Latest / The SHEA Podcast / COVID-19 International Perspectives: Europe, 9/24

Transcript

COVID-19 International Perspectives: Europe, 9/24 · The SHEA Podcast

• 0:07
  SPEAKER_00: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America today, promoting the prevention of healthcare-associated infections and antibiotic resistance, and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:23
  SPEAKER_00: I am Dr.
• 0:23
  SPEAKER_00: Jennifer Hanarhan, infectious disease specialist at the University of Toledo, and I will serve as your moderator.
• 0:29
  SPEAKER_00: Discussion on the podcast does not reflect today's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:39
  SPEAKER_00: Today is excited to launch this episode of the podcast, COVID-19 update, What We Know Now.
• 0:45
  SPEAKER_00: Today's discussion will focus on international perspectives from Europe.
• 0:49
  SPEAKER_00: Our speaker today is Dr.
• 0:51
  SPEAKER_00: Stefan Harbaugh, Infection Control Program at Geneva University Hospitals, Geneva and World Health Organization Collaborating Center.
• 1:00
  SPEAKER_00: Thank you for joining us today.
• 1:02
  SPEAKER_00: I would like to get us started with a brief news and guidance update of the week.
• 1:07
  SPEAKER_00: As of September 23, 2020, there have been 31,375,325 confirmed cases of COVID-19 and 966,399 deaths in the world.
• 1:21
  SPEAKER_00: In the news this week, a draft version of proposed changes about how SARS-CoV-2 spread was posted in error on the CDC official website.
• 1:31
  SPEAKER_00: CDC is currently updating its recommendations regarding airborne transmission of SARS-CoV-2.
• 1:36
  SPEAKER_00: Current information states that the virus is thought to spread mainly from person to person via droplets.
• 1:43
  SPEAKER_00: A review article published in Anals of International Medicine September 17th describes the viral, host and environmental factors for transmission of SARS-CoV-2.
• 1:52
  SPEAKER_00: The authors state that rust for transmission is the dominant mode of transmission.
• 1:56
  SPEAKER_00: Vertical transmission occurs rarely.
• 2:01
  SPEAKER_00: Cats and ferrets can be infected and transmit to each other, but there are no reported cases to date of transmission to humans.
• 2:07
  SPEAKER_00: On the other hand, minks transmit to each other and to humans.
• 2:12
  SPEAKER_00: Direct contact and fomitransmission are presumed, but are likely only an unusual mode of transmission.
• 2:17
  SPEAKER_00: And although live virus has been isolated from alive entities, and viral RNA has been isolated from semen and blood donations, there are no reported cases of SARS-CoV-2 transmission via fecal oral, sexual, or blood-borne route.
• 2:30
  SPEAKER_00: To date, there is one cluster of possible fecal respiratory transmission.
• 2:34
  SPEAKER_00: An article published in JAMA on the in vitro efficacy of a poladone iodine nasal antiseptic for rapid ineffectivation of SARS-CoV-2 evaluated efficacy of a poladone iodine nasal antiseptic for the inactivation of SARS-CoV-2 at contact times of 15 and 30 seconds.
• 2:52
  SPEAKER_00: SARS-CoV-2's virus stock was tested against nasal antiseptic solutions, consisting of aqueous povidone iodine as a total active ingredient with three different concentrations of study solution and ethanol 70% as a positive control on test media infected with SARS-CoV-2.
• 3:10
  SPEAKER_00: Povidone iodine nasal antiseptics at three concentrations completely inactivated SARS-CoV-2 within 15 seconds of contact.
• 3:18
  SPEAKER_00: The ethanol 70% positive control did not completely inactivate SARS-CoV-2 after 15 seconds of contact.
• 3:24
  SPEAKER_00: The nasal antiseptic tested performed better than the standard positive control routinely used for in vitro assessment of anti-SARS-CoV-2 agents at a contact time of 15 seconds.
• 3:35
  SPEAKER_00: No cytoptic effects on cells were observed after contact with each of the nasal antiseptics tested.
• 3:42
  SPEAKER_00: Authors concluded the POVON iodine nasal antiseptic solutions at concentrations as low as 0.5% rapidly inactivated SARS-CoV-2 at contact times as short as 15 seconds.
• 3:54
  SPEAKER_00: Internatal use of povidon iodine has demonstrated safety at concentrations of 1.25% and below, and may play an adjective role in mitigating viral transmission beyond personal protective equipment.
• 4:06
  SPEAKER_00: While the coronavirus pandemic is ongoing, another study in JAMA reminds us that we still have an opioid epidemic in the United States.
• 4:13
  SPEAKER_00: Patients with opioid overdoses from March 1st to June 30th, 2019, and from March 1st to June 30th, 2020 were identified from electronic medical records from the Virginia Commonwealth University.
• 4:25
  SPEAKER_00: The total number of nonfatal opioid overdose visits increased from 102 between March and June 2019 to 227 during the same time period in 2020.
• 4:35
  SPEAKER_00: In contrast, compared with 2019, the total number of acute myocardial infarction diagnoses decreased from 41 to 31, and the number of emergency department visits decreased from 36,565 to 26,061 in March through June 2020.
• 4:51
  SPEAKER_00: In this emergency department in Virginia, a greater number of visits for opioid overdoses was observed in the first four months of the COVID-19 pandemic.
• 4:58
  SPEAKER_00: And Black patients made up a relatively larger proportion of opioid overdose visits compared with the previous years.
• 5:04
  SPEAKER_00: The authors note that the findings are from one emergency department and may not be generalizable, and that the number of opioid overdoses was underestimated because official reporting of fatal opioid overdoses is delayed, and because patients who did not present to the emergency department were not included.
• 5:18
  SPEAKER_00: The findings demonstrate additional evidence of racial, ethnic disparities in health that have been magnified during the COVID-19 pandemic and the recent historical protests.
• 5:27
  SPEAKER_00: And that's the news for this week.
• 5:29
  SPEAKER_00: Now we will turn to our moderated discussion.
• 5:33
  SPEAKER_00: Dr.
• 5:33
  SPEAKER_00: Harbat, thank you so much for joining us today.
• 5:36
  SPEAKER_01: Thank you.
• 5:37
  SPEAKER_00: What is the current state of COVID-19 in your country?
• 5:41
  SPEAKER_01: So I'm I'm located in Geneva in Switzerland.
• 5:44
  SPEAKER_01: Switzerland is a small country with about 8.5 million inhabitants.
• 5:48
  SPEAKER_01: At the moment, we are facing the second wave, the start of the second wave, but it's really not in all parts of the country.
• 5:56
  SPEAKER_01: So it's mostly in the French-speaking parts of the country that we see a recordescence with a lot of cases.
• 6:03
  SPEAKER_01: Fortunately enough, like in other Western European countries, we see very small amount of hospitalizations and attributable deaths.
• 6:12
  SPEAKER_01: So that's the good news.
• 6:14
  SPEAKER_01: But at the same time, we realize that now we we have ongoing endemic COVID transmission again after a period of silence more or less in June, July, where we had very few cases.
• 6:27
  SPEAKER_00: So I'm really interested to hear that you're having a second wave.
• 6:30
  SPEAKER_00: I mean, that implies that for a period of time you were seeing very little transmission or very few cases.
• 6:35
  SPEAKER_00: Is that correct?
• 6:37
  SPEAKER_01: Absolutely.
• 6:37
  SPEAKER_01: Yeah, we had a pretty successful lockdown until May, and then we had a period of grace where we had very few hospitalizations.
• 6:48
  SPEAKER_01: We even decreased the level of alert.
• 6:51
  SPEAKER_01: We we stopped certain screening procedures in the hospital setting, etc.
• 6:55
  SPEAKER_01: etc.
• 6:56
  SPEAKER_01: But now we start to see again also small clusters in nursing homes.
• 7:00
  SPEAKER_01: We see small clusters of nosocomal transmission.
• 7:03
  SPEAKER_01: In the July-August period, interestingly, it was really related to the younger parts of the population that got sick.
• 7:11
  SPEAKER_01: Now we start to see also some spillover into the elderly population, which is still at the moment not in any way a particular burden to the overall healthcare system.
• 7:22
  SPEAKER_01: But of course, we are very uh frightened because this reminds us of the scenario we observed in January, February earlier this year, where we saw the same kind of events going on in other parts of Europe, and then suddenly there was this spillover with a sudden increase in cases.
• 7:40
  SPEAKER_01: But of course, we are much better prepared now than we were in February, March.
• 7:45
  SPEAKER_00: So, how early in the pandemic did your country go into lockdown?
• 7:49
  SPEAKER_00: And how was it implemented?
• 7:51
  SPEAKER_01: We went into a relatively mild lockdown by mid-March.
• 7:56
  SPEAKER_01: So for certain parts of Switzerland, especially this Italian-speaking part, that's the so-called Ticino, which is in contact with the North Italy, the lockdown started too late.
• 8:07
  SPEAKER_01: The western parts of Switzerland, which is mainly the French-speaking regions of Switzerland, we were just on time.
• 8:15
  SPEAKER_01: But luckily, the German-speaking parts of Switzerland, so that's more the north and the east of Switzerland, they benefited of the lockdown because they went really into an early lockdown because they saw the damage and the burden in other parts of Switzerland, and that's where I think they were able to protect a lot of vulnerable people.
• 8:34
  SPEAKER_01: Overall, we had a relatively mild lockdown, so that means that there was not a curfew like in some other parts of the world.
• 8:43
  SPEAKER_01: We didn't have to justify any kind of movement outside of the home, like in France, where people had to always justify whether they had a reason to leave their homes.
• 8:55
  SPEAKER_01: But still, we of course we closed down any kind of sport activities, all the public places, uh the theaters, etc., they were all closed, like in in most parts of the world.
• 9:07
  SPEAKER_01: So overall, it was a relatively mild lockdown, but it still had quite a substantial effect, of course, on the economics of the country.
• 9:16
  SPEAKER_00: And you know, you mentioned nursing homes.
• 9:19
  SPEAKER_00: You know, one of the things we've had a lot of issues with overall is uh personal protective equipment.
• 9:25
  SPEAKER_00: What is the state of your personal protective equipment supplies?
• 9:29
  SPEAKER_00: Was that an issue in your country?
• 9:31
  SPEAKER_01: During the first wave, of course, now there's no major issue.
• 9:35
  SPEAKER_01: It's mostly about the reagents for the testing.
• 9:39
  SPEAKER_01: Like in other countries, we we have now again beginning shortages and supply chains that are quite tense related to testing, the molecular testing.
• 9:52
  SPEAKER_01: So far, there is no anti-gen test that has been approved by the Swiss regulatory authorities.
• 9:58
  SPEAKER_01: So we still rely only on PCR-based uh molecular testing.
• 10:04
  SPEAKER_01: And here, what's really grotesque, one of the major producers is Roche, and they're not even able to provide enough material for their own country.
• 10:12
  SPEAKER_01: So we we don't have the same kind of uh instinct like in the US, where as you know, that certain materials were now embargoed for national purposes in the United States.
• 10:24
  SPEAKER_01: So far, Roche didn't say, okay, Switzerland first for their supply of reagents for the testing.
• 10:30
  SPEAKER_01: But overall, as you know, Switzerland is a very rich country and we can always afford to buy material even if it's getting very expensive on the world market.
• 10:40
  SPEAKER_01: But it was a different picture during this first wave, where of course, in certain hospitals, certain regions, we had shortages that became sometimes quite difficult to handle, but we never had a situation where we were completely in catastrophic conditions to work.
• 10:58
  SPEAKER_00: So, you know, one of the issues that we have really been struggling a lot with is getting people to wear masks.
• 11:04
  SPEAKER_00: In the United States, as you may know, it's been made into a political issue.
• 11:09
  SPEAKER_00: And, you know, there are people that are very much opposed to wearing masks, and some of our politicians were very late to endorse the idea of wearing masks.
• 11:19
  SPEAKER_00: Has that been an issue in Switzerland and are people in general masking in public?
• 11:25
  SPEAKER_01: Yeah, so we have the same kind of controversy in March, April, where it took quite some time to introduce universal masking policy in public, and especially in the public transport.
• 11:36
  SPEAKER_01: Then over the summer, it was uh interesting because Switzerland is a very federalistic country.
• 11:43
  SPEAKER_01: So that means that some regions abandoned the universal masking in public transport, and now we are getting back to that.
• 11:51
  SPEAKER_01: So, in the entire national public transport system in Switzerland, there is a mandatory masking policy.
• 11:57
  SPEAKER_01: However, there is also quite some controversy, some protest movement.
• 12:03
  SPEAKER_01: In certain areas of Switzerland, you know, people are a little bit like in New Hampshire, you know, live free or die.
• 12:09
  SPEAKER_01: By the way, they exported some of that spirit to the United States when uh Swiss people immigrated to.
• 12:15
  SPEAKER_01: So we have also some really violent protest movement against some of the masking policies, and this is causing some trouble, also, for instance, um, for the schools, for the universities.
• 12:28
  SPEAKER_01: But in general, in the healthcare system, there is no doubt people really are adherent to this policy.
• 12:35
  SPEAKER_00: So that's interesting.
• 12:37
  SPEAKER_00: I'm wondering, you know, you said that people were better about wearing the masks early on, and then you had this period where you weren't really having that many cases.
• 12:45
  SPEAKER_00: I'm wondering if this people now protesting and not wanting to wear masks is contributing to a resurgence.
• 12:52
  SPEAKER_01: Could be.
• 12:53
  SPEAKER_01: It may not be a major factor because at least, you know, when when you just look at the adherence in public transport or so, it's pretty good.
• 13:02
  SPEAKER_01: And we still don't have, for instance, a general masking policy in the streets, like in certain areas in neighboring France where you cannot even go shopping in the streets outdoor without wearing a mask.
• 13:14
  SPEAKER_01: So this is not the case in Switzerland.
• 13:16
  SPEAKER_01: So therefore, I think that it's reasonable, but of course, you can see that when you go into restaurants or so, that there is a very mixed picture of compliance with these kind of recommendations.
• 13:28
  SPEAKER_00: What about healthcare workers?
• 13:29
  SPEAKER_00: How have you dealt with healthcare worker concerns about their own vulnerability?
• 13:36
  SPEAKER_01: Yeah, that's a good question.
• 13:37
  SPEAKER_01: We of course had to fight a lot of myths and beliefs and misconceptions like everywhere around the world.
• 13:45
  SPEAKER_01: It has been not an easy exercise, especially uh here in the western part of Switzerland because we have a very international healthcare worker staff.
• 13:54
  SPEAKER_01: So there we have lots of people coming from neighboring countries.
• 13:58
  SPEAKER_01: It's a very mixed population.
• 14:00
  SPEAKER_01: Some of those colleagues brought in their anxiety levels because they were in permanent contact with Italian colleagues or French colleagues.
• 14:07
  SPEAKER_01: So Geneva, we had definitely major challenges to handle this kind of concerns by healthcare workers.
• 14:15
  SPEAKER_01: It was partially, even I would call it a little bit of a psychological warfare.
• 14:20
  SPEAKER_01: So definitely, at least in the western part of Switzerland, we had a lot of challenges.
• 14:25
  SPEAKER_01: In the eastern part of Switzerland, people are more disciplined and they followed pretty well the general uh infection control recommendations.
• 14:34
  SPEAKER_01: But of course, you always had the same kind of fear factor as saying, oh, we are not enough protected, please give us more material, etc.
• 14:42
  SPEAKER_01: etc.
• 14:43
  SPEAKER_01: But overall, for instance, we we did a zero prevalence study here at my own university hospital, and we saw more or less that our zero conversion rate among healthcare workers was comparable to the general population in Geneva.
• 14:58
  SPEAKER_01: So it's not that they were completely overexposed and that they were not protected.
• 15:03
  SPEAKER_01: But when you look into more the granularities, you can see, of course, there were sectors, departments in my hospital and elsewhere where people working in giretrics or long-term care facilities, they were at higher risk of acquiring COVID during their uh work time.
• 15:20
  SPEAKER_01: Last but not least, we are now trying to convince healthcare workers that it's not that they are at risk of acquiring COVID at the hospital.
• 15:29
  SPEAKER_01: We see that more and more that they are the vectors, they are the guys who import uh COVID into the hospital.
• 15:35
  SPEAKER_01: So it's the other way around.
• 15:37
  SPEAKER_01: And we try to change this kind of picture, you know, that they realize that by going to a party on Friday evening, you may have some positive nurses and patients five days later in an orthopedic ward.
• 15:49
  SPEAKER_01: To finalize this very tricky question, so far, at least to the best of my knowledge, at least in Western uh Switzerland, we have not one single fatality among active healthcare workers working in acute care hospitals.
• 16:04
  SPEAKER_01: There are retired physicians who died.
• 16:07
  SPEAKER_01: We had some very severe cases of GPs who acquired uh COVID in their private practices, but so far in the hospital setting, no fatality was reported among healthcare workers.
• 16:19
  SPEAKER_00: Yeah, I think you know it's interesting.
• 16:22
  SPEAKER_00: We had a lot of healthcare worker concerns early on, but we really have not seen the same case fatality rate among healthcare workers that we're seeing in the general population.
• 16:33
  SPEAKER_00: So, you know, I I think it's been interesting to watch.
• 16:35
  SPEAKER_00: Certainly, this has not behaved like SARS-1 did, where it was really amplified in healthcare setting and ended up, you know, a lot of people getting sick.
• 16:44
  SPEAKER_00: What has the most challenging part been from the infection prevention standpoint in terms of responding to COVID-19 for you?
• 16:52
  SPEAKER_01: Uh there were, of course, multiple challenges, and maybe I just provide you my very subjective answer to that.
• 16:58
  SPEAKER_01: I think that first we had to handle this kind of very vague evidence base first, you know, because of course we had a lot of literature on flu or SARS-1.
• 17:10
  SPEAKER_01: But here we had this kind of very rapidly evolving picture of the evidence base.
• 17:15
  SPEAKER_01: Second challenge was certainly, like I mentioned before, there were so many myths and beliefs and fake news circulating in the healthcare setting, outside the healthcare setting, that certainly was also a major challenge.
• 17:29
  SPEAKER_01: Third point was in Switzerland we are exposed to a lot of conflicting guidelines.
• 17:34
  SPEAKER_01: We are a small country, and of course, we are surrounded by larger countries that they all had their own guidelines.
• 17:41
  SPEAKER_01: And even we had some controversy with WHO.
• 17:45
  SPEAKER_01: WHO headquarters is about uh eight kilometers away from my hospital, and sometimes they had still recommendations that were completely unrealistic, and where we said we told the colleagues, hey, come over to the hospital, see real life, and see that some of your recommendations are outdated or whatever, especially about these two negative PCR tests to end the isolation of patients.
• 18:09
  SPEAKER_01: You know, these were the kind of examples we had to fight.
• 18:11
  SPEAKER_01: Then, of course, we had also, as mentioned before, we had the supply chain issues.
• 18:17
  SPEAKER_01: But for me personally, I think that the biggest challenge was to have a coherent reaction and to have a very good communication and coordination within the hospital.
• 18:28
  SPEAKER_01: It was not so much about very specific infection control measures, but it was just the kind of coherence because all the time suddenly it uh colleagues declared themselves infection control specialists and tried to convince their own colleagues that what we were recommending was not accurate, etc.
• 18:47
  SPEAKER_01: So this this, but I I guess that that's what lots of other colleagues experienced during the first peak of the disease, nothing that has been unique to our hospital.
• 18:58
  SPEAKER_00: Yeah, the problem with conflicting messages about what we should be doing and and then having different societies put out guidelines for their recommendations, that has certainly been very challenging.
• 19:11
  SPEAKER_00: What have you learned from COVID-19 that has changed practice?
• 19:16
  SPEAKER_01: That's a very good question.
• 19:17
  SPEAKER_01: I would say that from a very practical perspective, if you ask me what was for me as a hospital epidemiologist, the main change in my own conventional wisdom is the fact that we started to very actively screen even asymptomatic patients or healthcare workers for SARS-CoV, which normally you wouldn't ever do for RSV or for influenza.
• 19:40
  SPEAKER_01: I've been very active as a person doing research on screening for multi-resistant organisms.
• 19:46
  SPEAKER_01: So I've done studies for the last 15-20 years.
• 19:49
  SPEAKER_01: But if you had asked me a year ago, hey Stefan, do you think there could be a time where you start to have very intensive, proactive screening protocols to even detect pre-symptomatic, asymptomatic, paus-symptomatic patients, healthcare workers, I would have said no, this is nonsense.
• 20:08
  SPEAKER_01: But this has really changed practice.
• 20:09
  SPEAKER_01: We have now very elaborate protocols for these kinds of situations.
• 20:14
  SPEAKER_01: That's number one.
• 20:15
  SPEAKER_01: The second was from a more political perspective, what I learned was really that as a hospital epidemiologist during such a crisis, it's not only about diplomacy, it's really about having the right cohesion, the coordination, the communication, to really be extremely diplomatic with colleagues, to find the right tone, to handle their fear.
• 20:40
  SPEAKER_01: It's something that is beyond what you learn normally as a hospital epidemiologist, because of course we try to be just evidence-based and convince colleagues to do the right thing.
• 20:49
  SPEAKER_01: So that's something that uh certainly I learned.
• 20:52
  SPEAKER_01: And then the the last point I think that I learned what it means to still keep humanity in your work because we had so many tricky discussions and decisions, especially in the elderly populations.
• 21:06
  SPEAKER_01: Normally you're not confronted with these kinds of discussions about whether an elderly patient should still undergo a non-invasive ventilation, what's the risk for the healthcare workers or the patients?
• 21:19
  SPEAKER_01: So suddenly it was a moment where we had even more philosophical considerations of our infection control work until where should we go?
• 21:28
  SPEAKER_01: Should we really be very aggressive with the healthcare workers?
• 21:31
  SPEAKER_01: Should they get punished if they contaminate people, patients, because they didn't follow certain rules, you know, what's the level of uh personal accountability?
• 21:40
  SPEAKER_01: So these were all things that normally we don't have to handle that so much in our field.
• 21:46
  SPEAKER_01: So it's it's a question about you know, what's the larger framework of our activity in hospital epidemiology?
• 21:53
  SPEAKER_01: It's another dimension.
• 21:54
  SPEAKER_01: So that's what I learned.
• 21:56
  SPEAKER_01: I would say that uh there have been practical lessons.
• 22:00
  SPEAKER_01: But there have been also almost some philosophical lessons for me over the last seven months.
• 22:05
  SPEAKER_00: You know, it's interesting to hear that we have all been really dealing with the same types of questions.
• 22:11
  SPEAKER_00: And so even though we're we're a continent apart, it sounds like it's been very similar in the United States.
• 22:17
  SPEAKER_00: You mentioned that you are heading into the second wave now.
• 22:22
  SPEAKER_00: What are you doing to prepare for influenza season?
• 22:26
  SPEAKER_01: It's easy.
• 22:27
  SPEAKER_01: We of course intensify our flu vaccination programs, the promotion campaigns for the healthcare workers.
• 22:35
  SPEAKER_01: Unfortunately, our general flu immunization coverage is really low compared to some tertiary care hospitals in the United States.
• 22:44
  SPEAKER_01: So we definitely try to improve the flu vaccine uptake.
• 22:49
  SPEAKER_01: Otherwise, we are at least a little bit reassured by the news from the Southern Hemisphere saying that the flu uh season in the Southern Hemisphere was pretty mild.
• 23:01
  SPEAKER_01: So we hope that this will happen again.
• 23:03
  SPEAKER_01: And then the second answer is of course, we are improving our rapid diagnostic capacity.
• 23:08
  SPEAKER_01: So, for instance, in the emergency rooms, we will have ultra-rapid tests available for both influenza and SARS-CoV to make sure that we can perform the triage of patients with respiratory infections very soon after admission.
• 23:24
  SPEAKER_00: Do you have any advice based on what Switzerland has done well or has done poorly that you would like to share with others?
• 23:32
  SPEAKER_01: Yeah.
• 23:33
  SPEAKER_01: So normally Swiss people they don't articulate self-criticism in public, you know.
• 23:40
  SPEAKER_01: So, but of course, as I mentioned before, Switzerland is a very federalistic country, and this is also a strength but also weakness.
• 23:47
  SPEAKER_01: So we we had maybe uh certain situations where a more centralized, powerful public health authority could have been beneficial.
• 23:57
  SPEAKER_01: So that's definitely something that uh, but uh otherwise, I would say that one of the main lessons that our country has learned is that you need a very robust and solid healthcare system in general, because Switzerland has a high-performing healthcare system in general, it has universal health care coverage, and this is, of course, a real security and insurance for these kinds of dramatic pandemic situations.
• 24:22
  SPEAKER_01: So it's a stress test, of course, for an entire country and its healthcare system to see how they can handle these kinds of situations.
• 24:29
  SPEAKER_01: And Switzerland was very well prepared because the level of medical care, the number of bats, the number of well-trained critical care physicians, etc., etc., was at a very high level.
• 24:41
  SPEAKER_01: So it shows that yes, if you invest in a universal healthcare system and with universal health coverage, for these kinds of situations, it can bring you a lot of benefit.
• 24:52
  SPEAKER_01: You see a little bit my side pointing towards maybe some issues in other countries, maybe also North America, where you know that there are certain challenges with the healthcare system, as you know.
• 25:04
  SPEAKER_00: Well, Dr.
• 25:04
  SPEAKER_00: Harbaugh, I'd like to thank you very much for joining us today.
• 25:08
  SPEAKER_00: It's been really interesting to hear about what's going on in Switzerland.
• 25:12
  SPEAKER_00: Thank you so much.
• 25:13
  SPEAKER_01: Thank you.
• 25:13
  SPEAKER_01: It was my pleasure.
• 25:14
  SPEAKER_01: Thank you.
• 25:15
  SPEAKER_00: Thank you very much to our speaker for sharing your perspectives and experiences and a sincere thank you from Shay to all healthcare personnel for all that you're doing to respond to COVID-19.
• 25:25
  SPEAKER_00: This podcast can be accessed on Shay's online education center at Learning CE under the Rapid Response Program.
• 25:32
  SPEAKER_00: You will also find resources such as the recorded webinars, healthcare facility outbreak preparedness, and the Shay COVID-19 town hall.
• 25:40
  SPEAKER_00: Additional resources available on Learning CE pertinent to this pandemic include Shay CDC outbreak response training program and the prevention course and HAI knowledge and control prevention check.
• 25:51
  SPEAKER_00: You can now receive 75% of JA membership for the remainder of 2020 using the coupon code podcast during checkout.
• 25:59
  SPEAKER_00: That concludes this episode of the Rapid Response Podcast.
• 26:03
  SPEAKER_00: Thank you for tuning in.