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Influence of CDC Guidance on COVID-19 Policies · The SHEA Podcast

• 0:08
  SPEAKER_01: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of health care associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:25
  SPEAKER_01: I'm Dr.
• 0:25
  SPEAKER_01: Whitney Buckle, System Antimicrobial Stewardship Pharmacist Manager at Intermountain Healthcare, and I will serve as today's podcast moderator.
• 0:34
  SPEAKER_01: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:43
  SPEAKER_01: Shay is excited to launch this episode of the podcast, COVID-19 updates, what we know now.
• 0:48
  SPEAKER_01: Today's discussion will focus on the influence of CDC guidance on COVID-19 policies, with perspectives coming from physicians who work in what we call blue and red states.
• 0:58
  SPEAKER_01: Our speakers today are Dr.
• 1:00
  SPEAKER_01: Erica Schnoy, Associate Chief of the Infection Control Unit at Massachusetts General Hospital, and Dr.
• 1:06
  SPEAKER_01: Julie Trevetti, Medical Director of Infection Prevention for UT Southwestern Medical Center.
• 1:11
  SPEAKER_01: Thank you for joining us today.
• 1:13
  SPEAKER_01: Let's move right into the discussion.
• 1:15
  SPEAKER_01: The CDC moved to community levels on February 25th, which considers current information about COVID-19 hospitalizations in the community, as well as the potential for strain on the local health system and COVID-19 cases in the community when making decisions about community prevention strategies and individual behaviors.
• 1:34
  SPEAKER_01: How has this impacted you within your hospitals and communities?
• 1:38
  SPEAKER_02: I can take that one first.
• 1:39
  SPEAKER_02: So this is a really great question because I think it's really important for people in the community to be able to have accurate guidance to help them decide how to then move about their lives as they try to figure out what is their new normal.
• 1:52
  SPEAKER_02: So I'll comment on the masking portion of this.
• 1:55
  SPEAKER_02: So when our mask mandate expired last year, just in the after the few days after that, we saw a significant decline in the amount of masking in the community, including many of our school districts.
• 2:06
  SPEAKER_02: And then with each surge, those percentages would go up and then come back down again after the surge was starting to take to wind down.
• 2:14
  SPEAKER_02: So prior to the community guidelines, we were already seeing downtrending with regards to masking in the community.
• 2:20
  SPEAKER_02: And this has continued.
• 2:22
  SPEAKER_02: We've had extensive forecasting data and modeling data at UT Southwestern, and that has shown that self-reported masking currently in our county is about 50% and basically approaching levels of what we were seeing in July of 2021.
• 2:36
  SPEAKER_02: And of note, you know, we had a slight uptick in the number of employees testing positive in the past week compared to the last couple of weeks, which might be related to relaxation of behaviors as well as recent travel for spring break.
• 2:49
  SPEAKER_02: So I think that the CDC community guidelines have probably not had as much of an impact here where we are in North Texas as they might have in other parts of the country.
• 3:01
  SPEAKER_02: But I think it has been important for people to have a better sense of what kind of behaviors they should engage in when they are out in the community and things that they can do to protect themselves.
• 3:12
  SPEAKER_00: I think those are all great points.
• 3:14
  SPEAKER_00: In Massachusetts, our masking mandate expired last spring and there and it was more of a guidance.
• 3:20
  SPEAKER_00: And in fact, there was a lot of community masking, I think, until more recently.
• 3:25
  SPEAKER_00: I think one thing about the challenges between having community level and then the transmission maps is that there are different standards, obviously, in healthcare.
• 3:34
  SPEAKER_00: And I think part of the challenge that we're in right now is communicating that there are certain behaviors that are appropriate in the community and based on community levels, but that in healthcare, at least up here in the Northeast, we're really still basing our masking and other policies related to the community transmission levels, which are more in the moderate and substantial still.
• 3:55
  SPEAKER_00: And so I think some of the challenging conversations are what you're doing outside the hospital is okay based on those community levels, but in the hospital, it's a different story.
• 4:04
  SPEAKER_02: Those are some really great points, Erica, and something that I did not mention, correct?
• 4:08
  SPEAKER_02: So I would agree we had a lot of questions coming out about why are we doing something different in the healthcare settings compared to what we're doing out in the community.
• 4:16
  SPEAKER_02: And it was trying to help people understand the differences and the risks there and the potential implications of someone having COVID and what that could mean in their environment.
• 4:24
  SPEAKER_01: Yeah, that's super helpful to hear that discussion.
• 4:27
  SPEAKER_01: And I do think that has caused a lot of questions.
• 4:30
  SPEAKER_01: And so I think it's interesting to hear how you guys are dealing with it.
• 4:34
  SPEAKER_01: Moving on to something similar in terms of prevention strategies, there has been some interesting data regarding the difference in vaccination rates and mortality in what are considered blue and red states.
• 4:46
  SPEAKER_01: Given one of you comes from a blue and one of you from a red state, what are your thoughts on this?
• 4:51
  SPEAKER_00: I'm happy to start with this one.
• 5:04
  SPEAKER_00: And really across all age groups, we've exceeded the national numbers, including in boosting.
• 5:10
  SPEAKER_00: And so that, you know, we still have a ways to go with boosting, but our uptake has been really, really favorable.
• 5:16
  SPEAKER_00: And I think this has been actually one of the leading factors in reducing hospitalizations and deaths and preserving our healthcare capacity.
• 5:23
  SPEAKER_00: And when I think back on our most recent Omicron surge, it was really different in so many ways from prior surges.
• 5:30
  SPEAKER_00: One of the ways it was different is that we certainly had increases in patients in the hospital with COVID in terms of sheer numbers that rivaled our first surge.
• 5:39
  SPEAKER_00: However, they were very different sorts of illnesses.
• 5:42
  SPEAKER_00: And in fact, in our most recent state data, we're finding that the majority of people in the hospital with COVID are there for another reason, the so-called kind of a secondary diagnosis of COVID.
• 5:54
  SPEAKER_00: And that's why, while those patients still have, of course, resources with respect to use of PPE, et cetera, they actually, it's a little bit different because they represent a volume of admissions that we would have already had to manage otherwise.
• 6:07
  SPEAKER_00: They came in for their, you know, total hip or they came in for exacerbation of heart failure.
• 6:12
  SPEAKER_00: And those patients would have already been here.
• 6:14
  SPEAKER_00: Whereas before with prior surges, because that more of it was driven by actual admission for COVID, that was, in a sense, additional volume.
• 6:23
  SPEAKER_00: And so it was a different surge, challenging for different reasons.
• 6:25
  SPEAKER_00: But I think vaccination and the amount of vaccination in Massachusetts really, in some ways, protected us in terms of the severity of illness that we saw.
• 6:34
  SPEAKER_02: Yeah, I think that's a really great overview of that.
• 6:36
  SPEAKER_02: And what's interesting is that although our vaccination rates in Texas started out pretty strongly, we certainly began to lag behind.
• 6:45
  SPEAKER_02: And currently in our region in North Texas and many other counties in the state, we are certainly well below what the domestic trends are, and even some other regional trends for pretty much all age groups.
• 6:58
  SPEAKER_02: There are some counties within Texas that had really, really high vaccination rates for the elderly.
• 7:04
  SPEAKER_02: And then once it became more available to everyone over the age of five, certainly a big uptick there.
• 7:10
  SPEAKER_02: But what's interesting is that we saw similar patterns in our hospitalization numbers, as Dr.
• 7:15
  SPEAKER_02: Chinoy just informed us about.
• 7:17
  SPEAKER_02: We, again, with this most recent surge had a pretty significant number of patients.
• 7:22
  SPEAKER_02: We surpassed where we were with Delta.
• 7:25
  SPEAKER_02: But absolutely, we saw many patients coming in with COVID, but not necessarily because of COVID.
• 7:31
  SPEAKER_02: I think that, you know, the impact on mortality as well, you know, I certainly believe that vaccination has a big impact on that.
• 7:39
  SPEAKER_02: But it also makes me question whether there were other factors, such as maybe more rural locations, having more access to care, recognition of illness.
• 7:48
  SPEAKER_02: And so I think that although vaccination for us wasn't certainly where it has been in some of the other states, we saw similar trends in our hospitals.
• 7:57
  SPEAKER_02: So it was kind of an interesting picture to see as far as mortality rates and you know, really what the role of vaccination was in that.
• 8:06
  SPEAKER_01: Yeah, interesting to hear the different experiences from your respective states.
• 8:10
  SPEAKER_01: In addition to what we've talked about in terms of masking and vaccination, the federal government has also sent out home antigen testing to try to increase testing and early testing as part of a pandemic mitigation strategy.
• 8:23
  SPEAKER_01: How are each of you handling things like pre-procedural testing, given the availability of home testing now?
• 8:30
  SPEAKER_02: Yeah, so I can take that one first.
• 8:32
  SPEAKER_02: You know, the topic of pre-procedural testing is certainly a favorite one lately.
• 8:36
  SPEAKER_02: We're seeing lots of pressure from community, from other healthcare workers, surgeons, as well to talk about whether or not we can de-escalate some of our pre-procedure testing.
• 8:47
  SPEAKER_02: I would say that, you know, the availability of home antigen testing has certainly been extremely beneficial for people to be able to have more ready access to testing themselves and testing their family members.
• 9:00
  SPEAKER_02: We don't actually utilize the results of home antigen testing when we are screening patients for surgeries and testing them beforehand.
• 9:08
  SPEAKER_02: So those tests that we require are PCR-based or other molecular assays that are done at our institution or another reputable reference laboratory.
• 9:18
  SPEAKER_02: So in that sense, we aren't using the results of home testing.
• 9:21
  SPEAKER_02: We have not accepted negative home antigen tests from employees or patients, but we have accepted positive ones when they might be coming in for a clinic visit or something else, and we have evidence that, or they inform us that they had recently tested positive.
• 9:35
  SPEAKER_02: And if they're able to show us proof, we then utilize that information in helping to determine when they can safely come back on campus.
• 9:43
  SPEAKER_02: And then the other aspect of the home antigen testing also has been in helping with the distribution of monoclonal antibody infusions.
• 9:51
  SPEAKER_02: So we'd no longer required a PCR assay or molecular assay to confirm that somebody had COVID in order to determine if they were eligible for monoclonal antibody.
• 10:01
  SPEAKER_02: In those situations, we did accept some rapid home antigen tests if they were in fact positive.
• 10:06
  SPEAKER_00: I don't have too much to add to that because I think we're pretty aligned in that.
• 10:10
  SPEAKER_00: We've maintained that a negative PCR is required in the setting of uh pre-admission or pre-procedural testing.
• 10:18
  SPEAKER_00: And we've used the home antigen tests when they're positive to either make treatment decisions or make decisions around the duration of isolation.
• 10:27
  SPEAKER_00: I think that the challenge, and this is when you're in this intermediate period, and especially with Amacron, with the steep rise and then the incredible like free fall in terms of prevalence in our communities, is the value of these tests really change based on what the community prevalence is and really the pretest probability that you have for disease.
• 10:45
  SPEAKER_00: And so when we've looked at the current community prevalence right now, it's around 2% here in Massachusetts.
• 10:52
  SPEAKER_00: Some of these antigen tests, you know, a large proportion of the positives are actually going to be false positives.
• 10:57
  SPEAKER_00: And that presents some distinct challenges because, you know, how do you believe the positive?
• 11:02
  SPEAKER_00: Well, in someone who is symptomatic or has a known exposure, that, you know, you're more likely to believe it.
• 11:07
  SPEAKER_00: But in someone who is truly asymptomatic, no known exposures, it does make you wonder whether or not that represents a false positive and what to do about that should you try to proceed with PCR kind of confirmation or refuting it.
• 11:19
  SPEAKER_00: And those are, you know, there are resources associated with that.
• 11:22
  SPEAKER_00: I'm speaking mostly on the patient or the employee side because they have to go in and get tested.
• 11:27
  SPEAKER_00: And so the antigen has a place clearly in the strategy, but it does represent some challenges, especially as community prevalence waxes and wanes.
• 11:36
  SPEAKER_01: Those are great points.
• 11:38
  SPEAKER_01: I think that we have to remember that these tests are not 100% sensitive, 100% specific, right?
• 11:45
  SPEAKER_01: And no test is perfect.
• 11:46
  SPEAKER_01: And so I think really when you get into the nuances of that, that's where a lot of the challenges lie.
• 11:52
  SPEAKER_01: As the community is relaxing standards, how are you planning for this impact on your patient population?
• 11:58
  SPEAKER_01: And what impact, if any, do you see that the new BA.2 variant playing?
• 12:05
  SPEAKER_00: I think the the mantra is always vigilance.
• 12:08
  SPEAKER_00: Looking at it, at least here in Massachusetts, we pretty much after the really steep decline during the BA1 part of the Omicron surge, have been around 2%.
• 12:19
  SPEAKER_00: We went briefly below 2%, and now we're just kind of flat.
• 12:23
  SPEAKER_00: And at the most recent variant tracker, which is probably about a week old at this point, we were already at 75% BA2.
• 12:30
  SPEAKER_00: And that kind of gives me a little bit of a reassurance that, you know, compared to what we experienced a few months ago when we went straight up at lower proportions of the BA1, that will probably kind of ride this one out, a combination of having a lot of immunity as BA1 kind of ripped through the population here, as well as the vaccination.
• 12:52
  SPEAKER_00: And hopefully we can ride this out.
• 12:54
  SPEAKER_00: And it might be, I just heard the term earlier today, maybe a ripple and less of a surge here in Massachusetts.
• 13:00
  SPEAKER_00: I mean, I think part of this will mean better access to therapeutics and trying to prep and build capacity in those areas that we can in case after this ripple or whatever it ends up being, if later down the line we do have more of a surge.
• 13:15
  SPEAKER_02: Thanks, Erica.
• 13:16
  SPEAKER_02: Yeah, those are really, really great points.
• 13:18
  SPEAKER_02: And I can't emphasize enough the importance of remaining vigilant, you know, and really encouraging people to take precautions based on their risk factors, based on whether they're immunocompromised and have medical conditions.
• 13:30
  SPEAKER_02: And then even, you know, the helping to guide what types of participation they might have in community events and other community settings.
• 13:37
  SPEAKER_02: Our overall asymptomatic positivity had dropped to less than 1%, and our overall positivity had also dropped to less than around 2%.
• 13:46
  SPEAKER_02: And so, you know, these are some of the lowest numbers that we've seen throughout the pandemic.
• 13:50
  SPEAKER_02: So it's really reassuring in that regard.
• 13:52
  SPEAKER_02: And here at UT Southwestern, we are sequencing all positive specimens and have also seen an upward trend in the overall percent positivity due to BA.2, but it's not been as high as what we are seeing in the United States.
• 14:06
  SPEAKER_02: Looking at our region here, HHS region 6, really our percent positivity is around 30 to 35% due to BA.2 compared to the other strains of Omicron.
• 14:18
  SPEAKER_02: And so it's really interesting to see geographic variations in the amount of BA2.
• 14:23
  SPEAKER_02: And I think one of the other things to think about is that if all of the individuals who previously had Omicron are technically immune to BA.2, then I don't think we're going to see as much of an impact and we'll see more of a ripple, as Erica pointed out.
• 14:38
  SPEAKER_02: And I think that that will, you know, provide some sense of reassurance to everyone that, you know, the likelihood of getting reinfected with BA2 after having had Omicron earlier is pretty small.
• 14:47
  SPEAKER_02: I know there's been a few reported cases around the world.
• 14:51
  SPEAKER_02: But I think that it's allowed us also to then come up with a framework to say at what point might we want to restart pre-procedural testing or admissions testing for everyone, if in fact we do de-escalate from those areas as well.
• 15:06
  SPEAKER_02: So I think that we are hopeful and uh yeah, pretty much hopeful that BA2 won't have anywhere near as significant impact as the other subvariants of Omicron.
• 15:18
  SPEAKER_02: And then we'll just have to see what happens.
• 15:20
  SPEAKER_00: And I know, I mean, the weather is probably not as much of a factor for you all in Texas, but here in the Northeast, as uh the weather is getting better, we're also counting on that to help with people doing many more outside activities than during the very cold winter months up here in the Northeast.
• 15:37
  SPEAKER_01: Well, I've really enjoyed this discussion because I'm very hopeful, you know, that we do maintain some of these low rates.
• 15:44
  SPEAKER_01: I love the idea, Erica, of a ripple.
• 15:46
  SPEAKER_01: I'm very hopeful that's the case.
• 15:47
  SPEAKER_01: And I agree, Julie, that we just also need to be vigilant because I think one thing that we've all learned is that predicting the future in the time of this pandemic has been incredibly difficult.
• 15:58
  SPEAKER_01: So keeping in mind that we have these decreased community rates and things are maybe looking up.
• 16:04
  SPEAKER_01: I'm going to combine these next two questions here.
• 16:07
  SPEAKER_01: So if you look at your facilities policies pre-pandemic and today, what are the major differences and what changes do you see on the horizon?
• 16:15
  SPEAKER_01: You know, maybe commenting specifically on how you're managing masking for staff in your facilities?
• 16:21
  SPEAKER_02: Well, yeah, these are really great questions.
• 16:24
  SPEAKER_02: You know, I think that the pandemic gave us the steepest learning curve we could ever imagine, right?
• 16:30
  SPEAKER_02: I think that, you know, what's interesting is many of these policies regarding hand hygiene and isolation precautions, environmental cleaning were already in place at that time.
• 16:41
  SPEAKER_02: And, you know, much of it was again reinforced when we had other high-consequence infectious diseases like Ebola coming through sporadically in the community.
• 16:49
  SPEAKER_02: But I think the current pandemic really helped everyone realize how important hand hygiene, appropriate PPE, and environmental cleaning really were.
• 16:59
  SPEAKER_02: And I think that that has been probably one of the biggest changes that we've seen is the amount of attention people are paying to following those policies.
• 17:08
  SPEAKER_02: But also another impact is the amount of attention healthcare workers are paying to symptoms that people might have, whether it's themselves or coworkers.
• 17:17
  SPEAKER_02: And the whole purpose with is, you know, the goal of reducing presenteeism.
• 17:22
  SPEAKER_02: I mean, I think many of us had many, many stories of the healthcare worker or someone who came to work with a cough, maybe a low-grade fever, and then that was the cause of exposing numerous patients or other staff to influenza A, B, or whatever the virus of the day was.
• 17:38
  SPEAKER_02: You know, so I think that with the general hypervigilance about symptoms and symptoms related to COVID, I think we started to see a lot less presenteism.
• 17:48
  SPEAKER_02: And so that's a really amazing thing.
• 17:50
  SPEAKER_02: And we're also so much better in our forecasting, monitoring testing data, admissions data, being able to monitor our PPE supply utilization.
• 17:59
  SPEAKER_02: So I think that, you know, our institutional policies as far as how they might have changed, you know, we've had a lot more insight on the size of gatherings and how we would scale up activities or scale them down based on the number of, let's say, healthcare workers who are testing positive and community levels and hospitalization numbers.
• 18:18
  SPEAKER_02: As far as masking is concerned, we are still continuing to require masking in all clinical areas or buildings that house clinical areas.
• 18:28
  SPEAKER_02: We, you know, cannot mandate masking in the non-clinical areas.
• 18:32
  SPEAKER_02: So many of the other parts of campus, where there may be research labs or faculty offices, in those areas, masking is strongly encouraged or strongly recommended, but they are not required or mandated.
• 18:44
  SPEAKER_02: So currently that's what we're doing.
• 18:47
  SPEAKER_02: We did, you know, masks are highly available to everyone, and 95s at this point are highly available to anyone who is interested in using one of those as well.
• 18:57
  SPEAKER_02: But I know the discussions are starting to come around as far as when we might be able to relax masking in healthcare facilities.
• 19:05
  SPEAKER_02: And I think one point that might help bring us towards that might be with the healthcare worker mandate for vaccination.
• 19:12
  SPEAKER_02: And that once we have an established number of, you know, what percentage of our healthcare workers are vaccinated, what percentage have exemptions, it might take on a similar flavor to influenza when we're in influenza season, that those individuals who are unvaccinated would be required to wear a mask during flu season.
• 19:31
  SPEAKER_02: The caveat being that with COVID, we've not certainly seen any seasonality to it.
• 19:36
  SPEAKER_00: So I think that's a great point.
• 19:39
  SPEAKER_00: I think I try to think about the anchor of how we manage flu and how far away we are to that, not just in terms of masking, but in terms of exposures, prophylaxis, that sort of thing.
• 19:50
  SPEAKER_00: So that's an anchor because we know that well and we manage that for many, many years effectively in healthcare.
• 19:56
  SPEAKER_00: I would say that when I think of how we're different today than before, right now at this moment, and this is not just for Mass General Hospital, we're part of a larger 14 facility system, Mass General Brigham.
• 20:09
  SPEAKER_00: The main pieces are masking, where we require masking of all in public, common, and clinical areas.
• 20:17
  SPEAKER_00: We don't make a distinction between buildings that may be just research buildings or not.
• 20:22
  SPEAKER_00: So we've kept the universal face mask in those locations.
• 20:25
  SPEAKER_00: But most recently, we have allowed for non-distanced, non-massed interactions between our fully vaccinated healthcare workers in conference rooms, break rooms, eating locations.
• 20:39
  SPEAKER_00: And that's just uh occurred over the last maybe four or so weeks, partly because of the community rates, partly because of high levels of vaccination, and also because the density on our campuses has made it really challenging to maintain those sorts of physical distancing places for when people need breaks and need to eat.
• 20:58
  SPEAKER_00: I think it's also been, at least my impression so far, a real boost to morale to be able to have some more of those normal interactions or pre-pandemic interactions.
• 21:08
  SPEAKER_00: And it's all mask optional.
• 21:10
  SPEAKER_00: So people, regardless of whether they're full, if you're fully vaccinated, you're obviously permitted to do this.
• 21:15
  SPEAKER_00: But some people who are fully vaccinated still want to maintain wearing our face mask in those settings, and that's perfectly fine.
• 21:21
  SPEAKER_00: The second piece, uh, separate from masking, I totally agree with your point about this focus on presenteism.
• 21:27
  SPEAKER_00: We have maintained the daily symptom at testation.
• 21:30
  SPEAKER_00: You know, sometimes that can be kind of rote, but every time I'm trying to log into my computer in the morning and it's prompting me to ask those questions, I think it is kind of reminding all of us about being honest with it.
• 21:41
  SPEAKER_00: So and trying to avoid presenteism.
• 21:44
  SPEAKER_00: And then that last piece we kind of covered before is the testing around asymptomatic individuals.
• 21:48
  SPEAKER_00: If we think about that anchoring to flu, we would never test someone for flu if they were asymptomatic or prior to a procedure.
• 21:55
  SPEAKER_00: So we're pretty far away still from that piece of it and for considering exposure.
• 22:00
  SPEAKER_00: Exposures and management of exposures.
• 22:02
  SPEAKER_00: So I guess many things have changed a lot.
• 22:05
  SPEAKER_00: You highlighted the kind of core principles of infection prevention and control.
• 22:10
  SPEAKER_00: But I'm really optimistic that we're headed towards a time when we would start thinking about this.
• 22:14
  SPEAKER_00: Hopefully, it'll become more seasonal and we can approach it in a similar way that we have, you know, obviously with lessons learned from COVID, but in a similar way that we have with flu, which is less disruptive to kind of the entire system.
• 22:28
  SPEAKER_02: I think those are great points, Erica.
• 22:30
  SPEAKER_02: And, you know, another thing that I was thinking about is that all of this will allow us to be more nimble in the future.
• 22:36
  SPEAKER_02: You know, I think that what might change is the pathogen that we're dealing with, but we've learned so much about how to disseminate information to the healthcare community, including our own employees.
• 22:47
  SPEAKER_02: We've learned so much about identifying trends and healthcare settings and community settings, and then being able to adapt as needed.
• 22:54
  SPEAKER_02: So a lot of that adaptation, we could certainly set policies in place.
• 22:58
  SPEAKER_02: But just to kind of touch upon the part as far as daily symptom attestation, we actually ended up moving away from that probably a few months ago.
• 23:07
  SPEAKER_02: And, you know, a lot of it was really more on our system and on our code, you know, that if you're coming into the healthcare facility by entering in there, that in and of itself was saying that, you know, you didn't have any symptoms and you weren't ill or haven't been recently exposed.
• 23:22
  SPEAKER_02: And I think, you know, that's been really helpful for people, showing that they do have some autonomy over themselves and also addressed some of the inadequacies with temperature scanning at the entries, right?
• 23:36
  SPEAKER_02: We've all had those stories of somebody coming in with a temperature of 94 and just, you know, how many of these policies that we had put in place or these practices, you know, were never perfect, right?
• 23:46
  SPEAKER_02: But they were really there as part of harm reduction and risk mitigation strategies, but knowing that they were never going to catch every single person that was going to come through the door, possibly with COVID or some other type of respiratory illness.
• 23:59
  SPEAKER_00: That's a great point.
• 24:00
  SPEAKER_00: So you've gone away from the daily symptom attestation.
• 24:04
  SPEAKER_00: We've talked about it and what value does it bring.
• 24:06
  SPEAKER_00: I think the other piece of our attestation piece is it's linked to access to if you want to schedule a test, if you want to schedule, you know, vaccination.
• 24:16
  SPEAKER_00: And so it's almost like a module.
• 24:18
  SPEAKER_00: So it's kind of built into that.
• 24:20
  SPEAKER_00: But I think, you know, at some point it is really important to say like the expectation is when you come to work, you are really by stepping onto our premises, attesting to all these things.
• 24:30
  SPEAKER_00: And we just haven't gotten there yet here.
• 24:32
  SPEAKER_00: I think because of the linkages around what do you do in a household exposure and some of the teachings that happen in this app that the employees in our system use to do attestation either on their phone or when they log into the computer.
• 24:46
  SPEAKER_02: Yeah, it's really interesting to see the variability in what different healthcare facilities are doing and how a lot of that is related to the general, I'm going to say the flavor of COVID restrictions or, you know, mitigation strategies in their community as well.
• 25:02
  SPEAKER_02: And we've seen variability.
• 25:03
  SPEAKER_02: I mean, there are still some hospitals that are doing temperature screening.
• 25:07
  SPEAKER_02: There are others that have moved away from actively screening any healthcare workers.
• 25:12
  SPEAKER_02: We still do infection risk screen for our patients and our visitors that are coming in because they may not necessarily be as aware.
• 25:21
  SPEAKER_02: And I think another feature that you mentioned as far as having access to scheduling for testing or vaccination, we incorporated all of that into our Epic MyChart app that everybody who works here and you know who was vaccinated, let's say at UT Southwestern, has access to.
• 25:37
  SPEAKER_02: So they have that freedom now to be able to go in there, schedule a test, schedule their second booster if they want it currently, and whatever else that they need to do.
• 25:46
  SPEAKER_02: So I think really providing that autonomy and giving a lot of that back to the healthcare workers and other employees has been really helpful and instrumental.
• 25:54
  SPEAKER_01: All great points.
• 25:56
  SPEAKER_01: I really think uh you hit it on the head well that you're we've learned a ton throughout this pandemic, and it's exciting to see how far we've come.
• 26:04
  SPEAKER_01: And it's exciting to even be talking about what it might look like post-pandemic and how we can maybe not go exactly back to how it was before, but carry some of those lessons forward.
• 26:15
  SPEAKER_01: Before we wrap up today, do either of you have any final thoughts for our listeners?
• 26:20
  SPEAKER_00: I just wanted to call out something that was mentioned around being able to be flexible and respond to metrics in the community.
• 26:29
  SPEAKER_00: And I think one of the challenges is the metrics have changed over time.
• 26:33
  SPEAKER_00: And so one of the things I valued with Shay is the ability to have, well, this conversation, but also the town halls every other week where you hear how many people are addressing the same issues.
• 26:44
  SPEAKER_00: We're all in different places, either because of where we are geographically in the country or the physical setup of our facilities, or if we're in acute care versus long-term care.
• 26:54
  SPEAKER_00: So there's all those considerations.
• 26:56
  SPEAKER_00: And so having the community within Shea to bounce ideas off and learn from each other has just been, I don't know, a lifeline during the pandemic.
• 27:04
  SPEAKER_00: And I've really appreciated this conversation today and the other conversations that have been informal, but also during the Shay Town Halls.
• 27:11
  SPEAKER_02: Thanks, Erica.
• 27:12
  SPEAKER_02: Yeah, I would agree completely that I've really appreciated this conversation and many other conversations that have been had throughout the pandemic.
• 27:20
  SPEAKER_02: And I think that I would agree completely that it's, you know, one thing that we've learned is that we may not have a perfect solution, but that whatever can be done to help reduce harm is certainly going to be helpful and beneficial as well.
• 27:36
  SPEAKER_02: So it's really about connecting with the community, sharing information with each other, because that is how we're all learning as we go along.
• 27:44
  SPEAKER_02: So that's really been an honor and a privilege to be able to be part of Shay and partake in some of these conversations.
• 27:50
  SPEAKER_01: Great point, both of you.
• 27:52
  SPEAKER_01: Erica and Julie, thank you for such a great conversation and for joining us today.
• 27:56
  SPEAKER_01: Thank you, Whitney.
• 27:58
  SPEAKER_01: Thanks for having us.
• 27:59
  SPEAKER_01: Thank you again to our speakers for sharing their perspectives and experiences.
• 28:03
  SPEAKER_01: This podcast can be accessed on SHA's online education center, Learning CE, under the Rapid Response Program, where you will also find resources such as the SHA COVID-19 town hall mentioned here.
• 28:15
  SPEAKER_01: Interested in becoming a SHA member?
• 28:17
  SPEAKER_01: Take$20 off any membership type using the coupon code LEARNINGCE22 at checkout.
• 28:22
  SPEAKER_01: This concludes today's episode of the Rapid Response Podcast.
• 28:26
  SPEAKER_01: Thank you for tuning in.