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Biweekly Rounds 3-22-20


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DFA’S WEEKLY ACTION ITEM:

As the COVID-19 pandemic continues to unfold and impact so many of you deeply, we ask that you take a few minutes to share with the DFA community and the world your stories. Tell us your frontline experiences so that we can amplify them to educate the world about what you are facing in order to care for your patients. Team DFA is working on statements and developing actions to address the dramatic risks faced by you and your provider colleagues while working on the frontlines including the shortage of PPE, access to testing, mental health services, paid sick leave, access to rest areas, and so many other issues. There is further ongoing work dedicated to developing actions designed to assist our vulnerable patients across all of the issues DFA has held central to its work to ensure that health – and health care --  is accessible to everyone in our country, equitably and affordably.

Post a video - Tweet a few lines. Please tag @DrsforAmerica and

Use the hashtags #COVIDUS19Frontlines, and #DFAdocs

 

AN ALL-IN MOMENT FOR AMERICA:Hospital systems across the U.S. are struggling right now … We know that masks and gowns and visors to protect our eyes are especially important right now, particularly for our health care workers, I’m talking to folks in hospitals across the country -- doctors and nurses who are having to reuse masks. “We’re now seeing in Atlanta and more cities around the country that doctors are now getting sick with COVID-19 and it’s taking them out of the workforce at exactly the time when we need them.  .. This is hard, really hard for all of us," "But this is really an all-in moment for America. This is one of those moments where unless all of us are stepping up to do our part, we cannot keep each other safe. If we do so, I believe we can come out stronger than before." - Vivek H. Murthy - Former U.S. Surgeon General & Founder - Doctors For America

Lawmaker Requests Probe Into Government Failure to Deliver Coronavirus Tests

OUR LIVES DEPEND ON IT:It’s not a matter of “if” or “when” - It’s not a matter of politics or ideology.  We need a massive increase in personal protective equipment NOW Our patients, our healthcare system, and our lives depend on it.”  Matt Klein MD

NOT GOOD: “The bottom line: We're only at the beginning of our fight against the coronavirus, and our most important line of defense — health care workers — increasingly don't have the tools they need. That's not good.” - Caitlin Owens, Axios

PROTECTION:  “I just think this has been atrocious. On January 21 the first patient was diagnosed in the U.S. Now it’s two months later and we still don’t have these methods of protecting patients, doctors and care workers.” - Eric Topol, Cardiologist at Scripps Research

FLYING BLIND: "The testing capacity remains extraordinarily limited compared to where we should be. And in many ways we are absolutely flying blind at the moment," - Michael Mina, Epidemiologist at the Harvard T.H. Chan School of Public Health

NY ASKING FOR SOME HELP: “URGENT! New York State is calling on recently retired health care professionals to sign up to be part of a reserve staff if the need arises. We also need qualified medical and nursing school students & staff. Enlist today: http://health.ny.gov/assistance”  - Governor Andrew Cuomo (D-NY)

IBUPROFEN: "There’s no good scientific evidence that says ibuprofen can make coronavirus worse," - Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease

“WE’RE NOT A SHIPPING CLERK”:Governors are supposed to be doing a lot of this work, and they are doing a lot of this work,  The Federal government is not supposed to be out there buying vast amounts of items and then shipping. You know, we’re not a shipping clerk.” - The President of the United States of America

MEDIA COVERAGE:

COVID-19:

Younger Adults Make Up Big Portion of Coronavirus Hospitalizations in U.S. - New C.D.C. data shows that nearly 40 percent of patients sick enough to be hospitalized were age 20 to 54. But the risk of dying was significantly higher in older people - American adults of all ages — not just those in their 70s, 80s and 90s — are being seriously sickened by the coronavirus, according to a report on nearly 2,500 of the first recorded cases in the United States. (Pam Belluck, New York Times)

Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State - In this case series, we describe the clinical presentation, characteristics, and outcomes of incident cases of COVID-19 admitted to the intensive care unit (ICU) at Evergreen Hospital to inform other clinicians treating critically ill patients with COVID-19. (Matt Arentz, Eric Yim, Lindy Klaff, Sharukh Lokhandwala, Francis X. Riedo, Maria Chong, Melissa Lee,  JAMA Network)

Before Virus Outbreak, a Cascade of Warnings Went Unheeded - The work done over the past five years, however, demonstrates that the government had considerable knowledge about the risks of a pandemic and accurately predicted the very types of problems Mr. Trump is now scrambling belatedly to address.. (David E. Sanger, Eric Lipton, Eileen Sullivan and Michael Crowley, New York Times)

The Coronavirus Is Killing Far More Men Than Women - Upward of 70 percent of deaths in Italy have been men. The question is: Why? (Chris Mooney,  Sarah Kaplan and  Min Joo Kim, Washington Post)

Understanding What Works: How Some Countries Are Beating Back the Coronavirus -Here’s a look at some of the techniques these governments employed, and how they stack up to steps being taken in the United States as well as the United Kingdom, which has come under heavy scrutiny for its approach, fairly or not. (Helen Branswell, STAT)

PERSONAL PROTECTION EQUIPMENT (P.P.E)

Doctors Using TV and Social Media to Sound the Alarm: 'We Need Masks Today' - Right now I want to hear less from politicians, and much more from doctors. Covid-19 hospitalizations are surging, as expected. ER doctors, nurses and health care experts are using traditional media and social media to sound alarms about supply shortages and other serious problems. "DOCTORS SOUND ALARM AS A NATION STRUGGLES" is the banner headline in Friday's NYT. (Brian Stelter, CNN Business)

Strategies for Optimizing the Supply of Facemasks - Purpose: This document offers a series of strategies or options to optimize supplies of facemasks in healthcare settings when there is limited supply. It does not address other aspects of pandemic planning; for those, healthcare facilities can refer to COVID-19 preparedness plans. (Centers for Disease Control & Prevention)

‘At War With No Ammo’: Doctors Say Shortage of Protective Gear Is Dire - With coronavirus cases soaring, doctors, nurses and other front-line medical workers across the United States are confronting a dire shortage of masks, surgical gowns and eye gear to protect them from the virus. (Andrew Jacobs, Matt Richtel and Mike Baker, New York Times)

Hospital Workers Battling Coronavirus Turn to Bandannas, Sports Goggles and Homemade Face Shields Amid Shortages - Just 11 weeks into a pandemic crisis expected to last months, the nightmare of medical equipment shortages is no longer theoretical. Health-care workers, already uneasy about their risk of infection amid reports of colleagues getting sick and new data showing even relatively young people may become seriously ill, are frustrated and fearful. “That has really freaked everybody out,” said Elissa Perkins, an emergency medicine physician at Boston Medical Center. (Ariana Eunjung Cha, Michael E. Miller, Christopher Rowland and Lena H. Sun, Washington Post)

Change in U.S. Law Will Make Millions More Masks Available to Doctors and Nurses, White House Says - Vice President Mike Pence said Thursday that new legislation will allow tens of millions more protective masks to reach U.S. healthcare workers each month, beginning immediately, but it was still unclear whether total production will be enough to meet demand. (Jeanne Whalen, Washington Post)

COVID-19 TESTING:

TOOL: COVID-19 Self Triage Tool - The USC Gehr Family Center for Health Systems Sciences & Innovation

Special Report: How Korea Trounced the U.S. in Race to Test People for Coronavirus - South Korea’s swift action stands in stark contrast to what has transpired in the United States. Seven weeks after the train station meeting, the Koreans have tested well over 290,000 people and identified over 8,000 infections. New cases are falling off: Ninety-three were reported Wednesday, down from a daily peak of 909 two weeks earlier. The United States, whose first case was detected the same day as South Korea’s, is not even close to meeting demand for testing. About 60,000 tests have been run by public and private labs in a country of 330 million, federal officials said Tuesday. (Chad Terhune, Dan Levine, Hyunjoo Jin, Jane Lanhee Lee. Reuters)

U.S. Coronavirus Testing Starts To Ramp Up But Still Lags - More than 71,000 tests have been done so far in the U.S., according to the Covid Tracking Project, and thousands more are being conducted each week by federal and state labs, hospitals and private companies, officials say. (Rob Stein, National Public Radio)

The Latest Obstacle to Getting Tested? A Shortage of Swabs and Face Masks - Hospitals and doctors say they are critically low on swabs needed to test patients for the coronavirus, as well as face masks and other gear to protect health care workers. - (Katie Thomas, New York Times)

Coronavirus Testing Chaos Across America - As cases of Covid-19 have exploded across the U.S., state and local governments are taking on the task of testing for the coronavirus that causes it—and they have been quickly overwhelmed. Slowed by equipment shortages and struggling to keep pace, officials have set up a chaotic patchwork of testing sites, with access varying wildly from one place to another. Now some states and counties are pulling back, using their limited resources to test only the most vulnerable. (Dan Frosch, Ian Lovett, Deanna Paul, Wall Street Journal)

HEALTH SYSTEM RESPONSE:

Hospitals Need a Surge — of Doctors - Hospitals are struggling to find enough doctors, nurses and other health care workers to care for mounting numbers of critically ill coronavirus patients. The staffing problems are on top of the equipment problems — the lack of ICU beds, ventilators, and masks and other protective equipment needed to prevent the healers from becoming patients. Hospitals are taking extraordinary measures to bulk up the workforce, from calling on retirees for help to assigning medical students to answer the phones. (Rachel Roubein and Joanne Kenen, Politico)

A View From The Front Lines Of California’s COVID-19 Battle - Interviews with California physicians on the front lines of COVID-19 offer a sobering portrait of a health care system preparing for the worst of a pandemic that could be months from peaking. In the Bay Area, the battle is being waged hospital by hospital, with wide variations in resources. (Anna Maria Barry-Jester, Kaiser Health News)

TRACKING THE SPREAD:

State Data and Policy Actions to Address Coronavirus - To date, states have taken a number of actions aimed at reducing existing barriers to testing and treatment for those affected. These specific policy actions are compiled below, along with data on current cases and deaths as well as additional state-level data on health coverage and provider capacity within each state, important factors that may play a role in how effectively states respond to this outbreak. These data will be updated regularly and new information will be added in response to the evolving situation. (Kaiser Family Foundation)

Coronavirus Deaths Top 10,000 Globally - Governments move with urgency to contain pandemic, as death tolls rise sharply in Iran and Italy - Deaths from the pneumonia-causing pathogen have more than quadrupled in the U.S. over the past week to 205, while confirmed infections in the country have surged to 14,250 from around 1,700 on March 13. The majority of U.S. cases are in three states: New York, Washington and California. (Jennifer Calfas, Stella Yifan Xie and Sune Engel Rasmussen, Wall Street Journal)

TRUMP ADMINISTRATION RESPONSE:

‘We’re Not a Shipping Clerk’: Trump Tells Governors to Step up Efforts to Get Medical Supplies - President Donald Trump on Thursday put the onus on governors to obtain the critical equipment their states need to fight the coronavirus pandemic, telling reporters that the federal government is “not a shipping clerk” for the potentially life-saving supplies. (Quint Forgey, Politico)

Frustration Mounts at Trump's Reluctance to Use Emergency Production Powers - But in a subsequent tweet on Wednesday evening, Trump indicated that even though he invoked the act, he is in no rush to use it. "I only signed the Defense Production Act to combat the Chinese Virus should we need to invoke it in a worst- case scenario in the future," he said. "Hopefully there will be no need" (Nathaniel Weixel, The Hill)

Facing Medical Supply Shortages, Trump Invokes Wartime Law That Could Give Government Authority Over Private Manufacturing - President Trump on Wednesday said he would invoke the Defense Production Act, a law that gives the federal government sweeping power to ramp up manufacturing capacity during a national crisis, as a response to the coronavirus pandemic. The law could allow the president to effectively force private companies to manufacture specific goods necessary to the government’s efforts to stem the pandemic. (Lev Facher, STAT)

The Defense Production Act, the Law Trump Is Using to Boost Coronavirus Supplies, Briefly Explained - This is what military and crisis response experts as well as top politicians have been pushing for as the outbreak spread across the country. The reason is simple: Invoking this act gives the president broad authorities to order domestic manufacturing industries to make products the nation needs in a time of crisis.  (Alex Ward, Vox)

With Minimal Evidence, Trump Asks F.D.A. to Study Malaria Drugs for Coronavirus - President Trump on Thursday exaggerated the potential of drugs available to treat the new coronavirus, including an experimental antiviral treatment and decades-old malaria remedies that hint of promise but so far show limited evidence of healing the sick. (Denise Grady and Katie Thomas, New York Times)

Coronavirus: State Department Tells Americans: 'do Not Travel' Abroad, Come Home If Overseas - The State Department told Americans not to travel abroad at all, the strongest U.S. alert yet as the novel coronavirus continued its steady march across the globe. The department on Thursday issued a Level 4 advisory for travel abroad – "do not travel" – only four days after it issued a Level 3 advisory that urged Americans to "reconsider travel."  (Curtis Tate, Deirdre Shesgreen, USA Today)

COVID-19 & IMMIGRATION:

What Coronavirus Means for Tens of Thousands of People In ICE Custody - There are nearly 40,000 people in ICE custody across the United States. And there's a big question looming as the novel coronavirus spreads. What will happen if there's an outbreak inside one of Immigration and Customs Enforcement's detention facilities, which have long faced criticism for how they handle even routine medical care? (Catherine E. Shoichet, CNN)

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REACH OUT:  If you get an opinion piece or letter to the editor published PLEASE send me (Pete Van Vranken - pete@drsforamerica.org) an email with a link to your piece and I will include it in the next edition of the Physician Rounds.  Also please send me any feedback you may have on the “Rounds” - Much Appreciated  - Pete

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