent in Established SoHo Primary Care Practice
Newly constructed loft space. Dedicated private waiting area available. This space is ideal for individual psychiatry, psychology, social work, physical therapy, or acupuncture services. Potential to work with existing Primary Care Practice as a referral source. Centrally located in the heart of SoHo, close to all subways. Available 7 days/week. Contact: SpringPrimaryCare@gmail.com.
Medical Office and Medical Practice (Upper East Side)
79th St near Lexington / Park. 750 sq Ft beautiful, street entrance, medical office for sale with a 25 + yr internal medical practice for sale. Office is in move in condition. Physician retiring. Waiting room. Secretarial area for 3. 1 Consult room. 2 exam Rooms 2 Toilets. Please contact: 917-770-8700 / email email@example.com
For Rent Medical Office 800 2nd Ave, 806
FOR RENT 800 2nd Avenue, 806 – Fully built out Medical office ready for use – reception area; 2 office/ consultation rooms; 4 examination rooms with plumbing; 1 sterilization room or pantry; 1 file/ nurse room, Total 8 rooms. All examination rooms are set up with plumbing and cabinetry. 24/7 doorman/ Elevators. Central location, Grand Central Station, buses Subways. Rent: $65 per Rentable Sq Ft; Sq Ft: 1,482 Rentable; Gross Lease. Showings or video contact Maya – Broker – firstname.lastname@example.org or mobile 646-258-4460 listing information http://www.mallannyhomes.com/properties/detail/800-second-avenue-806/
Founded in 1988, this well-established Single Practitioner Allergy Practice has over 3500 active patients, with very positive patient reviews. The office is only one of a few in the area, but patients are seen from throughout the NYC Metropolitan Area, as well as Long Island. Potential for growth. Centrally located next to major public transportation. Retirement planned. Lease is assignable. Well-trained, extremely personable staff of three, including a Registered Nurse. Payer mix85% private, 10% Medicare 5% other. Email any questions to: email@example.com
Two (2) Prime Commercial Spaces
Two (2) affordable office spaces available for immediate occupancy. Located in Sheepshead Bay Brooklyn, surrounded by multiple co-ops and private homes. Space can be viewed at your convenience. Price negotiable. Call: Avi 212-736-3680 ext. 15
Date Posted: 03/23/21 Applications Due: 04/06/21 Vacancy ID: 85272
|Agency||Health, Department of|
|Title||Health Program Director 2 -TBD|
Other Professional Careers
|Bargaining Unit||M/C – Management / Confidential (Unrepresented)|
|Salary Range||From $122092 to $154253 Annually|
|Jurisdictional Class||Non-competitive Class|
Hours Per Week
|Compressed workweek allowed?||
|Street Address||CCH; Division of Family Health
Corning Tower, ESP
|Minimum Qualifications||Twelve years of professional level work experience, three of which must have included managerial, decision-making and/or oversight responsibilities for a major health-related program or in the direction of a major administrative function of a large health-related organization. A bachelor’s degree may be substituted for four years of the general professional experience.
Twelve or more years of progressively responsible administrative experience in programs that improve perinatal health, child and/or adolescent health, early care, and learning, and/or sexual violence prevention, including four years of managerial, decision-making, and/or program direction. Seven years of this experience would also include fiscal management, policy making and oversight responsibilities, and statewide supervision of professional level staff. The preferred candidate would be familiar with representing departmental interests and serving as a spokesperson and liaison to Executive staff, and have experience working with other state and federal governmental programs. Experience with second-level professional supervision as well as strong oral and written communication skills is also desired. A master’s degree in an appropriate field may substitute an additional one year of the general professional experience, not to exceed a maximum of five years total allowable educational substitution. Please refer to full listing