Preventing and Responding to Infectious Disease Outbreaks
We are again confronting multiple respiratory outbreaks that put all New Yorkers at risk. Expectations are that three respiratory diseases – Covid, flu and RSV – will be prevalent well into 2024, and physicians and scientists are calling it the “Triple Pandemic.” MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response continues to educate physicians and the healthcare community on how they can work best with the State’s public health infrastructure to prevent the spread of these communicable diseases.
- Influenza (flu) is a contagious respiratory illness caused by viruses that infect the nose, throat, and lungs. Some people, such as people 65 years and older, young children, and people who are pregnant or have certain chronic health conditions, are at higher risk of serious flu complications. According to the CDC, 31 million people got sick with flu, 14 million people visited a health care provider with flu, 360,000 people were hospitalized with flu, and 21,000 people died due to flu illness or related complications. Additionally, 176 flu related deaths in children were reported to CDC for the 2022-23 season – the third largest number of child deaths since 2004-05 flu season. The Advisory Committee on Immunizations Practices (ACIP) recommends that anyone six months and older be immunized against the flu. MSSNY recommends that all healthcare workers be immunized against the flu.
- COVID-19. While the COVID-19 public health emergency officially ended on May 11, 2023, hospitalizations due to infection were on the rise in New York in the fall and could be exacerbated by new variants. The growing prevalence of at-home testing and the potential for individuals to contract the virus multiple times have also meant that totals of those infected may be significantly A significant protection for New Yorkers is to be immunized against COVID-19 including receiving an updated booster dose.
- Respiratory Syncytial Virus (RSV). RSV is a common respiratory virus that causes mild cold-like symptoms for many, but for some can be more severe. The CDC has recommended three new immunizations to protect those most at risk of severe RSV. According to the CDC, RSV causes:
- 1 million visits to a healthcare provider (non-hospitalization) among children younger than 5
- 58,000–80,000 hospitalizations among children younger than 5 100–300 deaths in children younger than 5 years.
- 60,000–160,000 hospitalizations among adults 65 years and
- 6,000–10,000 deaths among adults 65 years and
- Other Threats. Mpox is a rare, viral infection that spreads through close, physical contact, and certain populations are more at risk. Based on previous outbreaks of MPox around the world, some groups may also be at heightened risk for severe outcomes if they contract MPox. Polio also continues to be of concern to physicians and to the NYS Department of Monitoring of New York State’s wastewater system will help identify if this disease is prevalent in the state.
MSSNY continues to aggressively promote the importance of immunizations. Vaccines have reduced and, in some cases, eliminated, diseases that killed or severely disabled people just a few generations ago. It is not an overstatement to say that immunization protects future generations. Smallpox has been eradicated because of vaccine. Vaccinations against rubella has dramatically decreased the risk that pregnant women will pass this virus on to their fetus or newborn. Vaccines are safe and effective—and they save lives.
In 2019, MSSNY together with many other groups supported a law to require every child attending a public, private, or parochial school to receive the appropriate immunizations, except when it is medically contraindicated. However, there has seen an increase in the number of medical exemptions issued to school- age children from vaccination requirements. MSSNY has strongly encouraged physicians to follow the CDC guidance when issuing a medical exemption and has reminded that falsely certifying a medical exemption form could result in a disciplinary action. MSSNY will continue to ensure that there are only medical exemptions for the school requirement.
MSSNY continues to support state funding for a public health campaign to promote immunizations to educate “vaccine- hesitant” individuals. MSSNY also supports requiring all public, private, and parochial schools in New York State and New York City to report immunization rates and medical exemptions to one central NYS Department of Health database, to help effectively track immunization rates throughout the state. MSSNY supports universal reporting of adult immunizations to the New York State Immunization Information System (NYSIIS), either directly or via health information exchanges and supports removing the requirement for patient permission to report adult vaccines to the registry.
Protecting Women’s Access to Needed Health Care Services
Preserving the right and ability of women to have access to reproductive and sexual health care services has never been more essential.
MSSNY is strongly opposed to any federal or state legislation that would prohibit physicians from exercising clinical judgment in the delivery of medical care, and strongly supports New York State protections for physicians from legal sanctions in New York for providing needed patient care illegal in other states, but legal in New York. MSSNY supports measures to protect practitioners licensed and residing in New York from legal or personal liability when delivering healthcare services to residents of New York State or any other state, whether in person or via telemedicine, when the services provided comply with New York State laws and regulations.
MSSNY supports legislation to provide protections, including against extradition to any other state, for providers who perform comprehensive women’s health services that are legal in New York State. MSSNY supports legislation that allows anyone sued in another state for providing or helping someone access reproductive health services in New York to file their own legal action for unlawful interference with a protected right, and to recover damages from the out of state litigant.
Additionally, ensuring access to reproductive health services medications should continue to fall under the FDA’s authority to determine whether drugs are safe and effective. MSSNY also supports legal efforts to ensure that mifepristone and misoprostol are available to anyone for whom they are prescribed and will support efforts to ensure that both these medications continue to be available, and that the FDA retain its regulatory authority. MSSNY supports legislation and other efforts to expand access to emergency contraception, including making emergency contraception more readily available, and will continue to support sexual health education programs amongst adolescents.
Providing End-of-Life Care
Challenging decision-making concerning end-of-life care has increased the burden on physicians, patients, and family members. These challenges have divided family members, physicians, and the social fabric of society. To address these challenges, MSSNY supports:
- Developing a state central depository for eMOLST (Medical Orders for Life Sustaining Treatment)
- Requiring adequate reimbursement for end-of-life
- Expanded options for obtaining affordable long-term care
- Urging NYS DOH to develop educational resources for physicians, allied professionals, and patients on end- of-life care.
- Urging NYS DOH to simplify the hospice recertification
- Reaffirming Policy 989 in opposition to Physician Assisted Suicide and Euthanasia.
MSSNY also supports and recognizes that expanding protections of end-of-life care is necessary. Therefore, MSSNY also:
- Recognizes that healthcare, including end-of-life like hospice, is a human
- Supports the education of medical students, residents, and physicians about the need for physicians who provide end-of-life healthcare services.
- Supports the medical and public health importance of access to safe end-of-life healthcare services and the medical, ethical, legal, and psychological principles associated with end-of-life care.
- Supports education of physicians and lay people about the importance of offering medications to treat distressing symptoms associated with end-of-life including dyspnea, air hunger, and pain.
- Will work with interested state medical societies and medical specialty societies to vigorously advocate for broad, equitable access to end-of-life care.
- Supports shared decision-making between patients and their physicians regarding end-of-life
- Opposes limitations on access to evidence-based end-of-life care
- Opposes the imposition of criminal and civil penalties or other retaliatory efforts against physicians for receiving, assisting in, referring patients to, or providing end-of-life healthcare services.
Responsibly Addressing Substance Use Disorders
MSSNY actively works to increase physician awareness and leadership to combat the opioid and pain crisis and supports efforts to expand access to medications for addiction treatment including buprenorphine, methadone, and injectable naltrexone for patients with opioid use disorders. MSSNY also supports the development and access to methadone into office-based practices when prescribed by addiction medicine physicians and dispensed at local pharmacies, with appropriate safeguards in place.
According to data provided by IQVIA, total New York prescription opioid use has declined to 50% of the peak volume in 2011. Certainly, this progress is the result of comprehensive efforts by many, including the physician community, to better ensure that the prescribing of pain medications is appropriate to the patients’ needs. Concurrently, the New York Legislature enacted numerous measures to further regulate opioid prescribing, including a 2012 law to require consultation with the I-STOP database prior to a controlled substance prescription. Additionally, a 2016 law requires all DEA-registered prescribers to take Continuing Medical
Education coursework on pain management and limiting initial acute pain medication prescriptions to seven days, a course MSSNY develops for physicians.
At the same time, MSSNY will advocate to protect the right of physicians to prescribe medications most appropriate to treat the patient’s particular condition, as over-aggressive enforcement efforts have in some cases caused a chilling effect on prescribing for patients suffering from pain even when such treatment is clinically appropriate. This is reflected in the revised CDC pain treatment guidelines, which were updated to be less rigid, to respond to many reports that pain is being undertreated.
Permitting Safe Injection Facilities
MSSNY supports the creation of pilot studies to assess the role of Safe Injection Facilities and that pilot locations include New York City and two other areas outside NYC. Additionally, MSSNY advocates that these pilot studies provide screening, support, referral for treatment of substance use disorders and co-occurring medical and psychiatric conditions, and provide education on harm reduction strategies including Naloxone training.
Promoting Health Equity
MSSNY adopted a statement developed by the MSSNY Committee on Health Equity that says in part that MSSNY affirms that racism is a public health crisis and that MSSNY’s mission statement will be evaluated to ensure that it supports equity in all aspects of its work. Furthermore, MSSNY will systematically evaluate its policies and procedures to be clear that it supports equity in all aspects of its work, in both existing and in future policies and procedures, and that records of this process will be visible to all members. MSSNY, through its Committee on Health Equity will seek to:
- Increase awareness of how discrimination based on factors such as racism, classism, cisgenderism, heterosexism, ableism, patriarchy, and xenophobia contribute to both societal and health inequities and to ensure that all New Yorkers receive the best care possible and can achieve the best health possible.
- Work with stakeholders, including the AMA, specialty societies, Albany leadership, community groups, and others to eliminate inequities, particularly those inequities that adversely impact the health and well-being and access to and quality of care for persons who are from historically disadvantaged populations.
- Prevent and manage diseases that are prevalent in historically disinvested populations burdened with the worse disease outcomes, including diabetes, hypertension, and cancer, through educational programming for physicians and other stakeholders. MSSNY will also advocate for fair payment for treatment of such
- Reverse the troubling increases in race/ethnic-based health inequities such as maternal mortality; and promote expanded funding for programs that attract a more diversified physician workforce, increasing the number of minority faculty including female, Black, Latinx, Native American, LGBTQ, and faculty with disabilities teaching in medical MSSNY will also work to expand medical school pipeline programs in rural and urban areas to address the shortage of physicians in medically underserved areas of New York.
- Support gender affirming care by advancing the ability of physicians in New York to provide gender affirming care to people including transgender and non-binary youth and opposing the criminalization of gender affirming care for youth.