Governor Charlie Baker announced last week that the best evidence available predicts that the healthcare system will experience a surge of COVID-19 patients between April 10 and 19. As of yesterday there have been 231 deaths in Massachusetts attributable to COVID-19 since the first was reported on March 20. Fifteen deaths were reported yesterday, 24 on Saturday. To try to avoid the frightening spike of patients flooding hospitals, as has been seen in Italy and New York, the health and hospital community and the state took a series of actions through the week and weekend. And Massachusetts society at large did its part by staying as isolated as possible.
  

WORKFORCE

  

CLINICAL FELLOWS LICENSURE

Due to the COVID-19 pandemic, the Massachusetts Board of Registration in Medicine has authorized expediting full licensure for clinical fellows. That is, physicians who have completed training but have not been licensed can apply for a temporary 90-day license to hit the frontlines immediately.
  

APRN SCOPE OF PRACTICE EXPANDED

Advance practice registered nurses at Department of Mental Health-licensed facilities, who hold certification in the field of psychiatric mental health, now have the same authority as qualified physicians to provide specific mental health services, including involuntary and voluntary admissions to inpatient psychiatric facilities, according to a new DPH order. APRNs at non-DMH facilities were granted more authority to work independent of physician oversight by an earlier order.
  

CALLING BACK RETIRED CAREGIVERS

If you are a licensed out-of-state provider in good standing, or if you were licensed in Massachusetts within the past 10 years and your license expired or wasn’t renewed, the state wants you to be able to practice again. A new order issued last week by DPH Commissioner Monica Bharel, M.D., seeks to expand the workforce in Massachusetts able to combat the COVCID-19 epidemic. Physicians whose licenses were suspended or revoked aren’t eligible for the emergency call back. 
  

FUNDING

  

PAYMENTS PER BED?

Without elective surgeries and with almost all M.D. visits and outpatient care on hold, revenue at Massachusetts hospitals has evaporated. A reasoned analysis shows that the losses to Massachusetts hospitals total nearly $1 billion per month. Last week, the American Hospital Association wrote to U.S. Health & Human Services and CMS asking that a portion of the $100 billion in hospital payments contained in the $2.2 trillion CARE Act be distributed directly to hospitals – not through Medicare Administrative Contractors (MACs) – and that the money be dispersed at the rate of $25,000 per bed, and $30,000 per bed for “hot spot” regions of the U.S. While agreeing that MACs should be used for processing applications and making payments from the fund to hospitals and health systems, AHA notes such a process is not an easy or quick task. Thus, there is a need for an immediate distribution of funds.
  

STATE & INSURER RELIEF

MHA has been in discussions with state leaders about a relief package. And last week MHA President & CEO Steve Walsh wrote to the Massachusetts Association of Health Plans, the group representing the state’s health insurance industry, saying that while insurers have taken positive steps during the crisis, “given the magnitude of this public health emergency, we must ask that the health plans do more to support our frontline caregivers and to ensure that our hospitals and health systems remain open for business both now and in the future." 
  

PPE

  
The arrival of nearly 1 million masks from China, delivered on a New England Patriot/Kraft family plane was the big news last week, along with today’s expected arrival of the Battelle N95 decontamination system. Other developments include:
  

MHA DELIVERS MASKS

In March MHA partnered with the Massachusetts Biotechnology Council, Massachusetts Medical Device Industry Council, and Conference of Boston Teaching Hospitals to form the “Massachusetts Life Sciences Emergency Supply Hub,” which solicits donations from life sciences organizations, including lab, testing, and diagnostics supplies; personal protection equipment (PPE); and medical and scientific expertise. To date, more than 450 companies and many private citizens have answered the call and MHA has been able to facilitate the direct donation of 56,000 N95 masks, 1,500 KN95s, and 1,500 surgical masks to hospitals in need, primarily those designated as safety net hospitals. Many more supplies were directed to MEMA as part of their efforts to bring supplies to healthcare facilities. In particular, MilliporeSigma, Novanta, Mevion Medical Systems, and Mascon, gave generous donations of PPE to hospitals in need. To make a donation, please contact supplyhub@massbio.org.
  

FDA NOW OK WITH KN95 MASKS

The FDA said on Friday that through its Emergency Use Authorization powers it now considers that Chinese-made KN95 face masks “are appropriate to protect the public health or safety.” KN95s are very similar to the gold-standard protection mask – the N95s – but they aren’t NIOSH approved and the federal government had until Friday considered them sub-standard. However, even 3M, the main U.S. producer of N95s, said as recently as January 2020 that KN95s, along with a series of other foreign-made masks are “equivalent” to US NIOSH N95 masks in their ability to filter “non-oil-based particles,” including “bioaerosols (e.g. viruses).” The KN95s still have to be reviewed by the FDA to ensure they’re authentic and meet other production guidelines, but the bottom-line conclusion is that the KN95 is indeed a reputable substitute for an N95 for use in healthcare settings fighting COVID-19.
  

VENTILATORS

  
The state has requested ventilators from the federal government, has been promised 1,000, and as of yesterday has received 100. While the wait continued, DPH on Friday morning issued a memorandum on ventilators that said hospitals should “immediately identify any anesthesia ventilators, transport ventilators, and noninvasive ventilators in their organizations that can potentially be used for COVID-19 clinical management, ensure they are in proper working order, ensure they are available to use for the care of patients who need ventilator support, and ensure there are adequately trained staff to operate these resources.” DPH recommended that Certified Registered Nurse Anesthetists (CRNA), who through waivers and emergency orders are now able to function to the full extent of their licenses, should be integrated into hospital emergency preparedness planning and the intensive care clinical workforce to help manage patients who require ventilators.
  

MOLST FORMS, AMBULANCES

  
The state EMS Office issued two new guidance documents allowing for: 1) witnessed and documented verbal consent to take the place of an actual signature on a patient’s MOLST form. (MHA partnered with Honoring Choices and others to bring this to the administration’s attention); and 2) ambulances carrying childbirth parents and patients with pregnancy complications to go directly to the labor and delivery unit, or other appropriate hospital department, instead of to the emergency department.