COVID-19 Weekly Roundup: In Case You Missed It
Week of May 11-15, 2020
As of May 15, there are 2,300 confirmed cases of COVID-19 in Alameda County and 82 deaths (including City of Berkeley information). There are As of May 15, there are 1,100 confirmed cases of COVID-19 in Contra Costa County and 33 deaths. Please check  www.accma.org/COVID-19  for the latest updates.

As of May 15, there are 74,936 confirmed cases of COVID-19 in California and 3,108 deaths. As of May 15, there are 1,412,121 cases of COVID-19 in the United States and 85,990 deaths.

Review hospital case number graphs by county. Review national hospitalization rates .
The Department of Getting Back to Quasi-Normal

While President Trump continued to champion restarting the economy, public health officials in the Trump Administration issued stark warnings in US Senate testimony this week about the downstream costs of reopening too quickly. In California, Governor Newsom and the California Department of Public Health announced that counties may proceed to phase two of the reopening process , releasing additional guidance for the reopening process and safety modifications. In Alameda and Contra Costa County , local orders remain in effect that are stricter than what the state is allowing. Regional and state public health officials are using a range of metrics to determine our community’s readiness to reopen , and it is expected that stay at home orders will continue to be relaxed slowly in the weeks ahead.
County Testing, Guidance, and Isolation (Oh My!)

Alameda County has increased COVID-19 testing , with four new testing sites launched in the past week in East Oakland (2 sites), Ashland Cherryland, and Hayward. The Alameda County Public Health Department (ACPHD) has also released updated guidance for COVID-19 laboratory testing in an increased effort to control the epidemic.

Meanwhile, Contra Costa County Health Services (CCCHS) has released two new guidances related to quarantining. First, CCCHS released an updated mass quarantine order for individuals who have had close contact with a person with COVID-19 . Anyone who has been in contact with (within 6' of) someone diagnosed with COVID-19 must self-quarantine for 14 days following the encounter - violation of this order is a misdemeanor. Second, CCCHS Health Officer Dr. Chris Farmitano issued orders extending the amount of time people diagnosed with COVID-19 must remain in isolation from 7 to 10 days.With those guidances in mind, along with extensive research regarding the risk of spread in large gatherings, Contra Costa County is urging schools to host virtual graduation ceremonies rather than in-person celebrations.
In the Political Sphere - Budgets, Advocacy, Relief Plans, Funding, Remdesivir

On the political side of things, there have been numerous budget changes, proposals, and funding issues this week. In California, Governor Gavin Newsom released an updated state budget proposal for 20-21 . He starts off by addressing how dramatically the world has shifted since his initial budget proposal in January - "This is no normal year. And this is no normal May revision."

While this budget revision is a step in the right direction in providing protection to Californians affected by COVID-19, the California Medical Association (CMA) and the California Hospital Association (CHA) are calling on Congress to pass legislation that provides increased legal protection for those on the frontlines of this pandemic - healthcare workers. Physicians and other health care workers should not have to fear legal consequences while making the difficult decisions they're having to make on a daily basis in the treatment of COVID-19 patients, postponing elective procedures, switching to telemedicine, etc. 

U.S. House Speaker Pelosi revealed a new $3 trillion coronavirus relief plan on May 12, which allocates $1 trillion in direct aid for states. The plan will also increase federal matching payments for Medicaid and offer an additional $100 billion in direct aid to physicians and hospitals , which will not need to be repaid. In response to the $3 trillion plan , CMA President, Dr. Peter Bretan, said, "The House Democratic proposal is the right prescription to get America back on track and meet the future challenges this disease, and its fallout, will present for the American people and the economy."

Meanwhile, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded $15 million to increase telehealth capabilities in the wake of the ongoing COVID-19 pandemic (review the full list of award recipients ).

The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced an emergency $40 million grant program for suicide prevention - it is currently accepting applications for funding and will provide funding to 50 applicants. HHS Assistant Secretary for Mental Health and Substance use, Elinore F. McCance-Katz, MD, PhD, states, “We know the stressors that are accompanying this pandemic – job loss and financial instability, anxiety, grief, depression, and other factors – can lead to suicide and suicide attempts.” As such, the goal of the funding is to support states and communities during the COVID-19 pandemic as they attempt to curb the increase in suicide rates.
What We're Reading (Updated Guidance)  

First and foremost, the CDC has prepared a COVID-19 FAQ for Healthcare Professionals , answering clinical questions about COVID-19. The CDC has also developed preparedness tools for healthcare professionals and facilities respond to COVID-19. They published staffing resources for state, tribal, local, and territorial health departments on staffing the public health workforce. They released interim guidance on unsheltered homelessness , highlighting that individuals suffering from homelessnes are at an increased risk of contracting COVID-19. Finally, they published special considerations for patients on home dialysis to ensure that home dialysis patients are receiving appropriate treatment during the pandemic.

The California Department of Public Health (CDPH) has released COVID-19 guidance for pregnant and/or breastfeeding women , including basic guidance for obstetrical care providers . CDPH promises to update this guidance as new information becomes available. The CDC has also released similar guidelines for pregnant, breastfeeding, or caregivers of young children .

CDPH released guidance for hospitals regarding allocation of scarce medications for COVID-19 , with recommendations designed to help maximize transparent and fair allocation of scarce medications.

An All Facilities Letter from the CDPH alerts health facilities to the Centers for Disease Control and Prevention's (CDC'S) updated COVID-19 symptoms. Health facilities should ensure that their screening process and policies reflect the updated symptoms. Updated symptoms includes loss of taste or smell; updated emergency symptoms includes confusion or inability to rouse . The CDC has also released an update on COVID-19 symptoms , highlighting the risk of serious complication for individuals with underlying medical conditions.

A second CDPH letter , this time addressed to Skilled Nursing Facilities (SNFs), draws attention to the requirement for SNFs to submit a facility-specific COVID-19 mitigation plan with specified elements to the CDPH within 21 calendar days. The letter also provides updated infection control guidance for Health Care Providers employed at SNFs.
Resources for Resuming Practice

While we can't quite put a timeline on when things will be back to normal, we do know that Alameda and Contra Costa County will not be modifying the stay at home orders for now. That being said, Alameda County has released guidance for resuming non-urgent health care services so physicians can (mostly) transition back into normal practice. The AMA checklist also provides helpful step-by-step guidance to manage the safe reopening of practices in a manner that protects patients, clinicians, staff and the public. 

The ACCMA has also developed several new resources for resuming practice, bringing together guidances, webinars, and information physicians may need to properly and securely reopen their practices. First, the ACCMA has developed a free online series - " Re-Inventing and Re-Opening Your Practice , " including sessions focused on following CDC guidelines for safely resuming practice, addressing HR and employment issues, and telemedicine and reimbursement support. Register for the series today if you need support re-opening your practice. Second, ACCMA is hosting virtual roundtable discussions for physicians with similar specialties to share ideas, thoughts, and resources for resuming practice in their specialty. Specialties include procedural-based and surgical specialty practices, pediatric/OB-GYN practices, and office-based practices (e.g., non-surgical, psychiatry, etc.). These discussions will take place every other week from 5:30 - 6:30 PM on select days. Read more about the discussions and register online . Finally, ACCMA has begun using Slack as a communication platform for physicians - share questions, resources, and coordinate with fellow local physicians, all online! To access the Slack channel, click here and follow the instructions to sign up.

In other news, the California Division of Workers' Compensation (DWC) announced on May 12 that it will increase reimbursement for telephone evaluation and management (E/M) codes (CPT codes 99441, 99442, 99443). This will be particularly beneficial to practices that have transitioned to telemedicine and mirrors the Medicare reimbursement changes announced on April 30. If your practice is interested in transitioning to telemedicine, visit the ACCMA's Telemedicine Series webpage , where you can access on-demand webinars focused on incorporating telemedicine into your practice . You can also review CMA's Telehealth Toolkit for Medical Practices and join ACCMA's Telehealth focused Slack-channel to discuss telehealth and telemedicine tips and tricks with other local physicians (click the link above and follow the instructions to join Slack).

The U.S. Small Business Administration (SBA) issued a new FAQ to clarify certain rules for the Paycheck Protection Program (PPP) , which provides forgivable loans to physician practices to cover operating expenses.
WEBINARS

The ACCMA is hosting virtual, roundtable discussion forums to help physicians within similar specialties share their methods for resuming practice . Discussions may revolve around telemedicine, PPE, resources, practice workflows, safety and any other topics pertaining to resuming practice during California’s reopening. Virtual roundtables will be held via Zoom for three groups: office-based practices (e.g., non-surgical, psychiatry, etc.), procedural-based and surgical specialty practices, and pediatric/OB-GYN practices. Please note that these will be participant-driven roundtable discussion – please come prepared to share what you are doing and to ask questions of your peers. These Zoom sessions are  free  and open to all interested physicians and practice managers.  Sessions will take place every other week from 12:30 to 1:30 PM.

To register, click here and complete the JotForm.

Procedural/Surgical-based Practices:  Thursdays 5/28, 6/11  
Pediatrics/OB/GYN Practices:  Tuesdays 5/19, 6/02, 6/16 
Office-based Practices:  Thursdays 5/21, 6/04, 6/18 
Register for all sessions here.

FREE | On-Demand Video Available Soon
Following CDC guidelines for posting signs outside the office, disinfecting the office, and preparing the office before and after patient visits. How to manage without a waiting room and to evaluate staff needs.

FREE | Wednesday, May 20 |12:30 to 1:30 PM
Planning for your staff to return to work. Addressing work-from-home, termination, and unemployment issues. Setting new policies for your practice office to maintain safety for both staff and patients.

FREE | Friday, May 22 | 12:30 to 1:30 PM
Gear up for scheduling patients and training staff to make appointments via a telemedicine platform. Use technology to optimize your time by combining office visits and telemedicine visits, scheduling appointment reminders via text, and filling cancelled or open appointments in your schedule. Efficiently manage your CARES money and quarterly reporting responsibilities.
FREE | CME Available | Thursday, May 28 | 12:30 to 1:30 PM
Register for the webinar here .

This seminar will provide physicians with new approaches to maintaining treatment for patients with Opioid Use Disorder (OUD) and/or addiction. During the seminar, providers from MAT clinics will be joined by narcotic treatment program representatives from Alameda and Contra Costa counties to understand if/how they are keeping their patients on a treatment regimen. Presenters will discuss the impact COVID-19 has had on physicians’ abilities to provide MAT treatment and ideas on how protocols can be altered so that they are still safe, legal, and harm-reducing but available to patients despite not
meeting face-to-face.
ACCMA's On-Demand Library


FREE | Available On-Demand
Telehealth services are expanding rapidly during the COVID-19 crisis. In partnership with Bay Area medical associations, the ACCMA teamed up with experts to develop a comprehensive webinar series to help physicians swiftly ramp up their telemedicine capabilities, from technology to practice implementation to coding. Experts discuss choosing a telemedicine platform; compliance; privacy and security considerations; billing and payment; policies, procedures, and workflow; informing your patients; and malpractice. Physicians who have experience practicing telemedicine share their practical reflections.
QUESTIONS/CONCERNS?
Please contact ACCMA at 510-654-5383 or   accma@accma.org   with any questions or concerns you have. Although we may not currently have an immediate answer to all questions, we want to know the information and resources that you need to continue to provide care for our community during this difficult time. Questions can also be directed to the ACCMA Slack channel , where physicians can respond to and receive feedback from other physicians.
 
This information will also be posted online at www.accma.org/COVID-19 and will be updated frequently. Please check the ACCMA website regularly for updates.