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Medicare budget neutrality, COVID-19 relief for safety net and rural acute care providers, CDC on mask-wearing, and more.

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APTA Teams With AMA and Other Organizations To Warn Against Medicare Cut Amid Pandemic
Calling the proposal "unconscionable," APTA has once again joined with the American Medical Association and a host of other health care organizations to fight a CMS plan to dramatically cut Medicare payment to physical therapy and more than three dozen other professions in 2021. The latest effort, a letter to U.S. Department of Health and Human Services Secretary Alex Azar, is aimed at convincing the agency to suspend fiscal requirements that CMS says are forcing the reductions. This letter echoes the theme of an earlier sign-on letter sent to U.S. congressional leaders: Moving forward with the proposed cuts while the country continues to struggle with the delivery of health care during a pandemic could prove disastrous to needed care.

From the CDC

Over 3.8 Million COVID-19 Cases in U.S. So Far, Deaths Top 140,000
CDC reported 3,819,139 cases of COVID-19 as of July 21, an increase of 57,777 cases compared with the previous day. In addition, there were 473 new deaths, for a total of 140,630.

From the World Health Organization

WHO Updates Guidance on COVID-19 Transmission and Infection Control
WHO revised its technical guidance to include airborne transmission as a possible mode of infection, especially in confined spaces or during aerosol-generating procedures. The virus also can be transmitted via droplets and close contact with infected individuals and by touching the eyes, nose, or mouth after touching contaminated surfaces and objects.

In the Media

Increase in Nursing Home Cases of COVID-19 in “Hotspot” States
From Kaiser Family Foundation: “Long-term care cases in ‘hotspot states’ with wider community transmission have risen at four times the rate as long-term care cases in non-hotspot states. Long-term care facility cases in 23 hotspot states where data are available rose by 18% over a 14-day period (from 123,000 cases to 144,800 cases), while long-term care cases in 12 non-hotspot states rose by 4% over a similar 14-day period (from 125,500 cases to 130,300 cases). These patterns indicate likely connection between widespread community transmission and long-term care cases, despite precautions in place in most long-term care facilities.”

HHS Unveils New Coronavirus Hospitalization Database, Says Raw Data Available to Hospitals
From CNBC: As of July 15, hospitals are required to submit their daily COVID-19 reports to the Department of Health and Human Services, rather than the Centers for Disease Control and Prevention's National Healthcare Safety Network, according to an HHS advisory. According to CNBC, "the publicly available HHS portal uses the same ‘predictive models’ that had been used by the CDC to analyze the raw data collected. [Jose Arrieta, HHS’s chief information officer] said the raw data itself will also be available for hospitals to download and incorporate into their own dashboards and analyses if they wish to do so. He said at least some of the raw data will be available to the public, including third-party researchers, too.”

Review of COVID Testing Sites Reveals Unequal Access
From and ABC News: "According to a new, extensive review of testing sites …sites in communities of color in many major cities face higher demand than sites in whiter or wealthier areas in those same cities. The result of this disparity is clear: People of color, especially Black and Hispanic people, are more likely to experience longer wait times and understaffed testing centers."

CMS To Deliver Point-of-Care COVID-19 Tests to All Nursing Homes
From McKnight's Long-Term Care News: "The testing devices initially are to be given to 2,000 nursing homes next week, said Assistant Secretary of the Department of Health and Human Services Admiral Brett Giroir. He described them as 'rapid on the spot, 20 tests per hour' devices and said that the goal is to get them to 'every single one of the 15,400 nursing homes within this country.'"

Patients Recovering From COVID-19 Require Comprehensive Care, Including Physical Therapy
From New York Times: Patients recovering from COVID-19 face a wide array of potential problems, including fatigue, respiratory issues, muscle weakness, trouble walking, and PTSD, but medication may not be the right treatment. "Practicing breathing exercises and using a spirometer, a device that measures how much air a person can breathe and how quickly, can improve respiratory issues. Physical therapy can help restore muscle strength, movement and flexibility. Occupational therapy can help people regain the ability to do everyday tasks, like grocery shopping and cooking. Speech therapy can help with swallowing and vocal cord issues."

New in Research

COVID-19 "Should Be Considered" for Pediatric Patients With Primary Neurologic Symptoms Without Systemic Involvement
In a case series of four children hospitalized with COVID-19 multisystem inflammatory syndrome, researchers describe new-onset neurological symptoms including headache, brainstem signs with dysarthria or dysphagia, encephalopathy, meningism, cerebellar ataxia, muscle weakness, and reduced reflexes. Three of the patients showed mild myopathic and neuropathic changes as per nerve conduction studies and electromyography, authors write. At the end of the study, two of the children remained hospitalized and needed wheelchairs due to muscle weakness.

COVID-19 Patients at Higher Risk for Stroke Than Those With Flu
In a study of two New York City hospitals, patients with COVID-19 were more than seven times as likely to experience ischemic stroke than were flu patients. "Clinicians should be vigilant for symptoms and signs of acute ischemic stroke in patients with COVID-19 so that time-sensitive interventions, such as thrombolysis and thrombectomy, can be instituted if possible to reduce the burden of long-term disability," authors write.

CDC Officials Urge Universal Mask Wearing
In a recent editorial in JAMA, CDC officials, including CDC Director Robert R. Redfield, MD, make the argument for universal mask wearing. Citing several studies, including an economic analysis suggesting that widespread masking could avoid the need to bring back stay-at-home orders, authors write, "Broad adoption of cloth face coverings is a civic duty, a small sacrifice reliant on a highly effective low-tech solution that can help turn the tide favorably in national and global efforts against COVID-19."

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