Madhury (Didi) Ray, MD, MPH Critical Care Planning Lead NYC Department of Health and Mental Hygiene COVID-19 19 HEALTHCARE Julia Schillinger, MD, MSc Senior Director of STI Surveillance, Epidemiology, and PROVIDER Special Projects, UPDATE NYC Department of Health and Mental Hygiene Jennifer Rakeman, PhD M AY 8,2020 Assistant Commissioner, Public Health Laboratory NYC Department of Health and Mental Hygiene
• Our understanding of COVID-19 is evolving rapidly DIS ISCLAIMER • This presentation is based on our knowledge as of May 7, 2020, 5 PM
Madhury ry (D (Didi) Ray, , MD, , MPH Critical Care Planning Lead NYC Department of Health and Mental COVID-19 19 Hygiene NYC UPDATES
SURVEILLANCE UPDATES CLINICAL UPDATES Outline LABORATORY ISSUES QUESTIONS AND DISCUSSION
• Over two months have passed since the confirmed arrival of COVID-19 in NYC • Over 19,000 people have died due to confirmed or probable COVID-19 in NYC • There are signs that mitigation measures, including WHERE physical distancing, are making a difference WE ARE • The number of new daily cases, hospitalizations, and deaths due to COVID-19 continue to decline • Some alternate care sites have closed • Mitigation measures must be maintained until we can safely transition to suppression measures
• Over 13,000 volunteers registered with the Medical Reserve Corps • Volunteers working in hospitals, nursing homes, mortuaries, and alternate care sites • Hotels being used to house healthcare workers, symptomatic individuals from congregate settings, and CURRENT individuals discharged from hospitals that are COVID-19+ and require an isolated setting ACT CTIVITIES • Food distribution programs providing millions of free meals through the NYC Department of Education and Department for the Aging • City to create and maintain 90-day stockpile of PPE in case of resurgence
CUMULATIVE CASES AND DEATHS, WORLDWIDE 5/7/20 , 5:00PM >3,860,000 cases >270,000 deaths Cumulative confirmed cases, Johns Hopkins University https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
CUMULATIVE CASES AND DEATHS, US 5/7/20, 5:00PM >1,200,000 cases (33% of confirmed global cases) >75,000 deaths (28% of reported global deaths) Confirmed and probable cases, New York Times https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
Laboratory confirmed cases 174,709 CURRENT STATUS OF Hospitalized 43,744 OUTBREAK, Deaths total 19,540 NYC 14,162 confirmed 5/7 /7/20 5,378 probable NYC Health Department Coronavirus Data NYC Health Department Data Portal – updated daily
COVID-19 RATES BY BOROUGH, NYC 5/7/20 Shows number of positive cases per 100,000 people in each borough NYC Health Department Coronavirus Data NYC Health Department Data Portal – updated daily
PHASES OF THE RESPONSE BASED ON SURVEILLANCE DATA WIDESPREAD TRANSMISSION DECLINING TRANSMISSION LOCAL TRANSMISSION CLUSTERS OF NO SPORADIC CASES CASES CASES TEST & TRACE Meet Indicators/Milestones Vital Strategies COVID-19 Playbook https://preventepidemics.org/wp-content/uploads/2020/04/COV040_COVID19Playbook_v2-1.pdf
CASES COVID-19 CASES NYC 3/6/20 – 5/7/20 Shows number of COVID-19 cases, HOSPITALIZATIONS hospitalizations, and deaths based on a daily analysis since March 3 Deaths lag 1-2 weeks after hospitalizations DEATHS 3/1 5/3 DATE
PEOPLE ADMITTED TO NYC HOSPITALS FOR COVID ID-19 19-LIKE IL ILLNESS MILESTONE: This chart may indicate when COVID- 19’s spread is slowing by showing 10 consecutive days when the daily number of people admitted to NYC hospitals for influenza-like illness and pneumonia is less than 200. That would be double the average for prior years in the city
PEOPLE IN IN CRIT ITICAL CARE ACROSS NYC HEALTH + HOSPITALS Number in critical care at NYC H&H MILESTONE: This chart may indicate when critical care volume is at sustainable levels by showing 10 consecutive days when the daily number of people in critical care at NYC Health and Hospitals is less than 375.
• FDA authorized emergency use of remdesivir to treat hospitalized patients of all ages with severe COVID-19 (May 1, 2020) 1 • Authorization is temporary; remdesivir remains an REMDESIVIR investigational drug and has not been formally approved by the APPROVED FDA for any use • Severe suspected or confirmed COVID-19 disease defined as FOR oxygen saturation ≤94% on room air, or requiring supplemental oxygen, or mechanical ventilation or requiring extracorporeal EMERGENCY membrane oxygenation (ECMO) USE • Remdesivir must be administered intravenously; optimal dosing and duration is still unknown • See FDA's emergency use fact sheet for recommended use 2 1. U.S. Food and Drug Administration. Letter: emergency use authorization of remdesivir for the treatment of hospitalized 2019 coronavirus disease (COVID-19) patients. May 1, 2020. https://www.fda.gov/media/137564/download 2. U.S. Food and Drug Administration. Fact Sheet for health care providers: emergency use authorization (EUA) of remdesivir (gs- 5734™). May 2020. https://www.fda.gov/media/137566/download
• NIH study found patients taking remdesivir recovered faster and had lower mortality rate based on preliminary results REMDESIVIR • Randomized, double blinded controlled trial included 1,063 hospitalized patients with confirmed COVID-19 who had lung APPROVED involvement and need for supplemental oxygen or had abnormal chest x-ray, or, requiring mechanical ventilation FOR • 31% faster recovery; median time to recovery was 11 days with remdesivir (vs. 15 days on placebo) EMERGENCY • Recovery defined as being well enough for hospital discharge or returning to normal activity level USE • Mortality rate was 8% with remdesivir (vs. 11.6% in placebo group) National Institutes of Health. NIH clinical trial shows remdesivir accelerates recovery from advanced COVID-19. April 29, 2020. https://www.nih.gov/news-events/news-releases/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19
• Gilead study found similar clinical improvement for both the 5-day and 10-day treatment course REMDESIVIR • Randomized, multi-center clinical trials Included 397 hospitalized APPROVED patients with severe COVID-19 who did not require mechanical ventilation FOR • Time to clinical improvement for 50% of patients was 10 days in 5- day group and 11 days in 10-day group; more than half of patients EMERGENCY in both treatment groups were discharged from the hospital by USE day 14 Gilead. Gilead announces results from phase 3 trial of investigational antiviral remdesivir in patients with severe COVID-19. April 29, 2020. https://www.gilead.com/news-and-press/press-room/press-releases/2020/4/gilead-announces-results-from-phase-3-trial-of- investigational-antiviral-remdesivir-in-patients-with-severe-covid-19
Ju Julia Schillinger, MD, , MSc Senior Director of STI Surveillance, PEDIATRIC Epidemiology, and Special Projects, MULTI-SYSTEM NYC Department of Health and Mental IN INFLAMMATORY Hygiene SYNDROME
• Providers in United Kingdom, other countries, and some U.S. cities reporting pediatric multi-system inflammatory syndrome. • Patients with “overlapping features of toxic shock syndrome and PEDIATRIC atypical [incomplete] Kawasaki disease (KD)” 1,2 • Some patients positive by PCR for SARS-CoV-2 MULTI-SYSTEM • Cases series (n=8) from the UK 3 IN INFLAMMATORY • Age range: 4-14 years SYNDROME • Persistent fever; most with abdominal pain, rash, and conjunctivitis • laboratory markers of inflammation, single/multiple organ systems • All 8 patients had positive serologic tests for SARS-CoV-2 1. Paediatric Intensive Care Society. PICS Statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease. April 27, 2020. https://picsociety.uk/wp-content/uploads/2020/04/PICS-statement-re-novel-KD-C19-presentation- v2-27042020.pdf 2. Jones VG, Mills M, Suarez D, et al. COVID-19 and kawasaki disease: novel virus and novel case. Hosp Pediatr. 2020. https://hosppeds.aappublications.org/content/hosppeds/early/2020/04/06/hpeds.2020-0123.full.pdf 3. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during the COVID-19 pandemic. Lancet . May 7, 2020. https://doi.org/10.1016/S0140-6736(20)31094-1
• NYC Health Department Health Alert #13 describes initial outreach to NYC pediatric ICUs • Identified 15 cases of incomplete or typical KD (Ages: toddler – adolescent) PEDIATRIC • All had subjective or measured fever and more than half reported MULTI-SYSTEM rash, abdominal pain, vomiting, or diarrhea • PCR results for SARS-CoV-2: 4 positive, 10 negative, and 1 INFLAMMATORY IN indeterminate SYNDROME • More than half required blood pressure support; five required mechanical ventilation • No fatalities • Relationship to COVID-19 infection not yet defined NYC Health Department. Health alert #13: pediatric multi-system inflammatory syndrome potentially associated with COVID-19. May 4, 2020. https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/2020/covid-19-pediatric-multi-system-inflammatory- syndrome.pdf
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