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COVID-19: Lessons Learned In Pediatrics, 8/27 · The SHEA Podcast

• 0:07
  SPEAKER_01: 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.
• 0:22
  SPEAKER_01: I'm Dr.
• 0:23
  SPEAKER_01: Jennifer Hanarhan, infectious disease specialist at the University of Toledo, and I will serve as your moderator.
• 0:29
  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.
• 0:39
  SPEAKER_01: Shay is excited to launch the 27th episode of this podcast, COVID-19 updates, what we know now.
• 0:46
  SPEAKER_01: Today's discussion will focus on COVID-19 and pediatrics.
• 0:50
  SPEAKER_01: Our speaker today is Dr.
• 0:51
  SPEAKER_01: Matt Lynum, Associate Professor of Pediatric Infectious Diseases at Emory University School of Medicine and Children's Healthcare of Atlanta.
• 1:00
  SPEAKER_01: Thank you for joining us today.
• 1:02
  SPEAKER_01: I'm going to briefly go over the news and then we will move into discussion.
• 1:07
  SPEAKER_01: As of August 26, 2020, there are 23,697,273 cases of COVID-19 in the world and 814,438 deaths.
• 1:20
  SPEAKER_01: One of the biggest questions we've had since the onset of the pandemic is whether infection provides long-term immunity and whether reinfection occurs.
• 1:28
  SPEAKER_01: There are now several cases of repeat infection reported.
• 1:31
  SPEAKER_01: Researchers from Hong Kong demonstrated that a man was reinfected four and a half months after initial infection, as demonstrated by genetic analysis showing two successive infections caused by two different strains of SARS-CoV-2 virus.
• 1:44
  SPEAKER_01: CDC changed its guidance for testing on August 24th, stating that for those who have been in close contact, meaning within six feet of a person with COVID-19 infection for at least 15 minutes, but do not have symptoms, they don't necessarily need a test unless they are vulnerable or recommended to have a test by a healthcare provider.
• 2:02
  SPEAKER_01: The guidance states that a negative test does not mean that people will not develop infection and should continue monitoring for symptoms.
• 2:08
  SPEAKER_01: People should adhere to guidelines to protect vulnerable individuals.
• 2:12
  SPEAKER_01: If you do not have COVID-19 symptoms and have not been in close contact with someone known to have COVID-19 infection, you do not need a test.
• 2:20
  SPEAKER_01: A negative test does not mean you will not contract an infection at a later time.
• 2:24
  SPEAKER_01: If you work in a nursing home or long-term care facility, you will need to be tested unless you have already been tested as part of your facility's operational plans.
• 2:32
  SPEAKER_01: If you live in or receive care in a nursing home or long-term care facility, you will need to be tested unless you've already been tested.
• 2:38
  SPEAKER_01: For all categories, people should be tested if symptomatic.
• 2:41
  SPEAKER_01: A study published in JAM on August 21st titled Effective REM Desvier versus Standard Care on Clinical Status at 11 days in patients with moderate COVID-19 demonstrates that patients who were randomized to a five-day course of REM desivere had a statistically significant difference in clinical status compared with standard care, but the difference was of uncertain clinical importance.
• 3:01
  SPEAKER_01: Extended care to a 10-day course made no difference.
• 3:04
  SPEAKER_01: And that's the news for this week.
• 3:06
  SPEAKER_01: I now want to move into the discussion with Dr.
• 3:08
  SPEAKER_01: Lynham.
• 3:09
  SPEAKER_01: Matt, there has been a lot of discussion about the capacity of children to transmit COVID-19 and how that may vary with age.
• 3:16
  SPEAKER_01: What's our current understanding of the ability of children to transmit COVID-19?
• 3:21
  SPEAKER_00: Yeah, thanks for the opportunity to join in on this podcast today and talk about COVID-19 in kids.
• 3:27
  SPEAKER_00: The ability for children to transmit COVID-19 has been sort of a big question since the very beginning.
• 3:46
  SPEAKER_00: Current data in the US shows that children only represent about 9% of all of the COVID-19 cases, less than 5% of the hospitalizations and less than half percent of the deaths.
• 4:00
  SPEAKER_00: Not as many cases, and thankfully not as impacted.
• 4:04
  SPEAKER_00: But what we don't really know is is that because kids are less susceptible to COVID-19 and not as likely to transmit it?
• 4:14
  SPEAKER_00: Or is that really a factor that we lock things down and kids were pulled out of school, and you know, for the most part, kids have been isolating at home for the last few months.
• 4:24
  SPEAKER_00: So they haven't had the opportunity to sort of play a role in transmitting of the infection.
• 4:30
  SPEAKER_00: But like everything, we've had lots of new studies published over the course of the last few months that have begun to kind of flesh this topic out and help us kind of understand it a little bit better.
• 4:40
  SPEAKER_00: There was a study published a few weeks ago that outlined the experience in South Korea with their sort of very in-depth contact tracing program.
• 4:49
  SPEAKER_00: And what they found was when they looked at sort of the presumed index case and sort of stratified those by age and then the percentage of household contacts that became infected, it appeared that children less than age 10 were much less likely to be a source of transmission to other household contacts than children over the age of 10 or adults.
• 5:13
  SPEAKER_00: And this was actually kind of surprising because we've always thought that, you know, and this we see this with all these other respiratory viruses, that kids are playing an important role in the ongoing transmission of respiratory viruses like flu outbreaks every year.
• 5:28
  SPEAKER_00: So this was kind of surprising.
• 5:29
  SPEAKER_00: But then right around the same time, there was another study that was published in Jamma PEDs that looked at 145 people that had mild to moderate COVID-19 infections.
• 5:39
  SPEAKER_00: And during the first week of their symptoms, they quantified the amount of SARS-CoV-2 that was detected in their nasopharynx, and they found that children under the age of five had significantly more virus detected in their nasopharynx than children over the age of five or adults.
• 5:57
  SPEAKER_00: Children over the age of five and adults were pretty equivalent in the amount of virus that they had.
• 6:02
  SPEAKER_00: And this actually made a little bit more sense.
• 6:03
  SPEAKER_00: This seemed to fit a little bit more with conventional wisdom with how kids tend to be more likely to spread the virus.
• 6:11
  SPEAKER_00: But it sort of left us with this disconnect of, well, you know, this one study says they're not transmitting, and then this amount of virus would suggest that they do.
• 6:19
  SPEAKER_00: But the last study that I just kind of wanted to highlight was one that was a MMWR report that was published by the CDC a few weeks ago, and it outlined an overnight camp in my home state of Georgia.
• 6:30
  SPEAKER_00: And what they found is in this camp, the way they were set up is they wanted everybody to have a negative test for COVID-19 within 12 days of coming to camp and of course not have any symptoms.
• 6:41
  SPEAKER_00: But they encouraged MASP, but they didn't require them.
• 6:44
  SPEAKER_00: And very quickly after the camp opened up, out of almost 600 participants, 260 ended up getting COVID-19 infections.
• 6:53
  SPEAKER_00: So this ended up being an attack rate of like 44%.
• 6:56
  SPEAKER_00: And I think this highlighted to me that children in the right setting where they have the opportunity to be in close contact, they're not wearing masks, they're not physically distancing, they very much can play a role in transmitting COVID-19 to others.
• 7:11
  SPEAKER_00: So I think as we move into the school year and we have more kids back in school, more kids involved in activities, I think we'll begin to really see what potential role kids may play in the ongoing transmission of COVID-19.
• 7:25
  SPEAKER_00: But also, you know, hopefully with some of these mitigation strategies that are being put in place, both in schools and out in the community, hopefully we'll not see a big spike in cases just because kids are back in school.
• 7:38
  SPEAKER_00: So I think we've still got a lot to learn.
• 7:40
  SPEAKER_01: Yeah, I think it has been really surprising.
• 7:42
  SPEAKER_01: You know, the things that we have learned from this virus, I think they're gonna also teach us a lot of things about other respiratory viruses that maybe we didn't look at as closely before.
• 7:51
  SPEAKER_00: Yeah, I totally agree.
• 7:53
  SPEAKER_00: I think we've learned, especially with mask use, the impact that it can have on interrupting the transmission of different types of respiratory viruses.
• 8:02
  SPEAKER_00: So it'll be interesting to see how things change in life post-pandemic, whenever that's going to be.
• 8:08
  SPEAKER_01: So you and I talked a little bit about this before we started recording the podcast, but many schools have reopened across the country.
• 8:14
  SPEAKER_01: And although it's still early, what are some early lessons learned related to school reopening?
• 8:20
  SPEAKER_00: Again, I live in Atlanta, and you know, we still have a lot of ongoing transmission of COVID-19.
• 8:26
  SPEAKER_00: And like a lot of areas around the country, there's been a push to reopen schools and try to get kids back in school in person because of all of the additional benefits for being in-person learning, not just sort of better instruction, but also some kids depend on that for getting food.
• 8:42
  SPEAKER_00: It also serves as a safety net to watch for kids that may be having neglect or abuse at home.
• 8:48
  SPEAKER_00: So it's there's a lot of reasons to get back in school.
• 8:49
  SPEAKER_00: And so there's been a lot of push to get back in school, but there's been a lot of different strategies for trying to get kids back in school.
• 8:56
  SPEAKER_00: And I think a lot of it's centered around recommendations by CDC and state health departments, you know, screening, enhanced cleaning.
• 9:04
  SPEAKER_00: And then what you know, we've been talking a lot about sort of term the three W's, wash your hands, wear a mask, and watch your distance.
• 9:13
  SPEAKER_00: And I think that's one area where I've seen a lot of difference in how schools have implemented things.
• 9:19
  SPEAKER_00: Different schools have done different things to try to reduce the population density in a school.
• 9:24
  SPEAKER_00: You know, some small private schools may be able to do the physical distancing and spacing out the desks and things like that without sort of limiting the number of kids in school.
• 9:34
  SPEAKER_00: But for larger schools, a lot of them have been trying various types of hybrid models where a portion of the student body will go on some days while the rest of the school is learning virtually, and then they'll have that flip back and forth in various different combinations, all to try to reduce the number of students in the building at any one time.
• 9:54
  SPEAKER_00: The other thing we've seen a lot of variation just here in Atlanta, and that's you know, part I think is because we don't have a statewide mandate or requirement for wearing masks, is you know, there's been sort of different degrees of implementation of mask use in schools.
• 10:08
  SPEAKER_00: A lot of the public schools are recommending masks, but not requiring them.
• 10:13
  SPEAKER_00: And as you can imagine, pictures from those schools have shown lots of kids moving around without wearing masks.
• 10:19
  SPEAKER_00: But then there's been a lot of other schools that are requiring masks.
• 10:22
  SPEAKER_00: I've got three kids in three different schools, and all three of them are requiring masks.
• 10:28
  SPEAKER_00: And you know, one of the things I was really impressed with was how well children seem to have risen to the occasion in wearing masks, even down to like kids as early as in kindergarten.
• 10:40
  SPEAKER_00: You know, I've seen them wearing masks all day long and doing very well at it.
• 10:45
  SPEAKER_00: That's really was sort of one of the pleasant surprises for me is how well kids have joined in and helped prevent the spread.
• 10:52
  SPEAKER_00: And I think that's where we see some of the changes.
• 10:54
  SPEAKER_00: I think in some of these schools that have not required masks, quickly they'll have cases being identified in the school.
• 11:00
  SPEAKER_00: And those aren't necessarily cases that occurred in the school, but may have been acquired outside the school, but the child was in school.
• 11:06
  SPEAKER_00: So there was potential exposures to other students and teachers in the classroom.
• 11:11
  SPEAKER_00: And you know, when they're not wearing masks, that quickly results in a lot of people being quarantined and causing some schools even having to convert to a virtual learning model for a period of time.
• 11:22
  SPEAKER_00: I think the other thing, and I think this really is to me been evident from colleges and some of the challenges that they're facing is it's not just what happens in school that matters, but it's also what happens outside the school or classroom that can really make or break the success of whether a school can open up and stay open.
• 11:42
  SPEAKER_00: As we're seeing from colleges, you know, they have all these great processes in place, but then the students go off and they're hanging out together without masks and going to restaurants and bars and doing other things outside schools in large groups, and we're hearing about lots of cases popping up in these different schools.
• 11:59
  SPEAKER_00: And I think the same is true for grade schools and high schools.
• 12:02
  SPEAKER_00: You know, the activities and interactions that students are having outside the classroom can really have a positive or negative impact on how well schools stay open.
• 12:12
  SPEAKER_00: So it'd be interested to see.
• 12:14
  SPEAKER_00: I think you know, we're still really early in this reopening and sort of understanding what's going to happen.
• 12:19
  SPEAKER_00: You know, my kids have only been in school for not quite two weeks.
• 12:22
  SPEAKER_00: So I think it's really early, and it'll be interested to see how things go.
• 12:26
  SPEAKER_00: I'm, you know, I'm really hopeful that at least for some of my kids who are in fully in-person learning with masks, I kind of have my fingers crossed hoping that they do very well and that these can be model examples for you know putting some of these mitigation strategies in place, like you know, washing your hands more, wearing masks, watching your distance, that these can really allow schools to open and stay open effectively.
• 12:49
  SPEAKER_01: Yeah, I really like the three W's.
• 12:51
  SPEAKER_01: I've not heard that before.
• 12:52
  SPEAKER_01: I'm definitely going to be using that.
• 12:54
  SPEAKER_01: I think that's a great way for people to remember what they're supposed to be doing.
• 12:58
  SPEAKER_01: And I think you raised some interesting points.
• 13:00
  SPEAKER_01: It's interesting to hear that in some ways, a lot of grade schools seem to be doing better than colleges.
• 13:07
  SPEAKER_01: I think college students in particular have a really hard time understanding why it's so necessary for them to do the things they're being asked to do.
• 13:15
  SPEAKER_01: What impact do you think higher mask wearing is gonna have on respiratory illness in general this winter?
• 13:22
  SPEAKER_01: I think a lot of people are really worried about influenza coming up with COVID at the same time.
• 13:27
  SPEAKER_01: And so what do you think is gonna happen this winter?
• 13:30
  SPEAKER_00: You know, it's a really good question.
• 13:32
  SPEAKER_00: It's kind of like I need my magic eight ball to find that answer.
• 13:36
  SPEAKER_00: But we've seen this use of mass has really sort of cut down on a lot of transmission of COVID-19, but also other respiratory viruses.
• 13:45
  SPEAKER_00: And we saw this here in the US.
• 13:47
  SPEAKER_00: Our flu season was sort of bumping along.
• 13:49
  SPEAKER_00: And then as soon as COVID-19 hit and we went on lockdown, our flu season here in the US really ended fairly abruptly, much faster than it would have if things had just sort of progressed on normally.
• 14:01
  SPEAKER_00: And as you look at the Southern Hemisphere, you know, we often look to Australia and other countries in the southern hemisphere to sort of get a sense of what to expect for the coming flu season.
• 14:12
  SPEAKER_00: You know, Australia's had a really pretty mild flu season this year.
• 14:17
  SPEAKER_00: And I think a lot of that has been attributed to these basic mitigation strategies like mask wearing and physical distancing that they've had in place there.
• 14:26
  SPEAKER_00: And it's really made for a fairly mild flu season.
• 14:29
  SPEAKER_00: So I think really it's just it's gonna depend on how well people sort of hold to these strategies and how well they sort of continue those into the holiday season when I think people are gonna start to have another round of mask fatigue and cabin fever and you may be likely to sort of forego some of these recommendations.
• 14:49
  SPEAKER_00: And I think it also will depend on how many people go get the flu shot this year.
• 14:54
  SPEAKER_00: Will the fact that we have a pandemic going on and everybody's worried about the flu this year, sort of being sort of this perfect storm of two respiratory viruses, if that's enough to get people out, you know, getting flu vaccine as much or more as they have in prior seasons, or if the fact that people are staying home, socially distancing from others, if that's going to result in less immunizations, like we've seen with some of the impact this pandemic's had on childhood immunization numbers.
• 15:23
  SPEAKER_00: If we see something like that similarly happen with flu vaccine, we could end up with a pretty bad flu season.
• 15:29
  SPEAKER_01: Yeah.
• 15:29
  SPEAKER_01: So, you know, most kids who've developed COVID-19 have had relatively mild illness, but some have gone on to develop multi-system inflammatory syndrome in children.
• 15:39
  SPEAKER_01: What do we know about the serious complication of COVID-19 in children?
• 15:43
  SPEAKER_00: You know, this whole pandemic has been really fascinating on so many different levels.
• 15:48
  SPEAKER_00: But within about a month, two months after the pandemic started, we started hearing reports first coming out of Europe and then shortly after that, popping up around the US of children who were developing sort of this inflammatory syndrome that had a lot of overlapping characteristics of Kawasaki's disease and toxic shock syndrome, and seemed to have sort of this link to COVID-19.
• 16:14
  SPEAKER_00: You know, many of these kids were testing positive either by PCR or by serologic testing for having a current or recent COVID-19 infection.
• 16:24
  SPEAKER_00: And you know, as we've learned more and more about this, it seems to be kind of its own separate entity and not just Kawasaki's disease related to this multisystem inflammatory syndrome in children.
• 16:37
  SPEAKER_00: And you know, I think as people are digging in more and starting to do some immunologic studies, they're looking at cytokine profiles and they're seeing some difference in the cytokine profile.
• 16:47
  SPEAKER_00: But as of yet, I don't think we've really figured out what are those key characteristics that really tease it out from some of these other syndromes and conditions.
• 16:56
  SPEAKER_00: And so, you know, the current case definition from the CEC, you know, not surprisingly, right now, is pretty broad because we're trying to really sort of catch all the cases and then sort of figure out where the right place to draw that line is.
• 17:10
  SPEAKER_00: So the current definition is persons under the age of 21 with fever for at least 24 hours, with laboratory evidence of inflammation, like an elevated uh CRP, sedate, ferritin, things like that, that have severe enough illness to require hospitalization and at least two or more organs that are involved, no other plausible explanation for their symptoms, and then some recent evidence of current or recent uh SARS-CoV-2 infection based on either PCR or serology.
• 17:41
  SPEAKER_00: And that's sort of the basic definition.
• 17:44
  SPEAKER_00: And the CDC just published their description of this big case series of MISC in children, and this included 570 children that met the MISC definition.
• 17:58
  SPEAKER_00: The median age was about eight years of age, pretty evenly split between males and females.
• 18:05
  SPEAKER_00: A pretty hefty predominance of black and Hispanics, Hispanics representing about 44% of the cases, and black about 33%.
• 18:14
  SPEAKER_00: But that I think also sort of tracks along with what we've been seeing with actual COVID-19 infections, where it seems to have been those races and ethnic groups have been more hard hit.
• 18:24
  SPEAKER_00: And so it stands to reason that those are also more represented with MISC.
• 18:29
  SPEAKER_00: And this tends to track about four to eight weeks after a spike in cases.
• 18:34
  SPEAKER_00: So, you know, within sort of the six weeks after our initial spike of COVID-19, we started to see a spike in MISC cases.
• 18:43
  SPEAKER_00: And then as we moved into sort of June and July, with this sort of new surge of cases, we've similarly seen a more recent spike in cases of MISC.
• 18:56
  SPEAKER_00: And what was interesting about the way this the MMWR sort of broke things out, they kind of broke it out into three different categories, and it really made a lot of sense to me from my own experience of seeing a number of these kids over the last few months.
• 19:10
  SPEAKER_00: There was one group, which was about 200 of the kids, that really kind of had sort of this classic MISC sort of picture.
• 19:16
  SPEAKER_00: They very frequently had multi-organ involvements, about all of them had some degree of cardiovascular involvement.
• 19:23
  SPEAKER_00: And what's interesting is they, whereas we tend to think of COVID-19 as a little bit more of a respiratory illness, you know, it's been well described that patients can have, you know, sort of a predominance of GI symptoms.
• 19:34
  SPEAKER_00: And that's what we've seen more in these sort of classic MISC sort of pictures.
• 19:39
  SPEAKER_00: They tend to have more GI involvement.
• 19:42
  SPEAKER_00: Almost all of them have had some abdominal pain, vomiting, diarrhea, something like that.
• 19:46
  SPEAKER_00: And most of them are antibody positive for uh SARS-CoV-2.
• 19:52
  SPEAKER_00: You move into sort of the second category, which represent about 169 of these 570 kids.
• 19:57
  SPEAKER_00: There was really kind of more of an overlap of acute COVID-19 infection and sort of this kind of over-exuberant inflammatory response.
• 20:06
  SPEAKER_00: And most of these kids, about three-fourths of these kids, had some degree of respiratory involvement, everywhere from pneumonia to acute respiratory distress syndrome.
• 20:15
  SPEAKER_00: And in about 85% of these kids, they actually were PCR positive.
• 20:21
  SPEAKER_00: So a little bit different.
• 20:22
  SPEAKER_00: And then the last bucket of just under 200 kids really had more of a Kawasaki's-like presentation with sort of the you know mucocutaneous involvement and rash, and many of them met criteria for actual Kawasaki's disease.
• 20:36
  SPEAKER_00: And we're still trying to learn how to manage this.
• 20:38
  SPEAKER_00: And you know, I think a lot of the management initially followed along because it had a lot of overlapping features with Kawasaki's.
• 20:46
  SPEAKER_00: We managed it very similar to how we manage Kawasaki's disease.
• 20:50
  SPEAKER_00: So a lot of our treatment recommendations have included infusions of IVIG similar to Kawasaki's andor steroids.
• 20:59
  SPEAKER_00: And I think here at Children's in Atlanta, we've flipped a little bit.
• 21:03
  SPEAKER_00: And now we're for those kids that really have classic multi-system inflammatory syndrome, we're starting to lean more towards giving them steroids first.
• 21:11
  SPEAKER_00: And then those kids that have more of a Kawasaki's like presentation, starting with IVIG first.
• 21:16
  SPEAKER_00: But we're still, as you know, some of my colleagues have said, we're sort of in a data-free zone.
• 21:21
  SPEAKER_00: We're still kind of trying to, you know, there's just no clear evidence-based guidance yet.
• 21:26
  SPEAKER_00: So we're still, I think, collectively trying to figure out what's the right strategy to manage these kids.
• 21:32
  SPEAKER_00: Thankfully, most of them have responded very well to these treatments.
• 21:36
  SPEAKER_00: And only out of those 570 children that were in this report, only 10 of them succumbed to the illness.
• 21:43
  SPEAKER_00: So overall, they're doing really well, but we're still learning a lot about this.
• 21:47
  SPEAKER_01: Yes, MISC certainly is a big concern, but there's a lot of other health concerns for children.
• 21:54
  SPEAKER_01: So as a pediatrician, what's your biggest concern regarding COVID-19 and its effect on child health?
• 22:00
  SPEAKER_00: You know, I think the biggest thing that concerns me is something that we saw very early on in the pandemic when everybody went on lockdown, and of course, people were afraid to go out, and families started delaying health maintenance visits.
• 22:16
  SPEAKER_00: And that included delays in getting their childhood immunizations for their kids.
• 22:22
  SPEAKER_00: And you know, there was actually an MMWR that came out a couple months ago that actually highlighted this, and it showed that right around the time that the US declared a national emergency, there was a significant drop in both ordering and administering non-flu childhood immunizations, including MMR-containing vaccinations.
• 22:42
  SPEAKER_00: And so from a pediatrician standpoint, you know, that's pretty concerning.
• 22:46
  SPEAKER_00: And we start to see an erosion in our delayed immunizations, we start to see some erosion in our herd immunity, and we could start to see outbreaks of different vaccine-preventable diseases popping up around the country.
• 23:01
  SPEAKER_00: Um, so that's probably one of my biggest concerns.
• 23:04
  SPEAKER_00: I think with sort of the recognition that this was happening, there's been a lot of communication from the American Academy of Pediatrics and other organizations really trying to encourage families to not delay those immunizations and get out there.
• 23:19
  SPEAKER_00: And we have seen some improvement in parents, you know, getting their kids immunized.
• 23:23
  SPEAKER_00: But that's probably one of my big concerns is that sort of some of those downstream negative impacts that we can see just because of the pandemic.
• 23:32
  SPEAKER_01: Thank you, Dr.
• 23:32
  SPEAKER_01: Lynham, for sharing your perspectives and experiences.
• 23:36
  SPEAKER_01: And a sincere thank you from Shay to all healthcare personnel for all that you are doing to respond to COVID-19.
• 23:42
  SPEAKER_01: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 23:49
  SPEAKER_01: You will also find additional resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHAY COVID-19 town halls.
• 23:58
  SPEAKER_01: Additional resources available on Learning CE pertinent to this pandemic include SHA CDC Outbreak Response Training Program and the Prevention Course and HAI Knowledge and Control Prevention Check.
• 24:09
  SPEAKER_01: That concludes this episode of the Rapid Response Podcast.
• 24:13
  SPEAKER_01: Thank you for tuning in.