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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 6-21-2020


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DFA’S WEEKLY ACTION ITEM: 

Women’s Health Workgroup:  We would like to formally introduce and invite you to become involved in our newest DFA Workgroup: Women’s Health! Our guiding principles are: Equity: Every woman in America has a fundamental right to equitable, high-quality, and affordable health care regardless of race/ethnicity, socioeconomic status, and geography. Justice: All womxn should have the opportunity and autonomy to lead a healthy life. Every part of society should value and promote healthy families and safe communities. Partnership: Doctors of all specialties should take a leadership role in improving health care of womxn and ending health disparities.

To Get Involved With the Women’s Health Workgroup and Be the First to Hear About Our Current and Upcoming Projects. Click HERE

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:

Upcoming DFA Webinar: Health Professionals Facing Racism
Date: Thursday, June 25th
Time: 6 PM Eastern Time
To Attend: Register with Zoom. Click here.
If Zoom webinar is at capacity, please watch via Facebook Live 

Recent DFA Webinar: Addressing Police Brutality 
Tuesday, June 16, 2020
Addressing Structural Racism, Police Brutality, Advocacy, and Racism Health Professionals Face - What Can You Do?
Hosted by Armen Henderson, MD, MBA; Isabelle Rostain, MD; Jace Valcore, PhD
Click HERE to view a recording of our Webinar  (Passcode: 0l#59Vv9)

DFA Member & Med Student - Daniel Pham - SQ 802 (Medicaid Expansion) Would Be a Step Forward for Oklahoma - ...However, the economic arguments mean little to me because as a future health care professional, I do not want to practice in a system that fails to meet the health needs of our most vulnerable. The COVID-19 pandemic magnified the fact that individual health is connected to the health of an entire community. We are only as strong as our weakest link. For those with adequate and comprehensive health coverage, it is imperative that we collectively ensure everyone around us has access to the care they need. In medical school, I learn to examine the social determinants of health and believe that one of the biggest developments the state could make would be to give every Oklahoman access to high-quality health care and guarantee it as a human right. There is work to be done toward providing everyone the care they deserve, and voting for State Question 802, Medicaid expansion, is the first step in that direction.

THE WEEK IN QUOTES:

HEALTH DISPARITIES’: “What we politely call a ‘health disparity’ is killing people of color daily. It is causing people of color to live sicker and die quicker, because of the color of their skin.” The data on COVID-19 provides the latest proof of this enduring fact. - Dayna Bowen Matthew, Tiffany Ford, Sarah Reber, and Richard V. Reeves, The Brookings Institution

TRIPLE THREAT: For both the African American and Latino populations there's a triple threat, The first is that there's more exposure, the second is that there's more underlying health problems sometimes, and the third is there's less access to health care.” - Former CDC Director Dr. Tom Frieden

PEOPLE WILL LISTEN: The fact that we have those two letters after our name means that, for good or for bad, we go to certain tables and people will listen to us more than people who aren’t physicians.” Dr. Nathan Chomilo, Pediatrician and Minnesota Doctors for Health Equity

PERSONAL PROTECTIVE EQUIPMENT: I hoped that the federal government would have stepped in to demand an increase in production and accountability so that we could deal with this, But five months in, it’s really immoral that they haven’t stepped up to the plate.” - Deborah Burger, Co-President National Nurses United / President of the California Nurses Association 

NOT FADE AWAY: it’s fading away, it’s going to fade away, but having a vaccine would be really nice and that’s going to happen.” The President of the United States of America

THE BOSS: “With all respect, sir, show some consideration and care for your countrymen and your country. Put on a f---ing mask.” - Bruce Springsteen 

THE GREATER GOOD: During World War II, the government called upon every American to make personal sacrifices for the good of the nation. Americans need to chip in for the greater good once again. But instead of being asked to sacrifice food, gasoline or their very lives, they are being asked to endure some slight inconveniences for just a little while longer. Wear a mask. Don’t gather in crowds. Maintain social distancing. Is that so hard?” The LA Times Editorial Board

HEARTLESS AND DANGEROUS: This pandemic has underscored the need for every American to have health coverage when they need it -- and they need it now. As lawyers and stakeholders continue to file amicus briefs in the latest case to overturn the ACA, we must continue to expose this repeal attempt for what it really is: heartless and dangerous. The American people must once again raise their voices once and tell Donald Trump: stop playing politics with our health care.U.S. Senator Kamala D. Harris (D-CA)

ALABAMA SURGE: “It’s bad, The hospitals are darn near at capacity. We’ve got a lot of patients. It’s just steadily gone up the last week. The number of cases. People on ventilators. It’s bad. Unfortunately, it’s going to continue to get worse, I’m afraid.” Dr. David Thrasher, Head of Pulmonology at Jackson Hospital (Alabama)

COLORADO: We’re only a few steps ahead of this virus, We can’t let good news give us a false sense of security. We see some of our neighboring states, Arizona and Utah, moving the wrong way…. The minute human behavior lapses, this will surge back.” - Colorado Governor Jared Polis

DEFYING SCIENCE: “I find it literally incomprehensible that the president, who is an extraordinary narcissist, is willing to sacrifice the health not only of the people who attend his indoor rally, but those people who come into contact with the people who attend the indoor rally, You have public officials in Oklahoma begging him not to do this rally. It is in defiance of what science is telling us is appropriate. And the leader of the United States government is defying science in order to hear cheers from his supporters, It is incredibly irresponsible.” - U.S. Senator Bernie Sander (I-VT)

Please click for the remainder of the stories you are used to reading on DFA’s Weekly Rounds. 

REACH OUT: If you get an opinion piece or letter to the editor published PLEASE email with a link to Pete Van Vranken - pete@drsforamerica.org for publication in the next edition of the Physician Rounds. Your feedback is welcome.

MEDIA COVERAGE: 

STRUCTURAL RACISM - THE PUBLIC HEALTH CRISIS:

An Obligation’: Doctors and Other Health Workers Increasingly See Protesting Racial Injustice as Part of the Job - Amid the dual crises of a global pandemic and a reckoning with systemic racial injustice, health workers and health educators are grappling with a momentous question that hovers between personal and professional: how much of an activist should a health care worker be? Doctors, epidemiologists, and nurses are increasingly abandoning their characteristic reticence in favor of direct advocacy. (Ruth Hailujune, STAT)

Rising Coronavirus Cases Among Latinos Alarm Public Health Experts - Latinos Age 25 to 54 Have a Coronavirus Mortality Rate at Least Five Times Greater Than White People. (Laura Barrón-López, Politico)

Racism, Hazing And Other Abuse Taints Medical Training, Students Say - As doctors and nurses across the United States continue to gather outside hospitals and clinics to protest police brutality and racism as part of the White Coats for Black Lives movement, LaShyra Nolen, a first-year student at Harvard Medical School, says it's time to take medical schools to task over racism, too. (Mara Gordon, National Public Radio)

Many Medical Decision Tools Disadvantage Black Patients - Doctors look to these digital calculators to make treatment decisions, but they can end up denying black patients access to certain specialists, drugs and transplants … The unintended result, the paper concludes, has been to direct medical resources away from black patients and to deny some black patients treatment options available to white patients. (Gina Kolata, New York Times)

Medical Bias: From Pain Pills to COVID-19, Racial Discrimination in Health Care Festers - Whether it's unconscious, explicit, institutional or research bias, discrimination in the health care system contributes to the stark disparities seen in how COVID-19 sickens and kills patients of color, health care experts agree. (Jayne O'Donnell & Ken Alltucker, USA Today)

Missing Data Veils Coronavirus Damage to Minority Communities - The coronavirus’ brutal impact on African Americans and other minorities may never be fully known because of consistent gaps in gathering data on race and ethnicity that persist more than four months into the pandemic. (Laura Barrón-López, Adam Cancryn, Maya King and Darius Tahir, Politico)

COVID-19:

How Exactly Do You Catch Covid-19? There Is a Growing Consensus - Surface contamination and fleeting encounters are less of a worry than close-up, person-to-person interactions for extended periods - Six months into the coronavirus crisis, there’s a growing consensus about a central question: How do people become infected?....  the major culprit is close-up, person-to-person interactions for extended periods. Crowded events, poorly ventilated areas and places where people are talking loudly—or singing, in one famous case—maximize the risk. (Daniela Hernandez, Sarah Toy and Betsy McKay, Wall Street Journal)

California Orders People to Wear Masks in Most Indoor Spaces - “Science shows that face coverings and masks work,” Gov. Gavin Newsom said in a statement about the new order. “They are critical to keeping those who are around you safe, keeping businesses open and restarting our economy.” States including Michigan, New York, Maine, Delaware and Maryland already have statewide mask orders in place. (Kathleen Ronayne and Amy Taxin, Associated Press)

Nebraska Governor Ricketts Tells Local Governments They Won't Get Federal COVID-19 Money If They Require Masks - He doesn’t want local officials to require masks. In fact, he’s told counties that they won’t receive any of the $100 million in federal COVID-19 money if their “customers” are required to wear masks….The no-mask mandate has been poorly received in some corners of the state, with officials criticizing the loss of local control. It also runs counter to the advice of public health officials, who have stressed the importance of wearing masks. (Paul Hammel, Omaha World-Herald)

Montgomery, Alabama City Council Votes Down Mask Ordinance, Sends Doctors Out in Disgust  - More doctors followed him to the microphone, describing the dead being carried out within 30 minutes of each other, and doctors being disturbed when people on the street ask them if the media is lying about the pandemic as part of a political ploy. … the council killed the ordinance after it failed to pass in a 4-4 tie, mostly along racial lines.  (Brad Harper, Montgomery Advertiser)

What Colorado Is Getting Right About Reopening - Colorado Gov. Jared Polis stood out because he embarked on a slow and methodical economic recovery in late April — even before the White House’s stay-at-home guidelines expired. … Colorado’s methodical approach is working. (Dan Goldberg, Politico)

Vermont Borders States With Major COVID-19 Outbreaks, but You Won’t Find That Here - “We took a lot of steps early, and we didn’t waste a lot of time, and Vermonters accepted that,” Governor Scott said at a recent news conference. “And they also complied with all the measures. So, I think that resulted in us having very low rates and put us in the position we’re in today.”.. Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security, said the coronavirus’s trajectory through Vermont stands out because the number of cases spiked in early April and then fell sharply, a sign that “they did something right.” “Most states don’t look like that,” she said. (Maria Sacchetti, Washington Post)

PERSONAL PROTECTIVE EQUIPMENT:

Few N95 Masks, Reused Gowns: Dire PPE Shortages Reveal COVID-19's Racial Divide - Nearly 100 days after the World Health Organization declared the coronavirus outbreak a pandemic, health care workers across the country are still facing major shortages of personal protective equipment, or PPE, including crucial equipment such as masks, gowns, gloves and N95 respirators. Amid an alarming rise in coronavirus cases across the United States, the situation is especially dire at hospitals serving communities of color or patients on Medicaid, NBC News has found. (Lauren Dunn and Sarah Fitzpatrick, NBC News)

TRUMP ADMINISTRATION RESPONSE:

With the Federal Health Megaphone Silent, States Struggle With a Shifting Pandemic - As state and local governments confront a new wave of coronavirus infections, President Trump is sending mixed messages and Washington’s public health bully pulpit has gone silent (Sheryl Gay Stolberg, Noah Weiland, Sarah Mervosh and David E. Sanger, New York Times)

Vice President, Mike Pence Opinion Piece - There Isn’t a Coronavirus ‘Second Wave’ - In recent days, the media has taken to sounding the alarm bells over a “second wave” of coronavirus infections. Such panic is overblown. Thanks to the leadership of President Trump and the courage and compassion of the American people, our public health system is far stronger than it was four months ago, and we are winning the fight against the invisible enemy. (Vice President, Mike Pence, Wall Street Journal)

WOMEN’S HEALTH: 

Medicaid Expansions May Have Affected Contraceptive Choices, Says Study - A recent study has shown that Medicaid expansions may have affected contraceptive choices. In states where the Affordable Care Act–sponsored Medicaid expansions have taken place, there’s been a small but important increase in access to the most effective methods of contraception. A study published on JAMA Open Network in June 2020 has found that in states that expanded Medicaid under the Affordable Care Act, more people are using long-term birth control methods. The research found that of the 310,000 women they studied in expansion states, 6% were using long-acting reversible contraceptives in 2016. This compares to 2.4% of women in non-expansion states. (Alice Broster, Forbes)

DRUG AFFORDABILITY:

A Majority of Americans Fear Pharma Will Use COVID-19 as an Excuse to Raise Prices - Amid a race to find therapies and vaccines to combat Covid-19, a new poll finds that nearly 9 in 10 Americans are concerned that drug makers will take advantage of the pandemic to raise prices. (Ed Silverman, STAT)

SUPREME COURT:

'We Won': DACA Recipients Overwhelmed by Surprise Supreme Court Victory Over Trump - In a deeply divided 5-4 opinion written by Chief Justice John Roberts, the court ruled that the Department of Homeland Security's "arbitrary and capricious" process to end DACA was unlawful. That means that the Deferred Action for Childhood Protection (DACA) program created by President Barack Obama in 2012 will endure, allowing more than 650,000 DACA recipients to continue legally living and working in the U.S. (Alan Gomez, USA Today)

Aligning With Liberals On DACA and LGBTQ Rights, Chief Justice John Roberts Asserts His Independence - The winners at the Supreme Court this week were the nation's LGBTQ community and undocumented immigrants. The losers were conservatives, led by President Donald Trump. And the man most responsible for the unexpected turn of events was the leader of the supposedly conservative court – a label that is coming under a little re-examination. John Roberts, the chief justice of the United States, was in the majority in both cases, along with all four of the court's liberal justices. In delivering the one-two punch to the president and his base, Roberts served notice that he can be either side's punching bag. (Richard Wolf, USA Today)

Supreme Court's LGBTQ Ruling May Sideline Trump's Health Care Rules - The Supreme Court’s historic ruling on LGBTQ nondiscrimination could sideline the Trump administration's new policies on health care and adoption. Why it matters: The ruling's ripple effects will be felt immediately, and could ultimately derail regulations the administration had finalized just days ago. … The bottom line: It may take a while for some of these issues to work their way through the courts, but the Supreme Court's ruling Monday will make many forms of LGBTQ discrimination harder to defend, and in the scheme of things, that will likely happen pretty quickly. (Sam Baker, Alayna Treene, Axios)

SUBSTANCE USE DISORDER:

A New Addiction Crisis: Treatment Centers Face Financial Collapse - Costs have gone up for addiction treatment centers in recent months, as they have had to invest in teletherapy and personal protective gear. "We are at risk for not having the funding that we need to keep our doors open," says one medical director. - Fewer patients in recent months have been showing up for drug and alcohol treatment at REACH Health Services in Baltimore. But Dr. Yngvild Olsen, the medical director there, suspects it's not for good reasons: Some have likely relapsed or delayed drug and alcohol addiction treatment, while others likely fear infection and have stayed home.  (Yuki Noguchi, National Public Radio)

DOCTORS - MEDICINE & RESEARCH:

WHO to Update COVID-19 Clinical Guidance, Stresses That Steroids Should Not Be Used as Prevention - The World Health Organization will update its clinical guidance for COVID-19 following the University of Oxford's announcement of results from a trial on the steroid dexamethasone. WHO Director-General Tedros Adhanom Ghebreyesus called the findings "very welcome news" during a media briefing Wednesday, but stressed that the drug should only be used in severe cases under close clinical supervision. "We will update our clinical guidance to reflect how and when dexamethasone should be used," Tedros said. Oxford researchers said in a press release Tuesday that dexamethasone was found to reduce deaths in patients with severe COVID-19, such as those on ventilators or oxygen. (Sara G. Miller, NBC News)

CDC Report Offers Detailed Demographic Breakdown of Who Is Getting Coronavirus -New numbers released by the US Centers for Disease Control and Prevention offer a comprehensive picture of who in the United States has been diagnosed with Covid-19 and how they fared. The latest figures confirm that older people, minorities and those with preexisting health conditions are at the highest risk of death. (Andrea Kane and Paul LeBlanc, CNN)

Why Virtual Care Will Outlast the Pandemic - With millions of people suddenly video chatting their doctors, there's pressure on Washington to make telehealth a permanent option. An explosion of virtual care during the pandemic is raising expectations that Washington will make sure Americans can continue video chatting with their doctors after the health crisis subsides. (Mohana Ravindranath, Politico)

Study Ties Blood Type to COVID-19 risk; O May Help, A Hurt - A genetic analysis of COVID-19 patients suggests that blood type might influence whether someone develops severe disease. (Marilynn Marchione, Associated Press)

 

Back to the Top


Weekly Rounds 6-14-2020


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DFA’S WEEKLY ACTION ITEM: 

At Doctors for America we share the deep concern of many Americans across the country who have decided to take action to protest, and to demand change. Issues of structural racism, inequality, unequal justice and economic disparities must be of concern to us all, and as physicians we recognize how these impact social determinants of health and have serious detrimental effects on the welfare of the disadvantaged and vulnerable in our society.

DFA would like to better represent our concerns and add our respected voice to those who are demonstrating and urging for change. You can help us tell the story of these times by sharing with us any photos of healthcare providers and advocates who are engaging in these important efforts. Our mission is to place patients before politics, and images tell a powerful story.

Please share your photos with us through your social media accounts, or by sending directly as an email attachment. We will credit images with your name unless you request otherwise. Click on this link to easily share your images. 

Thank you for your continuing advocacy and your support of DFA and the work we must continue.

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:

Copello Fellowship Call: “Racial Inequities Experienced or Witnessed – What Can You Do?” with Armen Henderson, MD; Jennifer Edgoose, MD
Recording of the Call can be found HERE (Passcode: 4d?6#80!) 

Upcoming Event:  Doctors For America: “Addressing Police Brutality” webinar.
Date: Tuesday, June 16th
Time: 4 PM Eastern Time
To Attend: Register with Zoom by Clicking Here.
If Zoom webinar is at capacity, please watch via Facebook Live, by clicking on this link.  

DFA Dr. Margo D. Simon: We Are Protesting During a Pandemic: Local Authorities Should Act Like It - Passionate protesters, fueled by centuries of racism, are taking to the streets and trying to do so responsibly: wearing masks and physically distancing. Still, the COVID-19 pandemic rages on, and local governments should start acting like it: health authorities should bring free, voluntary, curbside COVID testing and mask distribution to protesters; crowds should be given space and time to assemble, and crowding peaceful protesters into wagons and jails should cease. ..Beyond the obvious direct public health benefits, a public health presence at protests could also be symbolic of local government supporting civil rights (and against state-sponsored brutality) while still raising awareness of ongoing and severe health risks during the pandemic and doing something about it. Health workers' presence might even deescalate tensions between protesters and police, discouraging tear gas, rubber bullets, assaults, arrests, and other abuses of power. (Dr. Margo D. Simon, The Hill)

DFA Dr. Shetal Shah: As the Economy Shrank, Families Have Slipped Backward Into Poverty, Jeopardizing Health Care … As a pediatrician, I’ve had a front-row seat to the impact of the coronavirus pandemic and our shelter-in-place policies on children. ...As the economy shrank 4.8% in the first quarter of 2020, children have slipped backward into poverty, creating a social environment adverse to both their short and long-term health. Children are already the poorest members of our communities. ...Children can no longer be an afterthought as policymakers continue to debate all aspects of our shared medical and economic recovery.  (Dr. Shetal Shah, Columbus Dispatch)

THE WEEK IN QUOTES:

THE DIRECT RESULT OF RACISM: “People of color right now are more likely to be infected, and we’re more likely to die. What we’re seeing here is the direct result of racism, That’s the thing that is slapping us in the face. Actually, it’s lashing us like whips.” - Camara Phyllis Jones, an epidemiologist who recently served as president of the American Public Health Association

BLACK COMMUNITY BRACES FOR NEXT THREAT: MASS EVICTIONS: “One knee to the neck just explode[d] a tinderbox of other injustices that we must address, and one of them is housing, Housing security is a matter of justice, as structural racism puts communities of color unfairly at risk of being rent-burdened or homeless.” House Speaker Nancy Pelosi

PUBLIC OPINION ON RACE RELATIONS: “In my 35 years of polling, I’ve never seen opinion shift this fast or deeply, We are a different country today than just 30 days ago. The consequences politically, economically, and socially are too great to fit into a tweet. This is big.”  - Frank Luntz, Republican Pollster

U.S. SURGEON GENERAL, JEROME ADAMS: “I look at him, (George Floyd) and I really do think that could have been me,” 

WEAR A MASK IN PUBLIC: “Our analyses support the immediate and universal adoption of face masks by the public,” Richard Stutt, Cambridge University

THE FORGOTTEN PLAGUE: “I have some good news and bad news. The good news: At last, there is some bipartisan agreement in America. The bad news: It’s a tacit agreement to pretend that the threat from the novel coronavirus has somehow gone away. Covid-19 has become the forgotten plague — and it’s nowhere near ending. - Max Boot - Washington Post Columnist 

STILL AT THE BEGINNING:  In a period of four months, it has devastated the whole world. And it isn’t over yet.”....“Where is it going to end? We’re still at the beginning of it,Dr. Anthony Fauci

NOT GOING AWAY: “This virus is not going to go away. Period, We don’t have a vaccine and we don’t know we’re going to develop one … so we’ve all got to learn to live with this virus.” - David Nabarro, World Health Organization

YA THINK? With rapid escalation of transmission rates in several states this week, investors are beginning to recognize that their enthusiasm for a rapid return to normal is premature,” Wayne Wicker, Chief Investment Officer at Vantagepoint Investment Advisers 

CORONAVIRUS LIABILITY DISCLAIMER: By attending the Rally, you and any guests voluntarily assume all risks related to exposure to COVID-19 and agree not to hold Donald J. Trump for President, Inc.; BOK Center; ASM Global; or any of their affiliates, directors, officers, employees, agents, contractors, or volunteers liable for any illness or injury,”  - President Trump’s Campaign Invite

REACH OUT: If you get an opinion piece or letter to the editor published PLEASE email with a link to Pete Van Vranken - pete@drsforamerica.org for publication in the next edition of the Physician Rounds. Your feedback is welcome.

MEDIA COVERAGE: 

STRUCTURAL RACISM - THE PUBLIC HEALTH CRISIS:

White Coats and Black Lives: Health Care Workers Say 'Racism Is a Pandemic Too' - In the midst of staggering statistics, health care workers across the country are hitting the streets in solidarity to protest--some right after their shifts, still donned in their scrubs and personal protective equipment. (Terrance Smith, ABC News)

To Battle Racism, Experts Say Make Health Equity a Central Principle - “In the healthcare profession, we’re not making widgets; we’re saving lives. Prejudice and inequities and racism can kill people—and it does kill people.” … But experts say many health organizations have yet to really address the role structural racism and racial bias play as health determinants within their own institutions, as well as throughout their communities. (Steven Ross Johnson, Modern Healthcare)

‘The Direct Result of Racism’: COVID-19 Lays Bare How Discrimination Drives Health Disparities Among Black People - The demonstrations sparked by the killing of George Floyd in Minneapolis have prompted a reckoning over racism and police brutality. But, among those in the medical communities, there have also been calls for urgent action to address the role that systemic racism plays in health disparities among Black people. … The Covid-19 pandemic has only made those disparities — and the structural discrimination they are rooted in — all the more apparent. (Meghana Keshavan, STAT)

Black Community Braces for Next Threat: Mass Evictions - A Federal Moratorium on Evictions — Which Only Applies to the 1 in 4 Rental Units That Are Backed by the Government — Expires in a Matter of Weeks. - A new tremor is threatening to shake minority communities as protests over racial injustice sweep the country: A wave of evictions as a federal moratorium on kicking people out of their rental units expires. The ban on evictions — which applies to rentals that are backed by the government — expires in a matter of weeks. On top of that, the federal boost to unemployment benefits that many laid-off workers have used to pay their rent is set to end July 31. (Katy O'Donnell, Politico)

American Indian Tribes Thwarted in Efforts to Get Coronavirus Data - The CDC has turned down tribal epidemiologists’ requests for data that it’s making freely available to states.

Federal and state health agencies are refusing to give Native American tribes and organizations representing them access to data showing how the coronavirus is spreading around their lands, potentially widening health disparities and frustrating tribal leaders already ill-equipped to contain the pandemic. (Darius Tahir and Adam Cancryn, Politico)

Where Protesters Go, Street Medics Follow - Through Tear Gas and Rubber Bullets, Professional and Amateur Medical Volunteers Have Stepped Forward to Aid the Injured (Emma Grillo, New York Times)

Over 5,000 Scientists Stop Work in Protest Against Systemic Racism in STEM - Thousands of scientists pledged to halt research on Wednesday as part of a protest over systemic racism against black academics and STEM (science, technology, engineering and math) professionals.  More than 5,000 academics from institutions across the globe signed an online pledge to strike posted by Particles for Justice. (Rebecca Klar, The Hill)

COVID-19:

Widespread Mask-Wearing Could Prevent COVID-19 Second Waves: Study - Population-wide face mask use could push COVID-19 transmission down to controllable levels for national epidemics, and could prevent further waves of the pandemic disease when combined with lockdowns, according to a British study on Wednesday. (Kate Kelland, Reuters)

Alarming Rise in Virus Cases as States Roll Back Lockdowns - States are rolling back lockdowns, but the coronavirus isn’t done with the U.S. ... The analysis found that in 21 states as of Monday, the rolling seven-day average of new cases per capita was higher than the average seven days earlier. (Mike Stobbe, Associated Press)

Michigan Coronavirus Cases, Deaths Continue Downward Trajectory, Hit New Lows Since Outbreak's Peak - A seven-day rolling average of new cases has fallen by a third over the past week, to an average of 210 new cases per day. That figure stood at 378 new cases per day a week earlier, according to figures from the Michigan Department of Health and Human Services. Deaths have also fallen. (Crain's Detroit Business)

Public Health Workers Fighting Virus Face Growing Threats - In the battle against COVID-19, public health workers spread across states, cities and small towns make up an invisible army on the front lines. But that army, which has suffered neglect for decades, is under assault when it’s needed most. ...Elected officials and members of the public who are frustrated with the lockdowns and safety restrictions have at times turned public health workers into politicized punching bags, battering them with countless angry calls and even physical threats. (Michelle R. Smith, Lauren Weber and Anna Maria Barry-Jester, Associated Press)

PERSONAL PROTECTIVE EQUIPMENT: 

Health Workers Resort To Etsy, Learning Chinese, Shady Deals To Find Safety Gear - The global pandemic has ordinary health care workers going to extremes in a desperate hunt for medical supplies. Community clinics, nursing homes and independent doctors, in particular, find themselves on the fringe of the supply chain for masks, gowns, gloves and ventilators. (Eli Cahan and Sarah Varney, Kaiser Health News)

Internal Document Reveals Federal Plan to Ask Nurses to Reuse Masks - The slides show FEMA’s plan to ramp up supply into June and July hinges on the reusing of N95 masks and surgical gowns, increasing the risk of contamination. Those are supposed to be disposed of after one use.  (Emily Kopp, Roll Call)

TRUMP ADMINISTRATION RESPONSE: 

A Detailed Timeline of All the Ways Trump Failed to Respond to the Coronavirus - Here’s what Trump and the federal government have — and have not — done to respond to the virus: (Cameron Peter, VOX)

Trump’s Decision to Leave W.H.O Came With Bluster, but No Action So Far - Nearly two weeks have passed since President Trump announced he was withdrawing the United States from the World Health Organization. To date, none of the levers that would need to be pulled to follow through on that decision has been pulled. (Helen Branswell, STAT)

DOCTORS - MEDICINE & RESEARCH:

Immunity to the Coronavirus Remains a Mystery. Scientists Are Trying to Crack the Case - Scientists stress that just because someone has recovered from Covid-19 and produced antibodies to the coronavirus does not mean they are protected from contracting it a second time. No one’s yet proven that. That, then, leaves open the question: What does immunity look like? (Andrew Joseph, STAT)

U.S. Blood Reserves Are Critically Low - The U.S. blood supply is at critically low levels after Covid-19 shutdowns have emptied community centers, universities, places of worship and other venues where blood drives typically occur. The American Red Cross, which supplies about 40% of the nation’s blood, said more than 30,000 planned blood drives have been canceled since mid-March. (Amy Dockser Marcus, Wall Street Journal)

A New Embryo-like Model Could Help Scientists Study the ‘Black Box’ of Early Human Development - Researchers have developed the first-ever embryo-like model from human embryonic stem cells, a workaround that will let them examine birth defects and diseases they couldn’t otherwise, given ethical and technical issues with studying a human embryo in the lab. The model resembles a human embryo around 18 to 21 days old — complete with the layers of the cells that will eventually form the nervous system, muscles, the gut, and other cells and structures in the human body. (Natalya Ortolano, STAT)

AFFORDABLE CARE ACT AND COVERAGE ISSUES:

House Majority Leader Steny Hoyer: House Will Vote Soon on Bill to Improve ObamaCare - The House will vote the week of June 29 on a bill aimed at improving the Affordable Care Act (ACA), House Majority Leader Steny Hoyer (D-Md.) said Thursday.  (Peter Sullivan, The Hill)

Kentucky Governor Pledges Health Coverage to All Black Residents - Offering few specifics, Kentucky Gov. Andy Beshear said his administration is committed to ensuring that 100% of the state’s black residents have health insurance. (Alex Ebert, Bloomberg News)

Millions at High Risk of Severe COVID-19 Outcomes Lack Coverage to Cover Costs - More than 18 million people who were most at risk of experiencing severe outcomes from COVID-19 at the start of the outbreak had the least access to healthcare because they were either uninsured or underinsured, according to a new study. (Steven Ross Johnson, Modern Healthcare

DRUG AFFORDABILITY:

U.S. States Accuse 26 Drugmakers of Generic Drug Price Fixing in Sweeping Lawsuit - Twenty-six drug manufacturers were sued on Wednesday by the attorneys general of most U.S. states and several territories, which accused them of conspiring to reduce competition and drive up generic drug prices. (Diane Bartz, Jonathan Stempel, Reuters)

Wholesale Drug Prices — and Net Prices — Keep Falling for Most Drugs - Amid continued political pressure on the pharmaceutical industry, a new analysis finds that brand-name drug makers increased their wholesale prices by 2.3% in the first quarter of this year, a much smaller boost than 3.2% hike that occurred during the same time a year ago. (Ed Silverman, STAT)

IMMIGRANT AND REFUGEE HEALTH JUSTICE:

Trump Administration Moves to Solidify Restrictive Immigration Policies - Under the cloak of a pandemic and the convulsions of anti-racist protests, the Trump administration continues to advance its policies to restrict legal immigration, halting the flow of foreign workers and raising the bar for asylum seekers hoping for sanctuary. (Zolan Kanno-Youngs and Maggie Haberman, New York Times)

Advocates Sue Trump Administration Over Mass Border Expulsions - It’s the first challenge to the Trump administration’s policy of mass expulsions of border-crossers, under which nearly 45,000 migrants — including 2,000 children — have been pushed out of the U.S. (Dara Lind, ProPublica)

DeVos Issues Rule Barring Colleges from Granting Coronavirus Relief Funds to DACA Recipients - Education Secretary Betsy DeVos issued a rule Thursday that would ban colleges from granting coronavirus relief funds to noncitizens, including those protected under the Deferred Action for Childhood Arrival (DACA) program. (J. Edward Moreno, The Hill)

GUN VIOLENCE EPIDEMIC:

Coronavirus Could Make America’s Gun Problem Even Deadlier - Stress and isolation combined with another feature of American life — easy access to firearms — could form a deadly brew. …On the other hand, evidence that guns may be misused and do serious harm — to owners and their family members, including children — is substantial and growing. It’s a lopsided balance sheet that should give pause to people who own guns or are considering buying their first gun. (David Studdert, Matthew Miller and Garen Wintemute, New York Times)

SUBSTANCE USE DISORDER:

How Americans’ Drinking Habits Have Changed During the Pandemic - Stay-at-home orders posed a special challenge to Americans who struggle with addiction and rely on the support of in-person recovery meetings. Many others found their alcohol consumption patterns changed significantly during the pandemic. William Brangham reports on the impact COVID-19 has had on Americans’ substance use -- including consequences that could long outlast the virus. (William Brangham, Leah Nagy, PBS NewsHour).

 

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Weekly Rounds 6-7-2020


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DFA’S WEEKLY ACTION ITEM: 

Structural racism and race-based violence are among our nation’s enduring sins and serve as the root cause of many health-related problems such as gun violence, maternal mortality, substance use disorder, and inequities in health insurance coverage, and access to care. This is reflected in the dysfunction of our justice system, our educational systems, our neighborhoods, and most recently thehealth outcomes around COVID-19.  

Our hearts are filled with passion; thus we will not wallow in our despair. There is freedom in action – in trying to make big ideas happen, working together to make the foundational changes necessary to promote equality and equity. If we’re really going to heal our nation – we cannot just feel angry or simply put on Band-Aids - we must collaborate and take meaningful action on these fundamental, structural issues. Each of us as individuals can take action right now, by engaging with policymakers and your local chief of police on your concerns about the impact of structural racism. Phone your chief of police and tell them you want to have a conversation about what they can do to help. Personalize this suggested message and send it to your federal legislators now. - Thank you for your work, and for your willingness to stand up and make your voices heard. - Take Action Right 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 Taking Action:As Coronavirus Cases Increase at Detention Centers, Doctors’ Group Demands Release of Immigrants - As confirmed COVID-19 cases increase inside Immigration and Customs Enforcement’s detention centers, Doctors for America protested Friday at facilities in Conroe and near San Antonio, demanding the release of non-violent immigrants. The demonstrations at Joe Corley Detention Facility in Conroe and Karnes County Residential Center southeast of San Antonio were part of a series of actions across the country organized by the advocacy group. (Olivia P. Tallet, Houston Chronicle)

DFA's Dr. Howard Forman - COVID-19 Highlights Racial Disparities in Our Health Care System - "The global pandemic is a dark moment in US history, exposing our lack of attention to health equity in the nation. However, it can be a moment when we begin to address long-standing failures of our health care system, promote equitable access to health services and help communities of color to achieve the care that all Americans should have." (Aneta Gasiewska, Dr. Howard P. Forman and Dr. Darin Latimor, USA Today)

DFA Webinar - End High Drug Prices - END HIGH DRUG PRICES: Webinar talking with Rep. Lloyd Doggett, Rep. Jan Schakowsky, Abdul El-Sayed, about real life health care stories and why Congress must act to #EndHighDrugPrices. DFA leader, Dr. Reshma Ramachandran, shared a patient story about the devastations of high prescription drug prices.

DFA Webinar - Mental Health and Safe Gun Storage - a webinar on mental health, gun safety, and safe storage during the #COVID19 pandemic. Co-hosted with  @bradybuzz, moderated by @RambaKy, featuring  @EmmyBetz, @PsychBrownBag & our very own Dr. Arka Deb! 

THE WEEK IN QUOTES:

#ThisIsOurLaneToo: We are physicians when we are at work in the hospital, but we are always Black men. We don’t live in our white coats — we live in our Black skin. For those like us who experience these tragedies as terrifying, the silence of the medical community is deafening. Where loss of life due to police brutality is concerned, #ThisIsOurLaneToo.” - Chijioke Nze, Elorm F. Avakame, Olusola J. Ayankola, and Jamaji C. Nwanaji-Enwerem, STAT

A REALITY THAT NONE OF US SHOULD TOLERATE: And we must keep in mind that institutional racism and injustice are at the root of disparate outcomes in health. Uprisings affect people’s health in the short term, but the reason they are occurring is because of the long-standing reality that people’s lives are valued differently in our society. This is a reality that none of us should tolerate.”  - Dr. Leana S. Wen - Former  Baltimore Health Commissioner

A PUBLIC HEALTH CRISIS:At the end of the day, racism is the original sin here, Racism attacks people’s physical and mental health,” It’s “an ongoing public health crisis that needs our attention now.” - Dr. Georges Benjamin, executive director of the American Public Health Assn.

MY GREATEST RISK: I’ve spent the last several months of my life imploring and exhorting people to protect themselves, to reduce the spread of this virus and save lives,” But after Floyd’s death under the knee of Minneapolis police officer Derek Chauvin, “it dawned on me that my greatest risk is not COVID-19. It’s the color of my skin.” - Dr. Clyde W. Yancy, Cardiologist at Northwestern University’s Feinberg School of Medicine

DANGEROUS: The police tactics — the kettling, the mass arrests, the use of chemical irritants — those are completely opposed to public health recommendations, They're causing protesters to violate the six-feet recommendation. The chemicals may make them have to remove their masks. This is all very dangerous.” - Malika Fair, Director of Public Health Initiatives at the Association of American Medical Colleges

THE CHARACTER OF OUR POPULACE:How does a civil society — if indeed we are civil — respond not only to disproportionate suffering but also to a legacy of injustice? We will soon know the character of our populace.” Dr. Clyde W. Yancy, Cardiologist at Northwestern University’s Feinberg School of Medicine

NOT A FAIRY TALE: American history isn’t a fairy tale with a guaranteed happy ending. The battle for the soul of this nation has been a constant push and pull for more than 240 years, a tug of war between the American ideal that we’re all created equal, and the harsh reality that racism has long torn us apart. The honest truth is that both elements are part of the American character, both elements. At our best, the American ideal wins out. But it’s never a route, it’s always a fight and the battle is never fully won. But we can’t ignore the truth that we’re at our best when we open our hearts rather than to clench our fist.” - Vice President, Joe Biden - June 2, 2020 Philadelphia, PA

EVERY 3 DAYS: “2,977 people were killed in the terrorist attacks on Sept. 11, 2001. As of now, the daily average of COVID-19 deaths equal that total every three days.” - (Jiachuan Wu, Nigel Chiwaya and Robin Muccari, NBC News)

THE CDC: Here is an agency (The C.D.C) that has been waiting its entire existence for this moment, And then they flub it. It is very sad. That is what they were set up to do.” - Dr. Peter Lurie, Former Associate Commissioner at the Food and Drug Administration 

VERY EARLY: “We are really early in this disease, If this were a baseball game, it would be the second inning.” - Dr. Ashish Jha, Director, Harvard Global Health Institute 

AN UNTENABLE SITUATION:The pandemic amplified an already untenable situation, where women are burning the candle at both ends as they drown in work and hack together child care,” - Alexis Barad-Cutler, Not Safe For Mom Group

IRRESPONSIBLE AND DAMAGING: “The pandemic has also dealt a huge setback to vaccination campaigns against measles, diptheria and polio. In a statement, the World Health Organization and others estimated that routine immunization services are being substantially hindered in at least 68 countries and about 80 million children under the age of 1 year old are likely to be affected. Public health experts worry that as nations throw limited resources into fighting the pandemic, there will be less for fighting HIV/AIDs, malaria and tuberculosis. All of this will put extra demands on the WHO, which has been at the front lines of fighting disease in the developing world — and it’s more evidence that President Trump’s decision to abandon the WHO is irresponsible and damaging.” - Editorial Board - Washington Post

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

MEDIA COVERAGE: 

Cause of Death: COVID-19, Police Violence or Racism? - Doctors and public health experts will tell you that, compared to white Americans, African American people die prematurely and disproportionately of many ills: heart disease, stroke, COVID-19, police violence. The proximate causes of these early deaths vary. But there is a sameness to the pattern, experts say, and a common source of the skewed statistics. Racism — not in its overt, name-calling form, but the kind woven deeply into the nation’s institutions — harms the 44 million Americans who identify as black and potentially shortens their lives, according to those who study racial inequities in health. Melissa Healy, LA Times)

‘This Is What Happens to Us.’ How U.S. Cities Lost Precious Time to Protect Black Residents from the Coronavirus - The coronavirus crisis in black America follows a familiar pattern, from the AIDS epidemic to maternal mortality to breast cancer to even natural disasters such as Hurricane Katrina, where community concerns were overlooked until gross disparities were revealed. (Robert Samuels, Aaron Williams, Tracy Jan and Jose A. Del Real, Washington Post)

Protests Will Likely Spread The Coronavirus. These Doctors And Nurses Are Protesting Anyway - Doctors, nurses, residents, medical students, and others in the medical field are just some of the thousands of protesters flooding town squares and downtowns. To some, their participation may seem controversial or hypocritical. (Stephanie M. Lee, BuzzFeed News)

Police Using Rubber Bullets On Protesters That Can Kill, Blind Or Maim For Life - … when fired at close range, rubber bullets can penetrate the skin, break bones, fracture the skull and explode the eyeball, he said. Rubber bullets can cause traumatic brain injuries and “serious abdominal injury, including injuries to the spleen and bowel along with major blood vessels,” said Dr. Robert Glatter, an emergency physician in New York City and a spokesperson for the American College of Emergency Physicians.” (Liz Szabo, Kaiser Health News)

Mass Arrests Jeopardizing the Health of Protesters, Police - Mass arrests of protesters across the country — many held for hours in vans, cells and other enclosed spaces — are heightening the risk of coronavirus spread, according to public health experts and lawsuits filed by civil rights groups. As tens of thousands of people take to the streets to protest police brutality after the killing of George Floyd in Minneapolis, the arrest and detention of thousands further jeopardizes the health of demonstrators — and that of police officers and the broader community.  (Alice Miranda Ollstein and Dan Goldberg, Politico)

A Minneapolis School Asked People to Donate Food for Students After Looting Closed Stores. ‘Miles of Cars’ Lined Up - “There were miles of cars holding food, wrapped around our city blocks,” said Mara Bernick, family liaison for Sanford Middle School. Hundreds of people showed up to give what they could. Some arrived in U-Haul trucks and trailers, and some came carrying groceries in their hands. Soon, the school property was covered with thousands of bags of groceries. By the end of the day, an estimated 30,000 food kits were delivered, and more than 500 families and individuals were able to stock their pantries and fridges. (Sydney Page, Washington Post)

DOCTORS - MEDICINE & RESEARCH:

Red Cross Warns of a ‘Staggering’ Drop in Blood Supplies - Hospitals have resumed elective surgeries and many Americans are venturing out of their homes again, but the rate of donations has yet to bounce back - As protests and violence erupt in cities, the United States faces a new threat: The country is running out of blood. (Christopher Flavelle, New York Times)

Proteins in COVID-19 Patients' Blood Could Predict Severity of Illness, Study Finds - Scientists have found 27 key proteins in the blood of people infected with COVID-19 which they say could act as predictive biomarkers for how ill a patient could become with the disease. (Kate Kelland, Reuters)

Convalescent Plasma Not Helpful in China Study; Hydroxychloroquine Doesn't Prevent Infection - Convalescent plasma disappoints in Chinese trial - Infusions of antibody-rich blood plasma from people who have recovered from the coronavirus, so-called convalescent plasma, failed to make a difference in a study of hospitalized patients in China. (Nancy Lapid, Reuters)

ICUs Become A ‘Delirium Factory’ For COVID Patients - Although COVID-19 is best known for damaging the lungs, it also increases the risk of life-threatening brain injuries — from mental confusion to hallucinations, seizures, coma, stroke and paralysis. The virus may invade the brain, as well as starve the organ of oxygen by damaging the lungs. To fight the infection, the immune system sometimes overreacts, battering the brain and other organs it normally protects. (Liz Szabo, Kaiser Health News)

Doctors Are Tweeting About Coronavirus to Make Facts Go Viral - Dr. Wachter, 62 years old, is part of a growing group of scientists and public-health officials who are increasingly active and drawing large audiences on social media. They say they feel a moral obligation to provide credible information online and steer the conversation away from dubious claims, such as those in “Plandemic,” a video espousing Covid-19 conspiracy theories that drew millions of views last week. (Georgia Wells, Wall Street Journal)

COVID-19 TESTING:

Race, Ethnicity Data to Be Required With Coronavirus Tests Starting Aug. 1 - Federal health officials announced Thursday they will require laboratories to report race, ethnic and other information about each person tested for the novel coronavirus, following months of criticism that the Trump administration has been insensitive to the pandemic’s profound demographic disparities. (Amy Goldstein, Washington Post)

Coronavirus Antibody Tests: Facts, Myths and Everything You Need To Know - Are the tests reliable? What do they tell you? Your antibody test questions answered…. For a closer look at all of these issues, we asked experts what we know—and don’t know—about the tests. (Sumathi Reddy, Wall Street Journal)

TRUMP ADMINISTRATION RESPONSE: 

The C.D.C. Waited ‘Its Entire Existence for This Moment.’ What Went Wrong? - The technology was old, the data poor, the bureaucracy slow, the guidance confusing, the administration not in agreement. The coronavirus shook the world’s premier health agency, creating a loss of confidence and hampering the U.S. response to the crisis.  (Eric Lipton, Abby Goodnough, Michael D. Shear, Megan Twohey, Apoorva Mandavilli, New York Times)

Experts Warn of Dire Global Health Consequences If U.S. Withdraws from the World Health Organization - An American withdrawal from the World Health Organization could wreak profound damage on the global effort to eradicate polio and could undermine the world’s ability to detect and respond to disease threats, health experts warned. (Helen Branswell, STAT)

The Trump Administration Has Yet to Pay Out Billions in Emergency Health Aid - Months after Congress approved $175 billion in emergency aid to health providers, the Trump administration has yet to pay out the majority of the funds — nearly $100 billion — amid a series of setbacks and internal uncertainty over how best to distribute the money.  (Adam Cancryn, Politico)

COVID-19 & IMMIGRATION:

Doctor Who Advised Homeland Security Testifies Against COVID-19 Protocols in Immigration Detention - A doctor contracted by the Department of Homeland Security to advise on detention health conditions appeared before Congress on Tuesday to personally criticize the Trump administration as COVID-19 continues to spread through civil immigration detention centers. (Quinn Owen, ABC News)

Fear, Illness and Death in ICE Detention: How a Protest Grew on the Inside

For months in ICE’s detention centers, nobody really knew how many immigrant detainees had Covid-19, because the agency was scarcely testing, even as public-health experts warned of a pending crisis… In response to the pandemic, immigrants in at least a dozen ICE facilities have announced protests and strikes. (Seth Freed Wessler, New York Times)

Illinois to Become 1st State to Provide Medicaid Regardless of Immigration Status - Illinois will become the first state to provide Medicaid for undocumented seniors ...Tucked in near the end of the 465-page budget implementation bill that passed the Illinois General Assembly late Saturday night was a provision giving Medicaid access to noncitizens over 65 years old and whose income is $12,670 or less (Kade Heather, The State Journal-Register)

DRUG AFFORDABILITY:

Long-Delayed Drug-Price Legislation Not Dead Yet, Grassley Says - Senate Finance Committee Chairman Chuck Grassley said that he intends to push for a vote this year on a bill that would limit drug-price increases, even as pharmaceutical companies race to find treatments and vaccines for Covid-19. (Riley Griffin & Emma Court, Bloomberg News)

Medical Societies Have ‘Extensive’ Financial Ties With Drug and Device Makers

Many leaders of influential U.S. medical societies have extensive financial relationships with drug and device makers, raising concerns about the extent to which industry may influence research, physician education, and treatment guidelines, a new study finds. (Ed Silverman, STAT)

GUN VIOLENCE EPIDEMIC: 

Handgun Ownership Vastly Increases Suicide Risk, Large Study Confirms - A large new study confirms what mental health experts and those who research firearms have known for some time: Owning a handgun vastly increases one’s risk of suicide. The research, published Wednesday in the New England Journal of Medicine, goes beyond what smaller past studies have shown, however, by capturing suicide risk down to the individual level. (Shraddha Chakradhar, STAT)

SUBSTANCE USE DISORDER:

Overdose Deaths Have Skyrocketed in Chicago, and the Coronavirus Pandemic May Be Making It Worse - Opioid-related deaths in Cook County have doubled since this time last year, and similar increases are happening across the country. “If you’re alone, there’s nobody to give you the Narcan,” said one coroner. ...“This is going to make it so much worse,” said Kathleen Kane-Willis, a researcher with the Chicago Urban League who has studied the opioid epidemic for more than a decade, adding that the true impact of the pandemic on drug overdoses likely won’t be known for some time. (Melissa Sanchez and Duaa Eldeib, ProPublica)

 

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Healing America – Structural Racism and Racially Motivated Murder MUST END


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We are writing to you today with heavy hearts – hearts filled with sadness after witnessing Mr. George Floyd killed in front of our eyes and the widespread expressions of sincere anger that have resulted.  

While details surrounding Mr. Floyd’s death, and the following violence and destruction continue to come out, many of us feel the fabric of our communities and nation tearing apart. Sadly, we recognize that the causes of our nation’s dysfunction are not new – this is just the latest iteration – now made instantaneously visible through the advent of technology. Today as we face a tremendous crisis, perhaps the greatest we have ever seen, we must hear the most important call to action of our time.

Structural racism and race-based violence are among our nation’s enduring sins and serve as the root cause of many health-related problems such as gun violence, maternal mortality, substance use disorder, and inequities in health insurance coverage, and access to care. This is reflected in the dysfunction of our justice system, our educational systems, our neighborhoods, and most recently the health outcomes around COVID-19.  

Take action right now.

What is occurring in Minneapolis and elsewhere in our country is not about just one person, or one single event. George Floyd is just the latest victim in a long line of Black and brown people impacted by structural racism.  

While racial inequities in Minnesota are among the worst in the nation, we know these issues are endemic to all communities across our nation. This reality affects us all, regardless of economic or social status, as Dr. Armen Henderson, a DFA Copello Advocacy Fellow, recently experienced firsthand in Miami.

It angers us that the President of the United States chooses to tear our nation’s wounds further - dividing us by conjuring partisanship, visions of flying bullets and dogs attacking protestors – malicious tools from a history not yet forgotten. We recognize it is our time to lead. Our profession has a respected, knowledgeable, and effective voice which, especially now, we must use to the benefit of those who are not being heard. Collectively, we can change the national discourse and set a course towards a better future.  

Our hearts are filled with passion; thus we will not wallow in our despair. There is freedom in action – in trying to make big ideas happen, working together to make the foundational changes necessary to promote equality and equity. If we’re really going to heal our nation – we cannot just feel angry or simply put on Band-Aids - we must collaborate and take meaningful action on these fundamental, structural issues.

As a first step in supporting our actions, DFA will host a Webinar about the Intersections of Racism and Health that will be scheduled to take place in the next few weeks; watch for the invitation.

Each of us as individuals can take action right now, by engaging with policymakers and your local chief of police on your concerns about the impact of structural racism. Phone your chief of police and tell them you want to have a conversation about what they can do to help. Personalize this suggested message and send it to your federal legislators now.

Thank you for your work, and for your willingness to stand up and make your voices heard.

Evan Saulino, MD, PhD, Board Chair
Krishnan Narasimhan, MD, Vice Chair
Joe Kanter, MD, MPH, Treasurer
Meenakshi Bewtra, MD, MPH, PhD
Cedric Dark, MD, MPH
Jeff Huebner, MD
Justin Lowenthal
Dona Kim Murphey, MD, PhD
May Nguyen, MD, MPH
Julie Parsonnet, MD
Christine Petrin, MD, MPH
Farheen Quarashi, MD
Meghana Rao, MD

“I am no longer accepting the things I cannot change. I’m changing the things I cannot accept”  
- Angela Davis

 

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Weekly Rounds 5-31-20


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DFA’S WEEKLY ACTION ITEM: 


Doctors for America share the deep concern that Physicians for Human Rights has about the ethical dilemmas and safety issues that those providing care to patients in the midst of the COVID-19 pandemic are facing. There is an urgent need to better understand what frontline health care professionals are experiencing across a range of health care settings, clinical roles, geographic areas, and policy environments. To address this need, Physicians for Human Rights is collaborating with researchers at the University of California at Berkeley to drive advocacy for better policies to protect both health care workers and the patients we serve. Doctors for America is asking you to participate in a brief and completely anonymous survey, which will take LESS than 10 minutes. CLICK HERE to take the survey. Please respond prior to Sunday, June 7th. 


Stay safe and well during this difficult time.


DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:


DFA Founder Dr. Vivek Murthy  - Former Surgeon General Dr. Vivek Murthy Receives Award - The Vilcek Foundation and The Arnold P. Gold Foundation are pleased to announce Dr. Vivek Murthy, 19th Surgeon General of the United States, as the recipient of the 2020 Vilcek-Gold Award for Humanism in Healthcare. This award shines a spotlight on immigrant leaders in U.S. healthcare and recognizes the positive impact that humanistic care has on public health. A shared initiative between the two foundations, the Vilcek-Gold Award embodies the missions of both the Vilcek Foundation and the Gold Foundation. … “There is no better person exemplifying this effort than Vivek Murthy. His outstanding leadership is grounded in a profound empathy.”


DFA Doctor Brian Williams: The Other Public Health Crisis \Legislators Must Address: Gun Violence - Before the COVID-19 pandemic, operating on countless black and brown patients who are most of Illinois’ gun violence victims constituted my days and nights as a trauma surgeon. Now, having spent time in an intensive care unit dedicated to COVID-19 patients fighting for their lives, I see how these two crises intersect…. I went into medicine to treat patients with limited or no access to health care. Along the way, I realized I can do more than just treat. I can advocate for change and become part of the solution. I urge you to join me. While no law will save every life from gun violence, if we can reduce the devastation in black and brown communities caused by illegal guns, passing this law is worth it. (Dr. Brian Williams, Chicago Tribune)

 

DFA Doctor Mara Divis This Isn’t the Time for Bombastic Tributes to Health Care Workers - The Blue Angels have awed generations with tight aerial choreography and the sonic roar that heralds their aerobatics. No doubt millions have felt patriotic goosebumps watching their technical mastery at summer air shows. Last week, as the fighter jets tore over an emotionally strained Chicago, with the stated intent of paying tribute to health care workers and first responders, I felt only a pit of hard anger. (Kevin Md)


DFA Doctor Ranit Mishori - The Price of Speaking Out: Protecting Health Workers Amid COVID-19 - Frustrated and scared, health care workers have taken risks to speak out about the dangerous lack of personal protective equipment (PPE) and other safety provisions to care for patients during the COVID-19 pandemic. Many are being silenced, threatened, suspended, or dismissed from their jobs instead of being commended for their commitment to safety as they risk their lives to carry out their professional duties. … Time and effort should not be spent punishing doctors and nurses advocating for the safety of themselves and their patients during a pandemic that has already taken more than 330,000 lives worldwide. Health care institutions can and must do better. - (Susannah Sirkin, Elizabeth Kaselitz and Dr. Ranit Mishori, The Hill)


DFA Doctor Jay Bhatt: America's COVID-19 Response Should Borrow a Page From NASA:  - Without a centralized "Mission Control," the implementation of a plan to realize this vision cannot happen. Communicating with citizens transparently and authoritatively requires a comprehensive and up-to-date fact base that records and reports verifiable progress and learnings and then builds on that repository to inform future strategy. It also allows leaders to demonstrate these efforts are working. (Dr. Jay Bhatt and Joel Goldhammer, ABC News)


THE WEEK IN QUOTES:


COMPASSION: We’re living in a moment when national sentimentality and displays of compassion are muted because the government doesn’t conceive itself as a first responder, There is empathy, but it’s been localized — it’s in the states and cities and neighborhoods.” - Lauren Berlant, University of Chicago

 

A GOOD PLACE TO START: “I personally believe the Affordable Care Act is a good place to start. It was always intended to be a start, to inspire further transformation. In spite of the persistent assaults on it, the A.C.A. has done much good. But much more needs to be done. Repairing the damage that has been done to this program and using it to build a more functional health care financing system that is understandable, transparent, accountable and uniquely ours is essential to our nation’s health and financial future.Sister Carol Keehan - The Former President and Chief Executive Officer of the Catholic Health Association of the United States


OHIO GOVERNOR DEWINE: “Wearing a face covering is not about politics — it’s about helping other people,” Ohio Governor Mike DeWine (R)  

 

HYDROXYCHLOROQUINE:  "The scientific data is really quite evident now about the lack of efficacy,"- Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases

 

HE WOULD TAKE IT AGAIN:He (The President of the United States of America) is feeling absolutely great after taking this regimen.” he “would take it again if he thought he was exposed.” White House Press Secretary Kayleigh McEnany

 

SENATOR JOHN CORNYN (R-TX) - ACA CHEERLEADER? : "Well, the good news is that if you lose your employer-provided coverage, which covers about 180 million Americans, that is a significant life event, which makes you eligible to sign up for the Affordable Care Act. And as you know, it has a sliding scale of subsidies up to 400 percent of poverty. So that's an option for people." The "good news is people can find, get coverage under the Affordable Care Act or via Medicaid based on their income." - United States Senator John Cornyn (R-TX) - NOTE: Mr. Cornyn has voted 20 times to repeal the Affordable Care Act


NOT THAT SERIOUS: Everything is sort of lining up in the direction that if we're serious about it, we can control this thing, We're just not being serious about it." Samuel Scarpino, Northeastern University's Network Science Institute


OPIOID EPIDEMIC: While the COVID-19 crisis is very troubling and challenging for our county, we are also still in the middle of an opioid epidemic, Unfortunately, it’s getting worse.”Lee Harris - Shelby County (TN) Mayor


MIFEPRISTONE:At every other turn during this pandemic, the federal government is trying to make it easier for patients to get the medical care they need without unnecessary health care visits that jeopardize their safety, But when it comes to patients who need to end an early pregnancy or treat a miscarriage, the administration is forcing them to travel to a hospital, clinic, or medical office just to pick up a pill they are already permitted to swallow later at home.”  - Julia Kaye, ACLU


Larry Kramer - June 25, 1935 - May 27, 2020: “Larry Kramer was a force of nature. … I believe that Larry Kramer fundamentally changed the world of medical research. He made Tony Fauci and others realize that it is not ethical to deny people treatment when no proven treatment exists, and that if experimental treatments are being developed, you’ve got to figure out a way to accelerate access to them. Building on the tradition of civil rights activism, Larry laid the groundwork for a new generation of health activists. He started a new style of focused in-your-face activism that was valid and changed health advocacy work from service organizations to organizations focused on creating structural changes to help people live better lives. He also turned a bright spotlight on the ethics of medical research, and changed that for the better. Tom Frieden, Former Director of the Centers for Disease Control and Prevention and former commissioner of the New York City Health Department


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


MEDIA COVERAGE: 


DOCTORS - MEDICINE & RESEARCH:


Higher Death Rates Found Among Cancer Patients With COVID-19 - Cancer patients infected with the new coronavirus are dying at significantly higher rates than Covid-19 patients in the general population, a new study suggests. In the study, conducted by an international group of researchers and published online by the Lancet, researchers looked at data on 928 Covid-19 patients in the U.S., Canada and Spain who had cancer that was either active or in remission. Thirteen percent of those patients died within 30 days of their Covid-19 diagnosis, according to the study. In contrast, the case fatality of Covid-19 patients in the U.S. is 5.9%, according to global coronavirus data compiled by Johns Hopkins University. (Sarah Toy, Wall Street Journal)


Obesity Is America's 'Achilles Heel' When It Comes To COVID-19 - A recent study finds obesity is a risk factor in COVID-19 hospital admissions for people under 60. Published in The Clinical Infectious Diseases Journal, the observational research looks at the risk of hospitalization according to body mass index, or BMI. Researchers found obese adults under age 60 had a higher risk of admission to the hospital and the intensive care unit compared to people who have a healthy weight, says lead author of the study Dr. Jennifer Lighter. (Jeremy Hobson, Allison Hagan, WBUR Boston)


COVID-19 Has Killed Close To 300 U.S. Health Care Workers, New Data From CDC Shows - The coronavirus continues to batter the U.S. health care workforce. More than 60,000 health care workers have been infected, and close to 300 have died from COVID-19, 

according to new data from the Centers for Disease Control and Prevention. (Carrie Feibel, Will Stone, National Public Radio)


Physicians, ACLU Sue FDA Over Abortion Pill Limits - A group of medical providers represented by the American Civil Liberties Union sued the Food and Drug Administration on Wednesday, challenging federal requirements that limit how medication abortions are dispensed. The medical group coalition, led by the American College of Obstetricians and Gynecologists, opposes an FDA restriction on mifepristone, a drug used to end a pregnancy or for miscarriage management. Medication abortions use a two-pill regimen to end a pregnancy. (Sandhya Raman, Roll Call)


COVID-19:


U.S. Coronavirus Death Toll Surpasses 100,000, Exposing Nation’s Vulnerabilities - One hundred thousand Americans dead in less than four months. It’s as if every person in Edison, N.J., or Kenosha, Wis., died. It’s half the population of Salt Lake City or Grand Rapids, Mich. It’s about 20 times the number of people killed in homicides in that length of time, about twice the number who die of strokes. (Marc Fisher, Washington Post)


Coronavirus Doesn’t Have to Be So Deadly. Just Look at Hong Kong and Singapore - Hong Kong and Singapore reported their first cases of the novel coronavirus in January. Four months later, the densely packed Asian metropolises, with a combined population of about 13 million, have seen 27 fatalities between them.... The cities’ fatality rates—among the lowest in the world—show that coronavirus outbreaks don’t have to result in large-scale loss of life. Their playbook: test widely, quarantine aggressively and treat patients early to avoid fatal complications and overburdened health systems. (Newley Purnell and Feliz Solomon, Wall Street Journal)


A Third of Americans Now Show Signs of Clinical Anxiety or Depression, Census Bureau Finds Amid Coronavirus Pandemic - A third of Americans are showing signs of clinical anxiety or depression, Census Bureau data shows, the most definitive and alarming sign yet of the psychological toll exacted by the coronavirus pandemic. .. The findings suggest a huge jump from before the pandemic. For example, on one question about depressed mood, the percentage reporting such symptoms was double that found in a 2014 national survey. (Alyssa Fowers & William Wan, Washington Post)


COVID-19 TESTING:


Bad State Data Hides Coronavirus Threat as Trump Pushes Reopening - The spotty data flow is particularly worrisome to public health officials trying to help Americans make decisions about safely venturing out. The lack of accurate and consistent Covid-19 data, coupled with the fact that the White House no longer has regular briefings where officials reinforce the need for ongoing social distancing, makes that task even harder. (Darius Tahir and Adam Cancryn, Politico)


Antibody Tests Were Hailed as Way to End Lockdowns. Instead, They Cause Confusion. - Once hailed as a solution, the current crop of tests, which have not been thoroughly vetted by any regulatory agency, now seem more likely to add chaos and uncertainty to a situation already fraught with anxiety. “To give people a false sense of security has a lot of danger right now,” said Dr. Travis Riddell, the health officer for Teton County, which includes Jackson, Wyoming. - (Christie Aschwanden, Kaiser Health News)


Sewage Testing Gives Clues of Coronavirus - New studies increasingly show that the coronavirus's genetic code can be detected in the remnants of fecal matter that flows through sewers and into sewage facilities, either in raw wastewater or in what is euphemistically known as sludge…. “It's a leading indicator, it seems to be ahead of cases and it's ahead of hospital admissions as well,” Peccia said. “If I were a governor or a mayor, I would want to know that seven days in advance of what I already know.” (Reid Wilson, The Hill)


PERSONAL PROTECTIVE EQUIPMENT:


They Evoke Darth Vader, but These Masks May Save Your Doctor’s Life - With medical masks in short supply, several hospitals have turned to industrial models. They get rave reviews and are allowed by the F.D.A., but the Trump administration has no plans to encourage distribution or production. … Government-supported research predicted over a decade ago that a pandemic would cause a dire shortage of disposable masks, and multiple federal agencies urged hospitals and policymakers to consider stockpiling elastomerics, which are designed to be cleaned and reused for years and are government-certified to protect at least as well as N95s. (Chris Hamby, New York Times)


Federal Agencies Turn to Untested Suppliers for Big PPE Contracts - Already, some have failed to deliver: two of the seven largest contracts given to companies that were new to federal contracting have been canceled after the suppliers didn't deliver promised respirator masks. And questions remain about the quality of equipment delivered by other vendors, including the company formed by former Trump administration aide Zachary Fuentes.  (Casey Tolan, CNN)


TRUMP ADMINISTRATION RESPONSE:


Trump Team Killed Rule Designed To Protect Health Workers From Pandemic Like COVID-19 - When President Trump took office in 2017, his team stopped work on new federal regulations that would have forced the health care industry to prepare for an airborne infectious disease pandemic such as COVID-19. That decision is documented in federal records reviewed by NPR. "If that rule had gone into effect, then every hospital, every nursing home would essentially have to have a plan where they made sure they had enough respirators and they were prepared for this sort of pandemic," said David Michaels, who was head of the Occupational Safety and Health Administration until January 2017. (Brian Mann, National Public Radio)


Trump Announces End of US Relationship with World Health Organization - President Donald Trump announced on Friday that the United States will terminate its relationship with the World Health Organization, a move he has threatened throughout the coronavirus pandemic. (Jason Hoffman, CNN)


US Demands Removal of Sexual Health Reference in UN's Covid-19 Response - Civil society groups have condemned calls by the Trump administration to remove references to sexual and reproductive health from the UN Covid-19 humanitarian response plan (HRP). (Liz Ford, The Guardian)


COVID-19 & IMMIGRATION:


Lawsuit Says Trump Admin's Covid-19 Immigration Order Separates Families With Older Kids - A class-action lawsuit filed in federal court Thursday alleges that the Trump administration's ban on legal immigration in response to the COVID-19 pandemic unfairly separates parent from children who are on the cusp of turning 21 years old. (Julia Ainsley, NBC


AFFORDABLE CARE ACT AND COVERAGE ISSUES:


Pandemic Upends State Plans to Expand Health Insurance - The coronavirus pandemic has derailed Democrats’ efforts in statehouses across the country to give more Americans government-backed health coverage. (Dan Goldberg, Politico)


Coronavirus Widens Healthcare Divide Between Red States and Blue States - Regional differences have long been a hallmark of American healthcare. But the gap between blue and red states has yawned wider in the 10 years of political battles that followed passage of the 2010 health law, often called Obamacare. (Noam N. Levey, LA Times)


Trump Finalizing LGBTQ Discrimination - While the country deals with the onslaught of COVID-19 Trump’s Administration is reportedly finalizing its changes to Section 1557 of the Affordable Care Act also known as the Health Care Rights Law. These proposed changes will strip away protections for LGBTQ people & people for whom English is not their first or primary language.  (Charlotte Robinson, Outtake Voices)


DRUG AFFORDABILITY:


Trump Administration to Take Action to Cap Insulin Costs for Seniors - President Trump announced Tuesday that his administration is taking action to cap insulin costs for seniors with diabetes — a move that comes as polls show Trump lagging behind former vice president Joe Biden, the presumptive Democratic nominee, with the important voting bloc of older Americans. (Seung Min Kim and  Yasmeen Abutaleb, Washington Post)


A Senator From Arizona Emerges As A Pharma Favorite - Sinema is a first-term Democrat from Arizona but has nonetheless emerged as a pharma favorite in Congress ... She is a leading recipient of pharma campaign cash even though she’s not up for reelection until 2024 and lacks major committee or subcommittee leadership posts. (Jay Hancock and Elizabeth Lucas, Kaiser Health News)


Pharma Panics as Washington Pushes to Bring Drug Manufacturing Back to the U.S. - As the coronavirus pandemic disrupts global supply chains, lawmakers are increasingly calling on drug makers to exclusively manufacture medicines in the United States. But for a large swath of the pharmaceutical industry, that’s an existential threat. (Nicholas Florko, STAT)


GUN VIOLENCE EPIDEMIC: 


Gatherings as States Reopen Could Spell Return of Another Dark American Phenomenon: Mass Shootings - And it was a jarring reminder that although much of the United States is transitioning from some degree of quarantine, a return to normalcy probably will be accompanied by the return of something that has become an all-too-regular part of American culture: the mass shooting. (Robert Klemko, Washington Post)


SUBSTANCE USE DISORDER:


Drug Overdoses Climb During COVID-19 Pandemic - Drug overdoses have risen in some areas during the COVID-19 pandemic, less than a year after the Trump administration touted decreases in the nation’s overdose epidemic. From Memphis to Milwaukee, a range of cities and counties across the country are reporting spikes in fatal and nonfatal overdoses. (Sandhya Raman, Roll Call)


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.

 

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Enact Public Health Safeguards and Provide Support and Protection for Health Workers during the Coronavirus Outbreak


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Doctors for America Statement and Sign-on Letter Addressed to National, State, & Local Government Officials and Health System Leaders:

SIGN THE PETITION HERE: https://actionnetwork.org/petitions/enact-public-health-safeguards-and-provide-support-and-protection-for-health-workers-during-the-coronavirus-outbreak

The US is experiencing a national emergency due to the coronavirus outbreak that threatens not only the health of all Americans but our entire health care system. Outbreaks in China, Italy, Iran, Spain, and now New York have demonstrated the serious risk, where the pandemic has overwhelmed systems already stretched to the breaking point. Meanwhile, physicians, nurses, and other health workers and first responders who are on the front lines of saving lives both here and abroad are in one of the highest risk groups for contracting COVID-19 as a result.

When 1) our federal elected officials do not communicate a message consistent with scientific and medical realities, 2) our strategic stockpiles are not effectively accessed, and 3) public health recommendations for social distancing and shelter-in-place are not reinforced, then hospitals and health systems are stretched beyond their capacities and all people are threatened.

And when front-line doctors, nurses, and other health workers risk becoming patients themselves, the work of keeping the healthy from becoming sick, sick patients from becoming sicker, and the sickest patients from dying becomes even more difficult. The combined effects are disastrous to the personal and financial health of our patients, communities, and the nation.

We cannot combat COVID-19 without limiting the number of people who get sick in the first place. We also cannot combat COVID-19 without protecting health workers and supporting them so they can continue providing patient care, including through ensuring access to protective gear, providing support services such as childcare and mental health services, enacting protections such as work hour limitations and paid sick leave, and giving priority in confirmatory testing.

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.

We have already missed critical windows for action, but future scenarios of disease spread, illness, death, health system stress, and societal trauma can still be mitigated if our leaders enact public health measures now. An effective response to this unprecedented pandemic cannot occur without enacting stringent public health mandates now to reduce the number of patients needing care. Voluntary social distancing guidance is inadequate, and lockdowns reacting to disease flare-ups are not effective. A nationwide shelter-in-place order, maintained as long as is necessary to control the outbreak, identify and treat patients who need care, and protect the public’s health, is the best way to limit the number of people who are infected.

Thus, shelter-in-place should be implemented nationwide through federal and/or state-level action, and resources must be freed to pursue contact tracing and local containment once hotspots are identified. These shelter-in-place mandates should be sensitive to legitimate concerns regarding financial stressors, address basic needs of the communities affected, and avoid enforcement measures that would promote over-policing.

2. Ensure access to Personal Protective Equipment (PPE) & clear protocols on PPE use.

As an organization advocating for the health of our patients and communities, empowering physicians and other health professionals to be effective health advocates, Doctors for America (DFA) is also concerned about the health and safety of all health workers involved in managing the COVID-19 pandemic. Our teams include everyone — physicians, nurses, students, technicians, volunteers, environmental and food services workers, and more — working in hospitals, emergency rooms, outpatient clinics, nursing homes, long-term care and community-health centers, correctional facilities, and other locations. Many health workers in the US continue to have inadequate access to appropriate PPE (masks, respirators, gowns, gloves, face shields, and more).

We must protect and support health workers through the COVID-19 outbreak, and beyond, to ensure that patients have people to care for them. The US government must more effectively access and disperse National Strategic Stockpile supplies and contract with manufacturing directly via the Defense Protection Act to ensure that all workers are able to use PPE. Importantly, the US should not at this time of crisis loosen hospital safety rules and protections for essential health workers, forcing health workers to provide or feel pressure to provide care without adequately protecting and caring for themselves.

3. Ensure that our health workers will continue to be healthy and available to take care of our patients and communities.

In addition to immediate infection control through public health action and health care workforce protection, we call for measures to:

  • Set minimum standards for health worker shift length, rest, and whistleblower protections, including alternative sleeping quarters for those who may need to isolate themselves (to protect their families) and a health worker safety hotline to report unsafe conditions.
  • Make paid sick leave available to all health workers regardless of employment status.
  • Prioritize health worker access to COVID-19 testing and treatment to keep health care workers providing care to those who need it.
  • Provide safe child care options for health workers who may need them.
  • Provide freely-accessible, consequence-free mental health services to health workers.
  • Ensure that medical licensing and liability regulations are relaxed to allow health workers to provide care for patients wherever those patients might need them.
  • Ensure that health workers-in-training — residents, fellows, medical & nursing students, and volunteers — receive protections similar to those of other health workers, especially from exploitative working conditions.

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Doctors for America asks our physician and medical trainee colleagues, those in other health professions, organizations advocating for patients and communities, and our public health and science communities to join in our call for public health safeguards and protection of health workers.

Join our efforts to respond effectively to COVID-19 by signing on to this letter.

Signed,

Ranit Mishori, MD, MHS
Kate Tulenko, MD, MPH, MPhil, FAAP
Co-Authors, DFA Members

Justin Lowenthal, MD-PhD Candidate
Jeff Huebner, MD, FAAFP
Evan T. Saulino, MD, PhD
Co-Authors, DFA National Board of Directors

Dona Murphey, MD, PhD
Farheen Qurashi, MD
Julie Parsonnet, MD
Joe Kanter, MD, MPH
Christine Petrin, MPH, MD Candidate (recently matched!)
May Nguyen, MD, MPH, FAAFP
Cedric Dark, MD, MPH
Meenakshi Bewtra, MD, MPH, PhD
Meghana Rao, MD
Krishnan Narasimhan, MD
DFA National Board of Directors

View Our Member's Signatures

###

In addition to the above and below organizations and individuals signing on to this letter, we would also like to highlight overlapping sign-on letters and petitions from our colleagues, listed below, and the number of signatures they have accumulated, to fully depict the support for these issues:

Doctors for America: Open Letter to Florida Leaders

449 signatures (as of 3/26/20 at 11:06AM)

Healthcare workers in Florida: Open letter to Florida Governor

713 signatures (as of 3/26/20 at 11:06 AM ET)

Committee to Protect Medicare: COVID-19 Letter to the Trump Administration & CDC

3,585 signatures (as of 3/26/20 10:25 AM ET)

Informal group of health providers nationwide: Open letter (& Sign-on Link) on Shelter-in-Place

5,000+ signatures (as of 3/25/20)

Massachusetts physicians: Letter (reported by WBUR) to Massachusetts Governor

1,000+ signatures (from report)

Tennessee health providers and TMA: Letter & Petition to Tennessee Governor

21,555 signatures (as of 3/26/20 at 11:06AM)

Petition: US Physicians/Healthcare Workers For Personal Protective Equipment in COVID-19 Pandemic

1,298,612 signatures (as of 3/26/20 at 11:21 AM)

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The undersigned organizations and individuals have signed on to endorse this letter.

Organizations:

Individuals: View Signatures

 

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Tell your story on social media today


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SHARE YOUR EXPERIENCE AND THOUGHTS AS A DOCTOR ON THE FRONTLINES: As the COVID-19 pandemic unfolds there just is not enough reliable information. It is critical that the public and policymakers understand the REAL story of what is going on from a frontline caregiver perspective across our nation as this crisis evolves!!

Please share with the DFA community and the world your stories from the frontlines of the US COVID-19 epidemic.

Share your feelings, a thought, or concerns. Post a video. Let the world know how you’re doing and what you and your patients need!

What do you and your patients need to identify infection and treat that you don’t have? (PPEs? Ventilators? what else?)

How easy or hard is it to get patients tested?

What do you think the public and policymakers should be doing to help beat back this epidemic?

What did you do to prevent getting sick yourself? How did you feel when your colleague got sick?

Did you have a 100 - hour week – and if so what kept you going?

What actions or simple “healing” acts of kindness did you experience and witness?

Tell your story – OUR story - via social media:

Twitter: Tweet at us @DrsforAmerica or tag us in your tweets so we can “hear” you – and use the hashtag #COVID19Frontlines (and #HealingAmerica #DFAdocs if room) to amplify your voice.

Facebook: Tag us https://www.facebook.com/DoctorsforAmerica/

Instagram: Tag us @DrsforAmerica so we can “hear” you – and use the hashtag #COVID19Frontlines, #HealingAmerica and #DFAdocs to amplify your voice.

DFA will “retweet”, "like", and repost your important experiences – AND can also direct your information to policymakers.

Please also consider tagging, tweeting at, etc. key policymakers who should listen to doctors on the frontlines of this crisis: @realDonaldTrump , @your Governor, @your two Senators

Thank you for the critical work you are doing now.

 

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Weekly Rounds 5-24-20


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DOCTORS FOR AMERICA SPEAKING OUT & GETTING PUBLISHED:


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


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


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


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


THE WEEK IN QUOTES:


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


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


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


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


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


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


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


MEDIA COVERAGE: 


DOCTORS - MEDICINE & RESEARCH:


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


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


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


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


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


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


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


COVID-19:


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


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


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


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


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


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


COVID-19 TESTING:


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


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


PERSONAL PROTECTIVE EQUIPMENT:


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


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


TRUMP ADMINISTRATION RESPONSE: 


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


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


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


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


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


COVID-19 & IMMIGRATION:


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


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


AFFORDABLE CARE ACT AND COVERAGE ISSUES:


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


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


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


REACH OUT: If you get an opinion piece or letter to the editor published PLEASE send me (Pete Van Vranken - pete@drsforamerica.org ) an email with a link to your piece and I will include it in the next edition of the Physician Rounds. Also please send me any feedback you may have on the “Rounds” - Much Appreciated - Pete

 

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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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