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COVID-19: Frequently Asked Questions, 2/24 · The SHEA Podcast

• 0:07
  SPEAKER_00: 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.
• 0:22
  SPEAKER_00: Shay is excited to launch the first episode of this podcast, Novel Coronavirus, Frequently Asked Questions.
• 0:29
  SPEAKER_00: I am Dr.
• 0:30
  SPEAKER_00: David Bannock from the University of Connecticut, and I will serve as the moderator for today's podcast.
• 0:34
  SPEAKER_00: In the next episode, we'll be learning more about the current state of the novel coronavirus, its epidemiology, and the current public health strategies for preventing its spread throughout the U.S.
• 0:44
  SPEAKER_00: Our speaker today is Dr.
• 0:45
  SPEAKER_00: Michael Bell, the Deputy Director of CDC's Division of Healthcare Quality Promotion.
• 0:50
  SPEAKER_00: His first position at CDC was in the hospital infections program, investigating outbreaks of health care associated illness and writing national infection control guidelines.
• 0:59
  SPEAKER_00: Prior to his current position, he was the chief of the epidemiology unit at the Viral Special Pathogens Branch, addressing infection control for high-risk pathogens such as Ebola virus.
• 1:08
  SPEAKER_00: He received his medical degree from the University of Washington and trained in internal medicine at the University of Colorado and in infectious disease at the University of California, San Francisco.
• 1:18
  SPEAKER_00: Thank you, Dr.
• 1:18
  SPEAKER_00: Bell, for joining us on this podcast.
• 1:21
  SPEAKER_00: Thank you for having me.
• 1:22
  SPEAKER_00: So I would like to start the discussion with the following question.
• 1:26
  SPEAKER_00: Thinking about how we're going to be discussing this novel coronavirus, could you provide some insight and some background into what the best terminology or the most appropriate terminology for the virus may be at this time?
• 1:37
  SPEAKER_01: Sure.
• 1:37
  SPEAKER_01: Well, the novel coronavirus, novel, indicates the fact that this is not a strain of coronavirus that has been known to circulate amongst human beings to date.
• 1:46
  SPEAKER_01: So as with previous coronaviruses that have emerged, this one is new to our population.
• 1:53
  SPEAKER_01: The taxonomy of the virus has recently been clarified by the International Committee on Taxonomy of Viruses, and the name that they've settled on is SARS-CoV-2.
• 2:02
  SPEAKER_01: This is a little bit confusing because if you use this in documents and so on, people get confused with SARS that we know from the previous emergence.
• 2:11
  SPEAKER_01: The name of the disease is COVID-19.
• 2:15
  SPEAKER_01: This is something that the World Health Organization has settled on.
• 2:18
  SPEAKER_01: And that is a little bit easier to identify as the current covirus outbreak.
• 2:23
  SPEAKER_01: That's in a nutshell what we're dealing with.
• 2:26
  SPEAKER_01: In terms of where we are, we are seeing the results of significant transmission in China where this began.
• 2:35
  SPEAKER_01: The city of Wuhan in the province of Hubei has been the epicenter, as many of you know.
• 2:40
  SPEAKER_01: That outbreak has reached very large proportions, and now we're observing some spread in locations outside of China.
• 2:48
  SPEAKER_00: Thanks for clarifying some of the terminology.
• 2:50
  SPEAKER_00: I think as this has progressed, the change in terminology has been a challenging So let's talk a little bit more about the spread of COVID-19.
• 2:58
  SPEAKER_00: You mentioned a little bit about how it spread from China, but can you talk a little bit more about how contagious this particular virus is?
• 3:05
  SPEAKER_01: Sure.
• 3:06
  SPEAKER_01: Well, so early on in the outbreak, what we are having recorded for us is that the origin appears to have been a live animal market.
• 3:14
  SPEAKER_01: That animal-to-human transmission matches previous patterns that we've seen for emerging coronaviruses with camels, for example, in MERS, and prior to this, the palms of it being identified for SARS.
• 3:28
  SPEAKER_01: That may have happened again in the live animal market, but thereafter we've seen substantial person-to-person spread.
• 3:35
  SPEAKER_01: If you look at the epidemiology, what we're saying is that although initially identified individuals infected with this virus had a linkage to that live animal market, thereafter there has been sustained person-to-person spread within the community in China.
• 3:51
  SPEAKER_00: Thanks for clarifying some of that.
• 3:53
  SPEAKER_00: Can you comment a little bit on the person-to-person spread and what we know about how contagious this virus is and if there's any potential to compare it to other previous experiences with emerging viral infections?
• 4:04
  SPEAKER_01: So comparisons are still difficult at this point.
• 4:07
  SPEAKER_01: What I can share is that the spread patterns that we're seeing are associated with close person-to-person contact, either direct exposure to an ill individual, or sometimes in group gatherings where there is close proximity and somebody in the group was infectious, we've seen a efficient spread that way.
• 4:26
  SPEAKER_01: The pattern of spread does not match that of a classic airborne infectious disease such as measles or tuberculosis.
• 4:34
  SPEAKER_01: We are not seeing entire buildings become symptomatic in unison the way you might expect with something like measles or chicken pox.
• 4:42
  SPEAKER_01: Instead, we're seeing sporadic transmission associated with that closer contact.
• 4:47
  SPEAKER_01: This is something that we associate with a droplet transmission type pattern.
• 4:52
  SPEAKER_01: One thing to note is that there's no way to discern how much or whether there is a component of inhalational transmission at close range, since that would look similar.
• 5:03
  SPEAKER_01: And that gets to some of our protective equipment recommendations that we'll talk about in a moment.
• 5:08
  SPEAKER_00: Thanks for sharing.
• 5:08
  SPEAKER_00: We'll talk a little bit more about PPE and personal protective equipment in a little bit.
• 5:13
  SPEAKER_00: I do want to talk a little bit more about the clinical manifestations of the viral infection.
• 5:18
  SPEAKER_00: We've talked about how the virus spreads, how contagious it may be, but can you give some insight into the types of signs and symptoms we may see in the clinical setting that would raise concern for COVID-19?
• 5:30
  SPEAKER_01: A challenging feature of coronavirus is that the symptoms are nonspecific.
• 5:35
  SPEAKER_01: People who have been identified with this disease to date have had a wide range of symptoms in terms of severity from very minor upper respiratory symptoms to very significant lower respiratory disease.
• 5:49
  SPEAKER_01: Fever, cough, and shortness of breath have been the most common features of most infections documented to date.
• 5:55
  SPEAKER_01: But other nonspecific symptoms like sore throats have also been noted.
• 5:59
  SPEAKER_01: The incubation period is expected to be somewhere between two and 14 days based on what we know from previous coronavirus outbreaks, including the MERS outbreak.
• 6:10
  SPEAKER_00: Thanks for clarifying that incubation period.
• 6:12
  SPEAKER_00: As we think about these patients presenting in healthcare settings, having some understanding of the signs and symptoms is really critical.
• 6:20
  SPEAKER_00: But what do you suggest to healthcare practitioners when we're trying to think about how to identify these patients, kind of integrating both the epidemiologic factors as well as the clinical signs and symptoms that we might see?
• 6:34
  SPEAKER_00: What's the current guidance that's being provided to be able to identify these potential patients with COVID-19?
• 6:40
  SPEAKER_01: So, especially given the fact that our symptom spectrum is so nonspecific and the severity range is so wide, effective triage becomes more critical for this disease than for many others.
• 6:52
  SPEAKER_01: And by effective triage, I mean detecting people who have an exposure history either with direct travel to China or close contact with a person who's known to have had infection with the virus in the 14 days before symptoms began.
• 7:06
  SPEAKER_01: That systematic identification is essential in order to quickly isolate the patient and implement appropriate source control.
• 7:15
  SPEAKER_01: What we would really like to see is that everyone with respiratory symptoms is screened to ensure that they don't have those other risk factors, and if they do, they should be placed in a private room or a separate area away from other people, and they should be asked to wear a face mask right away.
• 7:33
  SPEAKER_01: The importance of source control is hard to overstate given that having somebody with unrecognized symptoms that remains infectious amongst other patients in waiting areas or near healthcare staff can contribute significantly to a secondary outbreak.
• 7:49
  SPEAKER_00: Thank you for that guidance.
• 7:50
  SPEAKER_00: I think that's something that all of us at healthcare facilities are really focusing on the concept of early identification and implementing those initial infection prevention strategies to prevent any potential spread.
• 8:04
  SPEAKER_00: Now, besides the isolation from other patients, what do you suggest as far as initial steps that should be taken once a patient with potential COVID-19 presents to a healthcare facility in order to reduce the potential for spread as much as possible?
• 8:21
  SPEAKER_01: So, in addition to quickly identifying these people and separating them from others, and as I mentioned, having the individual who's ill wear a surgical mask, there's a need to very promptly notify your state and local health department so that appropriate testing can be done.
• 8:36
  SPEAKER_01: Testing will go a long way towards figuring out what further steps are required.
• 8:40
  SPEAKER_01: In parallel, testing for other routine etiologies of respiratory infection is very important since the incidence in this country of the novel coronavirus is expected to be low, and the season during which it's happening is certainly one when other respiratory pathogens are common.
• 8:59
  SPEAKER_01: So other etiologic tests are certainly indicated.
• 9:03
  SPEAKER_01: The discussion with public health results in a need to acquire specimens for covirus testing for COVID-19.
• 9:11
  SPEAKER_01: We recommend getting nasopharyngeal and oropharyngeal swabs.
• 9:15
  SPEAKER_01: This is something that can be accompanied by lower respiratory specimens if available.
• 9:19
  SPEAKER_01: Regardless of which specimens are obtained, infection control practices are essential to make sure that healthcare personnel aren't exposed to infectious material.
• 9:29
  SPEAKER_01: I'm particularly concerned when it comes to nasopharyngeal swabs, that this is likely to trigger sneezes and coughs.
• 9:36
  SPEAKER_01: And if you're face to face with somebody obtaining the sample, that could put you at risk if you're not appropriately protected.
• 9:43
  SPEAKER_00: Thanks for making that important point.
• 9:44
  SPEAKER_00: I think you've made several key points, namely to approach these patients cautiously thinking about COVID-19, but also keeping a broader picture in mind for other potential etiologies.
• 9:55
  SPEAKER_00: And then the comment you made about specimen collection is really important.
• 9:58
  SPEAKER_00: And I think something that we need to be mindful of in healthcare settings that our sample collection may have the potential for spreading COVID-19 to healthcare providers in the environment.
• 10:10
  SPEAKER_00: So let's talk a little bit more about healthcare professionals and what can be done from the personal protective equipment perspective in order to best protect healthcare professionals who are providing care for a patient with suspected COVID-19 or confirmed.
• 10:26
  SPEAKER_00: What's the recommendation at this point for PPE use here in the US?
• 10:31
  SPEAKER_01: So PPE is a crucial component of protecting healthcare personnel and healthcare facilities, not to mention other patients.
• 10:38
  SPEAKER_01: Before I launch into PPE issues, I will just say that patient placement probably supersedes that in terms of importance and effectiveness.
• 10:46
  SPEAKER_01: So what we are saying, in addition to segregating an individual who is being assessed for possible COVID-19, we're recommending at the moment that that patient be cared for in a negative pressure isolation room.
• 10:59
  SPEAKER_01: That is something that is an extremely cautious approach.
• 11:02
  SPEAKER_01: Might not be ultimately necessary, but at the beginning of the outbreak, we're making use of the resources that we have in this country.
• 11:10
  SPEAKER_01: Similarly, when it comes to protective equipment, we are recommending respiratory protection with an N95 disposable face piece.
• 11:18
  SPEAKER_01: We are recommending contact isolation with gloves and gowns worn for entry into the room, removed immediately after with hand hygiene performed.
• 11:27
  SPEAKER_01: We're also emphasizing the importance of eye protection.
• 11:30
  SPEAKER_01: Eye protection is something that gets forgotten when we think about isolation.
• 11:35
  SPEAKER_01: The reality is that if something splashes you in the eye, even if there are not specific binding sites for that pathogen in the conjunctiva, we do have tear ducts, and those can deliver infectious material to the back of the pharynx.
• 11:49
  SPEAKER_01: And as such, I think it's crucial, especially when gathering samples, but any time you're taking care of a patient like this, to remember to protect your eyes.
• 11:57
  SPEAKER_01: That can be with goggles, which are unpleasant and uncomfortable, or it can be with a disposable face shield, which has become far more common and easily obtained.
• 12:07
  SPEAKER_00: Great.
• 12:07
  SPEAKER_00: Thanks for sharing that insight.
• 12:09
  SPEAKER_00: I think that the eye protection is really critical and I agree often underappreciated.
• 12:13
  SPEAKER_00: In terms of the patient care environment, you did mention that these patients should be cared for under airborne precautions in a negative pressure room when possible.
• 12:20
  SPEAKER_00: Do you have any guidance to offer in facilities, particularly outpatient facilities, on how to handle situations where a negative pressure room may not be readily available in thinking of evaluating and taking care of these patients?
• 12:33
  SPEAKER_01: So negative pressure isolation rooms are the Cadillac option in terms of ensuring that the healthcare facility is maintained in a safe way while these patients are cared for.
• 12:46
  SPEAKER_01: That doesn't necessarily mean that they are absolutely required.
• 12:50
  SPEAKER_01: There, as I said before, have not been any indicators of efficient long-distance airborne transmission of this infection.
• 12:57
  SPEAKER_01: We're not seeing patterns that would indicate that.
• 13:00
  SPEAKER_01: We're continuing to watch to make sure that that remains the case.
• 13:03
  SPEAKER_01: And until then, we're recommending negative pressure rooms.
• 13:05
  SPEAKER_01: If you're in a facility that doesn't have one, then at a minimum the patient should be in a separate room from others, a private room with the door closed.
• 13:13
  SPEAKER_01: If possible, it's good to ensure that that particular room doesn't exhaust its air supply directly into another room where other people are congregating.
• 13:24
  SPEAKER_01: The recommendation for the time being is to continue to use a negative pressure room.
• 13:30
  SPEAKER_01: One thing related to airborne isolation is the issue of respiratory protection.
• 13:37
  SPEAKER_01: One of the reasons for recommending respiratory protection, even though we are not seeing that long-distance airborne transmission pattern, is what I think has been called in the past opportunistic inhalational transmission.
• 13:49
  SPEAKER_01: This refers to the fact that even if you're not in direct line of sight of an infectious patient, if you're close to them, within, we generally say now about six feet, it's possible that small particles that are generated from people cough or speak could float in the air and you could inhale them as opposed to being directly splashed.
• 14:09
  SPEAKER_01: Given that surgical masks do have side gaps in many cases, we prefer a respirator that fits close to the face and provides filtration effect in that close range setting.
• 14:20
  SPEAKER_01: And I bring this up because even though it's possible or even likely that we might arrive at a point where we no longer require negative pressure rooms for management of these patients, we might continue to recommend respiratory protection, that is the use of an N95 recipe.
• 14:36
  SPEAKER_00: Okay, thanks for clarifying and providing some of the rationale behind those recommendations.
• 14:42
  SPEAKER_00: One question that has arisen is comparing the current USCDC guidance on PPE use to some of the PPE recommendations that are coming from other countries throughout the world.
• 14:55
  SPEAKER_00: Would you be able to comment a little bit on why we may be seeing some differences between what's being recommended here in the US and other countries?
• 15:04
  SPEAKER_01: So the US approach to infection control when it comes to emerging infections like this is framed by a couple of things.
• 15:12
  SPEAKER_01: One is the availability of resources.
• 15:14
  SPEAKER_01: We are fortunate in this country to have access to not only negative pressure rooms, but a range of personal protected equipment and so on.
• 15:21
  SPEAKER_01: And our approach has evolved to be that we do the most we think is necessary up front with an eye towards scaling back if evidence supports that.
• 15:33
  SPEAKER_01: Scaling back can be a challenging thing, as many of us in the field know, but we feel like we are obligated to start high and then move from there.
• 15:42
  SPEAKER_01: Other parts of the world have a tradition of starting medium and escalating if necessary.
• 15:49
  SPEAKER_01: Those places are equally challenged, but in the other direction.
• 15:53
  SPEAKER_01: There are certainly descriptions of pushback from the healthcare provider world in both directions.
• 16:00
  SPEAKER_01: If we take our neighbors to the north in Canada, even within Canada, different provinces take differing approaches, and a lot of that is related to the local culture.
• 16:12
  SPEAKER_01: When I look at this, I think a lot of the variation is understandable, but the key is to have insight into the rationale.
• 16:20
  SPEAKER_01: What it is that's driving one community to do one thing versus another community to do another.
• 16:26
  SPEAKER_01: The last thing that I'll say is that there is the significant challenge of places with low or limited resources where they have to make the best decisions possible given the resources that they have.
• 16:38
  SPEAKER_01: And that's certainly a challenge that WHO grapples with and it attempts to provide useful recommendations that may not be completely the same as what we practice here in the United States.
• 16:50
  SPEAKER_00: Okay, great.
• 16:51
  SPEAKER_00: Thanks for commenting on that.
• 16:52
  SPEAKER_00: I think that's been a question that's been percolating, but I think having your insight is uh very valuable.
• 16:57
  SPEAKER_00: Let's step away a little bit from the healthcare facility.
• 17:01
  SPEAKER_00: Let's talk more about general public.
• 17:02
  SPEAKER_00: You know, a lot of questions that we get from individuals in the community, even sometimes our patients, is really what's the best thing that the general public can do to protect themselves from COVID-19 in terms of routine day-to-day life?
• 17:16
  SPEAKER_00: Can you offer some guidance as far as what we should be uh encouraging the general public in terms of infection prevention?
• 17:23
  SPEAKER_01: For the public, protecting yourself from COVID-19 boils down to doing all the same things that we do to protect ourselves from a bad flu season or any other respiratory viral infection that might be spreading in the community.
• 17:36
  SPEAKER_01: This is something that happens season after season, and so this is in many ways nothing new at all.
• 17:41
  SPEAKER_01: Clearly, you don't want to be in close contact with sick people if you can help it.
• 17:46
  SPEAKER_01: This is not something that we can always control.
• 17:48
  SPEAKER_01: Depending on your level of concern, some people are avoiding places with you know large groups of people, some people are even rescheduling big gatherings.
• 17:59
  SPEAKER_01: That may or may not be necessary given the low numbers that are present in the United States at the moment, but it's certainly not an irrational thing to think about.
• 18:08
  SPEAKER_01: The other part of it is what we do for ourselves in terms of our own hygiene.
• 18:13
  SPEAKER_01: One thing to remember is that these respiratory viruses enter our bodies through our eyes, nose, or mouth.
• 18:20
  SPEAKER_01: As such, there's the one part that we've already mentioned, which is don't get face-to-face with somebody who's sick, don't get coughed on.
• 18:27
  SPEAKER_01: Those of you with little children are thinking that's impossible, and that would be true.
• 18:32
  SPEAKER_01: But the other part of it is don't deliver potentially infectious virus to your eyes, nose, or mouth.
• 18:37
  SPEAKER_01: And by that I mean when you think about what touches your eyes, nose, or mouth, it's probably mostly your hands.
• 18:42
  SPEAKER_01: And so ensuring that your hands are clean before you adjust your contact lenses or you know touch your face for any reason is very, very important.
• 18:53
  SPEAKER_01: Those of us who wandered through any public space will recognize that humans seem to reflectly rub their eyes, noses, mouths on a frequent basis.
• 19:03
  SPEAKER_01: And so that gets to the importance of interrupting transmission using hand hygiene as frequently as possible.
• 19:11
  SPEAKER_01: It doesn't matter whether it's soap and water or an alcohol-based rub, the key is the frequency with which your hands are cleaned so that there's every opportunity to block that chain of transmission.
• 19:24
  SPEAKER_01: In addition to personal hygiene, there is environmental hygiene.
• 19:28
  SPEAKER_01: If you're managing a location where people congregate, or you're having a large family with shared spaces, making sure that surfaces are cleaned frequently, daily or so, with a normal household cleaner is another way to reduce the risk of infections spreading within a household.
• 19:47
  SPEAKER_01: And then lastly, there's what we can do if we're sick.
• 19:51
  SPEAKER_01: This is a challenging issue, especially in our field.
• 19:55
  SPEAKER_01: But first and foremost, if you're ill, try to stay home.
• 20:00
  SPEAKER_01: This is very, very difficult for people who don't have a permissive sick leave policy.
• 20:04
  SPEAKER_01: I think there are many policy implications when it comes to the issue of presentedism, and that's something that I know many healthcare facilities struggle with.
• 20:13
  SPEAKER_01: The corollary to this is if you are ill and you're going out, make sure that you're able to maintain cough etiquette and respiratory hygiene, by which I mean be ready to cover your cough or sneeze.
• 20:25
  SPEAKER_01: Use a tissue if you can.
• 20:26
  SPEAKER_01: I'm somewhat unconvinced about the elbow because I see people sort of coughing into the elbow from about 10 inches away, which doesn't strike me as being very effective.
• 20:35
  SPEAKER_01: But nonetheless, covering your cough or sneeze and then cleaning your hands right away afterwards is key.
• 20:40
  SPEAKER_01: One option is for people who have symptoms to wear a mask when they're out and about.
• 20:44
  SPEAKER_01: That is not something that is a routine part of our culture in North America, but as you've seen in many pictures from East Asia, it is a part of routine etiquette there, where somebody who has the sniffles or a bit of a cough will wear a disposable mask when they're in a public conveyance.
• 21:03
  SPEAKER_01: That might be something worth considering actually in healthcare facilities to encourage people who show up with a sniffle, which might be nothing, but might be something more, to at a minimum consider wearing a mask.
• 21:14
  SPEAKER_00: Thanks.
• 21:15
  SPEAKER_00: It sounds like a lot of the infection control guidance really hones in on some of the fundamentals of infection prevention, namely hand hygiene, respiratory etiquette, and just a heightened awareness of these particular strategies, potentially coupled with some additional uh kind of more enhanced uh strategies as well.
• 21:32
  SPEAKER_00: But I think it does offer an opportunity to really emphasize the fundamentals, uh, which are really key.
• 21:38
  SPEAKER_00: So we've talked a lot about the present state of the outbreak, but I do want to think a little bit about the future, and I'm interested in your input into what the future may hold, both from the clinical care perspective as well as the future of the epidemic and thinking about public health and overall infection prevention and strategies.
• 22:00
  SPEAKER_00: So first, would you be able to comment a little bit on the treatment as it stands today and maybe what you anticipate the future may look like for treating patients with COVID-19 infection?
• 22:11
  SPEAKER_01: COVID-19 patients at present are managed with supportive care.
• 22:16
  SPEAKER_01: All of the things that we do for anybody with a severe systemic illness are part of that bundle.
• 22:21
  SPEAKER_01: We do recognize that symptom severity seems to be associated with greater age.
• 22:26
  SPEAKER_01: A lot of the mortality that we've seen is in 70, 80, and 90-year-old patients.
• 22:33
  SPEAKER_01: That said, beyond supportive care, we do have hope that antiviral medications will be available sometime in the coming several months.
• 22:43
  SPEAKER_01: I can't pinpoint the timing of availability given all of the clearance requirements and so on, but there is active work looking at antivirals.
• 22:51
  SPEAKER_01: And similarly, vaccine work is underway, but as I'm sure you've heard, the availability of such a vaccine is likely to be many months away.
• 22:58
  SPEAKER_01: So in the interim, quickly identifying patients, putting them in a safe place, caring for them safely so that healthcare personnel don't get infected, and then giving them the best quality of supportive care is the strategy that we have.
• 23:12
  SPEAKER_01: When we think about the future, the future of the outbreak and the future of how we manage these things, I think that the outbreak part first, those of us who maintain an optimistic outlook are likely hoping that this will follow the pattern of MERS and SARS before it, wherein after an initial singular amplification event and then some secondary spread therefrom, the outbreak then quiets down and fades back.
• 23:43
  SPEAKER_01: That's certainly the hope.
• 23:44
  SPEAKER_01: We're starting to see trends in that direction looking at international data and data in China, but it's too early to say with any certainty whether that's going to happen.
• 23:54
  SPEAKER_01: So we're watching very, very carefully.
• 23:56
  SPEAKER_01: In terms of the future of managing similar outbreaks, I think the message here is clear.
• 24:00
  SPEAKER_01: We are going to see more of these.
• 24:02
  SPEAKER_01: It's increasingly likely as the world is more and more crowded and international travel and commerce continue to grow that worldwide dissemination of emerging pathogens is likely to continue to happen.
• 24:16
  SPEAKER_01: With that said, I think there is an opportunity and indeed a need to think carefully about how we want to receive patients into care settings and what that should look like.
• 24:30
  SPEAKER_01: And I mean by this the fact that despite it being 2020, many waiting areas in acute care settings and ambulatory settings look remarkably similar to how they looked at the turn of the previous century.
• 24:44
  SPEAKER_01: We really haven't changed how we do things.
• 24:46
  SPEAKER_01: When you look at the arrival to an emergency department, there is still, in many, many cases, a crowded waiting area where everyone's mixed together.
• 24:55
  SPEAKER_01: That strikes me as a great system for making it difficult to prevent the arrival of an infectious person into a population in a hospital.
• 25:04
  SPEAKER_01: So, you know, when I think about the future, some of this is about designing a system that makes it much more effective to assess, triage, diagnose patients who might have infectious disease of concern.
• 25:18
  SPEAKER_01: Some of this is likely to be related to telemedicine.
• 25:21
  SPEAKER_01: I think that the smartphone handset has many opportunities for use.
• 25:26
  SPEAKER_01: And then similarly, I wonder a lot about human factors and design in healthcare facilities that can guide people to the right location for triage and assessment in a way that doesn't require a healthcare professional to have face-to-face contact.
• 25:41
  SPEAKER_01: These are all things that we can do with today's technology.
• 25:44
  SPEAKER_01: It is difficult getting them implemented and certainly retrofitted given the margins on which healthcare facilities run.
• 25:50
  SPEAKER_01: But nonetheless, I think it would be silly to think we won't have another one like this in the coming decade.
• 25:56
  SPEAKER_01: And now would be a great time to start preparing.
• 25:59
  SPEAKER_00: Thank you.
• 26:00
  SPEAKER_00: I think that sounds like the current message is maybe one of cautious optimism, but I think that a lot of the points that you raise, both pertaining to COVID-19 specifically, but more broadly to our approach to clinical care and public health strategies when faced with an emerging infection, are really critical.
• 26:20
  SPEAKER_00: So I'm really pleased to see that we're looking at a very big picture here, both from the individual provider-patient level, spreading and thinking more broadly into the individual facility level as well as the broader public health and the international health uh perspective.
• 26:35
  SPEAKER_00: I think that is a really sound approach to be taking.
• 26:39
  SPEAKER_00: I would like to once again thank our speaker, Dr.
• 26:43
  SPEAKER_00: Michael Bell, for sharing your perspective and your experiences from the CDC standpoint on this COVID-19 outbreak.
• 26:50
  SPEAKER_00: Please be sure to tune into a follow-up webinar called Healthcare Facility Outbreak Preparedness, which will be scheduled on Thursday, March 5th from 3 to 4 p.m.
• 26:59
  SPEAKER_00: Eastern Time.
• 27:00
  SPEAKER_00: Are you looking to expand your knowledge in infection prevention?
• 27:03
  SPEAKER_00: Then join us at the 6th International Conference on Healthcare Associated Infections, the Decennial 2020.
• 27:10
  SPEAKER_00: This conference will be held in Atlanta, Georgia from March 26th to March 30th, and is co-hosted by Shea and the CDC.
• 27:17
  SPEAKER_00: Find out more and register at www.decennial2020.org.
• 27:22
  SPEAKER_00: And this concludes this episode of the Rapid Response Podcast.
• 27:26
  SPEAKER_00: Once again, I'd like to thank Dr.
• 27:27
  SPEAKER_00: Michael Bell from the CDC for sharing his very valuable and insightful perspective.
• 27:33
  SPEAKER_00: Thank you, Dr.
• 27:33
  SPEAKER_00: Bell.
• 27:34
  SPEAKER_01: Thank you.
• 27:35
  SPEAKER_00: Bye bye.