Latest / The SHEA Podcast / COVID-19: Call the Healthcare Epidemiologist, 7/16

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COVID-19: Call the Healthcare Epidemiologist, 7/16 · The SHEA Podcast

• 0:08
  SPEAKER_02: Welcome to the Rapid Response Podcast, brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:21
  SPEAKER_02: I am Dr.
• 0:22
  SPEAKER_02: David Bannock from the University of Connecticut and I will serve as your moderator.
• 0:25
  SPEAKER_02: The 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.
• 0:33
  SPEAKER_02: Shay is excited to launch the 22nd episode of this podcast, COVID-19 Updates, What We Know Now.
• 0:38
  SPEAKER_02: We hope this episode will help you compare your approach to what others in healthcare epidemiology and infection prevention are doing around the country.
• 0:45
  SPEAKER_02: Shay hopes this discussion provides a glimpse into what others are concerned about and how they are approaching these decisions.
• 0:50
  SPEAKER_02: Our speakers today are Dr.
• 0:51
  SPEAKER_02: Jennifer Hanrahan, an infection specialist at the University of Toledo, and Dr.
• 0:55
  SPEAKER_02: Waleed Javade, Director of Infection Prevention and Control at Mount Sinai Downtown Network, Mount Sinai, Brooklyn.
• 1:01
  SPEAKER_02: Thank you for joining us today.
• 1:02
  SPEAKER_02: I would now like to turn it over to Dr.
• 1:04
  SPEAKER_02: Hanrahan to get us started with a brief news and guidance update from the week.
• 1:08
  SPEAKER_01: Thank you.
• 1:08
  SPEAKER_01: There are now 13,119,239 cases of COVID-19 in the world, and there are 573,752 deaths.
• 1:20
  SPEAKER_01: On July 8th, the Infectious Disease Society of America issued a statement calling on the public to wear a mask to slow the spread of COVID-19.
• 1:28
  SPEAKER_01: The statement by Infectious Disease Society of America President, Dr.
• 1:31
  SPEAKER_01: Thomas File, implores the public to take the only simple and effective steps we have to slow the spread of the coronavirus and save lives, key among which is to wear a mask.
• 1:42
  SPEAKER_01: The statement says that with no vaccine and limited treatment options, we must work together to protect one another or risk prolonged human and economic suffering.
• 1:53
  SPEAKER_01: Masks are especially important in enclosed spaces and should be worn in all community settings.
• 1:58
  SPEAKER_01: The World Health Organization Director General's opening remarks at the media briefing on COVID-19 on July 13th summed up the situation as follows.
• 2:08
  unknown: Dr.
• 2:08
  SPEAKER_01: Gabriel Assis states, let me be blunt.
• 2:11
  SPEAKER_01: Too many countries are headed in the wrong direction.
• 2:14
  SPEAKER_01: The virus remains public enemy number one, but the actions of many governments and people do not reflect this.
• 2:19
  SPEAKER_01: The only aim of the virus is to find people to infect.
• 2:22
  SPEAKER_01: Mixed messages from leaders are undermining the most critical ingredient of any response, trust.
• 2:28
  SPEAKER_01: If governments do not clearly communicate with their citizens and roll out a comprehensive strategy focused on suppressing transmission and saving lives, if populations do not follow the basic public health principles of physical distancing, hand washing, wearing masks, coughing etiquette, and staying home when sick, if the basics aren't followed, there is only one way this pandemic is going to go.
• 2:50
  SPEAKER_01: It's going to get worse and worse and worse.
• 2:52
  SPEAKER_01: In addition to increasing numbers of COVID-19 cases and deaths, there has been a great deal of discussion about airborne transmission of COVID-19.
• 3:00
  SPEAKER_01: An article summarizing theoretical considerations and available evidence for airborne transmission of SARS-CoV-2 was published July 13th in JAMA.
• 3:10
  SPEAKER_01: The authors make the point that while experimental data support the possibility of airborne transmission, even in the absence of aerosol generating procedures, the data on infection rates and transmission are not consistent with long-range aerosol-based transmission, and that the secondary attack rate among household contacts and healthcare workers unknowingly exposed to patients with COVID-19 is low.
• 3:33
  SPEAKER_01: Although there have been some instances of widespread transmission in enclosed spaces, those cases are unusual.
• 3:40
  SPEAKER_01: On a promising note, an article published in the New England Journal of Medicine on July 14th describes a phase one dose escalation open label clinical trial that included 45 healthy adults who received two vaccinations of a candidate messenger RNA vaccine.
• 3:55
  SPEAKER_01: The vaccine was found to be immunogenic and was generally well tolerated.
• 3:59
  SPEAKER_01: The authors described that the product development process, which usually takes years, was completed in two months, and first participants were vaccinated on March 16.
• 4:08
  SPEAKER_01: The rapid development of the candidate vaccine and preliminary data allowed the start of a large-scale clinical trial within six months of the start of the pandemic.
• 4:17
  SPEAKER_01: And that's the news.
• 4:19
  SPEAKER_02: Thank you very much, Dr.
• 4:20
  SPEAKER_02: Hanrahan.
• 4:21
  SPEAKER_02: So I'd like to move this into more of a discussion.
• 4:23
  SPEAKER_02: You know, I think both of you have had a lot of experience going through the COVID-19 pandemic, and we're also seeing a lot of the same questions that keep arising, and really some of them have clear answers, but a lot of them don't.
• 4:34
  SPEAKER_02: So I think it's important for us to discuss some of these challenges and how we've been approaching them and learn from each other.
• 4:40
  SPEAKER_02: I think to get everything started, why don't I have you guys kind of update us on where things stand, both at your respective hospitals and in your geographic areas in terms of COVID-19 prevalence and kind of give us an understanding as to where we are at the moment.
• 4:52
  SPEAKER_02: So I'll start with you, Dr.
• 4:54
  SPEAKER_02: Hanorhan.
• 4:55
  SPEAKER_01: Sure.
• 4:55
  SPEAKER_01: You know, it's really interesting because this has really changed quite a bit.
• 4:59
  SPEAKER_01: In Ohio, right now, we actually have the most cases that have been reported in a single day.
• 5:06
  SPEAKER_01: So we actually had more cases reported yesterday than at our peak.
• 5:11
  SPEAKER_01: Basically, that means we're currently at our peak.
• 5:13
  SPEAKER_01: And at the same time, we're not seeing nearly as many patients hospitalized.
• 5:18
  SPEAKER_01: So, you know, of course, it's not completely clear what this means.
• 5:21
  SPEAKER_01: Are we doing a lot more testing or are people less sick than they previously were?
• 5:26
  SPEAKER_01: I mean, just in terms of the people who are in the hospital, we're definitely not seeing the same number of deaths that we were seeing previously, and you know, we're not having as many patients on ventilators.
• 5:38
  SPEAKER_01: So that part is good.
• 5:40
  SPEAKER_01: But clearly the numbers continue to go up.
• 5:42
  SPEAKER_02: And how about in your region in general?
• 5:44
  SPEAKER_02: Are you seeing increases in number of cases in Ohio and number of hospitalizations?
• 5:49
  SPEAKER_01: In Ohio as a whole, you know, the numbers are going up, but you know, it's difficult.
• 5:54
  SPEAKER_01: In our region, the hospitalizations are not going up.
• 5:56
  SPEAKER_01: You know, they've been at a fairly low rate for some time, and it's been pretty steady.
• 6:01
  SPEAKER_02: All right.
• 6:02
  SPEAKER_02: Dr.
• 6:02
  SPEAKER_02: Javaid, can you share with things stand in Brooklyn and New York City as a whole?
• 6:07
  SPEAKER_00: Yeah, so in Manhattan or New York City as a whole, and in the hospitals I work in, what we are seeing is consistently lower numbers of patients with coronavirus illness, especially getting admitted.
• 6:19
  SPEAKER_00: Overall, I think I'm looking at New York State numbers, they have been testing more and more patients, but the percentage positivity has gone down substantially.
• 6:30
  SPEAKER_00: At one point in our hospital, we had percentage positivity, which is how many tests we did versus how many were positive.
• 6:38
  SPEAKER_00: It was as high as 50 to 60 percent, and now it is less than 1%.
• 6:44
  SPEAKER_00: And that gives you a picture of how much testing we are doing.
• 6:47
  SPEAKER_00: But overall, I think the numbers have decreased substantially.
• 6:50
  SPEAKER_00: That has also taken some pressure off our frontline staff in terms of looking at this pandemic.
• 6:56
  SPEAKER_00: The issue now we are facing is people coming from out of state.
• 7:00
  SPEAKER_00: How do we deal with them?
• 7:02
  SPEAKER_00: Their quarantine requirements and other issues, and then possibly having a second surge.
• 7:07
  SPEAKER_02: So I think we are in kind of a similar situation here in Connecticut.
• 7:11
  SPEAKER_02: We have lower rates, although still having positive test results.
• 7:14
  SPEAKER_02: I think statewide our positivity rate of all testing is under 1%.
• 7:18
  SPEAKER_02: And you know, in our hospital, it's only, I would say, less than a handful of patients.
• 7:22
  SPEAKER_02: But you know, we share the same concerns.
• 7:24
  SPEAKER_02: You know, we see what's happening in other parts of the country, and there's certain regions, I know Florida and Texas have gotten a lot of attention with rising rates of cases and hospitalizations and the influence that that's going to have on other states, including ours, I think, is what we're really uh attentive to at this point.
• 7:40
  SPEAKER_02: So you guys had talked a little bit about testing.
• 7:42
  SPEAKER_02: Can you kind of elaborate in some more detail where your respective institutions are focusing testing practices in terms of patients in both inpatient and outpatient settings and how that's evolved in the over the last few weeks?
• 7:57
  SPEAKER_02: I'll turn it over to Dr.
• 7:58
  SPEAKER_02: Javed first.
• 8:00
  SPEAKER_00: So we actually are trying to test as many people as possible, and anybody who's admitted, who's getting procedures, there are certain individuals who are getting discharged to nursing homes.
• 8:13
  SPEAKER_00: So there are certain pre-existing requirements that we fulfill, and then also anybody who wants to get tested.
• 8:25
  SPEAKER_00: The screening is another issue.
• 8:27
  SPEAKER_00: Very recently we have started screening everybody coming into our hospital.
• 8:30
  SPEAKER_00: There are a few methods we're using, but we try to screen patients and visitors, and then visitors have certain classes, visitors or vendors and others.
• 8:40
  SPEAKER_00: We are screening everyone coming into our hospital at this time.
• 8:45
  SPEAKER_00: The screening questions are simple, they are based on CDC if they have symptoms and if they have been to a state or have been out of the United States, they might be exposed to coronavirus illness.
• 8:59
  SPEAKER_02: Yeah, we're in sort of the same situation.
• 9:01
  SPEAKER_02: Um our testing primarily is focusing on pre-procedural testing, and these screening processes are becoming a bit of a challenge.
• 9:10
  SPEAKER_02: We are adding questions to our screening, including recent travel.
• 9:14
  SPEAKER_02: Um and our state, and I think um some other states as well have identified specific regions where if individuals are coming from those high prevalence regions, they need to quarantine upon arrival.
• 9:24
  SPEAKER_02: So we're asking specific questions about that, and that literally changes every week, you know, as we get new states that are coming up on that list uh that our state releases.
• 9:32
  SPEAKER_02: So I think that's been a challenge.
• 9:34
  SPEAKER_02: Another area that we've been grappling with is you know how to staff the screening stations.
• 9:38
  SPEAKER_02: We had previously deployed folks from other areas of the hospital to staff these screening stations, and now that we are resuming our normal operations, they've moved back to their original locations of work, so we're having a difficult time finding individuals to staff the screening stations.
• 9:54
  SPEAKER_02: I don't know if either of you are encountering the same challenges.
• 9:57
  SPEAKER_02: So, Dr.
• 9:57
  SPEAKER_02: Hammering, where do you think stand with testing as well as uh screening processes at your facility?
• 10:03
  SPEAKER_01: Yeah, so you know, for screening, it sounds like we're all doing really similar things.
• 10:07
  SPEAKER_01: Yeah, I think there definitely are challenges with staffing all of the screening stations.
• 10:12
  SPEAKER_01: We have actually gone to some automated temperature recording on some shifts, you know, with the thermal scanning that you stand in front of.
• 10:21
  SPEAKER_01: And so when employees come in, they have to take their temperature.
• 10:24
  SPEAKER_01: We are screening all visitors and you know, patients are being screened as well whenever they come into a facility.
• 10:31
  SPEAKER_01: As far as testing, you know, the testing is still a challenge.
• 10:34
  SPEAKER_01: I have to say that, you know, I know that our microbiology lab sends the test to multiple different facilities depending on how quickly the test needs to come back.
• 10:43
  SPEAKER_01: We still are not really at the point that I would like to be, like we don't have capacity right now to test everybody who comes into the emergency department who maybe is not sick enough to be hospitalized, but still you'd like to know whether or not they're positive.
• 10:57
  SPEAKER_01: We are focusing testing on people who are gonna have procedures done, people are gonna be starting chemotherapy, and then of course, symptomatic healthcare workers and also anyone who comes into the hospital who has symptoms consistent with COVID-19 or you know, there's some suspicion.
• 11:13
  SPEAKER_01: So we are doing a lot more testing, but it's still not enough.
• 11:18
  SPEAKER_01: I mean, ultimately, I think we will need to have the capacity to be able to test absolutely everybody who gets admitted to the hospital.
• 11:24
  SPEAKER_01: And it sounds like New York is there, but we're not there yet.
• 11:28
  SPEAKER_02: Yeah, I think that's been an ongoing struggle.
• 11:30
  SPEAKER_02: You know, we have different tests that we're using based on our capacity to do different things, and they have all different turnaround times, and you know, figuring out which testing platform is appropriate for which setting based on the turnaround time, I think has been constant evolution.
• 11:46
  SPEAKER_02: Ideally, we have rapid testing available universally, but you know, unfortunately we haven't been able to uh secure that.
• 11:52
  SPEAKER_02: And I think a lot of places across the country have also been struggling with turnaround times, particularly the areas that are having a real rise in the number of cases.
• 12:00
  SPEAKER_02: Sounds like they're still having some challenges with getting rapid turnaround times.
• 12:03
  SPEAKER_02: So I I think that has to be a huge focus moving forward, and you know, hopefully we'll see uh some more progress.
• 12:09
  SPEAKER_01: You know, one of the interesting things that has come up recently is in some of these patients who would normally be going through the evaluation for PCR testing, we're actually doing antibody tests on some of these patients, and you know, that actually comes back much more quickly in some instances than the nasopharyngeal swab.
• 12:27
  SPEAKER_01: And what's been interesting is we had someone the other day who came in with shortness of breath and had, you know, these hatchy infiltrates on chest x-ray that really looked like it could be COVID, but it ended up that we ended up getting an antibody, and his antibody was positive, and then we ended up getting a CT scan, and really it was metastatic cancer rather than COVID.
• 12:47
  SPEAKER_01: So, you know, I think certainly the way that we're doing the testing is going to be evolving as we learn more information.
• 12:54
  SPEAKER_01: But I think antibody testing can also be used in some situations and in patients.
• 12:59
  SPEAKER_02: I'm interested in how both of your organizations are using antibody testing.
• 13:03
  SPEAKER_02: We've been using it on a limited basis, kind of looking at specific clinical situations where we've had negative PCR testing and used antibody testing in that sense.
• 13:12
  SPEAKER_02: I think other uh institutions are looking at using it for things like determining how long individuals may need to be on precautions who test negative and taking them off precautions.
• 13:22
  SPEAKER_02: I don't know if either of you can speak to any additional experience you had using antibody testing.
• 13:27
  SPEAKER_01: Yeah, so we have used antibodies in some situations where patients have been in the hospital for a really extended period of time.
• 13:34
  SPEAKER_01: You know, when they start to get beyond three weeks, we have been evaluating those patients for coming out of isolation if they are afebrile.
• 13:44
  SPEAKER_01: Like, for example, a lot of patients who get intubated are severely deconditioned afterwards and they no longer are having fever or any infectious complications, but they're still in the hospital.
• 13:54
  SPEAKER_01: And in those situations, you know, I think it makes sense to actually test for antibodies.
• 13:58
  SPEAKER_01: Obviously, we don't have all the information that we need, but I think it's unlikely that those people are continuing to be contagious.
• 14:05
  SPEAKER_01: And so we have been removing those patients from isolation.
• 14:09
  SPEAKER_02: So, Dr.
• 14:10
  SPEAKER_02: Vade, any experience with antibody testing at your hospital?
• 14:14
  SPEAKER_00: Yeah, very similar to what Jennifer said.
• 14:16
  SPEAKER_00: I think the lays for antibody testing is there both sometimes in diagnostics and also possibly removing precautions.
• 14:24
  SPEAKER_00: But there are a few things to consider here.
• 14:27
  SPEAKER_00: For example, for our state health department as well as for CEC, they don't really include antibody testing as part of their workup for removing precautions.
• 14:38
  SPEAKER_00: And I wanted to highlight this because recently we had a lot of conversation about how we can use antibody testing, especially in these scenarios.
• 14:48
  SPEAKER_00: So what we are doing now, and I think fortunately we are in a position to do it, is people who were positive in March or who had symptoms in March and April was the time when New York had their highest number.
• 15:01
  SPEAKER_00: So when we had those patients preparing to have symptoms but may not have been tested, and they now are testing positive but are not symptomatic, to see what the antibody level is and to possibly kind of gauge of what kind of status they are in currently.
• 15:17
  SPEAKER_00: I think the this kind of helps us also rule in or rule out people who might have persistent positive VCR tests, but now have developed antibodies and possibly are protected and not infectious anymore.
• 15:31
  SPEAKER_00: I think that there are some ways to use it, and again, like we probably continue to evolve in our understanding of how to best use it going forward as well.
• 15:41
  SPEAKER_02: So I think one thing that you alluded to and something that I think is worth some discussion is basically the removal of transmission-based precautions for patients.
• 15:50
  SPEAKER_02: You know, that's something that we have struggled with, and you know, the CDC has kind of consistently revised guidelines on strategies for discontinuation of transmission-based precautions based on you know symptom criteria or time-based criteria for people who are asymptomatic.
• 16:04
  SPEAKER_02: We have individuals that come in and test positive and then need to be retested, like to be discharged to a nursing facility.
• 16:13
  SPEAKER_02: There's some requirements for that, and continue to test positive.
• 16:16
  SPEAKER_02: And that creates a real sort of conundrum and some discomfort amongst our staff when we have individuals who test repeatedly positive, even though our general practice is not to repeat testing.
• 16:25
  SPEAKER_02: Um we've actually used antibody testing in some of those situations as a component in the decision making for discontinuation of precautions, but it's still uh a challenge, you know, because we know that uh patients will stay PCR positive for several weeks, and then you know, working with uh the frontline staff and helping them feel comfortable with discontinuing precautions.
• 16:46
  SPEAKER_02: I'd be interested to hear how you guys have had experiences in that and any uh advice you might have in order to kind of reassure the staff that uh it's okay to discontinue precautions.
• 16:56
  SPEAKER_01: And so those are the most difficult questions, and they're the questions that we've had since the beginning, and we just really don't have enough answers on this particular thing yet.
• 17:05
  SPEAKER_01: So South Korea did a really large study looking at people who were what they called repositive, so people that had tested positive, then tested negative, and then tested positive again for whatever reason.
• 17:18
  SPEAKER_01: And when they looked at those people who tested positive again, they actually did not have any secondary transmission afterwards.
• 17:26
  SPEAKER_01: So it gave me more confidence that these people who are repeatedly testing positive.
• 17:31
  SPEAKER_01: And you know, we've had people who tested positive for, you know, more than 50 days and you know, longer.
• 17:38
  SPEAKER_01: And I don't think those people are still contagious, and there's been a lot of debate about that, but it's really not looking like those people are continuing to be contagious.
• 17:47
  SPEAKER_01: So we have decided that basically at 21 days we look at the patient and see whether or not they're having any fever or you know, ongoing symptoms, and if they're not having symptoms, at that point we take them out of isolation.
• 18:01
  SPEAKER_01: We're actually not doing repeat testing by PCR anymore because we know that it often comes back positive, and that doesn't necessarily mean anything.
• 18:11
  SPEAKER_01: To me, this is gonna raise a lot of questions in the future because if people can get reinfected, which is another thing that we don't really know at this point, but it sounds like there's starting to be some cases being reported.
• 18:23
  SPEAKER_01: If that happens, then how are you gonna interpret these tests?
• 18:27
  SPEAKER_01: So the biggest problem that I see is that we don't have a test that tells us with certainty whether or not somebody has active infection.
• 18:34
  SPEAKER_01: And that is, I think, the most difficult thing about all of this.
• 18:38
  SPEAKER_02: I agree.
• 18:39
  SPEAKER_02: I think you nailed it perfectly.
• 18:41
  SPEAKER_02: You know, we know that the PCR stays positive for quite a while, but an individual who several weeks after the initial diagnosis is presenting with a febrile illness, you know, we get a positive PCR.
• 18:51
  SPEAKER_02: What does that really mean?
• 18:51
  SPEAKER_02: Is that a new infection?
• 18:53
  SPEAKER_02: Is that you know just persistent viral shedding from the previous infection?
• 18:56
  SPEAKER_02: You know, I I think there's a lot of unknowns and starting to create some discomfort, especially with some of these reports that are coming out of re-infections.
• 19:03
  SPEAKER_02: So I think we're gonna continue to grapple with this in the future, and you know, hopefully uh we'll get some more insight into how to answer these questions outside of being able to perform cultures for live viruses to really determine infectiousness.
• 19:16
  SPEAKER_02: But you know, I think uh these are gonna um continue to be challenges moving forward.
• 19:20
  SPEAKER_02: And I do want to think a little bit about the future.
• 19:22
  SPEAKER_02: You know, we know that the flu season's coming up, and uh we are doing some planning with our laboratory, um, even with our facility as a whole, uh, thinking about the flu season and how we're gonna be able to potentially navigate through both COVID and influenza.
• 19:38
  SPEAKER_02: And I think there's gonna be a lot of challenges.
• 19:41
  SPEAKER_02: You know, even thinking about our testing platforms, they don't necessarily align in the absence of a true like multiplex.
• 19:48
  SPEAKER_02: I think that's gonna be an ongoing challenge.
• 19:50
  SPEAKER_02: I'm interested to hear in with what kind of challenges you guys are facing at your institutions pertaining to the upcoming fall with COVID and flu overlapping.
• 19:58
  SPEAKER_01: So it's gonna be more challenging, as you've mentioned, because we still don't have enough nasopharyngeal swabs to be able to do all the testing that we want to do.
• 20:07
  SPEAKER_01: So I think there's gonna be substantial supply challenges in the fall unless you know there's a big increase in production.
• 20:15
  SPEAKER_01: So we're struggling with this.
• 20:16
  SPEAKER_00: Dr.
• 20:17
  SPEAKER_02: Vade, what do you think?
• 20:18
  SPEAKER_00: Yeah, so it's a really good question.
• 20:20
  SPEAKER_00: We are actually looking at a multiplex assets that would include influenza as well as coronavirus and obviously other viruses.
• 20:28
  SPEAKER_00: Because I think as Jennifer said, I think we will otherwise quickly run out of all swaps as we had earlier in this pandemic.
• 20:36
  SPEAKER_00: We really would need to have one swap and that gives us all the answers.
• 20:40
  SPEAKER_00: Otherwise, we will struggle.
• 20:42
  SPEAKER_00: And I think this kind of situation is also going to be difficult because not everybody is going to have a multiplex test.
• 20:50
  SPEAKER_00: And how do we rule in and rule out influenza, which is also contagious and dangerous versus coronavirus, which obviously is the current pandemic?
• 20:59
  SPEAKER_00: The other issue to probably highlight is that there has been some indication or discussion that there might be a more challenging influenza season this year as well.
• 21:09
  SPEAKER_00: So looking at all these factors, we need to possibly prepare for all the worst-case scenarios.
• 21:15
  SPEAKER_00: Looking at all these things, supply chain may be a challenge.
• 21:19
  SPEAKER_02: I think these are good questions, but I think you know having these kinds of discussions periodically to look at the most pressing issues that we're all facing is going to be really critical.
• 21:27
  SPEAKER_02: And you know, we'll look forward to doing that moving forward with future podcasts.
• 21:31
  SPEAKER_02: I do want to thank you both for joining this podcast.
• 21:34
  SPEAKER_02: I think this is very informative and I think will serve as kind of a stepping stone for future podcasts.
• 21:41
  SPEAKER_02: So I do want to extend a sincere thank you from Shay to all healthcare personnel for all that you are doing to respond to COVID-19.
• 21:47
  SPEAKER_02: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 21:54
  SPEAKER_02: You will also find additional resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHAY COVID-19 town halls.
• 22:01
  SPEAKER_02: Additional resources available on Learning CE pertinent to this pandemic include the SHAY CDC Outbreak Response Training Program, ORTP, and the Prevention Course in HAI Knowledge and Control Prevention Check.
• 22:13
  SPEAKER_02: This concludes this episode of the Rapid Response Podcast.
• 22:16
  SPEAKER_02: Thank you to Dr.
• 22:17
  SPEAKER_02: Hanrahan and Dr.
• 22:18
  SPEAKER_02: Javade, and thank you all for tuning in.