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Challenges in Treating COVID-19 with SIDP · The SHEA Podcast

• 0:11
  SPEAKER_00: Welcome to the We're All In This Together COVID-19 Allies and Infection Prevention podcast series as part of the Society for Healthcare Epidemiology of America, or SHA, Rapid Response Program.
• 0:23
  SPEAKER_00: I am Dr.
• 0:24
  SPEAKER_00: Jamie Wagner, a clinical assistant professor at the University of Mississippi School of Pharmacy and antimicrobial stewardship pharmacist at St.
• 0:31
  SPEAKER_00: Dominic Memorial Hospital, and I will serve as your SHA moderator and speaker.
• 0:36
  SPEAKER_00: I'm also happy to welcome Dr.
• 0:37
  SPEAKER_00: Bruce Jones, an infectious diseases clinical pharmacy specialist at St.
• 0:41
  SPEAKER_00: Joseph's Candler Health System and Clinical Assistant Professor at the University of Georgia College of Pharmacy, who will serve as your Society of Infectious Diseases Pharmacists speaker for today's podcast.
• 0:53
  SPEAKER_00: Discussion on the podcast does not reflect Shay's or SIDP's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 1:04
  SPEAKER_00: Today's episode will focus on collaborations between healthcare epidemiology and infectious diseases pharmacists and how we as a team can work together to address the COVID-19 outbreak.
• 1:15
  SPEAKER_00: So, Bruce, how have things been at your hospital?
• 1:18
  SPEAKER_01: Yeah, thank you for asking and thank you for having me on this podcast.
• 1:21
  SPEAKER_01: It's great to be able to come in and represent the society.
• 1:24
  SPEAKER_01: Obviously, COVID-19 has become a big staple in the life of myself and most ID pharmacists out there.
• 1:30
  SPEAKER_01: And I think one of the biggest issues that we're running into and things we're trying to address is all of the information that seems to change almost weekly.
• 1:38
  SPEAKER_01: What we're doing now is completely different from what we were doing back in March.
• 1:42
  SPEAKER_01: So trying to just stay on top of that information as much as possible.
• 1:45
  SPEAKER_00: Yeah, same with us.
• 1:47
  SPEAKER_00: I find it extremely challenging to constantly tell the providers, oh, there's something new.
• 1:53
  SPEAKER_00: We need to change something.
• 1:54
  SPEAKER_00: But how are you finding ways to kind of keep your providers updated?
• 1:59
  SPEAKER_01: Yeah, absolutely.
• 2:00
  SPEAKER_01: I think being able to disseminate that information we're trying to stay on top of is the other big side of it.
• 2:05
  SPEAKER_01: Kind of a local, more small scale, I think getting it to your infectious diseases physicians, your pulmonologist, and your hospitalist specifically, physician-wise, trying to get that information to them so that they can make timely decisions.
• 2:19
  SPEAKER_01: And then on a national level, I'll tell you one of the things I've been involved in within SIDP specifically is I've helped to produce and coordinate videos on some of the experimental therapies that are out there.
• 2:30
  SPEAKER_01: And you can go to actually SIDP's websites and we offer CE credit.
• 2:34
  SPEAKER_01: And I think we have 18 videos up there as of now that can kind of help share some of the information that's out there specifically on therapy.
• 2:42
  SPEAKER_00: Awesome.
• 2:42
  SPEAKER_00: That sounds like great resources for a lot of providers and pharmacists who are looking for reliable information to how to handle these things.
• 2:50
  SPEAKER_00: As great as that is, what challenges are you facing?
• 2:54
  SPEAKER_00: Because I'm sure you're not alone.
• 2:55
  SPEAKER_00: And what do you recommend to other people in order to overcome some of these challenges?
• 3:01
  SPEAKER_01: Yeah, absolutely.
• 3:02
  SPEAKER_01: I I think the biggest one out there for me is fact versus fiction.
• 3:07
  SPEAKER_01: I always say there are two epidemics out there.
• 3:09
  SPEAKER_01: First one being obviously COVID-19, and the second one being all the information or the misinformation that is out there.
• 3:16
  SPEAKER_01: And I think it's hard to find good information that you can truly trust.
• 3:20
  SPEAKER_01: And it's not hard to look at whether it's politicians, social media, or even other healthcare professionals sometimes.
• 3:26
  SPEAKER_01: The misinformation is rampant.
• 3:29
  SPEAKER_00: Yes, agreed.
• 3:30
  SPEAKER_00: I find it very difficult to try to get past barriers of educating not just providers and patients, but just the community.
• 3:40
  SPEAKER_00: Being at a community hospital, I find it very challenging when patients come in on some of these more experimental or not proven therapies from physicians that don't really interact with the healthcare system, that they are strictly community providers.
• 3:55
  SPEAKER_00: Have you been seeing the same thing?
• 3:57
  SPEAKER_01: Yes, absolutely.
• 3:58
  SPEAKER_01: From the provider standpoint that we deal with on the inpatients, I've had to spend a lot of time really trying to sit down with them.
• 4:05
  SPEAKER_01: A good example for myself is the hospitalists that we work with.
• 4:09
  SPEAKER_01: They rotate a seven-on, seven-off ship.
• 4:12
  SPEAKER_01: I try and sit down with them every Monday usually and we'll go through everything that's changed because it may be two weeks since the start of their previous shift.
• 4:20
  SPEAKER_01: So really being able to let them know everything that's changed and going through drug supply, drug shortages, and be able to update everyone and go through restriction.
• 4:28
  SPEAKER_01: I think the restriction kind of ties into, I think, more of the question you're asking, you think into the community?
• 4:34
  SPEAKER_01: Absolutely.
• 4:35
  SPEAKER_01: We still see a lot of experimental things, things that aren't necessarily even recommended being used in the community right now.
• 4:41
  SPEAKER_00: Yeah, and Bruce, this was actually something that happened, I think, just this past week, where Remdesivir's EUA got changed to say that the recommendation is now everybody can have it.
• 4:52
  SPEAKER_00: And how has that impacted what you're now doing for your patients at your facility?
• 4:57
  SPEAKER_01: Yes, early on, I think restricting hydroxychloroquine and making sure we give it to the right patients was the thing we focused most off of.
• 5:06
  SPEAKER_01: And we had specific criteria for use.
• 5:08
  SPEAKER_01: We were even locking it in our control substance case to help prevent concerns over diversion.
• 5:14
  SPEAKER_01: And I was taking call at the time to even approve.
• 5:17
  SPEAKER_01: You know, it wasn't uncommon for me to get a call at 12:30 a.m.
• 5:20
  SPEAKER_01: about approving it.
• 5:21
  SPEAKER_01: And then once we kind of moved away from that and moved into Rimdesivir, kind of saw a lot of the same process with criteria for use, evaluating patients and who otherwise would be best to receive it.
• 5:32
  SPEAKER_01: And kind of as you have mentioned, that's something that's changed almost every couple of weeks in terms of being recommended five versus 10-day courses, who's the exact patient to give it to.
• 5:42
  SPEAKER_01: So we evaluate these patients on a daily basis because there still is an amount of both subjectivity and really even ethics of who gets this product, especially in a time of supply shortage.
• 5:54
  SPEAKER_00: Working with your treatment options at the hospital, how has that changed from the start in March with hydroxychloroquine and azethrysin, and now the supposed EUA with convalescent plasma that was coming out and then not coming out?
• 6:08
  SPEAKER_00: What have you guys been using?
• 6:11
  SPEAKER_01: I think as we sit here, you know, end of August into the first of September, three of our mainstays of treatment have kind of been the steroid, dexamethasone, remdesivir, as well as convalescent plasma.
• 6:25
  SPEAKER_01: Specifically the last two, a lot of things have changed over the last couple weeks.
• 6:28
  SPEAKER_01: Remdesivir is recently expanded, and now really any patient that is admitted with a diagnosis of COVID-19, it's now a treatment option.
• 6:37
  SPEAKER_01: And then with convalescent plasma specifically, I mean, originally it was navigating the expanded access program, which no longer exists, and we've moved more into expanded use.
• 6:48
  SPEAKER_01: Then also any of these therapies, shortages come into play and remdesivir.
• 6:53
  SPEAKER_01: We've seen shortages, and now with convalescent plasma, specifically dependent on blood type, and then trying to decide who to give it to.
• 7:01
  SPEAKER_01: So another quick plug I could throw out here with convalescent plasma being as short as it is.
• 7:05
  SPEAKER_01: I always like to say for any of the listeners out there, if you or someone you know has recovered from COVID-19, please consider giving blood, please consider giving plasma to help with the shortage of this.
• 7:17
  SPEAKER_00: And speaking of helping more and more patients and patients being potential future patients for those who have yet to either be exposed to the virus or are carrying it around with all the vaccine trials that are happening.
• 7:29
  SPEAKER_00: So, what are your thoughts from a pharmacist perspective on the vaccines and the clinical trials that are going on?
• 7:36
  SPEAKER_00: What have you heard?
• 7:37
  SPEAKER_00: What have you interacted with?
• 7:38
  SPEAKER_00: Like what are your thoughts on those?
• 7:39
  SPEAKER_01: Yes, I've been trying to follow along.
• 7:41
  SPEAKER_01: The last I looked, there were three main vaccines that I think have hope for the end of 2020 into first quarter 2021.
• 7:50
  SPEAKER_01: And I think as with most of us, we're eagerly awaiting some of the phase two, phase three data to come out to show safety, to show efficacy, to see if this is going to be a viable option.
• 8:00
  SPEAKER_01: And then the question will be on one side of it, how long will this give us immunity to COVID?
• 8:06
  SPEAKER_01: But on the other side of it, are people gonna go out and get it?
• 8:09
  SPEAKER_01: I've seen a lot of different surveys.
• 8:11
  SPEAKER_01: Some show as low as 50% of the population in the United States that would be willing to get this, some even down to 30%.
• 8:18
  SPEAKER_01: So that's gonna be the next question is even if a vaccine does come out, is the general population going to go out in mass and get this?
• 8:26
  SPEAKER_00: That seems to be the question.
• 8:28
  SPEAKER_00: Absolutely.
• 8:29
  SPEAKER_00: You know, we have enough anti-vaxxers out there for the vaccines that are available.
• 8:33
  SPEAKER_00: I agree with you.
• 8:34
  SPEAKER_00: I I don't know how many are going to voluntarily submit themselves to a vaccine, especially if it's a two-step.
• 8:42
  SPEAKER_00: Furthermore, after that would be what is the lifetime immunity capability of the vaccine?
• 8:48
  SPEAKER_00: Those were, I think, some of the initial challenges with creating that vaccine is how long is it going to last, especially now with more and more data coming out saying people are becoming reinfected again with the virus.
• 9:01
  SPEAKER_00: And so is exposure enough?
• 9:03
  SPEAKER_00: Is this vaccine going to be sufficient to protect the population?
• 9:07
  SPEAKER_00: So I think that's something that we're waiting to see in the next few months.
• 9:11
  SPEAKER_01: Absolutely.
• 9:11
  SPEAKER_01: I agree.
• 9:13
  SPEAKER_00: The other problem we had challenges with outside of the drugs is the isolation of all of these patients.
• 9:18
  SPEAKER_00: Which ICU units did we designate as a COVID unit?
• 9:22
  SPEAKER_00: Did we have to transform other areas of the hospital into COVID isolation units?
• 9:28
  SPEAKER_00: How do we allow visitors to come into the hospital?
• 9:31
  SPEAKER_00: Do we allow them in?
• 9:32
  SPEAKER_00: How many?
• 9:32
  SPEAKER_00: Are there restricted times?
• 9:34
  SPEAKER_00: That kind of thing.
• 9:35
  SPEAKER_00: And it's really difficult for a lot of our providers to try to explain to family members that their loved one is extremely sick.
• 9:43
  SPEAKER_00: And when they can't see how sick that loved one is, it makes it very challenging to be the middle person trying to convey this message.
• 9:53
  SPEAKER_01: Absolutely.
• 9:54
  SPEAKER_01: And you know, Jamie, when you look back, a lot of our bigger meetings and committee meetings that we are both a part of were canceled early on.
• 10:02
  SPEAKER_01: And we're just now getting back into the mold where we're able to a lot of times do them via teleconference.
• 10:07
  SPEAKER_01: And that's a lot of what we're discussing is isolation status, being able to move these patients in and out of the hospital.
• 10:13
  SPEAKER_01: We've actually rearranged certain places in our hospital to be able to handle should we see any kind of surge in the future.
• 10:21
  SPEAKER_00: Yes, and this whole response has been a team effort, but it's like you had brought up earlier, a 24-7 ordeal where there's really not a lot of break time.
• 10:32
  SPEAKER_00: And I feel like we're doing everything that we can to work together and keep both ourselves and our patients safe.
• 10:40
  SPEAKER_00: And long term, how do you think those will end up changing how we all interact with each other?
• 10:45
  SPEAKER_01: I've seen a little bit of a shift.
• 10:47
  SPEAKER_01: It's gonna be interesting to see once this epidemic is over, what parts of what we were doing before do we keep?
• 10:53
  SPEAKER_01: And a good example of that is how so many of our meetings have moved to an online, maybe even kind of Zoom format.
• 11:01
  SPEAKER_01: Times, I'm not gonna lie, I kind of enjoy that.
• 11:04
  SPEAKER_01: But it will be good to be able to get out and see people again.
• 11:07
  SPEAKER_01: Kind of as you'd mentioned earlier, I think a big part disseminating information, getting the local and regional data in and sharing it with everybody.
• 11:15
  SPEAKER_01: For us, we have four infectious disease physicians in Savannah, and they actually go to all three acute care hospitals and both long-term acute care hospitals.
• 11:24
  SPEAKER_01: We've had to actually do an even better job of getting together with our competitor hospitals to share information.
• 11:31
  SPEAKER_00: Nice.
• 11:31
  SPEAKER_00: Yes.
• 11:32
  SPEAKER_00: We have two infectious disease physicians at my facility, and it just seems like they're constantly running around trying to help things.
• 11:42
  SPEAKER_00: And so trying to even pin them down for five minutes seems to be a challenge, even virtually.
• 11:48
  SPEAKER_00: But I agree with you.
• 11:49
  SPEAKER_00: I think that we're going to be moving a lot more towards these virtual meetings unless there are certain things where you absolutely need to see a face.
• 11:58
  SPEAKER_00: Because I feel like a lot of the virtual meetings right now don't include video capabilities.
• 12:04
  SPEAKER_00: Being able to interact with people or meet new people or what have you, it just seems to be a little bit more difficult.
• 12:11
  SPEAKER_00: I agree with you as time goes on and we're able to settle into things a little bit easier and spread information a little bit better and coordinate all of our efforts, that things will settle down.
• 12:23
  SPEAKER_00: Bruce, kind of along these lines of maybe the health system will settle down, but when we come home from work, I don't know if we're truly settled down from that.
• 12:33
  SPEAKER_00: How have you been dealing with work following you home?
• 12:38
  SPEAKER_01: That's a great question.
• 12:39
  SPEAKER_01: I like to sit down and think that the family understands.
• 12:42
  SPEAKER_01: I really believe they do.
• 12:43
  SPEAKER_01: I have a five-year-old daughter and a three-year-old son.
• 12:46
  SPEAKER_01: And I tell you, just this past weekend, I watched my five-year-old daughter and she's having a conversation with another girl that I think was about the same age, and they're talking about the virus.
• 12:54
  SPEAKER_01: And it is amazing to hear two five-year-olds talk about it and obviously learn what she picks up from me when I come home and speak to her about it.
• 13:02
  SPEAKER_01: But it was it was a pretty amazing thing to see.
• 13:04
  SPEAKER_01: And then the other thing is I think the honest truth is it's a blessing and a curse with the electronic medical record these days.
• 13:11
  SPEAKER_01: I'm able to access patient information from home.
• 13:14
  SPEAKER_01: If something comes up and I need to go in and look at labs, if I need to put it in order, I can do that from home.
• 13:20
  SPEAKER_01: And like I said, it's a blessing and a curse.
• 13:22
  SPEAKER_01: I've been able to use it to my advantage in a time like this.
• 13:25
  SPEAKER_01: But those are probably two of the things I've noticed more recently.
• 13:29
  SPEAKER_00: Yeah, bringing work home and how you had mentioned earlier, just getting the phone calls in the middle of the night, assuming that has kind of settled down a little bit as well.
• 13:39
  SPEAKER_01: A little bit.
• 13:40
  SPEAKER_01: It's definitely gotten a lot better.
• 13:41
  SPEAKER_01: I think people have gotten their feet under them and we've learned more about treating these patients, and it's definitely helped.
• 13:47
  SPEAKER_00: We appreciate you very much for being our speaker today and for joining us and sharing your perspectives and experiences.
• 13:54
  SPEAKER_00: And a sincere thank you from Shay and to all your healthcare personnel for all that you are doing to respond to COVID-19.
• 14:00
  SPEAKER_00: This podcast can be accessed on Shay's online education center, Learning CE, under the Rapid Response Program.
• 14:08
  SPEAKER_00: You will also find additional resources such as the recorded webinars, Healthcare Facility Outbreak Preparedness, and SHAY COVID-19 Town Halls, and the additional podcast series, COVID-19 update, what we know now, which is released every Thursday.
• 14:22
  SPEAKER_00: That concludes this episode of the Allies and Infection Prevention Podcast Series.
• 14:26
  SPEAKER_00: Thank you for tuning in.