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COVID-19: Surge Planning and Testing, 3/12 · The SHEA Podcast

• 0:08
  SPEAKER_01: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the fields of healthcare epidemiology and antibiotic stewardship.
• 0:22
  SPEAKER_01: I am Dr.
• 0:22
  SPEAKER_01: David Bannock, Associate Professor of Medicine and Hospital Epidemiologist at the University of Connecticut School of Medicine.
• 0:28
  SPEAKER_01: I'll be the moderator for today's podcast.
• 0:30
  SPEAKER_01: Shea is excited to launch the third episode of this podcast, COVID-19 updates, What We Need to Know.
• 0:36
  SPEAKER_01: Today's episode will focus on a few different areas, including the current state of COVID-19, updates and guidance, and addressing issues regarding search testing.
• 0:45
  SPEAKER_01: Our speakers today are Dr.
• 0:47
  SPEAKER_01: Cindy Prinz from the University of Florida and Dr.
• 0:49
  SPEAKER_01: Waleed Javed from Mount Sinai Hospital downtown.
• 0:52
  SPEAKER_01: Thank you for joining us today.
• 0:53
  SPEAKER_01: I will now turn it over to Dr.
• 0:55
  SPEAKER_01: Prinz for a news update on COVID-19, as well as a summary of recent updates to guidelines.
• 1:02
  SPEAKER_02: Thank you, Dr.
• 1:03
  SPEAKER_02: Bannock.
• 1:04
  SPEAKER_02: There was a sharp increase in confirmed COVID-19 cases in the U.S.
• 1:08
  SPEAKER_02: this week.
• 1:08
  SPEAKER_02: CDC's Wednesday update listed 938 cases and 29 deaths, with about 15% of all cases so far being reported in the first two weeks of March.
• 1:18
  SPEAKER_02: And there was also a heightened public health response to the COVID-19 outbreak that we the World Health Organization finally declared COVID-19 a pandemic on Wednesday afternoon.
• 1:29
  SPEAKER_02: The countries are not doing enough to prepare for the outbreak.
• 1:32
  SPEAKER_02: In the US, we don't have any colleges and universities with their campus classes completely online.
• 1:38
  SPEAKER_02: Why does our cancellations of large gatherings and the addition of travel rejected to the US for 25 European countries?
• 1:47
  SPEAKER_02: In terms of COVID-19 epidemiology, have public health labs could have been technically for the virus.
• 1:57
  SPEAKER_02: But could learn that it's provided over the availability of reading the recommended.
• 2:03
  SPEAKER_02: In particular, with difficulty of needing are they particularly companies with approved product?
• 2:10
  SPEAKER_02: It was announced that anyone can be captured on a different order.
• 2:13
  SPEAKER_02: But there's concern that the testing capacity in the US may not probably be difficult to meet in COVID.
• 2:20
  SPEAKER_02: Dr.
• 2:20
  SPEAKER_02: Bennett and Dr.
• 2:21
  SPEAKER_02: Java will discuss more about testing capacity later in the podcast.
• 2:25
  SPEAKER_02: Also they need to be updated their interim and vector prevention and control recommendations for patients with expected for the COVID-19 in healthcare technical.
• 2:36
  SPEAKER_02: With concerns about supply chain for the data, 95 respirators.
• 2:43
  SPEAKER_02: With respirators, we're all generating procedures.
• 2:51
  SPEAKER_02: With a supply data for healthcare workers are advised to return to using respirators for COVID-19 care.
• 3:00
  SPEAKER_02: The Department of Health and Human Services announced that they'll be protecting 500 million N95 returators over the next year and a half to add to the certificate health file, which instead would encourage manufacturers to ramp up N95 production without being confirmed for the left effects supplies when the demand falls.
• 3:18
  SPEAKER_02: The revised CDC guidelines also updated the recommendations regarding the use of airborne infection isolation.
• 3:25
  SPEAKER_02: They specified that these rooms should be reserved for those inspected or confirmed COVID-19 patients who are undergoing aerosol generating procedures.
• 3:34
  SPEAKER_02: Respiratory specimens for testing can be collected from patients in a normal exam room.
• 3:39
  SPEAKER_02: Healthcare workers collecting respiratory specimens should wear an N95 or higher level respirator if that's available.
• 3:46
  SPEAKER_02: But a face mask may be worn in the event of N95 supply chain shortages.
• 3:51
  SPEAKER_02: Now Dr.
• 3:51
  SPEAKER_02: Bannock and Dr.
• 3:52
  SPEAKER_02: Javaid will discuss COVID-19 surge planning and testing.
• 3:56
  SPEAKER_01: Thank you, Dr.
• 3:57
  SPEAKER_01: Prinz, for that update.
• 3:58
  SPEAKER_01: I think you gave us a lot of great information there.
• 4:00
  SPEAKER_01: We recognize it's going to be an evolving situation, but I think that really provides us a great update on where things stand at the moment.
• 4:07
  SPEAKER_01: So I want to transition to more of a discussion with Dr.
• 4:10
  SPEAKER_01: Javed.
• 4:11
  SPEAKER_01: Dr.
• 4:11
  SPEAKER_01: Javed, thanks for coming onto the podcast.
• 4:13
  SPEAKER_01: I think there's a few questions that have been circulating within our field.
• 4:17
  SPEAKER_01: I'm interested in your thoughts and if you could reflect on some of your experiences.
• 4:21
  SPEAKER_01: One of the major uh challenges that's come up has been testing.
• 4:25
  SPEAKER_01: Each facility has had different approaches to testing, selecting patients for testing, and even proceeding with the actual implementation of testing.
• 4:34
  SPEAKER_01: So I know that you practice in New York City, there have been cases of COVID-19.
• 4:38
  SPEAKER_01: I was wondering if you could share what your experience has been like in terms of approaching testing in general and how that's been going.
• 4:46
  SPEAKER_00: Thank you so much for having me.
• 4:48
  SPEAKER_00: David, that is a very good question.
• 4:50
  SPEAKER_00: I wanted to get into testing processes.
• 4:52
  SPEAKER_00: And over the last several weeks, as you know, we have had ease of testing restrictions from CDC.
• 4:58
  SPEAKER_00: And that has resulted in other areas, other states being able to test more and more patients.
• 5:06
  SPEAKER_00: What we have seen recently, in the last several days, is cities and state health departments have relaxed the specific guidance on who should be tested.
• 5:15
  SPEAKER_00: Even now in New York, they are saying if physicians are recommending it and there's reasonable clinical picture, they would test.
• 5:23
  SPEAKER_00: But I do want to make sure that everybody understands what we're trying to say.
• 5:27
  SPEAKER_00: There are very high-risk individuals that have to be tested, which include people who have traveled to China or high-risk countries or CDCs, travel advisories, individuals who have had direct contact with COVID-19, and patients who are getting admitted to ICU with respirator illness, with ARDS that is unexplained, those patients should be tested regardless.
• 5:51
  SPEAKER_00: And I think that is a guidance we should not change.
• 5:54
  SPEAKER_00: What we're really discussing is other individuals.
• 5:56
  SPEAKER_00: I think that is dictated by local epidemiology.
• 6:00
  SPEAKER_00: So if you have a lot of cases in your locality, then you might want to consider testing a lot more patients versus less.
• 6:09
  SPEAKER_00: But I think having this interaction with public health individuals, looking at what's happening in your community, and then testing people who are at risk.
• 6:19
  SPEAKER_00: Those might include people with advanced heart disease or other comorbidities that may make this illness very challenging for them.
• 6:27
  SPEAKER_01: I think, you know, just reflecting on our experience here in Connecticut, I know we have a really strong Department of Public Health, and they've really had a great leadership role throughout the state in guiding testing.
• 6:36
  SPEAKER_01: I think, you know, we've been limited based on our testing capacity through our state public health laboratory.
• 6:42
  SPEAKER_01: But now as we begin to expand our testing into a much broader context, even into outpatient settings, you know, we're starting to explore different opportunities to do outpatient testing in an efficient way.
• 6:55
  SPEAKER_01: I believe that you had mentioned earlier that your facility is expanding testing into outpatient type settings.
• 7:01
  SPEAKER_01: Can you reflect on any types of hurdles or challenges that you've had as you moved from a much more narrow focus of testing because of limited resources into a much broader scope of testing?
• 7:13
  SPEAKER_00: Yes.
• 7:13
  SPEAKER_00: As we were discussing earlier, we have started to test more and more individuals as our local epidemiology is changing, and we are really incorporating all resources available.
• 7:24
  SPEAKER_00: So absolutely, the public health have been extremely helpful, and they really guide us into testing and how do we get tests to depart on health.
• 7:33
  SPEAKER_00: But as all of us know, certain private labs have already started to test, and we have tapped into those resources as well.
• 7:42
  SPEAKER_00: And managing people, we are moving people or testing in different areas, so sending some to the state health lab and sending some to the private lab.
• 7:50
  SPEAKER_00: So that the testing can be done quickly, and also it doesn't overwhelm one resource over the other.
• 7:57
  SPEAKER_00: We do need to understand that not everybody has all the resources that one would think are needed.
• 8:03
  SPEAKER_00: So we don't want to overwhelm our systems, but we also want to protect our patients, our staff, and our community.
• 8:11
  SPEAKER_01: I've had a similar experience.
• 8:50
  SPEAKER_01: I want to move a little bit from the technicalities of testing to thinking about the settings in which testing is performed.
• 8:56
  SPEAKER_01: You know, there's been a lot of discussion and even some recent changes in the infection control guidelines put forth by CDC with regard to the appropriate environment for performing COVID-19 testing.
• 9:08
  SPEAKER_01: Dr.
• 9:08
  SPEAKER_01: Prinz alluded to some of that in her discussion of the recent changes in infection control guidelines.
• 9:13
  SPEAKER_01: So could you share some of the experience from your facility with regard to environment of care where testing is performed?
• 9:19
  SPEAKER_00: As recently as yesterday, CDC has made some changes in their recommendations.
• 9:24
  SPEAKER_00: A couple things that make it easier for our evaluation is PPE, including when we are performing aerosol generating procedures and/or if we are testing, at that time we need to wear N95s.
• 9:37
  SPEAKER_00: The other issue that has been addressed is that we can perform testing in a non-nagropressure room.
• 9:43
  SPEAKER_00: So those things will help.
• 9:46
  SPEAKER_00: Obviously, everyone realizes not every place has a lot of negro pressure rooms and not every patient can be moved very quickly, but these guidelines do help testing more and more patients through the same facility.
• 9:58
  SPEAKER_01: I agree, that's been a big focus for our testing approach in the fact that we're able to test in uh environments that are not necessarily airborne isolation rooms.
• 10:07
  SPEAKER_01: Although airborne isolation rooms would be the ideal, expanding testing locations really uh offers an opportunity to expand the number of patients in the types of environments where we can actually do the testing.
• 10:18
  SPEAKER_01: So I think that's been a real important update that's happened recently.
• 10:21
  SPEAKER_01: So now that we've spoken a little bit about uh some of the logistics of testing, we're looking forward to a future podcast talking about the more technical aspects of the testing, including uh the test performance, thinking about how to evaluate testing accuracy and those kinds of questions.
• 10:35
  SPEAKER_01: One question that has come up a lot, um, and I was wondering if you could share some of your experience, is testing individuals who have been exposed but are not yet symptomatic.
• 10:43
  SPEAKER_01: Can you offer some thoughts on how to approach that kind of scenario?
• 10:47
  SPEAKER_00: Absolutely.
• 10:48
  SPEAKER_00: So I think most of those cases we try to do one of two things.
• 10:51
  SPEAKER_00: We try to look at the current symptomatology, and as you said, if they are asymptomatic, that makes it a little harder to test, just like for influenza, testing somebody when they are asymptomatic may not give us the correct picture.
• 11:04
  SPEAKER_00: In those cases, we do partner with our public health to see what their thoughts are about that specific event.
• 11:12
  SPEAKER_00: And sometimes they actually already know that hey, this was a big conference.
• 11:15
  SPEAKER_00: We have had several other exposures and some are positive.
• 11:18
  SPEAKER_00: So they can be very helpful to partner with them on those cases.
• 11:22
  SPEAKER_00: But on the other hand, some of the cases that are really mild or some people who have other healthcare issues, we do try to test them more so that we can optimize their care if needed.
• 11:33
  unknown: Dr.
• 11:33
  SPEAKER_01: Javed, thank you for um offering some insights on testing.
• 11:36
  SPEAKER_01: I do want to talk a little bit about surge planning.
• 11:38
  SPEAKER_01: You know, that's been on the forefront of our minds as we move forward into the COVID-19 epidemic.
• 11:44
  SPEAKER_01: Can you reflect a little bit on some of your experiences with surge planning at your institution?
• 11:49
  SPEAKER_00: Yeah, so we all have had surge planning for influenza, for pandemic, flu, and all, and we all have had these plans ready for a long time.
• 12:00
  SPEAKER_00: I know ever since we have seen the COVID-19 spread throughout the world and then throughout the US, we have been looking at the search planning and how are we gonna deal with the high number of patients coming our way.
• 12:13
  SPEAKER_00: Right now, we should be thinking about it as it is going to happen.
• 12:18
  SPEAKER_00: We need to look at our search plans.
• 12:20
  SPEAKER_00: We need to make sure our search plans are relevant to today's date.
• 12:24
  SPEAKER_00: We need to look at how, with the current epidemiology of the illness, that we are going to manage these patients.
• 12:30
  SPEAKER_00: How are we going to manage patients who have little symptoms and are going to get discharged, but also who need to be admitted and quote unquote ruled out for COVID-19 infection versus who are going to ICU?
• 12:43
  SPEAKER_00: How are we going to manage if we have twice the number of patients coming in as compared to normal years in the same time?
• 12:51
  SPEAKER_00: All those things need to be evaluated, and that really is where our search plan becomes important.
• 12:57
  SPEAKER_00: Secondly, who is going to staff this search?
• 13:01
  SPEAKER_00: Do we have enough supplies for this search?
• 13:03
  SPEAKER_00: Do we have enough beds or other equipment to handle a search like this?
• 13:08
  SPEAKER_00: So all these things need to be looked at, evaluated, and carefully discussed with leadership.
• 13:14
  SPEAKER_00: The approach we took was to go with the incident command structure, not necessarily calling incident command, but using the same structure.
• 13:24
  SPEAKER_00: So we had the same groups report out and get us to that readiness level because there's a lot of departments that gets involved in any or all search.
• 13:34
  SPEAKER_00: As of today, we are not in search, but again, we have planned for any possible search.
• 13:40
  SPEAKER_00: So my message to everybody would be: if you haven't done so, make sure you have reviewed your search plans.
• 13:47
  SPEAKER_00: It is updated, everybody in leadership agrees with it, you can walk through it.
• 13:51
  SPEAKER_00: And once your search plan is final, you need to exercise on that search plan.
• 13:56
  SPEAKER_00: You need to make sure that works.
• 13:58
  SPEAKER_00: And if anything doesn't work, you need to fix it before we get into that high volume of patients coming our way.
• 14:04
  SPEAKER_01: I agree.
• 14:05
  SPEAKER_01: I think that not just having the plan in place, but having uh some experience with implementing the plan through maybe a tabletop exercise or some sort of simulation can really be helpful.
• 14:16
  SPEAKER_01: We actually just did that and encountered uh some areas of opportunity to improve our plan that we hadn't necessarily thought of until we actually did a full simulation.
• 14:25
  SPEAKER_01: I think one of the other complexities that's come to light is thinking about staffing in a broader context.
• 14:31
  SPEAKER_01: You know, we have a lot of staff that have children, and now there's discussion about school closures and how that might impact our staffing.
• 14:38
  SPEAKER_01: And you know, I think taking a larger approach that this extends not just beyond an individual facility and more into sort of the general context of day-to-day life, I think has really come to light, and uh, we've had to adapt our surge planning accordingly.
• 14:52
  SPEAKER_00: So I think you you touch upon a very important point.
• 14:55
  SPEAKER_00: At this time, we have seen other organizations looking at working from home.
• 14:59
  SPEAKER_00: I want to stress here is that even healthcare, we need to look at those opportunities.
• 15:04
  SPEAKER_00: If we have to manage our hospital when our staff might not be there all the time, so who can work remotely?
• 15:11
  SPEAKER_00: Those things need to be addressed.
• 15:13
  SPEAKER_00: And if people need remote access, they should probably be identified and given access.
• 15:18
  SPEAKER_00: Think about this.
• 15:19
  SPEAKER_00: If somebody in any meeting, for example, is tested positive for COVID two hours later or five hours later, all those people will get in quarantine.
• 15:29
  SPEAKER_00: The problem with that is do we have planned for that eventuality?
• 15:34
  SPEAKER_00: Should we even have those meetings or not?
• 15:36
  SPEAKER_00: So those are the questions and discussions we should start having rather than thinking about those after the fact.
• 15:43
  SPEAKER_01: Yeah, I completely agree.
• 15:44
  SPEAKER_01: I think uh you know the planning extends not just beyond the direct provision of clinical care, but the entire picture of operations.
• 15:50
  SPEAKER_01: And if we were to uh potentially not have a large contingent of facility being able to come to work, you know, that would be tremendously impactful.
• 15:57
  SPEAKER_01: Um, incidentally, you did mention meetings.
• 15:59
  SPEAKER_01: Has your um institution begun to evaluate the role of meetings, potentially uh limiting the size of meetings or the frequency of meetings?
• 16:07
  SPEAKER_01: Is that something that's been uh up for discussion at your hospital?
• 16:11
  SPEAKER_00: Yes.
• 16:12
  SPEAKER_00: So our institution has, and a lot of other institutions in the city have also really thoughtfully crafted processes to limit the extent of the meetings.
• 16:22
  SPEAKER_00: And everything really needs to be re-looked and re-evaluated.
• 16:25
  SPEAKER_00: Having a big meeting or a big lecture could be really important, but if there is one single positive person over there, what is going to happen?
• 16:35
  SPEAKER_00: I think we need to look at this as there's a possibility that somebody might be positive in a big gathering.
• 16:42
  SPEAKER_01: I agree.
• 16:43
  SPEAKER_01: I literally, before recording this podcast, just came from a meeting about meetings, and we looked around the room and saw that we had a large group gathering of people from different areas of the institution within a single room.
• 16:54
  SPEAKER_01: You know, we all looked at each other and really had to think is this really the best way to be uh having this discussion about future meetings.
• 17:01
  SPEAKER_01: So I think um, you know, the whole notion of group gatherings within the institution needs to be closely examined.
• 17:06
  SPEAKER_00: And similarly, like can we transfer more meetings to phone calls?
• 17:09
  SPEAKER_00: Do we have to have individuals there?
• 17:11
  SPEAKER_00: Remotely, things we can do without having physical interaction between people probably are the ways to go.
• 17:18
  SPEAKER_00: It might be difficult for workflow for some organizations, but I think it's either this or you might end up putting a substantial number of people on quarantine.
• 17:28
  SPEAKER_00: So I think there's a lot of balance that organizations need to think about.
• 17:32
  SPEAKER_01: Thank you, Dr.
• 17:33
  SPEAKER_01: Javain and Dr.
• 17:34
  SPEAKER_01: Prinz, for providing some perspective on your experiences in the outbreak.
• 17:38
  SPEAKER_01: Please be sure to tune in to next week's episode.
• 17:40
  SPEAKER_01: We'll be addressing diagnostic testing for COVID-19.
• 17:43
  SPEAKER_01: This podcast can be accessed on Shay's online education center, learning CE, under the Rapid Response Program.
• 17:49
  SPEAKER_01: You will also find additional resources such as the recorded webinar, healthcare facility outbreak preparedness.
• 17:55
  SPEAKER_01: This concludes this episode of the Rapid Response Podcast.
• 17:58
  SPEAKER_01: Thank you for tuning in.