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Weekly Rounds 5-17-20


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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)


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)



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)


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)


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)


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 - ) 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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