Maine Medicine Weekly Update - Maine Medicine Weekly E-Update, July 20, 2022
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July 20, 2022

Governor Mills Hosts 4th Annual Opioid Response Summit


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COVID Hospitalizations Rising

 

 

Governor Mills Hosts 4th Annual Opioid Response Summit


 

Nearly 1,200 participants gathered at the Cross Insurance Arena in Bangor for Governor Mills’ 4th Annual Opioid Response Summit this past Monday, July 11th. The event highlighted the urgency of responding to a crisis that took the lives of nearly 600 Mainers in 2021 alone.

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COVID Hospitalizations Rising

The BA.5 subvariant is now the most prevalent coronavirus strain in the United States, has been the leading cause of rising COVID-19 cases in the United States, and is sparking concern about an increase in hospitalizations.

The Portland Press Herald reported Wednesday that Maine COVID hospitalizations have risen nearly 30% in 10 days and Maine Public highlighted Maine CDC data showing hospitalizations in Maine have risen to the highest level in over a month.

The strain, which is considered "hypercontagious," according to the Mayo Clinic, is more defiant against messenger RNA vaccines – four times more resistant to be exact.

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Monkeypox Now a Reportable Condition in Maine

The Maine CDC Health Alert Network System (HAN) has announced a temporary change to the Notifiable Diseases and Conditions.

The most recent count of confirmed monkeypox cases in the U.S. was more than 2,000. However, cases are believed to be undercounted due to limited testing capabilities. The World Health Organization (WHO) reports 14,000 monkeypox cases worldwide, 5 deaths.

  • Any confirmed case of monkeypox is immediately reportable to Maine CDC within 24 hours; and
  • All monkeypox or non-variola orthopoxvirus test results (positive or negative) are reportable to Maine CDC within 24 hours.
 

The Maine CDC Health Alert Network System (HAN) has announced a temporary change to the Notifiable Diseases and Conditions.

The most recent count of confirmed monkeypox cases in the U.S. was more than 2,000. However, cases are believed to be undercounted due to limited testing capabilities. The World Health Organization (WHO) reports 14,000 monkeypox cases worldwide, 5 deaths.

  • Any confirmed case of monkeypox is immediately reportable to Maine CDC within 24 hours; and
  • All monkeypox or non-variola orthopoxvirus test results (positive or negative) are reportable to Maine CDC within 24 hours.

Reporting of notifiable diseases and conditions is required under 22 M.R.S., Chapter 250, §802 and §822. Failure to report could result in preventable morbidity or mortality. Maine CDC is authorized to advise through publicly noticed Health Alerts the public health need for the temporary reporting of any disease or condition in the state of Maine to study and control any apparent outbreak or unusual occurrence of communicable diseases.

All results should be reported electronically as required by statute. These changes will remain in effect for a period of one year and may be reassessed at any time.

As previously noted, swab samples for monkeypox testing can be sent to Maine CDC’s Health and Environmental Testing Laboratory (HETL) or to a commercial laboratory. Currently there are several commercial labs that offer monkeypox testing; other labs are expected to become available in coming weeks and months.

For more information:

Maine CDC Health Alert Network System (HAN): Monkeypox Now a Reportable Condition in Maine - July 15, 2022

Maine CDC monkeypox website: http://www.maine.gov/dhhs/monkeypox

Maine CDC notifiable conditions rule: https://www.maine.gov/dhhs/mecdc/infectiousdisease/epi/disease-reporting/documents/notifiable-conditions-rule-2-17-2021.pdf

Analysis: Years Of Neglect Leaves Sexual Health Clinics Ill-Prepared For Monkeypox (Reuters)

HHS Orders Additional Vaccine, Increases Testing Capacity To Respond To Monkeypox Outbreak (HHS press release)

For Monkeypox Testing, Use Lesion Swab Samples to Avoid False Results (FDA MedWatch)

 

Federal COVID-19 Public Health Emergency Extended

The U.S. Department of Health and Human Services (HHS) has extended the COVID-19 public health emergency through October and the key flexibilities on telehealth and reporting deadlines. The declaration is valid through October 13, 2022. Another 90-day extension is likely, considering there’s an election in November and coronavirus numbers have typically surged in the fall.

 

The U.S. Department of Health and Human Services (HHS) has extended the COVID-19 public health emergency through October and the key flexibilities on telehealth and reporting deadlines. The declaration is valid through October 13, 2022. Another 90-day extension is likely, considering there’s an election in November and coronavirus numbers have typically surged in the fall.

During the Public Health Emergency (PHE), people nationwide have benefited from continuous and Medicaid or CHIP coverage.

The federal government has promised a 60-day notice of when the public health emergency will expire.

Renewal Of Determination That A Public Health Emergency Exists – DHHS

Public Health Emergency Declaration – DHHS

Public Health Emergency Declaration Q&As – DHHS

Novavax COVID-19 Vaccine Authorized by FDA & CDC

The Food and Drug Administration (FDA) last week approved an emergency use authorization (EUA) for the Novavax COVID-19 vaccine, bringing a fourth vaccine to help against the backdrop of a BA.5 Omicron subvariant surge and lagging vaccine and booster dose uptake.

Earlier this week, Centers for Disease Control and Prevention Director Rochelle Walensky endorsed the Novavax COVID-19 vaccine following a 12-0 vote recommending the traditional protein-based shot by the agency's Advisory Committee on Immunization Practices (ACIP). Novavax's vaccine will hit the market in the coming weeks.

 

The Food and Drug Administration (FDA) last week approved an emergency use authorization (EUA) for the Novavax COVID-19 vaccine, bringing a fourth vaccine to help against the backdrop of a BA.5 Omicron subvariant surge and lagging vaccine and booster dose uptake.

Earlier this week, Centers for Disease Control and Prevention Director Rochelle Walensky endorsed the Novavax COVID-19 vaccine following a 12-0 vote recommending the traditional protein-based shot by the agency's Advisory Committee on Immunization Practices (ACIP). Novavax's vaccine will hit the market in the coming weeks.

Emergency use of the Novavax COVID-19 vaccine is for individuals 18 years of age and older. The vaccine is authorized for emergency use as a two-dose primary series, given three weeks apart.

The vaccine will be permitted to be given to adults as a primacy immunization series, limiting its use given roughly two-thirds of people have already received their initial shots. However, the vaccine may be a good option for those allergic to components of the messenger RNA vaccines developed by Pfizer-BioNTech and Moderna.

The Biden administration has bought 3.5 million doses of the vaccine, which is administered in a two-dose series given 3 to 8 weeks apart. Those with moderate or severe immune compromise should receive the doses 3 weeks apart.

For More Information

Fact Sheet for Recipients and Caregivers

Fact Sheet for Healthcare Providers Administering Vaccine

Advisory Meeting Webcast

Maine Joins National Launch Of 988 Suicide And Crisis Lifeline

Mainers who find themselves in a mental health crisis can now call or text 988 to access a trained crisis counselor. Support is available 24 hours a day, seven days a week to individuals of all ages.

The 988 Suicide and Crisis Lifeline went live on Saturday, July 16.

 

Mainers who find themselves in a mental health crisis can now call or text 988 to access a trained crisis counselor. Support is available 24 hours a day, seven days a week to individuals of all ages.

The 988 Suicide and Crisis Lifeline went live on Saturday, July 16.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has a resource page designed to help states, territories, Tribes, and mental health and substance use disorder professionals understand the background, history, funding opportunities, and implementation resources for strengthening suicide prevention and mental health crisis services.

The new mental health hotline, 988, has been nationally launched despite concerns of staffing capacity required to cover expected calls.

The Maine Department of Health and Human Services has been collaborating with federal, national, and statewide partners since March 2021 to plan for successfully implementing the new 988 system in Maine. Over 60 representatives from across the spectrum of Maine’s mental health crisis services – providers; emergency first responders/911, and members of diverse communities such as deaf and hard of hearing, people with lived experience and more – have tackled key issues such as increasing operating capacity at Maine’s 988 call center and the critical connection between 911 and 988 services.

Secretary of Health and Human Services Xavier Becerra, and other Federal officials, worry that most states are ill-prepared to meet the hotline’s long-term needs, a failing that could hamper state’s ability to quickly answer crisis calls with operators familiar with local resources. New funds have been dispatched to states considering the mental health crisis, but federal officials say few states have held up their end of the bargain and implemented long-term funding.

Maine plans to only soft launch the new mental health hotline until its provider can increase staffing ahead to handle higher volume. Over half of the country’s public health officials say they do not have the funding or the staffing to handle the mid-July rollout, according to a recent Rand Corp report. Maine expects to being taking callings by the deadline, but the contracted provider for the hotline will not heavily promote the new line until they have appropriate staffing.

“I anticipate it’s not going to be a difficult launch; it’s going to fall into place as we start rolling with it” said Tracy Mallwitz, the clinical director of the Maine Crisis Line.

Maine set aside $450,000 in state and federal funds to facilitate the rollout, wrote a Department of Health and Human Services official in a letter to the Portland Press Herald. The state also allocated $13 million for state and federal crisis lines.  The states current hotline will continue to operate for the time being.

Every state currently has the 10-digit phone number, 800-273-TALK, as part of the National Suicide Prevention Lifeline network, launched in 2005. This will be replaced by the 988 number on Saturday. Some states like Maine have 24-7 call centers already in places, but others are just not expanding round-the-clock operations.

Read More:

988 set for quiet launch in light of state, federal concerns about crisis call spike, Politico

Staffing issues will slow rollout of Maine’s new 988 mental health hotline, Portland Press Herald

 

Recent Reports of Human Parechovirus (PeV) in the United States

The Centers for Disease Control and Prevention issued a Health Alert Network (HAN) Health Advisory to inform physicians and public health departments that parechovirus (PeV) is currently circulating the Untied States. Since May 2022, the CDC has received reports from healthcare providers in multiple states of PeV infections in neonates and young infants.

 

The Centers for Disease Control and Prevention issued a Health Alert Network (HAN) Health Advisory to inform physicians and public health departments that parechovirus (PeV) is currently circulating the Untied States. Since May 2022, the CDC has received reports from healthcare providers in multiple states of PeV infections in neonates and young infants.

Parechoviruses are a group of viruses known to cause a spectrum of disease in humans. Physicians are encouraged to include PeV in the differential diagnoses of infants presenting with fever, sepsis-like syndrome, or neurological illness (seizures, meningitis) without another known cause and to test for PeV in children with signs and symptoms compatible with PeV infection. Commercial laboratory assays, multiplex platforms for meningitis and encephalitis, and testing through state public health laboratories are available to test cerebrospinal fluid (CSF) for PeV to confirm a diagnosis, CDC laboratory support is also available.

CDC Recommendations for Physicians

  • Be aware that PeVs circulate in the summer and fall. In the absence of an identified pathogen, consider PeV infection in a neonate or infant presenting with fever, sepsis-like syndrome, or signs of neurologic involvement.
  • Become familiar with specimen collection, storage, and shipping procedures. Testing for PeV is available at commercial clinical laboratories and SPHLs, and hospitals may use multiplex meningitis and encephalitis panels for CSF testing that include PeV. Testing and typing for PeV are also available at CDC when other options are unavailable; clinicians should still work with their state public health department to send specimens to CDC. Please contact PicornaLab@cdc.gov before submitting specimens. Accepted specimens include CSF, throat or nasopharyngeal swabs, blood, and stool.
  • Consider cohorting an infant hospitalized with detected PeV infection with other affected infant(s) to avoid healthcare-associated transmission in nurseries or neonatal intensive care units.
  • Use Contact, Droplet, and Standard Precautions. In most clinical situations, alcohol-based hand sanitizer (ABHS) is preferred for cleaning hands with an alcohol content of at least 60%. However, soap and water is the preferred method after patient care involving diapering or toileting, before eating or feeding, and if hands are visibly soiled (e.g., dirt, blood, body fluids). Although non-enveloped viruses may be less susceptible to alcohol than enveloped viruses, ABHS offers benefits in skin tolerance, compliance, and overall effectiveness, especially when combined with glove use. See Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings –Recommendations of the HICPAC for more information.
  • Consult the state health department with questions about PeV.

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Maine Physicians Direct Primacy Care Model to Improve Medical Care

The New England Direct Primary Care Alliance, an experiment, and a movement to redefine and improve the doctor-patient experience, has 20 Maine Physicians committed to better continuity and access to care.

Dr. Alison Lee told WMTW News 8 that her last job was “all about volume” and productivity, she was burned out from seeing 25 patients a day. “When I decided I wanted to become a doctor, I wanted to have a relationship with my patients, continuity of care” said Dr. Lee.

 

The New England Direct Primary Care Alliance, an experiment, and a movement to redefine and improve the doctor-patient experience, has 20 Maine Physicians committed to better continuity and access to care.

Dr. Alison Lee told WMTW News 8 that her last job was “all about volume” and productivity, she was burned out from seeing 25 patients a day. “When I decided I wanted to become a doctor, I wanted to have a relationship with my patients, continuity of care” said Dr. Lee.

Direct primary care practices like Dr. Lee’s Leeward Health, in Portland, are a members-only model that requires patients pay a monthly fee to get on the doctor’s list. In return, the patients get more time with their physician and appointments are easier to get. Direct primary care physicians answer patient texts and emails and say the extra access results in higher quality care.

The average fee in Maine for direct primary care is around $75 a month for an individual, according to president of the New England Direct Primary Care Alliance, Dr. Michael Ciampi. The cost would be more for couples and families. Participating physicians don’t get involved with health insurance, they won’t submit bills, but there are generally no bills for office visits. The administrative burden of co-pays and billing insurance is done away with.

Direct primacy care physicians can refer patients to specialists or for test that insurance does cover, however. Lab work can also be done inexpensively in the office, costing a patient five to ten dollars.

Appointments that used to be rushed, lasting 5 to 12 minutes, are now 45 to 60 minutes says Dr. Lee. “This is a step some of us are trying to get innovative, get creative, trying just to do something different to make it better, because our system is so fractured” says Dr. Lee.

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New England Direct Primacy Care Alliance

MMA Government Affairs Developing 2023-2024 State Legislative Agenda

The Maine Medical Association Legislative Committee is seeking 2023 Legislative Priority Requests for the upcoming session of the Maine Legislature starting in January. Nearly everything you do each day as physicians, from initial licensing through retirement is governed or directed by some federal or state law, or rule/regulation.

Beginning now through Labor Day, September 5, 2022, we are welcoming all Maine specialty societies, MMA committees, and any individual MMA member to identify priority issues, what change is needed, how to change it, and what personal or organization resources and relationships may be available to help MMA.

 

The Maine Medical Association Legislative Committee is seeking 2023 Legislative Priority Requests for the upcoming session of the Maine Legislature starting in January. Nearly everything you do each day as physicians, from initial licensing through retirement is governed or directed by some federal or state law, or rule/regulation.

Beginning now through Labor Day, September 5, 2022, we are welcoming all Maine specialty societies, MMA committees, and any individual MMA member to identify priority issues, what change is needed, how to change it, and what personal or organization resources and relationships may be available to help MMA.

The MMA’s Legislative Committee (LC) is the legislative arm of the Maine Medical Association.  Every two years as we approach Maine state legislative elections, the LC makes recommendation to the MMA’s Board of Directors on which public policy issues should be given "priority" status.

The dedicated members of the LC, chaired by emergency physician, Jay Mullen, M.D., track the development of priority legislation, identify new issues that require the MMA’s support (or opposition), and works with MMA Government Affairs to share information about the legislative process with MMA members across the state. 

For priority bills, the MMA testifies at the hearings scheduled by the Legislature and takes additional action as needed during the legislative session.  For the other "bills we are monitoring", the MMA submits letters to the relevant legislative committees. 

After developing its Legislative Agenda, the MMA works with individual physician members to match them with relevant legislators to familiarize them with MMA priority issues.

Download a copy of MMA suggested Legislative Priority Request form and an example submission from 2020 to use as a guide.

Do not hesitate to reach out to MMA’s Government Affairs staff at (207) 480-4199 or by emailing Director of Communications and Government Affairs, Dan Morin (dmorin@mainemed.com) or Public Health and Government Affairs Associate, Mikenzie Dwyer (mdwyer@mainemed.com).

CDC Launches New Addiction Medicine Toolkit

The Addiction Medicine Toolkit is designed to provide an introductory overview of addiction medicine for clinicians and provide strategies that can be implemented in your practice. CDC and the American Society of Addiction Medicine (ASAM) have additional resources to continue to build your knowledge on this complex subject. 

 

The Addiction Medicine Toolkit is designed to provide an introductory overview of addiction medicine for clinicians and provide strategies that can be implemented in your practice. CDC and the American Society of Addiction Medicine (ASAM) have additional resources to continue to build your knowledge on this complex subject.

For Quality Care Clinical Guidelines, visit https://www.asam.org/quality-care/clinical-guidelines. To access ASAM’s eLearning resources, visit https://elearning.asam.org/.

Learn about the relationship between substance use disorders (SUDs) and the field of addiction medicine, levels of care within SUD treatment, communication strategies to build a collaborative patient relationship, and the role of care coordination in the treatment of SUDs. Clinicians are eligible to earn continuing education (CE) after completing all four modules.

Training Modules | CDC's Response to the Opioid Overdose Epidemic | CDC

Revised Narcotic Treatment Program Manual

The United States Drug Enforcement Administration (DEA) recently released a revised Narcotic Treatment Program Manual, A Guide to DEA Narcotic Treatment Program Regulations. The original guidance was released by the DEA during April 2000.

 

The United States Drug Enforcement Administration (DEA) recently released a revised Narcotic Treatment Program Manual, A Guide to DEA Narcotic Treatment Program Regulations. The original guidance was released by the DEA during April 2000.

The DEA was encouraged by clinical groups to revise the original guidance and the manual provides several policy updates, which includes mobile van regulations. The new document has been sent to OTP operators/providers and has been shared with State Opioid Treatment Authorities and DEA field agents. 

Download the REVISED Narcotic Treatment Program Manual

American Association for the Treatment of Opioid Dependence (AATOD) announcement on Twitter

Governor Mills Hosts 4th Annual Opioid Response Summit

Nearly 1,200 participants gathered at the Cross Insurance Arena in Bangor for Governor Mills’ 4th Annual Opioid Response Summit this past Monday, July 11th. The event highlighted the urgency of responding to a crisis that took the lives of nearly 600 Mainers in 2021 alone.


 

Nearly 1,200 participants gathered at the Cross Insurance Arena in Bangor for Governor Mills’ 4th Annual Opioid Response Summit this past Monday, July 11th. The event highlighted the urgency of responding to a crisis that took the lives of nearly 600 Mainers in 2021 alone.

 

Members of the recovery community publicly recounted their past struggles with addiction. Their stories of hardship and strength along with their words and courage brought life to the theme of this year’s summit: “Community, Connection, and Compassion”. The event’s many keynotes were book-ended by voices of Maine recovery, those with the most personal stories of the addiction crisis in Maine. 

 

Keynote speakers stressed the importance of prevention, treatment, and recovery resources to lessen the growing number of those afflicted with substance use disorder (SUD). Prominent attendees included Governor Janet Mills; Director of Opioid Response, Gordon Smith; Senator Angus King; Maine CDC Director Dr. Nirav Shah; Maine DHHS Commissioner Jeane Lambrew; U.S. Attorney for the District of Maine, Darcie McElwee; Acting Director of the Maine Office of Behavioral Health, Sarah Squirrel; Maine Attorney General, Aaron Frey; and representatives from the Office of National Drug Control Policy, SAMHSA, and DEA. 

 


 

 

Attendees gathered from each corner of Maine and around the nation to build their own “Community, Connection, and Compassion” led by those in recovery themselves. Participants included physicians, legislators, researchers, recovery workers, allies, law enforcement officials, and members of the judicial system.  

 

There was a sense of state pride amongst the crowd that Mainers value the voices of recovery. The Summit embodied a commitment to act as allies of the Maine recovery movement while serving as a guidepost for the rest of the nation on how to respond to the opioid epidemic most effectively. 

 

The experiences of those in recovery underscored a powerful perspective on the importance of solving the opioid epidemic and advocating for substantive policy change. The content of the event coupled with high attendance in an in-person environment provided hope for many in the audience while providing a forum to discuss valuable tactics for building a stronger recovery community in Maine.

 

Additional Information: 

 

The State of Maine’s premier resource for data on the substance use crisis: Maine Drug Data Hub

 

More on the Summit’s organizing agency may be found here: Office of Opioid Response 

Concerns About BA.5 Variants Contagiousness, Hospitalizations

The BA.5 subvariant is now the most prevalent coronavirus strain in the United States, has been the leading cause of rising COVID-19 cases in the United States, and is sparking concern about an increase in hospitalizations.

The Portland Press Herald reported Wednesday that Maine COVID hospitalizations have risen nearly 30% in 10 days and Maine Public highlighted Maine CDC data showing hospitalizations in Maine have risen to the highest level in over a month.

 

The BA.5 subvariant is now the most prevalent coronavirus strain in the United States, has been the leading cause of rising COVID-19 cases in the United States, and is sparking concern about an increase in hospitalizations.

The Portland Press Herald reported Wednesday that Maine COVID hospitalizations have risen nearly 30% in 10 days and Maine Public highlighted Maine CDC data showing hospitalizations in Maine have risen to the highest level in over a month.

 

The strain, which is considered "hypercontagious," according to the Mayo Clinic, is more defiant against messenger RNA vaccines – four times more resistant to be exact.

Unvaccinated people have about five times higher chance of contracting the virus that those who are vaccinated and boosted, while chances of hospitalizations are 7.5 times higher, and changes of death are 14 to 15 times higher, said Dr. Gregory Poland of Mayo Clinic’s Vaccine Research Group.

In nearby Massachusetts, The Boston Public Health Commissionreported COVID cases in Boston spiked by nearly 40% last week. Area hospitals are averaging about 150 new COVID-related admissions per day — up nearly 24%.

In Maine, COVID-19 is now the third leading cause of death, behind cancer and heart disease. The Maine Shared Community Health Needs Assessment, in collaboration with the CDC and state’s four major hospital systems, said there are concerns that the long-term effects of COVID could be the state’s newest chronic disease.

Visit Maine CDC’s website for updated COVID-19 FAQs.

Los Angeles Daily News: California COVID Hospitalizations Have Quadrupled

Sign Up Now for the MMA 169th Annual Session in Bar Harbor!

We are excited to be building toward our 169th Annual Session coming up on September 9-11.

As we continue to organize this in-person event, we wanted to present a reminder that if you already know you want to be with us in September, register now.

We would be honored to have you with us.


The Maine Medical Association’s Annual Member Meeting will be held in Bar Harbor on September 9-11. We look forward to seeing you this fall!

 

This meeting will be presented in person only with no remote participation option, but we will still conduct this meeting in compliance with current US CDC guidelines.

all attendees must be vaccinated against COVID-19 in accordance with recommendations and

indoors we will observe social distancing and wearing of masks, except when eating or drinking.

The 169th Annual Session is being held at the Harborside Hotel & Marina in Bar Harbor.

9.0 CME credits are pending, and CME credit earned from this activity can be used for AAFP elective credits.

This program offers a variety of relevant topics during the weekend.  In addition, opportunities are available for networking with colleagues, recreation on beautiful Mt. Desert Island, and participating in the MMA’s governance and other business.

Special Thanks to MMA's Program Committee

This program would not be possible without the leadership of Lisa Ryan, DO, Program Chair, and the planning committee members; Ryan Best, MD, Maroulla Gleaton, MD, Patrick Killoran, MD, and Charles Pattavina, MD.

 

ASGE Colon Cancer Appropriate Screening Test Campaign

The American Society for Gastrointestinal Endoscopy (ASGE) would like to invite you to join them in an effort to prevent colon cancer.

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