Navigating the Cozy Covid Corner: Updates, Insights, and Discussions

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Amid the ongoing Covid-19 crisis, this activity offers valuable information on immunology, PPE updates, Covid case developments, and open discussions. Stay informed, earn CME and ABIM MOC credits, and engage with professionals in this interactive session.

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Title (Single Line) The Cozy Covid Corner This activity has been designated for CME and ABIM MOC credits and is being recorded Agenda for 6/29/2020 Immunology study Office PPE update Proper use of PPE Covid case update Miscellaneous/Open Discussion

TEXT YOUR ATTENDANCE Its important that we know you are participating Text Attendance Number: (858) 247-3111 Today s Activity Code: 13534

Skype Etiquette Mute your phone and computer during the call, as severe echoes can occur. Mute using either a mute button, or *6 which toggles mute on and off. Do not place the on hold, as many hold line play music or narratives which disrupts the call Once done talking, re-mute The chat box is monitored if you would like to submit questions or issues TAC is available for technical problems at the physician line 858-672-5202

As the world wrestles with the unprecedented implications of the COVID-19 coronavirus pandemic, "we are facing a human crisis unlike any we have experienced" and our "social fabric and cohesion is under stress. UN Deputy-Secretary-General Amina J. Mohammed during a digital meeting of the Forum's COVID Action Platform on 8 April

Economic developments since Covid began 2.9 million more Americans have filed for unemployment, bringing the two- month total to more than 36 million. The US April unemployment rate has risen to a record 14.7%, with more than 20 million jobs lost last month. EU GDP is forecast to contract by 7.5% during 2020.

From the US Commerce Department 4/29/20

Some things you may hear from patients Its no worse than the flu, I m not worried `COVID-19 produces signs and symptoms that are similar to influenza, which makes it difficult to distinguish between the two. The death rate of the seasonal flu varies but is about 0.1% compared to about 2% for COVID-19. (based on base estimates when populations are studies in total) Coronavirus is more contagious: each person with it is likely to spread it to two others, compared to a rate of roughly half for flu.

Im not going to wear a mask, Im protected by the first amendment of the constitution for freedom of speech Indeed it is, and another constitutional amendment (10th) was also passed, allowing for compulsory public health, with the following application by the US Supreme Court: 1095 Jacobson v. Massachusetts, upheld the authority of states to enforce compulsory vaccination laws. It articulated the view that individual liberty is not absolute and is subject to the police power of the state It gave the states authority to take public health emergency actions, including quarantines, and business restrictions

Recently, face mask exempt cards have appeared on social media, and references the DOJ and the Americans for Disability Act, including potential fines for violating the ADA. The UD Department of Justice has said these were neither issued nor endorsed by the Department. Refer to the ADA at www.ADA.gov for specific regulations relating to these claims. Those with real difficulty wearing masks due to respiratory problems, should stay home if they can, make their trips count, and frequent rest breaks. Going without a mask carries dangers as well. (Tanis Elliott, MD, American College of Allergy, Asthma, and Immunology)

Face Covering Update 6/18 CDPH All people in California must wear face coverings when they are in the high-risk situations listed below: Inside of, or in line to enter, any indoor public space Obtaining services from the healthcare sector Waiting for or riding on public transportation or paratransit or while in a taxi, private car service, or ride-sharing vehicle Driving or operating any public transportation or paratransit vehicle, taxi, or private car service or ride-sharing vehicle when passengers are present. When no passengers are present, face coverings are strongly recommended While outdoors in public spaces when maintaining a physical distance of 6 feet from persons who are not members of the same household or residence is not feasible.

Face Covering Exemptions 6/18 CDPH Persons age two years or under. because of the risk of suffocation Persons with a medical condition, mental health condition, or disability that prevents wearing a face covering. This includes persons with a medical condition for whom wearing a face covering could obstruct breathing or who are unconscious, incapacitated, or otherwise unable to remove a face covering without assistance Persons who are hearing impaired, or communicating with a person who is hearing impaired, where the ability to see the mouth is essential for communication Persons for whom wearing a face covering would create a risk to the person related to their work, as determined by regulators or workplace safety guidelines Persons who are obtaining a service involving the nose or face for which temporary removal of the face covering is necessary to perform the service Persons who are seated at a restaurant or other establishment that offers food or beverage service, while they are eating or drinking, provided that they are able to maintain a distance of at least six feet away from persons who are not members of the same household or residence Persons who are engaged in outdoor work or recreation such as swimming, walking, hiking, bicycling, or running, when alone or with household members, and when they are able to maintain a distance of at least six feet from others.

Updates Canada has now closed the boarder to the US except for essential travel. The European Union is considering the same. Governors from NY, NJ, CT issue a travel advisory. Visitors from high infections rates have to quarantine for 14 days Governor Newsom released a COVID assessment tool, for modeling local and state responses, and can be found here: Governors Covid Assessment Tool This tool shows the current epidemiological state, forecasts for the next 2 weeks, and long term impacts under different scenarios Some changes were made to the Health Care Workers Hotel Program for those who could not quarantine at home. See info here: Hotel Program Most employees who work around COVID patients and get sick are presumed covered workers comp

CDC Expands Lists of COVID-19 Symptoms 6/26/20 Fever or chills Cough Shortness of breath or difficulty breathing Fatigue Muscle or body aches Headache New loss of taste or smell Sore throat Congestion or runny nose Nausea or vomiting Diarrhea

Sharp Volunteer Re-Entry Post Covid 6/24 A small group of volunteers are being allowed back into facilities, to perform essential duties. The priority is as follows: o Escorts/Runners o Family Resource Center/Zoom assistants o Spiritual Care o Integrative Therapy/Arts for Healing/Pet Therapy o Gift shops o Shuttle service (once increased visitor/clinic opening) o Nursing Units

Infection Control Ambulatory clinics (CDC) June 19 (For patients with, or suspected to have Covid-19) Telehealth strategies, including telephone triage when making appointments Messaging to reschedule routine appointments if symptomatic Asymptomatic patients should be instructed to wear facemasks into the office Establish screening stations if feasible, outside of the office Physical distancing if feasible, 6 ft, limit those accompanying patients, and # of patients scheduled or in the waiting room, or wait in their car until called HCP wear facemasks at all times, including break rooms, if encountering others If a patient is coughing and likely to spread respiratory droplets, contact isolation, with mask, eye protection, gown and gloves. Also if prevalence in SD increases If patient is not likely spreading droplets, a facemask is enough while maintaining physical distancing.

PCR Testing (nasal swab) Hospitalized patients Symptomatic and asymptomatic healthcare workers, first responders, and other social service employees Symptomatic individuals age 65 and older or symptomatic individuals of any age with chronic medical conditions that increase the risk of severe COVID-19 illness Individuals who are tested as part of disease control efforts in high-risk settings Asymptomatic residents and employees of congregate living facilities when needed to prevent disease transmission Symptomatic and asymptomatic individuals in essential occupations such as grocery store and food supply workers, utility workers and public employees Other individuals with symptoms consistent with COVID-19

Lets Work Together MarqueMedical.com 1-877-MY-DOC-NOW Let Our Family Take Care of Yours https://youtu.be/_lKIXTGGTyc

Serology In the CDC Interim guidance, the CDC states that in areas of low prevalence, <5% (like SD), antibody testing might result in more false positive and results, and more false negatives. CDC Interim Guidance click HERE So, in an area of 5% prevalence, and a test with a 90% sensitivity and 95% specificity, the positive predictive value is 49% The CDC recommends serology not be used for diagnosis of acute disease, or to determine immunity, There are 3 populations where it has potential value In a patient with presumed Covid disease, but the PCR is negative, and symptoms for at least a week, antibody testing has value these would be hospitalized patients generally, and with a potential treatment at hand, would alter the plan of care For those who had Covid disease and with to donate convalescent serum for the treatment of others. For diagnosis of children thought to have Multi-System Inflammatory Disorder

Immunological assessment of SARS-CoV-2 A Chinese study was published Friday, to evaluate the antibodies in 2800 people 37 people who were asymptomatic for the 14 days prior to testing, and tested positive for the antibody Of asymptomatic individuals, 93.3% (28/30) and 81.1% (30/37) had reduction in IgG and neutralizing antibody levels, respectively, during the early convalescent phase, as compared to 96.8% (30/31) and 62.2% (23/37) of symptomatic patients Viral shedding ranged from 6 days to 45 days, with a mean of 14 days in patients with mild disease Previous studies show that for SARS and MERS, immunity lasted 2 years Covid-19, however, shows a decrease of neutralizing antibodies within 2-3 months after infection. Those with milder disease showed a more rapid decrease. A serostudy is needed to study the true re-infection rate

County Health Department testing sites as of 6/29/20 If you are experiencing symptoms, contact your healthcare provider. If you do not have a healthcare provider, call 2-1-1. If you have serious symptoms, like difficulty breathing, call 911. Patients with no symptoms are directed by the county website to first contact their PCP, however, our guidance is not to test asymptomatic persons. They should be referred to the county. The best way to secure a spot for testing is by utilizing their website at .www.211sandiego.org . A state supported interactive map has information relative to each site. Here is the link to testing: https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/2019- nCoV/testing.html Reservations are required at all sites. Results are generally available within 5 days. A link to the testing schedules can be found here: https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/2019- nCoV/testing/testing-schedule.html

New cases Reported 6/27, 6% of tests reported positive

Covid cases around San Diego

Resources Clinician On-call Center is a 24 hours hotline with trained CDC clinicians standing by to answer questions from healthcare personnel, at 800-CDC-INFO (800-232-4636) National Institutes of Health: Coronavirus Disease 2019 (COVID-19) Treatment Guidelinesexternal icon State Health Department After-Hours Contact Listexternal icon Guidelines for exposure at work https://www.sandiegocounty.gov/coronavirus.html California Health Alert Network (CAHAN) Sharp specific coronavirus site The reopening continues, with the following, while observing physical distancing: https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/commu nity_epidemiology/dc/2019-nCoV/reopening.html