Mary Foote, MD, MPH Senior Health Security Specialist, Bureau of Healthcare System Readiness NYC Department of Health and Mental Hygiene Suzanne Elgendy, PhD Implementation and Improvement Scientist COVID-19 19 Bureau of Mental Hygiene Community Engagement Policy and Practice NYC Department of Health and Mental Hygiene HEALTH CARE Julia Schillinger, MD, MSc PROVIDER Senior Director of STI Surveillance, Epidemiology, and Special Projects NYC Department of Health and Mental Hygiene UPDATE Philip Zachariah, MD, MS Assistant professor of Pediatrics & Hospital Epidemiologist-Pediatric Infectious Diseases M AY 15,2020 Columbia University Irving Medical Center, New York-Presbyterian Hospital Eva Cheung, MD Assistant Professor of Pediatrics-Pediatric Cardiology Columbia University Irving Medical Center, New York-Presbyterian Hospital Multisystem Inflammatory Syndrome in Children Presentation: 2:45 PM Slides will be posted on the Health Department COVID-19 provider page: on.nyc.gov/covid19provider
WHERE WE ARE NOW SURVEILLANCE UPDATES OUTLINE MITIGATION IS WORKING. WHAT COMES NEXT? MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN QUESTIONS AND DISCUSSION
• Our understanding of COVID-19 is evolving rapidly DIS ISCLAIMER • This presentation is based on our knowledge as of May 14, 2020, 5 PM
• The COVID-19 pandemic continues worldwide • Suppression has been achieved in some areas, but the outbreak is accelerating in others • Since the first confirmed case of COVID-19 in NYC, over WHERE 20,000 deaths have been attributed to the disease WE ARE • Following a peak in early to mid-April, daily case counts, NOW hospitalizations, and deaths have been declining • This suggests that mitigation measures, including physical distancing, are working • These measures must be maintained as we prepare to transition to suppression measures
CUMULATIVE CASES AND DEATHS, WORLDWIDE 5/14/20 >4,400,000 cases >300,000 deaths Johns Hopkins University. COVID-19 dashboard: cumulative confirmed cases. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
CUMULATIVE CASES AND DEATHS, U.S. 5/14/20 >1,390,000 cases (~1/3 of confirmed global cases) >84,000 deaths (~1/4 of reported global deaths) New York Times. Coronavirus in the U.S.: latest map and case count. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
Laboratory-confirmed cases 186,293 CURRENT Hospitalizations 49,516 STATUS OF OUTBREAK, Deaths NYC Confirmed 15,349 5/1 /14/20 Probable 5,057 NYC Health Department. COVID-19: data. Updated daily. https://www1.nyc.gov/site/doh/covid/covid-19-data.page
CASES COVID-19 CASES, NYC 3/3/20 – 5/12/20 HOSPITALIZATIONS Shows number of COVID-19 cases, hospitalizations, and deaths based on a daily analysis since March 3 Deaths lag 1-2 weeks after hospitalizations DEATHS DATE
COVID-19 RATES BY BOROUGH, NYC 5/14/20 Shows number of positive cases per 100,000 people in each borough NYC Health Department. COVID-19: data. Updated daily. https://www1.nyc.gov/site/doh/covid/covid-19-data.page
MIL ILESTONE: PEOPLE ADMITT TTED TO NY NYC HOSPITALS FOR COVID-19 19-LIKE IL ILLNESS MILESTONE: This chart may indicate when COVID- 19’s spread is slowing by showing 10 consecutive days when the daily number of people admitted to NYC hospitals for influenza-like illness and pneumonia is less than 200. That would be double the average for prior years in the city.
MIL ILESTONE: PEOPLE IN IN CRI RITICAL CARE ACROSS NY NYC HEALTH + + HOSPITALS Number in critical care at NYC H + H MILESTONE: This chart may indicate when critical care volume is at sustainable levels by showing 10 consecutive days when the daily number of people in critical care at NYC Health + Hospitals is less than 375.
BACKGROUND • Confirmed and probable COVID-19-associated deaths only include ESTIMATE OF deaths that are directly associated with SARS-CoV-2 infection • Deaths in persons with chronic health conditions that increase risk of EXCESS severe COVID-19 might not be recognized as attributable to COVID-19 DEATH THS, , NYC METHODS • Excess deaths occurring during widespread community MARCH 11 11- transmission estimated MAY 2, 2, 20 2020 20 • Difference between seasonally expected baseline and reported all- cause deaths Preliminary estimate of excess mortality during the COVID-19 outbreak — New York City, March 11 – May 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:603-605. http://dx.doi.org/10.15585/mmwr.mm6919e5external icon
Total: 24,172 excess deaths • 13,831 (57%) confirmed COVID-19 – associated • 5,048 (21%) probable COVID-19 – associated • 5,293 (22%) additional excess NUMBER OF LABORATORY-CONFIRMED Morb Mortal Wkly Rep. May 2020: Confirmed deaths were in AND PROBABLE COVID-19 ASSOCIATED persons with a positive laboratory test for SARS-CoV-2. Probable deaths were in persons without a positive test but for whom the DEATHS AND TOTAL ESTIMATED EXCESS death certificate listed COVID-19 or similar as a cause of death. DEATHS – NYC, MARCH 11-MAY 2, 2020 Excess all-cause deaths were observed minus expected.
• Physical distancing, demand on the health care system, and public fear might lead to delays in obtaining lifesaving care* IM IMPLICATIONS: • This is a good time to remind patients that some symptoms always require immediate care, including: ESTIMATE OF • Trouble breathing • Persistent pain or pressure in the chest or abdomen EXCESS DEATHS, , • Cyanosis NYC • Alterations in mental status • Symptoms suggestive of a stroke • Advise patients with risk factors for severe COVID-19 to notify a health MARCH 11 11- care provider if they develop symptoms of COVID-19 – enable prompt MAY 2, 2, 20 2020 20 escalation of care, if needed • Consider proactively contacting patients to support chronic disease management during physical distancing Preliminary estimate of excess mortality during the COVID-19 outbreak — New York City, March 11 – May 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:603-605. http://dx.doi.org/10.15585/mmwr.mm6919e5external icon
UPDATED ASYMPTOMATIC PEOPLE WHO TEST POSITIVE GUID IDANCE: • All asymptomatic people (including health care workers) who test positive for SARS-CoV-2 with a molecular-based test should self-isolate EXTENDED and monitor their health for at least 10 days (previous guidance – 7 days) • After 10 days, can discontinue monitoring unless symptoms consistent DURATION OF with COVID-19 develop IS ISOLATION AND • If symptoms of COVID-19 develop during monitoring, follow guidance for MONITORING symptomatic persons NYC Health Department. Health Alert #14: Updated NYC Health Department COVID-19 Recommendations. May 14, 2020. https://www1.nyc.gov/assets/doh/downloads/pdf/han/advisory/2020/covid-19-update-05142020.pdf
NON-HOSPITALIZED PATIENTS WITH COVID-19 • CDC updated guidance on discontinuing home isolation for non- hospitalized people with possible or confirmed COVID-19 (April 30, 2020) • Minimum duration of isolation: UPDATED • At least 10 days after symptom onset; AND • Absence of fever for at least 3 days without antipyretics (if ever febrile); AND GUID IDANCE: • Overall illness has improved DIS ISCONTINUING HOSPITALIZED PATIENTS • In addition to meeting above criteria for fever and improved symptoms, ISOLATION IS should be isolated for at least 14 days after symptom onset • Patients discharged from a hospital to a nursing home must first have a negative result on a COVID-19 diagnostic test (New York State Executive Order 202.30, May 10, 2020) CDC. What To Do If You Are Sick. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html New York State. Executive Order 202.30. May 10, 2020. https://www.governor.ny.gov/news/no-20230-continuing-temporary- suspension-and-modification-laws-relating-disaster-emergency NYC Health Department. Health Alert #14: Updated NYC Health Department COVID-19 Recommendations. May 14, 2020. https://www1.nyc.gov/assets/doh/downloads/pdf/han/advisory/2020/covid-19-update-05142020.pdf
ADDITIONAL PRECAUTIONS FOR PEOPLE WITH CERTAIN RISK FACTORS • Isolation for at least 14 days OR • Negative molecular testing for SARS-CoV-2 before discontinuing isolation UPDATED APPLIES TO: GUID IDANCE: • Members of highly vulnerable populations: • Residents and employees of long-term care facilities DIS ISCONTINUING • Residents of facilities for people with developmental disabilities • Residents of supportive housing or shelter settings in which individuals share ISOLATION – IS bathrooms, kitchens, or sleeping areas VULNERABLE • Persons with chronic illnesses that may compromise immune response POPULATIONS • Including chronic lung, heart, kidney, or liver disease; obesity; and diabetes • Severely immunocompromised people (e.g., receiving chemotherapy) • Molecular testing for SARS-CoV-2 is preferred for this group New York State Department of Health. Health Advisory: Discontinuation of Isolation for Patients with COVID-19 Who Are Hospitalized or in Nursing Homes, Adult Care Homes, or Other Congregate Settings with Vulnerable Residents. April 19, 2020. https://coronavirus.health.ny.gov/system/files/documents/2020/04/doh-covid-19-discontinuing-isolation-hospital-congregate- setting.pdf NYC Health Department. Health Alert #14: Updated NYC Health Department COVID-19 Recommendations. May 14, 2020.https://www1.nyc.gov/assets/doh/downloads/pdf/han/advisory/2020/covid-19-update-05142020.pdf
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