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COVID-19: John's Hopkins Map, 8/20 · The SHEA Podcast

• 0:08
  SPEAKER_02: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:24
  SPEAKER_02: I am Dr.
• 0:24
  SPEAKER_02: Jennifer Hanrahan, infectious disease specialist at the University of Toledo, and I will serve as your moderator.
• 0:31
  SPEAKER_02: Discussion on the podcast does not reflect Shay's perspective but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:41
  SPEAKER_02: Shay is excited to launch the 26th episode of this podcast, COVID-19 updates, What We Know Now.
• 0:48
  SPEAKER_02: Today's discussion will focus on the Johns Hopkins COVID-19 map and other aspects of infection prevention.
• 0:55
  SPEAKER_02: Our speakers today are Dr.
• 0:57
  SPEAKER_02: Claire Rock, Associate Professor of Medicine at the Johns Hopkins Hospital, Dr.
• 1:02
  SPEAKER_02: Lisa Marigakas, Senior Director of Infection Prevention for the Johns Hopkins Health System.
• 1:08
  SPEAKER_02: Thank you for joining us today.
• 1:09
  SPEAKER_02: I would like to get us started with a brief news and guidance update of the week.
• 1:14
  SPEAKER_02: As of August 19th, 2020, there are 21,938,207 cases of COVID-19 in the world and 775,582 deaths.
• 1:27
  SPEAKER_02: In the news this week, Dr.
• 1:28
  SPEAKER_02: Anthony Fauci has been widely quoted regarding temperature checks.
• 1:32
  SPEAKER_02: Dr.
• 1:32
  SPEAKER_02: Fauci stated, quote, we have found at the NIH that it is much, much better to just question people when they come in and save the time because the temperatures are notoriously inaccurate many times.
• 1:43
  SPEAKER_02: Dr.
• 1:43
  SPEAKER_02: Fauci said at an event with the Walter Reed National Military Medical Center.
• 1:47
  SPEAKER_02: Dr.
• 1:48
  SPEAKER_02: Fauci noted that temperature can be affected by hot weather.
• 1:51
  SPEAKER_02: This serves as a reminder to screen for symptoms and not rely on temperature alone.
• 1:57
  SPEAKER_02: CDC has updated guidance on children with COVID.
• 1:59
  SPEAKER_02: While children infected with SARS-CoV-2 are less likely to develop severe illness compared with adults, children are still at risk of developing severe illness and complications from COVID-19.
• 2:10
  SPEAKER_02: Recent COVID-19 hospitalization surveillance data shows that the rate of hospitalization among children is low, eight per 100,000 population compared with that in adults, 164.5 per 100,000 population, but hospitalization rates in children are increasing.
• 2:27
  SPEAKER_02: While children have lower rates of mechanical ventilation and death than adults, one in three children hospitalized with COVID-19 in the United States were admitted to the intensive care unit, which is the same as in adults.
• 2:38
  SPEAKER_02: Current evidence suggests that children with certain underlying medical conditions and infants might be at increased risk for severe illness from SARS-CoV-2 infection.
• 2:47
  SPEAKER_02: Current evidence suggests children with medical complexity, genetic, neurologic, metabolic conditions, or with congenital heart disease might be at increased risk for severe illness from COVID-19.
• 2:57
  SPEAKER_02: And similar to adults, children with obesity, diabetes, asthma, and chronic lung disease, sickle cell disease, or immunosuppression might also be at increased risk for severe disease from COVID-19.
• 3:08
  SPEAKER_02: The Centers for Disease Control and Prevention and the U.S.
• 3:11
  SPEAKER_02: Department of Health and Human Services, in collaboration with agencies throughout the federal government, are initiating the National Wastewater Surveillance System in response to the COVID-19 pandemic.
• 3:20
  SPEAKER_02: The data generated by the National Wastewater Surveillance System will help public officials to better understand the extent of COVID-19 infections in communities.
• 3:30
  SPEAKER_02: CDC is currently developing a portal for state, tribal, local, and territorial health departments to submit wastewater testing data into a national database for use in summarizing and interpreting data for public health action.
• 3:42
  SPEAKER_02: CDC has also updated guidance on when to quarantine and have clarified that people who have been in close contact with someone who has COVID-19, excluding people who have had COVID-19 within the past three months, should be quarantined.
• 3:54
  SPEAKER_02: Close contact is defined as being within six feet of someone who has COVID-19 for a total of 15 minutes or more, providing care at home to someone who is sick with COVID-19, direct physical contact with the person who are sharing, eating, or drinking utensils.
• 4:08
  SPEAKER_02: CDC reminds people to stay home for 14 days after last contact with a person who has COVID-19 and watch for fever, defined as 100.4 cough, shortness of breath, or other symptoms of COVID-19, and if possible, to stay away from people who are at high risk for getting very sick.
• 4:24
  SPEAKER_02: Finally, a study published in JAMA titled Filtration Efficiency of Hospital Face Mask Alternatives Available for Use During the COVID-19 pandemic demonstrated that of the 29 different fitted face mask alternatives tested, expired N95 respirators with intact elastic straps and respirators subjected to ethylene oxide and hydrogen peroxide sterilization had unchanged filtration efficiency.
• 4:48
  SPEAKER_02: The performance of N95 respirators in the wrong size had slightly decreased performance, and surgical and procedural face masks had filtering performance that was lower relative to that of N95 respirators, with procedural face masks secured with elastic earloops showing the lowest efficiency.
• 5:05
  SPEAKER_02: So while masks with earloops may be more convenient, they may be less efficacious.
• 5:10
  SPEAKER_02: And that's the news this week.
• 5:12
  SPEAKER_02: I now want to move into the discussion.
• 5:15
  SPEAKER_02: So for the first question, the Hopkins COVID map has been a resource across the U.S.
• 5:20
  SPEAKER_02: to track cases and data.
• 5:22
  SPEAKER_02: And actually, it's been a resource across the world.
• 5:24
  SPEAKER_02: I have to admit that in January and February, I looked at the map multiple times a day, and I woke up every morning.
• 5:31
  SPEAKER_02: First thing I did was look at the map, and before I went to bed, I looked at the map.
• 5:34
  SPEAKER_02: So it has been an incredible resource.
• 5:37
  SPEAKER_02: What has it been like from your perspective and how has it helped your hospital team?
• 5:43
  SPEAKER_02: Dr.
• 5:43
  SPEAKER_02: Maragakis, can you address that question?
• 5:46
  SPEAKER_01: Of course.
• 5:47
  SPEAKER_01: Thank you so much for having us today for this important discussion.
• 5:51
  SPEAKER_01: We are very grateful that Dr.
• 5:54
  SPEAKER_01: Lauren Gardner and the team at the Center for System Science and Engineering developed this map.
• 6:00
  SPEAKER_01: And I think that it just reflects such an innovative approach that really gives so much power to have insight into what's happening across the world.
• 6:11
  SPEAKER_01: And I'm really not aware of another resource like it that pulls so many data points together into one place.
• 6:19
  SPEAKER_01: And I think that's been one of the main challenges.
• 6:21
  SPEAKER_01: Well, there's so many, but certainly a main challenge in the COVID-19 response is having access to accurate and timely data at your fingertips that can guide policy and decision making and really inform all of us about where the hotspots are and what is happening.
• 6:42
  SPEAKER_01: I think data analysis is always a challenge in epidemiology, and to pull all of this together was a huge lift, but a true service to everyone.
• 6:54
  SPEAKER_02: Dr.
• 6:55
  SPEAKER_02: Grock, what have you learned from this process about COVID that surprised you the most?
• 7:00
  SPEAKER_00: You know, I think there's been so many things that have been surprising about COVID and the response to COVID.
• 7:08
  SPEAKER_00: And I think one of the things that's really been striking is how much what's happening in the community really impacts what's happening in the hospital and how there's such an immediate reflection on each other, and how the public health policies and implementation, even at the state level, and working varied across the different states, seem to have such a huge impact on the community rate of COVID and of the health organizations.
• 7:45
  SPEAKER_00: And the different approaches that we've seen nationally and internationally, which have really led to different numbering of cases and different numbers of hospitalizations.
• 7:56
  SPEAKER_00: And so it really brought the board, I think, the need for strong public health and guidance and collaborative seeking of expertise from healthcare epidemiologists also.
• 8:09
  SPEAKER_02: Okay.
• 8:10
  SPEAKER_02: Testing seems to have slowed across the US.
• 8:13
  SPEAKER_02: What does this mean for those in healthcare who are responding to COVID cases?
• 8:18
  SPEAKER_01: You know, testing is so important to our response.
• 8:22
  SPEAKER_01: It's really the way in which we can learn who has the disease, who does not have the disease.
• 8:28
  SPEAKER_01: I think most recently we're realizing that we really need two separate streams of testing capacity.
• 8:37
  SPEAKER_01: And one of those is, of course, for people with symptoms and for clinical diagnostic purposes and rapid response for those who are infected with the virus.
• 8:48
  SPEAKER_01: And then we need a surveillance testing system so that we can learn who is carrying the virus even if they do not have symptoms at all or they do not have symptoms yet.
• 9:01
  SPEAKER_01: And this part of it will be key to our ability to safely reopen businesses and schools and to really have our sustained long-term response.
• 9:13
  SPEAKER_01: And unfortunately, as we all have seen, we have significant supply chain challenges that remain around the reagents for these laboratory tests.
• 9:24
  SPEAKER_01: We also have operational challenges, obtaining the samples, really getting the tests to the people who need them in both the clinical diagnostic and the surveillance settings.
• 9:36
  SPEAKER_01: And then we really need new platforms that are rapid turnaround time and point of care.
• 9:44
  SPEAKER_01: And hopefully some of these will be on the horizon.
• 9:47
  SPEAKER_01: But that I think is what will really revolutionize the surveillance arm of testing.
• 9:53
  SPEAKER_02: Yeah, I think you know you mentioned an important point.
• 9:56
  SPEAKER_02: I think the idea of more broad surveillance like this wastewater surveillance, I think that is potentially really exciting.
• 10:04
  SPEAKER_02: It may give us some early information before people actually start getting sick.
• 10:09
  SPEAKER_02: So that would be great if that actually turned out to be helpful.
• 10:13
  SPEAKER_02: Dr.
• 10:14
  SPEAKER_02: Rock, are there any other testing challenges that Dr.
• 10:17
  SPEAKER_02: Marigak has didn't mention that you're seeing right now?
• 10:21
  SPEAKER_00: Yeah, I think that there's similar challenges.
• 10:23
  SPEAKER_00: Since the very beginning with testing, it's really been resource constraint, and it's really changed between um shortage of reagent versus shortage of swaps and the different pieces that need to come together to allow adequate testing to occur.
• 10:40
  SPEAKER_00: So those supply chain issues I think are still very much to the fore.
• 10:45
  SPEAKER_00: And then the other aspect that we have coming too is food season and the challenges that the virology microbiology laboratories are having with strategizing about how to include strategically testing, with food testing, and what that means for the allocation that the hospitals are going to receive for those combined tests and how to best utilize and implement them.
• 11:17
  SPEAKER_00: And I think there are challenges that are going to be seen across the country in the coming few months to actually start to make an appearance and people start testing for it.
• 11:29
  SPEAKER_00: I think the other challenge is that there are so many new tasks that are coming that it's difficult for people to even keep up to date with all the different options for testing.
• 11:41
  SPEAKER_00: And so it means that education to help their workers and help their providers so they're understanding the testing that's happening at the specific hospital that they're working becomes very important.
• 11:55
  SPEAKER_00: And hopefully there will be some rapid antigen tests that come to the market that have high sensitivity that will really help decrease the turnaround times that some of the molecular tasks are taking, but will have that increased sensitivity so that we can rest assured in the positive and negative predictive value associated with the results.
• 12:19
  SPEAKER_02: Yeah, I think you raised some really interesting points.
• 12:21
  SPEAKER_02: I think you know influenza is uh going to certainly make this very complicated.
• 12:26
  SPEAKER_02: And I have to say, I have a great deal of trepidation about this coming flu season.
• 12:31
  SPEAKER_02: I think this is going to be a really difficult situation.
• 12:34
  SPEAKER_02: You know, I want to mention one of the things that we're saying, and you mentioned about you know different types of tests available.
• 12:42
  SPEAKER_02: One of the challenges we're seeing now is that people who are in the hospital for syndromes that are not consistent with COVID-19, but are having testing done because they're getting a procedure and then they test positive by nasopharyngeal swab, and then you also have to try to figure out what this actually means.
• 13:00
  SPEAKER_02: Are they actually sick now with COVID or are they shedding from you know prior infection?
• 13:06
  SPEAKER_02: I think all of the testing questions are becoming more complicated as time goes on and there's more people who've previously been infected.
• 13:14
  SPEAKER_02: I don't know if either of you are dealing with any of those questions.
• 13:18
  SPEAKER_01: I would just say it's an absolutely a concern, I think, for all of us.
• 13:22
  SPEAKER_01: And one of the surprising things about this virus, perhaps we should not be surprised, but certainly the pattern of prolonged viral shedding, prolonged PCR test positive after having the illness, and many of the questions about immunity and transmissibility have really made it difficult to make some of the infection prevention and policy decisions.
• 13:47
  SPEAKER_01: So more data are coming out all the time.
• 13:49
  SPEAKER_01: I think we will learn as we go, but these are challenging issues.
• 13:54
  SPEAKER_02: There's a lot of talk about herd immunity versus social distancing, masking.
• 13:59
  SPEAKER_02: Based on the data, can you give us your thoughts on what's better and why, Dr.
• 14:04
  SPEAKER_02: Maragakis?
• 14:06
  SPEAKER_01: You know, our goal is to achieve herd immunity and or to be in a position, of course, to have a vaccine for SARS-CoV-2.
• 14:16
  SPEAKER_01: I think right now the data show us that we are best served by sticking with the very basics of infection prevention.
• 14:27
  SPEAKER_01: And social distancing, universal use of masks, hand hygiene, cleaning and disinfection, and the like are, I think, here to stay as strategies.
• 14:38
  SPEAKER_01: Sorology studies and population level data continue to tell us that even though we have had widespread transmission of the virus and many tragic deaths due to this infection, that we're not yet anywhere near achieving herd immunity.
• 14:57
  SPEAKER_01: So I would say that the data really tell us that we need to be diligent and very patiently apply over the long term changes to the way that we do things so that we can protect ourselves and each other until we get to the point where we have a therapeutic or a vaccine.
• 15:16
  SPEAKER_02: Yes, hopefully that will be sooner rather than later.
• 15:19
  SPEAKER_02: You know, everyone keeps talking about a second wave, although I have to say that you know, we're still seeing a lot of cases.
• 15:26
  SPEAKER_02: We are actually pretty close to where we were when we were at our height in April.
• 15:31
  SPEAKER_02: So I feel like the first wave never went away.
• 15:34
  SPEAKER_02: Um, but you know, people talk about the second wave.
• 15:36
  SPEAKER_02: So, Dr.
• 15:37
  SPEAKER_02: Rock, what are you doing to prepare for a potential second wave this fall?
• 15:41
  SPEAKER_00: So, as you say, I mean, in Maryland, we wrote the first wave, and there was a lot of public health response with early universal masking and self-isolation and closing down of schools and businesses, and that really allowed a way to come to a fairly low and stable type of numbers.
• 16:04
  SPEAKER_00: And there have been some more recent reopenings that were associated with increasing community numbers, particularly among the other age projects.
• 16:15
  SPEAKER_00: And so our governor has uh responded by some of the indoor dining and indoor and bar areas.
• 16:24
  SPEAKER_00: And it has been responsible decreasing the community right.
• 16:30
  SPEAKER_00: And so it still remains unpredictable, like the not going to reopen in the first time.
• 16:41
  SPEAKER_00: And so that will help keep the ammunity right now.
• 16:45
  SPEAKER_00: But at the same time, we prefer after the way to happen, and there's no way that we can predict the file that I feel no way to get what's going to happen.
• 19:00
  SPEAKER_00: I think we need to get all those pieces hopefully have us better prepared than we were during the beginnings of the first.
• 19:10
  SPEAKER_00: And really a lot that we were understanding and implementing simultaneously from an infection prevention policy uh perspective.
• 19:19
  SPEAKER_01: I agree with you, Claire.
• 19:21
  SPEAKER_01: I think I think you raise very important and excellent points.
• 19:25
  SPEAKER_01: I would add regarding influenza that you know, one important measure that we can take is emphasizing now more than ever the importance of influenza vaccination.
• 19:38
  SPEAKER_01: And there are some operational challenges, much as we see with any aspect of life these days, in conducting a flu vaccine campaign and getting everyone vaccinated without violating physical distancing principles.
• 19:55
  SPEAKER_01: Like in a normal year, we have long lines that form of our employees who are waiting to get their flu vaccines, and obviously we want to avoid that.
• 20:04
  SPEAKER_01: So we're going to extend our flu vaccination period this year.
• 20:08
  SPEAKER_01: It will take longer.
• 20:10
  SPEAKER_01: We're going to start earlier, but really emphasizing the importance so that we can prevent flu to the maximum extent possible so that we don't have that challenge on top of COVID-19.
• 20:24
  SPEAKER_02: Dr.
• 20:24
  SPEAKER_02: Mary Gakis, one last question, and I think this is probably the hardest question.
• 20:29
  SPEAKER_02: There's a lot of research going on with COVID and transmissibility.
• 20:32
  SPEAKER_02: What's the one area that if you had unlimited time and funds to study that you think would be really worthwhile and why?
• 20:40
  SPEAKER_01: This is a really difficult question.
• 20:42
  SPEAKER_01: There's so many important areas of research, and of course, leading among those is you know the search for an effective vaccine and therapeutics.
• 20:52
  SPEAKER_01: But I think we discussed earlier one of the most daunting challenges that we have, and that is really understanding the natural history of this illness and how we can best prevent transmission from individuals who may have prolonged viral shedding or who may appear to have what looks like a clinical relapse and conducting research into the level of immunity.
• 21:20
  SPEAKER_01: So it would be incredibly helpful to understand if people actually are immune after they've had a natural infection.
• 21:27
  SPEAKER_01: And in particular, does immunity occur after an asymptomatic carriage of this virus?
• 21:34
  SPEAKER_01: So I think those are the questions that will really help to inform our policy going forward.
• 21:40
  SPEAKER_02: Thank you.
• 21:41
  SPEAKER_02: Yeah, I think those are really important areas.
• 21:45
  SPEAKER_02: Thank you very much to our speakers for sharing their perspective and experiences and a sincere thank you from Shay to all healthcare personnel for all that you are doing to respond to COVID-19.
• 21:56
  SPEAKER_02: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 22:03
  SPEAKER_02: You will also find additional resources such as the recorded webinars, healthcare facility, outbreak preparedness, and the SHAY COVID-19 town halls.
• 22:12
  SPEAKER_02: Additional resources available on Learning CE pertinent to this pandemic include SHAI CDC Outbreak Response Training Program and the Prevention Course in HAI knowledge and control.
• 22:24
  SPEAKER_02: Thank you for tuning in.