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Weekly Rounds 4-26-20


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


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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)




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






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)




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)




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)




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)




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)




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)




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)




REACH OUT:  If you get an opinion piece or letter to the editor published PLEASE send me (Pete Van Vranken - 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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