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Weekly Rounds 7-19-2020


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 DFA ACTION ITEM: 

Please sign change.org’s petition - We Need A Federal Mask Mandate. As doctors and medical students, we know first hand how important it is to follow science and keep our patients, ourselves and our loved ones safe. WEAR A MASK.   The science is clear - We are all safer if we all wear masks in public. This is a public health issue not a political issue.

We implore Congress to urgently implement a national mandate for masking to halt the spread of COVID-19.   A national mandate for universal masking will save lives, revitalize our economy, allow our children to return to school, and unite the country against our common enemy, COVID-19. SIGN THE PETITION HERE

Please Make a Tax-Deductible Donation to Doctors for America so it can amplify the trusted voices of physicians and medical students in debates about the impact of structural racism and a pandemic on the health of the marginalized and the vulnerable in our country. DFA is committed to healing America and building a new system that will make health truly accessible to everyone; Please Click Here to Contribute.

Upcoming Webinar:

Register; If Zoom is at capacity, join us on Facebook Live

Deval Zaveri, MD: Deval, following medical school in India, entered residency training in psychiatry at SUNY Downstate Medical Center in Brooklyn NY and has worked in acute care psychiatric settings, focused on underserved communities.

Libby Benedict, MPA: (she/her/my name) Libby is the Womxn’s Policy Institute Program Manager at the Womxn’s Foundation California. Prior to the Foundation, she was the Director of Physicians for Reproductive Health’s Leadership Training Academy, a national program that trains doctors to become reproductive health advocates. She graduated from UCLA (BA, Sociology/Criminology), and Golden Gate University (MPA). 

Krista Niemczyk, MPP: Krista is the Public Policy Director for the The California Partnership to End Domestic Violence (the Partnership) where she represents domestic violence programs at various government agencies, including the California State legislature. Through this advocacy, Krista ensures that the voices of domestic violence programs and survivors are heard and reflected in public policies.

DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:

Recent DFA Webinar: Abortion Under Attack During COVID - July 13, 2020
Pratima Gupta, MD; Bhavik Kumar, MD, MPH; Fabiola Carrion, JD
View a Recording (Passcode: Womxn##3)

DFA BOARD MEMBER CEDRIC DARK: Researchers Find New, More Contagious Coronavirus Strain - Emergency Medicine Physician, Dr. Cedric Dark, Weighs in on 'America's News HQ - Alarming new research may tell why Houston is having such a high spike in corona virus cases.Joining me now Cedric Dark emergency medicine physician assistant professor at Houston's Baylor College of Medicine is also the founder of Policy Prescriptions and a board member of Doctors for America.

DFA COPELLO FELLOW PRATIMA GUPTA: One Hundred Years of Women's Suffrage - Health Care Advocacy, and Why We Vote - In recognition of the 100th anniversary of women's suffrage, we reviewed the difficulties reformists overcame in passing the 19th Amendment and discuss the similarities to current challenges in providing evidence-based, affordable, accessible women's health care. (Obstetrics & Gynecology)

DFA COPELLO FELLOW CHRISTINE JAMES: People With COVID-19 Who Live in Highly Polluted Areas Are More Likely to Die -  The COVID-19 pandemic has shone a spotlight on the health inequities many Americans face because of where they live and the air they breathe. Physicians and other health care workers must advocate for more stringent air quality standards. (KevinMD)

DFA MEDICAL STUDENTS, ROB PALMER, ISAAC FREEDMAN, AND JOSH HYMAN: Doctors and Democracy: Why Vote-By-Mail is Good Public Health - Yale medical students working on vote-by-mail initiatives get published in (The Health Care Blog).

THE WEEK IN QUOTES:

SLAPPING THE FACE OF SCIENCE:When you disrespect Tony on matters of public health science, you’re slapping in the face all of U.S. science,” - Dr. David Relman, a Microbiologist at Stanford University

ZERO CREDIBILITY: "First of all, the people speaking out against Tony Fauci have absolutely no medical credibility, no public health credibility, and frankly, no policy credibility when it comes to any kind of disaster or situation involving human health, They are undermining not just Fauci but everyone in the administration. You cannot have a competent public health response without a clear communication strategy. This isn't it." Georges Benjamin, the Executive Director of the American Public Health Association

DR ANTHONY FAUCI: I cannot figure out in my wildest dreams why they would want to do that, (Attack Dr. Fauci)  I think they realize now that that was not a prudent thing to do, because it’s only reflecting negatively on them….  I think the problem is too important for me to get into those kinds of thoughts and discussions. I just want to do my job. I’m really good at it. I think I can contribute. And I’m going to keep doing it.” Dr. Anthony Fauci

BLOCKED: The district court blocked Georgia’s abortion ban, because it violates over 50 years of Supreme Court precedent and fails to trust women to make their own personal decisions,” Sean Young, American Civil Liberties Union of Georgia

WE STILL HAVE A TESTING PROBLEM: I know it isn’t popular to talk about in some Republican circles, but we still have a testing problem in this country. My son was tested recently; we had to wait 5 to 7 days for results. My daughter wanted to get tested before visiting her grandparents, but was told she didn’t qualify. That is simply inexcusable at this point in the pandemic.” - Former Trump White House Chief of Staff Mick Mulvaney

UNREAL: There are more guns than people in the United States (400 million are in circulation for a population of 330 million).  In just the first six months of 2020, approximately 19 million firearms have been sold, representing more than one firearm for every 20 Americans.” (Phillip Levine and Robin McKnight -Brookings Institute

AN UNNECESSARY DILEMMA: “So we’re now facing a terrible, unnecessary dilemma. If we reopen in-person education, we risk feeding an out-of-control pandemic. If we don’t, we impair the development of millions of American students, inflicting long-term damage on their lives and careers. And the reason we’re in this position is that states, cheered on by the Trump administration, rushed to allow large parties and reopen bars. In a real sense America drank away its children’s future.  - Paul Krugman New York Times Opinion Columnist

TRUMP ADMINISTRATION STRIPS C.D.C. OF CONTROL OF CORONAVIRUS DATA: Centralizing control of all data under the umbrella of an inherently political apparatus is dangerous and breeds distrust, It appears to cut off the ability of agencies like C.D.C. to do its basic job.” - Dr. Nicole Lurie, Who Served as Assistant Secretary for Preparedness and Response Under Former President Barack Obama

STRONG FEDERAL LEADERSHIP: If you look at every country that has been successful in managing this, it’s been strong federal leadership, While all public health is local, federal direction is huge.” - Michael Osterholm, Director of the University of Minnesota’s Center for Infectious Disease Research and Policy

REACH OUT: If you get an opinion piece, letter to the editor, or media appearance distributed PLEASE alert Pete Van Vranken - pete@drsforamerica.org for publication in the next edition of the Physician Rounds. Your feedback is welcome.

MEDIA COVERAGE: 

AFFORDABLE CARE ACT AND COVERAGE ISSUES:

Millions Have Lost Health Insurance in Pandemic-Driven Recession - The coronavirus pandemic stripped an estimated 5.4 million American workers of their health insurance between February and May, a stretch in which more adults became uninsured because of job losses than have ever lost coverage in a single year, according to a new analysis. (Sheryl Gay Stolberg, New York Times)

As Millions Lose Health Insurance, Trump Administration Offers Little Help - As millions of people lose jobs in the coronavirus outbreak, jeopardizing their health benefits, the Trump administration and many states are doing little if anything to connect Americans with other insurance coverage. The U.S. Health and Human Services Department hasn’t launched any special effort to publicize the availability of Medicaid, the Children’s Health Insurance Program or health plans being sold on marketplaces created by the Affordable Care Act. And federal officials haven’t made any substantial new commitment of money for outreach or to help people enroll in coverage. (Noam Levey, LA Times)

Imagine a World With a COVID-19 Pandemic and Without the Affordable Care Act. Trump Does. - If the Trump administration wants to cripple the nation’s ability to fight COVID-19, add to the suffering of the infected and  undermine our health care system over the long term, it could hardly pick a better strategy than repealing the Affordable Care Act in the throes of the worst health care crisis the nation has faced since 1918. (Dr. David Blumenthal, President of the Commonwealth Fund, USA Today)

Supreme Court Appears Likely to Sidestep Obamacare Hearing Before Election - The Supreme Court has all but ruled out hearing a GOP-backed challenge to Obamacare before Election Day, likely avoiding a high-stakes showdown over a lawsuit that will factor prominently into this fall's campaigns. (Susannah Luthi, Politico)

Pandemic Upends Trump’s Plans to Shrink Health Care Safety Net - Voters in even the reddest parts of the country are approving or weighing Medicaid expansions as the coronavirus tears through communities and historic levels of unemployment leave workers without health coverage. And Republican governors aren't lining up for Trump’s two major moves to restrict Medicaid: work requirements for many adults and block grants to states instead of open-ended funding. (Rachel Roubein, Politico)

WOMEN’S HEALTH:

Federal Judge Voids Georgia ‘Heartbeat’ Abortion Restriction - A federal judge on Monday permanently blocked Georgia’s 2019 “heartbeat” abortion law, finding that it violates the U.S. Constitution. U.S. District Judge Steve Jones ruled against the state in a lawsuit filed by abortion providers and an advocacy group. Jones had temporarily blocked the law in October, and it never went into effect. The new ruling permanently enjoins the state from ever enforcing House Bill 481. .. Republican Gov. Brian Kemp, who has supported the restriction, immediately vowed an appeal. “We will appeal the court’s decision,” Kemp said in a statement. “Georgia values life and we will keep fighting for the rights of the unborn.” (Jeff Amy, Associated Press)

Judge: Women Can Get Abortion Pill Without Doctor Visits - A federal judge agreed Monday to suspend a rule that requires women during the COVID-19 pandemic to visit a hospital, clinic or medical office to obtain an abortion pill. U.S. District Judge Theodore Chuang in Maryland concluded that the “in-person requirements” for patients seeking medication abortion care impose a “substantial obstacle” to abortion patients and are likely unconstitutional under the circumstances of the pandemic. (Michael Kunzelman, Associated Press)

STRUCTURAL RACISM - THE PUBLIC HEALTH CRISIS:

Racism in Care Leads to Health Disparities, Doctors and Other Experts Say as They Push for Change - The protests over the deaths of black men and women at the hands of police have turned attention to other American institutions, including health care, where some members of the profession are calling for transformation of a system they say results in poorer health for black Americans because of deep-rooted racism. (Tonya Russell, Washington Post)

Latinos Hit Hard by Coronavirus, but Chicago Suggests It’s Even Worse Than it Looks - Official statistics show that Latinos are hospitalized and dying from the coronavirus at four times the rates of whites, but even those high numbers may be seriously underestimated, says Andres Ramirez, a health care expert with Protect Our Care, a coalition trying to fend off Republican attacks on the Affordable Care Act. (Kristian Ramos, Washington Post)

COVID-19 TESTING:

Virus Spread, Not Politics Should Guide Schools, Doctors Say - As the Trump administration pushes full steam ahead to force schools to resume in-person education, public health experts warn that a one-size-fits-all reopening could drive infection and death rates even higher. They’re urging a more cautious approach, which many local governments and school districts are already pursuing. But U.S. Education Secretary Betsy DeVos doubled down on President Donald Trump’s insistence that kids can safely return to the classroom. “There’s nothing in the data that suggests that kids being in school is in any way dangerous,” she told Chris Wallace on “Fox News Sunday.” (Lindsey Tanner, Associated Press)

PERSONAL PROTECTIVE EQUIPMENT: 

Trump Administration's Delayed Use of 1950s Law Leads to Critical Supplies Shortages - Nearly four months after invoking a 1950s-era law in order to compel businesses to manufacture equipment for the fight against the coronavirus, the Trump administration has made only sparing use of its authorities, leaving front-line workers in dire need of supplies like masks, gowns and gloves amid the recent surge in cases. (Priscilla Alvarez, Curt Devine, Drew Griffin and Kristen Holmes, CNN)

TRUMP ADMINISTRATION RESPONSE: 

As the Coronavirus Crisis Spins Out of Control, Trump Issues Directives — but Still No Clear Plan - There is no cohesive national strategy, apart from unenforced federal health guidelines. Instead, the administration is offering a patchwork of solutions, often in reaction to outbreaks after they occur. Although Trump and his team declare sweeping objectives, such as reopening schools, they have largely shirked responsibility for developing and executing plans to achieve them, putting the onus instead on state and local authorities. (Philip Rucker, Yasmeen Abutaleb and Ashley Parker, Washington Post)

Trump Administration Strips C.D.C. of Control of Coronavirus Data - Hospitals have been ordered to bypass the Centers for Disease Control and Prevention and send all patient information to a central database in Washington, raising questions about transparency. (Sheryl Gay Stolberg, New York Times)\

Hospital Officials, Experts Say New Federal Rules for Covid-19 Reporting Will Add Burdens During Pandemic - State health leaders, public health experts and hospital officials warn that an abrupt change in how the Trump administration requires them to report coronavirus data will increase the burden on facilities already strained by the pandemic and could impede the distribution of critical medicines. (Amy Goldstein and Lena H. Sun, Washington Post)

IMMIGRANT AND REFUGEE HEALTH JUSTICE:

Doctors Not Part of DHS Review of Migrant Children’s Deaths - A government auditor did not employ medical professionals when his office cleared U.S. border agents of wrongdoing in the deaths of two Guatemalan children, the auditor said Wednesday. (Nomaan Merchant, Associated Press)

Die in Detention or at Home? U.s. Pandemic Forces Cruel Choice on Asylum Seekers - Reuters spoke to more than 30 lawyers, immigration advocates, detainees and their family members who said the risks of contracting COVID-19 inside detention facilities have driven people to seek deportation. Fifteen immigration lawyers and advocates, who together say they have received hundreds of requests from detainees seeking to leave facilities in eight U.S. states for health reasons, told Reuters they are seeing increases in the number of people considering abandoning their cases. Reuters found 12 cases of detainees who stopped fighting their cases and instead agreed to deportation or voluntary departure due to the pandemic. (Laura Gottesdiener, Reuters)

GUN VIOLENCE EPIDEMIC:

Record Numbers of Americans Try to Buy Guns - Americans are buying guns in record numbers. The new coronavirus pandemic, civil unrest after the killing of George Floyd and the ensuing movement to defund police are bringing in new buyers worried about their personal safety, according to buyers, store owners and gun experts….  Background checks in June for civilians seeking a license to carry were the highest since the FBI began conducting checks 20 years ago. (Julie Wernau and Zusha Elinson, Wall Street Journal)

Three Million More Guns: the Spring 2020 Spike in Firearm Sales - When Americans are concerned about their personal security, they buy firearms. Such concerns have been rampant since March, initially due to the onset of the COVID-19 pandemic and then the social unrest in June that followed George Floyd’s killing. Our estimates indicate that almost three million more firearms have been sold since March than would have ordinarily been sold during these months. Half of that increase occurred in June alone. This pattern highlights an important potential consequence that may result from this tumultuous period: more firearms in the hands of private citizens. (Phillip Levine and Robin McKnight, Brookings Institute

SUBSTANCE USE DISORDER:

New Peak of 71k US Overdose Deaths in 2019 Dashes Hopes - Nearly 71,000 Americans died of drug overdoses last year, a new record that predates the COVID-19 crisis, which the White House and many experts believe will drive such deaths even higher. Preliminary numbers released Wednesday by the Centers for Disease Control and Prevention show the trend is driven by fentanyl and similar synthetic opioids, which accounted for 36,500 overdose deaths. Deaths involving cocaine and methamphetamine also are rising. With billions of dollars devoted to ending the opioid epidemic, policymakers had hoped overdose deaths would continue to decline, or at least plateau, after 2018 showed a dip for the first time in three decades. (Carla K. Johnson, Associated Press)

Opioid Overdoses Have Skyrocketed Amid the Coronavirus, but States Are Nevertheless Slashing Addiction Treatment Program Budgets - Drug overdoses have skyrocketed and demand for addiction treatment medicine has soared as the coronavirus pandemic continues. But many cash-strapped states are nevertheless slashing budgets for opioid crisis programs… The budget cuts — many spurred by state budget shortfalls wrought by the economic consequences of the coronavirus pandemic — will hit behavioral health services when they are needed most, addiction treatment advocates told STAT. (Amy Sokolow, STAT)

DOCTORS - MEDICINE & RESEARCH:

First Coronavirus Vaccine Tested in Humans Shows Early Promise - An experimental coronavirus vaccine made by the biotech company Moderna provoked a promising immune response against the virus and appeared safe in the first 45 people who received it, researchers reported on Tuesday in The New England Journal of Medicine. (Denise Grady, New York Times)

Coronavirus Associated With Heart Damage, Study Finds - More than half of COVID-19 patients showed some form of heart damage in scans after their illness, according to a recent study that adds to mounting evidence showing the virus may cause cardiac injury. An observational analysis of more than 1,200 confirmed and suspected COVID-19 patients across 69 countries between April 3 and April 20 found heart abnormalities in 55% after they underwent echocardiograms, with 1 in 7 experiencing severe cardiac disease. The results were recently published in the European Heart Journal–Cardiovascular Imaging. (Steven Ross Johnson, Modern Healthcare)

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