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Weekly Rounds 5-24-20


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DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:


DFA Copello Fellow - Vanessa Ferrel, MD MPH - "This pandemic is nothing short of state-sanctioned violence. It has decimated the Bronx. I know that when this is over, the absence of so many loved ones and community members will leave us forever unsettled." - Structural Violence, COVID-19, and The Bronx: A Black Physician on Health Inequities  (Vanessa Ferrel, Left Voice)


DFA Board Member Dr. Dona Kim Murphey and DFA Doctors King & Levison: As Texas Reopens, It’s Crucial to Ramp up Testing and Contact Tracing - Once the initial surge of COVID-19 has passed in Texas, how can the cities get moving again while avoiding a resurgence of the virus? Local governments and health providers need to guarantee that expansion of SARS-COV2 testing includes testing of asymptomatic people and surveillance testing which should go hand-in-hand with an infrastructure of contact tracing to move beyond quarantine. (Elizabeth Chiao, Katherine Y. King, Judy Levison and Dona Kim Murphey, Dallas Morning News)


Copello Fellow, Dr. Juliana Morris: How the COVID-19 Pandemic Highlights the Need for Class Consciousness Among Physicians - What labor struggles do a grocery worker, custodian, and doctor in the United States have in common? A few months ago, many people’s answers may have been – not much. But ever since the COVID-19 pandemic hit, our shared challenges are becoming ever more apparent. … we hope that doctors take this moment to critically examine our position within capitalism and commit to worker solidarity. It is only together that we can collectively combat not only the pandemic, but the global threats of capitalism. We must join our fellow workers in building towards a more equitable future on the other side of the coronavirus. (Juliana E. Morris, Md and Simon Ma, KevinMD)


VIDEO RECORDING NOW AVAILABLE ONLINE:  Doctors for America’s Webinar with U.S. Representative Pramila Jayapal (WA-07) and Dr. Abdul El-Sayed and moderated by Micah Johnson (soon-to-be MD) on policy prescriptions needed in response to the COVID-19 pandemic.  https://attendee.gotowebinar.com/recording/3135763588856938256


THE WEEK IN QUOTES:


BLACK AMERICANS DYING OF COVID-19 AT THREE TIMES THE RATE OF WHITE PEOPLE: The disparities are continuing to be reflected in the data, yet we still have a complete lack of guidance from the federal government about how to mitigate these divisions. There is no real plan how to deal with it,” Uché Blackstock, Urgent Care Physician and CEO of Advancing Health Equity


PRESIDENT OBAMA: “... let’s be honest — a disease like this just spotlights the underlying inequalities and extra burdens that black communities have historically had to deal with in this country. We see it in the disproportionate impact of COVID-19 on our communities, just as we see it when a black man goes for a jog, and some folks feel like they can stop and question and shoot him if he doesn’t submit to their questioning.” - Former President of the United States Barack Obama


NOT A SINGLE SENATOR:  I thought the Justice Department’s argument was really flimsy, What they are arguing was that when we voted to get rid of the individual mandate, we voted to get rid of Obamacare. I don’t know one single senator that thought that.” - United States Senator Lamar Alexander (R-TN)


ACTIVELY ANTI-SCIENCE: “The Covid-19 pandemic is a problem that must be understood and addressed using sciences such as virology, epidemiology, public health, and biomedicine. Yet in the face of a crisis that needs science, America is led by an administration that not only isn’t scientific but is actively anti-science.” - Jason Karlawish M.D., Co-Director of the Penn Memory Center, and Author


APPALLING: The lack of preparation and coordination has been appalling, In past disasters, the federal government, with its enormous buying power, took the lead in procurement, This time, federal inaction forced states into competing with each other for these scarce products. ” - Stephen S. Morse, an Epidemiologist at Columbia University Who Has Advised Republican and Democratic Administrations on Planning for a Pandemic


THE PUBLIC HEALTH LANE: "I respect and admire Dr. Fauci immensely but he represents the scientific and research lane, and Dr. Birx represents the policy lane at the White House level," The CDC represents the public health lane, internationally as well as working with state and territorial health offices, so I would want a representative from that lane." Dr. Howard Markel, University of Michigan


SCIENCE VIEWED AS A PROBLEM: "The message we received in previous administrations was, you guys are the scientists," That's not the case this time. If the science that we are offering up contradicts a specific policy goal, then we are the problem." CDC Employee


MEDIA COVERAGE: 


DOCTORS - MEDICINE & RESEARCH:


How Masks Helped Hong Kong Control the Coronavirus - New York City, with a population of about 8.4 million, has had over 28,000 coronavirus deaths as of May 18. Meanwhile, Hong Kong has officially recorded only four Covid-19 deaths, despite having 7.5 million residents. One reason that could help explain the stark disparity: In Hong Kong, nearly everyone wears a face mask in public. (Alex Ward, Vox)


‘It’s Something I Have Never Seen’: How the COVID-19 Virus Hijacks Cells - Recent studies show that in seizing control of genes in the human cells it invades, the virus changes how segments of DNA are read, doing so in a way that might explain why the elderly are more likely to die of Covid-19 and why antiviral drugs might not only save sick patients’ lives but also prevent severe disease if taken before infection (Sharon Begley, STAT)


Low White Blood Cell Counts Linked to Severe COVID-19 Cases - Host factors rather than viral genetic differences appear to influence disease outcomes among COVID-19 patients, according to a new study from China. ..."The determinants of disease severity seemed to stem mostly from host factors such as age, lymphocytopenia, and its associated cytokine storm, whereas viral genetic variation did not significantly affect the outcomes," Lu and his colleagues wrote in their paper. (Modern Healthcare)


The CDC Roadmap:  60-page roadmap for states, restaurants, schools, child care programs, mass transit systems and other businesses to navigate reopening during the pandemic.


‘I Can’t Turn My Brain Off’: PTSD and Burnout Threaten Medical Workers - Before Covid-19, health care workers were already vulnerable to depression and suicide. Mental health experts now fear even more will be prone to trauma-related disorders…. Medical workers like the young nurse have been celebrated as heroes for their commitment to treating desperately ill coronavirus patients. But the heroes are hurting, badly.  (Jan Hoffman, New York Times)


Black Healthcare Workers Hit Harder During Pandemic, Paper Finds - Experts say healthcare workers of color could face some of the same disproportionate effects of the COVID-19 pandemic as minority patients, according to a new paper. An article published Friday in the Harvard Business Review proposes that the healthcare settings many black clinicians have chosen to work in could put them at higher risk for exposure to the virus. (Steven Ross Johnson, Modern Healthcare)


Hospitals Knew How to Make Money. Then Coronavirus Happened. - The American health care system for years has provided many hospitals with a clear playbook for turning a profit: Provide surgeries, scans and other well-reimbursed services to privately insured patients, whose plans pay higher prices than public programs like Medicare and Medicaid. The Covid-19 outbreak has shown the vulnerabilities of this business model. (Sarah Kliff, New York Times)


COVID-19:


'We've Been Muzzled': CDC Sources Say White House Putting Politics Ahead of Science - In interviews with CNN, CDC officials say their agency's efforts to mount a coordinated response to the Covid-19 pandemic have been hamstrung by a White House whose decisions are driven by politics rather than science. (Robert Kuznia, Curt Devine and Nick Valencia, CNN)


Lockdown Delays Cost at Least 36,000 Lives, Data Show - If the United States had begun imposing social distancing measures one week earlier than it did in March, about 36,000 fewer people would have died in the coronavirus outbreak, according to new estimates from Columbia University disease modelers. (James Glanz and Campbell Robertson, New York Times)


‘This Feels Great’ - throwing caution to the wind - … In this grand gamble, Georgia has gone first, with Gov. Brian Kemp (R) dismissing public health experts who’ve warned that opening too soon could cause a catastrophic surge of deaths, placing his faith instead in the citizens of Georgia to make up their own minds about what risks and sacrifices they were willing to accept. (Stephanie McCrummen, New York Times)


All 50 States Are Now Reopening. But at What Cost? - Governors face intensifying pressure to reopen their economies, but experts warn it could mean thousands of new deaths. (Sarah Mervosh and Amy Harmon, New York Times)


Black Americans Dying of COVID-19 at Three Times the Rate of White People - The racial wound at the center of the coronavirus pandemic in the US continues to fester, with latest data showing that African Americans have died from the disease at almost three times the rate of white people. (Ed Pilkington, The Guardian)


Nearly 39 Million Have Sought U.S. Jobless Aid Since Virus Hit - More than 2.4 million people applied for U.S. unemployment benefits last week in the latest wave of layoffs from the viral outbreak that triggered widespread business shutdowns two months ago and sent the economy into a deep recession. Roughly 38.6 million people have now filed for jobless aid since the coronavirus forced millions of businesses to close their doors and shrink their workforces, the Labor Department said Thursday. (Christopher Rugaber, Associated Press)


COVID-19 TESTING:


‘How Could the CDC Make That Mistake?’ - We’ve learned that the CDC is making, at best, a debilitating mistake: combining test results that diagnose current coronavirus infections with test results that measure whether someone has ever had the virus. The upshot is that the government’s disease-fighting agency is overstating the country’s ability to test people who are sick with COVID-19. (Alexis C. Madrigal & Robinson Meyer, The Atlantic)


Florida Governor Defends Firing Of Top Data Scientist - Florida Gov. Ron DeSantis is defending the firing of the state's top data scientist tracking the coronavirus pandemic. Rebekah Jones was ousted from her position with the Department of Health on Monday. She says she was let go for refusing to manipulate data to support the state's reopening. (Greg Allen, National Public Radio)


PERSONAL PROTECTIVE EQUIPMENT:


Mask Shortage for Most Health-care Workers Extended Into May, Post-Ipsos Poll Shows - Front-line health-care workers still experienced shortages of critical equipment needed for protection from the coronavirus into early May — including nearly two-thirds who cited insufficient supplies of the face masks that filter out most airborne particles, according to a Washington Post-Ipsos poll. (Lenny Bernstein and Alauna Safarpour, Washington Post)


‘No Offense, but Is This a Joke?’ Inside the Underground Market for Face Masks. - While profiteers and crooks make their fortunes, medical workers across the United States are rationing masks, recycling them and treating infected patients without them.  (Desmond Butler, Juliet Eilperin and Tom Hamburger, Washington Post)


TRUMP ADMINISTRATION RESPONSE: 


Trump Describes Medical Researchers as Enemies Because He Doesn’t Like Their Results - It’s a bizarre claim in general, that a team of seven doctors would conspire to study the efficacy of an antimalarial drug to undermine the president politically. But it’s an even more ridiculous claim when you consider how the study was completed. (Philip Bump, Washington Post)


A Pandemic Plan Was in Place. Trump Abandoned it — and Science — in the Face of COVID-19 - Over the course of the Obama presidency, a pandemic infrastructure was put in place. It included recommendations for a top-level White House official devoted to planning and responding to emerging infectious threats and, to guide that person’s work, the “Playbook for early response to high-consequence emerging infectious disease threats and biological incidents.” And then on Jan. 21, 2017, Donald Trump became president. (Jason Karlawish, STAT)


Trump Threatens to Permanently Cut W.H.O Funding, Leave Body If Changes Aren’t Made Within 30 Days - President Trump threatened Monday to permanently halt U.S. funding to the World Health Organization and “reconsider” the country’s membership in the United Nations body if it does not “commit to major substantive improvements” within the next 30 days. (Teo Armus, Washington Post


Trump Expresses Opposition to Extending Unemployment Benefits Enacted in Response to Pandemic President Trump on Tuesday privately expressed opposition to extending a weekly $600 boost in unemployment insurance for laid-off workers affected by the coronavirus pandemic, according to three officials familiar with his remarks during a closed-door lunch with Republican senators on Capitol Hill. (Seung Min Kim, Washington Post)


Trump Allies Lining up Doctors to Prescribe Rapid Reopening - Republican political operatives are recruiting “extremely pro-Trump” doctors to go on television to prescribe reviving the U.S. economy as quickly as possible, without waiting to meet safety benchmarks proposed by the federal Centers for Disease Control and Prevention to slow the spread of the new coronavirus. (Michael Biesecker and Jason Dearen, Associated Press)


COVID-19 & IMMIGRATION:


Trump Administration Extends Order Blocking Migrants at Border - The Trump administration extended a public-health order allowing it to reject migrants crossing U.S. borders without giving them access to the asylum system until the government determines the new coronavirus no longer poses a danger to the public. (Michelle Hackman and Andrew Restuccia, Wall Street Journal)


Elderly Immigrant Dies by Suicide in California Detention Center - A 74-year-old South Korean man died of apparent suicide at a US immigration detention center after advocates said they unsuccessfully sought his release, citing a high risk of his being infected with the coronavirus. Choung Woong Ahn was found unresponsive in his cell Sunday at the Mesa Verde Ice Processing Center in Bakersfield, California, and efforts to revive him were unsuccessful, US Immigration and Customs Enforcement said in a statement. The agency said the case remains under investigation. (Associated Press)


AFFORDABLE CARE ACT AND COVERAGE ISSUES:


The Pandemic’s Next Blow: Over 1 Million Texans Will Lose Health Insurance  - The worst is about to get worse. In Texas, where 5 million people already go without health insurance, nearly 1.2 million more are projected to join their ranks — far more than any other state. That’s the estimated collateral damage from the coronavirus recession, assuming the national unemployment rate hits 20%, according to a recent Urban Institute report.  (Mitchell Schnurman, Dallas Morning News)


Medicaid Clinics And Doctors Have Been Last In Line For COVID-19 Relief Funding - That approach, however, has left out a large swath of the health system infrastructure that serves the low-income Medicaid population and children (Julie Rovner, National Public Radio)


Please Make a Tax-Deductible Donation to Doctors for America.Donations are necessary for DFA, during the world pandemic, to illuminate through its physician and medical student network the many shortcomings and as well as necessary solutions to heal America during COVID-19 and after. Together we must work toward a better normal where health truly is for all; Please Click Here to Contribute.


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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