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Rising To The Challenge Of COVID - 19 with PIDS · The SHEA Podcast

• 0:10
  SPEAKER_01: Hi everyone, welcome to the We're All in This Together COVID-19 Allies and Infection Prevention Podcast Series, part of the Society for Healthcare Epidemiology of America, our SHA Rapid Response Program.
• 0:23
  SPEAKER_01: I'm Dr.
• 0:23
  SPEAKER_01: Tom Sandora.
• 0:24
  SPEAKER_01: I'm a hospital epidemiologist at Boston Children's Hospital and an associate professor of pediatrics at Harvard Medical School.
• 0:31
  SPEAKER_01: And today I will serve as your SHA moderator and speaker.
• 0:34
  SPEAKER_01: I'm also very happy to welcome Dr.
• 0:36
  SPEAKER_01: Angela Myers, the director of the Division of Infectious Diseases at Children's Mercy Kansas City, and professor of pediatrics at the University of Missouri Kansas City School of Medicine, who will serve as the Pediatric Infectious Diseases Society or PID speaker for today's podcast.
• 0:52
  SPEAKER_01: Hi, Angie, how are you?
• 0:54
  SPEAKER_00: Hi, I'm fine, thank you.
• 0:56
  SPEAKER_01: Thanks for being here.
• 0:57
  SPEAKER_01: Just a couple of things to start us out.
• 0:59
  SPEAKER_01: Discussion on this podcast does not reflect Shay's or PID's perspective, but facilitates communication of multiple perspectives and experiences as we go through this pandemic together.
• 1:09
  SPEAKER_01: Today's episode will focus on collaborations around COVID-19 and how we as a team can work together to address the most important questions during this COVID-19 pandemic.
• 1:19
  SPEAKER_01: Let's go ahead and get started.
• 1:21
  SPEAKER_01: So, Angie, we've all been facing a lot of challenges since this pandemic started seven or eight months ago.
• 1:27
  SPEAKER_01: You want to tell us a little bit about one or two of the biggest challenges that your institution has faced and how you've handled it and how it's working.
• 1:34
  SPEAKER_00: Sure.
• 1:35
  SPEAKER_00: So I think one of the biggest challenges, we are a freestanding children's hospital, and so having enough testing supplies has been a particular challenge for children's hospitals because most testing supplies have been diverted to large adult facilities, which makes sense because there's so much more disease seen in adults than there are in children by and large.
• 1:56
  SPEAKER_00: So we've been creative.
• 1:58
  SPEAKER_00: The head of our microbiology lab, Dr.
• 2:00
  SPEAKER_00: Silverangan, has been very creative in having multiple different platforms running so that we are able to get a certain amount of supplies from each company and therefore maintain our ability to continue testing and then has continued to be very forward-thinking, looking into the fall and winter, and how we're going to add additional modalities for testing so that we can make sure that the children of our community have that opportunity to be tested and diagnosed and appropriately isolated when positive.
• 2:29
  SPEAKER_00: One of the other major challenges that we have had, which has been a universal challenge around the country, is PPE and more recently, hand sanitizer.
• 2:39
  SPEAKER_00: We have been creative with that as well.
• 2:41
  SPEAKER_00: We've done some reusable gowns in the NICU setting.
• 2:44
  SPEAKER_00: We have sourced gowns and masks from other places.
• 2:48
  SPEAKER_00: Like many institutions, we have done reuse protocols for N95s and have been disinfecting N95s first with UV light and now with hydrogen peroxide.
• 2:58
  SPEAKER_00: In terms of hand sanitizer, we have gone through several different products as well.
• 3:03
  SPEAKER_01: Yeah, I think these are both challenges that we've experienced as well, and they've been common to, I think, a lot of hospitals around the country.
• 3:09
  SPEAKER_01: The testing one is tricky because you know we're starting to hear now about these professional sports teams and schools that are testing and retesting thousands of people, it seems, every week.
• 3:19
  SPEAKER_01: And it's not totally clear to me how exactly they're getting enough reagents and test kits to do that.
• 3:24
  SPEAKER_01: We often don't know the details about what kind of tests they're doing.
• 3:28
  SPEAKER_01: But our lab has been really key to the response at our hospital, and they did a great job of setting up a platform and then kind of stockpiling as many tests as we needed in order to provide the clinical care.
• 3:39
  SPEAKER_01: But certainly there's a high demand, and there's a lot of interest in testing, both from patients and families as well as from our staff members.
• 3:46
  SPEAKER_01: And so being able to sort of keep that going at the level that the interest is out there has been challenging.
• 3:53
  SPEAKER_01: I think we're, I don't know if you're experiencing this in the Midwest, but for us in New England, we had our big surge of COVID-19 back in March and April.
• 4:01
  SPEAKER_01: And so our numbers are a lot lower now than they were back then.
• 4:05
  SPEAKER_01: And we're finding that right now, because our rates are a bit lower than many states, that now the supplies for testing and equipment are being diverted to high-risk states.
• 4:15
  SPEAKER_01: Where even though we're not sort of in our peak phase, this is a period of time where we could be trying to rebuild our supplies and restock, but it's been difficult because we're not the top priority at the moment.
• 4:27
  SPEAKER_00: That's interesting.
• 4:28
  SPEAKER_00: So our increase in cases really didn't occur until mid to late July when it's kind of continued.
• 4:36
  SPEAKER_00: It resulted in a lot of changes right around when school would normally start.
• 4:41
  SPEAKER_00: So there's been some aspects related to that that have been challenging as well because we didn't have very many cases early on, and then they kind of really increased over the course of the summer.
• 4:52
  SPEAKER_00: And right now in our community, we're at about a 10% positivity rate.
• 4:57
  SPEAKER_00: Things in the Midwest they tend to happen later than they do on the coasts.
• 5:02
  SPEAKER_01: Yeah, it was just uh it was a consequence of luck, I think.
• 5:06
  SPEAKER_01: A lot of it was related to travel from Europe early on before all the travel restrictions were in place.
• 5:11
  SPEAKER_01: That's how a lot of the cases got introduced here in Boston.
• 5:14
  SPEAKER_01: And so we just saw this early wave, and then unfortunately we're able to get it under control, and now it's been kind of percolated along while other states have really been surging.
• 5:24
  SPEAKER_01: We've also been seeing some of the same challenges you talked about with PPE.
• 5:29
  SPEAKER_01: I'm curious to hear about how you guys are doing in terms of respirators and fit testing.
• 5:33
  SPEAKER_01: Are you using multiple brands of respirators?
• 5:35
  SPEAKER_01: Did you have to re-fit test all of your staff?
• 5:37
  SPEAKER_01: How have you managed that?
• 5:39
  SPEAKER_00: We have had to expand different brands of respirators.
• 5:43
  SPEAKER_00: We did not refit test people who had been fit tested previously, provided that they could still wear the same mask, same size in 95, and didn't have you know major life changes that would include that.
• 5:56
  SPEAKER_00: We have been able to maintain the N95s for the people who have been fit tested by and large.
• 6:04
  SPEAKER_00: We have had some people that have had to get refit tested related to shortages, and then people who hadn't previously been fit tested because we had stopped fit testing some years ago before the pandemic because we had switched over to Pappers.
• 6:18
  SPEAKER_00: And unfortunately, Pappers have been such short supply, we can't just only do Pappers.
• 6:23
  SPEAKER_00: So people who are newly fit tested are getting fit tested to the duck bills, which is not a real popular in '95, but but it is what it is, what we've got.
• 6:33
  SPEAKER_01: Yeah, we had a baseline before the pandemic, we had a particular brand of respirators that we use, and we needed to fit test a large proportion of our staff to a second brand once the pandemic hit, just to ensure that we have adequate supply for everyone.
• 6:48
  SPEAKER_01: Right now we're in a pretty good state, but we have sort of the third brand waiting in the wings in case there's a second peak in New England and we really need to start using respirators at a higher rate than we are right now.
• 6:58
  SPEAKER_01: So I think that's been difficult because staff are so accustomed to just having one type of equipment that they used to use and not needing to keep track of different brands and worry about all these kinds of new challenges.
• 7:11
  SPEAKER_01: Absolutely.
• 7:13
  SPEAKER_01: Let's talk a little bit about school and school re-entry since it is September and this is sort of one of the hot um ticket issues of the moment.
• 7:21
  SPEAKER_01: I'm wondering if you could tell us about some of the questions or challenges that have come up for you around school entry and how you've maybe been involved in planning or helping schools to figure out how to manage it.
• 7:34
  SPEAKER_00: Partners in my division and across our COVID response team in the institution, our emergency preparedness physician, been really engaged with school districts, individual school principals for some of the private schools and the health department to help them really work through the possibilities of return to school.
• 7:55
  SPEAKER_00: For the most part, our public schools have chosen an online option for the start of the school year because our rates were higher in the community.
• 8:04
  SPEAKER_00: There is some plans to move forward with hybrid over the next few weeks.
• 8:09
  SPEAKER_00: There is also a lot of desire among the parents in our community to be able to play sports despite having online learning.
• 8:18
  SPEAKER_00: So there's been a lot of involvement on that end and helping to explain the data to school districts and school boards and supporting the health department in that.
• 8:29
  SPEAKER_00: Additionally, our folks, a couple people in my division, created a very thorough document for schools and school districts around, you know, once they make decisions about in-person learning, what are the different aspects they need to consider?
• 8:46
  SPEAKER_00: So, how do they go about with school transportation and screening and different aspects like recess and lunch and what to do when a kid gets sick and goes to the nurse's office and which kids should be tested and all of that, who should be quarantined and who should be on home isolation, and all of those things to really kind of help those schools walk through what their policies might look like as they bring kids back to school.
• 9:14
  SPEAKER_01: Yeah, we similarly had several of the members of our division of infectious diseases, as well as some of our infection preventionists from our infection prevention and control program sat on a couple of panels with members of the community and folks who are in charge of school re-entry planning to really answer some of the common questions about how far apart did the desk need to be and should the students eat lunch in the classroom versus somewhere else.
• 9:39
  SPEAKER_01: And some of these key questions that seem so easy on the surface but actually require a lot of really thoughtful planning in order to pull off school in a safe way if students are going to be there in person.
• 9:51
  SPEAKER_01: Have you had any questions come to you about testing related to kids in school or kids kind of outside of your own healthcare system?
• 9:59
  SPEAKER_00: So we have one of the things that we got up and running, and I think other places around the country have done this too, is we developed drive-by testing at our urgent care sites.
• 10:09
  SPEAKER_00: We have three urgent care sites in different areas of the community for our community pediatricians.
• 10:14
  SPEAKER_00: Community pediatricians are having a hard time getting younger kids tested in certain areas.
• 10:20
  SPEAKER_00: So some of our health departments will only test kids down to seven or not younger kids.
• 10:25
  SPEAKER_00: Some of the community hospitals are not testing younger kids.
• 10:29
  SPEAKER_00: And so we created an ability for the community pediatrician to put in an order.
• 10:34
  SPEAKER_00: We call the family, schedule them for a 15-minute appointment for a drive-by test at one of our urgent cares, and they are resulted by the next day.
• 10:42
  SPEAKER_00: That's worked pretty well.
• 10:43
  SPEAKER_00: Additionally, we have been working with surrounding counties on both the Missouri and the Kansas side to secure CARES Act funding so that we can hopefully, when kids are back in school in person, that we can put some tests in the schools and have the kids be able to be tested at the school nurse's office prior to leaving once they develop symptoms at school.
• 11:08
  SPEAKER_00: I mean, then those tests would be couriered over to us and we would run those tests.
• 11:12
  SPEAKER_01: Yeah, that's been one of the big logistic challenges in Massachusetts as well, is thinking about when kids do get sick or need to be tested, whether it should be done at school versus in a separate setting, and then who should run those tests?
• 11:24
  SPEAKER_01: Should it go to the hospital?
• 11:26
  SPEAKER_01: Should it go to a large reference laboratory that has more capacity for testing a large number of students?
• 11:32
  SPEAKER_01: These are not easy questions to answer, but that's what people have been really working to try to plan here as well.
• 11:36
  SPEAKER_01: We also have been doing some drive-through testing for kids, and one of our challenges, there are actually many testing sites across Massachusetts, and a lot of them will test kids, but as you kind of alluded to, they don't necessarily have the same degree of comfort, especially with the youngest kids or kids who have behavioral challenges.
• 11:54
  SPEAKER_01: Obviously, they look to our children's hospitals for those kinds of situations, and to be able to provide some capacity for drive-through testing for kids certainly has been helpful.
• 12:04
  SPEAKER_01: But I think, particularly if there happens to be a surge once more kids are back in school in person, it may be challenging to actually absorb all the testing capacity that people would be interested in having.
• 12:15
  SPEAKER_00: Yeah, I think you're right.
• 12:16
  SPEAKER_00: I think you're right, Tom.
• 12:17
  SPEAKER_00: I think that is going to be difficult.
• 12:19
  SPEAKER_00: It's possible that we'll need to be flexible and have continue to do drive-by sent in from the community pediatric office, but then also potentially have in-school testing where, like you said, maybe those come to our hospital, or maybe we end up working with a reference lab in the community, depending on the numbers of those tests and how many need to be done.
• 12:40
  SPEAKER_00: I do think I think it will probably evolve over the rest of this year as we see what happens in our community and what what the testing rate is, and then also what the positivity rate is.
• 12:52
  SPEAKER_00: Right.
• 12:52
  SPEAKER_01: So it's very hard to make predictions about exactly what to expect and what the needs are going to be, but obviously we'll all be monitoring our own state's positivity rates and progress really closely to try to inform those decisions.
• 13:04
  SPEAKER_01: Tell us a little bit about some of the resources that you guys have created, either for your community or for the schools, in order to help people work through some of these challenges.
• 13:13
  SPEAKER_00: Yeah, so one of the community resources that we created, one of my partners worked with the sports medicine group and then later brought in the cardiologists when more started coming out around cardiac manipulations of COVID-19, around return to sports.
• 13:28
  SPEAKER_00: And they've created a really nice document to provide some guidance around what to do in terms of kids going back to playing sports, not just for schools, which was one of the aspects, but also for club teams, because there's a whole lot of that going on, I'm sure, in your community as well.
• 13:45
  SPEAKER_00: And so that has been really helpful.
• 13:47
  SPEAKER_00: And they have refined it, I think a couple of different times as new things have arisen and been brought up.
• 13:54
  SPEAKER_00: It's very much a working document in terms of updating it.
• 13:59
  SPEAKER_00: And the same is true for our return to school or school guidance document.
• 14:04
  SPEAKER_00: As new issues have come up around that as well, we have added to that document, including things from our behavioral development physicians around how to work with kids to wear masks and developmentally appropriate kind of messaging and things of that nature.
• 14:22
  SPEAKER_00: So that's part of what we've done.
• 14:24
  SPEAKER_00: One of the other things we have done, which came from our our actually our safety officer led this, created a letter for us internally, but then also for community pediatricians that really states in it with different options.
• 14:37
  SPEAKER_00: You know, your child was tested and they were negative, your child was tested and they were positive, and they need to be on home isolation for this long, or your child was exposed and they need to be in quarantine for this long, and that kind of thing.
• 14:49
  SPEAKER_00: And we've we've put that on our website so people can easily grab it off and then check whichever one is appropriate for their patient and sign it and send them on their way, really as kind of a community resource, in addition to a resource for our clinics here at children's mercy, so that the same information gets put out the same way every time, so that patients don't hear it one way from their pediatrician and another way from us when they come see us.
• 15:14
  SPEAKER_01: That's great.
• 15:15
  SPEAKER_01: Yeah, we've also been developing a slew of family education seats.
• 15:19
  SPEAKER_01: We always have a lot of family ed sheets to begin with, but we created so many different versions of COVID-19 family ed sheets depending on what your exact situation was.
• 15:28
  SPEAKER_01: If you were asymptomatic, if you're exposed, if you had illness symptoms, and how to quarantine and isolate a home correctly.
• 15:35
  SPEAKER_01: So I think those kinds of materials are really important for patients and families as well as the pediatricians, as you said.
• 15:41
  SPEAKER_00: I'm sure you've also created some for your immune-compromised host patients and transplant patients as well, because I know that we have to.
• 15:49
  SPEAKER_01: That's right, yeah.
• 15:50
  SPEAKER_01: We've actually we had a really nice document put together by our faculty at the hospital across all of the different subspecialties, thinking about which underlying conditions really place children at higher risk if they were to get COVID-19 in order to help guide pediatricians to have discussions with families, with children who have those conditions to think about the risk versus benefits of in-person versus remote learning and really being thoughtful about school re-entry and which children did it make sense to really stay home and learn versus which children, you know, was there less risk if they actually were to go to school and attend in person.
• 16:25
  SPEAKER_01: What about uh social media?
• 16:26
  SPEAKER_01: Do you guys have any interesting social media outreach that you've been doing that's been successful?
• 16:32
  SPEAKER_00: We have done a lot of social media.
• 16:34
  SPEAKER_00: In fact, I recently contacted our media relations team just to see how much we've done since the onset of COVID-19, and it's amazing.
• 16:44
  SPEAKER_00: And I'm sure it is.
• 16:45
  SPEAKER_00: If you if you ask your media people and you get it pulled for your division, I'm sure it is for you too.
• 16:50
  SPEAKER_00: We have done a ton of PSAs that go to Facebook, Twitter.
• 16:54
  SPEAKER_00: First, we're like talking about just the infection itself, then talking about all of the physical distancing, masking, staying out of the public.
• 17:02
  SPEAKER_00: We've talked a little bit about school re-entry, we've talked a little bit about sports, we've done some specific ones.
• 17:08
  SPEAKER_00: Two of my partners are very involved in our Latinx program here at the hospital.
• 17:13
  SPEAKER_00: And so they have done some really good ones dispelling myths.
• 17:17
  SPEAKER_00: So the top 10 myths for the Latinx communities, and it was done in Spanish, of course, and they found physicians from across the hospital from all the subspecialties, each to dispel one myth and recorded that for social and then had it also subtitled in English for folks who wanted to read it who don't speak Spanish, which has gone really, really well and has led to some other opportunities with Spanish radio stations and things like that to really message kind of our entire population so that we're not, you know, so that we're touching everybody.
• 17:48
  SPEAKER_01: I love that.
• 17:48
  SPEAKER_01: That's a great idea.
• 17:49
  SPEAKER_01: Yeah, it's it's so easy to reach out and reach a lot of people through social media, and we've had similar experiences with tweeting about masks and which types of masks are effective and so forth.
• 18:00
  SPEAKER_01: And we've got multiple members of our faculty and infectious diseases who are doing regular television interviews with various news media outlets, try to keep patients and families and pediatricians informed about the basics of COVID-19.
• 18:13
  SPEAKER_01: So I think it's a really important way for us to get the right messages out there in terms of public health and preventing infections.
• 18:21
  SPEAKER_01: Well, Angie, I think we could talk about COVID-19 for many more hours, but I think we're coming to a close of our time for this podcast.
• 18:28
  SPEAKER_01: So I just want to thank you very much for joining us today and sharing your perspectives and experiences.
• 18:33
  SPEAKER_01: And we both want to thank Shay and all healthcare personnel for everything that people are doing to respond to COVID-19.
• 18:40
  SPEAKER_01: Just a reminder for listeners, this podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 18:49
  SPEAKER_01: And you will also find additional resources such as the recorded webinars, healthcare facility outbreak preparedness, and also SHAY COVID-19 town halls, and an additional podcast series called COVID-19 update, what we know now, which is released every Thursday.
• 19:05
  SPEAKER_01: So that concludes this episode of the Allies and Infection Prevention Podcast series, and thank you all for tuning in.