As you’ve noticed, the COVID surge situation in NYC and at NYP has been escalating rapidly — and some of the changes have been difficult to keep up with. I’ve included a few brief updates below regarding some of the most important issues. Please note that guidelines and procedures tend to change quickly – please check the infonet and most up-to-date email updates from Columbia and NYP for current guidance. Feel free to email me with questions or clarifications and I’ll attempt to obtain information from the most accurate sources.
Eligibility and Distribution of Oral Antiviral Medication – now available
The FDA has authorized two oral antivirals for emergency use:
PAXLOVID is produced by Pfizer. MOLNUPIRAVIR is produced by Merck.
PAXLOVID – reduces risk of hospitalization and death by 80%. This is the preferred product and is available for patients 12y and older. MOLNUPIRAVIR – reduces risk of hospitalization and death by 30%. Consider for patients 18y and older for whom other product is not available.
- NYP distributed guidance earlier today regarding the use of oral antivirals. That document is attached to this email and linked here on our Teams site. PLEASE USE THIS GUIDANCE DOCUMENT TO IDENTIFY ELIGIBLE PATIENTS AND INITIATE TREATMENT.
Who should get these drugs and how can I prescribe them?
This is complicated. The cross-campus ED evidence-based medicine group is working to develop ED-focused guidelines for clinicians asap. These guidelines will mirror state and city eligibility and prioritization guidelines. In New York City, ALTO PHARMACY is the sole distributor of these medications. Prescribers will need to send a prescription to ALTO pharmacy. Once the prescription is delivered, patients will contact the pharmacy via phone, text, or mobile app to schedule a same-day delivery. Outside of New York City, a small number of pharmacies in each region have allocations of the medication. In Westchester, this is initially CVS in Portchester, Peekskill, and Yonkers.
- The most recent guidance from NYS is here.
- And the most recent guidance from NYC is here (external link).
- More detailed information for ED providers is forthcoming – including smartphrases for specific discharge instructions.
- Currently, availability of these medications is severely constrained and NYP endeavors to follow FDA and state eligibility guidelines to ensure that our most at-risk patients receive these potentially lifesaving medications. Please carefully consider the guidelines prior to prescribing.
- Pro tip – the information for these medications is available in Lexicomp – including contraindications and drug-drug interactions.
Return to work guidelines for employees:
- Confusing? You bet! Here’s the upshot:
- COVID-positive health care workers may return to work after FIVE DAYS HAVE PASSED following symptom onset, or following a positive test if asymptomatic. NYP and CU guidance now align on this matter. That means the day of the test or the first symptoms is day 0, and you return to work on day 6.
- Return to work criteria include symptom improvement, afebrile for 72 hours, and able to safely and comfortably wear an N95 mask.
- You are NO LONGER REQUIRED TO CALL THE WHS HOTLINE TO OBTAIN CLEARANCE TO RETURN TO WORK. Please do continue to email the AOC and Jimmy+Zysa.
- Per yesterday’s guidance, personnel may return to work if qualified as above, without the CU test trace team.
- Dec 29 NYP guidance is linked here (infonet link).
- Use https://covidtracker.nyp.org to report illness and get further information.
One last word about returning to work:
- You’ll notice that the isolation period for covid-positive workers has been significantly reduced, in light of available evidence regarding transmissibility of the delta and omicron variants. And clearly staffing is very tight.
- This doesn’t mean that you’re expected to work while sick, or that you should feel pressured to return before you are healthy and ready to work. No one wants to leave their colleagues high and dry — but dragging your sniffly cough cough foggy-headed self to work before you’re ready doesn’t help your patients or your co-workers.
Testing for Employees – expanded availability
- Alternative testing locations are available for CUIMC personnel. Employees should not be referred to the ED for testing.
- The CU testing center in the Black Building is available for employees, but will be closed from Thursday, Dec 30 through Monday, Jan 3. Normal hours will resume on Jan 4th.
- As of yesterday, the Black Building site was accepting walk-ins. This may change.
The Heart Center NYP testing center has expanded capacity and will now be open 7am-7pm Monday through Friday. The Heart Center site will be open for symptomatic testing only on Friday 12/31, Sat 1/1, and Sun 1/2 (830am-5pm each day). Use the Connect app to schedule.
- We are able to expedite testing for symptomatic employees who need to work clinically. If you find yourself in this situation, contact the ED AOC (residents, contact program leadership) for help.
Community-based testing remains scarce
- Testing capacity is very limited. The NYC DOH has begun to operationalize community based testing sites at a variety of locations, hopefully there are more to come.
- Here is a list of NYC DOH testing sites, including mobile sites and availability over the coming holiday weekend.
- A searchable map of testing sites is here.
- For tests done at NYP, the capacity to follow up pending tests and notify patients of positive results is constrained. When possible, please encourage patients to enroll in Connect to track their test results.
- See Laurie’s Tuesday email describing how to enroll a patient in connect. Here’s the quick reference sheet that she attached.
“Cough and Cold” clinics are back!
- A ‘cough and cold’ clinic operated by the faculty practice and ACN has been opened in the VC lobby at CUIMC. The purpose is to provide evaluation and care for low acuity patients as an alternative to an ED visit. Screeners should be stationed at the Broadway ED lobby to help direct appropriate patients to the clinic. As of now, likely hours are 10a – 8p, hopefully 7d/week.
- Plans are in the works for similar clinics at other clinical sites — stay tuned. See Angela’s email from earlier today for more detail.
Bonus Situational Awareness Info – New Year’s Eve
If you’re looking to scroll some helpful info while waiting for the ball to drop, here you go (also if you’re traveling or working on NYE):
Estimated Attendance: 15,000 attendees
Attendees must show proof of full vaccination and valid photo identification Unvaccinated minors under the age of 5 must be accompanied by a vaccinated adult to enter the event. Attendees will be required to wear masks and the event is fully outdoors. Viewing areas will be filled with fewer people to allow for social distancing. Visitors won’t be allowed entry until 3:00 pm.
Vehicle traffic from 45th through 48th Streets in Times Square is generally closed by the early morning 12/31 By 3:00 pm, the streets are closed from 42nd to 49th Streets between 6th and 8th Avenues
Certain subway access will be altered in the Times Square area (the actual time of the system changes could change) TIMES SQUARE-42 ST STATION: The 42nd Street entrances close at approximately 11:00 am 49 ST STATION <N/R/W>: This station will be bypassed beginning at about noon 12/31 until approximately 12:15 am, 1/1 50 ST STATION <1>: This station will be bypassed beginning at noon, 12/31 until approximately 12:15 am, 1/1
- Updated information is here.
One last reminder — please be vigilant with PPE. Current recommendations are for N95 + eye protection for all patient care. We’re at that point now where even patients with broken ankles are covid positive. This also means exercising care in team rooms, break rooms, etc.
That’s plenty for now. I’ll continue to send out periodic updates as the situation evolves. Remember, the next couple of weeks are going to be a bit sporty, but we’ve got this. Take some time to exercise, enjoy the outdoors and New Year’s holiday.
12/31 Update: Oral antivirals – guide for providers
Here’s the NYP ED guide for provision of oral antivirals
. This document summarizes the guidelines I mentioned yesterday. Please note that we’re still in category 1A, which means only patients who are moderately to severely immunocompromised or age 65+ AND not fully vaccinated AND one or more risk factors for severe disease.
- The document is attached here as well.