Plan to Attend the 7th Annual Tilton Award Event!

The Medical Society of Delaware together with the Tilton Society are pleased to announce this year's recipient of the Tilton Award, recognizing medical achievement in Delaware. This award pays tribute to MSD's first President, James Tilton, MD, who was a medical pioneer, innovator, and statesperson. Each award recipient must meet the characteristics of Dr. Tilton, first and foremost being a member of MSD:

Potential for Increases in COVID-19 Cases

The Delaware Division of Public Health (DPH) issued a health advisory regarding the early increase in COVID-19 cases and the potential for Variant Influenza during the summer months. Other viruses that cause respiratory illnesses, including RSV, remain a risk. While multiple viruses continue to circulate, clinicians should prioritize those at-risk for severe illness. Prevention and treatment measures for respiratory illnesses are key, including keeping vaccinations up to date and providing applicable pharmaceutical interventions as needed. Increases in respiratory illness cases from the previous week to the current week of Aug. 1, 2023, to Aug. 9, 2023, demonstrates increasing incidence in RSV, Influenza, and COVID-19. In addition, the Michigan Department of Health and Human Services reported an Influenza A/H3 swine variant, associated with an individual at a county fair. COVID-19 is also on the rise with 207 recorded cases in the current week versus the prior week where 157 cases were recorded. Rises in wastewater surveillance are evident, further reiterating the need to stay vigilant in prevention and treatment strategies.

Highly Mutated Strain Found in US

The Centers for Disease Control and Prevention (CDC) posted on X (formerly known as Twitter) that it is tracking a new lineage of the coronavirus that causes COVID-19. This lineage is named BA.2.86, nicknamed "Pirola," and has been detected in the US, Denmark, and Israel. The World Health Organization (WHO) added the new lineage to its Variants Under Monitoring category last week. CDC has indicated the new BA.2.86 lineage of coronavirus may be more capable than older variants in causing infection in those who have previously had COVID-19 or who have received vaccines, and scientists are evaluating the effectiveness of the updated COVID-19 vaccine. CDC's current assessment is that this updated vaccine will be effective at reducing severe disease and hospitalization and that there is no evidence that this variant is causing more severe illness.

As COVID-19 cases rise across the US and this new variant emerges, misinformation about treatment or prevention of the disease perseveres. In an effort to combat a flurry of recent social media posts touting the use of ivermectin, the deworming drug, the US Food and Drug Administration (FDA) is reminding people on social media why it never approved it as COVID-19 treatment. The FDA pointed to recently updated National Institutes of Health COVID-19 treatment guidelines, which not only don’t approve of its use but recommend against it due to inefficiency and lack of evidence. While some studies on ivermectin as COVID-19 treatment do exist and some do testify to the drug’s efficacy, that data is overwhelmingly considered inconsistent, questionable and/or inconclusive by experts. It’s important to remember COVID-19 is a virus, not a parasite, and would not be targeted by ivermectin being introduced in the body. In 2021, the American Medical Association called on physicians in the US to stop prescribing ivermectin for COVID-19 treatment.

Vaccine to Prevent RSV in Infants

On Monday this week, the U.S. Food and Drug Administration (FDA) approved Abrysvo (Respiratory Syncytial Virus Vaccine), the first vaccine approved for use in pregnant individuals to prevent lower respiratory tract disease (LRTD) and severe LRTD caused by respiratory syncytial virus (RSV) in infants from birth through 6 months of age. Abrysvo is approved for use at 32 through 36 weeks gestational age of pregnancy. Abrysvo is administered as a single dose injection into the muscle. The FDA approved Abrysvo in May for the prevention of LRTD caused by RSV in individuals 60 years of age and older.

New Medicare Prescription Payment Plan Allows Payment Over the Year

President Biden’s prescription drug law, the Inflation Reduction Act, gives people with Medicare prescription drug coverage (Medicare Part D) the option to pay out-of-pocket costs in monthly payments spread out over the year, starting in 2025. On Monday this week, the Centers for Medicare & Medicaid Services (CMS) released draft guidance for comment that outlines the requirements and procedures for certain aspects of the new Medicare Prescription Payment Plan. By enabling seniors and people with disabilities with Medicare Part D coverage to spread out cost sharing over the year, the program could reduce the burden of high upfront out-of-pocket prescription drug costs. The draft guidance provides information on topics such as identifying Medicare Part D enrollees likely to benefit from the program, the opt-in process for Part D enrollees, program participant protections, and the data collection needed to evaluate the program. Given the size of the new program, CMS is releasing the guidance in two parts, starting with the guidance released on Monday. Additional draft guidance will be released for comment in early 2024.

USPSTF Recommends PrEP Medications Be Covered by Private Insurance

The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of preexposure prophylaxis (PrEP) with antiretroviral therapy for the prevention of HIV acquisition, and the diagnostic accuracy of risk assessment tools to identify persons at increased risk of HIV acquisition. The USPSTF concludes with high certainty that there is a substantial net benefit from the use of effective antiretroviral therapy to reduce the risk of acquisition of HIV in persons at increased risk of acquiring HIV. The USPSTF recommends that clinicians prescribe PrEP using effective antiretroviral therapy to persons at increased risk of HIV acquisition to decrease the risk of acquiring HIV (A recommendation). This recommendation is consistent with the 2019 USPSTF recommendation on PrEP for the prevention of HIV, the only difference being the consideration of the injectable form of the drug cabotegravir, known commercially as Apretude. It is important for clinicians to recognize that barriers to the implementation and uptake of PrEP exist. These barriers can include structural barriers, such as lack of health insurance, and other factors, such as an individual's belief that they are not a candidate for PrEP or lack of willingness to take PrEP. There are also racial and ethnic disparities in the use of PrEP. PrEP is underutilized, particularly for Black and Hispanic/Latino persons with indications for PrEP. As such, the USPSTF has given its highest recommendation to an expanded menu of HIV prevention strategies for adults and adolescents, a move that would require private insurers to cover the drugs without a co-pay or deductible under the Affordable Care Act.

Physician Practice Information (PPI) Survey Sent to Thousands of US Doctors

Thousands of U.S. physicians will be getting a short patient-care hours survey from either their practice directly or from Mathematica. The aim of the Physician Practice Information (PPI) Survey is to better understand the costs faced by today’s physician practices to support physician payment reform. Participation will ensure that practice expenses and patient-care hours are accurately reflected. Read more.

In the Midst of Hurricane Season, Prepare Yourself at Home and Work

Hurricane season runs from June 1 to November 30. Along with wet weather, we are also seeing an increase in wild fires. When gale-force winds start blowing and torrential rains raise water levels, or the winds of fire come your way, you need to be ready. Power outages mean refrigerated food and medicine supplies may spoil. Floods may contaminate tap water and emergency supplies not stored properly with sewage, chemicals, heavy metals, pathogenic microorganisms, or other contaminants. If the storm, flood, or fire is severe enough, you may need to evacuate with little time to prepare. With September dubbed National preparedness Month in 2023, don’t put off being prepared until the emergency hits. It's a great time to review recommendations, inventory emergency kits, and rotate/replace items that may be expired. Having a safe source of food, water, medications, etc. is essential during a crisis. Take a look at the US Food and Drug Administration's Hurricane Season: Be Prepared consumer update to ensure your emergency kit has everything you need. Recommendations for health care professionals.

Daily Team Huddles to Boost Efficiency, Productivity, and Communication

Boost efficiency, productivity and communication with daily team huddles between physicians and other team members. Keep them to 15 minutes or less and discuss clinic capacity, staffing levels or absences, patient needs, or other concerns for the day. It’s crucial to identify a huddle leader who can ensure the team hears from everyone who needs to speak.

LEARN MORE

Toolkits:

• Daily Team Huddles
• Team Meetings

Playbook: Wellness-Centered Leadership

Risk of Blood Clots; Not a Product Removal

Abiomed is recalling the labeling for Impella RP Flex with Smart Assist System Catheter because the catheters’ Instructions for Use (IFU) do not appropriately address precautions for health care providers to take when treating patients whose anticoagulation clotting time is below the recommended value. Patients with central venous lines and cardiac cannulas with systemic anticoagulation below IFU recommendation of 160-180 seconds are most at risk. The US Food and Drug Administration (FDA) has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death. Please be aware, this recall is a voluntary correction, not a product removal.

Contaminants in Airpath

Draeger Medical, Inc. is recalling its Carina Ventilators due to the presence of contaminants in the device’s airpath. The contaminants exceed acceptable levels if used by pediatric patients for more than 30 days. During testing, the firm found polyether polyurethane (PE-PUR) in the airpath of the Carina ventilator. This results in the emission of contaminant 1,3-Dichloropropan-2-ol, a potential carcinogen. Please be aware, this recall is a voluntary correction, not a product removal. Clinicians may continue to use the devices with adult patients and are instructed to not use the devices with pediatric patients. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

Due to Bacterial Contamination

The U.S. Food and Drug Administration (FDA) is warning consumers not to purchase and to immediately stop using Dr. Berne’s Methylsulfonylmethane (MSM) Drops 5% Solution and LightEyez MSM Eye Drops – Eye Repair due to bacterial contamination, fungal contamination, or both. FDA’s testing showed the products were contaminated with microbes and were not sterile. FDA is not aware of any adverse event reports associated with use of either products at this time. Patients who have signs or symptoms of an eye infection should talk to their health care professional or otherwise seek medical care immediately. Health professionals and consumers are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program.

Join Today!

Membership in the American Medical Association (AMA) unlocks access to exclusive content, worry-free benefits, and all the best the AMA has to offer. Join today. You may be eligible for 50% off your dues. 

What Physicians Wish Patients Knew

In the battle against obesity, physicians play a crucial role in guiding patients towards a healthier and more sustainable lifestyle. While healthy eating and physical activity remain fundamental pillars in weight management, there are instances when additional support becomes necessary. Enter anti-obesity medications—Food and Drug Administration-approved medications to help people achieve and sustain a healthier weight. But the world of anti-obesity medications is complex, and these new and emerging tools are often misunderstood. The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines. Listen to this article.

Bayhealth

Delaware Healthcare Association

Delaware Hospice

Westside Family Healthcare

Shazia Aziz, MD, Cardiovascular Disease Fellowship, ChristianaCare

Awele Maduka-Ezeh, MD, MPH, ID/IM, Delaware Department of Correction

Dakota M. Urban, MD, Plastic Surgery, Dakota M. Urban, MD, PA

Please join MSD in welcoming the newest members of the Medical Society of Delaware. As the third oldest medical society in the country, MSD has an amazing history. Thank you for taking part in our continued success!

Yehuda E. Kerbel, MD - Orthopaedic Surgery, First State Orthopaedics

Hamdan K. Mallick, MD - General Surgery Resident, Bayhealth

Jessica McKeown - Medical Student, PCOM/ChristianaCare

Kelly E. Moyer - Medical Student, SKMC/ChristianaCare

MSD members are afforded a seven-day review period from the date of this publication to comment regarding applicants for membership. Please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any comments on the current pending members listed above or if you know of someone interested in joining MSD. You could be eligible for a membership referral dues discount!

The Latin phrase Rerum Cognoscere translates to learn, examine, or become aware of facts or things. In this section, we highlight measurable items of interest in health care from MSD, Delaware, the US, and the world.

CDC Director Rochelle P. Walensky, M.D., M.P.H. adopted the 2023-2024 Advisory Committee on Immunization Practices’ (ACIP) recommendations on annual influenza (flu) vaccination for everyone 6 months and older in the United States on June 27, 2023. There were small changes to the annual recommendations around flu vaccination, including an acknowledgement of the updated flu vaccine composition for the 2023-2024 flu season and a change in the recommendations for vaccination of people with egg allergies. Dr. Walensky’s adoption of the ACIP recommendations makes them official CDC policy, which have been published in the Morbidity and Mortality Weekly Recommendation Report August 23, 2023. Health care professionals should begin vaccinating patients according to CDC’s recommended timing, which remains the same as last season. Read the CDC Vaccine Recommendations for the 2023-2024 flu season.

The national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic ended on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available, some of which have been updated based on recent action by Congress.

• Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (Updated 5/12/2023).
• Provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers
• Acute Hospital Care At Home
• Loss of Medicaid or CHIP coverage
• FAQs on CMS Waivers, Flexibilities, end of COVID-19 PHE (May 4, 2023)

Updates will continue to be provided as we approach the end of the PHE. You are encouraged to regularly visit the CMS Emergencies Page for the most up to date information.

• Find COVID-19 Vaccines: https://www.vaccines.gov/
• No Cost COVID-19 Testing Locator can help people find current community and pharmacy partners participating in the Increasing Community Access to Testing (ICATT) program.
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Federal website for information on navigating COVID: COVID.gov
• CDC Isolation and Precautions for People with COVID-19
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker
• CDC will report regional-level test positivity data from the National Respiratory and Enteric Virus Surveillance System (NREVSS)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• 2nd bivalent COVID-19 Vaccine Booster: Who Should Receive It?
• (Delaware) General Questions: call 211 or email DPHCall@delaware.gov or Vaccine@delaware.gov for vaccine-specific questions.
• Latest information on Delaware's response (testing, treatment, vaccination): de.gov/coronavirus (Updated 2/2023)