Firefox https://app.constantcontact.com/pages/campaigns/email

May 12, 2021

Email the editor

Dr. Hundley talks about cardiac MRI assessment

Many thanks to Dr. Greg Hundley, director of VCU's Pauley Heart Center, for yesterday's insightful Lunch of Tuesdays talk on the use of cardiovascular magnetic resonance to assess patients with cardiovascular disease.

RAM was thrilled to offer the meeting as a hybrid model, with some members attending in person for the first time in over a year! Other members watched via Zoom.

If you missed it, CLICK HERE for a recording. Passcode: i+Zt1X.b

Early voting underway for Dem nominees. Make your voice heard.

2021 is quiet in much of the country, but in , it's a big year for elections. We'll be electing a new governor, lieutenant governor and attorney general, as well as all delegates in the General Assembly.

Last week we told you about the Republican statewide convention to select candidates for the November election. The GOP chose a convention over a primary to select its nominees after a protracted battle among leadership. The results: Glenn Youngkin is the

1 of 9 5/13/2021, 8:30 AM Firefox https://app.constantcontact.com/pages/campaigns/email

Republican nominee for governor, Winsome Sears for lieutenant governor and Jason S. Miyares for attorney general.

On June 8, Democrats will hold the more traditional primary to nominate candidates. Early and absentee voting is now underway; CLICK HERE for information and ballot requests. In the gubernatorial contest, contenders include Lee Carter, Justin Fairfax, , Terry McAuliffe and Jennifer McClellan. Everyone can vote in the the Democrat primary, even if you are identify as a Republican or Independent. Next week, we'll look at the Republican primaries for the House of Delegates.

For the House, several prominent Democratic incumbents face challenges (incumbents marked with *). Below are the local Democrat candidates for House of Delegates who have primary challengers. If you don't see the district listed, then the incumbent is running unopposed for the nomination.

District 66 Linnard Harris, Sr. Katie Sponsler

District 68 * Kyle Elliott

District 71 Jeffrey Bourne* Richard Walker

District 74 Lamont Bagby* John Dantzler

Not sure of your district? CLICK HERE for the General Assembly's Who's My Legislator tool.

Deadline approaching! Submit your legislative proposals

The Academy’s Legislative Committee invites you to share your legislative ideas. Describe the problem, define the issue and propose a possible solution. Submit your ideas by May 19 for consideration at the Committee's May 26 meeting.

Make plans to advocate for your legislative idea at our May 26 meeting which will be held via Zoom. If you are unable to join on May 26, please find a representative to present the proposal in your stead.

The Committee will determine which legislative recommendations should be forwarded to the Medical Society of Virginia for consideration at their Advocacy Summit and possible inclusion in the 2022 Legislative Agenda.

CLICK HERE for sample proposals considered at last year's MSV Advocacy Summit.

Questions? Contact Lara Knowles at [email protected] or call her at 804-622-8137.

Legislative recommendations due WEDNESDAY, MAY 19!

SUBMIT YOUR LEGISLATIVE PROPOSAL

Northam hopes to lift Virginia's COVID-19 restrictions on June 15,

2 of 9 5/13/2021, 8:30 AM Firefox https://app.constantcontact.com/pages/campaigns/email

will follow CDC guidance on masks

Buoyed by rising vaccinations and falling COVID-19 cases, Gov. said last week that he hopes to lift emergency restrictions on public gatherings and social distancing by June 15, reports the Times-Dispatch.

With those restrictions due to ease on May 15 for restaurants, entertainment venues and indoor social gatherings, Northam raised the possibility that he will end them entirely a month later — if people get vaccinated against the coronavirus disease and infections continue to fall.

The governor also raised the possibility that he will allow the state of emergency to expire on June 30, more than 15 months after it began.

Virginia begins shifting vaccine supplies to primary care doctors

Primary care doctors are about to get what many have wanted since they knew a coronavirus vaccine was in development: a chance to offer patients shots at their offices, says The Virginian-Pilot. Virginia public health officials say they’ll be pushing more doses to doctors in the coming weeks.

Politico reports that the Biden administration and state health officials are rushing to overcome logistical hurdles to get more shots into doctors’ offices, believing that physicians who have largely been excluded from the inoculation effort so far could be key to boosting vaccination rates. Physicians have been lobbying the White House and state governments for direct shipments of vaccines, but officials instead focused their efforts on mass vaccination sites and other places that could quickly immunize hundreds or even thousands of people daily. Based on that history, AMA President Susan R. Bailey, M.D., said some physicians have been discouraged about getting vaccines, so they haven’t signed up to administer them.

Public health experts: CDC’s COVID-19 messaging is out of step with the moment

When the CDC released new guidelines last month for mask wearing, it announced that “less than 10 percent” of COVID-19 transmission was occurring outdoors. Media organizations repeated the statistic, and it quickly became a standard description of the frequency of outdoor transmission, says The New York Times. But the number is almost certainly misleading. It appears to be based partly on a misclassification of some COVID transmission that actually took place in enclosed spaces. An even bigger issue is the extreme caution of CDC officials, who picked a benchmark — 10 percent — so high that nobody could reasonably dispute it.

Stat reports that public health officials, academics, clinicians and other experts have slowly worked to refine and clarify their understanding of how SARS-CoV-2 works. But the CDC has been curiously slow in catching up to consensus, public health experts say. As early as last summer, many researchers converged on the idea that aggressively spraying down surfaces was likely unnecessary, but the CDC only settled on that idea last month. And there are other examples, from the CDC's again late-to-the-party admission that the coronavirus is airborne to issuing guidelines three months after vaccinations started in the U.S. on what activities vaccinated people could safely do.

The director of the CDC on Tuesday defended the agency against these accusations, reports The NYTimes. At a Senate hearing with other top federal health officials on the federal government’s pandemic response, Republicans accused Dr. Rochelle P.

3 of 9 5/13/2021, 8:30 AM Firefox https://app.constantcontact.com/pages/campaigns/email

Walensky, of accommodating special interests in the agency’s guidance for schools and of failing to recognize the low risk of outdoor transmission of the coronavirus.

FDA authorizes Pfizer vaccine for children 12-15

The FDA on Monday authorized use of the Pfizer-BioNTech COVID-19 vaccine for 12- to 15-year-olds in the U.S., a crucial step in the nation’s steady recovery from the pandemic and a boon to millions of American families eager for a return to normalcy, reports The New York Times.

CLICK HERE for a statement from Dr. Danny Avula.

A VCU survey reports that more than 60% of Virginia parents are willing to get their children vaccinated.

Most physicians now work outside of private practice

Healthcare Dive reports that for the first time, most physicians worked outside of physician-owned practices in 2020, as doctors continue to gravitate toward employment by hospitals and other organizations, according to a new American Medical Association survey.

The trade group's latest Physician Practice Benchmark Survey found that 49.1% of patient care physicians worked in physician-owned practices in 2020, a drop of almost 5 percentage points from 2018, when that figure was 54%. It's 11 percentage points lower than 2012, when 60% of physicians worked in physician-owned practices. Hospitals are one of the largest employers of physicians, with the proportion increasing nearly 50 % between 2012 and 2020.

There has been ongoing debate in recent years about physician burnout, with much of it attributed to their having to balance the administrative tasks of running a practice with caring for patients. Now, it appears that practicing as an employee is taking over.

Federal probe of drug middlemen urged

After years of accusations, a bipartisan group in the U.S. Senate wants federal regulators to investigate whether drug middlemen and their parent companies are rigging the system to raise prices and pad their pockets, reports The Virginia Mercury.

Sens. Chuck Grassley (R-Iowa) and Maria Cantwell (D- Wash.) last month filed legislation that would require the federal trade commission to investigate whether health care giants are using their dominance to bilk consumers and government payers such as Medicaid out of enormous sums of money. They also want the FTC to examine whether the corporations are unfairly driving community pharmacists and other competitors out of business.

Pharmacy benefit managers, or PBMs, “play a significant role in determining how much patients and the government pay for prescriptions,” Grassley said. “Much of their business model is cloaked in secrecy, and the industry has experienced significant consolidation in recent years. Our bill will provide Congress with a better understanding of the PBM industry, so any future legislation can better protect patients and safeguard competition.”

Virginia Attorney General Mark Herring joined a bipartisan group of 46 attorneys general in a 2020 amicus brief pressing for the right of states to regulate pharmacy benefits managers.

Lawmakers seek COVID money for opioid treatment

4 of 9 5/13/2021, 8:30 AM Firefox https://app.constantcontact.com/pages/campaigns/email

A bipartisan trio of lawmakers, including Abigail Spanberger (D-Va.) is asking Treasury Secretary Janet Yellen for latitude to use some of the president’s $1.9 trillion coronavirus stimulus package for addressing the opioid crisis, Axios reports. The opioid crisis — America's other rampant public health crisis — appears to be getting even worse, likely exacerbated by the isolation and economic effects of the COVID-19 pandemic.

More news on COVID-19

Early in the pandemic, there was hope that the world would one day achieve herd immunity, the point when the coronavirus lacks enough hosts to spread easily, says The New York Times. Experts now say it is changing too quickly, new more contagious variants are spreading too easily and vaccinations are happening too slowly for herd immunity to be within reach anytime soon. That means if the virus continues to run rampant through much of the world, it is well on its way to becoming endemic, an ever-present threat. In a significant move to combat the COVID-19 pandemic, the U.S. government agreed to support a controversial proposal to temporarily waive intellectual property rights for vaccines in a bid to increase global supplies of desperately needed doses. Mild COVID-19 infection was not linked to longer-term heart damage, according to a JACC Cardiovascular Imaging study late last week. Also, impaired phase 1 ejection fraction (EF1) —an indicator of potential heart damage—is associated with almost a fivefold increased COVID-19 mortality risk, according to a study published in Hypertension today. Coronavirus case counts and hospitalizations are at their lowest levels in over a year, with just 336 new infections reported Monday, says the Richmond Times- Dispatch. More than 6.9 million people have died from COVID-19, according to a new analysis from the University of Washington’s Institute for Health Metrics and Evaluation — which is more than twice the current estimated global death toll from the infection. The Virginia Department of Health spent $1.7 million in March and April on ads promoting vaccinations and public health measures, according to April 21 data from the department, reports WVTF.

Gloucester woman died after being vaccinated. A state investigation ruled she had COVID-19, but the family disagrees.

5 of 9 5/13/2021, 8:30 AM Firefox https://app.constantcontact.com/pages/campaigns/email

The state’s investigation into a woman’s death shortly after receiving a coronavirus vaccine ruled that the shot did not contribute to the fatality but she had COVID-19 and suffered other medical complications, reports The Virginian-Pilot.

The family of Drene Keyes, a 58-year-old Gloucester resident who died in January, disputes that determination. They paid for an independent medical examination that Keyes’ daughter, Lisa Jones, says conflicts with the state’s findings. The private investigation, which included an autopsy, indicated negative COVID-19 test results and evidence of a blood clot that investigators believed was linked to the administration of a COVID-19 vaccine, Keyes' daughter said.

Keyes received a first dose of Pfizer vaccine Jan. 30 and died shortly after at VCU Tappahannock Hospital. A report documenting her case in the federal Vaccine Adverse Event Reporting System said she began having trouble breathing in the parking lot of her vaccination site about 20 minutes after getting the shot.

The state’s investigation, which did not include an autopsy, ruled she died naturally — of complications arising from hypertensive cardiovascular disease and COVID-19, according to the Office of the Chief Medical Examiner. Other significant conditions, it said, were Type 2 diabetes, high cholesterol, obesity and hypoventilation syndrome, a breathing disorder.

Virginia medical facilities grapple with a new worry — a rise in drug-resistant fungus infections

An emerging fungal infection — one that’s especially dangerous for patients with weakened immune systems — is the latest risk facing long-term care facilities in Virginia after more than a year of weathering the COVID-19 pandemic, reports The Virginia Mercury. Called Candida auris, the yeast has been deemed a “serious global health threat” by the CDC thanks to the longevity of its infections and its resistance to antifungal drugs.

The number of cases identified in Virginia is still relatively small — a total of 37 since July 2020. But in a May 7 clinician letter, state Health Commissioner Dr. Norman Oliver warned it represents a more than ten-fold increase compared to the previous two years — a concerning trend experts worry has been driven by coronavirus-related precautions.

The latest on vaccines

The Cleveland Clinic on Tuesday released a study showing that 99.75% of patients hospitalized with COVID-19 between Jan. 1 and April 13 were not fully vaccinated. The latest Kaiser Family Foundation report monitoring vaccination attitudes in the U.S. finds that more than half of those polled say they've received at least vaccine dose, with an additional almost 10% who haven't done so saying they hope to as soon as possible, reports Stat. A wide range of skin reactions has occurred following coronavirus vaccination -- including some that mimic COVID-19 symptoms -- but none proved to be serious, according to initial data from an international registry, reports MedPage Today. Moderna's COVID-19 vaccine showed 96% efficacy in kids ages 12 to 17 in the phase II/III TeenCOVE study, and with no safety concerns, the company announced in its first quarter earnings statement. The European Union said it wasn't renewing its COVID vaccine contract with AstraZeneca after June. The news came a day after the EU separately signed a deal with Pfizer/BioNTech to provide up to 1.8 billion doses to the EU through 2023. Novavax has delayed plans to seek regulatory clearances for its COVID-19 vaccine, while shortages in raw materials are slowing the ramp-up in production of doses, the company said. The WSJ reports that delays may set back efforts to

6 of 9 5/13/2021, 8:30 AM Firefox https://app.constantcontact.com/pages/campaigns/email

increase vaccinations in developing countries, which have been dealing with limited doses of currently available shots and are looking forward to Novavax’s.

Women in Focus group looks at GERD

RAM's next Women in Focus program will feature a presentation on "Approach to refractory gastroesophageal reflux disease (GERD)" by Dr. Krista Edelman with Richmond Gastroenterology Associates.

The virtual program will be held Wednesday, May 19, at 6 p.m. CLICK HERE for details and registration.

Medical cannabis: What you need to know

RAM's series on medical cannabis continues to help members learn the science behind the issues, the mechanics of recommending it to a patient, what the patient does once it is recommended and what happens in a dispensary. Finally, take a tour of Richmond’s own production facility and pharmacy.

Wednesday, June 16, 6:30 p.m. Just Do It . . . the Mechanics of Recommending and Dispensing Rebecca Gwilt, partner at Nixon Gwilt Law, will review the legal and practical issues of how to recommend medical cannabis to a patient. You'll also learn how to refer that patient to a dispensary. Session will be held via Zoom.

Wednesday, July 21, TBD A Peek Under the Tent Concluding our series is a look inside an actual medical cannabis production operation and pharmacy. Details coming soon.

CLICK HERE for more information and registration. CME will be provided.

U.S. birth rate declines for sixth straight year

The birth rate in the U.S. declined in 2020, for the sixth consecutive year, according to new CDC data. More than 3.6 million babies were born in the U.S. in 2020, a 4% dip from 2019. The birth rate has gone down by an average of 2% every year since 2014, and last year was the lowest since 1979.

There was a decline in births across all races last year, ranging from a 3% decline in babies born to Hispanic women to an 8% dip in babies born to Asian women. Although there was a decline across most age groups, teens ages 15-19 saw the biggest decline, of 8%. The birth rate of those ages 45-49 was unchanged, as it has been since 2015.

Also, the world is currently facing a shortage of 900,000 midwives, according to the latest State of the World's Midwifery report from the WHO and other partner agencies, Stat reports.

After a year with virtually no flu, scientists worry the next season could be a bad one

More than a year after the pandemic started, COVID-19 is still ravaging parts of the world,

7 of 9 5/13/2021, 8:30 AM Firefox https://app.constantcontact.com/pages/campaigns/email

but now scientists are warning that another virus could be a serious threat in the coming months: influenza, says NBC News.

This season, the flu virtually disappeared, with less than 2,000 lab-confirmed cases in the U.S. to date, according to the CDC. In a typical flu season, the U.S. could see more than 200,000 lab-confirmed cases by this time of year, a tiny fraction of the true number of cases, estimated to range from 9 million to 45 million annually.

AMA issues anti-racism plan for itself, field

The nation’s largest doctors group Tuesday released a comprehensive plan aimed at dismantling structural racism inside its own ranks and within the U.S. medical establishment, reports the AP. The American Medical Association’s plan has been in the works for more than a year. The group’s leaders said health inequities highlighted by the pandemic, ongoing police brutality and recent race-based crimes have given the effort a sense of urgency.

The 83-page report on racial justice and health equity catalogs in detail the 174-year-old organization's misdeeds, including the consistent exclusion of Black, brown, and Indigenous physicians; promotion of racist practices; and harm to communities of color despite an oath to do no harm.

How one man’s near-death (and a RAM member) changed golf tournament policy

Here's a great story from Golf.com about how a RAM member saved a life and helped change policy at a major golf tournament:

On Friday morning of the 2018 Masters, Johnny Pruitt was just arriving at Augusta National’s 12th hole with a big day planned — plant his chair by Amen Corner, then wander the course — when his friend gave him a funny look.

“I was having a conversation with him and he said that I started mumbling my words,” Pruitt recalls. “I started stumbling and I stopped right in my tracks. And the next thing, he said, was I just fell like a tree, fallen backwards.” Pruitt was going into major cardiac arrest.

But he had one thing going for him: RAM member Dr. Mike Farrell, a gastroenterologist, was just arriving at the scene, too.

Not only did Dr. Farrell save Pruitt's life, he helped bring about changes to the way Augusta handles medical emergencies.

Thanks for reading The Leg.Up

Thank you for your calls and emails. Let us know what you'd like to see in The Leg.Up.

Please contact me with your ideas, suggestions and concerns (or complaints). You can reach me by email or at (804) 622-8136.

Lisa Crutchfield Barth RAM Communications and Marketing Director

Richmond Academy of Medicine

8 of 9 5/13/2021, 8:30 AM Firefox https://app.constantcontact.com/pages/campaigns/email

www.ramdocs.orgg

STAY CONNECTED

Richmond Academy of Medicine | 2821 Emerywood Pkwy, Ste 200, Richmond, VA 23294

Unsubscribe {recipient's email} Constant Contact Data Notice Sent by [email protected] powered by

Try email marketing for free today!

9 of 9 5/13/2021, 8:30 AM