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Weekly Rounds 4-5-20


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DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED: 

DFA’s Drs. Vivek Murthy & Alice Chen: An Open Letter to Our Brothers and Sisters in Medicine - ... Thank you for choosing to be a healer. We are so proud of you. We are so grateful for you. And we, along with so many others worldwide, are praying for you, for your health, safety, and strength in the long days ahead. (Drs. Vivek Murthy & Alice Chen, Medium)

DFA's Dr. Elinore Kaufman: Please, Stop Shooting. We Need the Beds. - Firearm injuries are calamitous for the more than 120,000 people shot each year in the United States and their families. But the consequences for our health system are even more dire as we fight the coronavirus. (Dr. Elinore Kaufman - fellow in surgical critical care and trauma surgery at the University of Pennsylvania, New York Times)

DFA’s Drs. Goel & Goldstein: A Plea from NYC Physicians: Our Window of Opportunity Is Closing to Avoid Italy's Fate - We are two New York City physicians and public health advocates and are pleading with our municipal, state and federal leaders to take drastic public health measures to save lives. The house is on fire, and this is the alarm bell. … Now is not a time for partisan politics. (Dr. Akash Goel and Dr. Andrew Goldstein, The Hill)

DFA’s Dr. Patricia Kellner: Now It’s Your Turn to Save Lives: Patricia Kellner - I’m a retired family doctor and I know I saved lives and added years to many others. Now it’s your turn to save lives. The lives you save may be your own, your family’s, your friend’s, your doctor’s, their staff, first responders – and all of their families. How can you save lives? Shelter in place. (Dr. Patricia Kellner, a retired family doctor, was voted a “best doctor” in Cleveland Magazine for 20 years in a row., Cleveland Plain Dealer)

DFA Drs. Morris, Fischer & Fei: End Immigration Detention to Save Lives - The best way to dramatically reduce health risks for people currently navigating the U.S. immigration and asylum systems, including the risk of COVID-19, is to get people out of detention. (Shangnon Fei, Briah Fischer and Juliana E. Morris, The Bakersfield Californian)

DFA Dr. Cedric Dark: An ER Doctor Describes What It's Like to Treat Covid-19 - The novel coronavirus is hitting emergency rooms in the US—hard. Cedric Dark, a physician at the Baylor College of Medicine, recounts the struggle. - (Cedric Dark, MD, MPH, FACEP., WIRED)

DFA Dr. Cedric Dark: Congress Should Not Spring Legislation on Surprise Medical Bills While Doctors Fight Coronavirus Back in December, emergency physicians felt like we were fighting for our lives against potentially disastrous attacks from misinformed Washington D.C. think tanks and their insurance industry allies over the contentious issue of surprise billing. (Cedric Dark, MD, MPH, FACEP. Houston Chronicle)

DFA Mentioned: Over 900 Florida Healthcare Workers Sign Petition Asking Governor to Order People to Shelter in Place Amid Covid-19 - Meanwhile, another petition, created by Doctors for America and signed by over 500 Florida healthcare workers, asked DeSantis to "issue a stay-at-home order immediately to fight the COVID-19 pandemic."

REMINDER: 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.  - Pete

THE WEEK IN QUOTES:

WE NEED A NATIONAL RESPONSE: “We need a national stay at home order. Needed it weeks ago. It remains the most powerful tool we have at this moment to reduce the spread of #covid19. The reluctance to call for such a policy represents a critical failure of federal leadership that will cost lives”  - Vivek Murthy, Former Surgeon General of the United States, Founder Doctors for America

BILL GATES: “We need a consistent nationwide approach to shutting down. Despite urging from public health experts, some states and counties haven’t shut down completely. ... The country’s leaders need to be clear: Shutdown anywhere means shutdown everywhere. - Bill Gates - Co-Founder Microsoft and a Co-Chair of the Bill & Melinda Gates Foundation

WORLD WIDE RESPONSE: COVID-19 is the greatest test that we have faced together since the formation of the United Nations, This human crisis demands coordinated, decisive, inclusive and innovative policy action from the world’s leading economies – and maximum financial and technical support for the poorest and most vulnerable people and countries.” - United Nations Secretary-General António Guterres

BOLSTER MEDICAID: “There is no moment in recent memory more critical than now to bolster Medicaid. Covering more people in Medicaid is a rapid way to bring needed resources into the health care system and infuse federal dollars into state economies on the verge of a major downturn. Medicaid expansion also requires no new infrastructure or federal oversight to achieve, unlike many other types of stimulus spending. Medicaid remains highly popular with voters from both parties. And most important, expanding Medicaid can save lives.”  - Jonathan Gruber, Ph.D., and Benjamin D. Sommers, M.D., Ph.D., New England Journal of Medicine

THE DARKEST MONTH: April is going to be very hard. But public health officials are in agreement that hunkering down — in our own homes — and weathering one of the darkest months in American history is the only way to prevent millions of American deaths. …. we've never all had such an important role to play, as individuals, in mitigating a national crisis: staying home, and stopping the spread. ” - Caitlin Owens, Axios 

OUR HEALTHCARE SYSTEM IS IN SURVIVAL MODE: Last night in the ICU of a #NYC hospital, I cared for 20 patients who were all on breathing machines due to #COVID19. Some REALLY young (20s), without comorbidities. Everyone is extremely sick. But sicker patients keep flooding in…We are REALLY feeling the strain. We don’t have enough ICU beds. Many patients are being intubated as soon as they show up to the Emergency Room. We are doing our best to take care of them on regular floor beds and in the ER itself. But it is HARD… Some of our sickest patients with #COVID19 really need dialysis, but we don’t have enough machines. We are actively rationing care - something I thought I would never see in our healthcare system… It is heartbreaking to have end-of-life discussions w/ family members. No part of me was prepared to convey that a family member can’t say goodbye. That their love one would have to be alone during their final moments. I cannot imagine how they feel...how painful it is... Hospital staff are exhausted & honestly - scared. Our healthcare system is in survival mode...But I have never been prouder to be a physician in #NewYorkCity. My incredible colleagues - everyone - is rising to the occasion. We are doing our best. We will get through this together.” - Prakriti Gaba - Internal Medicine Resident in #NYC 

MEDIA COVERAGE: 

COVID-19:

Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients With Coronavirus Disease - Based on preliminary U.S. data, persons with underlying health conditions such as diabetes mellitus, chronic lung disease, and cardiovascular disease, appear to be at higher risk for severe COVID-19–associated disease than persons without these conditions. (CDC COVID-19 Response Team)

Essential Drug Supplies for Virus Patients Are Running Low - Medicines to alleviate breathing difficulty, relieve pain and sedate coronavirus patients are in very high demand, depleting stock around the country. (Knvul Sheikh, New York Times)

Infected but Feeling Fine: The Unwitting Coronavirus Spreaders - As many as 25 percent of people infected with the new coronavirus may not show symptoms, the director of the Centers for Disease Control and Prevention warns — a startlingly high number that complicates efforts to predict the pandemic’s course and strategies to mitigate its spread. In particular, the high level of symptom-free cases is leading the C.D.C. to consider broadening its guidelines on who should wear masks. (Apoorva Mandavilli, New York Times)

Covid-19 Changed How the World Does Science, Together - While political leaders have locked their borders, scientists have been shattering theirs, creating a global collaboration unlike any in history. Never before, researchers say, have so many experts in so many countries focused simultaneously on a single topic and with such urgency. (Matt Apuzzo and David D. Kirkpatrick, New York Times)

PERSONAL PROTECTIVE EQUIPMENT:

Inside America’s Mask Crunch: a Slow Government Reaction and an Industry Wary of Liability - The confluence of a slow initial response by the Trump administration, its wariness of compelling the industry to produce gear and a long-running debate about granting manufacturers legal protection in a health emergency contributed to a critical shortage of masks to front-line workers. (Jeanne Whalen, Rosalind S. Helderman and Tom Hamburger, Washington Post)

Trump Blames Hospitals for Mask and Ventilator Shortages - Trump’s boldest claim was about masks. He noted that current demand wasn’t commensurate with what hospitals typically use and suggested that masks were “going out the back door.” (Aaron Blake, Washington Post)

COVID-19 TESTING:

Piecemeal Testing Flusters Officials Tracking Coronavirus Pandemic - The surge in coronavirus testing was supposed to give public health officials a better grip on who’s sick and where. Instead, it’s exposing gaps in reporting, raising concern about whether complete results and basic information about patients that test positive is getting through to officials and health workers trying to contain the pandemic. (Darius Tahir, Politico)

The Scramble for the Rapid Coronavirus Tests Everybody Wants - As Abbott Laboratories began shipping its new rapid-response tests across the country Wednesday, a new flash point emerged in the nation’s handling of the pandemic: where to deploy the covid-19 diagnostics that could be one of the most effective tools in combating the outbreak. (Steven Mufson, Juliet Eilperin and Josh Dawsey, Washington Post)

Testing Coronavirus Survivors’ Blood Could Help Reopen U.S. - The theory is that such testing could be used to divide the world into people who’ve had it and aren’t at risk anymore — and those who are. Health-care workers with immunity could return to the front lines.. (Carolyn Y. Johnson, Washington Post)

HEALTH SYSTEM RESPONSE:

As Coronavirus Patients Surge, Medical Students Rushed Into Practice to Fight Pandemic - Despite the willingness of medical students to join responders on the front lines, the critical shortage of personal protective equipment to safeguard them from infection has frustrated that process. (Kelly Cannon, ABC News)

The COVID-19 Crisis Too Few Are Talking About: Health Care Workers’ Mental Health - In the midst of this global pandemic, people are talking about the urgent and critical need for personal protective equipment. They are sharing concerns about the impending lack of respirators and the need for testing. And they are encouraging people to #flattenthecurve through social distancing. But no one is talking about a potential mental health crisis facing health care workers on the frontlines of this pandemic. (Jessica Gold, STAT)

TRUMP ADMINISTRATION RESPONSE: 

Commander of Confusion: Trump Sows Uncertainty and Seeks to Cast Blame in Coronavirus Crisis - In the three weeks since declaring the novel coronavirus outbreak a national emergency, President Trump has delivered a dizzying array of rhetorical contortions, sowed confusion and repeatedly sought to cast blame on others. (Philip Rucker and Robert Costa, Washington Post)

Trump Set to Urge Americans to Wear Face Coverings When Outside - President Donald Trump is preparing to encourage Americans to wear face coverings, the latest effort to curb the spread of the coronavirus, according to three individuals with knowledge of the planned announcement. (Dan Diamond, Politico)

Days After Ventilator DPA Order, White House Has Done Little to Push General Motors - President Donald Trump invoked sweeping war powers last week to demand that General Motors start producing ventilators, but so far his administration has done little to enforce the order. (Gavin Bade and Megan Cassella, Politico)

Trump Ban on Fetal Tissue Research Blocks Coronavirus Treatment Effort - A senior scientist at a government biomedical research laboratory has been thwarted in his efforts to conduct experiments on possible treatments for the new coronavirus because of the Trump administration’s restrictions on research with human fetal tissue. (Amy Goldstein, Washington Post)

AFFORDABLE CARE ACT AND COVERAGE ISSUES:

Trump Rejects ObamaCare Special Enrollment Period Amid Pandemic - The Trump administration has decided against reopening Obamacare enrollment to uninsured Americans during the coronavirus pandemic, defying calls from health insurers and Democrats to create a special sign-up window amid the health crisis. .. The Trump administration oversees enrollment for about two-thirds of states. (Susannah Luthi, Politico)

Trump Hints at Using Federal Programs to Provide Coverage After ObamaCare Decision - President Donald Trump said he is considering using federal programs like Medicare and Medicaid to cover the rising ranks of the uninsured after his administration decided it would not reopen the Obamacare insurance markets to address the coronavirus crisis. (Susannah Luthi, Politico)

Affordable Care Act Sign-Ups Total 11.4 Million for This Year - ACA sign-ups steady for third straight year despite efforts by the Trump administration to roll back the Obama-era health law - About 11.4 million consumers signed up for health coverage on the Affordable Care Act’s exchanges in the 50 states and Washington, D.C., this year, according to data released Wednesday by the Trump administration, marking the third straight year sign-ups have remained steady. (Stephanie Armour, Wall Street Journal)

MEDICAID:

Medicaid Nearing ‘Eye Of The Storm’ As Newly Unemployed Look For Coverage - As the coronavirus roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed. That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers. (Shefali Luthra and Phil Galewitz and Rachel Bluth, Kaiser Health News)

Medicare and Medicaid Patients Get Temporary Access to Telemedicine Amid Coronavirus Crisis, but Challenges Remain - President Donald Trump’s administration took the unprecedented step on Monday to temporarily waive rules for the nation's largest insurer -- Centers for Medicare & Medicaid Services (CMS) -- giving some healthcare providers the ability to have phone-only visits with their patients as the coronavirus crisis rages on. CMS covers at least 140 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program, and Federal Exchange. (Lauren Lantry, ABC News)

DRUG AFFORDABILITY:

Lawmakers’ Coronavirus Response Means Delays for Drug Pricing Legislation - Before the coronavirus pandemic became Congress’ sole focus, late May was widely viewed as a final 2020 deadline for lawmakers to take action on key health policy issues, including legislation to lower the price of prescription drugs. But with the Covid-19 crisis dominating every aspect of American politics, such legislation will have to wait. (Lev Facher, STAT)

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