Demetre Daskalakis, MD, MPH COVID-19 19 Deputy Commissioner, Disease Control HEALTHCARE NYC Department of Health and Mental Hygiene PROVIDER April 17, 2020 UPDATE
• Our understanding of the novel coronavirus is evolving rapidly DIS ISCLAIMER • This presentation is based on our knowledge as of April 17, 2020, 12:30 PM
CURRENT STATUS OF OUTBREAK NYC SURVEILLANCE DATA Outline CLINICAL FINDINGS DOHMH BEHAVIORAL HEALTH RESPONSE DURING COVID-19 DISCUSSION
• There is still widespread community transmission of COVID-19 in New York City and around the world • Almost seven weeks have passed since New York City reported its first confirmed COVID-19 case • We are continuing to see high numbers of new WHERE diagnoses, including those who require hospitalization WE ARE • But we may have begun to flatten the curve – syndromic data shows improvement in emergency department visits and admissions • We cannot let down our guard but rather must reinforce mitigation measures that are working
CUMULATIVE CASES AND DEATHS, WORLDWIDE >2.1 million cases >147,000 deaths As of April 17, 2020, 10AM https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
Influenza-Like Illness and Pneumonia Emergency Department Visits per 100,000 Population (through April 15, 2020) Visit rate 0-17 Visit rate 18-44 Visit rate 45-64 Visit rate 65-74 Visit rate 75+ 60 50 Number of visits per 100,000 40 30 20 10 0 Date: January 1, 2020 to April 15, 2020
Influenza-Like Illness and Pneumonia Emergency Department Admissions per 100,000 Population (through April 14, 2020) Admit rate 0-17 Admit rate 18-44 Admit rate 45-64 Admit rate 65-74 Admit rate 75+ 45 40 Number of admissions per 100,000 35 30 25 20 15 10 5 0 Date: January 1, 2020 to April 14, 2020
CUMULATIVE CASES AND DEATHS, US >673,000 cases >30,800 deaths April 17, 2020, 12:25PM https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
• Laboratory Confirmed Cases CURRENT 117,565 STATUS OF • Total hospitalized OUTBREAK 30,903 NYC • Deaths • Confirmed Cases Apr. 16, 2020 7,563 2:30PM • Probable Cases 3,914
TOTAL CASES of COVID-19 IN NYC BY PATIENT ZIP CODE April 16, 2020
PERCENT OF PATIENTS TESTING POSITIVE FOR COVID-19 BY ZIP CODE April 16, 2020
CASES NYC COVID-19 CASES, HOSPITALIZATIONS, HOSPITALIZATIONS AND DEATHS OVER TIME Mar 6-Apr 16, 2020 Deaths lag 1-2 weeks behind hospitalizations DEATHS DATE
NYC CASE RATES BY BOROUGH COVID-19 April 16, 2020 This chart indicates spread of COVID-19 relative to each borough’s population
CASES NYC COVID-19 FEMALE MALE TOTAL RATES BY HOSPITAL SEX April 15, 2020 FEMALE MALE TOTAL Due to the small number of cases among transgender and gender- DEATHS nonconforming people, data on those cases are not included at this time FEMALE MALE TOTAL
• Not all persons infected with SARS-CoV-2 are diagnosed by laboratory confirmation • Routinely capture deaths for laboratory- DEATH confirmed COVID-19 cases SURVEILLANCE • To capture deaths for probable COVID-19 cases • Review of death certificates • Review excess mortality compared to expected mortality
Date of Death for Laboratory-Confirmed and Probable COVID-19 Deaths as of April 15, 2020 NYC _______________________________________________________ PROBABLE AND Due to delays in reporting, recent data are incomplete CONFIRMED COVID-19 Count of Deaths DEATHS Mar 2-Apr 14, 2020 Day of Date of Death
(as of April 15, 2020)
COVID-19 CASES, HOSPITALIZATIONS, AND DEATHS BY RACE/ETHNICITY Age-adjusted rates of lab confirmed COVID-19 non-hospitalized cases, estimated non-fatal hospitalized cases, and patients known to have died per 100,000 by race/ethnicity group as of April 16, 2020
• Report all deaths occurring in NYC to eVital through your facility administrator REPORTING • Email: eVital@health.nyc.gov for facility DEATHS permission • Do not report deaths by phone
• NYC Health Department cautions providers and clinical laboratories: WARNING • Unvalidated SARS-CoV-2 serology test kits • Many falsely advertising as “approved” may not be ABOUT reliable SEROLOGY • >95 companies informed FDA of intent to distribute serology ASSAYS FOR test kits for SARS-CoV-2 in U.S. marketplace SARS-COV-2 2 • Sensitivities, specificities, and predictive values of SARS-CoV-2 serology test kits not evaluated by any independent government agency, including FDA
WARNING • False positive and false negative test results occur often in test kits that have been evaluated ABOUT • No CDC guidelines for interpretation of serology tests SEROLOGY • Using a test inappropriately in point of care or moderate ASSAYS FOR complexity laboratory setting may put your practice out of SARS-COV-2 2 compliance and result in regulatory action
• Severe shortage of nasopharyngeal swabs and viral transport media (VTM) to diagnose COVID-19 SEVERE • As supply continues to decline, real possibility hospitals SHORTAGE will completely run out • Providers should continue to test only hospitalized OF SWABS patients to preserve resources that are needed to AND VIR IRAL diagnose and appropriately manage patients with more severe illness TR TRANSPORT • NYC Health Department actively working to mitigate MEDIA current barriers to testing
• Health care workers and staff who work while asymptomatic FACEMASK pose a risk to patients and each other POLICY • To reduce the potential risk of asymptomatic transmission to other staff and patients: FOR HEALTH • All health care facility staff should wear a facemask CARE regardless of type of setting or service being provided WORKERS • Follow guidance from the health care facility regarding what type of facemask to wear
• All New Yorkers must wear a face covering when in a public place if they cannot maintain physical distancing FACE • Excludes children <2 and people unable to medically tolerate • Governor Executive Order No. 202.17, effective April 17, 2020 COVERING at 8PM POLICY FOR • Face covering : a well-secured paper or cloth (like a bandana THE PUBLIC or scarf) that covers one’s mouth and nose. • Reduce the potential risk of asymptomatic transmission • Critical to still stress physical distancing and good hygiene
ALTERNATE CARE SIT ITES
• There are still no proven medications for treatment of COVID-19 USE OF • Trials of a variety of different medications are underway REMDESIVIR • A recent study of remdesivir used for hospitalized COVID-19 FOR PATIENTS patients who had oxygen saturation of ≤94% while they were WITH SEVERE breathing ambient air or were receiving oxygen support showed a benefit in most patients (36 out of 53, or 68%) COVID-19 19 • There was no randomized control group and evaluation of efficacy is therefore limited* *Grein J, Ohmagari N, Shin D, et al. Compassionate Use of Remdesivir for Patients with Severe COVID- 19 N Engl J Med . 2020 Apr 10
Role of public health in interventions in in Wuhan Pan A, Liu L, Wang C, et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. Published online April 10, 2020.
• We currently have a limited set of preventive measures for IM IMPACT OF COVID-19 and physical distancing is one of our main tools • Recent data from CDC show that efforts to promote physical PHYSICAL distancing in NYC have likely been effective at reducing DIS ISTANCING community mobility, and this in turn has likely reduced spread of the virus* *Lasry A, Kidder D, Hast M, et al. Timing of Community Mitigation and Changes in Reported COVID-19 and Community Mobility ― Four U.S. Metropolitan Areas, February 26– April 1, 2020. MMWR Morb Mortal Wkly Rep. ePub: 13 April 2020
Lasry et al.
Lasry et al.
Lasry et al.
• Survey of adults in multiple cities in China during February HEALTH 20-21, 2020 IM IMPLICATIONS • Those who stopped working reported worse mental and OF PHYSICAL physical health conditions and distress DIS ISTANCING • Data such as these emphasize the impact of COVID-19 even on those who may not have been infected by the virus Zhang SX, Wang Y, Rauch A, Wei F. Unprecedented disruption of lives and work: Health, distress and life satisfaction of working adults in China one month into the COVID-19 outbreak . Psychiatry Research 2020; 288:112958
• NYC Health Department is closely monitoring key public health signs to determine when physical distancing restrictions can be loosened for people not at high risk for serious COVID-19 illness LOOSENING • Indicators that are being followed include: PHYSICAL • Hospital admissions • Critical care capacity DIS ISTANCING • Positive test rates • See COVID-19 Public Health Milestones for the latest indicator data: https://www1.nyc.gov/site/doh/covid/covid- 19-goals.page
PERCENT OF NYC RESIDENTS WHO TEST POSITIVE
NYC Health Department: Behavioral Health Response During COVID-19 Myla Harrison, MD, MPH Assistant Commissioner- Bureau of Mental Health NYC Department of Health and Mental Hygiene Allison Baxter, LCSW Mental Health Communications Lead NYC Department of Health and Mental Hygiene April 17, 2020 35
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