Health of the Public
COVID-19 Outbreak Intensifies
Washington state has become the U.S. epicenter of the COVID-19 outbreak, with 18 confirmed cases.
On March 2, Jeff Duchin, MD, health officer at Public Health – Seattle & King County, announced March 2 that there were 14 confirmed cases and five deaths in the county. Four of the deaths were related to an outbreak at a long-term care facility in Kirkland, as have hospitalizations of several residents and the voluntary isolation of first responders.
Three presumptive positive cases and one death have been identified in Snohomish County.
The outbreak is not limited to Western Washington. On March 2, the Oregon Health Authority identified a resident who is currently being treated in a Walla Walla hospital. That person, a male from Umatilla County, is Oregon’s third presumptive positive case. The other two cases are located in suburban Portland.
Gov. Jay Inslee has declared a state of emergency across the state to provide additional resources to combat the outbreak. King County executive Dow Constantine announced a similar declaration for that area on March 2.
On Friday, the Centers for Disease Control and Prevention updated its interim guidance on COVID-19. The AAFP is also maintaining a webpage dedicated to COVID-19; the page was mentioned in a recent letter to members from AAFP President Gary LeRoy, MD, FAAFP.
Advice for Family Physicians
Rachel Wood, MD, MPH, FAAFP, a WAFP member who serves as the health officer for Lewis County, told WAFP that she would recommend family physicians continue normally treating patients with a fever and lower respiratory tract infections. A COVID-19 infection with those symptoms remains unlikely.
In the instance of hospitalization and an epidemiological link, she recommends contacting your local health jurisdiction, which will then determine the need for testing.
As of Feb. 28, the Washington State Department of Health has been able to test for COVID-19 without relying on the Centers for Disease Control and Prevention. Kathy Lofy, MD, the state health officer, announced on March 2 that the University of Washington will also begin testing for COVID-19, further increasing capacity.
Non-pharmaceutical interventions continue to be the recommended precautions for patients, including washing hands for at least 20 seconds, staying home when sick, covering the mouth and nose when sneezing or coughing, cleaning surfaces that are frequently touched, etc.
Public health organizations are advising patients who suspect a COVID-19 infection to contact their physician and not arrive unannounced at their local hospital.
- Trevor Bedford, PhD, a vaccine and infectious disease researcher at Fred Hutchinson Cancer Research Center in Seattle, posted on Twitter his estimation that, absent effective non-pharmaceutical interventions, the number of cases would double every seven days.
- Nine schools in King, Pierce and Snohomish counties were closed March 2; most cited an abundance of caution. The F5 Tower in downtown Seattle was also closed Monday after someone working there had contact with a person who is one of the confirmed COVID-19 cases.
- Between 100 and 150 people at the Department of Health are working on the COVID-19 response, along with another 100 people at Public Health – Seattle & King County, according to Washington Secretary of Health John Wiesman, DrPH, MPH. Wiesman was testifying before the state Senate’s Ways & Means Committee.
Register Today for WAFP’s 2020 House of Delegates and Annual Scientific Assembly!
Registration is now open for WAFP’s 2020 annual meeting, including the House of Delegates, Annual Scientific Assembly and the WAFP Foundation annual banquet and auction. The annual meeting will be held at Semiahmoo Resort in Blaine from May 6-9, 2020.
Register here: https://na.eventscloud.com/ereg/index.php?eventid=531792&
The WAFP Foundation is accepting donations — monetary and otherwise — for its annual banquet and auction. Please donate today! Click on the link in this paragraph for a donation form.
Please Participate in WAFP’s 2020 Member Survey!
WAFP’s member survey, conducted every three years, will arrive in inboxes in a few days.
The short survey shapes WAFP’s strategic plan, which the Academy will revise later this year. Your response to this survey will provide valuable input into the board’s discussions and help establish priorities that will make the biggest difference for you and the rest of our members.
As a membership organization, your voice is invaluable in this process! Please participate and tell us how we can support you in the coming years.
House of Delegates Resolutions Must be Submitted by March 8
If you want WAFP to pursue a particular action or advocate for a certain policy, now is the time to send those requests (in the form of a resolution) to the WAFP office! Staff must receive your resolution by March 8 for it to be automatically considered by the House of Delegates.
These resolutions, if approved by the House, guide the Academy’s policy direction for the coming year.
In recent years, the House of Delegates has adopted resolutions on topics as diverse as abortion, eviction reform, AAFP membership rules, climate change CME, medical aid in dying, opioid use disorder and primary care spending.
Medical Student Co-Trustees, Resident Trustee Selected for 2020-21
Medical student and resident members of WAFP have chosen — mostly — their leadership for the upcoming year.
The medical students have chosen Julia Swanson, MS-2, and Hannah Udell, OMS-3, to serve as medical student co-trustees. Swanson, at the Elson S. Floyd College of Medicine in Spokane, earned her undergraduate degree at Pomona College in Claremont, CA. Udell studies at Pacific Northwest University in Yakima and earned her undergraduate degree at the University of Wisconsin-Madison.
Deepthi Ennamuri, MD, will serve as WAFP’s resident delegate in 2020-21. She grew up in Portland, earned her undergraduate degree at Oregon State University and graduated from medical school at Oregon Health and Science University.
Two candidates for alternate resident trustee finished in a tie during the initial vote. Resident members of the WAFP are voting in a runoff election that was still open at the time of publication.
The new leadership will be installed at the annual meeting in May. Their term is for one year.
Is Your Address Up to Date?
The next time you find yourself logging CME hours in AAFP’s portal, please take a moment to double check your address in your member record.
Having accurate records allows WAFP to better communicate with you, our members. It also helps determine which local chapter you belong to.
If you have any questions, please contact WAFP staff at firstname.lastname@example.org.
Nominations Being Accepted for AAFP Board Positions
WAFP members wishing to serve on the AAFP Board of Directors are asked to notify WAFP staff of their intention to run.
Though the AAFP is currently accepting nominations for president-elect, speaker, vice speaker and vacancies on the Board of Directors, those nominations come from the chapter. The chapter is required to submit an official letter of nomination as well as a candidate photograph.
If you have any questions or wish to be nominated, please notify WAFP staff at email@example.com.
Members in the News
- Katie Buckman, OMS-3, has been awarded the President’s Civic Leader Award from the Washington Campus Compact for the 2019-2020 academic year. The award recognizes students who are dedicated to addressing critical needs across the state. For this academic year, the award’s selection committee identified five priority areas: housing and food insecurity, breaking the prison pipeline, the opioid epidemic, mental health, and K-16 civic education. “I am honored to be receiving this award,” Buckman said in a PNWU news release, “and I am looking forward to the opportunities of working with fellow award recipients to bring attention to — and hopefully mend — some of the biggest challenges facing many communities in Washington state, and the country as a whole.”
- Trina Davis, MD, medical director of innovation and business development for Kaiser Permanente Washington, took Queen Anne & Magnolia News on a tour of the company’s new clinic in Seattle’s Ballard neighborhood. The clinic site is just north of the Lake Washington Ship Canal in the Ballard Blocks 2 complex. Hannah Burdge, DO, was also mentioned in the article.
Primary Care Investment Language Appears in House Budget
Legislation to appoint a primary care collaborative, which was championed by WAFP and would bring together stakeholders to investigate spending on primary care in Washington, has been added to the state House’s supplemental budget.
Though the language does not appear in the Senate’s supplemental budget, the two chambers must still resolve the differences between their legislation.
The House bill calls for a convening of representatives from numerous sectors, including primary care physicians and nurse practitioners, consumers, self-insurers, commercial insurance plans, Medicaid-managed care organizations, the state’s three medical schools, federally qualified health centers, the state Office of the Insurance Commissioner, and the Centers for Medicare and Medicaid Services.
Updates on Other WAFP Legislative Priorities
A look at the status of legislation that was the focus of WAFP’s Family Medicine Advocacy Day in late January:
- Several bills were filed to modify the business and occupation (B&O) surcharge that had a disproportionate impact on independent physician practices. What emerged from those was SB 6492, originally sponsored by Sen. Jamie Pedersen (D-Seattle). Pedersen’s bill eliminated the surcharge and instead increased the B&O tax to 1.75 percent for businesses that earned more than $1 million in the previous year. Businesses with less than $1 million in revenue will continue to pay 1.5 percent for the B&O tax. The bill passed both chambers largely on a party-line vote and was signed into law by Gov. Jay Inslee on Feb. 10.
- SB 6288 to create a statewide office of firearm violence prevention, introduced by Sen. Manka Dhingra (D-Redmond), passed the Senate on a party-line vote. In the House, the measure was approved by the Committee on Civil Rights & Judiciary (again on a party-line vote) and referred to the Appropriations Committee, which was to discuss the legislation in executive session on Monday, March 2.
- SB 6254, introduced by Sen. Patty Kuderer (D-Bellevue), would further tighten regulations on vaping products. After consideration by the Senate Health & Long Term Care Committee, it was referred to the Ways & Means Committee, where it awaits action. A companion bill in the House, HB 2454, originally sponsored by Rep. Gerry Pollet (D-Seattle), has not been acted on by that chamber.
AAFP Ratchets Up the Pressure on Congress to Fund THCGME
Continued inaction from Congress has left the Teaching Health Center Graduate Medical Education (THCGME) program languishing, prompting a stern letter from AAFP leadership.
“We urge you to prioritize passage … and not wait until May to take action,” the letter, signed by AAFP Board Chair John Cullen, MD, FAAFP, stated. “Your positive action in the next few weeks will create stability in these important programs and avoid any further disruptions caused by lingering uncertainties associated with future program funding. “Failure to act in a timely manner only further impacts these programs, which results in decreased access to primary care for millions of people.”
A House bill to stabilize funding — Rep. Cathy McMorris Rodgers (R-Spokane) was among the original cosponsors — has not been acted on since public hearings last summer.
AAFP’s letter was sent to House and Senate leadership, as well as relevant committee leadership in both chambers.
Pentagon Budget to Send More Beneficiaries Off-Base for Medical Care
The Military Times reports that the Pentagon’s 2021 budget reduces the number of uniformed medical personnel and plans to send more non-active duty beneficiaries to contract or civilian providers for health care.
“The budget documents affirm what Defense Health Agency officials have said for months: the military health system must right-size the military medical forces to support operational medicine, while roughly 8 million non-uniformed beneficiaries will receive health care from civilian federal employees, contract care or in the community, via Tricare,” Military Times wrote. The non-active duty beneficiaries to be impacted include family members, retirees and their family members.
Washington state has 10 military hospitals and clinics in Airway Heights, Bremerton, Everett, Oak Harbor, Port Angeles, Seattle, Silverdale and Tacoma.
Flu Activity Remains Elevated Across the State
The Washington State Department of Health classifies current flu activity across the state as elevated, with 70 deaths (including six children) so far this flu season.
Though activity is elevated, sentinel data indicates that current activity is well off the peak: Across most regions of the state, ED visits for influenza-like illness was at its highest in the final weeks of December. Assuming no further spikes in activity, that peak was several weeks earlier than the 2018-19 flu season.
Sixteen people have died in King County; 12 in Pierce County; and eight in Snohomish County. The other 15 Washington counties reporting deaths all have five or fewer.
Webinar to Detail Immunization Rule Changes
The Washington State Department of Health will host a webinar on Tuesday, March 2, to explain immunization changes that will take effect in August.
Among the topics are the new immunization schedule, new immunization rules and updates to school and child care immunization requirements that go into effect on Aug. 1. CME credit is available for attendees.
If you’re interested, please register before the webinar begins.
Less Than Half of WA Adolescents are Up to Date on HPV Vaccinations
The Washington State HPV Task Force is asking health care providers around the state to recommend the HPV vaccination to 13- to 15-year old patients. Currently, only 49.3 percent of 13- to 15-year olds in the state are up to date, well short of the Healthy People 2020 goal of 80 percent.
The task force is a joint effort of the American Cancer Society and the Washington State Department of Health. A letter from the task force’s Peer to Peer Education Committee provides additional resources (including some that offer CME credit) and contacts around the state who can provide further information.
Soda Purchases Drop by a Third After Seattle Sales Tax
Researchers at the University of Illinois-Chicago found that sales of sugar-sweetened beverages fell by 30.5 percent in the months after a soda tax went into effect. Portland, which was used as a control group, saw sales declines of 10.5 percent.
“From a public health perspective, this is good,” Jim Krieger, MD, MPH, of the University of Washington and Healthy Food America, told The Seattle Times. “People are purchasing less sugary drinks, and we know that sugary drinks are associated with heart disease, diabetes, high blood pressure and strokes.”
Voters across the state prohibited further soda taxes in a 2018 vote.
WAFP Joins Statewide Groups to Combat Climate Change
WAFP and other statewide groups sent letters urging the Washington State Legislature to mitigate climate change and the health effects that come along with it. Specifically, the letter calls for the adoption of a low carbon fuel standard, redefining greenhouse gas emission reduction goals and robust support for foundational public health services.
Other signatories include Washington Physicians for Social Responsibility, the Washington State Medical Association, the Washington State Association of Local Public Health Officials, the Washington chapters of the American College of Physicians and American Academy of Pediatrics, the Washington Health Care Climate Alliance, the Puget Sound Asthma Coalition, and the American Lung Association of the Mountain Pacific.
AAFP Vaccine Science Fellowship Deadline: March 25
The AAFP is currently accepting applications for one its three vaccine science fellowships in 2020.
The fellowship is intended for mid-career physicians. Applicants must also be US citizens; must submit a CV and letter of interest; have minimal or no financial conflicts of interest related to entities that manufacture or distribute vaccines or related products; be able to devote approximately 10 percent of full-time employment for one year; and submit a letter from the applicant’s institution agreeing to allow 10 percent of his or her time to devote to the fellowship.
Applicants should submit their materials to AAFP’s clinical policies strategist Pamela Carter-Smith, MPA.
The deadline for applications is March 25.
Resident, Medical Student Socials Being Planned for Summer
WAFP is expanding its summer social offerings from 2019. The events bring together medical students, residents and practicing family physicians in fun locations around the state.
Two events have been confirmed with several more in the planning stages.
One will take place in Everett on Saturday, May 30, at Scuttlebutt Brewing Company. Another will be on Saturday, Aug. 15, at Hop Capital Brewing in Yakima.
In Tacoma, a social will be held Saturday, July 18, though the location is TBD.
More information on those events and others will be available in the coming months.
AAFP to Host Maternity Care Live Course in Bellevue July 29-Aug. 1
This summer, AAFP will host its Family-Centered Maternity Care Live Course at the Hyatt Regency in Bellevue from Wednesday, July 29, through Saturday, Aug. 1.
The course has been approved for 29 AAFP Prescribed credits.
At the end of course, attendees will be able to:
- Demonstrate an understanding of common clinical problems seen in maternity care, centered on the family.
- Construct evidence-based strategies to diagnose and treat common conditions related to maternity care.
- Prepare plans to address emerging public health topics that patients may present with and address concerns.
Early-bird registration fees and the conference rate at the hotel are available through June 25.
USMLE to Adopt Pass-Fail Scoring on Step 1 Exam in 2022
Acting on considerable input from stakeholders, including AAFP, the U.S. Medical Licensing Examination program has announced it will employ a pass-fail scoring model in its Step 1 exam beginning in 2022. The new model replaces the three-digit numeric scoring model.
The decision culminates a year-long process when USMLE’s cosponsors — the Federation of State Medical Boards and the National Board of Medical Examiners — convened a conference to discuss possible changes to the scoring method.
These changes are expected to help ease the stress and costs around preparing for the Step 1 exam.
“Students have often reported contemplating suicide, and some have even committed suicide in response to the stress they felt regarding Step 1,” Renee Chrichlow, MD, who works in both the family medicine residency program and the family medicine department at the University of Minnesota, told AAFP News. “USMLE Step 1 was never designed to be or meant to be a screening test for program directors to filter residency applications … A student score on this test has no predictive value or correlation with how well they will do as a physician.”
In Washington, One More PCP Per 10K People Equals Lower Mortality Rates
Researchers at the Elson S. Floyd College of Medicine at Washington State University have found that adding an additional primary care physician per 10,000 people leads to lower mortality for all causes of death in Washington.
In hard numbers, there were 6.2 fewer all-cause deaths per 100,000 people when adding a primary care physician. There were 3.3 fewer cancer deaths and 2.0 fewer heart disease deaths as well.
The average PCP access score across the state was 10 primary care physicians per 10,000 people. However, the study identified 21 block groups, or neighborhoods, with an access score of less than one physician per 10,000 people.
HCA Releases Results of 2019 Paying for Value Survey
The Washington State Health Care Authority has released results from a survey that asked providers and health plans for their insights on value-based purchasing experiences.
Among providers, most found their VBP experience to be neutral. A quarter found it to be positive, and just four percent found it to be negative. (No respondents indicated a very positive or a very negative experience.) Nearly all respondents expected their organizations to increase or maintain their current level of VBP activity.
A plurality (44 percent) said their organization was somewhat ready and capable for value-based purchasing; coincidentally, an equal number of respondents said their organizations were ready (“very ready and highly capable” or “mostly ready and capable”) or not ready (“not very ready with limited capacity” or “not ready with inadequate capacity”).
Have a Story Worth Sharing? The Nocturnists Want to Hear from You
The Nocturnists — a group of Bay Area physicians dedicated to sharing stories from the world of medicine — are bringing their live show to Seattle and have issued an open call for stories from physicians in the area.
Emily Silverman, MD, an internist at Zuckerberg San Francisco General Hospital, is the group’s creator and host; Alison Block, MD, a family physician at the Contra Costa Regional Medical Center, serves as executive producer.
The Seattle event will be Friday, May 15, at the Langston Hughes Performing Arts Institute at 17th Avenue South and East Yesler Way. Additional details are available on The Nocturnists’ website. The group also produces a podcast.