Latest / The SHEA Podcast / COVID-19 What's Happening in Long Term Care, 10/15

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COVID-19 What's Happening in Long Term Care, 10/15 · The SHEA Podcast

• 0:10
  SPEAKER_01: Welcome to the Rapid Response Podcast brought to you by Society of Healthcare Epidemiology of America, promoting the prevention of healthcare associated infections and antibiotic resistance, seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:27
  SPEAKER_01: I am Dr.
• 0:28
  SPEAKER_01: Walee Javed.
• 0:29
  SPEAKER_01: I'm the hospital epidemiologist for Mount Sinai Downtown, and I'll serve as your moderator today.
• 0:35
  SPEAKER_01: Discussion on this podcast does not reflect Shay's perspective, but facilitates the communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:48
  SPEAKER_01: Shay is excited to launch this episode of the podcast COVID-19 updates, What We Know Now.
• 0:55
  SPEAKER_01: Today's discussion will focus on long-term care.
• 0:58
  SPEAKER_01: Our speaker today is Dr.
• 1:01
  SPEAKER_01: Mohammed Saloman Ashraf, who is an associate professor in the Division of Infectious Disease, Department of Internal Medicine at the University of Nebraska Medical Center.
• 1:12
  SPEAKER_01: Thank you for joining us today.
• 1:14
  SPEAKER_01: Before we start our discussion, I would like to turn it over to Dr.
• 1:18
  SPEAKER_01: Jennifer Hanrahan to get us started with a brief news and guidance update of this week.
• 1:26
  SPEAKER_00: As of October 14, 2020, there have been 37,888,384 confirmed cases of COVID-19, including 1,081,868 deaths reported to the World Health Organization.
• 1:42
  SPEAKER_00: In the news this week, Johnson Johnson has temporarily halted its COVID-19 vaccine trial while an investigation is carried out into an unexplained illness in a study participant.
• 1:53
  SPEAKER_00: The adverse event is being reviewed by an independent data safety monitoring board as well as the company's internal clinical and safety physicians.
• 2:01
  SPEAKER_00: No further details are available about the illness or the health of the participant.
• 2:05
  SPEAKER_00: Also, Eli Lilly has halted Active 3, an independent NIH-sponsored study in hospitalized patients testing a monoclonal antibody VAMLANIVAMAB in combination with Premdesivir.
• 2:18
  SPEAKER_00: The pause was recommended by the Independent Data Safety Monitoring Board and impacts the Active 3 study only.
• 2:25
  SPEAKER_00: All other monoclonal antibody studies will continue.
• 2:29
  SPEAKER_00: A study of in-hospital cardiac arrest in critically ill patients with COVID-19 was published in British Medical Journal September 30th.
• 2:36
  SPEAKER_00: This study was done in intensive care units at 68 geographically diverse hospitals across the United States and involved critically ill adults aged greater than 18 years with laboratory-confirmed COVID-19.
• 2:49
  SPEAKER_00: The main outcome measures were in-hospital cardiac arrest within 14 days of admission to an intensive care unit and in-hospital.
• 2:56
  SPEAKER_00: Among 5,019 critically ill patients with COVID-19, 14% had in-hospital cardiac arrest.
• 3:04
  SPEAKER_00: Of those, 701 patients, 400 received cardiopulmonary resuscitation.
• 3:09
  SPEAKER_00: Patients who had in-hospital cardiac arrests were older with a mean age of 63, had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of ICU beds compared with those who did not have an in-hospital cardiac arrest.
• 3:23
  SPEAKER_00: 48 of 400 patients who received CPR survived to hospital discharge, and only 28 survived to hospital discharge with normal or mildly impaired neurological status.
• 3:34
  SPEAKER_00: Another study published in JAMA Internal Medicine described 60 of 1,309 patients who developed in-hospital cardiac arrest and underwent CPR.
• 3:43
  SPEAKER_00: Records were available for 54 patients.
• 3:46
  SPEAKER_00: At the time of cardiac arrest, 43 patients were receiving mechanical ventilation, 18 kidney replacement therapy, and 25 vasopressor support.
• 3:55
  SPEAKER_00: None of the 54 survived to discharge.
• 3:58
  SPEAKER_00: The authors of the second study note that these outcomes warrant further investigation into the risks and benefits of performing prolonged CPR in this subset of patients, especially because the resuscitation process generates aerosols that may place healthcare personnel at a high risk of contracting the virus.
• 4:16
  SPEAKER_00: The transmission of SARS-1 to healthcare personnel during CPR has been previously documented.
• 4:21
  SPEAKER_00: Further studies in this area would be beneficial and potentially aid in informing CPR guidelines for this patient population.
• 4:29
  SPEAKER_00: On October 8th, New England Journal of Medicine published an editorial that is critical of the COVID response in the United States and includes statistics about the death rate being greater than other countries, having less access to testing than other countries, and having an inconsistent response from leaders.
• 4:46
  SPEAKER_00: The National Institutes of Health has updated the COVID treatment guidelines as of October 9, 2020.
• 4:52
  SPEAKER_00: There are new sections, including therapeutic management of patients with COVID-19, special considerations in people with human immunodeficiency virus, and there are key updates to the guidelines, including clinical presentation of people with SARS-CoV-2 infection, with a new subsection entitled Persistent Symptoms or Illnesses After Recovery from Acute COVID-19.
• 5:14
  SPEAKER_00: Final notes that more research is needed to better understand the pathophysiology and clinical course of these post-infection sequelae and to identify management strategies for patients.
• 5:24
  SPEAKER_00: There are also new updates to the section on general considerations for critically ill patients with COVID-19, as well as discussion of use of convalescent plasma and mesenchymals.
• 5:34
  SPEAKER_00: A study published in MMWR describes the transmission dynamics by age group in COVID-19 hotspot counties in the United States, April through September 2020.
• 5:44
  SPEAKER_00: The 767 hotspot counties detected during June 1st through July 31st represented 24% of all U.S.
• 5:52
  SPEAKER_00: counties and 63% of the U.S.
• 5:54
  SPEAKER_00: population.
• 5:55
  SPEAKER_00: Percent positivity among persons aged 0 to 17 and 18 to 24 years began increasing 31 days before hotspot identification.
• 6:05
  SPEAKER_00: In hotspot counties, particularly those in the south and west, percent positivity increased earliest in younger persons, followed by several weeks of increasing percent positivity among older age groups.
• 6:16
  SPEAKER_00: The findings corroborate regional patterns in southern United States, where increased percent positivity among adults aged 20 to 39 years preceded increases among those aged greater than 60 years, provide evidence that among young adults, those aged 18 to 24 years demonstrate the earliest increases in percent positivity and underscore the importance of reducing transmission from younger populations to those at highest risk for severe illness or death.
• 6:43
  SPEAKER_00: There's an urgent need to address transmission among young adult populations, especially given recent increases in COVID-19 incidents among young adults.
• 6:53
  SPEAKER_01: Thank you, Dr.
• 6:54
  SPEAKER_01: Hanoghan.
• 6:55
  SPEAKER_01: I now want to move into discussion with Dr.
• 6:57
  SPEAKER_01: Ashraf.
• 6:58
  SPEAKER_01: Do you know how long-term care are double bedding in ICU rooms as part of their search plans?
• 7:06
  SPEAKER_01: If so, what criteria have you used?
• 7:08
  SPEAKER_01: Husband, wife, gender, cohorting by disease?
• 7:12
  SPEAKER_01: What do you look at?
• 7:14
  SPEAKER_02: Thank you, Dr.
• 7:15
  SPEAKER_02: Javed, for inviting me to join the discussion today.
• 7:18
  SPEAKER_02: When nursing homes are setting up COVID care units or COVID-19 units, there are some thought processes that they have to kind of put into place.
• 7:28
  SPEAKER_02: And I think I probably would like to start with the whole cohorting idea is what happens when a facility or nursing home is experiencing an outbreak.
• 7:38
  SPEAKER_02: As soon as you identify a case, you start to look into the cohorting, like how are we going to do that?
• 7:44
  SPEAKER_02: So there are three groups of people usually in the building at that point of time.
• 7:48
  SPEAKER_02: You know, those people who are suspected or confirmed COVID-19 residents, those who are exposed but not suspected yet of COVID-19 cases.
• 8:00
  SPEAKER_02: And then the third group is that those residents where you think that they may not have any exposure at all with the cases that you have identified in the building yet.
• 8:10
  SPEAKER_02: And I think that's where the facilities start to plan.
• 8:13
  SPEAKER_02: We call it in Nebraska red, yellow, and green zones.
• 8:16
  SPEAKER_02: And then usually the red zone patients, the patients who have COVID-19, then start to move into a COVID care unit.
• 8:25
  SPEAKER_02: Now, sometimes those facilities have identified the COVID care units in advance, or sometimes they have to just develop it, they have not planned for it before while the outbreak is happening.
• 8:36
  SPEAKER_02: Now that's not the ideal thing to do, but I think occasionally the facilities are in a situation where they are where there is no available space and they have to then start to make decisions on how to establish COVID care units while the outbreak is happening.
• 8:52
  SPEAKER_02: So looking into all of those things, you know, it becomes difficult sometimes.
• 8:56
  SPEAKER_02: The space and the capacity of the COVID-19 unit can be limited, especially if new cases are being diagnosed as the days are going on.
• 9:05
  SPEAKER_02: As you mentioned, the cohorting into the same room of COVID-19 diagnosed residents is definitely okay.
• 9:13
  SPEAKER_02: They can be in the same room together.
• 9:16
  SPEAKER_02: However, what we have recommended is that in order for them to be together, they should not have any other illness or disease or infections that prevents them from that cohorting.
• 9:28
  SPEAKER_02: So, for example, if one resident has C difficile infection also on top of COVID-19 that is going on, the other one does not, those two people are not going to be cohort together.
• 9:39
  SPEAKER_02: Husband and wife definitely, as you mentioned, can be in the same cohort.
• 9:42
  SPEAKER_02: Gender-wise, you have to do that also, that you know, the same genders.
• 9:46
  SPEAKER_02: But as long as they do not have a definite colonization with an infection that you want to prevent, like a CPC RE colonized person or an active C diffusel infection case, you don't want to keep them together in the same room.
• 9:59
  SPEAKER_02: Otherwise, if they just have COVID-19 and no other issues that would prevent them from being in the room together, then that will be perfectly fine in order to make the space.
• 10:10
  SPEAKER_01: Thank you very much, Dr.
• 10:11
  SPEAKER_01: Ashwav.
• 10:11
  SPEAKER_01: That was very comprehensive and very detailed answer.
• 10:14
  SPEAKER_01: I think it's an important aspect to kind of even plan ahead.
• 10:18
  SPEAKER_01: The long-term care facilities and/or facilities that receive or accommodate a lot of long-term care patients should probably have it planned ahead of time rather than when they are in the middle of crisis to know exactly what they are going to do or how they are going to cohort their patients.
• 10:37
  SPEAKER_01: Now, another big challenge we'll see very soon is the flu season.
• 10:41
  SPEAKER_01: Can you advise about testing during flu season?
• 10:44
  SPEAKER_01: Like, for example, do you recommend testing for both COVID and flu when respirator symptoms are present?
• 10:52
  SPEAKER_01: And what are the recommendations for isolation or cohorting during flu season in long-term care settings?
• 10:58
  SPEAKER_02: Yeah, so beside the loss of smell and taste that we see with sometimes with COVID-19 infection, really, if you are basing a diagnosis based on symptoms, it will be very hard to distinguish between the two viral illnesses.
• 11:13
  SPEAKER_02: So I do believe that testing will be required to make that diagnosis, and probably for both at this point.
• 11:20
  SPEAKER_02: Screening will be important.
• 11:23
  SPEAKER_02: The facilities have to continue doing the screening of their staff who's coming to work every day and their residents who are in the building.
• 11:30
  SPEAKER_02: Vital sign monitoring, symptoms check.
• 11:33
  SPEAKER_02: They will have to continue doing that.
• 11:35
  SPEAKER_02: And they will have to continue to practice universal masking, eye protection, stick with the principles of hand hygiene and other infection prevention policies and protocols.
• 11:46
  SPEAKER_02: The good thing is that the measures we take for isolation, cohorting for COVID-19 also are effective in limiting the transmission of influenza, also.
• 11:58
  SPEAKER_02: So basically, you know, when we are taking all these precautions, we are basically taking precautions for both influenza and COVID-19 together.
• 12:07
  SPEAKER_02: I know the facilities are pretty much experienced in managing influenza outbreaks, but even when influenza outbreak is going on in the facility, if it happens, they cannot let their guard down on COVID-19, even at that time.
• 12:22
  SPEAKER_02: So the short answer is yes, we definitely will need to test for both.
• 12:26
  SPEAKER_02: It will both be in our differential when we have those uh patients, and we will have to start our isolation and cohorting practices that we have established for COVID-19 in the meantime while we are diagnosing.
• 12:39
  SPEAKER_01: Yeah, it's again uh we know that influenza outbreaks have gone through nursing homes pretty extensively in the past, and I think is having COVID along with influenza kind of puts another layer of complexity in management of these patients and cohorting andor even managing how the exposures will be managed.
• 13:02
  SPEAKER_01: Another question, and it's a very difficult question to ask, is about reinfections in nursing home residents.
• 13:09
  SPEAKER_01: Now, how to proceed, knowing that there is very little evidence throughout the world at this time about reinfection.
• 13:15
  SPEAKER_01: I think there are a few, maybe one or two cases that have been reported as reinfections in reputable journals at this time.
• 13:23
  SPEAKER_01: So, what are your thoughts, Dr.
• 13:25
  SPEAKER_01: Asher?
• 13:26
  SPEAKER_02: Yeah, so the reinfection, it can happen.
• 13:28
  SPEAKER_02: Now, I have to say that I have not come across a reinfection case, at least in Nebraska, in the nursing homes right now, although we have some cases that we investigated, at least for the possibility of it, but we cannot confirm that there was a confirmed reinfection.
• 13:43
  SPEAKER_02: Now, at this point, based on all the data we have, the CDC have recommended that anyone who has tested positive for COVID-19 shouldn't get tested for the next three months time frame, because the reinfection in that three month time frame is less likely to happen.
• 14:00
  SPEAKER_02: Although I can say that it's not completely sure that that will never happen.
• 14:05
  SPEAKER_02: If someone develops symptoms that are consistent with COVID-19 and there's no other explanation for those symptoms, then that person should definitely get testing for COVID-19, even though they are within that three months timeframe.
• 14:18
  SPEAKER_02: Now, after the three months time frame has passed by, the facilities are required to retest.
• 14:25
  SPEAKER_02: And they do find, we see the report, you know, very often, they do find cases in their employees or in their residents, those who have already had positive cases three months ago now coming back testing positive.
• 14:40
  SPEAKER_02: So, what do they do at that point of time?
• 14:42
  SPEAKER_02: And that's a good question.
• 14:44
  SPEAKER_02: Many states right now are opening up a task force or teams that are looking into those reinfection cases.
• 14:52
  SPEAKER_02: So, first of all, know your resources.
• 14:54
  SPEAKER_02: If your state has something like that, I have a task force that are looking into reinfection, know about it.
• 15:00
  SPEAKER_02: So you can alert them, you can notify them.
• 15:02
  SPEAKER_02: So that's the number one process.
• 15:04
  SPEAKER_02: So if somebody is positive now, were positive before, notify them.
• 15:09
  SPEAKER_02: What will they do?
• 15:10
  SPEAKER_02: I think what usually they will do is look into a few things.
• 15:13
  SPEAKER_02: They first of all will look into the clinical presentation right now, they will look into the history or long ago was the test was the previous test result.
• 15:22
  SPEAKER_02: And then they will also try to figure out whether the sample from the previous test result is still available or not in the lab.
• 15:29
  SPEAKER_02: And they may want to kind of compare the two samples and do genomic sequencing to see whether the virus actually appears to be the same as before.
• 15:39
  SPEAKER_02: The other thing they might be looking into is what we call cycle threshold value or CT values, and they may look into those CT values and see whether those values are higher.
• 15:50
  SPEAKER_02: If the CT values are higher, they may, and it's not 100%, but they may indicate that maybe this is an older infection.
• 15:58
  SPEAKER_02: Now it can also be a very start of an infection.
• 16:02
  SPEAKER_02: So sometimes they may even want to do a follow-up PCR test and try to kind of see what the results from the follow-up PCR test come out.
• 16:11
  SPEAKER_02: So after doing all of those things, all of those investigations, they may be able to establish, based on all the information, whether this is a reinfection case or not.
• 16:21
  SPEAKER_02: Now, in the meantime, while this investigation is going on, usually our recommendations to the facilities is that they consider this person as a positive and do everything that they will do for any other positive person.
• 16:36
  SPEAKER_02: Now, if the investigation in the next two, three, four days, whatever comes out and this and the and the body that is investigating tells them that, okay, we are feeling comfortable that this is not a reinfection case, then at that point of time they can lift those restrictions that they have implemented after finding out the positive case.
• 16:54
  SPEAKER_02: So I hope I kind of answered the process of what the facilities need to kind of follow at that point.
• 17:00
  SPEAKER_01: I think you did answer the question, but also touch upon a very, very important point is the persistent positive test results.
• 17:07
  SPEAKER_01: I think that we continue to see sometimes weeks or months after.
• 17:12
  SPEAKER_01: I think some states had put rules in place that before discharging to nursing homes, you have to test negative for COVID-19.
• 17:19
  SPEAKER_01: And that was initially a part of the outbreak that was requested requirement.
• 17:24
  SPEAKER_01: And what we saw as a result was a lot of people kept on testing positive.
• 17:29
  SPEAKER_01: I had one patient and the first 90 days was tested about 10 to 15 times.
• 17:34
  SPEAKER_01: I'm not remembering exactly, but was positive 10 to 15 times.
• 17:39
  SPEAKER_01: And that's how challenging the situation can be.
• 17:44
  SPEAKER_01: Looking at persistent positive is another thing to consider.
• 17:47
  SPEAKER_01: Looking at cycle threshold, looking at infectivity.
• 17:51
  SPEAKER_01: But probably the most important thing, I think Dr.
• 17:54
  SPEAKER_01: Shabu also would agree, and think you mentioned as well, is the symptoms.
• 17:59
  SPEAKER_01: The people have not had any symptoms, the test has been positive for more than 10 days.
• 18:05
  SPEAKER_01: Even CDC recommends that you don't have to continue to isolate.
• 18:09
  SPEAKER_01: So a lot of things have to be placed in the equation of uh how the thoughts of reinfection or precise infection kind of comes into the big scheme of uh the complexity of long-term care of uh COVID-19 patients.
• 18:24
  SPEAKER_02: Yeah, I think I probably want to kind of even emphasize that test-based strategy is not recommended now for the continuation of the isolation.
• 18:33
  SPEAKER_02: For the most part, many of the folks who are getting COVID-19 infection can come out of the isolation after 10 days of illness or after 10 days of the symptom onset, or if they were asymptomatic 10 days after the test was obtained, test uh was positive.
• 18:49
  SPEAKER_02: So, so that basically for the most part, you know, there there are certain situations where you can prolong that isolation, especially if they were critically ill or if they have severely immunocompromised status.
• 19:02
  SPEAKER_02: In those situations, you may prolong that.
• 19:04
  SPEAKER_02: But even with prolonging, it doesn't go beyond 20 days.
• 19:08
  SPEAKER_02: So those days where we were you know keeping residents of the nursing home in the hospital for a month, six weeks, that shouldn't be happening now.
• 19:17
  SPEAKER_02: In my own observation, at least not happening in our state.
• 19:21
  SPEAKER_01: We'll switch gears a little bit and talk about outbreaks in long-term care.
• 19:26
  SPEAKER_01: Are there different patterns have you seen in long-term care setting and assisted living facilities in terms of outbreaks?
• 19:35
  SPEAKER_02: Yeah, so in terms of the outbreak, what I can say is that the timing of the outbreak detection can be a major driver of whether you are going to see a very localized outbreak in a nursing home versus a widespread outbreak in the nursing home.
• 19:52
  SPEAKER_02: If we identify the very first case or very first few cases early in the outbreak, then there is a better chance to keep that outbreak contained in the nursing home.
• 20:04
  SPEAKER_02: Now, if we have identified an outbreak where on the very first round of testing, while we are trying to figure out who is infected and who is not, several residents are being diagnosed now from several different units, and it has looked like already spread out in that nursing home, containment of that outbreak is really challenging after that.
• 20:28
  SPEAKER_02: It can also become more challenging if you do not have testing capacity where you can get a faster turnaround time on the testing results.
• 20:38
  SPEAKER_02: Because what ends up happening is that if you are having a widespread outbreak and you have staff working in your building that probably is exposed or even becoming asymptomatically positive, and you're not able to be going to identify them really quickly, especially those that have become infected, they will continue to work until the test results come back.
• 20:59
  SPEAKER_02: What we have seen is that for those facilities who are going to wait seven days on their PCR results to come back, it really becomes very difficult to contain the outbreak because that stuff that was tested seven days ago continue to work for next seven days in the building.
• 21:14
  SPEAKER_02: And then we find out that a week ago the test that was done was positive.
• 21:18
  SPEAKER_02: That has probably caused much more spread in that building in that in that seven days.
• 21:23
  SPEAKER_02: So testing does impact what we will see in terms of containment or widespread transmission in the nursing homes.
• 21:30
  SPEAKER_02: So the last point was that you know I think the rapid testing, rapid antigen testing.
• 21:36
  SPEAKER_02: Now there is questions on the sensitivity of the antigen testing, but usually with the antigen testing, if you're doing it repeatedly, you can overcome the challenge, the sensitivity problem at least to some degree.
• 21:49
  SPEAKER_02: And at least it's not taking seven days for you to find out who is positive.
• 21:54
  SPEAKER_02: For most people, you will identify when you identify a positive person, you will be rapidly able to take them out.
• 22:00
  SPEAKER_02: Of work and in terms of resident, you would be rapidly able to send them to a COVID unit, it would be much easier for you to contain the outbreak in that facility.
• 22:10
  SPEAKER_02: So I think I have seen benefits of rapid antigen testing in those places where VCR turnaround time was not fast enough.
• 22:19
  SPEAKER_01: I think we have also seen in facilities about rapid testing, our turnaround time is actually pretty fast, probably compared to a lot of other places in the country.
• 22:30
  SPEAKER_01: Even what we see with that is the point you have raised.
• 22:33
  SPEAKER_01: If somebody gets tested, do they need to be out of work?
• 22:37
  SPEAKER_01: That's one thing.
• 22:39
  SPEAKER_01: If somebody gets tested because they're symptomatic, do they need to be out of work?
• 22:43
  SPEAKER_01: The answer to that question was easier than just somebody getting tested because of exposure and whatnot.
• 22:48
  SPEAKER_01: And what do you do with exposures?
• 22:50
  SPEAKER_01: People who are staff members or others who have been exposed, what are our processes and performances?
• 22:56
  SPEAKER_01: What to do with those individuals?
• 22:58
  SPEAKER_01: What do we do now?
• 22:59
  SPEAKER_01: What we do when we are in outbreak setting.
• 23:02
  SPEAKER_01: I think planning for prevention of outbreaks is exceedingly important.
• 23:07
  SPEAKER_01: And even planning for when we have an outbreak in a situation like this is going to be very, very important.
• 23:13
  SPEAKER_01: I think planning ahead, seeing okay, exactly how will we be able to manage human resources during this time is all going to be extremely important.
• 23:22
  SPEAKER_01: I think another aspect about human resource really comes in the CMS testing and reporting requirements.
• 23:30
  SPEAKER_01: What are your thoughts on the long-term care facilities keeping up with the CMS testing and reporting requirements at this time?
• 23:37
  SPEAKER_02: So I think what facilities need to do, and what facilities have done that I know of that have been successfully implemented their testing programs, is they train some of their staff members into those rapid and testing the processes.
• 23:53
  SPEAKER_02: So they train their staff, they dedicated a group of staff that are going to be doing those testing, and they put groups together.
• 24:01
  SPEAKER_02: So it actually looks like you're putting more resources into that, but you you actually, what you're doing by not having one staff do the entire process, you're actually having one person do the swabbing, the other person running the machine.
• 24:14
  SPEAKER_02: What you are achieving with that is a higher efficiency in the process.
• 24:20
  SPEAKER_02: There are facilities when they have to do the timers, they have about multiple timers.
• 24:24
  SPEAKER_02: One person is going to do the swabbing, the other person is running the test in the machine and have multiple timers on it.
• 24:30
  SPEAKER_02: That is keeping tab of multiple different tests that have been obtained.
• 24:34
  SPEAKER_02: Doing that, keeping the same team and keeping the team trained in doing that.
• 24:40
  SPEAKER_02: And repeatedly, once they have done that process, they start to get proficient on that process.
• 24:45
  SPEAKER_02: So it makes it makes the testing process efficient.
• 24:49
  SPEAKER_02: It takes less time than otherwise it would have taken.
• 24:53
  SPEAKER_02: And that's what I will recommend facilities to do is to have a staff that is trained in that process, and then that staff is involved in doing the repeated testing so that they are they are just proficient in that and they are efficient in that and they can do it faster rather than having a new person every time do the testing without much training.
• 25:14
  SPEAKER_02: So that basically the recommendation.
• 25:16
  SPEAKER_02: And that's how I've seen the facilities that have successfully implemented those testing strategies.
• 25:22
  SPEAKER_01: Thank you, Dr.
• 25:23
  SPEAKER_01: Asher.
• 25:23
  SPEAKER_01: That's really, really important to understand.
• 25:26
  SPEAKER_01: Another aspect we have been asked about is the role of the medical director and then also infection prevention in long-term care settings.
• 25:35
  SPEAKER_01: Any thoughts that you can share with us on these?
• 25:38
  SPEAKER_02: I think medical director plays a very critical role here.
• 25:42
  SPEAKER_02: Anytime you are discussing infection prevention policies and protocols in setting up infection prevention policies and protocols, I think medical director input is important.
• 25:51
  SPEAKER_02: They should be involved in the process of setting up those policies and procedures.
• 25:55
  SPEAKER_02: If you're making a COVID-19 outbreak plan, they should be involved in that.
• 25:59
  SPEAKER_02: Your prevention plan, they should be involved in that.
• 26:01
  SPEAKER_02: And then what they also have to be involved in in management plans, if the facility is having an outbreak, then they will start having to make decisions on what care we need to provide for those people who are mildly symptomatic or asymptomatic, and what care we will need to provide to those people that need to be transferred to the acute care setting.
• 26:20
  SPEAKER_02: And how will we determine who goes out versus who stays in the building?
• 26:24
  SPEAKER_02: So I think those are the type of decisions where the medical directors have to be involved and have to be available to answer those questions.
• 26:32
  SPEAKER_02: They also carry the responsibility of employee health director in a way, because anytime a staff will come in and complain that I don't think I have any symptoms, but I do have allergy.
• 26:44
  SPEAKER_02: And many of the time we have seen those allergies are actually COVID-19 symptoms that people thought was allergy when they got tested.
• 26:52
  SPEAKER_02: So those kind of situations come along that an IP might not be able to resolve on their own.
• 26:57
  SPEAKER_02: And the medical director may need to weigh in on those decisions and have to be available for that.
• 27:03
  SPEAKER_02: In terms of what resources are available to the medical directors, there are many different avenues where they can go and find some resources.
• 27:15
  SPEAKER_02: We just talked about that, the reinfection issue.
• 27:18
  SPEAKER_02: When the cases of like coming in where their people are suspecting a reinfection or differentiating between flu and COVID, those are the type of decisions where the medical directors also have to be involved.
• 27:28
  SPEAKER_02: And, you know, the share have various resources that medical directors can tune in and find those relevant educational sessions and tools that they can use.
• 27:38
  SPEAKER_02: There are other societies out there, professional societies for long-term care that have their own tools and template that they can use.
• 28:05
  SPEAKER_02: So all of those guidance are there for them to utilize.
• 28:08
  SPEAKER_02: So I will encourage them to take note of those things and review those resources and see what fits best for them.
• 28:16
  SPEAKER_01: Thank you, Dr.
• 28:17
  SPEAKER_01: Aishovitz.
• 28:18
  SPEAKER_01: It was really great listening to your great advice.
• 28:21
  SPEAKER_01: And as you have mentioned already, that they has a lot of resources in place, including podcasts like this.
• 28:27
  SPEAKER_01: There are many other podcasts related to COVID and what people can do in different circumstances.
• 28:34
  SPEAKER_01: So I we I would encourage everybody to listen to the podcast and other opportunities that are available.
• 28:39
  SPEAKER_01: And thank you very much to our speaker for sharing your 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.
• 28:52
  SPEAKER_01: This podcast can be accessed on Shay's online education center, learning CE, under the Rapid Response Program.
• 29:01
  SPEAKER_01: You will also find resources such as recorded webinars, health facility, outbreak preparedness, and SHA COVID-19 town halls there.
• 29:12
  SPEAKER_01: You can now receive 75% off SHA membership for the remainder of 2020 using the coupon podcast during the checkout.
• 29:21
  SPEAKER_01: This concludes this episode of Rapid Response Podcast.
• 29:26
  SPEAKER_01: Thank you for tuning in.