The Cozy Covid Corner Updates and Reminders
Today's session covers updates on Covid-19 cases, state-wide mask orders, office PPE updates, proper PPE usage, and more. Important announcements regarding travel advisories and a bulk purchase offer for ACP members are included. Stay informed and engaged in the latest developments related to the pandemic.
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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 6/24/2020 New state-wide mask order 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: 13533
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
Last year we said, 'Things can't go on like this', and they didn't, they got worse. Will Rogers (1879-1935)
American College of Physicians obtained a one time bulk purchase, which may not be repeated The following are available: Makrite 9500 N95 masks (Box of 20 for $112.00) Polyethylene Level 1 gown, one size (bag of 15 for $22.80) Offer available to ACP members only Login to your ACP account to order ACP 800-227-1915, or 215-351-2600 Orders must be received by this Friday, 6/26
Updates The European Union is considering banning visitors from the US, as they open their borders, due to high case rates Governors from NY, NJ, CT issue a travel advisory. Visitors from high infections rates have to quarantine for 14 days Historic dust plume from the Sahara desert is expected to reach mainland US tomorrow morning, and has caused record decreases in air quality in Puerto Rico. People with underlying lung diseases could start seeking medical care Surges in Coronaviruses seen in Florida, with daily cases increasing by 35 each day Surges in other states seen in Texas, Arizona, Oklahoma, a total of 26 states showing increases Arizona ICU capacity down to 17% of available beds
County update 6/22 10 community outbreaks were reported within the last 7 days This one of the 13 triggers that could lead to re-establishment of restrictions Restrictions would likely be focused on the affected businesses rather than closing entire sectors of the economy Sectors still closed: Indoor playgrounds, such as ball pits and laser tag Saunas and steam rooms Live theater Nightclubs Concerts Festivals Theme parks Live audience sports Colleges and universities https://www.sandiegocounty.gov/conten t/sdc/hhsa/programs/phs/community_e pidemiology/dc/2019- nCoV/reopening.html
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.
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.
Removing PPE Reminder this activity is being recorded Gloves: Outside of gloves are contaminated! Grasp outside of glove with opposite gloved hand; peel off Hold removed glove in gloved hand Slide fingers of ungloved hand under remaining glove at wrist Goggles/face shield Outside of goggles or face shield are contaminated! To remove, handle by clean head band or ear pieces Place in designated receptacle for reprocessing or in waste container Mask Front of mask/respirator is contaminated DO NOT TOUCH! Grasp ONLY bottom then top ties/elastics and remove Discard in waste container
Removing PPE Gown Gown front and sleeves are contaminated! Unfasten neck, then waist ties Remove gown using a peeling motion; pull gown from each shoulder toward the same hand Gown will turn inside out Hold removed gown away from body, roll into a bundle and discard into waste or linen receptacle Hand Hygiene follows removal of PPE each time!
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
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 5/18/20 Testing sites are running in many locations. A physicians referral is required for the county sites, and appointments are mandatory. These can be made by calling 211, or at www.211sandiego.org . An 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
New cases Reported 6/21, 7% of tests reported positive Monday, now down to 3% again
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
Reminder this activity is being recorded Open Forum and Questions Are you about to obtain PPE, and are they available in sufficient quantities?
TEXT YOUR ATTENDANCE Its important that we know you are participating Text Attendance Number: (858) 247-3111 Today s Activity Code: 13533
