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Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!


Weekly Rounds 5-17-20


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PUBLIC-FACING EVENTS  / PUBLIC VIDEO WORK: DFA receives requests from reporters working on documentaries or stories, and other non-profit advocacy groups looking for speakers for their events (virtual for now), and other stakeholders creating television and digital ads around the epidemic, or healthcare system issues in general. Sometimes the requests are for political advertising, and consequently those interested in participating politically will be representing themselves, not DFA; but we are happy to connect you.  Help us build a database of DFA physicians and medical students willing and able to do public-facing events or public video work to use when DFA receives legitimate requests. If This Is Something That Interests You -Please Sign up Today

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.

DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:


DFA Board Member Dr. Bich-May Nguyen:For the sake of the people of Texas and the stability of our hospitals, expanding Medicaid is the right thing for Texas. Gov. Abbott, if you're going to ask for federal assistance to cover COVID-19 testing for uninsured people, you should ask for our FULL share of federal taxpayer dollars to cover their health care costs during the pandemic and afterward. This is money that Texans have contributed and it should be brought back here where it's needed.” - Dr. Bich-May Nguyen


DFA Board Member Dr. Julie Parsonnet: “Every institution, every county is having to devise its own strategies, how do we get supplies, whom do we test, how and how often do we test them, can we get resources to do this?  Requiring every institution to devise its own approach is enormously inefficient and very, very stressful.DFA Twitter Account

 

DFA Board Member Dr. Joe Kanter: We found ourselves competing against other States and other hospital systems and even the Federal Government on the private market for supplies and for ventilators. There are times when it makes sense to have States to compete against each other and there are times when it doesn’t. There is really a role for the Federal Government to be a convenor and a leader and there are real ramifications when that doesn’t happen.” DFA Twitter Account


DFA In the News: Panel of Health Care Experts Call for More Medical Supplies and Testing - U.S. PIRG, Get Us PPE and Doctors for America co-hosted a panel on which leading physicians and U.S. Representative Andy Kim (N.J.) from the House Select Committee on the Coronavirus Crisis discussed how we can keep health care workers safe so that they, in turn, can treat the general public.


DFA Doctors Drs. Ali Khan, Shikha JainHow We Can Reopen Illinois Safely - We need to work together to evaluate when is the safest time and the safest plan to open for everyone. But until then, let’s keep our distance. We’d rather be 6 feet apart than put anyone 6 feet under.  - (Drs. Ali Khan, Shikha Jain, Eve Bloomgarden and Laura Zimmermann, IMPACT, Chicago Tribune)


DFA Doctors Shikha Jain & Vineet Arora -While Businesses May Open, Avoid Business as Usual - Controlling the spread of COVID-19 should be seen as a marathon, not a sprint. COVID-19 will surely have long term impacts on the lives of our citizens, and the economy. To minimize the impact on all, a strategic plan to reopen the economy is necessary to not only save lives but also salvage our economy. In other words, reopening responsibly requires going beyond business as usual. (Drs. Emily Landon, Shikha Jain, Vineet Arora, The Hill)


DFA Action in the News:Hundreds of Doctors Demand CDC End Stephen Miller-led Asylum Order Exploiting Public Health Crisis - Hundreds of doctors, nurses, health workers, and public health professionals have signed onto a public letter calling on the CDC to end the Stephen Miller-pushed order that has exploited the novel coronavirus public health crisis to deport large numbers of migrant children and other vulnerable people back to danger. “The decision to halt asylum processes ‘to protect the public health’ is not based on evidence or science,” the over 770 signatories as of May 13 say in their letter to CDC director Robert R. Redfield. “In fact, this order directly endangers tens of thousands of lives and threatens to amplify dangerous anti-immigrant sentiment and xenophobia.” (Daily Kos)


DFA Doctor Brian Williams Featured:He’s a Doctor Who Never Felt Drawn to Politics. Treating Shooting Victims and Coronavirus Patients Changed That - Brian Williams relocated to Chicago to focus his work on gun violence victims. Now he spends half his time treating coronavirus patients, while grappling with the role that race plays in both crises - When trauma surgeon Brian Williams first saw the Cook County Medical Examiner’s map of coronavirus deaths, a prickle crept up the back of his neck. He felt he had seen it before. Sitting in his office at the University of Chicago Medical Center in Hyde Park, he loaded The Chicago Tribune’s map of homicides in the city. Looking at them side by side, he saw that they were almost identical — and both showed the highest concentration of deaths in Chicago’s majority black neighborhoods. (Ann Givens, The Trace)


THE WEEK IN QUOTES:


A STARK WARNING: The major message that I wish to convey to the Senate HLP committee tomorrow is the danger of trying to open the country prematurely, If we skip over the checkpoints in the guidelines to: ‘Open America Again,’ then we risk the danger of multiple outbreaks throughout the country. This will not only result in needless suffering and death, but would actually set us back on our quest to return to normal.”  - Dr. Anthony S. Fauci


MASK ARE MORE EFFECTIVE THAN THOUGHT: “Evidence is mounting that masks — if worn in public places, by everyone — are far more effective at stopping transmission than was previously realized.”- (Donald G. McNeil Jr., New York Times)


MISSION ACCOMPLISHED: In every generation, through every challenge and hardship and danger, America has risen to the task, We have met the moment and we have prevailed.” - President Trump - May 11, 2020 


POLITICS, IDEOLOGY: We’re not reopening based on science, We’re reopening based on politics, ideology and public pressure. And I think it’s going to end badly.” - Dr. Thomas R. Frieden, Former Director of the C.D.C. in the Obama Administration


COVERAGE OPTIONS: "Unlike in past recessions, most of those who lose their job-based coverage will be eligible for health coverage because of the Affordable Care Act, though some may find coverage unaffordable even with subsidies, As unemployment benefits expire, however, about two million more people in states that did not expand their Medicaid programs under the ACA will move into the Medicaid coverage gap and have no affordable option." - Larry Levitt - Kaiser Family Foundation


ANY DECENCY OR COMPASSION:The Administration has decided that now—amid the most pervasive need in a century—is a great time to crack down on Americans who rely on food stamps to keep their families from going hungry, Congress is investing more in this program so that we can meet the challenge before us. If they had any decency or compassion, they would abandon this appeal immediately,” - Rep. Marcia Fudge, (D-OH) Chair of the House Agriculture Subcommittee on Nutrition, Oversight and Department Operations


CLOSED BORDERS:This ban was never about the pandemic, and it was never about public health, As today’s news makes clear, the Trump administration is weaponizing Covid-19 to achieve the policy objective it’s sought from Day 1: shutting the border to people seeking safety.” - Charanya Krishnaswami, Amnesty International


DEATHS ARE BEING UNDERCOUNTED NOT OVERCOUNTED: "Most of us feel that the number of deaths are likely higher than that number, because given the situation particularly in New York City ... I think you are correct that the number is likely higher, I don't know exactly where it sits higher, but almost certainly is higher." - Dr. Anthony Fauci


THE PRESIDENT: “And don’t forget, we have more cases than anybody in the world, But why? Because we do more testing. When you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases.”.  “it could be the testing’s, frankly, overrated? Maybe it is overrated,”” - The President of the United State of America


WI SUPREME COURT INVALIDATES STAY-AT-HOME ORDER: “We’re the Wild West, There are no restrictions at all across the state of Wisconsin. … So at this point in time … there is nothing that’s compelling people to do anything other than having chaos here.” - Wisconsin Gov. Tony Evers (D)


MEDIA COVERAGE: 


DOCTORS - MEDICINE & RESEARCH:


Finding Reliable Information about Covid-19 - In this audio interview conducted on May 13, 2020, the editors discuss trustworthy sources of Covid-19 information and the role of medical journals. (Eric J. Rubin, M.D., Ph.D., Lindsey R. Baden, M.D., and Stephen Morrissey, Ph.D., New England Journal of Medicine)


AMA Issues Guidance on Using Coronavirus Antibody Tests - The American Medical Association is warning doctors against using tests designed to identify people already exposed to the coronavirus to make healthcare decisions for individual patients. .. While the AMA acknowledges the tests offer important information throughout the COVID-19 pandemic, the lobbying group also warns that physicians shouldn't use the test to determine a patient's immunity to the virus. (Maria Castellucci, Modern Healthcare)


FDA Cautions About Accuracy Of Widely Used Abbott Coronavirus Test - The Food and Drug Administration is cautioning the public about the reliability of a widely used rapid test for the coronavirus. The test, made by Abbott Laboratories, has been linked with inaccurate results that could falsely reassure patients that they are not infected with the virus. (Joe Neel & Hannah Hagemann, National Public Radio)


Coronavirus May Pose a New Risk to Younger Patients: Strokes - Neurologists in New York City, Detroit, New Jersey and other parts of the country have reported a flurry of such cases. Many are now convinced that unexplained strokes represent yet another insidious manifestation of Covid-19, the illness caused by the new coronavirus. (Roni Caryn Rabin, New York Times)


Dramatic Drop in Cancer Diagnoses Amid COVID Pandemic Is Cause for Concern, Doctors Say - Doctors are registering a troubling trend: a precipitous drop in cancer diagnoses. Some experts fear that with each passing day, the prognosis for some of those undiagnosed cases may be getting worse as potential patients huddle at home. “My level of concern is up with the eight or nine level [on a scale to 10],” said Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society. (Dr. Mark Abdelmalek and Lucien Bruggeman, ABC News)


Coronavirus Could Worsen the Opioid Abuse Epidemic - Now these substance abuse health providers are concerned about their financial state in an environment primed for increased struggles with addiction: The centers are anticipating a crushing wave of new demand amid the public health and economic crisis, even as they grapple with how to provide remote care.  (Paige Winfield Cunningham, Washington Post)


'Deaths of Despair': Coronavirus Pandemic Could Push Suicide, Drug Deaths as High as 150k, Study Says - The new study, released Friday by the Well Being Trust and the American Academy of Family Physicians, factored in isolation and uncertainty when it calculated the expected deaths from suicide, alcohol and drugs, based on nine unemployment scenarios. The likely toll from these "deaths of despair" was the loss of an additional 75,000 lives, the study found. Death estimates ranged from 27,644 if the economy recovers quickly, to 154,037 if recovery is slow. (Jayne O’Donnell, USA Today)


COVID-19:


CDC Guidance More Restrictive Than White House - The Associated Press obtained 

a 63-page document that is more detailed than other, previously reported segments of the shelved guidance from the U.S. Centers for Disease Control and Prevention. It shows how the thinking of the CDC infection control experts differs from those in the White House managing the pandemic response. … As of Tuesday, CDC’s web page on travel guidance during the pandemic still linked to the White House plan. The stricter guidance is not there. (Jason Dearen and Mike Stobbe, Associated Press)


CDC Releases Scaled-Back Guidance on Reopening After White House Blocked Earlier Release - The CDC on Thursday released previously withheld guidance documents on reopening schools, restaurants and other institutions locked down during the pandemic, one week after the White House ordered the agency to revise an earlier draft it deemed "too prescriptive." (Rachel Roubein, Politico)


House to Introduce Bill to Create a National Public Health Corps - The House plans to introduce a bipartisan bill on Tuesday to create a National Public Health Corps that would employ hundreds of thousands to help conduct testing, contact tracing and eventually vaccinations of those infected or potentially infected with coronavirus. The legislation aims to address the health and economic crisis by helping to create a national testing strategy and hire Americans who are searching for jobs in a weak market. (Alex Rogers, CNN)


Coronavirus Models Are Nearing Consensus, but Reopening Could Throw Them Off Again - There is growing consensus among modelers estimating the number of cases and deaths from the novel coronavirus in the next few weeks. But this convergence of estimates — 31,000 to 42,000 additional deaths through mid-June for roughly 120,000 total deaths in the United States — comes just as shifts in public policy are likely to create new uncertainty about the path of the pandemic after that. (Quoctrung Bui, Josh Katz, Alicia Parlapiano and Margot Sanger-Katz, New York Times)


36 Million Have Sought US Unemployment Aid Since Virus Hit - Roughly 36 million people have now filed for jobless aid in the two months since the coronavirus first forced millions of businesses to close their doors and shrink their workforces, the Labor Department said Thursday. An additional 842,000 people applied for aid last week through a separate federal program set up for the self-employed and gig workers. (Christopher Rugaber, Associated Press)


With Millions Out of Work, the Trump Administration Pushes to Limit Food Stamps - Amid a global pandemic that has rattled the United States economy and led to record-breaking job losses, the Trump Administration is continuing to push to restrict access to the nation’s largest food assistance program. (Abby Vesoulis, Time)


After Wisconsin Court Ruling, Crowds Liberated and Thirsty Descend on Bars. ‘We’re the Wild West,’ Gov. Tony Evers Says - Right after the Supreme Court’s conservative majority issued a 4-to-3 ruling, invalidating the extension of the stay-at-home order issued by Evers’s appointed state health chief, the Tavern League of Wisconsin instructed its members to feel free to “OPEN IMMEDIATELY!” (Meaghan Flynn, Washington Post)


AFFORDABLE CARE ACT AND COVERAGE ISSUES:


43 Million Americans in Danger of Losing Health Insurance as a Result of Coronavirus Crisis, Study Shows - As many as 43 million Americans are in danger of losing their current health insurance as unemployment surges amid the novel coronavirus pandemic, a new study has shown. (Jason Lemon, Newsweek)


Most Newly Uninsured Are Eligible for Subsidized ACA Coverage, Analysis Finds - As job losses mount amid the COVID-19 crisis, so will health insurance losses. A new analysis estimates that based on job losses between March and May, nearly 27 million people may have lost employer-based health coverage and become uninsured. Most of those people would be eligible for Medicaid or an Affordable Care Act marketplace subsidy, according to the Kaiser Family Foundation analysis published Wednesday. (Shelby Livingston, Modern Healthcare)


Study Ties ‘ObamaCare’ to Fewer Cancer Deaths in Some States - Cancer deaths have dropped more in states that expanded Medicaid coverage under the Affordable Care Act than in states that did not, new research reveals. The report Wednesday is the first evidence tying cancer survival to the health care change, which began in 2014 after the law known as “Obamacare” took full effect, said one study leader, Dr. Anna Lee of Memorial Sloan Kettering Cancer Center in New York. “For a policy to have this amount of impact in a short amount of years” is remarkable, because cancer often takes a long time to develop and prove fatal, she said. (Marilynn Marchione, Associated Press)


Coronavirus Pandemic Renews Push for Medicaid Expansion in GOP-Led States - The coronavirus pandemic’s impact on the U.S. health-care system and economy is fueling renewed efforts in some states to expand Medicaid as millions of people lose their jobs and health coverage. Medicaid expansion initiatives will be on ballots this year in Oklahoma and likely in Missouri, two of the 14 states that haven’t widened the federal-state program for low-income and disabled people since the enactment of the Affordable Care Act under Democratic President Obama in 2010. (Stephanie Armour, Wall Street Journal)


IMMIGRANT AND REFUGEE HEALTH JUSTICE:


Under Trump Border Rules, U.S. Has Granted Refuge to Just Two People Since Late March, Records Show - The Trump administration’s emergency coronavirus restrictions have shut the U.S. immigration system so tight that since March 21 just two people seeking humanitarian protection at the southern border have been allowed to stay, according to unpublished U.S. Citizenship and Immigration Services data obtained by The Washington Post. (Nick Miroff, Washington Post)


Trump Administration Plans to Extend Virus Border Restrictions Indefinitely - The Trump administration is moving to extend its coronavirus border restrictions indefinitely, advancing the crackdown through broad public health authorities that have effectively sealed the United States to migrants seeking protection from persecution, according to officials and a draft of a public health order. (Michael D. Shear & Zolan Kanno-Youngs, New York Times)


‘Everybody Was Sick’: Inside an ICE Detention Center - The American Civil Liberties Union has referred to the country’s detainee population as “sitting ducks.” The nonprofit Government Accountability Project recently estimated that almost all of those held in ICE facilities could be infected by the 90th day of a Covid outbreak. (Tammy La Gorce, New York Times)

 

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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Weekly Rounds 5-10-20


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As doctors, nurses and health experts from around the world, we are here to sound the alarm. Our job is to keep people safe. But right now we face not only a COVID-19 pandemic but a global infodemic, with viral misinformation on social media threatening lives around the world. Stories claiming cocaine is a cure, or that COVID-19 was developed as a biological weapon by China or the US, have spread faster than the virus itself. Tech companies have tried to act, taking down certain content when it is flagged, and allowing the World Health Organization to run free ads. But their efforts are far from enough. That’s why today we are calling on the tech giants to take immediate systemic action to stem the flow of health misinformation, and the public health crisis it has triggered.  Sign the Petition Now!

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.

DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:


DFA Board Member, Dr. Dona Kim Murphey: Texas COVID-19 Cases In Immigrant Detention Quadruple In Two Weeks, As ICE Transfers Continue - “You really shouldn’t be transferring people between facilities if you have any positives,” said Dr. Dona Kim Murphey, a neurologist and immigrant health advocate with Doctors for America. Murphey has been demanding the release of people from detention since the outbreak started. ….Murphey said. “With people who are constantly transferred between facilities, new people who are entering facilities, the staff who are actually traveling between facilities,” she said, “it’s very likely that you will have at some point the introduction of the infection into these populations, which then are kind of like tinderboxes.” (Elizabeth Trovall,  Houston Public Radio)


DFA Doctor Dr. Juliana E. Morris - San Francisco’s Homeless Need More Than Hotel Rooms to Survive During Coronavirus, and After - I knock on the hotel room door to greet my first patient of the day. I hear a rustling inside the room and a loud cough. My heart accelerates. Does he need to be tested? I adjust my mask and take a step back as I wait for the door to open... (Dr. Juliana E. Morris, San Francisco Chronicle)


DFA Doctors Ali Khan, Shikha Jain & Vineet Arora - All Americans Should Care About When States Reopen - But reopening the country prematurely, without effective test, trace, and treat measures in place, will most certainly result in a second surge. Failing to control the virus effectively now will likely lead to the inevitable consequence of worsening devastation and damage to the economy.  (US News & World Report)


THE WEEK IN QUOTES:


TOO HARD: Like many countries we picked a strategy to beat COVID-19. We just decided not to stick to it.Andy Slavitt


LESSONS FROM AROUND THE WORLD: Some lessons from around the world: the most successful global leaders in fighting coronavirus have communicated clearly, displayed empathy, and always favored science over politics.” Christiane Amanpour, CNN Chief International Anchor


MORE WORRIED, NOT LESS: If we were worried about it being overwhelmed a month ago or a month and half ago when the restrictions started, and there are more cases per day now, then we should be more worried, not less.” Marc Lipsitch, Epidemiologist - Harvard’s T.H. Chan School of Public Health


PICNIC IN YOSEMITE?: it’s great time to explore America, A lot of people haven’t seen many parts of America.” - Treasury Secretary Steve Mnuchin 


NOT WHO WE ARE: "The Confederate flags and nooses, the swastikas, the, you know, behavior that you've seen in all of the clips, is not representative of who we are in Michigan. And the fact of the matter is, I mean, we're in a global pandemic, we need to listen to the expertise and our institutions of higher learning and our health system and make decisions that are going to protect the lives of everyone." - Michigan Governor Gretchen Whitmer


KNOWINGLY GOING BACK TO MID-MARCH: “It will be tempting to see reopening as a return to our way of life before the coronavirus, but it will be anything but. As a society, we have made the decision to reopen before the science says we are ready. We are knowingly going back to where we were in mid-March, before the first exponential surge in infections and deaths. That surge will come again, but this time no one can say they didn’t see it coming.” - Dr. Leana S. Wen - Emergency Physician and Visiting Professor at George Washington University Milken Institute School of Public Health. Previously, She Served as Baltimore’s Health Commissioner.


ONTO A BATTLEFIELD WITHOUT ARMOR: "You talk about how essential, how needed, how grateful you are, and yet you throw us to the wolves, You throw us out onto a battlefield without armor and the more we complain we don't see anything being done.”Jean Ross, President of National Nurses United


PRICING OF REMDESIVIR: Drug prices have taken a backseat to the pandemic, but remdesivir is about to make the issue very relevant again.” - Caitlin Owens - Axios Vitals


STATEMENT BY VICE PRESIDENT JOE BIDEN - “By siding with the Republican Attorneys-General who are seeking to invalidate the ACA in the U.S. Supreme Court, Trump has made clear where his priorities lie. Not with protecting the millions of people who depend on the exchanges for their health coverage. Not with ensuring that more than 100 million people with pre-existing conditions won’t be denied coverage or charged more by their insurers. Not with the thousands of Americans who may develop new “pre-existing conditions” due to their battle with COVID-19. Not with the young people who can now stay on their parents insurance until 26. Not with women, who will no longer be protected against being charged more for their insurance. No — Trump has decided he’d rather destroy President Obama’s legacy than protect the health care of millions upon millions of Americans. He’d rather look after the profits of the insurance industry than make sure people can access healthcare in their hour of need. It’s despicable." - Former Vice President Joe Biden


REACH OUT: If you have 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


MEDIA COVERAGE: 


DOCTORS - MEDICINE & RESEARCH:


Coronavirus Hijacks the Body From Head to Toe, Perplexing Doctors - More than a respiratory infection, Covid-19 wreaks havoc on many organs; inflammation and abnormal blood clotting are likely culprits (Betsy McKay and Daniela Hernandez, Wall Street Journal)


Doctors Rush to Understand COVID-19's Second-Week Crash - Doctors have now described alarming situations in which patients with COVID-19 suddenly and inexplicably become critically ill around the eighth day after being infected with the virus. .. While doctors may be uncertain why the crash appears in the second week, they do have several theories as to what may be causing the crashes. (Dr. Angela N. Baldwin, ABC News)


New COVID-19 Study Raises Immunity Hopes for Recovered Patients - Researchers in China tested the blood of 285 patients hospitalized with severe COVID-19 illness and found that all had developed antibodies within two to three weeks of their first symptoms. (Jessie Hellmann, The Hill)


Eerie Emptiness Of ERs Worries Doctors As Heart Attack And Stroke Patients Delay Care - Across the U.S., doctors call the drop-off staggering, unlike anything they’ve seen. And they worry a new wave of patients is headed their way — people who have delayed care and will be sicker and whose injuries will be exacerbated by the time they finally arrive in emergency rooms. (Will Stone and Elly Yu, KPCC)


New Bill Would Forgive Medical School Debt for COVID-19 Health Workers - The idea is catching on. Last month, more than 500,000 people signed a MoveOn petition asking Congress to include student loan debt forgiveness for doctors in the next stimulus bill. (Erin Schumaker, ABC News)


Malaria Drug Shows No Benefit in Another Coronavirus Study - Hydroxychloroquine did not lower the risk of dying or needing a breathing tube in a comparison that involved nearly 1,400 patients treated at Columbia University in New York, researchers reported Thursday in the New England Journal of Medicine. (Marilynn Marchione, Associated Press)


Johns Hopkins' Ideas for Better Preparedness After COVID-19 - An action plan published Tuesday by researchers at Johns Hopkins University offers wide-ranging solutions for both the private healthcare sector and the federal government in response to the shortcomings that have come to light in the wake of the COVID-19 pandemic. The Report (Maria Castellucci, Modern Healthcare)


Facebook and Other Companies Are Removing Viral ‘Plandemic’ Conspiracy Video - Social media companies including YouTube, Vimeo and Facebook are removing a viral conspiracy theory video because of its claims regarding the coronavirus pandemic. The approximately 26-minute video was presented as an extremely long “trailer” for a full-length film titled “Plandemic” and features an extended interview with Judy Mikovits, a well-known figure in the anti-vaccination movement who has made various discredited claims about the effects of vaccines. (Travis M. Andrews, Washington Post)


AFFORDABLE CARE ACT AND COVERAGE ISSUES:


Trump Vows Complete End of ObamaCare Law Despite Pandemic - President Trump said Wednesday he will continue trying to toss out all of the Affordable Care Act, even as some in his administration, including Attorney General William P. Barr, have privately argued parts of the law should be preserved amid a pandemic. (Devlin Barrett, Washington Post)


In a Time of COVID-19, 'ObamaCare' Still Part of The Action - From nearly 12 million people to 35 million could lose their workplace coverage due to layoffs in the coronavirus shutdown, according to an estimate by the consulting firm Health Management Associates. They have more options because of the Obama-era law. (Ricardo Alonso-Zaldivar, Associated Press)


Thousands Will Go Uninsured in the Covid-19 Outbreak Because Republicans Rejected Medicaid Expansion - Republican-led states have for years refused to expand Medicaid eligibility to many of their poorest residents, and now, in the midst of the coronavirus pandemic and an unprecedented economic crisis, thousands upon thousands of Americans will fall through that hole in the safety net and end up uninsured. This was completely avoidable. (Dylan Scott, Vox)


COVID-19:


Coronavirus in the U.S.: An Unrelenting Crush of Cases and Deaths - Any notion that the coronavirus threat is fading away appears to be magical thinking, at odds with what the latest numbers show. (Julie Bosman, Mitch Smith and Amy Harmon, New York Times)


The Coronavirus Pandemic Is Pushing America Into a Mental Health Crisis - Anxiety and depression are rising. The U.S. is ill-prepared, with some clinics already on the brink of collapse. (William Wan, Washington Post)


Jobless Rate Spikes to 14.7%, Highest Since Great Depression - The U.S. unemployment rate hit 14.7% in April, the highest rate since the Great Depression, as 20.5 million jobs vanished in the worst monthly loss on record. (Christopher Rugaber, Associated Press)


PERSONAL PROTECTIVE EQUIPMENT:


How Profit and Incompetence Delayed N95 Masks While People Died at the VA - Federal agencies have hired contractors with no experience to find respirators and masks, fueling a black market filled with price gouging and multiple layers of profiteering brokers. One contractor called them “buccaneers and pirates.” (J. David McSwane, ProPublica)


After ‘Cutthroat’ Global Competition For PPE, U.S. Seeks to Make More at Home - Today's increased manufacturing in the U.S. should lead to less U.S. dependence on foreign imports. But, even today, front-line workers are paying the price for the shortage. (Nick Schifrin, PBS NewsHour)


COVID-19 TESTING:


'Not Nearly Enough' Coronavirus Testing to Safely Reopen, Senate Health Chair Says - The Harvard Global Health Institute released new data Thursday that suggest more than 900,000 coronavirus tests need to be completed daily to consider safely relax distancing measures, as a growing number of states are doing. That number is significantly higher than the approximately 250,000 tests per day the country is currently running, according to data from The COVID Tracking Project.  (David Lim, Politico)


TRUMP ADMINISTRATION RESPONSE:


White House Rejects C.D.C.’s Coronavirus Reopening Plan - White House and other administration officials rejected the recommendations over concerns that they were overly prescriptive, infringed on religious rights and risked further damaging an economy that Mr. Trump was banking on to recover quickly. (Abby Goodnough and Maggie Haberman, New York Times)


Trump Cheers on Governors Even as They Ignore White House Coronavirus Guidelines in Race to Reopen - States across the country are moving swiftly to reopen their economies despite failing to achieve benchmarks laid out by the White House for when social distancing restrictions could be eased to ensure the public’s safety during the coronavirus pandemic. These governors’ biggest cheerleader is President Trump. (Toluse Olorunnipa, Griff Witte and Lenny Bernstein, New York Times)


Trump Officials' Dysfunction Harms Delivery of Coronavirus Drug - A complete breakdown in communication and coordination within the Trump administration has undermined the distribution of a promising treatment, according to senior officials with direct knowledge of the discussions. .. "Some went to the wrong places, some went to the right places," said one senior official. "We don't know who gave the order. And no one is claiming responsibility." (Jonathan Swan, Axios)


COVID-19 & IMMIGRATION:


Before Covid-19, Trump Aide Sought to Use Disease to Close Borders - The president’s chief adviser on immigration, Stephen Miller, had long tried to halt migration based on public health, without success. Then came the coronavirus. - … The idea that immigrants carry infections into the country echoes a racist notion with a long history in the United States that associates minorities with disease. (Caitlin Dickerson and Michael D. Shear, New York Times)


GUN VIOLENCE EPIDEMIC: 


Open States, Lots of Guns. America Is Paying a Heavy Price for Freedom. - As a country, we seem resigned to preventable firearm deaths. Each year, 36,000 Americans are killed by guns — roughly 100 per day, most from suicide, according to data from the Giffords Law Center. Similarly, the Everytown for Gun Safety Support Fund calculates that there have been 583 “incidents of gunfire” on school grounds since 2013. In the first eight months of 2019, there were at least 38 mass shootings, The Times reported. Last August, 53 Americans died in mass shootings — at work, at bars, while shopping with their children. (Charlie Warzel, New York Times)


WOMEN’S HEALTH:


Justices Wary of ‘ObamaCare’ Birth Control Coverage Changes - The Supreme Court seemed concerned Wednesday about the sweep of Trump administration rules that would allow more employers who cite a religious or moral objection to opt out of providing no-cost birth control to women as required by the Affordable Care Act. … Even though the Trump rules remain blocked, a ruling by a federal judge in Texas in June already allows most people who object to covering contraception to avoid doing so. (Jessica Gresko and Mark Sherman, Associated Press)

 

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Weekly Rounds 5-3-20


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Doctors for America is joining with Migrant Clinicians Network, Refugee Health Alliance, and Human Impact Partners to demand that Robert R. Redfield, MD, the Director of Centers for Disease Control and Prevention immediately rescind the recently extended order “suspending introduction of certain persons from countries where a communicable disease exists” to May 20, 2020.  The decision to halt asylum processes “to protect the public health” is not based on evidence or science. In fact, this order directly endangers tens of thousands of lives and threatens to amplify dangerous anti-immigrant sentiment and xenophobia. Sign the Petition Now.

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.


DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:


DFA SPEAKING OUT: Kennedy & Jayapal Introduce Legislation to Guarantee Health Coverage During Covid-19 Pandemic - “Doctors for America and its 20,000 members nationwide have been on the frontlines of this pandemic and we commend Representatives Jayapal and Kennedy for including critical health and life-saving measures that aim to ensure increased availability and equitable distribution of PPE and other medical equipment for all frontline workers. We also know firsthand that COVID-19 has not merely caused – but rather, exposed – the deep and critical problems that our patients face in affordability, equity, and accessibility of their health care. We applaud this proposal for ensuring coverage, affordability, and access to health care for all of our patients during the COVID crisis, while illustrating one of several viable approaches for moving toward universal health care in the future. This crisis shows us that, as a nation, we are all in this together: We should all have access to PPE when caring for and serving others, and we should all have insurance coverage that does not disappear when you need it nor depend on your employment status during a pandemic,” said Drs. Justin Lowenthal and Meenakshi Bewtra, co-chairs of the COVID-19 response taskforce and members of the national board of directors of Doctors for America. 


DFA IN THE NEWS: Doctors Call for U.S. ‘Czar’ to Coordinate Equipment, Tests - U.S. doctors and other health-care workers dealing with the Covid-19 pandemic are urging a coordinated federal effort to make sure medical equipment, protective gear and tests get to where they’re needed…. Among the signers were Doctors for America, a group of more than 20,000 doctors and other health-care professionals; Get Us PPE, a grassroots movement founded by front-line physicians; and the U.S. Public Interest Research Group, which represents consumer advocates.  (Susan Decker, Bloomberg News)


Anonymous DFA Family Physician - N95 Masks are Disposable. Doctors are Not. - I never imagined that I would be the doctor who called out of work and then resigned during a pandemic. But, somehow in mid-April 2020, this is what happened. My emotions over the month leading to my resignation were overwhelming, and I want to share my experience with the hope that it helps others, particularly health care workers who are struggling with similar problems and organizations that need to change their practices. I’m publishing this anonymously to protect myself and my co-workers. (Anonymous Family Physician, Pandemic Diaries)


DFA Copello Fellow Doctor Rohit Abraham - Telemedicine in a Terrible Time: A Resident Physician’s Perspective - As I thought through Edward’s case, I decided I could not in good conscience call 911, as I would under normal circumstances, to send him to the ED. This could ultimately become a death sentence. (Rohit Abraham, MD, MPH, In House)


DFA Doctor Aakash Shah and DFA Medical Student Alex Pomerantz: The U.S. Should Make COVID-19 Testing, Prevention And Care Free To All - Coronavirus is a threat. To thoroughly contain it, we must thoroughly screen for it. And to thoroughly screen for and prevent it, the U.S. government must make all COVID-19 care free for patients. (Nicole Bustos, Alex Pomerantz and Aakash Shah, WBUR)


DFA Doctor Jay Bhatt - More Than a Disease, COVID-19 Exposes Health Risk of Food Insecurity: - As cases continue to surge and new hot spots emerge every week, we must take proactive measures to ensure that low-income, vulnerable individuals have access to healthy food options. Then, as soon as we win the battle against COVID-19, we must stop and rethink our aid strategy to ensure every American has equal access to health care and food. (Jay Bhatt, ABC News)


DFA Board Member  Dr. Krishnan Narasimhan: ‘South Asians for Biden’ Steps Up Efforts to Counter Rising Anti-Asian Hate Crimes in Wake of COVID-19 Pandemic South Asians for Biden and the Biden for President Campaign is jointly hosting a virtual forum on the impact of Coronavirus and its impact on the community in early May. The event will feature Dr. Krishnan Narasimhan, board member of Doctors for America; and Congressman Raja Krishnamoorthi (D-IL)


DFA Doctor Mona Mangat:Here’s who is advising Mayor Rick Kriseman on reopening St. Petersburg, Florida - Mayor Rick Kriseman on Friday named the 17 advisers he will lean on to decide when and how to reopen the Sunshine City for business after the month-long shutdown in response to the COVID-19 pandemic. … • Dr. Mona Mangat, member/past board chair, Doctors for America, allergist and immunologist.


THE WEEK IN QUOTES:


GASLIGHTING: The total number of coronavirus cases in the United States exceeded one million. The American death toll surpassed that of the Vietnam War. And the economy was reported to have shrunk by nearly 5 percent. But the White House on Wednesday declared its response to the crisis “a great success story.Peter Baker, New York Times


MORE AMERICANS THAN THE VIETNAM WAR:In not even three months since the first known U.S. deaths from COVID-19, more lives have now been lost to the coronavirus pandemic on U.S. soil than the 58,220 Americans who died over nearly two decades in Vietnam.David Welna, National Public Radio


MORE GASLIGHTING:We’re on the other side of the medical aspect of this, and I think we’ve achieved all the different milestones that are needed, so the federal government rose to the challenge and this is a great success story, And I think that that’s what really needs to be told.” White House Senior Adviser Jared Kushner 


BLAME THE WORLD HEALTH ORGANIZATION: The U.S. administration is very fixated on the reelection campaign and on who can get blamed for this catastrophic COVID-19 situation in the U.S., They are blaming WHO and China for it. Therefore it is very difficult to agree on a common language about the WHO.” - Senior European Official 


WE NEED THE REAL CDC BACK: This must be a painful time for the many extraordinary career scientists who continue to work at the agency. But it’s a painful moment for the American people, too, and with deadly consequences. Real CDC leadership — clear, science-based guidance, effective coordination of states, and public transparency of data — is absolutely essential for confronting and getting clear of this crisis. The CDC was once the world’s greatest public health agency. We need that CDC back, and we need it now.Ashish K. Jha, M.D., Director of the Harvard Global Health Institute and Professor of Global Health at the Harvard T.H. Chan School of Public Health


THE TESTING MESS: The federal government needs to play a critical role here, It’s been extremely disappointing for people who know what the federal government is capable of doing to see the chaos that exists now.” - Joshua Sharfstein, a Former Food and Drug Administration Official and a Vice Dean at the Johns Hopkins Bloomberg School of Public Health


PRESIDENT DECLARES THE U.S. WILL BE ABLE TO CARRY OUT FIVE MILLION TEST PER DAY:   There is absolutely no way on Earth, on this planet or any other planet, that we can do 20 million tests a day, or even five million tests a day.” - Admiral Brett Giroir, the Assistant Secretary of Health Who Is in Charge of the Government’s Testing Response 


UNREAL: "When Vice President Mike Pence ignores the safety policy and refuses to wear a face mask, he insults the hard work and sacrifice of all healthcare workers. Worse, he puts them, their patients, and their families at risk," Jamie Gulley, President of the SEIU Healthcare Minnesota


300 MILLION VIALS OF VACCINE: The Trump administration needs to prepare our domestic supply chain now for the delivery of an eventual vaccine that will need to be delivered to the entire country, It’s vital that federal agencies exercise better foresight so that we don’t see supply shortages like we continue to experience for testing and protective equipment.” U.S. Senator Shaheen (D-NH)


MEDIA COVERAGE: 


DOCTORS - MEDICINE & RESEARCH:


The Drugs and Treatments That Could Stop Covid-19 - There are now 72 registered clinical trials ongoing in the U.S. and abroad, according to the Food and Drug Administration. Here’s a rundown of how this process is taking shape, and the key results expected in the coming months. (Zachary Brennan, Politico)


DFA Doctor Jay Bhatt - To Study Coronavirus in the Air, All Eyes on a Chinese Restaurant

A new study of a COVID-19 outbreak tied to a restaurant in China is re-igniting questions about how far the novel coronavirus could spread in the air and how airflow through ventilators or air conditioners, and the air quality itself, could play a role. (Kaitlyn Folmer, Dr. L. Nedda Dastmalchi and Jay Bhatt, ABC News)


DFA IN THE NEWS: Frontline Medical Workers Organize May 2nd "Need Masks Today" Virtual March - Yale physicians and medical providers partner with GetUsPPE.org, Masks4America.org, Doctors for America, and the American Medical Student Association to discuss sustainable solutions for PPE and pharmaceuticals to be made in the USA.


9 Ways Coronavirus Changed Treating Patients - The precipitous climb of COVID-19 has led to substantial changes in both the art and the science of medicine. Amid a global pandemic, doctors and nurses are learning how to practice medicine differently -- adjusting the way they use resources, perform procedures, interact with patients and families, utilize technology, and work with public health and scientific communities for a common mission. (Dr. Delaram J. Taghipour, Dr. Vinayak Kumar, ABC News)


CDC Adds 6 Symptoms To Its COVID-19 List - The Centers for Disease Control and Prevention has added several new symptoms to its existing list of symptoms for COVID-19. . .. It has now added six more conditions that may come with the disease: chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell. (Scott Neuman, National Public Radio)


WHO Says No Evidence Recovery Prevents Second Infection - The World Health Organization on Saturday said there was not enough evidence that a person who has recovered from covid-19 is immune from a second infection. (Kim Bellware, Meryl Kornfield, Miriam Berger, Hannah Knowles, Jesse Dougherty and Candace Buckner, Washington Post)


Nearly a Third of Americans Have Put Off Healthcare During COVID-19 - Around 1 in 3 Americans are delaying medical care as they cope with the financial losses and stress caused by COVID-19, new studies show. (Alex Kacik, Modern Healthcare)


Coronavirus Has Created a Crisis for Primary Care Doctors and Their Patients - The coronavirus pandemic is creating yet another kind of health care crisis: America’s primary care practices are struggling financially as patient visits plummet, and patients themselves are missing out on vital routine care. (Dylan Scott, Vox)


Find a Vaccine. Next: Produce 300 Million Vials of It. - Scaling up the manufacturing of syringes and other medical products required to deliver a vaccine to millions of Americans will be just as important as the vaccine itself. (Knvul Sheikh, New York Times)


Why One Breakthrough Drug Won't End the Pandemic - Five Reasons to Be Cautious About Remdesivir. - The nation’s top health officials say they’re rushing to make sure Americans can get widespread access to the experimental drug remdesivir after a study showed that it shortens the recovery time for some coronavirus patients. … But there are still major questions about how well Remdesivir works, when the government might make it available to the public, and whether drugmaker Gilead can keep pace with rising global demand for the drug. Here’s what to watch as more data is uncovered. (Zachary Brennan and Sarah Owermohle, Politico)


PERSONAL PROTECTIVE EQUIPMENT:


Widely Used Surgical Masks Are Putting Health Care Workers At Serious Risk - With medical supplies in high demand, federal authorities say health workers can wear surgical masks for protection while treating COVID-19 patients — but growing evidence suggests the practice is putting workers in jeopardy. (Shefali Luthra and Christina Jewett, Kaiser Health News)


Trump Called PPE Shortages 'Fake News.' Health Care Workers Say They're Still a Real Problem - Doctors and nurses told POLITICO they're still recycling protective equipment and worry vulnerable areas are being overlooked. ….  hospitals, nursing homes and caregivers across the country tell POLITICO they are still struggling to obtain medical masks, gloves and gowns, undercutting Trump’s assertions. (Tucker Doherty and Brianna Ehley, Politico)


OSHA Complaints Flood in From COVID-19 Frontline Health Workers - Health-care workers and public employees in 10 states filed 40 complaints with the Occupational Safety and Health Administration on Tuesday, claiming employers failed to protect them on the frontlines of the coronavirus pandemic. (Olivia Messer, Daily Beast)


TRUMP ADMINISTRATION RESPONSE:


Trump Expands Battle With WHO Far Beyond Aid Suspension - President Trump and his top aides are working behind the scenes to sideline the World Health Organization on several fronts as they seek to shift blame for the novel coronavirus pandemic to the world body, according to U.S. and foreign officials involved in the discussions. (John Hudson, Josh Dawsey and Souad Mekhennet, Washington Post)


President’s Intelligence Briefing Book Repeatedly Cited Virus Threat - U.S. intelligence agencies issued warnings about the novel coronavirus in more than a dozen classified briefings prepared for President Trump in January and February, months during which he continued to play down the threat, according to current and former U.S. officials. (Greg Miller and Ellen Nakashima, Washington Post)


'Dangerous & Disrespectful': Doctors Tear Into Pence's Mask-Less Hospital Visit - Vice President Mike Pence's refusal to wear a mask during his visit to the prestigious Mayo Clinic this week was potentially dangerous and sent the wrong message about the federal guidelines he regularly touts, doctors and health care officials said. (Jane C. Timm and Dareh Gregorian, NBC News)


Trump’s Response to Virus Reflects a Long Disregard for Science - A disregard for scientific advice has been a defining characteristic of Mr. Trump’s administration. (Lisa Friedman and Brad Plumer, New York Times)


Trump Administration Signals Support for Allies’ Fight Against Virus Orders - A network of conservative leaders, donors and organizations has launched a legal onslaught against state and local restrictions intended to slow the spread of the coronavirus, pushing to allow churches to hold services, businesses to reopen and people to be able to visit with family and friends. They have been emboldened in recent days by increasing signs of support from a powerful ally: The Justice Department. (Lisa Lerer and Kenneth P. Vogel, New York Times)


COVID-19:


‘A Terrible Price’: The Deadly Racial Disparities of Covid-19 in America - On April 6, Louisiana became one of the first states to release Covid-19 data by race: While making up 33 percent of the population, African-Americans accounted for 70 percent of the dead at that point. Around the same time, other cities and states began to release racial data in the absence of even a whisper from the federal government — where health data of all kinds is routinely categorized by race.  (Linda Villarosa, New York Times)


Miscalculation at Every Level Left U.S. Unequipped to Fight Coronavirus

The swine flu, an outbreak of H1N1 flu, turned out to be a dry run for a major pandemic. But neither hospitals nor manufacturers nor the government made sweeping changes to be ready for one. Instead, each part of the medical-industrial equation acted in its own interest, and didn’t set aside resources that might have better prepared America for the coronavirus crisis. (Alexandra Berzon, Melanie Evans, Stephanie Armour and Austen Hufford, Wall Street Journal)


A Staggering Toll: 30 Million Have Filed for Unemployment - Another 3.8 million people filed claims for jobless benefits last week, according to the Labor Department. While that's down from the previous week's 4.4 million, a staggering 30.3 million have applied for unemployment in the six weeks since the coronavirus began taking a wrecking ball to the U.S. job market. That's roughly one out of five people who had a job in February. (Scott Horsley, National Public Radio)


COVID-19 TESTING:


Virus Test Shortages Undermine Drive to Restart U.S. Economy - With more states pushed toward reopening on Monday, experts warn that U.S. testing capacity, while improved, remains a fraction of what it should be. (Emma Court and Olivia Carville, Bloomberg News)


Unreliable Antibody Tests Flood the Market as FDA Waives Quality Reviews - The Food and Drug Administration is dealing with a flood of inaccurate coronavirus antibody tests after it allowed more than 120 manufacturers and labs to bring the tests to market without an agency review. (Zachary Brennan and David Lim, Politico)


COVID-19 & IMMIGRATION:


U.S. Borders to Remain Shut to Foreign Travelers as States Reopen - The Trump administration has no immediate plans to reopen the country’s borders after imposing a ban on foreign travelers from the European Union and the U.K. last month to slow the spread of the coronavirus…. Illegal immigration has slowed to a trickle at its southern border, where the U.S. has stopped processing asylum requests made after March 20. Last week, the administration also suspended green cards for prospective immigrants abroad for the next 60 days. (Jessica Donati, Wall Street Journal)


GUN VIOLENCE PREVENTION:


Prime Minister Trudeau Announces Canada Is Banning Assault-style Weapons

Canada has banned assault-style weapons following the murder of 22 people in the worst mass shooting in the country’s history, Justin Trudeau announced on Friday. “These weapons were designed for one purpose and one purpose only: to kill the largest number of people in the shortest amount of time. There is no use and no place for such weapons in Canada,” said the prime minister. “Effective immediately, it is no longer permitted to buy, sell, transport, import or use military-grade assault weapons in this country.” (Leyland Cecco, The Guardian)


New Online Safe Firearm Storage Map Helps Marylanders Find Locations to Temporarily Store Guns - Marylanders to Prevent Gun Violence (MPGV) has launched Maryland’s first-ever online map identifying locations for safe firearm storage outside homes to help community members who voluntarily seek local options to store their firearms. (Marylanders to Prevent Gun Violence, BayNet.com)

 

Back to the Top


Weekly Rounds 4-26-20


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Doctors for America is committed to fighting for equitable universal healthcare at the lowest costs to our patients and our country. Patients trust their physicians to heal them; at this moment in history, healing our patients requires us taking the step to Heal America. The Health for All Team has made substantial progress cultivating members’ views into DFA’s core principles but now it’s time to grow our ranks. That’s where you come in – please consider joining our team, we need your energy, intellect, and a little time – to help DFA’s effort to secure Health for All.  -CLICK HERE TO JOIN THE TEAM

 

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.

 

 

DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:

 

DFA DOCTOR HUSSAIN LALANI -Thousands of Americans Will Face Food Insecurity, Unless We Act Now -  We are now starting to face consequences related to unemployment and poverty. Preventing people from going hungry should be the bare minimum as we begin to rebuild our lives. Increasing SNAP benefits and eligibility is the most reliable way to support our citizens. But if we wait until the pandemic is over, it will be too late, as thousands will have already experienced food insecurity. The time to act is now. Dr. Hussain Lalani is co-chair of the DFA Drug Affordability Steering Committee (Hussain Lalani and Jacquelyn Corley, The Hill)

 

DFA DOCTOR SHETAL SHAH INTERVIEW ON CNN:U.N. Report on the  Downstream Effects That the Coronavirus Pandemic and Our Social Distancing Response Is Going to Have on Children.  - Shetal Shah is a professor of pediatrics and works at a children's hospital in New York. Professor, thank you for joining us. Good to see you. - DR. SHETAL SHAH, NEONATOLOGIST, MARIA FARERI CHILDREN'S HOSPITAL: Yes, thank you for having me. I think the U.N. report really does a good job of highlighting the downstream effects that the coronavirus pandemic and our social distancing response is going to have on children. … CURNOW: So basically, you're saying parents still need to take their babies and their kids to the doctors to get their immunizations. That they mustn't break the schedule. SHAH: That's correct. (CNN)

 

DFA MEDICAL STUDENTS BECKMAN & GONDI: During Covid-19, Americans Need Immediate Access to Health Insurance—here’s How Congress Should Grant That - Time and again, Congress and the White House have stepped up in times of crisis to ensure the uninsured can access care. The current situation is not markedly different from any of these examples. Millions are at risk of contracting covid-19, healthcare capacity is overrun, and financial markets are in turmoil. In times like these, it is the duty of our policymakers in Washington to take steps to protect the public and promote our collective health. Building on the Families First Coronavirus Response Act with a provision to extend comprehensive Medicaid coverage for all covid-related care—not just for testing—to uninsured individuals is part of that duty. (Suhas Gondi, Adam Beckman, Sara Rosenbaum, and Howard Forman, BMJ Opinion)

 

DFA DOCTOR LU:My Team Fights to Save the Sickest Patients. Give Us Head-to-Toe Protection - For the sake of all Americans, we must increase the standard of protective gear for health-care workers. This includes and goes beyond masks -- we must provide reusable head-to-toe protection. Currently, frontline health-care workers are exposed and unsafe. Dr. Alicia Lu is a Doctors for America Copello Health Advocacy Fellow (Alicia Lu and Dan Wu, CNN)

 

DFA DOCTOR KIM CULLEN:How COVID-19 Underscores the Consequences of Mass Incarceration - UC Health's Doctor Kimberly Cullen is a Doctors for America Copello Health Advocacy Fellow (Pete Lee and Kimberly Cullen, Colorado Springs Gazette)

 

DFA DOCTOR KIM CULLIN QUOTED:Coronavirus in Juvenile Detention Is a 'nightmare Scenario,' Doctors and Advocates Say - The "We are on the brink of the nightmare scenario," warned Dr. Kim Cullen, a physician in Denver and one of the authors of an open letter to governors and state justice officials from a group of concerned doctors. "If there isn't swift action to move children out of these environments where this virus can spread like wildfire," Cullen said, "we are just providing the kindling." (Tyler Kingkade, NBC News)

 

DFA MEDICAL STUDENT MATTHEW CRANE:We Were Learning About Coronavirus in Medical School. Now We’re Living It - Late in January, I had a presentation for my first-year medical school class on infectious diseases. The topic was public health emergencies of international concern, a phrase used by the World Health Organization to describe globally threatening disease outbreaks such as SARS, swine flu and Ebola. My section of this presentation was devoted to the novel coronavirus from Wuhan, China. At the time, we didn’t have a name for it. (Matthew Crane - a student at Johns Hopkins University School of Medicine, San Diego Union-Tribune)

 

THE WEEK IN QUOTES:

 

GOOD POINT: So many divisive debates in health policy revolve around two questions: 1. What is the appropriate role for government?   2. Are the majority of people who are generally healthy willing to sacrifice something for the minority who are more vulnerable? Now is no different.” -Larry Levitt - Kaiser Family Foundation

 

UTTERLY UNPREPARED FOR THE MARATHON AHEAD: As a country, we’re unprepared not just logistically but mentally for this next phase,” ..“For a while, people were told all we need is to get past the peak. Then, they started hearing all we need is testing. Meanwhile, the president keeps telling everyone that things are going to reopen in a matter of weeks. The way you prepare people for a sprint and marathon are very different. As a country, we are utterly unprepared for the marathon ahead.” -Michael T. Osterholm, University of Minnesota Infectious-Disease Expert

 

THIS COMING FALL: There’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through, And when I’ve said this to others, they kind of put their head back, they don’t understand what I mean...“We’re going to have the flu epidemic and the coronavirus epidemic at the same time,”CDC Director Robert Redfield

 

NOT THERE YET: We need to significantly ramp up not only the number of tests, but the capacity to perform them, so that you don’t have a situation where you have a test but it can’t be done because there isn’t a swab, or because there isn’t extraction media, or not the right vial, I am not overly confident right now at all that we have what it takes to do that. We are doing better, and I think we are going to get there, but we are not there yet.” -Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and Member of the White House Coronavirus Task Force

 

MORE TESTING NEEDED: We can’t let anyone go back to work until we’re confident that the case numbers have stabilized. There’s no way to do that effectively without testing,” -Jennifer Nuzzo, Epidemiologist, Johns Hopkins University

 

PASSING THE BUCK: The States have to step up their TESTING!” -The President of the United States of America

 

GEORGIA ON MY MIND: Gyms, nail salons, bowling alleys, hair salons, tattoo parlors, It feels like they collected a list of the businesses you know that were most risky and decided to open those first.” -Scott Gottlieb Former Food and Drug Administration Commissioner

 

AMERICA’S PRESTIGE: The United States was once known for its can-do culture. We built the Panama Canal and we put a man on the moon, And now we can’t get a swab or a face mask or a gown and we have no real chain of command. And we have two Americas, a Republican one and a Democratic one, and they won’t collaborate. We are not leading in the pandemic response, we are trailing other countries by a long shot. This is a crippling blow to America’s prestige around the world.” -Douglas Brinkley of Rice University

 

EXPAND MEDICAID: "If we can’t prioritize Medicaid expansion given the health implications of a pandemic of historic proportions and an economic catastrophe of historic proportions, we’re incapable of resolving this intractable problem," -David Becker, Health Economist, University of Alabama-Birmingham

 

MEDIA COVERAGE:

 

COVID-19:

 

HEROES:They Lived in a Factory for 28 Days to Make Millions of Pounds of Raw PPE Materials to Help Fight Coronavirus - The 43 men went home Sunday after each working 12-hour shifts all day and night for a month straight, producing tens of millions of pounds of the raw materials that will end up in face masks and surgical gowns worn on the front lines of the pandemic. (Meagan Flynn, Washington Post)

 

States Rushing to Reopen Are Likely Making a Deadly Error, Coronavirus Models and Experts Warn - There are no easy answers for the phase that comes next, especially with a continued lack of testing, contact tracing and detailed guidance from federal health agencies, disease experts said. Instead, every state will conduct its own improvised experiment with thousands of lives in the balance. (William Wan, Carolyn Y. Johnson, Joel Achenbach, Washington Post)

 

Reports Suggest Many Have Had Coronavirus With No Symptoms - A flood of new research suggests that far more people have had the coronavirus without any symptoms, fueling hope that it will turn out to be much less lethal than originally feared. (Marilynn Marchione, Associated Press)

 

CDC Director Warns Second Wave of Coronavirus Is Likely to Be Even More Devastating - Even as states move ahead with plans to reopen their economies, the director of the Centers for Disease Control and Prevention warned Tuesday that a second wave of the novel coronavirus will be far more dire because it is likely to coincide with the start of flu season. (Lena H. Sun, Washington Post)

 

DOCTORS - MEDICINE & RESEARCH:

 

Nearly All Patients Hospitalized With Covid-19 Had Chronic Health Issues, Study Finds - Only 6 percent of patients at one New York area health system had no chronic conditions. Hypertension, obesity and diabetes were common. (Roni Caryn Rabin, New York Times)

 

Rutgers Studying Healthcare Workers Exposed To COVID-19 - Rutgers University hopes to better understand and treat COVID-19 with the largest study of healthcare workers who have been exposed to the virus. (Steven Ross Johnson, Modern Healthcare)

 

An Overlooked, Possibly Fatal Coronavirus Crisis: A Dire Need for Kidney Dialysis - Doctors are sounding an alarm about an unexpected and perhaps overlooked crisis: a surge in Covid-19 patients with kidney failure that is leading to shortages of machines, supplies and staff required for emergency dialysis. (Reed Abelson, Sheri Fink, Nicholas Kulish and Katie Thomas, New York Times)

 

Doctors Try to Untangle Why They're Seeing 'Unprecedented' Blood Clotting Among Covid-19 Patients  - The Dutch study of 184 patients in the ICU with Covid-19-related pneumonia found that more than 20% were having clotting issues. A study of 81 similarly ill patients in Wuhan, China, found a 25% incidence of clots. (Elizabeth Cohen, CNN)

 

Vaccine Rates Drop Dangerously as Parents Avoid Doctor’s Visits - Afraid of Covid-19, parents are postponing well-child checkups, including shots, putting millions of children at risk of exposure to preventable deadly diseases. (Jan Hoffman, New York Times)

 

“Where Are All Our Patients?’: Covid Phobia Is Keeping People With Serious Heart Symptoms Away From ERs - A survey of nine major hospitals earlier this month showed the number of severe heart attacks being treated in U.S hospitals had dropped by nearly 40% since the novel coronavirus took hold in March, leaving cardiologists worried about a second wave of deaths caused indirectly by Covid-19: (Usha Lee Mcfarling, STAT)

 

COVID-19 TESTING:

 

Inside America’s Unending Testing Snafu - Here’s the latest on why the testing problem isn’t solved yet. (David Lim and Brianna Ehley, Politico)

 

Antibody Test, Seen as Key to Reopening Country, Does Not Yet Deliver - But for all their promise, the tests — intended to signal whether people may have built immunity to the virus — are already raising alarms. (Steve Eder, Megan Twohey and Apoorva Mandavilli, New York Times)

 

TRUMP ADMINISTRATION RESPONSE:

 

Health Chief’s Early Missteps Set Back Coronavirus Response - But interviews with more than two dozen administration officials and others involved in the government’s coronavirus effort show that Mr. Azar waited for weeks to brief the president on the threat, oversold his agency’s progress in the early days and didn’t coordinate effectively across the health-care divisions under his purview. (Rebecca Ballhaus and Stephanie Armour, Washington Post)

 

U.S Attorney General Barr Threatens Legal Action Against Governors Over Lockdowns - The Justice Department will consider taking legal action against governors who continue to impose stringent rules for dealing with the coronavirus that infringe on constitutional rights even after the crisis subsides in their states, Attorney General William Barr said. (Chris Strohm, Bloomberg News)

 

COVID-19 & IMMIGRATION:

 

Trump Signs Order Pausing Immigration for 60 Days, With Exceptions - President Trump signed an executive order Wednesday restricting certain categories of immigrants from entering the United States for 60 days as the country reels from the coronavirus pandemic. (Nick Miroff, Maria Sacchetti and Arelis R. Hernández, Washington Post)

 

U.S. Deported Thousands Amid Covid-19 Outbreak. Some Proved to Be Sick - In the scramble to contain the spread of Covid-19 in the United States, the Trump administration has been pushing forward with its aggressive immigration enforcement agenda, deporting thousands of people to their home countries, including some who are sick with the virus. (Caitlin Dickerson and Kirk Semple, New York Times)

 

AFFORDABLE CARE ACT AND COVERAGE ISSUES:

 

Administration Offers Plan to Cover COVID care for Uninsured - The Trump administration announced a plan Wednesday to start paying hospitals and doctors who care for uninsured patients with COVID-19, but Democratic lawmakers and health industry groups are likely to press for more. (Ricardo Alonso-Zaldivar, Associated Press)

 

First, the Coronavirus Pandemic Took Their Jobs. Then, it Wiped Out Their Health Insurance. -. In a nation where most health coverage is hinged to employment, the economy’s vanishing jobs are wiping out insurance in the midst of a pandemic. (Amy Goldstein, Washington Post)

 

DRUG AFFORDABILITY:

 

Despite Pricing Controversies, Pharma’s Reputation Is Improving Among Patient Groups - Even before the pandemic struck and drug makers were seen as potential saviors, the pharmaceutical industry had slightly improved its battered image among patient groups, according to a new survey. (Ed Silverman, STAT)

 

Drugmaker Tripled the Price of a Pill as it Pursued Coronavirus Use - This month, Jaguar Health more than tripled the price of its lone FDA-approved drug, right after asking the federal government to expand the use of its drug to coronavirus patients. (Bob Herman, Axios)

 

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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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Weekly Rounds 4-19-20


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We ask for you to join DFA by contacting the White House and your congressional representatives to ensure that our patients have affordable access to all COVID-19 treatments.


CLICK HERE: and provide your information which will customize the letter drafted by Doctors for America to be sent to your Congressional representative and Senators. Your signature will also be applied to the letter being sent to the White House and Congressional leaders along with your colleagues’ signatures.

 

THANK YOU for all your hard work. 


DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:


DFA Doctor Nina Agrawal - The Coronavirus Could Cause a Child Abuse Epidemic - This pandemic has brought with it additional challenges in protecting young people from abuse and revealed gaps in our existing approach. We have an opportunity to use new tools to ensure that children are safe — tools that will serve them during this crisis and long after. (New York Times)


THE WEEK IN QUOTES:


PROFESSIONALISM: Why do millions of health care workers — doctors, nurses, emergency responders, aides, transport specialists, and more — risk their lives every day to care for those with Covid-19, a potentially deadly infection? Personal courage is part of the explanation. But there’s more to it than that. What we are seeing is the professionalism of people like Anthony Fauci and thousands of health care workers at work. The essence of their professionalism is that they put the interests of patients and the public before their own. We take it for granted at our peril.” - David Blumenthal, M.D., President of The Commonwealth Fund


INTUBATION: Intubated patients with Covid lung disease are doing very poorly, and while this may be the disease and not the mechanical ventilation, most of us believe that intubation is to be avoided until unequivocally required,” - Dr. Reuben Strayer, Emergency Medicine Physician at Maimonides Medical Center in Brooklyn NY


DIRECT VIRAL INVOLVEMENT OF THE KIDNEY?: “It does raise the very clear suspicion that at least a part of the acute kidney injury that we’re seeing is resulting from direct viral involvement of the kidney, which is distinct from what was seen in the SARS outbreak in 2002,” Paul M. Palevsky, a University of Pittsburgh School of Medicine Nephrologist and President-elect of the National Kidney Foundation.


BLOOD CLOTS: This is a real-time learning experience, I don’t think any of us can declare anything definitively, but we know from the best available data that about one-third of patients who have Covid-19 infections do in fact have evidence of thrombotic disease,” - Clyde Yancy, Chief of Cardiology at Northwestern University Feinberg School of Medicine


WE NEED THE ACA: We need to leverage the Affordable Care Act so it can serve as the strong safety net that our country needs, especially given the job disruption that is causing many Americans to lose their health insurance,” - Dr. Patrice Harris, President American Medical Association


60,000 GET COVERAGE IN CA: "We are living in unprecedented times, and California is doing everything it can to make sure people have access to care during this public health emergency, Having more people insured and protected is the right thing for California's families and helps keep everyone better off as those with insurance don't delay getting needed care." - Covered California Executive Director Peter Lee


CONTACT TRACING: "Failing to invest in and train more workers for contact tracing now could extend this crisis months," Chris Meekins, Former Trump Administration Health Official who is now an Analyst at Raymond James


TRUMP CUTS OFF $ TO THE WORLD HEALTH ORGANIZATION:We're in the middle of a goddamn pandemic. It is ill-considered, irresponsible, and wrong to remove our support for the firefighters who are on the front lines of the 6 alarm blaze while we're fighting it. It hurts everyone, everywhere. This is not who we are.”  - Beth Cameron, Former National Security Council Official Known for Authoring the Obama-Era Pandemic Playbook.


CDC ON THE SIDELINES: The “CDC is seen as an incredibly important institution, not just for America but for the world, There is a void, when you have an organization that people have looked to that is not providing the kind of global leadership that it once did.” - Helene Gayle, Philanthropy Executive and 20-year veteran of U.S. Centers for Disease Control and Prevention


MEDIA COVERAGE: 


DOCTORS - MEDICINE & RESEARCH:


What Doctors on the Front Lines Wish They’d Known a Month Ago - Doctors, if you could go back in time, what would you tell yourselves in early March? (Jim Dwyer, New York Times)


COVID-19 Distancing Drives a Halt in Measles Vaccinations - experts worry that the postponement of routine immunizations could lead to an outbreak of vaccine-preventable diseases after social distancing practices begin to relax. (Steven Ross Johnson, Modern Healthcare)


Coronavirus Destroys Lungs. but Doctors Are Finding Its Damage in Kidneys, Hearts and Elsewhere. - Clinicians around the world are seeing evidence that suggests the virus also may be causing heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage and liver problems.  (Lenny Bernstein, Carolyn Y. Johnson, Sarah Kaplan and Laurie McGinley, Washington Post)


U.S. Races to Stock up on Dialysis Supplies as Kidney Failure Ravages Virus Patients - Approximately 20 percent of coronavirus patients in intensive care around the city need the kidney treatment, often for weeks, a development that many providers did not see coming. (Sarah Owermohle and Amanda Eisenberg, Politico


Blood Clots in Severe Covid-19 Patients Leave Clinicians With Clues About the Illness — but No Proven Treatments - Doctors treating the sickest Covid-19 patients have zeroed in on a new phenomenon: Some people have developed widespread blood clots, their lungs peppered with tiny blockages that prevent oxygen from pumping into the bloodstream and body. (Elizabeth Cooney, STAT)


Which Profession Has the Biggest Gender Pay Gap? - The biggest gender pay gap in the U.S. exists among physicians and surgeons. ...If you take men and women physicians who have the same length of training, the same kind of training, have the same kind of CV publications, even have the same grants from the National Institute of Health, work in the same field, with the same exact time parameters — and you do do a multivariate analysis with all things being equal, women are still being paid significantly less.” (Elizabeth Ralph, Politico)


COVID-19:


Thousands of Medical Workers Are Getting Sick from Coronavirus - Health-care workers may constitute between 1 and 2 of every 10 coronavirus cases in the United States (Paige Winfield Cunningham & Paulina Firozi, Washington Post)


Inside America’s 2-Decade Failure to Prepare for Coronavirus - When the pandemic finally came, the team that had prepared their careers for it were working for a president unwilling and unready to act. … Global health experts increasingly view the U.S. response as among the worst in the developed world. (Dan Diamond, Politico Magazine)


How Anthony Fauci Became America’s Doctor - At seventy-nine, Fauci has run the National Institute of Allergy and Infectious Diseases for thirty-six years, through six Administrations and a long procession of viral epidemics: H.I.V., sars, avian influenza, swine flu, Zika, and Ebola among them. (Michael Specter, The New Yorker)


W.H.O., Now Trump’s Scapegoat, Warned About Coronavirus Early and Often - The World Health Organization, always cautious, acted more forcefully and faster than many national governments. (Richard Pérez-Peña and Donald G. McNeil Jr., New York Times)


COVID-19 TESTING:


Testing Falls Woefully Short as Trump Seeks an End to Stay-at-Home Orders - Flawed tests, scarce supplies and limited access to screening have hurt the U.S.’s ability to monitor Covid-19, governors and health officials warn. (Abby Goodnough, Katie Thomas and Sheila Kaplan, New York Times)


Coronavirus Testing Hits Dramatic Slowdown In U.S. - The number of coronavirus tests analyzed each day by commercial labs in the U.S. plummeted by more than 30 percent over the past week, even though new infections are still surging in many states and officials are desperately trying to ramp up testing so the country can reopen. (David Lim, Politico)

The Next Coronavirus Testing Debacle - Blood tests that measure a person’s antibodies to the coronavirus could be a powerful tool to determine when it’s safe to reopen the country. But concerns about the accuracy and availability of the tests (David Lim, Politico)


TRUMP ADMINISTRATION RESPONSE:


He Could Have Seen What Was Coming: Behind Trump’s Failure on the Virus - An examination reveals the president was warned about the potential for a pandemic but that internal divisions, lack of planning and his faith in his own instincts led to a halting response. …  (Eric Lipton, David E. Sanger, Maggie Haberman, Michael D. Shear, Mark Mazzetti and Julian E. Barnes, New York Times)


Trump Leaves Trail of Unmet Promises in Coronavirus Response - For several months, President Donald Trump and his officials have cast a fog of promises meant to reassure a country in the throes of the coronavirus pandemic. Trump and his team haven’t delivered on critical ones. (Calvin Woodward, Associated Press)


COVID-19 & IMMIGRATION:


Fearing Deportation, Many Immigrants at Higher Risk of Covid-19 Are Afraid to Seek Testing or Care - Worsening matters is the federal government’s new “public charge” immigration rule that went into effect in late February, just as the virus was beginning to sweep through communities here. (Usha Lee Mcfarling, STAT)


AFFORDABLE CARE ACT AND COVERAGE ISSUES:


Trump’s Disdain for ‘ObamaCare’ Could Hamper Virus Response - The Trump administration’s unrelenting opposition to “ObamaCare” could become an obstacle for millions of uninsured people in the coronavirus outbreak, as well as many who are losing coverage in the economic shutdown. (Ricardo Alonso-Zaldivar, Associated Press)


As Coronavirus Rages, Republicans Still Don’t Have a Plan to Give Americans Health-Care Coverage - Republicans still did not have any sort of consensus plan for addressing such basic problems as the millions of Americans without health insurance or the insurance-company practice of denying coverage to those with preexisting health conditions.  …. And then came the coronavirus pandemic. Has that changed the Republican posture on health-care policy? Not in any significant way. (Ed Kilgore, New York Magazine)


WOMEN’S HEALTH:


Judge Rules Alabama Can't Prohibit Abortion During Coronavirus Crisis - A federal judge on Sunday ruled that Alabama cannot ban abortions as part of the state’s response to coronavirus. (Kim Chandler, Associated Press)


Calif. A.G. Becerra, Mass. A.G. Healey Lead Multistate Amicus Brief Defending Affordable Care Act Birth Control Coverage Mandate in Supreme Court - In the brief filed in Donald Trump et al. v. Pennsylvania, the attorneys general explain that states have an interest in safeguarding the ACA's birth control coverage requirement  (Newswires)


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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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Weekly Rounds 4-12-20


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Doctors For America joined forces with several other national organizations insisting that EVERY Affordable Care Act exchange reopen enrollment periods to help reduce the number of newly uninsured who have lost jobs and with it their employer-provided insurance. The DFA further is calling for the expansion of Medicaid in states that have yet to do so.

 

SIGN THE PETITION: EVERY Affordable Care Act (ACA) exchange must reopen enrollment to ensure everyone has access to healthcare amid the coronavirus pandemic.

 

Thanks & keep up the tremendous work you are doing for your communities and our country.


DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:


DFA’s Dr. Ximena Levander: Covid-19 Will Worsen the Opioid Overdose Crisis If We Don’t Prepare Now - In cities across the country, morning is peak time at almost any opioid treatment program. The line stretches from the front counter to the back door as patients wait to get their daily dose of methadone. It’s an absolutely essential gathering, but one that runs counter to containing the Covid-19 outbreak. (Ximena A. Levander & Sarah E. Wakeman STAT)


DFA’s Dr. Steven Weisman:In-Person Voting Expected to Contribute to Spread Of COVID-19 -  “I sat at home, aghast, when I saw the images of my fellow citizens lining up with masks, some without,” noting some held signs “expressing their disgust with the way the citizens of our state were treated.”  (WisBusiness)


THE WEEK IN QUOTES:


SPEAK THE TRUTH: Speak the truth. Speak it clearly. Speak it with compassion. Speak it with empathy for what folks are going through. The biggest mistake any [of] us can make in these situations is to misinform, particularly when we’re requiring people to make sacrifices and take actions that might not be their natural inclination,"  - President Obama


THAT’S NOT HOW BIOLOGY & RESEARCH WORKS: "The kind of normal where we go traveling, we go to restaurants, we go to concerts, we go to religious services, we go on cruises, until we have a vaccine that protects everyone. That's 18 months, it's not going to be sooner, Anyone who tells you we're going to have a vaccine in three or four months, that's just not the reality of how biology and research works,"  Dr. Zeke Emanuel, Special Adviser to the Director General of the World Health Organization - Oncologist, Bioethicist and Professor and Vice Provost at the University of Pennsylvania


SECOND WAVE: "What's really important is that people don't turn these early signs of hope into releasing from the 30 days to stop the spread — it's really critical, If people start going out again and socially interacting, we could see a very acute second wave very early." - Dr. Deborah Birx, White House coronavirus Response Coordinator


NO NATIONAL STRATEGY FOR TESTING:  “Unfortunately, states really are on their own, It’s problematic at best and egregious at worst, because some states have more resources than others; some states have more leadership than others.” - Joia Mukherjee, Partners in Health Medical Director


BLACK AMERICANS DISPROPORTIONATELY DYING FROM VIRUS:  “This outbreak is exposing the deep structural inequities that make communities pushed to the margins more vulnerable to health crises in good times and in bad, These structural inequities in our health care system do not ignore racial and gender disparities — and neither should our response to this pandemic.” - Dorianne Mason, the Director of Health Equity at the National Women’s Law Center


CALIFORNIA AS A NATION-STATE: “We've been competing against other states, against other nations, against our own federal government for PPE — coveralls, masks, shields, N95 masks — and we're not waiting around any longer,’ We decided enough is enough: let's use the power of the purchasing power of the state of California as a nation-state," - California Gov. Gavin Newsom


GOVERNOR INSLEE: "This is ludicrous, The surgeon general referred to Pearl Harbor. Can you imagine if Franklin Delano Roosevelt said, 'We'll be right behind you, Connecticut. Good luck building those battleships?'" - Governor Jay Inslee (D-WA)


GOVERNMENT WATCHDOGS: The Trump Administration seems to be engaged in a mass-culling of government watchdogs, which is a real threat to independent oversight, This appears to be part of an alarming trend by the Trump Administration to remove independent inspector generals and replace them with the president’s loyalists.” - United States Senator Jack Reed, Senate Armed Services Committee (D-RI)

MEDIA COVERAGE: 


COVID-19:


The U.S. Was Beset by Denial and Dysfunction as the Coronavirus Raged - From the Oval Office to the CDC, political and institutional failures cascaded through the system and opportunities to mitigate the pandemic were lost. (Yasmeen Abutaleb, Josh Dawsey, Ellen Nakashima and Greg Miller, Washington Post)


Bill Gates to Spend Billions on Coronavirus Vaccine Development - Microsoft Corp. co-founder Bill Gates said his foundation will spend billions of dollars to fund the construction of factories for the most promising efforts to develop a vaccine to combat the novel coronavirus. (Jennifer Calfas, Wall Street Journal)


The Coronavirus Is Infecting and Killing Black Americans at an Alarmingly High Rate - As the novel coronavirus sweeps across the United States, it appears to be infecting and killing black Americans at a disproportionately high rate (Reis Thebault, Andrew Ba Tran and Vanessa Williams, Washington Post)


C.D.C. Releases Early Demographic Snapshot of Worst Coronavirus Cases - Approximately 90 percent of the 1,482 hospitalized patients included in the study released Wednesday had one or more underlying medical conditions. (David Waldstein, New York Times)


Haywire Immune Response Eyed in Coronavirus Deaths, Treatment - Researchers are looking at treatments to suppress ‘cytokine storm,’ increasingly linked to the most severe Covid-19 cases. (Joseph Walker, Jared S. Hopkins, Wall Street Journal)


6.6 Million Americans Filed for Unemployment Last Week, Bringing the Pandemic Total to Over 17 Million - Economists say the U.S. unemployment rate is now 13 percent, the worst since the Great Depression. (Heather Long and Andrew Van Dam, Washington Post)


PERSONAL PROTECTIVE EQUIPMENT:


‘We’re Being Put at Risk Unnecessarily’: Doctors Fume at Government Response to Coronavirus Pandemic - Now, there’s simmering anger, and a deep sense of betrayal among health professionals who say they feel forsaken by their government. (Meghana Keshavan, STAT)


How Did the U.S. End Up with Nurses Wearing Garbage Bags? - What followed over the next two weeks was an inside glimpse of the dysfunction emanating from Trump’s Washington in the midst of the pandemic, a crash course in the breakdown that has led to nurses in one of the wealthiest countries in the world wearing garbage bags to protect themselves from a virus whose outbreak the President downplayed until it was too late to prepare for its consequences. (Susan B. Glasser, The New Yorker)


Government Watchdog: Hospitals Face Severe Shortages of Medical Gear, Confusing Guidance from Government - Hospitals across the country face dire shortages of vital medical equipment amid the coronavirus outbreak — including testing kits and thermometers — and fear they can't ensure the safety of health care workers needed to treat patients with COVID-19, according to an internal government watchdog report released Monday. (Laura Strickler, Hannah Rappleye, Dan De Luce and Ken Dilanian, NBC News)


Rationing Protective Gear Means Checking on Coronavirus Patients Less Often. This Can Be Deadly. - Low on essential supplies and fearing they’ll get sick, doctors and nurses told ProPublica in-person care for coronavirus patients has been scaled back. In some cases, it’s causing serious harm. (Joshua Kaplan, Lizzie Presser and Maya Miller, ProPublica)


COVID-19 TESTING:


In the Absence of a National Testing Strategy, States Go Their Own Way - Three months into the coronavirus epidemic, the Trump administration has yet to devise a national strategy to test Americans for the deadly disease — something experts say is key to blunting the outbreak and resuming daily life. In the absence of a national plan, several states are developing their own testing systems, but the emerging picture varies widely. (Juliet Eilperin, Laurie McGinley, Steven Mufson and Josh Dawsey, Washington Post)


Unprecedented Nationwide Blood Studies Seek to Track U.S. Coronavirus Spread - The United States has launched an unprecedented effort as well. One serosurvey is already underway in six metropolitan areas, including New York City, the hardest hit city in the United States. A second, even larger one, is on its heels, and together they should give a strong nationwide effort to track closely how many Americans have become infected as the pandemic unfolds. Serosurveys may also help efforts to develop vaccines, and, separately attempts to devise therapies to stop the virus from causing harm. (Jon Cohen, Science)


HEALTH SYSTEM RESPONSE:


Competing Hospitals Cooperate to Meet the Crisis - U.S. hospitals are cooperating in unprecedented ways. In addition to postponing elective surgeries and other procedures, they are transferring children from adult hospitals to pediatric hospitals and sharing staff, equipment and supplies. (Michael Ollove & Christine Vestal, Stateline)


Hospitals Open Grocery Stores for Providers Treating COVID-19 Patients - As frontline caregivers across the country struggle to treat a growing wave of coronavirus patients, hospitals are increasingly adding grocery stores with little or no cost markups so employees can grab the essentials on their way out. (Tara Bannow, Modern Healthcare)


Coronavirus Means Americans Are Finally Embracing Virtual Health Care  - Until now, the nation’s health-care system was slow to adopt new technologies allowing doctors, nurses and other medical providers to see or monitor patients remotely.  (Paige Winfield Cunningham, Washington Post)


TRUMP ADMINISTRATION RESPONSE:


Trump Administration Pushing to Reopen Much of the U.S. Next Month - The Trump administration is pushing to reopen much of the country next month, raising concerns among health experts and economists of a possible covid-19 resurgence if Americans return to their normal lives before the virus is truly stamped out. (Matt Zapotosky, Josh Dawsey, Jose A. Del Real and William Wan, Washington Post)


As Pandemic Deepens, Trump Cycles Through Targets to Blame - First, it was the media that was at fault. Then, Democratic governors came under fire. China, President Barack Obama and federal watchdogs have all had a turn in the crosshairs. And now it’s the World Health Organization that’s to blame. … There is no “The buck stops here,” like the sign once found on President Harry S. Truman’s desk. (Jonathan Lemire, Associated Press)


Trump Administration Says Front-line Workers Can Go Back to Work Sooner After Virus Exposure - The Trump administration Wednesday announced that health workers and other essential employees who have been exposed to the coronavirus will be allowed to go back to work instead of quarantining for 14 days. (Brianna Ehley, Politico)


Surprise Billing Banned for Providers That Get CARES Act Grants - The White House announced Thursday that providers receiving grants from the $100 billion aid fund in Congress' third stimulus package will be banned from balance billing patients for COVID-19 treatment. (Rachel Cohrs, Modern Healthcare)


COVID-19 & IMMIGRATION:


Trump Quietly Shuts Down Asylum at US Borders to Fight Virus - The U.S. government used an obscure public health law to justify one of its most aggressive border crackdowns ever. People fleeing violence and poverty to seek refuge in the U.S. are whisked to the nearest border crossing and returned to Mexico without a chance to apply for asylum. It eclipses President Donald Trump’s other policies to curtail immigration — which often rely on help from Mexico — by setting aside decades-old national and international laws. (Maria Verza, Elliot Spagat and Astrid Galvan, Associated Press)


AFFORDABLE CARE ACT AND COVERAGE ISSUES:


For Jobless Americans, Obamacare Is Still a Potential Lifeline - Millions of Americans losing their jobs may still be able to sign up for Obamacare — but Trump officials haven’t been urging people to grab onto that safety net while they can. … But Trump administration officials have done little to let people know how they can get covered under a health care law Trump has spent years trying to obliterate and is still fighting in the Supreme Court. Nor are they streamlining the sign-up system, which requires that people document that they’ve lost their jobs in order to qualify for coverage right now. (Susannah Luthi, Politico)


Coronavirus Double Whammy: Unemployed and Uninsured - While many of those people are now eligible for insurance through the Affordable Care Act (ACA) marketplaces or Medicaid, the White House isn’t promoting either of those options. (Jessie Hellmann, The Hill)


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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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Weekly Rounds 4-5-20


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Please sign on to our letter calling for public health safeguards and protection of health workers.  We currently have just over 2,400 signatures - our goal is 3,200. It only takes 30 seconds to add your name to ensure that our health workers will continue to be healthy and available to take care of our patients and communities:   

FULL TEXT & SIGN HERE >>

If you've already signed, thank you, and please share the above link with friends and colleagues.

We remain so proud and thankful for the work you are doing.

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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Weekly Rounds 3-29-20


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Please join our efforts to respond effectively to COVID-19 by signing on to our letter calling for public health safeguards and protection of health workers.

In the letter we call on federal, state, & local government officials and health systems to:

  1. Enact Shelter-in-Place Nationwide Through Federal And/or State-level Action.

  2. Ensure access to Personal Protective Equipment (PPE) & Clear Protocols on PPE Use.

  3. Ensure That Our Health Workers Will Continue to Be Healthy and Available to Take Care of Our Patients and Communities.

Read the full text of the open letter and add your name >>

If you've already signed, thank you, and please share it with friends and colleagues.

We remain so proud and thankful for the awe-inspiring work you are doing.

THE MUST READS:

What It’s Like Being a New York ER Doctor During This Pandemic - (Washington Post)

ER Doctor in NYC says ‘Everything is Transformed’ as COVID-19 Grips Hospitals - (PBS NewHour)

Note: Both of the above stories are about Dr Craig Spencer’s experience as an ER Doc. in NYC. Because Dr. Spencer tells his very personal story he has helped Americans to better understand the scope, reality and intensity of this pandemic. WE NEED MORE OF THIS. Please, If you can, tell your story on social media and tag @DrsforAmerica and use the hashtag #COVID19USFrontlines, and #DFAdocs

How the Pandemic Will End - (The Atlantic)

THE WEEK IN QUOTES:

 

THE EPICENTER: We (The United States) are the new global epicenter of the disease,” - Dr. Sara Keller, Johns Hopkins Medicine

 

FRONTLINES: "We are scared. We are stressed. And we are worried about ... our ability to take care of our patients and our communities. As well as our ability to take care of ourselves." - Dr. Megan Ranney

 

STAY HOME: If someone told me if I would be able to save 40 lives if I stayed home, missed school, lost income & missed socializing  for 6-10 weeks, I would do it in a second. Everyone would. If it was 4 lives or 1– someone’s mom— we would.Andy Slavitt - @ASlavitt - Former Medicare, Medicaid, ACA head for Obama 

 

A MESSAGE FROM ITALIAN DOCTORS: "We are learning that hospitals might be the main COVID-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patient," Italian Doctors - New England Journal of Medicine

 

THE ORIGINAL SIN: “The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases. None of that happened.Ed Yong - The Atlantic  - A MUST READ ARTICLE

 

PATCHWORK: The Trump administration declined to issue a national shelter-in-place order. The resulting patchwork across the country left enough economic hubs closed to crash the economy, but enough places up and running to allow the virus to continue to spread rampantly.” - Caitlin Owens, Axios

 

THE TIMELINE: "You don't make the timeline, the virus makes the timeline." - Dr. Anthony Fauci

 

BILL GATES: We’re entering into a tough period that if we do it right we’ll only have to do it once, for six to 10 weeks. It has to be the whole country, we have to raise the level of testing and the prioritization of that testing quite dramatically in order to make sure we go through one shutdown … Having states go at different things or thinking you can do it county-by-county, that will not work. The cases will be exponentially growing anywhere you don’t have a serious shutdown,” ... Basically the whole country needs to do what was done in the part of China where they had these infections.” - Bill Gates - Founder of Microsoft Corporation

 

YOU’RE MISSING THE MAGNITUDE OF THE PROBLEM: You want a pat on the back for sending 400 ventilators? What are we going to do with 400 ventilators when we need 30,000 ventilators? You’re missing the magnitude of the problem, and the problem is defined by the magnitude.”- New York Governor Andrew Cuomo

 

MEDIA COVERAGE: 

 

COVID-19:

 

Assessing Underlying State Conditions and Ramp-Up Challenges for the COVID-19 Response - (The Commonwealth Fund)

 

PERSONAL PROTECTIVE EQUIPMENT: 

 

Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment During the Covid-19 Pandemic - (New England Journal of Medicine)

 

Scramble for Medical Equipment Descends Into Chaos as U.S. States and Hospitals Compete for Rare Supplies - (Washington Post)

 

Governments and Companies Race to Make Masks Vital to Virus Fight (New York Times)

 

The Next Coronavirus Crisis Will Be a Shortage of Doctors and Nurses - (Vox)



COVID-19 TESTING:

 

CDC Coronavirus Testing Decision Likely To Haunt Nation For Months To Come - (Kaiser Health News)

 

FDA Approves Plasma Treatment for Coronavirus on Conditional Basis - (Wall Street Journal)

 

U.S. Communities Struggle to Deal With Coronavirus Testing Backlogs - (Wall Street Journal)

 

New Coronavirus Test Returns Results in 45 Minutes, but it May Be Limited to Hospitals - (STAT)

 

HEALTH SYSTEM RESPONSE:

 

Project N95 The National COVID-19 Medical Equipment Clearinghouse - (Project N95)

 

US Hospitals Brace for Another Challenge — an Unprecedented Shortage of Nurses - (NBC News)

 

The Hardest Questions Doctors May Face: Who Will Be Saved? Who Won’t? - (New York Times)

 

Health Workers Fear U.S. Hospitals Will Become Coronavirus Hot Spots - (Politico

 

CAPITAL HILL RESPONSE: 

 

What Exactly Is in This Massive $2 Trillion Senate Coronavirus Bill? - (Washington Post)

 

COVID-19 Economic Stimulus Deal Passes Senate With Billions in Hospital Funding - (Modern Healthcare)



TRUMP ADMINISTRATION RESPONSE:


Trump Team Failed to Follow NSC’s Pandemic Playbook - (Politico)

 

Exclusive: U.S. Axed CDC Expert Job in China Months Before Virus Outbreak - (Reuters)

 

AFFORDABLE CARE ACT AND COVID-19:

 

Could ObamaCare Save Jobless Americans from Coronavirus? - (Politico)

 

ACA Coverage Could Swell in Response to Coronavirus, Testing Health Law - (Wall Street Journal)

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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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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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On COVID-19


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It is hard to put into words the magnitude of the challenge facing the world and our nation today. But you know, the thousands of Doctors for America members across all 50 states are on the front lines. You are caring for patients who are worried for themselves, for people they love, and for their livelihoods. You are working to do whatever we can to serve an influx of patients in primary care clinics and community health centers, in care facilities, at major academic centers and community hospitals, not to mention those of you in key public health roles at the local, state, and federal level. You are fielding questions from patients, co-workers, family, and friends asking what will happen to them and how to keep people safe.

As sports leagues are cancelled, communities cancel mass public events, candidates transition to virtual rallies, and schools send their students home, we are mobilizing to do our jobs - provide the best care for the sick that we can, and prevent disease when we can. Our communities and nation need us as their trusted, informed voices now.

We have all envisioned the worst-case scenario, and we are all exasperated with the frustrating responses of our national leaders. We have watched colleagues across the planet struggling to keep up. But we at DFA also know there are solutions to these problems – working together, learning from and relying on each other, being innovating and comprehensive in our approaches, we can overcome these challenges – as other nations are demonstrating to us is possible.

While the crisis highlights the dysfunctions in our health care system and the institutional and administrative flaws, we cannot afford to be lost in our frustration. We must instead focus on solutions to the issues in front of us – effectively caring for our patients, our families, and our communities in a time of crisis.

DFA’s commitment is to provide our communities with well-reasoned, evidence-based, meaningful resources, as well as training, actions, and advice that is consistent with our mission focus and work. DFA wants to offer support to all of you – our members and colleagues, and our other health critical care team members working so hard to collaboratively design and implement strategies to treat patients, and to fight and control COVID-19.

In this public health emergency, just like around other important issues that affect us all, it is clear we must take effective advocacy action. DFA leaders across our organization are coordinating and developing specific actions around this issue as part of our Healing America Campaign - deciding how to dedicate resources that will offer you ways to engage and make a big-picture difference.

Access to timely, pertinent and reliable information is a challenge for us and for the public. To share (just) two reliable sources of information: the CDC has information around basic strategies for clinical practice and even provides detailed school recommendations. You also may find this infographic from Johns Hopkins University helpful – as well as the embedded link to additional resources and a map tracking new cases.

DFA’s response to this pandemic is evolving - if and when you can, please share with us your COVID-19 observations and concerns at info@drsforamerica.org in order to inform DFA actions, and so that we can contribute to a rational assessment and interventions around what is happening across our nation.

Expect to hear more from DFA about how you can engage as an advocate on these issues. Specifically look for a social media campaign launch in the coming days to share your frontline experiences, and provide input on solutions.

In the meantime, stay strong. Take time for self-care... give yourselves a “nature” or “exercise prescription”. And please reach out to us at info@drsforamerica.org with any suggestions or ideas on how we might help you weather the crisis.

 

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