Coronavirus First Responders
Petition to U.S. House of Representatives, U.S. Senate, Donald J. Trump, Vice President Mike Pence
US Physicians/Healthcare Workers For Personal Protective Equipment in COVID-19 Pandemic
As cases of COVID-19 escalate around the country, physicians and other healthcare workers (HCWs) are facing severe shortages of personal protective equipment (PPE). This shortage is already a major crisis and will place an insurmountable strain on the health system of this country as cases continue to rise and more people require hospitalization for complications of COVID-19. As a result of this shortage, recommendations from the Centers for Disease Control (CDC) for appropriate PPE for HCWs on the frontlines have shifted. This shift does not come in response to overwhelming evidence, rather to a supply chain issue. As quoted directly from the CDC website: “PPE recommendations for the care of patients with known or suspected COVID-19: Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand."..."When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19."(1) These statements in no way suggest that droplet precautions are adequate, supported by the statement that as soon as the supply chain has been restored, we should go back to using N95 respirators. As a result of these recommendations, many hospitals have taken the CDC recommendations to mean that facemasks are the preferred PPE, rather than a less desired (and potentially less safe) alternative. They have thus rationed respirators to be made available only for procedures, such as intubation and bronchoscopy, during which the virus is more likely to become aerosolized. This is putting our HCWs in tremendous danger of contracting and spreading COVID-19, which is unacceptable in the country with the most expensive health care system in the world. The evidence that droplet precautions are acceptable is lacking. CNN recently published an article titled “Health care workers getting sicker from Coronavirus than other patients”.(2) This statement is corroborated by data from a Harvard Study in China that suggested HCWs were at a 20% increased risk of severe infection compared to the general public. This risk decreased once the Chinese implemented full gear: protective suit, medical goggle, face shield, N95 mask and gloves – following this change there were no further reports of infected HCWs.(3) The debate is still ongoing as to whether or not COVID-19 can be transmitted via droplets vs. aerosols, yet as we speak, HCWs around the world continue to get infected, end up in critical condition, and die while using “appropriate PPE”. According to an ahead of print New England Journal Article on aerosol and surface stability of COVID-19, the virus can be detected up to 3 hours after aerosolization.(4) According to Dr. Milton, professor of environmental health at University of Maryland, “you cannot tell epidemiologically between something aerosol transmitted by weak sources and large droplet spray”, and he suspects the capability of long distance transmission will be dependent on the degree of symptoms.(5) Considering the mortality risk and lack of data to support a step-down to surgical masks, N-95 masks should continue to be the standard PPE for care of COVID-19 patients. As a physician, I do not know how long it takes to make an N95 mask, but I do know how long it takes to train a physician, a nurse practitioner, a physician’s assistant, a respiratory therapist or nurse. We are the supply chain that needs to be protected. Our friends from Italy have described the loss of infected HCWs as a critical hit to an already strained system. Infected HCWs are of no benefit to patients – in fact, they pose a serious risk.(6) They not only endanger the health of their colleagues, families, and communities, they also serve as a vector to infect the most vulnerable among us – the patients they care for. China, Italy, and S. Korea have more experience with this virus than we do and are taking the protection of their HCWs seriously. In France, Dr. Benjamin Davido, Infectious Diseases and Clinical lead for COVID-19, explains the importance of protecting HCWs against the severity of the illness, by using FFP2, the European equivalent of N95 masks.(7) “If we don’t do all we can to protect them (HCWs), they will quickly transition from providers to patients… Governments must support private-sector manufacturers in providing N95s and other equipment to HCWs.”(6) This letter serves to urge our government, industry, media and general population, to assist HCWs in obtaining immediate access to critical PPE, including N-95 masks. Our HCWs are already on the front lines, taking care of patients without appropriate protection, and our COVID cases and we are nowhere near the peak. Many hospitals are already running out of protective supplies. (NY Times, 3/9/2020) Recommendations to protect HCWs should not be based on what’s available; availability should be based on what is necessary. We urge the government to access the Strategic National Stockpile, and to utilize both the public and private sector to immediately increase production of PPE supplies. In addition, we urge our hospital systems to maintain the highest level of PPE standard for our HCWs, and demand the supply of N-95 masks. Sincerely, Dr. Milla J. Kviatkovsky Dr. Constance Chace Dr. Supraja Thota https://www.frontlineppenow.org/ References: 1) https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html 2) Howard and McLaughlin, ‘Health care workers getting sicker from coronavirus than other patients,’ expert says, CNN Health, March 12,2020 3) Xihong Lin, ‘Analysis of 25,000 Lab-Confirmed Cases in Wuhan: Epidemiological Characteristics and Non-Pharmeceutical Intervention Effects, Department of Biostatistics and Department of Statistics, Harvard University and Broad Institute 4) N Doremalen et Al, 2014, Aerosol and Surface Stability of HCoV-19 (SARSC-CoV-2) compared to SARS-CoV-1, New England Journal of Medicine 5) Souchery, ‘Unmasked: Experts Explain Necessary Respiratory Protectin for COVID-19’, Center for Infectious Disease and Research Policy, Feb 13, 2020 6) Osterholm and Olshaker, ‘Health-Care workers are the front-line warriors against coronavirus. We must protect them’, The Washington Post, Feb 14, 2020 7) Duqueroy, COVID-19: Advice From a French Doctor on the Frontline, Medscape, 3/16/2020
Petition to American Dental Association, New York State Dental Association, New York County Dental Association, Andrew M. Cuomo, Charles E. Schumer, Kirsten E. Gillibrand, Dr. Chad Gehani, Marko Vujicik
American Dental Association needs to promote COVID19 testing in the dental office
As part of the dental community, I have read countless postings about how impossible it will be to assure our patients that our dental offices will be safe once businesses are allowed to open again. Dental offices are different from most other small businesses. Our work requires us to create an aerosole in the mouth at almost every step. I contacted Abbott Labs and found out that it is both economically and physically feasible to use their 5 minute COVID19 testing machine in our dental office to screen ourselves and our staff at the start of each day and to screen every patient we need to treat. However, our malpractice insurance carriers will not insure us because as of now, COVID19 testing is not within the scope of dental practice. We need the American Dental Association to amend, at least until there is a vaccine, the scope of dental practice to include COVID19 testing in the dental office in order to assure patients that we are catching the asymptomatic patients at the door and sending them home, instead of spreading the virus to us as dental practitioners, to our families, our staff, their families and our subsequent patients and their families. This virus will not be eradicated soon. The vaccine will not be here soon. Please support this petition to have the American Dental Association add testing for COVID19 in the dental office as being within the scope of practice of all dentists. Thank you.
Petition to Donald J. Trump, Members of Congress, Nancy Pelosi, Steny H. Hoyer, Kevin McCarthy, James E. Clyburn, Steve Scalise, Hakeem S. Jeffries, Mitch McConnell, Charles E. Schumer
Support the COVID-19 Pandemic Physician Protection Act (CPPPA)
Colleagues, Friends, and Family, By now, many of you have been personally affected by the COVID-19 pandemic. In some households, it may be several family members, or even yourself. As physicians and healthcare workers, we have been called to the frontline of this war against COVID-19, and we do not take this responsibility lightly. However, we do need your support. We need more tools and assurances in this fight against COVID-19. After hearing the feedback of the grassroots physician community through online communities with membership totaling over 100,000 physicians, we have proposed the COVID-19 Pandemic Physician Protection Act (CPPPA), which outlines the areas where we need help the most. Highlights include: Ensuring that physicians and other healthcare workers have access to adequate Personal Protective Equipment (PPE), increasing access and removing restrictions for TeleHealth services, keeping our private practices financially solvent, ensuring mental health coverage for healthcare workers, canceling student loan debt, and creating provisions for our families if we die or become disabled during this pandemic. Please take a moment to sign our petition, which will also supports our proposed legislation (the CPPPA). We truly believe it will save lives - not only of physicians and other healthcare workers, but of patients throughout the United States of America. Respectfully submitted, Nisha Mehta, MD Carlos Vital, MD Karla Vital, MD
Petition to Mayor Bill de Blasio, New York City Police Benevolent Association (NYC PBA), Andrew M. Cuomo, Dermot Shea
Personal Protective Equipment (PPE) and COVID-19 Health Care for NYPD Officers
Hello Everyone, We are asking for urgent attention to the lack of adequate protection being offered to officers during this COVID-19 pandemic when they are at a high risk of exposure every single day in the line of duty. As of date, we have over 300 officers tested positive for Coronavirus and over 3,200 officers have called out sick. They are being provided with a single pair of gloves, 1 single surgical mask, and a 6 oz bottle of sanitizer (a few precincts received stock that expired in 2016!). Some officers have reported getting a SINGLE sanitizer wipe and some have reported getting nothing at all. The medical division and NYPD leadership is advising officers to continue working even if they were exposed to a positive COVID-19 carrier unless they develop symptoms. This is completely in conflict with the public health advice being issued by the CDC and especially to help "flatten the curve" for those officers who may be asymptomatic. If they do develop symptoms, they are only being given an average of one week of time off and not the minimum 14 day quarantine guidelines for the onset of symptoms and/or until full recovery. This is completely unacceptable. Our NYPD officers (and other first responders) should not be "just a number". Did we learn nothing post 9/11 regarding failure to supply PPE to our first responders and the toll it continues to take over nearly a decade later? We understand that health care workers are first priority when it comes to limited supply items but first responders need to be prioritized after! We cannot have them out on the front lines protecting the public if we don't provide them with the resources (PPE) to be protected and if we don't follow the guidance by official health authorities that protect and support them through to recovery if (AND MORE LIKE WHEN) they are exposed. WEARING PPE SHOULD BE MANDATORY, WE NEED TO TRAIN AND SUPPLY THEM WITH APPROPRIATE AND SUFFICIENT PPE, AND WE NEED TO GUIDE THEM WITH HEALTH PROTOCOLS THAT ARE IN LINE WITH THE CDC RECOMMENDATIONS! We are asking for immediate consideration to this matter. We are asking for change. We are asking to protect those who put their lives on the line every single day to protect us. Thank you, Concerned Civilians, the Blue Line Family, and supporters of the NYPD Please sign & share! Please keep up the momentum! We are over 36,000 officers strong! We are approaching leadership and are already in contact with media outlets! You can also click here to TWEET the mayor and the commissioner directly! https://ctt.ec/22340
Petition to United States Department of Health and Human Services, U.S. House of Representatives, U.S. Senate
Allow U.S.-Based IMGs to Work in the U.S. for COVID-19 Support
27% of U.S. physicians are internationally trained with 65,000 unlicensed IMGs in the country. AMOpportunities connects international medical trainees with clinical rotations in the United States and has a solution to our healthcare shortages. You can learn more at https://www.amopportunities.org We believe that an answer to the impending physician shortage in the United States and at present the global pandemic of COVID-19, necessitates U.S.-based international medical graduates. As such, we petition the United States healthcare system to allow IMGs to assist U.S. hospitals in any capacity. We're asking you to sign our petition to demonstrate your support and show the U.S. government and healthcare system the need for the expertise of IMGs. Our country is struggling to provide much-needed healthcare to the victims of COVID-19, which has infected more than 200,000 U.S. citizens. If we look at harder hit countries, it’s clear this number will only soar. Already, U.S. hospitals are calling on retired healthcare professionals and medical students to lend their support. Governor Phil Murphy of New Jersey recently signed Executive Order No. 112 authorizing the Division of Consumer Affairs to grant temporary licenses to doctors licensed in foreign countries. The rest of the country must follow suit. The 65,000 unlicensed IMGs in the U.S. are the answer to strengthening the healthcare workforce and ensuring we slow the spread of COVID-19 and eventually eradicate the virus. IMGs are limited to work by policy, geography, and cost. Many of them are unlicensed due to the lack of residency positions available. These 65,000 IMGs have medical degrees, and many have passed their board licensing exams, however these qualified near physicians cannot secure the necessary residency slots and thus can’t practice. In New York, IMGs that have completed three years of graduate medical education in a postgraduate training program accredited by the ACGME or the AOA can provide patient care services even if they’re unlicensed. This petition goes one step further. We ask all state officials and medical boards to pass policies that allow IMGs who are ECFMG certified to assist under the supervision of a licensed physician, regardless of whether they have completed any U.S. postgraduate training. The untapped knowledge and expertise of IMGs are precisely what frontline healthcare workers need to fight COVID-19. Join us as we petition the government and U.S. healthcare system to invite IMGs in the U.S. to lend their extensive medical experience. We all need to do our part to confront the uncertain time we find ourselves in. Thank you for your support. AMOpportunities https://www.amopportunities.org Here are other ways you can help us gain support for IMGs in the United States to practice in the U.S. during COVID-19. 1. Encourage your state to create an International Medical Assistance Program for a pathway to practicing in the U.S., similar to what Minnesota has done for IMGs. Washington is pushing similar action. You can see what other states have done to push a pathway for IMGs here. 2. Encourage universities to create programs that strengthen IMGs’ likelihood in matching into U.S. residency positions, similar to this program at UCLA. 3. Rural care has the greatest need of care from IMGs, and many live outside of major metropolitan areas, making it easier for them to practice in rural cities. Again, Minnesota has been working toward that same cause. You can also find more information here.
Petition to Andrew M. Cuomo, Mayor Bill de Blasio, Phil Murphy
Safeguard the Right of All Laboring People to Have Support During COVID-19 Crisis
On March 21, the NYS Department of Health issued clear guidelines on treating patients in labor during the COVID-19 crisis. These guidelines determined a support person, whether a spouse, partner or other chosen person, is essential to care for the patient during labor, delivery and in the postpartum period. The World Health Organization (WHO) agrees. We agree. As of March 26, all New York Presbyterian and Mount Sinai affiliated hospitals, and Staten Island University Hospital in the New York City area will act against WHO, CDC and DOH guidance and ban all support people--including spouses--from Labor & Delivery and Postpartum units. This means people in labor will give birth alone and parent alone. Parents will miss the birth of their child. Fundamentally, risks for the people laboring alone will increase substantially. Not only can partners and spouses provide physical and emotional comfort during labor and postpartum, they are also essential in alerting staff when something has gone wrong and the laboring patient cannot notify nurses themselves, like in the event of an eclamptic seizure or a fainting episode. Timing is critical in these cases and monitors can be unreliable. We cannot expect nursing staff, already spread thin, to spend the limitless hours needed with each patient to ensure their health and their baby's health, to provide physical assistance and emotional support. We know the hospital system is overwhelmed in this crisis. However, the burden will only be increased by banning support people from Labor & Delivery. We must ensure no one gives birth alone. We must ensure the maternal mortality rate does not increase during this time.
Petition to Donald J. Trump, Andrew M. Cuomo, Nancy Pelosi, Greg Abbott, Gavin Newsom, J.B. Pritzker, Secretary of State
Protect Doctors Nurses & Medics against punitive litigation during & after COVID-19 Crisis
Today, like so many physicians, nurses across the nation, I stepped in my intensive care - ICU and had to deal with the heightened alertness among all staff members. While ordinary people have been urged to save themselves from a killer disease by staying home - my Intensive care (ICU), Hospitalist, ED & other physician colleagues, nurses, phlebotomists, respiratory therapists, technicians, nurse assistance, cafeteria staff are the brave souls who have been sent to man the front line of defense against a deadly enemy. Treating Covid-19 sick patients who are forcibly separated from their loved ones when they need them the most as they cope with its debilitating and sometimes deadly effects is distressing enough but we have to also prepare and finalize details for an onslaught on our ICU where hard decisions will have to be made when resources like ventilators are limited. God forbid if another organ fails - as back up resources liked dialysis machines are even scarcer. It is heartbreaking to deal with the tragic loss of lives especially when medical staff is doing all they can within constraints beyond their control. But what is unacceptable is that these brave souls who are at the front line are vulnerable later on when the crisis is over for an assessment by other medical officers and especially lawyers which could include litigation against them. Join us to demand Federal & State legislation to protect these courageous front line physicians and other paramedical staff from any punitive litigious action resulting from impaired medical care during these globally turbulent and medically stringent times.
Petition to U.S. House of Representatives, U.S. Senate, Donald J. Trump
PLEASE SUPPORT IMMIGRANT HEALTHCARE PROVIDERS
Hi All, I am writing on behalf of immigrant physicians and more than a million of other immigrant health care professionals currently residing in United States of America. All the health care professionals are doing everything they could do to save American lives and are placing their professional responsibilities before their families. Today most of these health care professionals are very worried about future of their families in case they loose battle against COVID-19 pandemic. The real question is, “To be or not to be." Many of these providers are on immigrant visas, some of them have been waiting for their green cards for last 10 years and expected to wait for another 10-50 years depending on their priority date. If these providers lose their lives fighting this battle, families of these superheroes will be conveniently deported due to their dependent status as per current immigration laws of USA. I believe American government could do better, and they could treat these heroes with respect and dignity. I would expect Americans to tell these health care soldiers that, “we got your back." Providers are fighting this battle not with weapons but with compassion and care, and they would appreciate the same support to their loved ones. Many immigrant providers are unable to work in other hospitals due to their visa restrictions. Many of them are in the process of their visa renewal and delay in processing will make them out of status. Now is the time to call out Congress and Senators to take immediate actions on this urgent matter. With 2% fatality rate of COVID 19 , many lives will be lost and frontline health care professional would be hit hard. The risk that these providers are taking every day needs to be appreciated and every delay in doing it would result in significant consequences to them and their families So, I would urge Congress to: Pass a law expediting green cards of all frontline healthcare providers Protect the dependents of immigrant health care professionals, if they pass away managing COVID 19 pandemic patients Give all Immigrant providers on visa temporary license permit to work in any health care facility in any state if the need comes Sincerely, Sunny Chavan MD, MPH,FAAFP.