East Bay COVID-19 Update - April 3, 2020

As of April 3, there are 443 confirmed cases of COVID-19 in Alameda County and 12 deaths (including City of Berkeley information). As of April 3, there are 276 confirmed cases of COVID-19 in Contra Costa County and 3 deaths. Please check www.accma.org/COVID-19 for the latest updates.  

Public Health Officials Recommend Covering the Face
Bay Area health officials are recommending that residents cover their nose and mouth with cloth when leaving home for essential travel such as to doctor appointments, grocery shopping, or pharmacy visits.

The regional recommendation aligns with new guidance from the California Department of
Public Health. The face coverings do not have to be hospital grade but need to cover the nose and mouth. For example, bandanas, fabric masks, and neck gaiters are acceptable. Fabric covers and bandanas can be washed and used again.

We do not recommend that the public use medical masks (N-95 or surgical masks), which are in limited supply and must be preserved for our health care workers and pre-hospital transport providers.

To view the full Alameda County Press Release, click here .

Craneway Pavilion in Richmond to be Converted into a Federal Medical Station for COVID-19 Patients  

As part of local emergency preparations, Contra Costa County officials are working with Federal and state partners to convert the Craneway Pavilion in Richmond into a 250-bed medical station for COVID-19 patients.

Beds and medical supplies are being brought in by the National Guard this week to begin transforming the Craneway Pavilion, a large event center on the Richmond waterfront, into a temporary medical facility. The goal is to have the facility ready to receive patients by the third week of April, when health experts predict the Bay Area will see COVID-19 cases begin to peak. 

To view the full press release, please visit the  Contra Costa Public Health Department  website. 
Buprenorphine Prescribing and Opioid-Related Resources

We are in the midst of an epidemic, and things are changing every day on the ground. Patients are learning to adapt to new situations and restrictions, and providers are problem-solving with limited resources in an evolving landscape. The response has been an unparalleled level of innovation and collaboration, in order to save lives given an impossible new reality. This is the current picture of the addiction crisis in the US. 
Addiction treatment and recovery face new challenges with the COVID-19 pandemic. Social distancing can descend into social isolation, which is particularly dangerous for people suffering from a substance use disorder. Providers have had to cancel group sessions, counselors have switched in-person visits for phone check-ins, and many support services have transitioned from face-to-face meetings to virtual meetings. HHS and DEA  designated an exception  for telemedicine allowance to schedule II-V controlled substances.  
As things continue to change, the ACCMA has highlighted some DEA changes regarding prescribing and has compiled the following resources: 
Prescribing Buprenorphine to New or Existing Patients Based on a Telephone Visit

Physicians managing patients with opioid use disorder can now prescribe buprenorphine to new or existing patients based on a telephone visit as the COVID-19 pandemic continues, thanks to  new flexibility  announced on Tuesday by the U.S. Drug Enforcement Administration (DEA).  
The new guidance allows physicians and other health care providers who have a waiver to prescribe buprenorphine for the treatment of opioid use disorder to issue these prescriptions to new and existing patients based on an evaluation via telephone. The new policy is effective from March 31, 2020, for the duration of the COVID-19 emergency. 
This guidance removes a considerable barrier for many patients during the national emergency and, importantly, allows them to stay at home. 
DEA had  already announced  that physicians may, in general prescribe controlled substances to patients using telemedicine without first conducting an in-person evaluation during this public health emergency. 
  Requirements for Refills of Controlled Substances  

While a prescription for a controlled substance issued by means of the Internet (including telemedicine) must generally be predicated on an in-person medical evaluation ( 21 U.S.C. 829(e) ), the Controlled Substances Act contains certain exceptions to this requirement. One such exception occurs when the Secretary of Health and Human Services has declared a public health emergency under 42 U.S.C. 247d (section 319 of the Public Health Service Act), as set forth in 21 U.S.C. 802(54)(D). Secretary Azar declared such a public health emergency with regard to COVID-19 on January 31, 2020. 

Accordingly, as of March 16, 2020, and continuing for as long as the Secretary’s designation of a public health emergency remains in effect, DEA-registered practitioners in all areas of the United States may issue prescriptions for all schedule II-V controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided all of the following conditions are met: 

  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice; 
  • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system; and 
  • The practitioner is acting in accordance with applicable Federal and State laws. 

Provided the practitioner satisfies the above requirements, the practitioner may issue the prescription using any of the methods of prescribing currently available and in the manner set forth in the DEA regulations. Thus, the practitioner may issue a prescription either electronically (for schedules II-V) or by calling in an emergency schedule II prescription to the pharmacy, or by calling in a schedule III-V prescription to the pharmacy. 

The term "practitioner" in this context includes a physician, dentist, veterinarian, or other person licensed, registered, or otherwise permitted, by the United States or the jurisdiction in which s/he practices to prescribe controlled substances in the course of his/her professional practice ( 21 U.S.C. 802(21) ). 
CMA Prescribing FAQs  
What is the current guidance regarding the use of hydroxychloroquinine for prophylaxis and for active disease?   
The U.S. Food and Drug Administration (FDA) has  worked closely  with other government agencies and academic centers to investigate the use of the drug chloroquine, which is already approved for treating malaria, lupus and rheumatoid arthritis, to determine whether it can be used to treat patients with mild-to-moderate COVID-19 to potentially reduce the duration of symptoms, as well as viral shedding, which can help prevent the spread of disease. Studies are underway to determine the efficacy in using chloroquine to treat COVID-19. While there are no FDA-approved therapeutics or drugs to treat, cure or prevent COVID-19, there are several FDA-approved treatments that may help ease the symptoms from a supportive care perspective.

To view the full list of CMA’s Prescribing FAQs,  please click here
Upcoming Webinars
Presented by Schwartz Center for Compassionate Healthcare
Tuesday, April 7, 2020 | 10:00 - 11:00 AM | FREE
Join Richard Westphal, PhD and Patricia Watson, PhD as they discuss specific strategies health care leaders and managers can use to address the five essential human needs that support recovery from adversity and stress. They’ll also explain how to use the Stress First Aid framework for conducting a stress and coping assessment. Following their presentation, Schwartz Center Chief Medical Officer Beth Lown, MD, will moderate a brief Q&A session. To register for this webinar please click here

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.  
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.