VALLEY MEDICAL BLOG

Pediatric Pearl Update

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Antibiotic Stewardship Clinical Champion Update

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It is projected that by the year 2050, there will be over 10 million deaths per year worldwide attributable to antimicrobial resistance.

Acute Sinusitis

Most sinusitis in the ambulatory setting is due to a viral infection that will resolve on its own. Acute bacterial infection occurs in only 0.5 to 2.0 percent of cases.

Despite consistent recommendations to the contrary, antibiotics are prescribed in over 80% of outpatient visits for acute sinusitis.

Diagnosis

Use the following criteria to diagnose acute bacterial rhinosinusitis (ABRS), derived from the American Academy of Otolaryngology-Head and Neck Surgery guidelines and the Infectious Diseases Society of America guidelines:

  • Persistent symptoms or signs of acute rhinosinusitis lasting 10 or more days without evidence of clinical improvement or

  • A biphasic pattern of illness, typically extending over a 10-day period, characterized by signs and symptoms of ARS that initially start to improve but then worsen approximately five to six days later ("double worsening").

The onset of severe symptoms or signs of severe illness (eg, high fever [>39°C or 102°F], purulent nasal discharge, facial pain) for at least three to four consecutive days at the beginning of illness supports the diagnosis of ABRS. However, severity of illness alone is NOT sufficient criteria for starting antibiotics.

Treatment

In the majority of patients, ABRS is a self-limited disease. Systematic reviews and meta-analyses have found that 70 to 80 percent of immunocompetent patients improve within two weeks without antibiotic therapy.

  • For immunocompetent patients with ABRS who have good follow-up, we suggest symptomatic management and observation over a seven-day period (watchful waiting) (Grade 2B). For patients who have been managed with observation who have worsening symptoms or fail to improve within the observation period, antibiotics should be started

  • For patients who do not have good follow-up, we initiate antibiotic therapy upon diagnosis of ABRS.

 

Antibiotics:

  • Either amoxicillin (500 mg three times daily or 875 mg twice daily) or amoxicillin-clavulanate (500 mg/125 mg three times daily or 875 mg/125 mg twice daily) is appropriate initial therapy for patients who do not have risk factors for resistance

    • The evidence to support the use of amoxicillin-clavulanate rather than amoxicillin is stronger in children than adults

    • See UpToDate for more info on antibiotic selection in patients with risk factors or penicillin allergy

    • Macrolides (clarithromycin or azithromycin) and trimethoprim-sulfamethoxazole are not recommended for empiric therapy because of high rates of resistance of S. pneumoniae (stop those Z-packs!)

 

  • Duration of therapy: 5 to 7 days

 

  • Failure of initial therapy:

    • Patients who have worsening symptoms or fail to have improvement within seven days on initial therapy should have the diagnosis of ABRS confirmed. (Remember, 98-99.5% of cases are viral! Also consider allergic rhinitis, chronic rhinosinusitis, laryngeal reflux, headache syndromes, TMJ)

    • If ABRS remains the most likely diagnosis, treat with an alternate agent for 7 to 10 days

Meta-analyses have consistently found that, compared with placebo, patients with ABRS may benefit from antibiotics at the cost of increased adverse events. Estimates of the number needed to treat to benefit range from 13 to 18 patients, while the number needed to harm is approximately 8 patients.

  • “For clinically diagnosed sinusitis the identifiable utility of antibiotics is to reduce respiratory symptoms in a small percentage of patients, while trading this for (arguably more vexing) gastrointestinal symptoms in a larger percentage of patients.” (The NNT Group)

 

Prescribing longer courses of antibiotics than necessary leads to increased risk for resistance. As above, only treat for 5 to 7 days, or 7 to 10 days after initial treatment failure. Longer courses should be avoided. In the attached Excel file you will find data on our antibiotic prescribing for acute sinusitis in 2021, including the duration of those prescriptions (there are two tabs). Notice the variability among our providers, and take note of your own prescribing practices. Please work toward fewer unnecessary prescriptions and shorter courses in the coming years, to support the health of our community.

 

Aaron Grinstein, PA-C

Antibiotic Stewardship Clinical Champion

Deprescribing Clinical Champion Update

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Pediatric Pearl Update

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CHF Clinical Champion Update

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Hyperlipidemia and Lifestyle Clinical Champion Update

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Hypertension Clinical Champion Update

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Diabetes Clinical Champion Update

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Summary of 2021 HIPAA Violations 

February 8, 2022

The 2021 summary of HIPAA Investigations is now complete.  VMG completed 16 investigations of reported HIPAA concerns.  Of these investigations, 9 were determined to be HIPAA violations.  These 9 incidents were reviewed with all staff involved, and notifications were made in writing or by phone to the patients affected.  Each incident has been reported to the US Department of Health and Human Services Office of Civil Rights via their on line Breach Notification reporting system.   Below is a summary of the incidents:  

Breakdown of 2021 HIPAA investigations by center 

AMC    4 

EHC     3 

GHC    6 

NHC    3 

Breakdown of 2021 HIPAA violations by center 

AMC    2 

EHC     1 

GHC    4 

NHC    2 

Breakdown of 2021 HIPAA violations by department 

AMC Family Practice 1 

AMC Reception 1 

EHC Family Practice 1 

GHC Family Practice   2 

GHC Nutrition 1 

GHC Radiology 1 

NHC FP 1 

NHC Nutrition 1 

 

Breakdown of 2021 HIPAA violations by circumstance 

Demographics errors: phone number:  1 

Mailed/gave document to wrong patient: 5 

Use of email with PHI without permission: 1 

Use of clinical label (with PHI) for mailing label: 1 

Access a patient record and disclose info inappropriately: 1 

 

As we start 2022, please remember that each of us at VMG is responsible to safeguard and protect our patient’s healthcare information.

      

Amy Rice BSN, MSHA, RN    

Quality Director and Privacy Officer  

Smoking Cessation Clinical Champion Update

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Antibiotic Stewardship Clinical Champion Update

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Wellness Committee Update

Flow at Work: Learn to Return. Train to Sustain.

Recently I have been thinking about the relationship between the larger workplace atmosphere and our individual daily experience. I see the importance of building resilience in each of us as individuals and the positive impact that can have on the many people we interact with in our workplace. I happened upon a podcast on Mindfulleader.org by Cara Bradley that describes the concept of Flow, which she defines as a spectrum in which you “feel better and perform better”. Check out the podcast here when you are looking for inspiration, or consider these nuggets I gleaned:

Flow is when you mind and body are “in the zone”. It is when we are intuitively aware of emotional, social, physical experiences and our senses are heightened. It is when our performance peaks, and effort feels minimal.

Cara recommends we:

1) Know Flow to live in flow. Begin noticing more and more moments when you are naturally “in the zone”, and identify as many characteristics of what this feels like as possible. Become more aware of what makes you feel fully alive, and notice how it feels to be fully alive in your body and mind.

2) Learn to Return. Practice coming back to the sensation of Flow when you need it and when you don’t need it. When you are in Flow, you may notice that action and awareness merge, time may speed up or slow down and your inner critic may quiet.

3) Train to sustain. Practice your endurance for staying in the zone, or staying cognitively and physically focused. Set goals, and take breaks when needed. Match your individual patterns of attentiveness to tasks to be completed. Fine tune the midpoint between boredom and anxiety, the spot where the task is hard enough to make you stretch, but not hard enough to make you snap.

Cara notes that Flow is contagious-let’s see if we can help ourselves and each other find more success and satisfaction at work!

 

The VMG Wellness Committee’s mission is to support each VMG employee to make healthier choices that incrementally lead us, individually and collectively, toward improvements in nutrition, movement, sleep, emotional health, spirituality and connectedness.

The Wellness Committee is comprised of VMG employees who strive to uphold the above mission. We send emails 2-4 times per month, organize wellness activities, and on a daily basis hope to inspire those around us to feel good making healthy choices. We welcome anyone who would like to be part of this committee to facilitate this goal. Please reach out to me, Robin McKeon (rmckeon@vmgma.com), if you are interested in being part of the Wellness Committee in 2022.

 

The following is a recent Wednesday Wellness email example from Katie Coleman:

I recently learned a trick from a friend that helps us practice more gratitude in our daily lives—learn to replace the words “I have to” with “I get to”.

 

It is easy to take the simple things in life for granted, which could be luxuries to many other people. By changing our perspective, we are framing a more productive and positive experience, one that can make our lives just a little bit better.

 

Take a moment and think about all the tasks that you have to do tomorrow. Your list probably looks something like this:

· I have to go to work

· I have to exercise

· I have to cook dinner

Now replace the “have to” with “get to” and notice if there is a shift.

· I get to go to work—because I have a job at a time when many others do not

· I get to exercise—because my body is healthy enough to allow me to do so

· I get to cook dinner—because I am able to afford the food I need to nourish myself and my family

 

Reframing our way of thinking is a great way to improve our daily lives.

 

 

 

On behalf of the Wellness Committee, be well!

 

Robin McKeon, DPT

Greenfield Health Center

COPD Clinical Champion Update

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Additional resources for providers to use in the diagnosis and treatment of COPD are listed below, and available on the VMG intranet page in the Clinical Guidelines Important Information Link. Scroll to the COPD Guidelines to see all the resources available.  

 

Global Initiative for Chronic Obstructive Lung Disease (GOLD)

 

The global strategy for the diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease 2021 Report:

 

https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf

 

These documents are copy righted but can be downloaded with above link for individual use, 164 pages.

 

Also has a smart phone app “2021 Gold” that is more user friendly than the whole document and has these tables available, and can be downloaded for free. Search for “Gold Guidelines 2021” in your app store on your android or iPhone to download the app.

 

Pulmonary Function Tests

 

Below are YouTube videos explaining pulmonary function testing with increased complexity and detail from videos 1-5.  These are also available on the intranet page.

https://www.youtube.com/watch?v=6TApeMJ-rkc

 

https://www.youtube.com/watch?v=yNDKD_xI684

 

https://www.youtube.com/watch?v=4nQApZ8Q0XM

 

https://www.youtube.com/watch?v=j_oRQS2dnck

 

https://www.youtube.com/watch?v=6mZmpHycSuQ&t=17s

 

 

Also available on the intranet page is the table of Generic and Brand Name COPD medications.

 

Table of Generic and Brand Name COPD medications

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Transgender Awareness Week, Nov 13th – 20th

Celebrated annually around the globe, Transgender Awareness Week is a time to promote education around gender identity and to advocate against prejudice, discrimination, and violence that transgender and non-binary people face. The week culminates on November 20th with Transgender Day of Remembrance.  On this day, we honor and memorialize victims of transphobic violence. 

How can cis-gender people be better accomplices to the cause?

Trans and non-binary people of color respond in this powerful video put together by the Human Rights Campaign:

https://youtu.be/w5hd_5XeSaA

The Importance of Pronouns

Asking about and then correctly using a person’s pronouns is a sign of respect and validation.  Mis-gendering someone, or using the incorrect pronouns, is, to paraphrase transgender activist Laverne Cox, an act of structural and cultural violence. One can ask about pronouns in several simple ways, such as “what are your pronouns?” and “what pronouns do you use?” Another way to normalize discussing pronouns is to share your own, either when introducing yourself “my name is Sara and I use she/her pronouns” or by adding your pronouns to your nametag / e-mail signature / zoom signature. 

“Preferred pronouns” is an outdated term.  A person’s pronouns are not a preference, they are an important aspect of their identity.

In Athena, a patient’s pronouns are identified here:

 

We are currently working on a standardized workflow to ask all patients their pronouns and gender identity.

Powerful video below on why pronouns matter:

https://www.youtube.com/watch?v=9iKHjl5xAaA

Resources:

 

VMG intranet page > Clinical Guidelines > Scroll down to LGBTQ+ Guidelines

Glossary of Terms: https://www.lgbtqiahealtheducation.org/wp-content/uploads/2020/10/Glossary-2020.08.30.pdf

Transgender people’s stories in their own words

Movies / TV shows / Documentary Films :  Disclosure (on Netflix), Pose (on Netflix), Paris is Burning,

General Resources:

Resources for Transgender People:

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Diabetes Clinical Champion Update

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Diabetes is an ongoing epidemic in the United States with an estimated 30 million adults with T2DM. Additionally, nearly another 33% of adults have impaired fasting glycemia (IFG), or pre-diabetes. Studies have shown that of these pre-diabetic patients, only up to 15% are aware their blood sugar is abnormal. Traditionally, we discuss this as blood sugar being “slightly elevated” and reassure the patient they do not have diabetes. What if we took this as a warning shot, and encouraged significant lifestyle intervention as early as possible?

See the attached pre-diabetes guidelines (click here). Intensive lifestyle intervention has shown to delay progression to T2DM for an average of 11 years. This significantly reduces the time a patient has T2DM, which reduces their rates of micro- and macrovascular complications. Lower morbidity. Lower mortality. Metformin is an option for persistent and worsening pre-diabetes, but delays progression to T2DM by only 3 years. The most effective interventions are multi-disciplinary – this includes exercise programs (consider involving PT for an exercise adverse or exercise wary patient), behavioral health, nutrition, and diabetes education. Insurances do not cover diabetes education for this diagnosis, but many cover nutrition, which incorporates education. Please see the attached insurance coverage for our current best guesses for nutrition coverage. (click here)

At Valley Medical Group, we have 2550 patients with the diagnosis of IFG in their charts or notes at some point in time in the last year. Only 66% of these patients have IFG on their problem list, and this rate varies greatly by provider as shown below. If the studies are true, and nearly 1 in 3 of our adults have IFG, we are significantly under-diagnosing this condition. Screen regularly for IFG in these patients at risk, and add IFG to the problem list when appropriate.

 

 

Thank you,

Betsy Green NP and Trisha Rogers PA

Diabetes Clinical Champions

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Hypertension Clinical Champion Update

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Deprescribing Clinical Champion Update

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Hyperlipidemia and Lifestyle Clinical Champion Update

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Poor Diet Is the Leading Risk Factor for Death

The 2017 Global Burden of Disease Study indicated that an unhealthy diet is the leading risk factor for death in the United States and worldwide. Researchers from the University of Washington researchers analyzed data on 333 diseases in every state from 1990 to 2016. They implicated suboptimal diet in nearly 530,000 U.S. deaths in 2016 from heart disease (including stroke), diabetes, cancer, and other chronic diseases. Hypertension and obesity – also diet related – and tobacco use were the next major risks for early death.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 https://jamanetwork.com/journals/jama/article-abstract/2678018

 

 In 2017, between 10 and 12 million deaths worldwide were attributable to dietary risk factors. High intake of sodium (>3g/day), low intake of whole grains (<125g/day), and low intake of fruits (<250g/day) were the leading dietary risk factors for deaths globally and in many individual countries.

 https://doi.org/10.1016/S0140-6736(19)30041-8

Dietary guidelines in the United States are published every five years by the USDA with considerable input from lobbyists for the dairy, meat, and processed food industries. Industry involvement tends to water down data-driven recommendations, and as a result, most Americans don’t know what they should be consuming to stay healthy or prevent chronic disease. How should we and our patients be eating?

One example of an eating pattern that is healthier than the standard American diet is the OmniHeart diet:

 

 

 

 

 

 

 

 

 https://www.cspinet.org/eating-healthy/what-eat/days-worth-food

Another recent recommendation is to limit intake of red and processed meats because of their association with colorectal cancer; consuming 50 grams (1.75 oz.) of processed meat (such as a single standard hot dog) daily increases the risk of colorectal cancer by approximately 18%. The International Agency for Research on Cancer (IARC) of the World Health Organization classifies processed meat as a Group 1 carcinogen (carcinogenic to humans; the same group includes tobacco and asbestos). Data from the same studies suggest that eating 100 grams (3.5 oz.) of red meat (Group 2A, probably carcinogenic to humans) daily increases the risk of colorectal cancer by about 17%; consumption of red meat is also associated with pancreatic and prostate cancers. The IARC working group evaluated more than 800 epidemiological studies of large cohorts in many countries from several continents.

https://www.who.int/news/item/29-10-2015-links-between-processed-meat-and-colorectal-cancer

 Lisa Appleton, clinical champion for hyperlipidemia and lifestyle medicine

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Persistent Pain Clinical Champion Update

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Smoking Cessation Clinical Champion Update

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We are in a time of increasing ECig/Vaping use but now also Vaping Cessation.      

WHAT TO SAY TO YOUR ECIG USERS?  

  • There are many unanswered questions about safety and effectiveness of ECigs.

  • Likely less harmful than cigs.  (CDC guideline still not recommending using ECigs. No long term studies on health effects with ECig use; US Preventative Task Force Jan, 2021- ECig- insufficient evidence for its use, directs patients to proven products, Nicotine Replacement Treatment(NRT),  Chantix, and buproprion)

  • Recommend FDA approved (NRT)-  (unlike ECig, NRT has no other chemicals besides nicotine and insurance covers as part of the Affordable Care Act)

  • If smoker uses ECigs, encourage stopping concurrent use of cigs.

  • Encourage a plan to quit ECig use.

  • Use common ECigs and don’t tamper with them.

(ACE Consensus 2018)

Check out patients stories of quitting during Covid-  ICovidQuit.Org-   on QuittersWin.blog.    These patient insights are powerful and I found very informative and motivating.   Share these stories with your patients to help them in their quitting efforts. (youtube links below)  

https://www.youtube.com/watch?v=Aqv4ooCeh9A

https://www.youtube.com/watch?v=BqBmuk3IJgU

https://www.youtube.com/watch?v=Hxdy-b0EjYY

The Truth Initiative- truthinitiative.org- is a free and anonymous program to help  young people quit vaping.  This Is Quitting is there text message program for adolescents.   Also, they have a support for parents of vapers.   Check it out and share with your adolescent smokers/vapers. 

Thank you,

Smoking Cessation Committee Members

Ann Esrick and Liz Cory, Smoking Cessation Clinical Champions, Finn Olcott, Katie Coleman, Scott Meyers, Tim Sweeney, Wendy Baird, Stephanie Pick.

Diabetes Clinical Champion Update

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The most important weapons we have to fight/control diabetes are not pharmaceuticals, but lifestyle interventions.

At VMG we have many tools/supports to help our patients make positive lifestyle changes.  All centers now have IBH staff that can be called upon to come in during a visit to talk to patients about what may be contributing to their inability to lose weight or increase exercise.  Many of us have been trained in Motivational Interviewing techniques that have been proven to assist patients with lifestyle changes.  Collaboration and setting realistic and achievable goals is key. For example, instead of saying “I want you to lose weight before I see you next month”, ask the patient to set a measurable and realistic goal that they feel is attainable. (i.e. I want to cut out all soda and see how that affects my blood sugar levels).

 

Finally, as practitioners we need to emphasize the importance of exercise to help with blood sugar management, weight loss, BP control and overall health.  Exercise Is Medicine is a way to document for the patient what the mutual goals are for exercising and to help them see this as being just as important as taking medications for their diabetes.  Prescribe the Y is another way to reinforce the importance of regular daily exercise and gives patients a safe and non-threatening environment in which to start working out. See the attached links and start using these to help your patients understand that exercise is essential in managing diabetes.  We are working to have these included in “Print Forms” in the EMR.

 

Prescribe the Y (Hampshire and Franklin County links):


https://www.hrymca.org/wp-content/uploads/2020/02/Prescribe-the-Y-referral.pdf

 

https://your-y.org/prescribe-the-y/

 

Exercise is Medicine Prescription:

 

https://www.exerciseismedicine.org/assets/page_documents/EIM%20Prescription%202018%20pad%202-up.pdf

 

Coding Pearl:
If you have a patient with frequent episodes of hypoglycemia and you are seeing them to adjust their insulin dosing, and you put in your note wording such as “the risk of severe hypoglycemia is a current and significant concern”, this increases the complexity of your medical decision making and you can upcode to a 99215 if appropriate.

 

Thank you,

Betsy Green NP and Trisha Rogers PA 

Diabetes Clinical Champions

Risk Adjustment Factor (RAF) Clinical Champion Update

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Advanced Care Planning Committee Update

The Advance Care Planning Committee has continued to meet during the pandemic and will be presenting at the June 10 Primary Care Meeting on Determining Capacity and Invoking the Health Care Proxy, two topics which were touched upon in our last lunch in-service at the end of 2019.

 

Information is now available on the intranet page under Clinical Guidelines, scroll to Advance Care Planning.  Below is the list of the resources available in that link.

 

We hope you will find these new guidelines useful as you navigate complex capacity determination with your patients. The ACP Committee welcomes your feedback and suggestions for other resources and guidelines that would be helpful to you.

 

Henry Simkin, MD, Chair of ACP Committee

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CHF Clinical Champion Update

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Hyperlipidemia/Lifestyle Clinical Champion Update

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COPD Clinical Champion Update

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It has been a while since we have reviewed COPD. One thing that primary care providers often encounter is that patients are given the diagnosis of COPD based on CXR findings (hyperinflation), or without objective findings on spirometry or PFT. It is important that if there were no reports on the patient’s chart to verify the diagnosis, that the PCP orders studies to confirm/correct the diagnosis of COPD.

 

As clinical champions, we are in the early stages of piloting a pre-screening in Amherst and Northampton Health Centers focused on the cardinal symptoms in our patients who have smoked 100 cigarettes in their lifetime. Early identification can help slow disease progression as COPD carries significant morbidity and mortality. COPD currently affects more than 5% of the US population and is ranked as the fourth cause of death in the states. For this clinical champion update, we want to review the basics: Definition, cardinal symptoms, screening, and staging.

 

Definition:

The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) is as follows:

"COPD is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. The chronic airflow limitation that characterizes COPD is caused by a mixture of small airways disease (eg, obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person. Chronic inflammation causes structural changes, small airways narrowing, and destruction of lung parenchyma. A loss of small airways may contribute to airflow limitation and mucociliary dysfunction, a characteristic feature of the disease.”

Before GOLD standards, COPD was further classified into subtypes: Chronic Bronchitis, Emphysema and chronic obstructive asthma. Understanding the features of these conditions can help guide effective management. 

A few clinical pearls about the above;

 

  • Chronic bronchitis and emphysema with airflow obstruction commonly occur together. Some of these patients may also have asthma.

·       Persons with chronic bronchitis, emphysema, or both are not considered to have COPD unless they have airflow obstruction.

·       Patients with airflow obstruction due to diseases that have a known etiology or a specific pathology (eg, cystic fibrosis, bronchiectasis, obliterative bronchiolitis) are not considered to have COPD.

·       Many individuals have inflammatory features of both asthma and chronic bronchitis/emphysema.

·       Patients with asthma whose airflow obstruction is completely reversible are not considered to have COPD. Patients with asthma whose airflow obstruction does not remit completely are considered to have COPD.

 

Cardinal Symptoms:

The three cardinal symptoms of COPD are dyspnea, chronic cough, and sputum production

 

 

Screening and Staging:

Spirometry is essential to confirm diagnosis and staging of COPD.  If values are abnormal, a post bronchodilator test is indicated. Airflow limitation that is irreversible or only partially reversible with bronchodilator is suggestive of COPD rather than asthma. A post bronchodilator EFV1/FVC <0.7 is used to establish the presence of airflow limitation. 

 

In the presence of low FEV1/FVC, the % of predicted FEV1 is used to determine the severity of airflow limitation.

§  GOLD 1: Mild (FEV1 ≥80% predicted)

§  GOLD 2: Moderate (50% predicted ≥FEV1 <80% predicted)

§  GOLD 3: Severe (30% predicted ≥FEV1 <50% predicted)

§  GOLD 4: Very severe (FEV1 <30% predicted)

 

Pulmonary function tests are the cornerstone of diagnosis and determining severity of airflow obstruction, assess response to medication and follow disease progression. Note that supplemental oxygen is indicated for patients who sat <88% on RA.

 

  • 6 second forced expiratory volume (FEV6), obtained by stopping the expiratory effort at 6 seconds is an acceptable surrogate for the FVC. Use FEV1/FEV6.

 

  • Use DLCO when hypoxemia is present by pulse oximetry (RA sat<92), dyspnea out of proportion to the degree of airflow obstruction and before lung surgery.

 

 

Accurate staging guides appropriate management of acute and chronic symptoms. This month, try to ensure your patients with COPD have spirometry or Pulmonary Function Tests in their chart.

 

UptoDate Dyspnea Scale

UpToDate Assessment of COPD

UpToDate Initial Therapy for COPD

 

 

Niloufar Shoushtari MD and Emily Graef NP 

COPD Clinical Champions

MOVING IN MAY

Wellness takes Work. As much as I wish wellness just happened, I think it is important to remind ourselves that order to feel our best and enjoy life fully, we do need to be attentive to the dynamic balance of lifestyle choices we make. Wellness is an aspect of our health that we have control over, and we can improve. We have both the responsibility and the possibility of improving our wellness.

 

The VMG Wellness Committee’s mission is to support each VMG employee to make healthier choices that incrementally lead us, individually and collectively, toward improvements in nutrition, movement, sleep, emotional health, spirituality and connectedness.

 

The VMG Wellness Committee is comprised of volunteers who seek to promote wellness throughout our organization via informational and inspirational emails and other activities. During the month of May, we are promoting a Moving in May campaign. This is not a competition against each other, but rather a community effort to elevate everyone's fitness level. We are encouraging everyone to set a goal, big or small, for yourself to get your body moving!

 

Moving in May will focus on time spent moving. Include time you walk, run, bike, weight train, do yoga, gardening/yardwork or other movement activity. Track your minutes of movement and delight in your progress. Here is a link to a training log you can print and use for the Moving in May campaign: Log link

 

The U.S. Department of Health and Human Services recommends that all adults get at least 150 minutes/week of physical activity. We encourage each of us to become more aware of how much movement we are doing presently and consider a goal for the month of May.

 

Representatives from each health center will set up lunchtime walks 2x/week. Let us know if you are ready to step up and be a walking cheerleader at your health center.

 

Stay tuned for more details about Moving in May!

 

Be well,

Robin McKeon, DPT and the VMG Wellness Committee

VMG COVID-19 UPDATE

Vol II, Issue 9, April 27, 2021

 

It’s an odd stage in the pandemic. Just today, Governor Baker announced a plan that by late summer may permit us to go to outdoor water parks and parades, while at the same time we are stunned by the images of absolute desperation and human tragedy which are unfolding in India, where COVID has exploded and decimated a medical system which in many ways was as sophisticated as that in the United States. It occurred to me this morning that were it not for vaccines arriving when they did, things might have looked like India here at home. I realize I have not updated you in weeks out of a sense that “not much has changed.” And then it occurred to me. This is what it is like to live with a chronic disease. For many of our patients who get cancer, there is the terrifying hustle and fog of the early stages of chemotherapy, which in cancer care are called “induction.” Once things are under control, less toxic medications allow us to “consolidate” the control gained. And finally we enter “maintenance,” where periodic medications are provided while we watch for recurrences. Many of us thought we would see a cure, but instead we dwell in maintenance. It really isn’t bad news, but it is a different way of being.

 

The Human Cost

 

32 million people in the US have contracted COVID; 572,000 have died. In Massachusetts, the virus has sickened 684,000 and killed 17,500. In Hampshire and Franklin counties, 11,335 of our neighbors have become ill; 394 have been lost to this disease. 1 in 18 of us has been infected, and just under 1 in 300 has died.

 

Trends:

 

Rates continue to slowly decline. Locally, rates remain at 10/100,000 people which is far lower than at the peak of the surge, but still higher than we would hope. This means there might be 3-4 people in Northampton and 1-2 in Greenfield right now who are infected; we would hope for rates < 5/100,000 in a moderately well immunized population to continue the road to recovery without risking further outbreaks.

 

142 million Americans have received a dose of a COVID vaccine, and 97 million are now fully immunized. We are vaccinating 2.7 million Americans a day, down from a high of 3.4 million. This suggests that supply is now catching up or exceeding demand. At this rate, it is now estimated that 70% of the population could be vaccinated by July 11 and all those over 16 years (currently the earliest age for which vaccines are available) by the first week of August. We think these levels of vaccine are necessary to achieve herd immunity (the point where there are not enough susceptible people in the community to maintain an outbreak).

 

 At VMG:

 

We remain at Everyday Safety in Hampshire and Franklin County at our health centers. Even as we see the CDC making recommendations for easing restrictions for vaccinated patients and people out of doors, things will continue to look similar at VMG where we care for vulnerable populations in a health care setting. We will continue to mask (double or “fold and tuck”) and distance for now.

 

As of April 19th, vaccines are available throughout the country to all those over age 16 years. Locally, we are seeing more sites offering vaccines in our communities. Shots remain available through pharmacies, Community Health Centers, and public mass vaccination sites. Hospital systems including Baystate and Cooley Dickinson are offering vaccines. Pop up clinics are providing vaccines at places like Smith College and Greenfield Community College and through local Departments of Health. Keep referring your patients to mass.gov for information, but encourage them to pay attention to traditional media, social media, and information from family and friends. I predict access will continue to improve rapidly in coming weeks. 

 

As COVID rates stabilize and vaccination rates climb, we are working to bring more patients back into our health centers. It is fairly clear that many of our patients want and expect to resume in person care, and often enough this is the right thing for their needs. We are currently seeing 50-60% of patients in primary care in person; in some specialties, where care requires contact, numbers are closer to 90%. We think we may settle at around 75% in person visits in Primary Care by late Spring or Summer. Our reception and nursing staff are doing a remarkable job of moving patients safely and efficiently through our health centers at these levels.

 

Resilience:

 

I read an article this weekend in the New York Times about “Languishing.” Did you see it? Languishing is the middle ground, not the highs of elation or the lows of depression, but the middle ground of feeling somewhat joyless and aimless. I think most of us can relate at some time to this feeling. The author suggests it is worth naming this feeling. And then he suggests an antidote. “Flow.” This is the feeling of being completely immersed in something and loosing oneself. It could be getting absorbed in your work. It might be while reading or watching a great movie. Or setting a small goal to try something new. Anyone for golf? Bake your own bread? Learn some phrases in Italian? Seems worth a shot.

 

Paul

 

PS:  Keep wearing a mask (or two, while indoors). Practice Social Distancing. If you are vaccinated, take the opportunity to see others who are vaccinated or unvaccinated and low risk. And if you are not, take this chance to get protected so you can leave your mask at home while you walk, bike, or socialize.

Statement on Black Maternal Health Week

In honor of Black Maternal Health Week (April 11-17th), we want to raise awareness of the Kaiser Family Foundation's report on Racial Disparities in Women's Maternal Health. VMG stands firmly in the belief that "It Takes A Village" to raise a child, to raise awareness, and to undo racism! Therefore, we are sharing resources so our whole community can become more knowledgeable on this topic, starting with the Black Mamas Matter Toolkit!

 

Where better to begin than in utero to assert the birthright of our children, mothers, and all humans to live in a world free from racism. This past year, COVID highlighted the racial differences in access to healthcare and the prevalence of illnesses that co-exist among Black, Indigenous, and People of Color. Now, let us take the recent CDC statement committing to address racism as a serious threat to public health as a collective call to action to encourage systemic interventions to address the factors that impact the health and wellbeing of Black, Indigenous, and People of Color. These include stress, food insecurity, police brutality, inequities in the legal system, poverty, employment discrimination, environmental hazards, educational inequities, etc.

 

We hope this holistic, race conscious approach to health will redirect resources to racially marginalized groups and support funding for research on the long term impacts of racism and intergenerational trauma on mental and physical wellbeing. Valley Medical Group, for its part, has committed to a Climate Survey and Interrupting Racism trainings for our whole staff to root racism out of public health and provide culturally sensitive and proactive, racially responsive care to all our patients.  

 

For further resources, please check out: 

Nine Organizations Working to Save Black Mothers

Hypertension Clinical Champion Update

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VMG COVID-19 UPDATE

Vol II, Issue 8, March 17, 2021

 

Spring starts this Saturday. At 5:37 AM (I checked). Hopefully, the snow forecast for tomorrow will have melted, and we can all stop and breath in deeply the new spring air. It is an odd mix of the smell of rotting leaves and decaying wood and the sweet scent of new buds and blooms. Decay and rebirth. The symbolism could not be clearer in a year of so much suffering and loss, but also with the new found hope of re-emergence from the pandemic. Over 50% of Americans are now estimated to be vaccinated or naturally immune (from having caught the virus). With this, the pool of potential infections drops, and hopefully the rates of COVID continue to decline. And life returns to normal, little by little. You are seeing many more of your patients in person. If vaccinated, you may be gathering with one other family indoors and unmasked. Isn’t it amazing to hug your mom or friend, or marvel over your niece who has grown 4 inches since you last saw her. Hopefully, your kids are back in school in person. What a long, difficult year it has been for many children and their parents.

 

The Human Cost

 

29.6 million people in the US have contracted COVID; 537,000 have died. In Massachusetts, the virus has sickened 605,000 and killed 16,700. In Hampshire and Franklin counties, 9940 of our neighbors have become ill; 376 have been lost to this disease.

 

Trends:

 

Rates continue to decline. Locally, rates are 10-15/100,000 people which is far lower than at the peak of the surge. This means there might be 3-4 people in Northampton and 1-2 in Greenfield right now who are infected; we would hope for rates < 5/100,000 in a moderately well immunized population to continue the road to recovery without risking further outbreaks.

 

74 million Americans have received a dose of a COVID vaccine, and 40 million are now fully immunized. We are vaccinating 2.5 million Americans a day. At this rate, it is now estimated that 50% of the population could be vaccinated by mid-May and nearly all by early August. This is 3-5 months sooner than was estimated just 3 weeks ago, and speaks to the effects of a third vaccine and increasing supplies on the race to achieve herd immunity (the point where there are not enough susceptible people in the community to maintain an outbreak).

 

 At VMG:

 

We remain at Everyday Safety in Hampshire and Franklin County at our health centers. As rates decline further, it is hoped we can define less restrictive Safety Levels to permit more people to work together in our sometimes cramped clinical spaces. Stay tuned. In the meanwhile, I know it is tempting if you and your co-workers are vaccinated to want to drop the masks and distancing at work. I mean, you could do it at home, right? Well yes, but in workplaces, particularly in health care, where we are still seeing unimmunized and vulnerable patients in person, and where some of our staff have not quite decided it is the right time to get immunized, we must remain cautious. And so for now, please keep masking and distancing while at work.

 

Massachusetts continues to prioritize efficiency and access in allocating their supply of vaccines, which are mostly going to pharmacies, Community Health Centers, and public mass vaccination sites (like the Eastfield Mall in Springfield). Eligibility in Massachusetts will widen every 2 weeks so that by April 19th, all adults in Massachusetts will be eligible for COVID vaccines. Eligible patients should be directed to the Massachusetts Department of Public Health vaccine finder at https://www.vaxfinder.mass.gov. We understand this website is challenging (perhaps a generous interpretation) to navigate. In response, the State has a new system for preregistration for vaccines at mass sites at https://vaccinesignup.mass.gov/#.  This allows patients to receive updates on their status and an offer of a vaccine appointment when one is available. For those without internet, the State will schedule vaccines by calling 211; there is an option for those who preregister online to get updates and schedule by phone. Lifepath in Franklin County can also assist patients in scheduling vaccines. A VMG, we continue to have very limited supplies of COVID; our vaccine clinics continue to provide only second doses to patients we have already immunized. As first doses become available to us, we will again begin reaching out to eligible patients.

 

As COVID rates fall and vaccination rates climb, we continue the important work of bringing more patients back into our health centers. We are currently seeing 20-35% of patients in primary care in person; in some specialties, numbers are closer to 90%. We hope to be at 50% in person visits in Primary Care by early April and expect to peak at about 75% over the late Spring or Summer. We will be working hard to consider how to use space safely in our waiting and reception areas, clinical work areas, exam rooms and offices to reach these numbers. We will need to continue to provide telehealth visits due to space constraints in our health centers, but expect that patients and providers may choose to continue these visits even after the pandemic. Stay tuned.

 

Resilience:

 

I hope you sense my optimism. Certainly there are things that could go wrong to stall our recovery, but we know so much more and have so many more tools now than we did a year ago (remember washing off all your groceries?). Take a moment to acknowledge the hard work you did to survive the last year, and be grateful for someone or something which helped you persevere.

 

Paul

 

PS:  Wear a mask (or two). Practice Social Distancing. And for goodness sake, if you are vaccinated and they are low risk, hug someone you love who you have not seen in a year this week inside your home.

Smoking Cessation Clinical Champion Update

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Persistent Pain Work Group

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VMG COVID-19 UPDATE

Vol II, Issue 7, February 24, 2021

 

503,438. Most of you immediately recognize this as the grim toll of the pandemic on American lives. You likely have heard the comparisons: A higher death toll than World Wars 1 and 2 and Vietnam. The third leading cause of death in 2020, behind heart disease and cancer. Americans in 2020 lost 1.1 years from our life expectancy just due to deaths from COVID. The front page of the New York Times on Sunday contained a remarkable graphic made up of one half million dots, each representing a life lost to COVID. It is almost trite to note that each of these deaths was of a person, who was important, one who loved and was loved, who I hope was not someone you loved, or knew, but suspect was for too many of you.

 

The Human Cost

 

28.3 million people in the US have contracted COVID; 503,000 have died. In Massachusetts, the virus has sickened nearly 572,000 and killed 15,900. In Hampshire and Franklin counties, 9100 of our neighbors have become ill; 356 have been lost to this disease.

 

Trends:

 

Meanwhile, the pandemic continues to recede from the dizzying highs of late winter, due to distancing from the momentary closeness of the holidays, and almost certainly from our remarkable, though flawed, efforts to vaccinate the population.

 

45 million Americans have received a dose of a COVID vaccine, and 20 million are now fully immunized. We are vaccinating 1.4 million Americans a day. At this rate, it is now estimated that 50% of the population could be vaccinated by mid-August and nearly all by February 2022.

Limited vaccine supply and weather-related delays remain a major issue. However, I expect that this week the FDA will authorize emergency use of a third effective and safe vaccine from Johnson and Johnson. You will hear talk about whether it is as good as the Moderna and Pfizer vaccines because its efficacy was lower in recent studies. I have borrowed this slide from Dr Ashish Jha to remind us that all the current vaccines in use around the world performed identically in the most important outcomes. The best shot is the shot you can get!

 

 At VMG:

 

COVID rates continue to decline in the counties we serve. They are particularly low in Franklin County, where we will go to Everyday Safety starting on March 1. We will remain at an Enhanced Safety level of care at our Hampshire County health centers for the next week.

 

The State has prioritized efficiency and access in allocating their supply of vaccines, which are mostly going to pharmacies, Community Health Centers, and public mass vaccination sites (like the Eastfield Mall in Springfield). As a result, I am disappointed to share that our COVID vaccine clinics will only be providing second doses to patients we have already immunized for the immediate future. As first doses become available to us, we will again begin reaching out to eligible patients. Although eligibility has expanded to include those 65 years and older and those with two chronic health conditions, we will continue to focus our outreach for new doses on the oldest and sickest patients, for whom navigating websites and call centers and travel to unfamiliar sites is an undue burden. In the meanwhile, eligible patients should be directed to Massachusetts Department of Public Health vaccine finder at https://www.vaxfinder.mass.gov. For those without internet, the State will schedule vaccines by calling 211. Lifepath in Franklin County can also assist patients in scheduling vaccines.

 

As COVID rates fall and vaccination rates climb, we will begin the important work of bringing more patients back into our health centers. For many of us and our patients, this may feel unfamiliar or even unsafe. We have spent nearly a year making rules to create distance from our patients and now must begin to unravel the barriers, both literal and metaphorical. We know how much has been put off, and need to get back to the important work we have delayed, whether it is mammograms, checking the feet of diabetic patients, or putting eyes on young children or those with an addiction. We will be building more time in the clinic for practitioners. We will be doing away with hybrid visit types. We will be seeing patients discharged from hospital or nursing homes, individuals new to Medicare who need wellness visits, and those who don’t have video access and need to be examined or have problems not easily addressed at a distance. We hope to be at 30% in person visits in Primary Care by early March and 50% by early April. Some specialists will be seeing higher numbers. We will increase appointments in Radiology and the Lab, and make same day access available These numbers are guides, but we will be following them closely, and we ask your patience as we make changes meant to get back to “seeing” patients again.

 

Resilience:

 

Surely the snow which fell on Monday is gone as temperatures reached 50 degrees today. This is a sure sign Spring is coming; let’s enjoy the resurgence of life, the sounds of birds chirping in the morning, or the Crocus sure to poke out of the ground soon. I am reminded that snow is possible well into April, but it does not last long. Perhaps this is how life with COVID will look as more and more of us get vaccinated, an occasional snowy day, amidst the return of life. 

 

Paul

 

PS:  Wear a mask (or two). Practice Social Distancing. And avoid being indoors with those who are not in your household.

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Asthma Clinical Champion Update

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SUMMARY OF 2020 HIPAA VIOLATIONS

The 2020 summary of HIPAA Investigations is now complete. VMG completed 15 investigations of reported HIPAA violations (as compared to 33 in 2019). Of these investigations, 8 were determined to be HIPAA violations. These 8 incidents were reviewed with all staff involved, and notifications were made in writing or by phone to the patients affected. Each incident will be reported to the US Department of Health and Human Services Office of Civil Rights via their on line Breach Notification reporting system. Below is a summary of the incidents:

Breakdown of 2020 HIPAA violations by center

AMC 2

EHC 0

GHC 5

NHC 1

Breakdown of 2020 HIPAA violations by department

AMC Endocrinology 1

AMC Reception 1

GHC Endocrinology 1

GHC Family Practice 2

GHC Physical Therapy 1

GHC Reception 1

NHC FP 1

 

Breakdown of 2020 HIPAA violations by circumstance

Demographics errors: wrong email/phone number: 2

Mailed out lab results to wrong patient: 1

Faxing error (wrong provider/ fax number) 2

Other error with wrong patient info used during care/task 3

 

As we start 2021, please remember that each of us at VMG is responsible to safeguard and protect our patient’s healthcare information.

Amy Rice BSN, MSHA, RN

Quality Director and Privacy Officer

Hyperlipidemia/Heart Disease Clinical Champion Update

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VMG COVID-19 UPDATE

Vol II, Issue 5, February 3, 2021

 

Exhale. Like many of you, I have been holding my breath, it seems, since Thanksgiving. Headlines have told the story of a nation on the ropes, with many sick and in hospital, scarce resources, hope dwindling. Yet with each passing week, things seem to be getting better, slowly. Infection and test positivity rates are declining. More vaccines are becoming available. We are beginning to allow ourselves to imagine life after COVID. All this does not mean we are “out of the woods,” but it does mean we are making progress getting back to something closer to normal.

 

The Human Cost

 

26.5 million people in the US have contracted COVID; 497,000 have died. In Massachusetts, the virus has sickened nearly 529,000 and killed 14,700. In Hampshire and Franklin counties, 7600 of our neighbors have become ill; 332 have been lost to this disease.

 

Trends:

For the first time since November, the country is averaging fewer than 150,000 cases a day. Sustained declines in infections are occurring in 47 states. Deaths remain near record levels, but recall this will likely improve since deaths lag cases by several weeks. We are now vaccinating 1.2 million Americans each day. 26.4 million Americans have received a dose of a COVID vaccine, and 6.1 million are now fully immunized. We learned from Israel that hospitalization declined by 60% in those over 60 years 3 weeks after their first dose of vaccines, so relief is rapid.

Limited vaccine supply remains an issue but the government is providing 16 percent more doses beginning last week due to increased manufacturing of the 2 approved vaccines; furthermore, 200 million additional doses have been purchased. There is talk that Moderna may be able to squeeze 15 doses into the same vials they are currently using, reducing the bottleneck caused by insufficient glass supplies (see what I did there?). Johnson and Johnson’s vaccine may be approved for emergency use by the end of the month; while it may not be quite as effective, it requires only one dose and is far easier to store. Finally, Pfizer has fully enrolled its study of its COVID vaccine in kids 12-15 years (current vaccines are only available to those 16 and over).

The chorus asks about the new variants. Surely successes could be eroded should these more infectious versions of COVID become more prevalent. The current vaccines perform well against the variants, but there is concern that some strains could escape immune responses from the vaccines. The sooner we reach herd immunity, the less chance the viruses have to mutate and hide.

 At VMG:

 

As local infection rates decline, we remain at an Enhanced Safety level of care at all our health centers. We are hopeful that next week might bring the ability to move back to Everyday Safety.

 

We began our first COVID vaccine clinics for patients 75 years and older this week. I have heard on several occasions of grateful elders (and kind-hearted staff) crying with relief over finally getting a vaccine. I know many of you came to work (even on Saturday) to give doses, monitor patients, or respond to reactions; I thank you. We are working through kinks in the process, and hope if supply permits, to deliver more vaccines each of the next few weeks.

 

I have heard from many patients about our communications strategy in the last few weeks. I have not always been successful (sorry if you were on the receiving end of these messages). I will work hard to tell patients what we ARE doing (and less what we might do next week), and provide links to the Department of Public Health explaining what is to come. The situation is dynamic. Patients are confused, scared, and angry about this pandemic, how it has been handled, and what they have given up in the last year. I am trying not to take their entreaties personally. We are exploring new ways to keep our patients informed and free up your busy clinical time.

 

For those of you seeing or talking to patients, please ask about what they think and plan to do about getting vaccinated. We are learning more every day about those who are hesitant to take vaccines. Their reasons are varied, and we should not make assumptions or judgements. The decision to get vaccinated is very important, but also deeply personal. I have come to understand that we cannot “convince” people to do things they don’t want to do, but instead listen and acknowledge their concerns, and ask permission to share information or to talk again about vaccines. Here’s a link to some good information on approaching vaccines with hesitant patients from Deb Edelman:

 

How to Talk With Patients About the COVID-19 Vaccine ...

 

And here’s a great resource from John Novo on motivational interviewing approaches:

 

Vaccine Hesitancy Approaches

 

Resilience:

 

The experts would remind us that “doom and gloom” messaging is not an effective way to build compliance. Incoming Surgeon General Vivek Murthy said, “We’re always telling people, ‘No, no, no.’ Don’t eat that slice of pizza. Don’t drink that beer. Don’t smoke that cigarette…. Instead, [we have] to create guidance that helps people get to ‘yes.’” A hopeful visual message might, for instance, depict how a COVID-19 vaccine will help restore love and community through herd immunity. And a positive image might also help us all through these trying times.

 

Paul

 

PS:  Wear a mask. Practice Social Distancing. And avoid being indoors with those who are not in your household.

VMG COVID-19 UPDATE

Vol II, Issue 4, January 27, 2021

 

A little achy. A mild headache. Chilled but no fever. Very grateful. Words you might not expect to see together, but I got my second dose of COVID vaccine last night. I feel OK, but cancelled plans outdoors this evening to rest and make sure my symptoms get better (and I won’t come to work tomorrow if I get a fever > 101 or more severe symptoms, since I will need a COVID test to be sure I did not get sick before getting vaccinated). Is it serious (thanks for asking)? Likely no, but we do need to be honest with each other and our patients that the vaccine does activate our natural immunity, and so these type of symptoms are seen relatively commonly, but fortunately most often tell us the vaccine is doing its job. Because so many of us are being vaccinated, there is a good deal of talk about “reactogenicity” (the term for this response); however, it is expected and short-lived in most cases. So when out patients ask, tell them it can happen, is usually mild, and is confirmation that the vaccine is working to protect them against COVID.

 

The Human Cost

 

25.5 million people in the US have contracted COVID; 427,000 have died. In Massachusetts, the virus has sickened nearly 506,000 and killed 14,200. In Hampshire and Franklin counties, 7100 of our neighbors have become ill; 326 have been lost to this disease.

 

Trends:

 

Good news (glad to say). Infection rates have slowed nearly 30% over the last 2 weeks. Hospitalizations are down less, perhaps 15%, but deaths remain nearly unchanged. Why? Because it takes weeks or longer after am infection for a patient to succumb, making hospitalizations and deaths what we call a “lagging” indictor. There remains cause for cautious optimism. Vaccination continues. 20.7 million Americans have received a dose of a COVID vaccine, and 3.8 million are now fully immunized. In Massachusetts, 5.2% of the population, or 464,000 people, have gotten a COVID shot; unfortunately, this still represents <50% of the doses distributed so far and puts us in the bottom third of the pack amongst states. If you were wondering who is highest, 17% of American Samoans have been vaccinated, but surely that is a different (and sicker) population than we have in MA. Approaches to the roll out continue to differ from state to state. We are starting to see some uniformity from the new administration, and the hope is to have 300 million Americans get their shots by summer. But what about the new variants? Surely these are cause for concern, but for now the vaccines we have seem reasonably effective. Time is of the essence.

 

 At VMG:

 

As local infection rates decline, we remain at an Enhanced Safety level of care at all our health centers. Thanks for helping most of our patients stay safe at home the last 2 weeks in Hampshire County.

 

This week, we have given most of the second doses of the Moderna vaccine to our staff who received initial doses in December. We also vaccinated about 80 medical professionals working in our communities who were unable to access COVID vaccines. And with a revision in guidance from Massachusetts Department of Public Health, we are now able to offer a COVID vaccine to all VMG employees. While optional, I invite as many of you as can summon the courage to take a jab to protect your family, your colleagues, and our patients and communities. It is truly a selfless act of bravery, and I believe a strong antidote to the division and disinformation we have seen splashed on our newsfeeds all these weeks.

 

A special thanks to Martha, Amy, Joanne, Kris Ann, Beth, Patty Rachel, Wendy, Izzy, and Gina (and I am sure many others) who have been working tirelessly on plans to begin vaccinating our patients starting next week. We can’t control the weather. We don’t know how many vaccines we will get until the week before they arrive. And we can’t disrupt (too much) the other important work that takes place in our Health Centers every day. And we must distance ourselves from this at risk group of older folks. And yet, if all goes to plan, we will vaccinate 600 patients over 75 years of age next week. Is it enough? Probably not (unless it is your wife or mother), but we will work to scale up as much as we are able to put doses we can get into willing arms.

 

Resilience:

 

The days are getting longer. The new snow has made the dirty world a lovely white. I hope many of your kids are back to school, or going soon (since we now know schools are a remarkably safe place). If we can stay ahead of the mutants and get our people vaccinated by summer, the world may start to look a little better. I will happily grasp on to that hope, which makes me feel just a little less achy.

 

Paul

PS:  Wear a mask. Practice Social Distancing. And avoid being indoors with those who are not in your households.

VMG COVID-19 UPDATE

Vol II, Issue 3, January 21, 2021

 

At 5:30 on Tuesday night, bells tolled across the country to remember the loss of life from the pandemic. One year after the first patient with COVID was hospitalized in the United States, we reached 400,000 dead. Standing by the Lincoln Memorial reflecting pool illuminated by 400 lights representing the lives lost, President Joe Biden said, "It's hard sometimes to remember, but that's how we heal. It's important to do that as a nation." And so we remember.

 

The Human Cost

 

24.3 million people in the US have contracted COVID; 404,000 have died. In Massachusetts, the virus has sickened nearly 477,000 and killed almost 14,000. In Hampshire and Franklin counties, almost 6700 of our neighbors have become ill; 315 have been lost to this disease.

 

Trends:

 

Rates seem to be slowing locally and in many parts of the country, though hot spots remain. This is likely the result of holiday gatherings receding into the past and perhaps some early effects of vaccines. There is cause for cautious optimism. Vaccination continues but lags demand. 14.3 million Americans have received a dose of a COVID vaccine, and 2.2 million are now fully immunized after receiving a second dose. In Massachusetts, 4.2% of the population, or 330,000 people, have gotten a COVID shot; unfortunately, this represents <50% of the doses distributed so far and puts us in the middle of the pack amongst states. Approaches to the roll out differ from state to state. It is likely we may see a more uniform approach from the new administration.

 

 At VMG:

 

As rates decline, we will return to the Enhanced Safety level of care in Hampshire County next week.

 

This week, we will begin the second dose of the Moderna vaccine for those who received a first dose 4 weeks ago. Our staff has extended the offer of vaccines to grateful local health care workers in our communities who do not have access to COVID vaccines. Martha Mastroberti shared the story of one provider who shed tears at this kindness. Vaccine clinics for these providers begin later this week and into next week.

 

Gina and her teams are finalizing plans for vaccine clinics for our patients. As I shared last week, we will follow the guidance from the Massachusetts Department of Public Health. They continue to recommend a phased approach to start vaccines with the oldest and sickest patients once Phase 1 is complete later this month. We and our patients are struggling to understand “the rules.” What qualifies a risk factor? Why is a 74-year-old man treated differently than his 75-year-old wife? It helped me to remember this point by a New York Times columnist:

 

“We should focus on speed and access, not on punitive efforts to ensure strict adherence to complicated eligibility rules. Micromanaging the vaccination process to make sure these rules are never departed from is more likely to contribute to slowing us down and wasting vaccines, not to fairness.”

 

And so we will do our best to get vaccines into the old, sick, and marginalized while remembering vaccination is a matter of numbers. Aristotle said the pursuit of perfect is the enemy of good.

 

Resilience:

 

It feels at times like there is so much going on in the world, too much even to digest. The events of the last year feel like they could have filled a lifetime. And yet, many on this earth have lived and thrived in equally turbulent times, through plaque, and revolution, and climate disasters. And so we must continue on and be present in and enjoy the simple pleasures of life and also feel the real pains of loss and suffering. As John Kabat Zinn says, “You cannot stop the waves, but you can learn to surf.”

 

Paul

 

PS:  Wear a mask. Practice Social Distancing. And avoid being indoors with those who are not in your households.

VMG COVID-19 UPDATE

Vol II, Issue 2, January 15, 2021

 

I read an article this week in the New York Times on the current state of the pandemic. Not surprisingly, the news is not good. It offered 3 points: (1) New variants are scary. (2) The mass vaccination campaign in the US is off to a terrible start. (3) Things are going to get worse before they get better. First the hard part, but read to the end for the full story.

 

The Human Cost

 

The toll builds. I23 million people in the US have contracted COVID; 383,000 have died. In Massachusetts, the virus has sickened nearly 443,000 and killed more than 13,000. In Hampshire and Franklin counties, almost 6100 of our neighbors have become ill; 305 have been lost to this disease.

 

Trends:

 

The two offsetting forces we discussed last week persist. Vaccination continues at rates far lower than hoped for while cases (and deaths) surge to the highest numbers yet seen. 10.3 million Americans have received a dose of a COVID vaccine, 5 million more than 1 week ago, but well below the 25-30 million we hoped for. The process is challenging. Recommendations differ from one state to the next, guidelines change, and health systems struggle to keep up while managing to care for those sick with COVID and other ills. And inequalities persist. Most of you are aware of the stories of elders waiting hours in the cold in Florida for vaccines (I know, it’s not Massachusetts, but it can be chilly) and wealthy New Yorkers offering wads of cash to doctors to cut in line.

 

 At VMG:

 

We remain under a partial roll back of some routine care at our Hampshire County offices this week. We are watching rates of infection and positive tests closely and will adjust our approach to care as needed to keep our patients and staff safe. Please continue to do the work you can by virtual visits and see the patients who must be seen for conditions which are urgent and not well managed by telehealth, or which threaten health or life.

 

This week, more COVID vaccines are being given to our staff and providers. We will begin the second dose of vaccine for some next week. With excess doses, we have begun offering vaccine to providers and staff who lease space in our buildings. I am proud to share that we will also invite eligible health care workers in our communities who do not have access to COVID vaccines to get inoculated with this supply.

 

Gina and her teams are working overtime to develop plans to deliver vaccine for our patients. This week, I shared a communication going out to patients about our plans. The document specified a phased approach to vaccines starting with the highest risk patients. By now you have heard that the US Secretary of Health has suggested a different approach, throwing vaccination open to all over 65 years old. The Centers for Disease Control and Massachusetts Department of Public Health have not changed their plans to start vaccines with the oldest and sickest patients. And with the change in federal leadership next week, more changes to how vaccines will be given are likely. Is your head spinning? Mine too. While there are legitimate differences in how best to approach inoculating the population, please know our goal is to distribute vaccines in line with the best science and policy. This will likely include efforts to direct vaccine to those at highest risk, which as you know are the old, sick, and marginalized. Stay tuned.

 

Resilience:

 

Having been a provider for 16 years, I have come to expect a dip in January in my patients, colleagues, and myself. Maybe it is the letdown of the holidays. The short days. Or the weather (“chilly Florida” seems inviting). I find the best approach is accepting the inevitable (it is probably going to snow again) and resisting it a little less. And also finding small opportunities to seek light and warmth amidst the chill and darkness. Snuggle a loved one. Slide for fun, preferably on skis or skates and not in your car. Zoom a family member or friend and remember when you shared time and space in a world where social distancing did not exist. That day will come.

 

What works for you?

 

Paul

 

PS:  Wear a mask. Practice Social Distancing. And avoid being indoors with those who are not in your households.

VMG COVID-19 UPDATE

Vol II, Issue 1, 1/5/2021
 
It is striking to imagine we are entering the 2rd year of life under the COVID pandemic. On December 31, 2019, the World Health Organization sent its first tweet out about a cluster of 40 unusual pneumonia cases in Wuhan, China. How life has changed in 12 short months. We now speak about mRNA vaccines, quarantine, and oxygen saturations like senior researchers and intensive care physicians. And we use words like Zoom, remote school, and telehealth when they were hardly conceived of at this time a year ago.
 
The Human Cost

As of today, it is estimated that 86.5 million people worldwide have contracted COVID and nearly 1.9 million have died. In Massachusetts, the virus has sickened nearly 400,000 and killed 12,700. In Hampshire and Franklin counties, almost 5500 of our neighbors have become ill; 300 have been lost to this disease.
 
Trends:

There are two offsetting forces at work. First, the good news: Vaccines from Pfizer and Moderna continue to be distributed across our country. 5.3 million Americans, mostly clinicians and staff and residents of long term care facilitates, have received a dose of COVID vaccine. Experts believe that gradually, as rates rise, vaccination will offer us relief from the illness and isolation of COVID. Now the bad news: This is far short of the 20+ million doses we hoped for by now, and a fraction of the 17.2 million doses distributed thus far. Unfortunately, this is occurring amidst a worsening nationwide surge, spurred by holiday gatherings and lax personal safety measures. In hard hit California, paramedics are rationing oxygen and declining to transport patients near death from their homes to the hospital if they are unable to recover a pulse. In Arizona, many hospitals are operating at 120% capacity, and there are fewer than 5% ICU beds free. It is hard to imagine these events occurring in a resource rich country like America; it seems the intersection of a contagious deadly virus, a country at historic levels of division (as the events of yesterday brought into focus), and an astonishing abdication of leadership has brought us to this juncture. 

 At VMG:

 

We continue our usual but important work of providing acute and chronic care, while attending to the physical and mental toll of COVID. 

As you may have heard from Gina and Steve, in response to heightened disease activity, we are scaling back some routine care at our Hampshire County offices to prevent spread of the virus during elective services in our lab, radiology, and clinical areas. We know our patients are anxious to get back to in person visits and many of us long to see them and each other, but we must remain cautious.

We continue the important work of vaccinating our staff and providers, some of whom will be receiving their second doses of vaccine in just 2 weeks. Yesterday, Gina invited those who deferred shots and others who interact with patients or work in public areas of our health centers to schedule vaccines. I got my Moderna shot 2 weeks ago, and had no ill effects (other than mentioning my sore arm to my 15-year-old son, who thought it would be fun to jab me there). We know the vaccines are well-studied and exceptionally safe. I hope you will summon the courage to get yours when the time is right.

VMG is working hard to develop plans to vaccinate our patients, who are overwhelmingly anxious to get started once the Department of Public Health moves vaccine distribution into Phase 2. It will be a major undertaking for our staff to schedule and provide vaccines to our patients. While we are unsure of exact numbers, we think it is likely we will be providing dozens of vaccines a day at all our centers for months to meet local demand.  Details will follow soon from Gina and Steve as we work out logistics like scheduling, weather contingencies (as vaccines will have to take place outside our buildings), how to move vaccine from freezers to patients safely and efficiently, and methods to observe patients for reactions to vaccines. 

Resilience:

Some of what I have written is hard. It is sad, frightening, and at times, discouraging. But as John and I said in our Eggplant, humans are remarkable creatures. We adapt to change. We strive for something better. And very often we manage to thrive, even under adverse conditions. So remember to take care of each other. Hug your loved ones. Take a walk. Enjoy a sunset (which is coming a little later each day), or a song. 

And please:  Wear a mask. Practice Social Distancing. And avoid being indoors with those who are not in your households.
 
Thank you for everything.
 
Paul

And to borrow from Joel (Continue to Be patient and Be mindful)

VMG COVID-19 UPDATE

Thursday, December 31, 2020                                                                                                    Issue # 97

 

Some of you who have iPhones and use the Photos app know that the Apple gods send a set of photos to you about every other day to remind you of where you’ve been and what you did at some time in the past. Yesterday, I was looking at a photo I took with friends in NYC. It was March 1, 2020. All seemed normal then (though there were some stories about “a virus”). Then, within a week, NYC was effectively off limits. Within one more week, we started having incident command meetings at VMG and by the following week our Group had changed, dramatically.

 

The changes were made to do two things: 1. continue to provide what services we could to patients who depend on us for their care and, 2. provide those services in the safest possible way for patients and, importantly, for our staff and practitioners. Although we are still in the midst of the pandemic, I think we have so far managed to achieve these two key goals. Thanks to all of you, your hard work dedication, teamwork and your willingness to change and focus on our mission.

 

So 2020 is ending (anyone object?). 2021 brings hope (to quote a line from a Tom Clancy novel whose characters are away at sea) “as sleep brings dreams of home”. Hope to see the end of the pandemic. Hope to see a better economy for everyone. Hope to see real effort and change to heal the social and racial divisions in our country and world. Hope to begin to make a difference in climate change so our kids can have a chance to thrive in their lifetimes. And hope also to make the benefits of education, accurate information and truth available to all. Life happens in small steps. Please continue to take kind steps for all. It matters. Here’s to a much better 2021!

 

National

 

There have been two big stories about the pandemic in the news recently. The first is about the new “variant” of the coronavirus that causes COVID-19. While the science about this variant is not fully clear yet, we do know that mutations in viruses happen often and most don’t produce viruses that are more harmful. This variant appears to be more transmissible (maybe by up to 60%) but NOT more lethal or more likely to cause serious harm. In this country, it’s been found so far in California and Colorado. It’s probably in more states, including New England, or soon will be. But again, so far, there is no evidence that it is more harmful.

 

And the big questions have been about whether the vaccines will work against this new version of the virus (“variant”). Again, at this time, the news is that it’s expected the vaccines WILL work to protect against this variant (perhaps with a slight reduction in effectiveness).

 

What this does mean is that more people are likely to become infected (especially because the vaccine rollout is still far short of goal) and that efforts to contain the spread of the virus are more important than ever. Those efforts are the ones you know about so well (masks, social/physical distance, hand-washing, staying out of gatherings with people you don’t already regularly reside with, even during holiday and family occasions).

 

Now about those vaccines. We are right at the beginning of a long process to vaccinate a great proportion of our population. We have a long way to go and the rollout, so far, is much slower than what will be necessary. One physician commentator said that, at this pace, it would take 10 years to vaccinate enough of the U.S. to reach herd immunity by vaccination. However, with this reality check/shock, the pace will almost certainly begin to quicken soon. This immediate situation seems to be attributable to poor and incomplete planning at a national and state level for how to get the vaccines into peoples’ arms and, perhaps, to bottlenecks in the distribution channels. At a higher level, in my opinion, this is attributable to lack of a uniform, national health care and public health system. As citizens, we need to work to change that.

 

Here’s a final word about the vaccines. The vaccines will work to prevent people vaccinated from getting very sick, getting hospitalized, and dying (but remember that they are estimated to be about 95% effective which means that for 5% they will be less able to control the infection). And as Steve said this morning in an email: “since we don’t know if folks who have had the vaccine can get subclinical infection (meaning they are “carrying the virus”  without showing symptoms) you need to protect your family, contacts, patients and fellow workers from COVID by maintaining social distance, wearing masks, washing hands and, when at work, doing all of the above and using appropriate PPE.” Even when the vaccination efforts and rates pick up speed, even when you and your close family and colleagues are vaccinated, plan on wearing masks and all the above at least through the spring and early summer (unless we get better information before then).

 

State and Regional Information

 

Some of you have already gotten a text message from the state telling you that over half of the state is now considered at high risk for coronavirus infection. The advice is to stay out of gatherings, away from other people who are not in your regular and immediate household, wear masks, etc. The positivity rate in the state is now estimated at about 7.6% (higher than we want it to be –we thought 5% was a reasonable limit).

 

Locally, the last reported rates for our area were:

 

Franklin County                                                                4.1%

Hampshire County                                          3.9%

Hampden County                                            9.7%

Berkshire County                                             3.5%

 

At VMG

 

As you know, two weeks ago when Franklin County positivity rates were increasing, we moved GHC to a higher level of safety: “partial rollback.” Here’s a message from Gina about our current plans for safety level:

 

“In the continual review of COVID-19 data, the decision has been made to move GHC to the "Enhanced Safety" level effective Monday January 4th.  As of this day all four health centers will be at the “Enhanced Safety” level. 

 

Thank you to all at the Greenfield Health Center for your work these past two weeks during the “partial roll back” for your center.

 

Enhanced safety measures include all of the measures in "Everyday Safety" as defined below, and the additional measures in "Enhanced Safety".  If you have questions about your work please do not hesitate to talk with your manager. 

 

Everyday Safety 

Present VMG guidelines including multi-layered defense strategy. 

  1. Do as much video/telephonic medicine as is clinically possible (patients are safest at home). 

  2. Restrict access to health centers – screening/nonuse of waiting areas. 

  3. Outside care where weather and safety allow. 

  4. Masks all the time for patients and staff, hand washing and appropriate ppe  

  5. 6 feet spacing all the time – work in closed offices when possible 

  6. Staff and providers that can work at home should be allowed to work from home if possible 

 

Enhanced safety level 

When Covid positive testing over 5 and cases per 100,000 over 25 

  1. Continue as above 

  2. Reinforce health center access restrictions 

  3. Increase staff spacing to 8 feet and separate offices wherever possible. 

  4. If unable to accomplish above, find ways to have more staff work from home. 

 

 

 

As I’m sure you know by now, we received 200 doses of the Moderna vaccine from the state. It was sent to our Amherst Medical Center. The vaccines, once received, cannot be moved to another building so we have begun vaccinating “patient-facing” staff and practitioners across the Group at our Amherst location. So far, we’ve gotten about 200 vaccines into the arms of staff and practitioners. We don’t yet know when we will be receiving additional vaccine. As soon as we know, we’ll be planning more vaccination clinics for the rest of our staff and for patients (depending on supply and state requirements) and we’ll let you know.

 

While we are not requiring staff to be vaccinated, we are very, very, strongly recommending that you get vaccinated. It could be life-saving for you and/or your family and colleagues.

 

OK. It’s New Year’s Eve! Here’s a bit of Latin jazz to get you ready:

http://www.jazz.org/media/videos/begin-the-beguine-jazz-at-lincoln-center-orchestra-with-wynton-marsalis-ft-ruben-blades/

Begin The Beguine - Jazz at Lincoln Center Orchestra with Wynton Marsalis ft. Rubén Blades

Begin The Beguine - Jazz at Lincoln Center Orchestra with Wynton Marsalis ft. Rubén Blades November 13th, 2018

www.jazz.org

 

 

 

Please stay safe and well. Don’t travel or have people over who are not regularly living with you and please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         If you must have people over who do not live with you ordinarily, please keep the gatherings as small as possible, outdoors better than indoors, indoors with windows and doors open, distance at least 6 feet from each other, and everyone wear a mask as much as possible

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

And even though you won’t be going out and partying, I hope you have a great holiday and weekend.

 

Thank you, again, for everything.

 

Joel

Continue to Be patient and Be mindful

VMG COVID-19 UPDATE

Friday, December 18, 2020                                    Issue # 96

 

As this week comes to a close, the U.S. has set records for new COVID-19 cases, hospitalizations and deaths. We are worst in the world at controlling the pandemic.

 

Early this morning I was watching CNN and saw Sanjay Gupta, M.D. get vaccinated. As he was sitting there after his jab (he apparently is not fond of getting injections) he said something like this: science worked really hard these past years to create the technology that could be used to make this vaccine. Hundreds of millions of dollars have been spent and the injection he got was the result. AND, right now, those hundreds of millions, while key for our future with this virus, are not as important as the less than one dollar spent on the surgical mask he was wearing. The mask will save more lives right now than the vaccines. That’s what we have to make sure our neighbors and relatives understand. Get vaccinated when it’s your turn but wear your mask everywhere right now!

 

Some people say that they wear their masks in situations where they think they can be infected. My observation about this is that it’s like the guy who says he never wears his seatbelt close to home, only on the highway. I guess he feels OK about that until he gets in an accident on his own road (most accidents happen close to home – I know, I got hit by a garbage truck pulling out of my driveway a few years back – I was wearing my seat belt and did not get hurt).

 

So, the good news is about vaccines. The Moderna vaccine is set to be approved today and we got a notice that our first batch of this vaccine has been ordered by DPH (we don’t yet know when we will get it, whom we can inject, or how many doses in total but the system is starting to gear up and we’ll keep you informed).

 

The rollout of the vaccines is going to be complicated and the news media will be filled with information and also concerns. Some people will begin to think that we are “all clear” now. That’s certainly not true. To make this point, I want to repeat a bit of what I said last week. Here is a brief clip of a piece published last week in several news sources:

 

“An analogy may be helpful here. A vaccine is like a fire hose. A vaccine that’s 95 percent effective, as Moderna’s and Pfizer’s versions appear to be, is a powerful fire hose. But the size of a fire is still a bigger determinant of how much destruction occurs.”  And this “fire” is way out of control, all across the country and in Massachusetts. More than 3600 deaths occurred in the U.S. on Wednesday (the highest single day total since the pandemic began). “How could this be? No vaccine can eliminate a pandemic immediately, just as no (single) fire hose can put out a forest fire. While the vaccine is being distributed, the virus will continue to do its damage. “Bluntly stated, we’ll get out of this pandemic faster if we give the vaccine less work to do,” said A. David Paltiel, author of an article in Health Affairs and a professor at the Yale School of Public Health. “There is one positive way to look at this: Measures that reduce the virus’s spread” (the 3 W’s: wear a mask, wash your hands, watch your distance) “can still have profound consequences. They can save more than 100,000 lives in coming months.”

 

As expected, there are now numerous anti-vaccine hoaxes circulating on social media. We’re going to see this rise in the next few months. The Washington Post has published an article on how to spot these hoaxes: https://link.zixcentral.com/u/597a4ea8/Yh-rxjRB6xGO91PMR15mZw?u=https%3A%2F%2Fwww.washingtonpost.com%2Ftechnology%2F2020%2F12%2F18%2Ffaq-coronavirus-vaccine-misinformation%2F

 

Finally, in case someone you know is touting “herd immunity” instead of the latest science, Sweden tried “going for herd immunity” as its major way of fighting the virus. This morning, the King of Sweden announced that they have failed. Hospitals are filling up, ICUs also, and the death rate is climbing. They are now considering a lock down across the country. 

 

State and Regional

 

The positivity rate for the State of Massachusetts as of Wednesday (seven day rolling average) was 9.3%. (By contrast, when things were looking better this summer the rate was in the 3% range). Hospitals and ICUs in parts of the state are filling up with people who were infected after Thanksgiving.   The Governor is asking citizens to stay at home, with only the people we live with, through the remainder of this holiday season to avoid another, and perhaps bigger surge, after the Christmas and New Year holiday weeks. The Commissioner of Public Health, Monica Bharel, M.D., sent a voice mail to all citizens of the Commonwealth yesterday saying that more than half of Massachusetts communities are now considered high risk. She is urging us all to stay home this holiday season and NOT to celebrate together in person.

 

Although there are now more people in our local hospitals with COVID-19, the ICUs are not at capacity yet. We are still doing well compared to the rest of the state but that will not last through another holiday season with people gathering against the best advice and being careless about masking, social distancing, etc.

 

Franklin County now has a positivity rate higher than Hampshire and Berkshire counties and rising. We expect all local county rates to rise in the next few days as more cases are reported.

 

At VMG

 

Steve and Gina are closely monitoring rates in our locations and in the testing that we are doing to make decisions about whether we should cut back some services. Our own testing at Valley Medical group for all patients tested last week was 11% (twenty-three positive cases out of 208 tests completed). That rate has gone up significantly from the last reported rate.

 

So in our effort to keep providing needed services while keeping our patients and staff as safe as possible, and especially considering the rate in Franklin County, we will be re-scheduling all elective in-person visits for GHC for the next couple of weeks. We will not do elective mammograms, in-person preventive visits, etc. We will still see patients who are symptomatic in the respiratory clinic and some others as the clinical situation dictates (e.g. patients in pain in PT or Sports Medicine, etc.). We will continue to maintain our “enhanced safety” regimen at all centers. See Steve’s email sent earlier this week for details.

 

In preparation for our efforts to begin COVID-19 vaccinations once we get our supply, we want “all hands on deck” to make sure we have correct cell phone numbers for all patients with a cell phone who can receive text messages. We’ll be using Carebot, a texting platform, to schedule COVID vaccinations so correct cell phone numbers are required. We want to do this to reduce the number of phone calls involved in the scheduling process. So please do what you can, when you are talking with a patient, to help out.

 

And as a reminder, we still have flu vaccine, it’s still important to vaccinate against flu, and we’ll keep jabbing (as they say in the UK) all winter.

 

 

 

We are all, “always on your side:”

 

https://www.youtube.com/watch?v=FseuxxcTlvA  

 

Please stay safe and well. Don’t travel or have people over who are not regularly living with you and please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         If you must have people over who do not live with you ordinarily, please keep the gatherings as small as possible, outdoors better than indoors, indoors with windows and doors open, distance at least 6 feet from each other, and everyone wear a mask as much as possible

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a good weekend.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, December 11, 2020                                                      Issue # 95

 

Here’s an unpopular yet necessary message. Please don’t travel and don’t gather with people outside your regular household this coming holiday season. I know this is emotionally hard. And yet it is necessary to keep everyone safe.

 

Over the past 9 months we have tried to articulate a clear and simple message about what’s important in this pandemic: keep our patients safe while providing needed services and keep our staff and providers safe. Below you’ll see information about what we are doing to accomplish these objectives. Our decisions and practices are guided by the latest evidence, national and local statistics, the DPH and Governor’s regulations and restrictions, and our best judgments about how to accomplish all this.

 

You probably already know about the good news: vaccines are being readied for shipment. And the studies show that they are really effective and with minimal side effects. At the same time, the Thanksgiving holiday gatherings and travel have had the predicted effects: case rates have risen dramatically, hospitalizations have increased, and deaths are following. So we have to do what the Governor said earlier this week: build a bridge to the vaccine. That means, especially now, do the things that we know work to reduce the spread of the virus: wash your hands, social distance, WEAR A MASK, don’t touch your face, don’t gather with people outside your household. And if you do have small gatherings, have them outdoors or at least make sure windows and doors are as open as they can be for better ventilation inside. Stay safe to assure a more normal holiday season next year. And, unless absolutely necessary, don’t travel this holiday season or winter.

 

National

 

This is still a nationwide (and worldwide) pandemic with increasing rates, hospitals filling up, and death rising each day. It did not have to be this way. Mask wearing and other measures, if most of the country complied, could have reduced these rates significantly. And by adopting those measures now, the estimates are we could save 100,000 lives by spring.

 

There are some myths or rationalizations (excuses) that are out there for ignoring science and, admittedly, inconvenient public health measures:

 

·         “Most people recover so why worry?” Because we don’t know who is going to get deathly sick and who will have mild symptoms and recover. And since we can feel well with no symptoms while still spreading the virus, we can be contributing to others’ illnesses, hospital admissions and mortality. We have to take care of each other to get through this.

·         “It’s a matter of personal responsibility. People need to decide for themselves if they want to wear a mask, hold large events indoors.” Well, maybe that’s true some for some things at some times, but not in a public health emergency. Sometimes we need regulations and laws. We decided that mandating seat belts was necessary and it worked to reduce fatalities.

·         “There’s nothing we can do; if I die, I die.” No. We can reduce the spread and limit the casualties. We know how. Oh, and what about everyone else we may be infecting?

·         “The vaccine will stop this.” Well, that will be true eventually. But it will take time. Some have said that, right now, the vaccine is like using a fire hose to try to put out one of those huge forest fires out west. First you have to slow the progress of the fire and then you can put it out. It’s going to take time (and many, many fire hoses). You slow it by containment which in the case of the virus is masks, distance, hygiene, and all the things we know work. Then, as more and more people get vaccinated, we preserve health and life until most of us have immunity.

 

Regional, State and Local

 

This morning the NYT reported that the speaker of the New Hampshire House of Representatives, Richard Hinch, died suddenly of Covid-19 on Wednesday. Hinch, who was 71, recently attended an indoor meeting with his Republican colleagues where several members contracted the virus.

 

Massachusetts did well for many months but case rates are rising rapidly now compared to the summer. We used to be at the bottom of the list of states with high rates. We are much closer to the middle now. The Governor has taken some actions (though none of them have affected outpatient medical practice, yet). There are NO lower risk states (except Hawaii) on the DPH map now.

 

Locally, even Franklin County rates are rising and are now above Hampshire but below Hampden and Berkshire Counties. Local hospitals still have capacity in their ICUs but we are seeing increasing admissions (some floors are now essentially COVID floors) and local nursing homes are also seeing outbreaks.

 

All this is likely due to the Thanksgiving holiday gatherings, events, and travel. And this is before the end-of-year holiday season. We can expect another surge after the first of the year.

 

At VMG

 

You’ve seen emails from Steve and Gina about our plans for coping with increasing rates of infection. They’ve identified levels of safety based on the data and what we are seeing locally. Since case rates at VMG and in our communities are now above threshold levels, as of Monday, we are moving to “Enhanced Safety.” Please see Gina’s email from Thursday for details. We are not “rolling back” patient care. We are reinforcing previous measures (proper and consistent PPE use, telehealth whenever possible and indicated, etc.) and extending/increasing distancing (8 feet minimum and use of separate offices as possible and increasing work from home as necessary).

 

As you know, we are now registered with the state and CDC to distribute vaccines and we are planning measures to begin vaccination as soon as we have supplies. We are not yet certain when that will be but we will keep you informed. This will require an “all hands on deck” approach and we’ll let you know more as the timeline becomes clearer.

 

 

Please stay safe and well and please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a good weekend.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, December 4, 2020                                                 Issue # 94

 

Sometimes I wonder: could this year have been any more difficult. We’ve had the pandemic, the politics, the economy, and the continued unmasking of structural inequities in our social and health systems, and, hopefully some increasing awareness and commitment to change our culture, treat each other with dignity and respect, and make sure we all have an avenue to improve our lives. So much stress in reality. So much needs to be done. And yet, I look outside and it’s a bright sunny day, and almost everybody I know is well in our little part of the world. It’s easy to allow myself to think that the problems are “out there,” somewhere away from us.

 

We were watching David Attenborough’s A Life on Our Planet, the other night (I recommend it if you haven’t seen it yet – it’s on Netflix). Attenborough is a naturalist and journalist who has spent his life being in contact with nature all over the world, documenting amazing diversity on our planet and now spreading alarms about climate change and what we are doing to the natural world. There is a scene where he is in the rain forest of Borneo, in the thick of lush vegetation with an amazing number of animal and plant species all around him. He says that 75% of the island was once like this but now it’s less than 25%. The camera zooms up in the helicopter and what you see is that this thick rain forest is actually a strip on a much more barren island. The point I take is that we have to make an effort to see the real world and not be fooled by being in a “comfort zone” of what we are currently observing and experiencing. (BTW, while the first part of the show is hard to take, the second half is much more about how it’s not too late and about what we can do to get the planet back – a few things are actually relatively easy –and the images of the plants and animals are amazing).

 

Reality is Hard to Take

 

So, zooming out of our local counties, the bad news is that the numbers remain grim: 272,000 people have already died from COVID-19 in the U.S as of today (2,600 died on Wednesday alone). There are now 100,000 patients with COVID-19 in U.S. hospitals. The latest projected death toll from the disease is 450,000 by spring. These are the national statistics. Behind each number are friends, neighbors, families. We tend to push away that realization so we can go on with our lives. But it’s still real.

 

Yesterday, Governor Baker reported the state positivity rate at 4.9% and rising. Hospitalizations are increasing at a rate of 2-3% per day across the state; better than early spring but a steady increase now. Two field hospitals are being stood up (one in Worcester’s DCU Center is already up and able to receive patients by next week; the other will be in Lowell). Locally, Franklin county rates are higher than they were in summer and early fall but still relatively low especially compared to Hampden and Berkshire Counties (Hampshire County is between Franklin’s rates and the other local counties).

 

By now, you’ve also seen news reports of concern about holiday travel to and from areas with higher rates of infection. So where are those states? Massachusetts DPH publishes a weekly update of states considered lower risk for infection. In the recent past, generally the New England states (except for RI) were considered lower risk. As of today, the map published by DPH shows only Hawaii as lower risk; the entire rest of the country (including all of the New England states) is now NOT considered lower risk. You can find the DPH map and information on the Massachusetts COVID-19 Travel Order here: https://www.mass.gov/info-details/covid-19-travel-order The conclusion in looking at the map is that this is, indeed, a national (and world-wide) pandemic.

 

Considering the above, public health officials are saying that they expect another rise in infections and hospitalizations as a result of the Thanksgiving holiday travel and gatherings. Their recommendation is that we prepare for that now by changing any travel and visiting plans for the end of year holiday season. Considering that there is another holiday period coming up in a few weeks, now is the time to reconsider any traveling outside of Massachusetts and/or visiting with and receiving guests who are not currently in your household no matter where they may live (remember that we are seeing increasing rates of infection even locally and certainly in nearby states like RI and CT).  Steve reminded us that family contacts are a frequent cause of COVID transmission.  Stay within your regular household and avoid bringing new people into your household if they have not been living with you now.  He also reminded us that if a family member is awaiting test results, or tested positive, practice proper quarantine procedures. In other words, please stay home and only with people currently in your household.  It is going to be a long and difficult winter season due to the pandemic and we want you to be safe.

 

The Good News

 

There is good news “on the horizon” if we can get to the horizon safely. Several vaccines are being considered. VMG has “signed up” with DPH to be able to receive and give vaccines once they are available. However, we don’t yet know when that will be (probably some around the beginning of the New Year), who we will be permitted to vaccinate, and how much vaccine we will receive. It is clear that the vaccines will be limited to certain populations at first (probably those in nursing homes and front line medical staff – yet to be defined). The latest estimate is that they will begin to become available to the entire population by summer of 2021. There are many important details to be worked out. We will keep you informed.

 

On the Psychological Front: What We Can Do

 

Realizing that we are social animals and that people find it hard to give up plans to see family and friends, despite the best advice to not visit and travel, some social scientists are suggesting that if you will not give up plans for visiting and travel, you can at least consider what Sarit Golub, a psychology professor at Hunter College, calls a “personal risk budget.” In short, think about giving up higher risk activities but engage in limited lower risk activities and “budget” how much risk you are taking. You might give up going shopping in stores on any given day but instead go for a distanced walk with a friend outdoors.

 

David Leonhardt writing in today’s New York Times talks about a three step guide to minimizing risk. First, without exception, don’t spend time in a confined space (outside your household) where anyone is unmasked. No eating indoors at restaurants or in friend’s homes and don’t have close, unmasked conversations anywhere, even outdoors. Don’t have lunch with colleagues in the same room indoors, especially if you are not always well-distanced (we’ve seen group lunches cause outbreaks at local hospitals). Second, minimize spending extended time in close proximity to others even if you are masked. Choose to work out at home instead of at a gym, attend religious services remotely, etc. Third, and much easier to swallow, you can walk, ride your bike, etc. outdoors without much risk if you are socially distanced. Leonhardt reports that a friend told him he “considers keeping six feet of distance outdoors more important than wearing a mask.” Interesting example: If you are outdoors and your friend is not close enough to you to blow out a birthday candle you could be holding, that’s a safe distance. I’m not sure about the accuracy of the statement but you get the idea. Stay distanced (and I would add wear a mask around anyone not in your current household).

 

And you can do errands. Just remember to stay socially distant, wear a mask (and go to stores where others are masked), and wash your hands afterwards. Remember the personal risk budget (to minimize exposures) and stay within your budget.

 

Finally, recognizing that quarantine recommendations have caused some people to react by not quarantining, the CDC has offered two new ways to shorten quarantine periods. Those without symptoms may end quarantine after seven days if they are tested for the virus and receive a negative result, or after 10 days without a negative test. People should continue to watch for symptoms for 14 days. (Quarantine refers to people who are well but may become ill; isolation refers to those known to be ill.)

 

So, once again, please use the time now to make a plan with your friends and family for how you will safely handle the upcoming holiday season. And remember the advice above. Let’s get to next year’s holidays safely by staying home and protecting ourselves, our family and friends and neighbors now.

 

 

Things can change. What can Elvis, Arlo, Pete, and a whole bunch of German beer drinkers teach us about acting together?

 

https://www.youtube.com/watch?v=sSF89swJ9IU

 

 

 

Please stay safe and well and please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a good weekend.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, November 20, 2020                                                 Issue # 93

 

 

 

The graphic and message above is correct in terms of timing. New cases we “create” this Thanksgiving will lead to new COVID-19 cases and medical crises before the end of the year.

 

But, here’s the good news. If we make the right choices now, we’ll save lives and grief in the coming months. Vaccines are looking real. The FDA received an Emergency Use request this morning from Pfizer. It will take time to produce and distribute the vaccines. But they are coming and we have to get through that time.

 

So, it’s come to this. It’s come down to what we are willing to do to learn from our experience and slow the spread of virus and COVID-19 so that we preserve the lives of our loved ones and our fellow citizens until a vaccine is widely available and assure that we have a good Thanksgiving, with everyone around the table, next year. This is really hard emotionally, particularly after all we’ve been through and particularly because we cherish the end of the year holidays.

 

The public health message is not hard to understand; it’s very clear. From the CDC yesterday, the main message is don’t travel and don’t mix people who have not been in residence with you and keep gatherings very small. If you decide that’s not possible, then the CDC advises:

 

“If members of different households are gathering in someone’s home for the Thanksgiving meal, they should all wear masks, except when eating, and remain six feet apart, federal officials said.

Guests should be encouraged to wash their hands with soap and water, and no one should hug or exchange handshakes. When gathering inside, attendees should wear masks as much as possible when not eating. Windows and doors should be kept open as much as possible to improve ventilation.”

“The C.D.C.’s advice went so far as to urge people to speak in low voices, because shouting — or singing — can spread the virus. Only one person should serve the food, federal officials said. If there are overnight guests, they should have their own bathroom.”

 

This morning many of you got a voice mail from the Commissioner of the Massachusetts Department of Public Health describing her family’s decision to stay home and not gather with folks outside their residence. She is advising all of us to do the same and remember that limits for gatherings are 10 people inside and 25 if outside. Finally, those traveling form high risk states including CT, NY, NJ and D.C. must quarantine for 14 days or produce a negative test result.

 

So, unfortunately, we’re down to many individual choices for things we have always taken as a given: Thanksgiving dinners, grandparents, parents, kids around the table. Time spent close to one another, embracing, eating together, talking (sometimes shouting and arguing), enjoying the comforts of friends and family in person. And yet we need to consider real safety issues from a danger that can’t be seen. Leading us to have to make hard choices.

 

One reason this situation is hard is what Dr. William Schaffner calls “COVID disdain.” It’s not just that we are fatigued and worn out by all the worry. It’s that we are resentful and angry about this situation. Psychologists talk about dissonance theory. When we have strong beliefs, rational or irrational, and we then encounter facts and information to the contrary, we dig in and ignore the facts in favor of our strongly held beliefs. It is important that we stay connected. Our holiday times together are highly cherished. And we have to face the facts that this Thanksgiving has to be different.

I heard a doctor on the news this morning talking about, of all things, a scene from the movie JAWS. Quint, the shark hunter, is recounting his experience on the USS Indianapolis which was sunk in one of the last missions in WWII. Many sailors survived the sinking but were then surrounded by sharks, day and night. Rescue would not come for weeks (the mission, to deliver the atomic bomb, was so secret that no distress calls were issued). Quint says that the hardest time was when they were just about to be rescued. That’s the time he was most scared: so close to being safe yet there are those sharks. The doctor was saying that’s the situation we’re in now. Vaccines will be here soon. Although we are not fighting sharks, we do need to stay alert and keep protecting ourselves by wearing masks, distancing, washing hands, and finding new and hopefully temporary ways of being emotionally close while socially distant.

Lauryn Stafford reminded us that ZOOM has suspended the 40 minute limit on free time this Thanksgiving. Try to have a Zoomsgiving this year! It won’t be the same. But it will get us to the next Thanksgiving.

State and Local

 

From Gina: Massachusetts COVID-19 cases are now over 189,000 with a 3.31% positivity rate. Governor Baker and DPH are reinforcing the safety advisories for the Thanksgiving holiday. Keep alert for any changes in reopening plans as the rates are rising.

 

Positivity rates are higher in all parts of the state though our counties are not as high. If you have family or friends coming from outside our counties, the message is observe all the safety guidelines as carefully as possible and try to limit gatherings as discussed above (i.e. Zoomsgiving). 

 

Our local hospitals are still functioning well as of this writing but plans are being prepared for increasing capacity for COVID cases and limiting other services if necessary.

 

Last week at VMG we tested 208 patients. Sixteen tests came back positive for COVID which is a 7.69% positivity rate. 

 

Weekly data are being reviewed and monitored by Steve and Gina for signs that we might need to go to a higher level of prevention. Plans are in development for how this will happen and we’ll be discussing those soon.

 

A bit of good news: we have not seen much flu yet. Maybe that’s because of mask wearing and better hand hygiene. As a reminder: December 1st is the deadline for getting vaccinated against flu for all providers and staff.

 

 

After all that, I need some inspiration and positivity of a different sort. Our world, literally the world, has been so disrupted and affected. It’s important to remember this is a human problem for the whole world. So, although this video was originally put together in response to the 2010 earthquake and humanitarian crisis in Haiti, the message really does still apply. I hope it improves your mood too and reminds us to be thankful and lend a helping hand this holiday season.

 

 

https://www.youtube.com/watch?v=Glny4jSciVI&list=RDGlny4jSciVI&index=1

 

We Are The World 25 For Haiti - Official Video - YouTube

Recorded on February 1st, 2010, in the same studio as the original 25 years earlier (Henson Recording Studios, formerly A&M Recording Studios) "We Are The Wo...

www.youtube.com

 

Please stay safe and well and please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great Thanksgiving.

 

 

Joel

Be patient; be mindful

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VMG COVID-19 UPDATE

Friday, November 13, 2020                                            Issue # 92

 

 

 

 

Stand up, stay up, keep alert, and, according to the great philosopher Petty, don’t back down (“there ain’t no easy way out”). There is probably good news on the horizon (vaccines and new therapeutics and mitigation measures). Someone said it was the light at the end of the tunnel. But we have to get through the tunnel to get to it. And the tunnel is the end of year holidays, our increasing need to find solace in the embrace of our loved ones and friends from outside our households, and our increasing fatigue about COVID and the things we need to do to keep each other safe.

 

Vaccines may begin to be available by the beginning of 2021 although it will take many months to have enough vaccine produced and distributed to get to most people. And, it seems, it will need special handling and distribution channels which we don’t’ yet have. But it will come.

 

Steve and several of us were talking yesterday and he reminded us of the tragedy of soldiers who get killed after a peace is arranged at the end of a war. The situation we are in is a bit like that. To get to the promise of a vaccine we have to decrease transmission of the virus so that we decrease the number of  people we lose between now and then. That means that this Thanksgiving and holiday season will be like none we’ve experienced before. There is no getting around it (“there ain’t no easy way out”). Don’t travel. Don’t be with people who are not part of your regular household. Share your fond feelings and memories, photos, videos, songs, recipes. But don’t share your air in close proximity. Be socially distant while emotionally close. And most of all, assure that you will have a great Thanksgiving next year with all of your loved ones. Do it for each other. And if you decide that you can’t do this, take the most extreme precautions that you can (you know the list) and help your friends and family to do the same. And if you do travel, there are now only 6 states listed as “lower risk” which means you will have to fill out a Massachusetts Travel Form and quarantine and/or produce negative test results to re-enter Massachusetts (and check ahead; many states may require the same when you enter their territory).

 

National

 

By now you have probably seen updated maps of the outbreaks (really explosions) of virus across the country. Cases are outpacing expectations following mass gatherings for all sorts of reasons and hospitals are at or reaching capacity and deaths are increasing rapidly. As an example of the increasing risk, If you are at a small family gathering in Dubuque, Iowa, you now have a 63% chance of encountering someone with COVID (reported in the Washington Post). Staff shortages at hospitals and clinics coupled with greatly increasing need are getting so severe that international aid workers are now volunteering and staffing in urban and rural areas across the U.S. Mayors and governors in states across the country are calling for mask mandates, reduced gatherings, canceling Thanksgiving plans, reduced travel, rolling back school openings, etc.

 

Massachusetts

 

Earlier this week a group of Infectious Disease specialists in the Boston area wrote an opinion piece in the Boston Globe in support of Governor Baker’s plans and recent orders. “Baker’s orders includes a statewide facial covering order, regardless of distance, which is much easier to interpret and enforce; a limited stay-at-home advisory, in effect from 10 p.m. to 5 a.m.; and new limits for the number of people who may gather in groups — up to 10 people indoors and 25 outdoors.” (But remember the Dubuque example; it could be us soon).

 

There are now over 158,000 COVID cases in our state and the numbers are ticking up. The positivity rate is 2.88%; good, but rising.

 

Franklin and Hampshire counties remain on the list of lower incidence compared to other counties across the state. But cases are rising here  and there is no known reason other than citizen vigilance and compliance with protective measures to keep the rates from rising here too. So keep wearing masks to protect yourselves and others now and to protect our “tunnel” of time. Most of the rising incidence has been attributed to “small” family and friends gatherings without enough measures taken to mitigate spread (masks, hand-washing, ventilation, etc.).

 

At VMG

 

We are continuing to vaccinate against the flu. Please make sure you are all vaccinated by December 1.

 

Gina sent an email yesterday outlining our precautionary measures and levels: Everyday Safety, Enhanced Safety, Partial Rollback/Reduction in Services, and Significant Rollback/Reduction in Services. The movement between the levels will depend on positivity rates in our area. Here’s her memo. Please be familiar with this approach:

 

MEDICAL CARE AND SERVICES PHASE 3 AND PLANS TO RESPOND TO INCREASE IN COVID 19

November 11, 2020

 

Guidelines for roll back/reduction in services in response to rising Covid-19.  

Ultimately state guidelines by Governor Baker will supersede this policy if more restrictive than this policy.

 

A.       Everyday Safety - Present VMG guidelines including multi-layered defense strategy.

1.        Do as much video/telephonic medicine as is clinically possible( patients are safest at home).

2.        Restrict access to health centers – screening/nonuse of waiting areas.

3.       Outside care where weather and safety allow.

4.       Masks all the time for patients and staff, hand washing and appropriate ppe

5.       6 feet spacing all the time – work in closed offices when possible

6.       Staff and providers that can work at home should be allowed to work from home if possible

 

B.       Enhanced safety level: When Covid positive testing over 5 and cases per 100,000 over 25

1.       Continue as above

2.       Reinforce health center access restrictions

3.       Increase staff spacing to 8 feet and separate offices wherever possible.

4.       If unable to accomplish above, find ways to have more staff work from home.

 

C.        Partial “Roll Back”/Reduction in Services –Covid testing positive rate 10% cases per 100,000 over 35

1.        All above

2.       Providers and staff over 60 work in closed offices or off site

3.       Providers and staff over 70 work from home

4.       Discontinue routine procedures – screening mammograms/bone density/ in person well ness exams –routine lab work

 

D.       Significant “Roll Back”/Reduction in Services  Covid test positive rate over 15%  cases per 100,000 over 40

1.        All above

2.       All visits will start as video visits and providers will make decision about if patients need to be seen in person based on risk to life or limb.

3.       Routine chronic disease labs will not be drawn only labs impacting on acute urgencies, routine xrays will not be done unless urgent.

4.       Only staff and providers who cannot work from home or are needed to staff respiratory clinic or urgent care will work in office.

 

Bottom Line: Let’s protect ourselves, each other, and our communities as best we can. The future will be better but let’s all get there together.

 

Thanks again for all you do. I can’t say it enough.

 

Please stay safe and well and please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         If you have to be indoors with people at home, make sure you get as much fresh air inside as possible.

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

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VMG COVID-19 UPDATE

Friday, November 6, 2020                                                         Issue # 91

 

 

 

 

I think that this week, for a while, COVID-10 probably took a back seat in the media to the election coverage. Everyone is probably “tired” of hearing about both stories by now. I wish there were a way to get the virus to take some time off but that’s not happening. Yesterday the country saw more than 121,000 new cases. That’s the highest one day case total ever. The NYT reports that 23 states have reported more new cases this past week than in any other week since the pandemic hit the country. This appears to be the “next wave” that public health officials have been warning of. And Thanksgiving is coming.

 

I don’t think the Grinch story applies to Thanksgiving; but, this year, it should. I hate to be Grinch-like but…..if there ever was a year not to travel and not to gather with folks outside your household, this is the year. Family gatherings and celebrations with friends (and hockey practices and games) have been identified as a major way the virus is spreading in Massachusetts.

 

The other major way the virus spreads is through people who do not take, or forget to take, the mitigation measures we’ve been talking about since nearly the start. Mask wearing is key. There is a report this morning that across the country, in counties that have made mask wearing a political issue of freedom and independence, viral spread and new cases is highest. And staying home when sick is also vital. In a suburb of St. Louis, a supervisor of elections who tested positive was at work. He then died. About 2,000 voters visited that site on Election Day. The message is don’t go out if sick. And locally, we continue to see reports from hospitals of new cases from people not wearing masks in lunchrooms, corridors, and gatherings (even outdoors). Social/Physical distancing is still very important. Six feet is the minimum but 8 or more is better.

 

In the State and Region

 

Last week, the case positivity rate for the State of Massachusetts (7 day rolling average) was 1.86%, (an increase of 0.06 over the prior period). Here, the Valley Medical group rate for all patient tests completed the week ending 10/30/20 was 0.57%.  There were three positive cases out of 190 tests completed. Those numbers are still relatively low but they do seem to be rising. Our local county rates reported last week were:

 

2.4 per 100,000 in Franklin County; 6.7 per 100,000 in Hampshire County; 19 per 100,000 in Hampden County. Rates below 8 per 100,000 are considered the limit for more considered actions. There are also reports of increasing cases in hospitals statewide though our local hospitals have not yet seen a large increase. So while our Franklin and Hampshire county rates are still relatively low, we are going to see a rise as the holidays and the weather bring people into closer proximity.

 

In response, effective today, the Governor has issued orders:

 

·         Requiring all persons to wear face-coverings in all public places, even where they are able to maintain 6 feet of distance from others.

·         Reducing gathering size limit for gatherings at private residences: indoor gatherings at private residences are limited to 10 people and outdoor gatherings at private residences are limited to 25 people. The limit on gatherings held in public spaces and at event venues remains the same. Requires that all gatherings (regardless of size or location) must end and disperse by 9:30 PM.

 

Further information on the DPH and Governor’s orders can be accessed here:

 

https://www.mass.gov/info-details/covid-19-state-of-emergency#travel-restrictions-

COVID-19 State of Emergency | Mass.gov

On March 10, Governor Charlie Baker declared a state of emergency, giving the Administration more flexibility to respond to the Coronavirus outbreak. Below is a list of orders issued by Governor Baker, the Department of Public Health and other state agencies to respond to COVID-19, along with associated guidance and other related resources.

www.mass.gov

   

 

There are some preliminary reports on potential new therapeutics for treating cases and, interesting, a report on a nasal spray, tested in ferrets, that seems to block the virus. This will of course need validation in human trials and limitations (such as how long the blocking lasts) will need to be explored. But the point is that enough is known about the virus now that new approaches are being conceived and tested and bring hope.

 

At VMG

 

There’s been a lot of hard work to redesign our processes of care and a lot of persistence and ingenuity in providing that care, even outside in bad weather. Here are a few comments from patients posted to the Positively Greenfield Facebook page:

 

“Huge shout out to Valley Medical Staff. I've had a flu shot and Tdap shot in the last two weeks and both days it was freezing cold, even snowing one of the days. The staff that come out to the car are so friendly and patient. Even with the conditions they are working in they always have a smile on their face and truly care about your well being. Thank you!”

 

“Yess!! They’re so friendly and working extra hard to be completely safe and compassionate especially at this time!” 

 

“Valley Medical has been great throughout this time. I have had the flu shot in the parking lot, an examination by a gowned/masked/face shielded NP, and an ultrasound, and they are so positive, professional, no-nonsense, and kind!”

“It's the people that make the organization what it is!”

 

“Agreed, they are amazing and always so friendly and helpful! And their ability to adapt to this crazy time but keep it all moving forward is inspiring. Big thanks to the whole staff, you rock!”

 

I’ve seen comments like these from patients at our other centers too. Kindness, caring, and dedication really count in times of stress and need.

 

I echo Gina’s message (following): “Safety at VMG is in your hands.” Here’s what she said this morning:

 

“I have reached out regularly sending messages and information about important mandatory safety practices we all must follow at VMG.  Safety at VMG is our number one priority and it is in each our “hands” to do well, every day.  This week’s message below!

 

MASKS:

 

They must be work every day, all day, all of the time, unless in a private office or actively eating/drinking a meal/snack.

As of today, the new Governor’s order also requires statewide, masks be worn outside, all of the time, regardless of social distance.

 

SOCIAL DISTANCE:

 

We must remain 6 feet apart at all times, unless actively engaged in patient care that requires our proximity to a patient. In the centers, and outside the centers.

What does 6 feet of distance look like…..a twin size mattress between you and your work colleague, or a yoga mat, the length of a cow, the length of MacBook air charger cord. Envision what item you want to picture between you and the next person, to help you stay 6 feet apart!

 

GATHERINGS AS WE APPROACH THE HOLIDAYS

 

Gatherings and meals in the center that are a source of joy, fun, connecting with colleagues may not take place this year due to the pandemic.  This sadly means no potlucks, cookie exchanges, holiday meals etc. in the center.  Safety and health is paramount for each of us, and these cannot be held safely during the Covid-19 pandemic.  I highly discourage anyone from also doing so outside of work.

 

I guess I am the “Grinch” who stole the fun; I only want the absolute best for each and every VMG staff member and practitioner, to be safe and stay well.

 

ARE YOU A SAFETY CHAMPION?

I am looking for safety champions in each center, folks who are able to step up and help others when they see a safety practice lapse

(Individuals not 6 feet apart, pulling a mask down to answer the phone or talk to a colleague, groups gathering for lunch, etc.). Do you feel you have a special way of helping others, with a kind word, a discussion, and could do so in your center, to help us all keep going forward safely? Let me know, it would be great to “deputize” some safety champions in all of our centers!

 

Thank you for all you do to provide high quality care to our patients and for the work as a top notch team!”

 

 

 

That’s all for now.


Please stay safe and well and please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works) (six feet is the minimum but 8 is better – at least one cow length),

·         Avoid travel as you can and definitely avoid large gatherings, crowds, and prolonged contact (especially indoors – open windows and doors if you can) with people outside your household,

·         Definitely wear a mask when out and in public (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

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Smoking Cessation Clinical Champion Update

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VMG COVID-19 UPDATE

Friday, October 30, 2020                         Issue # 90

 

 

 

 

And all the news just repeats itself

Like some forgotten dream, that we’ve both seen

                …….John Prine

 

This is the 90th time I’ve written this newsletter since the pandemic hit our area in March. Over the course of these 90 times, we’ve seen what most of us have never seen before in our lifetimes. So much need. So much pain. And even though most of us here have been relatively spared, you see the news every day across the country and around the world. And now the winter is here. So what can we do to care for and protect our friends and families? Our patients and communities? That’s why we do this work.

 

It’s hard to balance what we all need to do to be safe with our desire to feel safe. Most of us are experiencing some kind of “COVID fatigue;” too much worry leading us to tune out warnings and perhaps stop taking proven steps to keep safe. How to find the right balance? Knowing what to do and then doing that to the best of our abilities, may be the key to being and feeling as safe as possible.

 

The holidays are usually (mostly) a time for closeness, fun, fulfillment, togetherness. Because of the pandemic, it’s different this year. So especially now, with the holidays approaching, here’s what you can do:

 

Make a plan for what you will do about holiday events with friends and family. Having a plan and a strategy, and talking about it with your family and friends, will help everyone feel as comfortable as possible.

 

The best advice for being safe is to think about a great celebration next Thanksgiving. This year, the greatest sign of love and respect might be NOT seeing people outside your household and celebrating in person. I know this seems harsh. I wish it were not so. If you can, don’t travel and don’t gather with folks outside your household this holiday season. Talk with family and friends about alternative ways of connecting via phone or video over the next few weeks. Send small gifts, photos, share recipes, watch sports together virtually, “Share” a meal, prepared in each household, over zoom or another video platform. It won’t be “the same.” But this is not the usual holiday season. Celebrate together, separately.

 

And even if you are home with members of your immediate household, consider wearing masks at home if someone has been out with others and may have been in touch with someone who has not been taking as good care as you have.

 

If you feel that you must travel and/or gather with others, talk with your people about the need to stay safe for each other. Hold gatherings, as small as possible, outdoors if weather permits. If you must be indoors, make sure your spaces have good ventilation with outside air: open windows, doors, etc. It might cost more in heating but it could be a lot less in medical expense and suffering.

 

In all cases, keep at least 6 feet apart (socially distanced while emotionally close) wear a mask or face covering, wash your hands frequently, don’t touch your face, and for this year, don’t hug. That’s hard, but safe. And think about next Thanksgiving and safeguarding that holiday.

 

Around the Nation and the State

 

While the pandemic in the first wave was focused in urban areas, almost every section of the country, urban AND rural, is seeing a rise in cases followed by a rise in hospitalizations and then the inevitable increase in deaths. This is the reality now and it should serve as a call to action for all of us. Do what we can even when it appears that we are safe in our area.

 

Here’s an encouraging sign about what we can do to cut cases. Counties in Kansas with mask requirements have seen about half as many new infections as counties without mask mandates. Masks work, everyplace.

 

In Massachusetts, 121 communities are now said to be at high risk for COVID-19 including several in our part of the state. Here’s the latest town by town map:

https://www.mass.gov/info-details/community-level-covid-19-data-reporting

 

Here are the numbers. As of yesterday, there were 150,498 cases reported in Massachusetts. The positivity rate was up to 1.8% (still good, but rising). VMG tested 208 patients with zero positive results.  Locally here are the numbers of cases by county: Franklin: 472; Hampshire: 1,472; Hampden: 9,901; Berkshire: 780. The state of Connecticut is now requiring Massachusetts visitors to quarantine.  Governor Baker is promoting having a healthy Thanksgiving with limited group gatherings. 

 

Earlier this week, Holyoke Medical Center reported a cluster of 15 staff with COVID-19 with the infection probably spread when they ate lunch together (masks off) but not socially distant. The hospital called this an example of COVID fatigue (getting lax, not thinking through necessary precautions). The lesson is to stay deliberately vigilant. It is tiring but necessary.

 

At VMG

 

Flu clinics are going well with hundreds of patients vaccinated (vaccines don’t save lives; vaccination saves lives). By using the software from Carebot, 2600 flu vaccine appointments were scheduled (without increasing volume on our phones). We’ve also been able to document 2200 flu vaccines received outside of VMG (e.g. supermarkets, pharmacies, etc.). We have now contacted all patients at least once about getting vaccinated.

 

Lab has moved indoors for the winter at AMC and EHC.  NHC and GHC will move indoors by next week.

 

COVID testing is continuing. As cases increase in Massachusetts and we all do more tests, we may begin to see turnaround times increasing. Be on the lookout for some advice about the messages we give to patients about turnaround time for tests so the know what to expect.

 

Let’s cross the ocean for some inspiration and be connected with the world as we cope:

 

https://www.youtube.com/watch?v=F1VJQObcs90

 

That’s all for now. Thank you once again for all you do,


Please stay safe and well and please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

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Hypertension Clinical Champion Update

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VMG COVID-19 UPDATE

Friday, October 23, 2020                        Issue # 89

 

 

 

 

And all the news just repeats itself

Like some forgotten dream, that we’ve both seen

                …….John Prine

 

I realize that some of you may not have seen the movie “Ground Hog Day.” Here’s the trailer: https://www.youtube.com/watch?v=GncQtURdcE4

 

I think, to some extent, we all feel like its ground hog day again. The news just repeats, though it gets worse each day. Now there are 41.9 million cases worldwide and 1.14 million deaths. In the U.S. there are now 8.49 million cases with 224,000 deaths. Yesterday there were 78,000 newly identified COVID cases in the U.S. and 828 deaths.

 

The CDC yesterday redefined what “close contact” means for COVID-19. Up until yesterday they defined close contact as 15 minutes in a room with a COVID positive patient. Now it’s 15 minutes or more over the course of a day. This means shorter contacts are “cumulative.”

 

Here in New England we are still mostly not seeing a large spike though the Boston public schools are suspending all in-person learning as the positivity rate in the eastern part of the state is rising. There is no reason to believe that we will not see a spike sometime in the next few weeks or months.

 

Here’s the latest Massachusetts DPH community level map of COVID rates:

https://www.mass.gov/info-details/community-level-covid-19-data-reporting

The overall positivity rate for the State of Massachusetts as of 10.21.20 (7 day rolling average) was 1.1%, about the same as last week. In our area, Sunderland, Amherst, Holyoke, Springfield, East Longmeadow are now in the “red” category meaning that the most recent positivity rates are higher than desired (showing the virus is still here). At VMG, the rate for all patient tests completed the week ending 10/16/20 was 0.47%.  One case was positive last week of 212 tests completed.

 

So, with the holiday season and the winter months coming, our best tools for protection remain our masks, social distancing, hand hygiene, and, most important…vigilance and consciousness. We need to keep being deliberate about assessing situations in our daily lives that could lead to infection. For many of us, perhaps the best gift we can give our loved ones who do not live with us is protection from transmission. This may be the first Thanksgiving where our best sign of love is staying physically apart (or, if we are visiting, being conscious of distancing, wearing masks, hand hygiene). There will be more Thanksgivings. Let’s make those a sure thing by protecting each other as best we can this holiday season.

 

If you must travel this holiday season, here’s the latest Massachusetts DPH graphic showing restricted states.

 

https://www.mass.gov/files/styles/embedded_half_width/public/2020-10/US-Travel-Map_2020-10-16_01-01.png?itok=7dk6avn5

 

At VMG

 

Information from Gina:

·         Flu vaccinations are going well. A big thank you for all the work being done by all staff to help our patients and each other get vaccinated (vaccines don’t save lives; vaccination saves lives). 

·         Lab returning indoors in next 7-10 days.  Please see the email earlier this week from Debbie Bolognani for timing and procedures for managing patient flows

Information from Martha Mastroberti:

·         Carebot continues with scheduling flu vaccine appointments.  All high risk and medium risk patients have been contacted.  2,000 flu clinic appointments scheduled.  Carebot also recorded 1100 patient who received vaccine elsewhere. 

·         PHQ9 forms for Wellness visits should be available through OhMD by 11/5.

 

Since I used lines from John Prine at the opening, here’s a video of a live recording late in his career:

https://www.youtube.com/watch?v=2gOVT7JbPsQ

 

Ann Esrick suggested this positive, locally produced, video of life in COVID times in Northampton:

https://www.youtube.com/watch?v=NPNbE6W7N2o&feature=youtu.be

 

That’s all for now. Thank you once again for all you do,


Please stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

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CHF Clinical Champion Update

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VMG COVID-19 UPDATE

Friday, October 16, 2020                                                                                                       Issue # 88

 

 

 

 

Let’s start on the up side. Here’s some positivity to start your weekend: Keb’ Mo’, the Boston Children’s’ Chorus (BCC) and choirs from around the world singing let Your Light Shine. BCC says that the song is a timely reminder that despite the challenges that the world throws at us, we all have the ability to make the world a better place, and share our light with the people around us.

https://www.youtube.com/watch?v=QTCNPZEsLF0&feature=youtu.be

 

The number one responsibility of leadership in a crisis, especially a pandemic, is to tell the truth so that people can begin to deal with reality. That was true in 1918 and it’s still true now. Most of us want all this to be over yesterday. But it’s not. So we will have to make, and continue to make, hard choices based on facts, science, and faith in each other to do the right thing for each other.

 

The news is hard to take in these days. We are about 9 months into this pandemic and, as a country we have not been able to come to agreement on what we need to do. This is partly the result of bad leadership. Anyone who says the pandemic is about to end or that there is a cure or, worse, that the answer is to let the virus infect as many people as it can so that we can reach herd immunity is just plain wrong (or worse).

 

National

 

Yesterday, there were more than 62,000 new cases reported (the worst day since mid-July when 66,000 new cases were reported) (reported in the Washington Post). Wisconsin, Idaho, Ohio, Indiana, North Dakota, Montana, New Mexico and Colorado had single day highs in positivity rate reports. Hospitalizations are also rising again with deaths following. The CDC is now estimating 23,000 more deaths in the next 30 days and the current death toll is more than 218,000.  This is not the result of more testing (which is still inadequate, btw). And yet, we still see large gatherings (political rallies) with many people crowding shoulder to shoulder, unmasked.

 

We have some harder choices to make. Just as the holiday season is coming and we feel the greater need to be with family and friends because we miss them, need their comfort, and want to provide them with solace, we see infection rates going the wrong way and a denial of reality by large numbers of the population. Here’s what Dr. Jonathan Reiner, a respected infectious disease specialist is saying: “the consequences of this virus, particularly for older folks -- the people that we really want to gather with on Thanksgiving -- can be really dire," he said. And, frankly, I'd rather do a Zoom Thanksgiving with people that I love than expose them to something that might kill them," he said. "Next year is going to be much better. Let's get through this, and let's get through it safely."

 

I know this is a hard message. Maybe it’s especially hard since the infection rates around here seem relatively low. But this is a virus. It spreads person to person and people can be infectious without symptoms and even a presumed negative test. And we have to remember that it’s not just the people in the room you have to be concerned with. It’s the people they were in a room with and the people those people were in a room with, etc., etc.

 

Some of you have had an “early Thanksgiving,” outside while the weather still permits. Consider this as an alternative to Thanksgiving weekend celebrations, especially if you will be having extended family and friends from outside your household.

 

Local

 

Here’s the latest information available from DPH, town by town, risk levels:

https://www.mass.gov/info-details/community-level-covid-19-data-reporting

 

While most of our local communities are not at the higher risk rates, Holyoke, Amherst, Sunderland, and Springfield are at higher risk. The positivity rate for the State of Massachusetts as of 10.14.20 (7 day rolling average) was 1.17%.  This is an increase from last week. At Valley Medical group, for all patient tests completed the week ending 10/2/20, the positivity rate was 0.47%.  And Vermont now has quarantine restrictions for anyone from MA traveling to VT (with the exception of Franklin and Hampshire Counties).

 

These low rates are good. Can we count on them staying that way? We don’t know.

 

Watching the rest of the state and the rest of the country seeing increases in cases, we have to be concerned especially with increased travel to and from our area during the holidays. Please consider Dr. Reiner’s recommendations and avoid travel and large gatherings (even holiday celebrations, in person) if you can. The safest gatherings are virtual, then small outdoor celebrations, then indoor (small numbers) with windows and doors open, for as short a period of time as possible, etc. And, everyone wears a mask, washes their hands frequently, and stays at least 6 feet apart. And if you travel, check our quarantine guidelines for your return.

 

From Gina:

 

·         There is increased availability of testing in our area now. Anyone with symptoms or concerns should be tested.

·         We will be transitioning most care from our tents to the buildings as of November 1.

·         Flu vaccine is now available at all centers and practitioners and staff are now being vaccinated (remember, vaccines don’t save lives; vaccination saves lives).

 

 

OK. We are all connected and we have to act that way and protect each other.

 

https://www.youtube.com/watch?v=ouclNLG0ppI

 

That’s all for now. Thank you again for all you do,


Please stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

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VMG COVID-19 UPDATE

Friday, October 9, 2020                                                                                           Issue # 87

 

 

 

 

Good afternoon and thank you again for all your efforts this past week and in these highly unusual times.

 

Marta Tellado, President and CEO of Consumer’s Union wrote recently about one of Aesop’s Fables, The Boy Who Cried Wolf (the one where the boy convinces his neighbor that his sheep are being killed – so often that he is not believed). It’s 2,600 years old and Tellado’s point is that misinformation, and the chaos it creates, is as old as information itself. Only now, it’s complicated and accelerated by social media and by the violation of multiple norms by many “in charge” resulting in all sorts of conspiracy theories and false assertions. This creates a dangerous situation, especially in the midst of a pandemic, when we need people to make choices on a daily basis to protect their health and the health of their neighbors.

 

So, some very basic facts (actual facts):

 

·         The virus is in our populations; it did not go away

·         There is no “cure” and no vaccine (yet)

·         It spreads by droplets and also by aerosol (think of what smoke “looks like”), passed from person to person (this is why we stress wearing a mask or face covering over the mouth and nose; at least this reduces the droplets and some of the “smoke”)

·         So being in proximity to someone who is transmitting the virus is dangerous (that’s why we stress social distancing; at least 6 feet and no crowds)

·         People can spread the virus even before they themselves are symptomatic (so you may not know who has the virus which is why we stress, again, no crowds, wear a mask)

·         Concentrations of the virus matter; so outdoors in open air is safer than indoors with poor air flow

·         Although it is true that most cases are mild to moderate, we have seen, and are still seeing, large numbers of deaths and hospitalizations; it is not true that very few are affected (by the time you read this, the U.S. alone will have had 212,000 deaths) and we are seeing in excess of 40,000 new cases per day this past week

·         It’s not always easy to predict who will be most vulnerable; on average, elderly men with underlying conditions and people who cannot social distance and may have poor access to good housing, food, and medical care are two groups at high risk (and there are many others). But we don’t know what we don’t know (it’s only been with us since February-March) and other groups may also be at high risk

 

Our best defense so far is to wear masks, social/physical distance, meet virtually or outdoors (with masks and social distance), wash our hands a lot, and don’t go out if sick. Yes, we have lost jobs and businesses and wearing a mask can be “a pain” but, as Tom Friedman said in the NYT a few days ago “it was never a choice between masks OR jobs but rather masks FOR jobs (the more we keep people healthy the faster our businesses get back to normal and jobs return). Wearing a mask is not a sign of weakness. Wearing a mask is a sign of strength, being in touch with reality, and civic duty as those who wear them are doing what they can to protect others.

 

One other thing. Don’t listen to junk science or self-serving propaganda from people who don’t know science and don’t deal in facts. This is telling: Scientific American endorsed a presidential candidate for the first time in 100+ years of publication and the New England Journal of Medicine did the same.

 

If you want a close look at facts and trends, the link to this infographic is informative (it’s updated daily): https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/

 

COVID-19 #CoronaVirus Infographic Datapack - Information is Beautiful

UPDATE 21st Apr: Reinstated our NEW trajectories chart.Now tracks average daily deaths, active cases as well as total cases and total deaths. Great work by Omid Kashan.Inspired the excellent Financial Times team.: updated ‘Those aged 60+’ graphic with new UK data: added new risk data by biological sex (men more likely to die) (): added new dataviz on DIY mask materials ()

informationisbeautiful.net

It also has a graphic presentation of activities rated by COVID risk.

 

National and State

 

The Midwest and great plains states are seeing a steep rise in cases, hospitalizations, and deaths. The Northeast which, as we know, was first hit the hardest and then seemed to contain the virus and reduce spread (mainly by social distancing and masking), may now be seeing an increase in cases. Some major cities including New York and Boston are now rolling back some reopening or halting plans for increased activity (including school attendance). New Jersey has begun to close parks and picnic areas trying to cut down on gatherings.

 

In Massachusetts a total of 167cases among students and 92 among staff members have been reported since school reopening began (very likely an under-count as many cases were probably not reported). This is likely to increase as there is a lag between reported cases and opening of schools.

 

Why? Probably, the colder weather is forcing people indoors. Students are now back at many schools and colleges reopened. But it is probably also lowered vigilance and tolerance for the work of staying safe. In today’s NYT, Danielle Ompad, an epidemiologist at NYU was quoted as saying “we’re all kind of exhausted with it. We have to acknowledge that this is not easy.”

 

At VMG

 

We continue to do the work of providing needed services to patients while trying to keep them and our staff and practitioners as safe as possible.

 

We continue to monitor the positivity rates for the virus in our local areas and in the tests we do at VMG. For last week, no test done at VMG was positive. We are not seeing large increases in our immediate communities (except for some increase in the town of Amherst reported in college students living off campus).

 

Gina shared the latest version of our safety guidelines earlier this week. Please make sure to follow these practices and politely remind others when you see lapses; it’s good for them and for all of us.

 

As the weather gets colder (and stormier), a lot of work is going on to prepare to bring a higher proportion of care indoors, in as safe a way as possible.

 

More flu vaccine is arriving and we’ve begun and are continuing to plan for more patients getting vaccinated. And, as a reminder, all staff and practitioners are required to be vaccinated against flu this year (unless you meet exclusion criteria). We don’t yet have the plan for staff vaccination yet; soon.

 

Thanks again to the Facilities Team and all the “outdoor workers” as the recent storms came through forcing us to improvise and respond.

 

We’ll be sending our next communication to patients by the end of next week. We’ll send you a copy also. Here are some of the things we’re planning to let them know:

  • VMG is following the state’s mandatory safety standards including providing healthcare as much as possible by virtual means (video with audio preferable)

  • When you come to a VMG Health Center, please arrive ten minutes early. Screening will take place at the entrance (including temperature check, screening questions, hand hygiene, social distancing, and masks for all over 2 years of age)

  • Patients will be asked to wait in their vehicle if they arrive early. We’ll explain that, for patients with cars, this is the safest waiting area

  • Patients will be asked to bring their cell phone (if they have one). We’ll use their cell as the way to contact them when it’s time to enter for their services

  • Patients will be told that, when in the health center for an appointment, measures will be taken to continue to protect them. We will be careful to limit time in exam rooms and we’ll use available technology (iPad or other devices or cell phone to complete part of the visit

  • VMG has a separate and distinct section for all patients who are being seen for illness in Greenfield, Northampton and Amherst

  • Testing for symptoms of flu, strep throat, COVID-19, will be completed as self-testing, outside, guided by a VMG staff member

  • We will be stressing the importance of flu vaccination for all patients

  • We’ll be reminding patients to try to be in quiet, private spaces during virtual visits.

OK, that’s all for now. Get outdoors this weekend, listen to some good music, read, see friends and family safely and have a good weekend.


Please stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

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VMG COVID-19 UPDATE

Friday, October 2, 2020                                                    Issue # 86

 

 

 

 

We all woke up to the news this morning that the President, First Lady, White House Aides and members of Congress have tested positive for coronavirus and some are experiencing symptoms of COVID-19. I wish them all well and a complete recovery. The situation is a good reminder that anyone can get this virus (setting aside the White House refusal to wear masks and stay out of crowds) and that the virus is still in the world’s population and will not disappear. We know how to be careful. And we all should continue to be careful.

 

We missed my favorite “holiday” last month (well, maybe my second favorite; Thanksgiving is my favorite). National Ampersand Day was September 8. Why do I like National Ampersand Day? First, if you don’t recognize the word, the ampersand is this character: “&”. We use it as a way to say “and” as in Johnson & Johnson, for instance.

 

But here’s the reason I think it’s important to think about the ampersand. We can hold two, sometimes contradictory, ideas as valid at the same time. This is not only true in culture and politics. It’s also true in medicine and science (this is sometimes why we run experiments). And it’s also true in organizations (on teams) as well as in close relationships (well, maybe not with kids, but go ahead and proceed as if…maybe your kids are exceptional). It’s a way to keep a conversation going, to learn better and more. Instead of laying out opinions as the only truths, instead of saying “yes, but,” we can say “yes, and.” Two things can seem irreconcilable but both can sometimes be true at the same time. Or maybe conducting discussions (when differences are apparent) with an ampersand can lead to better decisions, compromises, or at least to understanding the other person. And from that understanding, we can move past seeming impasses. Hold these thoughts, please.

 

On my way into work Thursday morning I had a near accident at an intersection. You know how when you approach a traffic light and it’s yellow and you go through it just as it’s turning red? We all do this, I’m sure, lots of times without accident. Well, Thursday morning a car approaching a light that was turning red picked up speed through the intersection just as I was turning left into his/her path. My brakes worked, the pickup truck behind me swerved and braked, and the car running the light also swerved and made it through. I’m sure my heart rate was through the roof. Someone told me this was my stress test for the day. Anyway, once I calmed, I couldn’t help thinking about the number of times I saw a light turn yellow and, without thinking, went through without incident. Almost every time it works out well so I don’t think about it much. (Remember how good the turkeys feel until Thanksgiving…). Having an accident in this situation is such a low frequency event for most of us we don’t consider what to do. We’re on autopilot. And that works until it doesn’t. Stay aware in those intersections.

 

One other example: most people who have a glass of wine or a beer or two at dinner don’t consider ourselves drunk. We might get in the car to drive home. And most of the time we don’t get in an accident. We make it home without harm to ourselves or others. Until….

 

Here’s the point I’m trying to make. We’re in that situation now with COVID-19. Since most of us are not infected (and maybe we don’t even know someone who is or was infected), we may be tempted to get lax about gatherings, traveling, wearing our masks, etc. We see other medical groups bringing in more and more patients to in-person visits to “get back to normal.” But maybe there is no “normal” until we have a vaccine and enough of us get vaccinated (“vaccines don’t save lives; vaccination saves lives”).

 

So as we approach what Steve called the “high risk season” (colder weather driving us indoors in enclosed spaces, windows closed, maybe not the best air flow for long periods of time while the virus is with us), we see two necessities: keep slowing transmission of the virus AND provide necessary services in volumes that move us toward “normal.” I’m sure this is true in your homes and personal lives too. You want to keep safe AND you want to enjoy your loved ones and friends. Let’s try to find reasonable paths to do both, as possible.

 

Maybe the most famous person in the world getting infected will help us all keep thinking that the virus is here AND we have to make good decisions. Read this:

 

https://www.cnn.com/2020/09/29/health/how-to-stay-safe-covid-fall-autumn-wellness-trnd/index.html

 

And this may help with perspective also:


https://www.cnn.com/2020/09/30/health/back-to-normal-bias-wellness/index.html

 

 

National and State

 

Half the states are experiencing increased cases and hospitalizations. The national death toll is now 208,000.

 

In our state, Boston and Springfield are now “red zones” meaning that DPH sees statistical increases of concern. The case positivity rate for the State of Massachusetts as of 9/30/20 (14 day rolling average) was 0.87% (still pretty low). However, yesterday that rate rose to 1.1% causing some localities to hold on or role back reopening plans. It’s too soon to know if this trend will continue but the fall is here, the weather is changing, and we’ll all have to be more careful.

 

At VMG

 

Since we are now doing COVID testing, we can report on our own small sample of test results. The Valley Medical Group rate for all patient tests completed the week ending 9/23/20 was 0.52%. We’re not sure what to make of that because the numbers of people tested are still relatively small but at least it’s not higher than the state. We are monitoring our own test results as well as the state and regional averages to make judgments about our own plans to continue bringing in more patients.

 

Flu clinics are in process and the plan is to continue to roll out more messaging and clinics as we get more vaccine. We’ll be updating employees about getting vaccinated in the next few days.

 

The storm Tuesday blew down our tent in Easthampton (again). Thanks to all the staff who worked on getting operations back up and running as the weather threw us a curve ball (I do wish we could just talk baseball – normality envy).

 

From the Concert in Central Park, 1991…We need bridges, ampersands, friends.

 

https://www.simonandgarfunkel.com/video/simon-garfunkel-bridge-troubled-water-concert-central-park/

 

 

Please stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

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RAF Clinical Champion Update

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VMG COVID-19 UPDATE

Friday, September 25, 2020                                                        Issue # 85

 

 

 

 

There’s a thing about turkeys that are raised on farms. They get fed and fed and fed and they must “think” that will always happen. And then…….Thanksgiving. We are not there now, though I must admit, it sometimes feels that way (and I know that these newsletters play a part).

 

We have been in COVID-19 “Ground Hog Day” for many months now. What must people who lived through the Great Influenza of 1918-20 have been thinking?  About a third of the world’s population became infected by the H1N1 virus, 50 million died worldwide and 675,000 died in the U.S. According to the CDC, mortality was highest in children less than 5, adults age 20-40 and over 65.

 

But this is 2020, not 1918. We know more about transmissibility now than we did back then. We have the ability to make a vaccine now that we did not have back then. And our scientific abilities and infrastructure is stronger now than it was then. We don’t have to have similar results. We can do better.

 

But to do better, we have to take advantage of what we know from science and public health. And we will have to be willing to take care of each other by doing the things that will slow the spread. We know we can do better and we know how we can do better. But are we? Will we?

 

Just today, looking at a map of rising infections across the country mostly west of the Mississippi river, you have to wonder why people are not taking the reasonable precautions that are easy to take and will get us lives saved (you know what they are). We now have passed 7 million cases of COVID and 203,000 deaths. Twenty three states are reporting rising numbers. Are people just believing the loudest voices and the politically induced anesthesia to scientific reality? Causing people to “rally” elbow to elbow, unmasked, for prolonged periods of time (even if outdoors) is a recipe for a viral fog that will  cause increased cases and deaths. But we are seeing that where people are taking reasonable precautions, case counts are lowest.

 

So the good news, at least so far, is that Massachusetts and much of New England are seeing case positivity rates less than 1.0. That’s pretty good considering the contagion. Here in Western Massachusetts, with the exception of an occasional spike, we’re in the .8% range. And here at VMG, we are, based on the recent COVID testing we are now doing, at about .8% for patients getting tested (with zero positive tests last week).

 

Let’s talk about vaccines. The work is being done. There are now assurances from the FDA that no vaccine will be released unless the rigorous scientific processes to assure that it works against the virus and that it is safe to use are followed. So, will you and your family “get in line” to get the vaccination (remember: vaccines don’t save lives; vaccination saves lives) when it’s finally available  I’m sure that will depend on what you hear and read about effectiveness and safety.

 

Dr. Ali Kahn, infectious disease specialist at the University of Nebraska, has been talking about three criteria for the vaccine: proven effectiveness, proven safety, and just as important, TRUSTWORTHINESS. With all the political interference (or attempted interference) with the FDA and the CDC, and with the public pronouncements of people in government with no scientific training and no regard for public health, trustworthiness is in question just when we will need it to be as certain as possible.

 

What this means is: put on your public health hat, read the science or the trustworthy summaries of the science and become a public advocate of science and health. For most patients, and most of our friends, neighbors and relatives, what we tell them may carry more weight than those who have not, or will not, read the science and speak only from their self-interest. That’s where we are today. Who would have thought?

 

At VMG

Since controlling flu outbreaks will be especially important this fall and winter, we’re arranging flu clinics now and awaiting vaccine shipments. The flu clinic outside at GHC recently went very well. We’re going to ramp this up as much as we can while the reasonable weather is with us. Our use of the Carebot texting platform for reserving vaccine and scheduling without having to go through reception is working well. Patients appreciate this.

Steve reminded us that the #1 cause of death remains heart disease and stroke with cancer at number two. COVID-19 is now number three. We need to continue to provide services to screen, protect and treat people for these conditions. So, we are working on plans for increased in person visits and services so long as we continue to see case positivity rates that are reasonably safe. If we see our rates in our communities rising to unsafe levels, we’ll make other plans.

 

 

 

Pete Seeger died in 2014 of natural causes. He was 94. He used his talents and following to protest against war and hunger and for civil rights and environmental causes (particularly in his home region of the Hudson Valley of New York, being a key contributor to the Hudson River cleanup). He wrote this song in 1967 as an anti-war protest of the time but it still has relevance today in our antiracism efforts and in combatting anti science.

 

https://www.youtube.com/watch?v=24VOo7-ctKU

 

Pete Seeger - Waist Deep in the Big Muddy

Vietnam War songs: https://rateyourmusic.com/list/JBrummer/vietnam_war_song_project/ Iconic American folk singer, Seeger played a key role in the 1950s folk revival and the 1960s anti-war movement. He often wrote political songs, protesting against war, segregation, and calling for environmental protection. The song "Waist Deep in the Big Muddy ...

www.youtube.com

 

So please stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Thank you, thank you, and thank you for all you do. Have a great weekend.

 

 

Joel

Be patient; be mindful

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VMG COVID-19 UPDATE

Friday, September 18, 2020                                                               Issue # 84

 

 

 

It’s been about 7 months since the COVID-19 pandemic came to our region. It feels like 7 years. Every day I get up, turn on the news, and hope for some really good news about a vaccine, a treatment, something. But what I know is that this is a very new virus and it’s only been 7 months.

 

 

 

Science takes time. I have to be patient; we have to be patient. We got through the pandemic of 1918 and 1919 (no, I don’t mean literally we; none of us are that old) and we will get through this one as well. But what can we learn and how can we make the outcome as good as possible?

 

One thing I know for sure is that kindness, cooperation, and being empathic really helps. Togetherness helps. Finding “common ground” helps. Picking up the spirits of someone else helps. I’ve seen this in our company, in the way we treat our patients and in the way we treat each other and that is really heartening and good for the soul.  And I see it in the “Tiger Box” responses. That’s an “old trick;” let’s keep doing it.

 

Now about the virus, what we know is a lot less than what we don’t know at 7 months in.

 

·         We know we can reduce transmission by wearing masks. Let’s keep doing that and help others to do that

·         We know that social distancing helps. Let’s keep doing that and help others to do that

·         We know that small gatherings, with social/physical distance really helps. Let’s keep doing that and help others to do that

·         We know that outdoors, with lots of air flow, is better than indoors with limited air flow for people to be together. Let’s keep doing that and help others to do that

·         We know that large gatherings without social distancing and mask protection do not work. Let’s not do that and try to remind others not do to that.

 

We know that the virus is here, in our world, and not going away. In Europe, there are now several countries that were doing well before the end of the summer that are now seeing an increase in cases (France and Spain are examples). This is probably due to travel and people feeling more complacent and loosening restrictions during the summer. In the U.S., we’re seeing rises in the Midwest and some less populous states. And, as you know we saw an outbreak in Millinocket, Maine from an indoor wedding without social distance and masks that has spread to relatives and families that were not even at the wedding. We do know how to prevent that kind of spread.

 

We’re learning as we go. There were reports that neck gaiters (the cylindrical materials worn by runners, bikers, skiers to keep their necks warm and now used as masks) were actually spreading virus at higher rates than masks. We learned that was not true. We heard that nearsighted people wearing eyeglasses were more protected from the virus. Nobody is sure of that yet, but probably not. There were reports of drugs that worked (e.g., hydroxychloroquine, Metamucil, Pepcid). Those have been disproven. On the other hand, we learned that some drugs do help to reduce stays in ICU’s and hospitals and lessen symptoms for some (Remdesivir, steroids). More to come, I’m sure.

 

There will be a vaccine. We don’t yet know when it/they will be proven safe and effective and how long it will take to manufacture enough for what the world will need (it’s not just about us; this is a pandemic). This will be a lesson not just in science, but in how we handle scarcity across the globe. Already there are reports that the richest countries are buying up future supplies at the expense of poorer countries. We have to deal with that as humankind (and we don’t have a good record of that by history). But we have the opportunity to change.

 

And finally for today on the opportunity to change and the need to change….

 

One million people lost their health insurance last year. We’re now in the midst of a pandemic. Can we use this “opportunity” to do what every other country with resources has done and provide access to healthcare for all?

 

We’ve learned, because the pandemic has further uncovered the inequities in resources, what we probably already knew but, as a country did not address: that people with poor access to uncrowded housing, good food, jobs with benefits, education, health insurance and healthcare providers, are getting sicker more often and dying at much higher rates than those with access. In our country, that means people of color, Native Americans, and many rural white Americans are suffering from these inequities at much higher rates than would be seen if inequities were lessened.

 

For a specific example, we’ve learned that “Black, Hispanic, and American Indian children are dying of coronavirus at much higher numbers than whites. For children, they account for 75% of the deaths but only 41 percent of the population. It may be true that these groups have higher rates of underlying health conditions. But what’s the cause of that? The most likely answer is unequal access to the resources of the richest large country on earth. Racism.

 

We have the opportunity to change. Please talk with each other. Join us in discussing at our upcoming VMG Community Forum. Vote for candidates who will take this on and move us to get better. Speaking up will help. The following is from UMass Basketball:

 

https://www.youtube.com/watch?v=bsIA6xenK70  

 

At VMG

 

We are ramping up testing for COVID-19 for symptomatic and asymptomatic patients of VMG, for any reason. Our most recent patient newsletter, going out now by email, is informing our patients.

 

Flu clinics are starting soon. Even though there are reports of milder flu this year form the southern hemisphere (e.g. Australia), that’s probably more true in places where they took mask wearing and social distancing more seriously. Complicating all this is that we are beginning to see the effects of the western wildfires on air pollution even in our area. We’ll need to be able to distinguish illness from COVID-19 and influenza. So let’s do what we can to lessen respiratory illness this fall and winter and getting vaccinated against the flu is something we can all do. For these reasons, as Gina’s email announced, we are now requiring all VMG staff and practitioners to get the flu vaccine prior to December 1 of this year (there are exceptions for medical and religious reasons – see Gina’s email for more information).

 

By the way, because the logistics of running flu clinics are much more complicated in the pandemic, we are looking to places like the GCC nursing program and the Westfield State PA program to help us “staff” the clinics.  Thanks to Mary, Rachel and Gina for pursuing these resources.

As previously announced, we’re using Carebot to automatically send texts to patients asking them to reserve and schedule flu vaccination (remember that “vaccines don’t save lives; vaccination saves lives”). Patients are responding well to the texts (30% response rate to reserve vaccine and half of responses have scheduled). 

 

A lot of work has been going on behind the scenes at investigating and regulating our HVAC systems to provide better air flow (and increase the mix of outside air) in our buildings. You’ll be seeing a few changes soon to make use of areas that are more optimal. This is important especially as we begin to increase the number of people in our buildings as we anticipate the winter months and the closing and/or reduction in use of our outdoor spaces.

 

Finally, our optical shop, Valley Opticare, is now fully opened for business in our Easthampton Health Center.

 

 

 

 

OK. How are virtual choirs created? https://www.youtube.com/watch?v=uS0ioMnVdHw

 

Stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

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Asthma Clinical Champion Update

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VMG COVID-19 UPDATE

Friday, September 10, 2020                                                                                       Issue # 83

 

 

 

 

I think we are all ready for the weekend. Thanks for another great week of taking care of our patients and each other. And that’s the good news of today and during these crises. Day after day you and we demonstrate we can do both. It means a lot to our communities and to our Board and we thank you for all your efforts.

 

There are some things and times that call for neutrality in business (most things, probably). We generally don’t want to confuse our mission and focus with politics. But we’re in much different times now in health care. We have numerous crises to deal with. So this is my opinion. It is well past time for change.

 

One thousand. That’s the number of deaths now attributable to COVID-19 per day in the U.S. for the last several days.

1209 = number of deaths in U.S. yesterday. The U.S. population is 328 million.

75 = number of total deaths yesterday in Spain, Italy, Japan, Canada, the UK, and Germany. The total population in those countries is 420 million. Finally,

53 is the number of days until the U.S. Presidential election.

 

Why am I starting with these numbers? Because it’s about all our health. Because it is undeniably clear that the outsized number of deaths and serious impact on health from COVID-19 are the result of incompetence, dishonesty, and failure to lead of this administration. If you haven’t seen the news in the last few days, in his own voice, our president has admitted to not telling the truth about the seriousness of this illness, about how it spreads, about whom it affects. And worse, he took no reasonable actions to mitigate and protect against this virus and LEAD by telling the truth and making the case for simple and effective means of protecting the country (masks, social distancing) and allowing the scientists to take center stage and communicate with the public. And worse than that, he’s still doing it (“we’ve rounded the corner”). And he’s still holding large, super-spreader, events.

 

The number one lesson we “learned” from the 1918 flu pandemic, in the words of historian John Barry, is “Tell the truth. People in authority need to tell the truth.” It’s the only way people can be roused to take action when faced with hard choices and maintain trust in the agencies charged with promoting health and keeping us safe.

 

Let’s connect some other dots. Black people, people of color, people with poor access to resources, people with less or no ability to stay home, people in overcrowded housing, people who rely on public transportation and with poor access to good food and supplies are still getting sick and dying in numbers 2-4 times higher than white people generally, and people with resources in particular. And the current administration says, in his own voice again, there is no systemic bias or racism. So the alternative facts might be that people of color and those without access to resources are choosing to get infected and die? Or they are the result of “random,” non-systemic factors? Let’s tell the truth here too. The answer is no. The data show the truth. Time to work on this, together. And about “together…”

 

What can a president do to “bring us together” to create a safer society in the face of a national tragedy? Here’s an example we’ve lived through (and probably not from someone you first thought I’d mention). Today is the 19th anniversary of 9/11. After the shock and profound sadness and grief over the loss of life in that horrific and unjustified attack on our country, there were many people who were set to start and amplify attacks on Muslim citizens (and our current president lied about seeing crowds of Muslims cheering at the burning buildings in NYC). What did our then President do? George W. Bush, almost immediately, went to a mosque in Washington D.C. to affirm that we would not be starting a war with Islamic peoples, though we would fight the terrorists. He understood that, while there were some people of the faith that committed these crimes, there were millions of others of that faith who were appalled and horrified by those crimes (and many who were killed in the attacks). He understood the need to keep our citizens together and focused on the real crimes and not a war on millions of innocent people. He told the truth about this at that time and did what he could initially to deal with our grief and wounds. He did not inflame the situation. He did this symbolically (by going to the mosque) and by his words. Words have meaning and consequences and he understood that.

 

What does this administration do when people are feeling vulnerable? He amplifies fear. He builds literal and figurative walls. He blames people who are victimized. He lies about the causes of disruption and demonstrations. He uses language that is misleading, full of bias and denigration.

 

Last number for today. 53 days until the election. Tom Seaver, one of the greatest and most reliable pitchers of all time, died almost two weeks ago of Lewy body dementia and COVID-19. He led the “Amazin” Mets in 1969 as they won the World Series. Back then, in anti-war demonstrations, there were signs that said “If the Mets can win the series, we can stop the war.” There is no “real” World Series this year (my opinion) and no “Amazin Mets.” But we can take a big step to stop what’s happening in our country at the ballot box in 53 days. Our democracy rests on citizen participation. Whether you agree with me or not, please vote as you will (and only once please).

 

As you know, the VMG Board has made a commitment to do what we can to counter bias in health care, systemic and personal, and become an antiracist organization. You’ll see a plan over the next few weeks to get us there and we are holding another VMG “community forum” on 9/29 to make sure we hear you and your concerns and share the work of our antiracism committee. We believe that listening to each other is the first step in this work. More details to follow. But first, if you will, watch this video and consider what it might mean:

https://www.pbs.org/video/pov-implicit-bias-peanut-butter-jelly-and-racism/

 

Now about the virus. “What we are dealing with is a giant tube of glitter. You open a tube of glitter in your basement, then two weeks later you are in the attic and all you find is glitter and have no idea how it got there,” Dr. Nirav Shah, the Maine CDC director, said this in a briefing a few days ago as the virus spread through a rural Maine community. The source was determined to be a wedding at a local church and venue. The state had marked Penobscot County as “green,” meaning there was a low risk of COVID-19 and students could likely return to school in person. The seclusion and self-dependence of Millinocket seemed to insulate it from the pandemic’s perils. But after the wedding, it became clear that in small towns built on close personal connections, those virtues could be hazards, too. We need to learn from this, probably over and over again.

 

Now some good news about vaccines in development (and this may not seem good, but it is). Several key manufacturers of vaccines publicly stated that they would not seek approval or release a vaccine until they followed all the rigorous steps in proving safety and efficacy. In addition, one trial was halted to investigate an unusual illness in a trial participant. That’s really good because the consequences of releasing a vaccine before establishing safety and efficacy are severe. As reported in a recent article, one, the vaccine may not be safe. Two, if it is not safe, people will lose faith in vaccines. Three, if a vaccine doesn't offer complete protection, people will have a false sense of security and increase their risk. Four, if a substandard vaccine gets an Emergency Use Authorization (an FDA approval to release a drug or vaccine “early”), a better vaccine may never get approval, because people would be reluctant to enroll in trials and risk getting a placebo instead of a vaccine. So good news there. Let’s be certain we’re doing it right.

 

State and Local

 

Massachusetts generally, and  our locations specifically, are still doing well with case positivity rates that are well below where they were in the worst months of the pandemic. There are outbreaks from time to time, usually traced to large gatherings without proper precautions (parties, etc.). Check out the community by community map at the DPH website (see previous editions for the link). Staying cautious about traveling, wearing masks, small gatherings outdoors, social distancing are still the rule of the day and our best defense against viral spread (remember the tube of glitter above).

 

At VMG

 

We are now doing two types of testing at VMG. First is PCR testing by nasal swab. This test detects the presence of viral genetic material and is a good test, at a point in time, to determine if someone has the virus. We’re doing this for VMG patients only. The second type of test is for antibodies to the virus. This test may have some clinical utility but, as Steve pointed out in an email to practitioners this morning, the clinical meaning is still of limited value since we don’t know if the antibodies detected actually man the patient is now protected from the virus and we don’t want people thinking that they can then “let down their guard.” We all still need patients to take the precautions we have relied on (you know what they are).

 

The AMC Optical Shop is now moved to EHC where we now have our only Eye Care practice. Hours are being determined and patients will be notified.

 

Our RN Team Leaders and Health Center Managers are working on bringing up plans for flu clinics. More information is coming (as is the vaccine). As you know, we want this to be an especially good year for flu vaccinations since we need to be able to reduce the impact of respiratory disease during the pandemic. Remember that “vaccine does not save lives. Vaccination saves lives.” And, “the most dangerous vaccines are the ones you don’t take.”

 

Our use of Carebot, a platform used to text patients to reserve their flu vaccine, is going well.  So far, 20,000 texts have been sent to our “highest risk” patients and 28% have reserved vaccine.  We want to remind everyone of the importance of getting patients’ mobile numbers for texting.  Medium risk patients will be contacted next week.

 

 

OK, just for fun, there are so many flash mob videos now out there. Here’s one from Japan.

 

https://www.youtube.com/watch?v=3lNaajK3Scc

 

Stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

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Diabetes Clinical Champion Update

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Friday, August 28, 2020                                                                                                                     Issue # 82

 

 

 

 

Thank you for another week of taking care of our patients and each other. The weekend is just about here and I hope you will enjoy it.

 

First some good news. The 7 day positivity rate fell to below 1% in Massachusetts yesterday. But that’s for the state as a whole. There are communities that DPH sees as higher risk (see the interactive map I sent last week). We’ll come back to this in a minute.

 

Some things about the pandemic are complex. There are many things we still don’t know about this virus and its effects on our bodies. We will learn more, I’m sure, the hard way (through experience) and by study (science).

 

But some things are not at all complex; they are simple. The virus spreads best in prolonged and close contact with people who have it, whether they are symptomatic or not. It spreads best when those people are not wearing masks and are in close proximity to each other. It spreads best when they are singing, talking loudly, yelling, etc. It spreads best when in enclosed spaces with less ventilation. So why are we, as a society, not avoiding these situations? There is a theory that the closer we get to a vaccine or treatment, the more these are discussed as “just around the corner,” the more risk people are taking in being exposed or in taking fewer precautions. The main problem with this thinking is that the virus is still there just as before and we are months away if not a year or more from widely available and effective treatments and vaccines.

 

Here are some recent examples. Close to home, a cluster of new cases and illness in Massachusetts was found for a group of people who attended a “bachelorette” party in RI in the last few weeks. More recent: forget the politics but look at what happened on the White House lawn last night. Hundreds of people, sitting inches apart, talking loudly, singing, without wearing masks (and almost all were not tested – I mean for coronavirus, not IQ -- prior). These were avoidable situations. This did not have to happen this way. We’ll see what happens a few weeks from now. Maybe they will learn “the hard way.”

 

There are unavoidable situations. A Harvard study reported by Dasia Moore in the Boston Globe yesterday (https://www.bostonglobe.com/2020/08/27/nation/new-study-finds-staggering-racial-disparities-covid-19-cases-massachusetts/?s_campaign=breakingnews:newsletter) “absolutely confirms and demonstrates what we saw [in Massachusetts] and the reasons why we saw it.” “Dr. Joseph Betancourt, vice president and chief equity and inclusion officer of Massachusetts General Hospital said that communities of color experience a “perfect storm of conditions for the spread of coronavirus,” including less access to health care and public health information, broken trust with medical communities, environmental and public health factors that contribute to poor overall health, and — in the case of COVID-19 — work and living conditions that increase exposure to the virus.

 

From the early days of the pandemic, Massachusetts cities with large Latino and Black populations have suffered high infection rates and death tolls. Chelsea, the city with the highest number of total cases per capita in the state, is 66.9 percent Hispanic or Latino. Of Massachusetts COVID-19 cases where the infected person’s race is known, 45.6 percent are non-Hispanic white, a group that makes up 71.1 percent of the state’s population. Similar patterns have played out nationally.”

 

Additionally reported, was the finding that “higher average household size and larger shares of food service workers, foreign-born noncitizens, and non-high school graduates across cities were all independent predictors of higher COVID-19 infection rates. A city’s foreign-born noncitizen population proved to have an especially strong correlation with higher COVID-19 case rates.”

 

Finally, they stated that because race is a social concept not based in biology or genetics, it does not by itself make a person more susceptible to COVID-19.

 

So what does this all mean? We have demonstrated an outsized proportion of cases (and deaths) in communities of color. You can choose whether or not to go to a bachelorette party (or a wedding) where people are not masked and crowded together. You can choose whether or not to go to a political rally and sit inches from others without masks, singing, talking loudly. But many cannot choose a less crowded living situation or choose a job that does not place them in close proximity with others having to get there by public transportation and without adequate masking. Many cannot choose to stay home for fear of losing a job or not having enough money to feed their families. Choices are less available in communities of color and economic disadvantage.

 

We believe that solutions to these situations will have to be found in making the vast resources of our society more evenly available to all, and without bias. We believe in becoming anti-racist.

 

The VMG Board of Directors has endorsed the following statement:

 

“Valley Medical Group stands against racism. We believe that racism and prejudice cause poor health and shortens lives. Valley Medical Group reaffirms its opposition to violence, hatred, and discrimination of any kind. We aspire to educate, discuss, and practice an anti-racist approach in all areas of our medical practices. We welcome feedback in support of our goal. Black Lives Matter.” 

 

Dr. Gump has already written to all of us inviting our participation in our efforts. You’ll be hearing more about opportunities in the next few weeks. I hope you will all join us in helping to create better communities, a better society, and healthcare that is even more welcoming, accessible and delivered to all equally.

 

At VMG

 

You’ll soon be hearing about COVID-19 PCR testing available at VMG. Testing will be for VMG patients only. It will be by nasal swab, “self-administered” during observation, and sent out to a national lab for reporting. Our thanks to Debbie Bolognani and the lab staff for the work in getting this going.

 

We are just now sending a special addition of our patient newsletter encouraging all to get flu shots beginning in a few weeks. (You can read the letter on the landing page for our VMGMA.com website). Plans are underway for flu vaccination clinics. You’ll hear more about this also very soon.

 

We are working with some new software to help us with managing access to the buildings and with appointments for flu clinics. You’ll be hearing more about “OhMD” (currently being trialed at EHC) and about CareBot (a system for texting patients to “reserve” their flu vaccine and notify them when it is available and avoiding phone calls to reception).

 

Dr. Mandile and Dr. Cai and our Eye Care Staff have reopened our Eye Care practice now in the Easthampton Health Center. She is seeing in person patients as well as virtual visits. Thanks to the Eye Care Staff and the Optometrists for getting us up and running. The first week went well. We’ll soon be moving our Optical Shop to EHC as well.

 

 

Keep together.

https://www.youtube.com/watch?v=foyH-TEs9D0

 

And please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

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VMG COVID-19 UPDATE

VMG COVID-19 UPDATE

Friday, August 21, 2020                                                                                                                                  Issue # 81

 

 

I’m going to start today with something on Public Health because, well:

 

·         It’s a societal good; it should be seen as basic infrastructure that allows us to grow and “live longer, better”

·         It needs work and funding; it is not “distributed evenly” and those with less means (money, housing, food, access to healthcare) don’t’ fare as well as those with greater means (

·         And, we’ve learned that in addition to honest, clear, and direct leadership in pandemics and health crises, it’s all we have

 

Ed Young, a really good science writer for The Atlantic, recently published an article called How the Pandemic Defeated America. Some excerpts:

At the end of the 20th century, public-health improvements meant that Americans were living an average of 30 years longer than they were at the start of it. Maternal mortality had fallen by 99 percent; infant mortality by 90 percent. Fortified foods all but eliminated rickets and goiters. Vaccines eradicated smallpox and polio, and brought measles, diphtheria, and rubella to heel. These measures, coupled with antibiotics and better sanitation, curbed infectious diseases to such a degree that some scientists predicted they would soon pass into history. But instead, these achievements brought complacency. “As public health did its job, it became a target” of budget cuts, says Lori Freeman, the CEO of the National Association of County and City Health Officials.

Today, the U.S. spends just 2.5 percent of its gigantic health-care budget on public health. Underfunded health departments were already struggling to deal with opioid addiction, climbing obesity rates, contaminated water, and easily preventable diseases. Last year saw the most measles cases since 1992. In 2018, the U.S. had 115,000 cases of syphilis and 580,000 cases of gonorrhea—numbers not seen in almost three decades. It has 1.7 million cases of chlamydia, the highest number ever recorded.

And some comments on some “special” populations:

 

America’s neglect of nursing homes and prisons, its sick buildings, and its botched deployment of tests are all indicative of its problematic attitude toward health: “Get hospitals ready and wait for sick people to show,” as Sheila Davis, the CEO of the nonprofit Partners in Health, puts it. “Especially in the beginning, we catered our entire [COVID‑19] response to the 20 percent of people who required hospitalization, rather than preventing transmission in the community.” The latter is the job of the public-health system, which prevents sickness in populations instead of merely treating it in individuals. That system pairs uneasily with a national temperament that views health as a matter of personal responsibility rather than a collective good.

 

You can read more here: https://link.zixcentral.com/u/2883b7bc/duJmxHPa6hG-VjfkMy1kxg?u=https%3A%2F%2Fwww.theatlantic.com%2Fmagazine%2Farchive%2F2020%2F09%2Fcoronavirus-american-failure%2F614191%2F%3Futm_source%3Dnewsletter%26utm_medium%3Demail%26utm_campaign%3Dmasthead-newsletter%26utm_content%3D20200808%26silverid-ref%3DNjY0MTI3MzYzMzk5S0

 

If you were wondering how we, at VMG, became public health workers, this is why. Now that we’re in it, let’s continue to avoid complacency and keep to facts, science, and making the difficult decisions necessary to provide needed care in the safest possible way.

 

Some words about flu (which is on the way). We’ve gotten some good questions lately about the coming together of flu season and COVID-19 outbreaks. They are separate illnesses. You can get then both. Having had one does not protect from having the other. And it’s probably true that If your lungs and other systems are weakened by one, you can be more vulnerable to the other and the effects can be more severe.

 

There are questions about whether getting the flu immunization will protect from getting COVID. It does not work that way; separate diseases. There are questions about whether getting the flu immunization during the pandemic can make you more vulnerable to COVID. Not so. So while the flu vaccine will not keep you from getting COVID, we believe that preventing flu by getting immunized will keep you from getting sick and being more vulnerable to COVID and other illnesses. As Dr. Maroun reminded me, the most dangerous vaccines are the ones you don’t take. So, as we prepare to vaccinate as many of our patients as we possibly can against the flu, please, please protect yourself and your families by getting the flu shot. More on our process for vaccinating staff will be coming shortly.

 

International and National

 

This continues to be a global pandemic. There are now more than 22 million cases and about 795,000 deaths attributed to COVID-19. You can see the effects here:

 

https://nytimes.com/interactive/2020/world/coronavirus-maps.html

 

As reported by the NYT,” The virus continues to affect every region of the world, but some countries are experiencing high rates of infection, while others appear to have mostly controlled the virus.” Much of South America, the U.S., Iraq and Spain appear to be global hot spots. There are more than 200,000 new cases reported, daily. The virus does appear, overall, to be showing a slight downward trend in the U.S. because of some slowing in the southern states that were hit the hardest (though Florida, Texas, California, and Arizona still have a lot of infections, hospital admits and high case positivity rates).

 

So while some countries and states are reporting recent downward trends (especially in places that were first to experience the pandemic), this pandemic is far from being controlled. New virus, no vaccine, no good treatments = Wear a mask, keep social distancing and avoiding crowds, wash your hands, stay isolated when sick.

 

In Our State and Region

 

While there is still a lot of political fighting about opening schools in the U.S. (and the results have not been good at some colleges and school systems across the country), NYC teachers are threatening to strike if the city persists with its plan to open to in-person instruction.

 

In our state, Boston public schools will start the school year with remote learning and then bring students back as conditions permit. Across the state, about 70% of school systems were planning at least partial in person instruction and the Governor has plans to deploy “mobile rapid testing units” to schools that may have outbreaks. It’s a good idea, but why not avoid the need?

 

Big picture in Massachusetts: the Governor reports that “73 percent of communities have seen a decrease or no change in daily average cases in the last two weeks” as reported in the Boston Globe yesterday. The 7 day weighted average of positive tests was 1.3% (that’s a good number). Locally, South Hadley was raised to high risk while Holyoke was lowered to moderate risk. Springfield, Chicopee, Holyoke, Easthampton were steady at 4-8 cases per 100,000; Northampton was at <4 cases per 100,000. These are relatively good numbers.

 

Hampshire and Franklin counties are still experiencing among the lowest rates in the state.

 

At VMG

 

Jim Wood and Greg Folta have been working with our HVAC companies to monitor and understand air flow and air exchanges in rooms across out centers. They have already adjusted the systems to increase the amount of outside, fresh air in the buildings. This helps to reduce risk of transmission along with our previously established processes: screening all who enter the buildings, using our outdoor “facilities” for lab, nursing, and other visits as much as possible, creating separate “pathways” for those with respiratory symptoms or suspected cases, and reducing time in exam rooms by hybrid visits and telehealth. We are doing well with virtual visits (but please remember to make sure that we are using video for all possible virtual visits; it’s better for “seeing” and understanding patient symptoms and better for our finances). We have adequate supplies of PPE and we are ordering “in advance” to maintain inventory.

 

We are considering the best methods for increasing in person visits over the next few months and in preparation for late fall and winter (when our tents will be difficult or impossible to use). We will proceed slowly and deliberately and monitor case positivity rates in our towns (and for patients where we have test results) and proceed or reduce our in-person access as the data suggest. You’ll hear more about this in the next few weeks.

 

None of us have been through this before. I am daily impressed by your efforts, your willingness to take on this public health mission and continued care, and our ability to change processes and do the best we can for all. Thank you again for your continued efforts to provide the care our patients need in the safest possible way for patients and your colleagues.

 

 

You’ve seen the numbers. We’ve lost many. But we go on and do better and remember:

 

https://www.youtube.com/watch?v=uFvHeqMfsJQ

 

And while we’ve lost many to the virus, we’re still aware of what we all have lost to systemic racism, and in discrimination in access to healthcare and public health. But this will change and the hope and work is uplifting:

 

https://www.youtube.com/watch?v=nPBi88v7adM

 

Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

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Friday, August 14, 2020                                                                                                                         Issue # 80

 

 

 

 

Let’s start with something lighter. The pandemic has forced lots of us to think in new ways and create new uses for established processes. Well watch this video from KLM for contactless return of lost items at the airport:

 

https://www.youtube.com/embed/NK-T_t166TY?feature=player_embedded

 

I was walking after work in my town yesterday. I was thinking about my day, what I was going to do that night, looking down at the ground, and then in front of a neighbor’s house, I looked up and saw…a good sized black bear about 10 feet from me. She was chomping on something from a garbage can. She looked at me, I looked at her and thought “that’s a big dog.” And then, snapped back to reality, I began backing up. She was too involved in scarfing up whatever and I walked away. Reality has a way of catching you when you’re not paying attention, especially if you’re in the midst of established routines.

 

This is the situation we are in. We’ve gotten used to, adapted to, this pandemic in many ways. It’s harder to maintain attention. But that’s what is required of us if we want to stay safe. You can see a bear. Not so much a virus. Stay vigilant, please, and help others to stay vigilant also.

 

But vigilance is not all that’s required. As we’ve seen with entrants to Phil Murphy’s (Governor of NJ) “Knucklehead Hall of Fame,” people are, for whatever reasons, just ignoring pandemic safety in favor of…large gatherings, COVID parties, and “valuing their freedom” by refusing to wear a mask. And to take it a step further, there are many incidents now of people punching workers in stores, amusement parks and restaurants who ask them to wear a mask. Airline passengers are becoming “unruly,” challenging flight attendants and personnel trying to keep people safe.

 

How can this be? Maybe they just don’t know anyone who has gotten really sick or died (yet). Maybe they just believe the anti-science propaganda. I don’t know. Could it be they just don’t care enough about other people’s safety, too selfish, etc.?

 

If you listen to podcasts, you may have come across one called “The Oath” with Chuck Rosenberg. I really recommend it. Season 3, episode 10 is an interview with “Sully” Sullenberger, the pilot who worked with his crew to land his passenger jet in the Hudson River in 2009 after losing both engines on a takeoff from a NYC airport. It’s an exciting real, real-life story (made into a movie starring Tom Hanks) and it’s worth listening to the podcast just for that reason. But more to the point, he talks about teamwork, being dedicated to his role, his team, and to his passengers and crew. The skills necessary to bring that plane in safely (all 150+ passengers and crew were safe) were not individual; they were team related. And the team was not just in the plane. The captains of New York Waterways ferries immediately coordinated and left their routes to get to the plane. And finally, he talks about what “we owe each other” as a society to be safe and healthy. What he calls “little gifts of civility” make civilization possible. We take care of each other. “As citizens we have things we owe to each other, in spite of how it seems in this winner take all world.” It’s not just about our rights. it’s also about our duties.” Leadership, teamwork, civic duty and responsibility, honesty, clear and open communication, and integrity make civilization work. “Independent, critical thought with decisions based on facts, not fears or falsehoods, no matter how loud they are told, make for bringing out the best in us. Good lessons in these times. (Oh, and see the movie, Sully, it’s really good. I saw it just before I got on a flight to Ireland – not a good idea).

 

National and International

 

Bottom line: new virus, no good treatments, no vaccine, community spread. This is a bad public health recipe.

 

Several of you have reminded me of the meaning of “pandemic” (from the Greek, “pan” – all; “demos” – people) and this is truly a worldwide catastrophe. Spain is considering shutting down. The UK, France, Russia, Australia just a few of the most heavily impacted countries. African nations are also affected though cases seem to be rising more gradually. And New Zeeland, which had escaped much of the early pandemic by shutting out travelers, is now seeing an outbreak. We are all connected for the good and the bad.

 

In the U.S., California, Texas, and Florida are the most affected states but other states continue to see outbreaks. In the Northeast, RI is now on the Massachusetts Governor’s “red list” meaning travel is restricted from RI to MA because of their rising numbers.

 

And, somewhat shockingly, some of the states with the highest increase in case, death, and case positivity rates are now reducing testing. I know there are times when we close our eyes in the face of danger. But that is not a public health strategy.

 

And as states push to reopen schools, more than 2000 students, teachers and staff have been quarantined in five states with more than 230 positive cases.

 

Pro sports are also seeing impacts at the player and team levels though some owners are insisting on opening (and even traveling). Many players are giving up playing this season.

 

There are hopeful signs. Many college football and athletic conferences are shutting down for the year.

 

In the State

 

Here is the latest color-coded map showing the incidence of cases across the state. Red areas are highest risk followed by yellow, green, and white:

 

https://www.mass.gov/doc/covid-19-average-daily-incidence-rate-august-11-2020/download

 

Yesterday, DPH and the Governor raised the number of higher risk communities by four for a total of 11 towns at highest risk. Two towns in our region were added as yellow: Holyoke and Granby. Northampton, Easthampton, South Hadley, Chicopee, Springfield, and Longmeadow are now in the yellow or green category. The incidence rates are still low compared to eastern Massachusetts and other states. The message is keep alert and take precautions (wear masks and face coverings when social distancing is challenging).

 

The good news is that some of our local colleges are taking more protective actions now. Smith College announced it will open but only for remote learning. UMass reversed an earlier decision to open for in person instruction but is now opening remotely for almost all students. The Greenfield schools will open remotely.

 

At VMG

 

Our patient newsletter, being sent over the weekend, has the following information on testing:

 

“We are getting many, many calls requesting referrals for COVID-19 testing. As you probably know, due to the pandemic erupting across the country, there are shortages of test kits, supplies, and longer than expected turn-around times. Because of this, we do not yet have the capacity at VMG to test everyone requesting testing. But we are working on bringing both point-of-care testing and PCR testing (more accurate; sent to national labs) in house. We anticipate having this capacity in September and we will keep you informed of progress. In the meantime, here is the best information on where and how to get tested: https://memamaps.maps.arcgis.com/apps/webappviewer/index.html?id=eba3f0395451430b9f631cb095febf13

 

We also included information on services that are expanding or reopening:

 

·         Blood pressure clinics are being held in our outdoor offices (tents) at each of our health centers

·         Bone density testing will resume in late September (we’ll let you know)

·         All other radiology services (x-ray, ultrasound, and mammography) are now available with all services adjusted for safety in the pandemic

·         Our optometry services are beginning to reopen beginning with our Easthampton Health Center; available now

·         Our Optical Shop in Amherst is now open, by appointment only. Call 413 282 4409 for an appointment

·         Diabetes Education classes will be offered this fall on Zoom, Wednesday mornings beginning 9/16, taught by Sara Anderson, RD and Marjorie Sobel, RD

·         Reminder that Physical Therapy is available by virtual visits or in-person, as determined by our therapists

 

Here’s some information about our case management services provided by Baycare:

 

“The Baycare Care Management program has relocated to working from home since the start of the pandemic.  We have modified our activities to keep the team and patients safe but continue to have regular communication with patients and the VMG teams.  The team consists of a Medical Assistant (Care Coordinator) and Registered Nurse (Care Manager) that focus on the following activities in conjunction with the providers and clinical staff:

  • Transitions of care – tracking/monitoring/communicating with all entities involved in the care as well as patients that go to the ER, Observation, Inpatient and SNF

  • Quality – outreach to patients in need of certain testing/screening for designated measures and disease management for those patients with elevated A1C’s, etc.

  • Complex/Disease Management

  • Care Coordination

 

All activities are visibly documented in the EMR.  You can send your designated CM/CC a patient case in Athena to make a referral.  Please do not pass up these valuable resources for your patients!

 

Here is the breakdown for coverage:

 

Amherst:  Laurie Runkle & Erika Olson

Easthampton:  Louise Whitworth & Erika Olson

Florence:  Maria Bianciardi & Erika Olson

Greenfield:  Galina Agapov, Lorrie McGrath & Melody Blanchette

 

Similarly, as a reminder, here’s some information from the iCMP staff from CDH working with our Medicaid ACO patients:

 

The Cooley Dickinson Integrative Care Management Program (iCMP) provides support to chronic and complex patients within the Medicaid ACO. The team is made up of two Social Workers, one Nurse Care Manager, and one Community Health Worker to support eligible patients. The goal of this program is to improve clinical outcomes for patients while improving patient quality of life.

 

iCMP is able to support patients with a multitude of needs including health coaching, accessing mental health resources, and supporting psychosocial needs including food and housing insecurity. There are designated Social Workers for each practice. Kevin Verni LICSW works with NHC and EHC while Nancy Delabarre LCSW works with AHC and GHC. Sara White RN is the iCMP Nurse Care Manager and Francheska Martinez is the iCMP Community Health Worker. Sara and Francheska work with all practices. If you have a patient that you think would benefit from additional support, please send a patient case to one of those listed above and they will be happy to consult with you.

 

The weekend is here and after all the news, you may need something magical to change your mood:

 

https://www.youtube.com/watch?v=Z8Ws4PEky28&feature=youtu.be

 

Right now our biggest risks are from lapses. So please remain vigilant. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

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VMG COVID-19 UPDATE

VMG COVID-19 UPDATE

Friday, August 7, 2020                                                                              Issue # 79

 

 

 

 

 

Happy Friday and thanks for your work again during this unusual week.

 

The great philosopher, Bob Dylan, once said “There’s too much confusion, I can’t get no relief.” (https://www.youtube.com/watch?v=bT7Hj-ea0VE)

With no clear, consistent, and accurate leadership across the federal government, with so much politicization of simple, important steps that can save lives (wearing masks), and with the added burden of hurricane season, flu season, and the election season, there is sure to continue to be “too much confusion.” This is a shameful situation since we’ve been here before; a hundred years ago, and we should have learned. (Read The Great Influenza, by John Barry for more).

 

Around the world, we stand out---for all the wrong reasons. From the NYTimes, yesterday:

 

“Nearly every country has struggled to contain the coronavirus. But only one affluent nation has suffered a severe, sustained outbreak for more than four months: the United States.”

 

“First, the United States has a tradition of prioritizing individualism over government restrictions. That aversion to collective action helped lead to inadequate state lockdowns and inconsistent adherence to mask wearing based on partisanship instead of public health.

 

“Second, many experts agree, America’s poor results stem in substantial measure from the performance of the Trump administration. “If you had to summarize our approach, it’s really poor federal leadership — disorganization and denial,” said Andy Slavitt, who ran Medicare and Medicaid from 2015 to 2017.

 

The administration’s travel restrictions were insufficient. Health officials initially gave confusing advice around wearing masks in public. And the president’s public statements — including claiming that the virus wasn’t serious and would disappear — regularly spread misinformation. In no other high-income country have political leaders so frequently departed from expert advice.

Together, skepticism toward collective action and the administration’s scattered approach have undermined the national response to the pandemic. True, the United States has made some improvements, including on mask wearing and testing. But unlike in South Korea, Germany and other countries, the virus continues to overwhelm daily life for Americans.

 

The frustration for many experts is that this outcome was avoidable. As one said: “This isn’t actually rocket science. We know what to do, and we’re not doing it.”

 

And, a recent survey showed:

“Two-thirds of Americans say they would likely accept a vaccine against the coronavirus for themselves or their children, and vaccination acceptance varies by geography, political affiliation, and race or ethnicity, according to a national survey released Thursday.

 

The findings are not good news for the vaccine effort. Experts estimate that 70 percent to 90 percent of people would need to be vaccinated to get the virus under control. But the survey provides a more encouraging number than a poll in May that found half of Americans would reject a vaccine against coronavirus.”

 

 

Finally, about schools… The city of Chicago just canceled its plans to open schools for in person learning and will open remotely. Of all the largest cities, only NYC is still planning to open in person. If in fact they open, the hope is that we can learn what works and what can be done safely. But, aside from the risk of spread, if they have to about face, confidence in public health and education authorities will fall (for contrast, the country of Kenya canceled their coming school year and will require students to repeat a year when it is safer). And if confidence falls in public health and other officials, wait for the controversy (which shouldn’t be) about getting vaccinated. We need confidence in officials, and a clear, consistent, science and fact-based set of messages to get through this. From The Great Influenza, the number one thing we need to do in a pandemic is “tell the truth” so that people can know what they hear is reliable.

 

One more school-related thing. Most schools that are opening are emphasizing wearing masks and social distancing. North Paulding High School in Dallas, Georgia, just suspended a student for sharing a photo of a hall way packed with students, shoulder to shoulder, not wearing masks. How is that helping to save lives?

 

There are more reports of promising vaccine trials. It’s just too early to tell but Dr. Fauci has been saying that a vaccine could be available by the first half of 2021. That would be a record-breaking time for a vaccine but any good news is welcome. And then we all have to remember that “Vaccines don’t save lives; Vaccination saves lives.”

 

In the State

 

Massachusetts is seeing a steady increase in case positivity. Deborah Birx, M.D., Coordinator of the White House Coronavirus Task Force, identified four major cities that now have increasing cases and increasing positivity of cases: Boston, Chicago, Detroit and D.C. And today, Governor Baker announced that he is slowing the reopening process.  The limit on the size of outdoor gatherings has been reduced from 100 to 50. In order to prevent restaurants from acting like bars, food prepared on site must now accompany any order of alcoholic beverages. He is also authorizing all state and local police to enforce the regulations and he is creating a COVID enforcement and intervention Team. Finally he is postponing going to step 2 of Phase 3 of reopening. He said that he is doing this because “now we are seeing the virus escalate in certain communities around the commonwealth and we have to put together a plan to stop it. This fight against COVID-19 is far from over.”

 

You already know about the travel ban and the requirements to quarantine if you travel to other states not on the “safe list.” That list is updated regularly and will change over time. Rhode Island is no longer a “safe state” and travelers to Massachusetts form RI will have to quarantine (or produce at negative COVID-19 test within 72 hours). Here’s the list: https://www.mass.gov/info-details/covid-19-travel-order#lower-risk-states-

 

So, how do we get back to lowering the positivity and case rates? One way is for all of us in this country to wear a mask (not a surprise). The latest data from the U of Washington (which has been among the leading institutions tracking and forecasting the pandemic) is that we could save 70,000 lives by the end of the year if 95% of us wore masks. I think we could agree that is well worth the inconvenience.

 

At VMG

 

First, thanks to all of you, and especially Jim Wood, for going the extra mile during and after the storm on Tuesday. The EHC tent essentially blew away and was back up and running the next day. And, all the other tents needed work too. Thanks to all staff involved.

 

We know the burden being placed on reception and clinical staff with all the requests for referrals and information on COVID testing. See above for the statement about confusion. We’re working to get the best information available to you and to patients. The hospitals, labs, retail pharmacies are all coping with shortages of some supplies and therefore turnaround time delays. Ultimately, we know that we will need to do testing at VMG for our patients and we are working toward that goal. We’ll keep updating as we have more information.

 

For the moment, we are pretty well stocked with PPE and, thanks to Val Felton, Amy Rice and Greg Folta, we have good processes in place to keep our supplies available.

 

Finally, flu season will be here soon and there is a lot of work going on to develop new processes for vaccinating what we hope will be a record number of our patients.

 

 

OK. We can adapt and still be in connection with each other. Here’s a video of a creative way two teenagers in Italy are playing tennis. And they got a surprise visit:

 

 

https://www.independent.co.uk/sport/tennis/roger-federer-italy-rooftop-tennis-match-vittoria-oliveri-carola-pessina-a9652626.html (You may have to scroll down to get to the video on rooftop tennis).

 

 

 

Right now our biggest risks are from lapses. So please remain vigilant. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

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VMG COVID-19 UPDATE

Tuesday August 4, 2020                                       Issue # 78

 

 

 

 

 

 

 

I hope you are all well. It’s been about a week since the last Update. Unfortunately, the coronavirus did not take a week off.

 

As you probably know by now, there are outbreaks in many states in the Midwest and south that were “spared” earlier in the pandemic. The west, including California, Arizona, Texas and New Mexico continue as hot spots. And we are seeing rising cases in New Jersey and Rhode Island with many cases attributed to what New Jersey Governor Phil Murphy called “knuckleheads” attending large parties. Massachusetts is also seeing some rising numbers in the Boston area and the Cape (though not yet at the level that would cause Governor Baker to roll back the Reopen Massachusetts plan).

 

What to do about schools. Prior to last week, it was said that reopening schools in states where new cases were low and the case positivity rate was low, was acceptable. There may be some re-thinking of that for in-person instruction now. The few school districts across the country that have opened already for in person instruction are finding viral outbreaks. And kids can get sick from coronavirus and they can also spread the virus. I think we’ll see some reconsideration soon. At the least, there will have to be much more support to school systems for equipment, sanitizing, training, and testing/contact tracing to make school reopening safe and successful.

 

What can be done? Short of a vaccine, the best things to do are what we already know: wear masks, socially distance, wash your hands, don’t come to work if sick, AND definitely do not attend large gatherings (especially indoors); that would qualify for the “Knucklehead Hall of Fame” that the NJ Governor is opening.

 

Here’s what wearing a mask can do to make you a life saver (sent to me by Stephanie, an article by John Bollard in the Daily Hampshire Gazette):

 

 

 

 

So help yourself (and others) save lives! (and pass the article along to family and friends who may need convincing).

 

Or do what Major League Baseball (MLB) is doing. Is anyone surprised that ballplayers are getting sick in record numbers? The virus spreads like a ….. virus. And even great athletes get sick (who, presumably, are strong and have “good immune systems). MLB should have a whole floor reserved in the KHOF (Knucklehead Hall….).

 

OK. The “Good News.” Yesterday, the President signed an executive order that effectively makes Medicare payments for telehealth permanent for most recipients. That is especially good news now but also into the future. And the federal government is now working on plans for vaccine distribution (when it becomes available) based on previous plans for large scale flu vaccine distribution. Let’s hope they have it ready in time and that it is well thought out.

 

At VMG

 

Not surprisingly then, masks are required at Valley Medical Group for staff, practitioners, patients, and visitors. Gina reports that a question arose regarding exception for religious reasons. There is no exception for religious reasons. The only exceptions identified by Massachusetts DPH are for situations that may inhibit an individual from wearing a face-mask safely. These may include, but are not limited to:  

  • Those who cannot breathe safely;  

  • Those who, due to a behavioral health diagnosis, are unable to do so;  

  • Those communicating with people who rely upon lip-reading;  

  • Those who require supplemental oxygen to breathe; and  

  • Those who are exercising outdoors and are able to keep physical distance from others.  

If a patient is not able to wear a mask they should be scheduled for a virtual visit. See Gina’s recent emails for more information. 

 

Flu season is coming. We’re planning for procedures to vaccinate lots of patients this year, and, lots of staff also. We’ll have more to say about how we’re going to do this soon.

 

We’re also beginning to plan for COVID testing. More to come on that as well in the next few weeks.

 

From Colleen: “The Eye Care/Optical departments have faced our own unique struggles with the pandemic the past 4 plus months and we are now preparing to reopen for in person patient care on August 11th in EHC. The Eye Care department in NHC has been moved to EHC, to support NHC's respiratory unit. Significant work has taken place to support this move and prepare for patient care. 

 

The optical shop at NHC has closed and we are preparing to reopen the Amherst Optical shop, which has been redesigned to be able to support customers during the pandemic.  Anticipated opening is the week of August 11th, by appointment only.

 

Here’s a graph, from Isaac Allen, showing VMG charges over time since the pandemic began. The green line is 2020; the red line (not the MTA) is 2019. We are recovering our charges mostly due to virtual visits.

 

 

Podiatry and Radiology continue to grow in number of visits, and Physical Therapy is increasing past 60%. Behavioral Health, Diabetes Education and Nutrition, Endocrinology, Rheumatology, Sports Medicine, Ambulatory Surgery (ASPC), and primary care are either at or above 2019 levels or climbing to get there. Eye Care, as above, will begin recovery later this month. Thanks to all of you for providing access for our patients and teamwork (including reception and clinical staff) to get them in.  We’ve all changed a lot of processes and workflows in the last few months and it is paying off.

 

Right now our biggest risks are from lapses. So please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

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VMG COVID-19 UPDATE

Monday, July 27, 2020                                                                                            Issue # 77

 

 

 

 

 

 

 

 

Here are the headlines:

  • The virus is still here. It is still highly contagious

  • We will see infections again

  • Baystate Medical Center just reported an outbreak of more than 30 staff and patients attributed to visiting from hot spots and “forgetting” to use masks and social distancing

  • The Governor has issued new travel rules for anyone entering Massachusetts from most other states and there are significant fines for violating the guidelines

  • These rules do apply to our staff and practitioners

 

Mistakes were made (but not by me). This is the title of a book by Carol Tavris and Elliot Aronson about “why we justify foolish beliefs, bad decisions, and hurtful acts.” This is what we are hearing now from policy makers at the federal level and in some states. It’s a step, I guess, but it’s had a cost in lives and misery. But that’s not my concern today.

 

My concern today is that it’s hard for all of us humans to remain vigilant, deliberate, and careful when things appear to be “calming down,” “when we need a break,” “when we’ve got things to do.” Sometimes this is especially true if we compare what we see “over there” (other cities, states, countries where things are “really bad”) with what we see with our own eyes around us. It’s a blessing and a (potential) curse that we have gotten through the early stages of this pandemic with as little in our region as we’ve seen. Up to this point, most of us don’t know anyone who has had COVID-19 or died from the disease (though some of us do and I’m sorry for the pain). And we have been relatively good about wearing masks or face coverings, hand hygiene, socially/physically distancing, and staying home when sick.

 

But now it’s easy to fall into the business as usual mindset and that’s when mistakes get made. There was an outbreak traced to a party on the Cape a few weeks ago. Visitors from “out of town” probably transmitted the virus. And we are seeing that here (at Baystate, for example) too as we see visitors and family from out of town or when we travel. As hard as it is, PLEASE stay alert: even, and perhaps especially, with family and friends who visit or whom we may visit. And remember that as you are interacting with your family and friends, you are also at risk from their contacts with family, friends, and acquaintances who may not have been as observant of the measures we take to avoid viral spread.

 

Baystate did a really great job of making risks known to staff and patients, setting up all the necessary systems for controlling, and reminders about, viral spread and they still had this outbreak. It can happen here but let’s make sure it doesn’t happen because we let our concentration lapse. When you see someone at VMG forgetting to wear a mask (or not wearing it properly – covering the nose and mouth), getting too close for social/physical distancing, gathering in groups in enclosed spaces, please remind them of our need to protect each other, our relatives and friends, and our patients and communities. If you need help, let one of our supervisors know. If you are the receiver of a reminder like this, please accept it graciously. It’s meant for the good of all of us. We all forget (30 minutes ago, I left the office without a face mask). We all make mistakes. It’s not just “them, out there.”

 

As for the new travel guidelines, you can read them here: https://www.mass.gov/info-details/covid-19-travel-order

Here’s the quick summary:

All visitors entering Massachusetts, including returning residents, who do not meet an exemption, are required to:

·        Complete the Massachusetts Travel Form prior to arrival, unless you are visiting from a lower-risk state designated by the Department of Public Health.

·        Quarantine for 14 days or produce a negative COVID-19 test result that has been administered up to 72-hours prior to your arrival in Massachusetts.

 

If your COVID-19 test result has not been received prior to arrival, visitors, and residents must quarantine until they receive a negative test result.

Failure to comply may result in a $500 fine per day.

Exemptions are for people

·         Traveling through the state or to a transportation connection (plane, rail, etc.)

·         Traveling from a low risk state (currently New England, Hawaii, New Jersey, NY)

·         Commuting for work or school

·         Patients seeking or receiving medical treatment

·         Military personnel required to travel to Massachusetts

·         Workers providing critical infrastructure

 

At VMG

 

We are in agreement with, and complying with, the Governor’s travel restrictions. If you are a VMG staff member or practitioner and you travel to any of the states that Massachusetts deems a “hot spot,” please consult the information in the mass.gov link above and consult with y