The Delaware Public Health Laboratory (DPHL) has identified a case of SARS-CoV-2 lineage BA.2.86 from a specimen provided to the laboratory for testing. This is the first case of BA.2.86 detected in Delaware, currently classified as a Variant Being Monitored (VBM) by the SARS-CoV-2 Interagency Group (SIG). The Centers for Disease Control and Prevention (CDC) is publishing weekly updates on this new variant including current risk assessment and scientific analysis on its website: https://www.cdc.gov/respiratory-viruses/whats-new/covid-19-variant-update-2023-08-30.html. 

These latest developments are a reminder that while the Public Health Emergency (PHE) for COVID-19 has ended, COVID-19 is not over. An updated COVID-19 vaccine, designed to protect against the newly circulating variants, will be available later this month pending final approvals, and more details will be forthcoming. To learn about vaccine and test availability, isolation guidelines, and more, please visit de.gov/coronavirus.  

CDC Issues Health Advisory

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to:

• Notify health care professionals, laboratories, and public health departments about recent reports of fatal Vibrio vulnificus (V. vulnificus) infections, including wound and foodborne infections. 
• Urge health care professionals to consider V. vulnificus as a possible cause of infected wounds that were exposed to coastal waters, particularly near the Gulf of Mexico or East Coast, and during periods with warmer coastal sea surface temperatures. 
• Share important guidance for managing V. vulnificus wound infections.

CDC Issues Health Advisory - New Prevention Tools Available

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to notify clinicians and caregivers about increases in respiratory syncytial virus (RSV) activity across some parts of the Southeastern United States in recent weeks, suggesting a continued shift toward seasonal RSV trends observed prior to the COVID-19 pandemic. Historically, such regional increases have predicted the beginning of RSV season nationally, with increased RSV activity spreading north and west over the following 2–3 months. RSV can cause severe disease in infants, young children, and older adults. In anticipation of the onset of the 2023-2024 RSV season, CDC encourages clinicians to prepare to implement new RSV prevention options. Monoclonal antibody products, including a new, long-acting product, nirsevimab (Beyfortus^TM, Sanofi and AstraZeneca), are available to protect infants and some young children at higher risk for severe RSV disease. For all infants ages <8 months, and infants and children ages 8–19 months who are at increased risk of severe RSV, clinicians should start to offer nirsevimab when it becomes available (expected by early October). Also, two new vaccines are available to protect older adults from severe RSV disease. For adults ages 60 years and older, clinicians should offer a single dose of an RSV vaccine, either RSVPreF3 (Arexvy, GSK) or RSVpreF (Abrysvo^TM, Pfizer), based on shared clinical decision-making between the health care professional and the patient. On August 21, 2023, FDA approved the RSVpreF vaccine (Abrysvo^TM, Pfizer) for use in pregnant people during weeks 32 through 36 of gestation for the prevention of RSV-associated lower respiratory tract disease in infants from birth through 6 months of age.

Aims to Improve Overall Health of a State Population

On Tuesday, the Centers for Medicare & Medicaid Services (CMS) unveiled a transformative step to test a state’s ability to improve the overall health care management of its state population. The States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD Model”) aims to better address chronic disease, behavioral health, and other medical conditions. Under the AHEAD Model, participating states will be better equipped to promote health equity, increase access to primary care services, set health care expenditures on a more sustainable trajectory, and lower health care costs for patients. The AHEAD Model represents the next iteration of the CMS Innovation Center’s multi-payer total cost of care models. States participating in AHEAD will be accountable for quality and population health outcomes, while reducing all-payer avoidable health care spending to spur statewide and regional health care transformation. Through this new voluntary Model, CMS will partner with states to redesign statewide and regionwide health care delivery to improve the total population health of a participating state or region by improving the quality and efficacy of care delivery, reducing health disparities, and improving health outcomes. AHEAD also includes specific payment models for participating hospitals and primary care practices as a tool to achieve Model goals. Through AHEAD, CMS aims to strengthen primary care, improve care coordination for people with Medicare and Medicaid, and increase screening and referrals to community resources like housing and transportation to address social drivers of health. CMS will issue awards to up to eight states. Each state selected to participate in the AHEAD Model will have an opportunity to receive up to $12 million from CMS to support state implementation. 

Reporting Requirements for Identification of Mpox

On August 31, 2023, Centers for Disease Control and Prevention's (CDC’s) Division of Select Agents and Toxins (DSAT) posted a Select Agent (SA) Gram to inform clinical and diagnostic laboratories and other entities that the standard (pre-October 4, 2022) reporting requirements for the identification of Mpox virus will be reinstated on October 30, 2023. The reporting requirements in place during the Mpox public health emergency will no longer be in effect. You are encouraged to review the SA Gram in detail. 

Effective September 1st

The Delaware Department of Transportation (DelDOT) and the Delaware Division of Motor Vehicles (DMV) aim to reduce motorcycle fatalities with a new endorsement motorcycle helmet law that went into effect on Friday, September 1, 2023. SB 86, sponsored by numerous legislators was signed by Governor John Carney on June 30, 2023. The new law will require everyone who obtains a new motorcycle endorsement on or after the above date or anyone riding with that person to wear a helmet and eye protection for two years after they receive their endorsement. Currently, every adult operating or riding as a passenger on a motorcycle must have a helmet in their possession and wear eye protection while operating or riding a motorcycle. And every person up to 19 years of age must wear a helmet and eye protection. Helmets and eye protection are already required for those operating with a temporary motorcycle instruction permit as required under § 2703 of Title 21 of the Delaware Code and no passengers are allowed.

Diabetes, Cancer, Nutrition/Weight Loss, Exercise for Adults with Disabilities

The Medical Society of Delaware supports and collaborates with organizations across the state to bring tools and resources to our physician members, their staff, as well as your patients; and in doing so would like to share information from the YMCA’s Healthy Living Programs.

The YMCA’s Diabetes Prevention Program (YDPP), LiveSTRONG at the YMCA (for cancer survivors), LEAN (Lifelong Essentials for Activity & Nutrition – a 14 week weight loss program), and Adaptive Fitness (an exercise program for adults with disabilities).

For more information about the programs or to inquire how a patient is doing in the program of choice, please contact Peter Campbell, Healthy Living Outreach Coordinator at healthyliving@ymcade.org or 302-572-9622.

New DE-PLANs Website Focuses on "Preparing Older Adults"

Governor Carney proclaimed September as Preparedness Month in Delaware to highlight the many ways families and businesses can “make a plan, build a kit, and stay informed” to be better prepared for emergencies and natural disasters. September coincides with the peak months for Atlantic hurricane season, which underscores the need for readiness. The 2023 theme is “Preparing Older Adults,” highlighting key challenges Delaware seniors can face when it comes to preparedness.

Application Cycle for the 2024 NHSC Students to Service Loan Repayment Program

The Health Resources and Services Administration (HRSA) opened the application cycle for the 2024 National Health Service Corps (NHSC) Students to Service Loan Repayment Program. Final-year students studying to become a medical doctor, physician assistant, nurse practitioner, certified nurse midwife, or dentist can apply for awards of up to $120,000 in exchange for a three-year commitment providing primary care services at NHSC-approved sites in high-need areas. This year, HRSA added an additional $40,000 supplement for medical students and certified curse midwives who commit to providing OB/GYN services in a maternity care target area (MCTA). Designated MCTAs are areas within an existing health professional shortage areas that are experiencing a significant shortage of maternity health care professionals. Applications are due Thursday, December 7, 7:30 p.m. ET. 

Loan Repayment Program Open for Applications

The National Institute of Health (NIH) Loan Repayment Program (LRP) is now open for applications. All qualified health professionals with doctoral degrees: apply now to the 2024 application cycle. Applications are accepted through online application portal until November 16 at 8:00 p.m. ET. The LRP offers loan repayment awards of up to $50,000 per year for up to 2 years. Awardees commit to engage in National Institute on Minority Health and Health Disparities (NIMHD) and NIH mission-relevant minority health and health disparities research in non-federal settings for at least two years. Since its inception, the NIMHD LRP has repaid the student loans of over 2,200 doctorate-level health professionals. Awardees have worked in a variety of disciplines, including medicine, epidemiology, psychology, social science, and health policy. LRP recipients have conducted research on areas such as cardiovascular disease, cancer, diabetes, HIV/AIDS, infant mortality, asthma, obesity, and kidney disease. Their investigations have examined biological, lifestyle, environmental, social, economic, institutional, cultural, and family influences on health disparities. Learn more.

Internship Applications Now Being Accepted with Rep Blunt Rochester

Internship applications for Representative Lisa Blunt Rochester's Washington, DC and Delaware offices for the spring of 2024 are now being accepted! Complete applications are due by Thursday, November 9 by close of business. This is an excellent opportunity for young people to learn public service first-hand and gain experience working in a congressional office. 

For more information on how to apply, please visit her website here.

Check Your MIPS Duties While You Sip Your Pumpkin Spice Latte

To help you optimize scores and minimize practice burden, below is a brief look at what to be doing for MIPS in September:

• Quality: September is the perfect time to revisit any unmet quality instances. It is also an ideal time to motivate your team! Consider an incentive to improve a chosen quality measure.

• Improvement Activities: This is the last month to plan for 90 days of activities! Reminder: Make sure that more than 50% of your eligible clinicians participate.

• Cost: Look at your most costly patients. How can you lower their costs? Can you lower cost by improving preventive services?

There are more duties be completed in September! Chirpy Bird provides a free “2023 MIPS Month-by-Month” eBook. Download it here!

Patient Safety and Risk Management Strategy

All pediatric and family practices should consider including a car window hammer as part of their emergency response cart or kit. It is an effective patient safety and risk management strategy, especially given the recent COVID-19 pandemic, when parents were asked to wait in their vehicles until they were ready to be seen by the practitioner. In the event an infant, toddler, or young child accidentally becomes locked inside a vehicle, a car window hammer can be a lifesaving tool—especially in hot climates, when seconds count in preventing serious harm or death. According to the National Highway Traffic Safety Administration (NHTSA):

• Even in cooler temperatures, a vehicle can heat up to dangerous temperatures very quickly. An outside temperature in the mid-60s can cause a vehicle’s inside temperature to rise above 110° Fahrenheit. The inside temperature of the vehicle can rise almost 20° Fahrenheit within the first 10 minutes.
• Heatstroke does not occur only during the summertime or in the Sun Belt States. This deadly issue can occur at any time of the year, in any weather condition, in any community—for any parent.
• Cold weather is just as dangerous. The risk of hypothermia during the winter season is also a concern if an infant, toddler, or young child is inadvertently locked inside a vehicle.

Patient Conversations: Diabetes

Create a powerful visual aid to assist patient conversations about diet choices and diabetes. Take an empty soda bottle and add granulated sugar to represent the sugar found in the sodas people drink every day. (A 20-ounce bottle of soda typically packs 16 teaspoons of sugar.) Place a bottle in each exam and discuss how reducing soda can help weight loss.

LEARN MORE:

Toolkits:

• Team-Based Care of Type 2 Diabetes and Prediabetes
• Health Coaching

Resources:

• CDC Diabetes Fact Sheets
• AMA Diabetes Prevention Toolkit

AMA STEPS Forward^® offers a collection of engaging and interactive educational content designed to help put the joy back into medicine.

ChristianaCare

Yeswanth Attoti, MD - Internal Medicine, Seaford Internal Medicine, LLC

Ronald A. Luna, MD - Internal Medicine, Seaford Internal Medicine, LLC

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!

Elizabeth Habash - Medical Student, Sidney Kimmel Medical College (2026)

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.

Flu Vaccination Guidance for Children

Flu can be a serious threat to children. During a COCA call on August 31, 2023, presenters discussed flu prevention and treatment recommendations from the American Academy of Pediatrics and CDC. If you’ve missed it, this recording is a great update on vaccination, coadministration of flu vaccines, coverage, and health disparities.

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)