COVID-19 Preparedness and Response Middlesex County ... · transmission/portal of exit/entry) Avoid touching your eyes, nose, and mouth (portal of entry) Clean and disinfect frequently

COVID-19 Preparedness and Response

Middlesex County Chamber of Commerce

March 13, 2020

Dr. Alina Filozov: Section Chief, Infectious Disease; Epidemiologist

Jodi Parisi: Infection Prevention Manager

Dr. Jonathan Bankoff: Chairman, Department of Emergency Medicine

Jim Hite: Director, Environmental Safety and Protective Services

Dr. Matthew Lundquist: Medical Director, Occupational Medicine/Employee Health

Presenters

COVID-19

-CO-Corona

-Vi-Virus

-D-Disease

2019-nCoV shares 79% of genetic make up with coronavirus (SARS-CoV), about 52% (MERS-CoV), and about 87% with two strains of bat-derived SARS-like coronavirus identified in Zhoushan in 2015. Humans are not the primary target for these viruses. COVID-19 is less dangerous than SARS or MERS, but it has a longer incubation period. The first patient with unexplained pneumonia was identified on December 12, 2019.

Symptoms and Risks for Severe Disease● Fever- 77- 98%● Cough- 46-82%● Shortness of breath- 3-31%● Muscle pain or fatigue- 32%● Heart palpitations, diarrhea, headache● Incubation period- 4-7 days to up to 14 days

Patients with a high risk for severe disease include: Smokers and patients with diabetes, chronic lung and heart disease and older individuals (51-70 years old).More than 80% of infected patients recover or have mild illness.Mortality: 0.7% in South Korea; 0.4% in China, outside of the epicenter of activity.

Transmission of the VirusThe virus is thought to spread mainly from person-to-person and mostly from symptomatic patients. It is thought to spread:

● Between people who are in close contact with one another (within about 6 feet)● Through respiratory droplets produced when an infected person coughs or sneezes● From contact with infected surfaces or objects

Surfaces can be contaminated for minutes to hours to days, but transmission is likely limited.

Mail, packages or money contaminated with the virus are unlikely to cause transmission.

Bleach or alcohol wipes successfully deactivate the virus from surfaces.

COVID-19 vs FluThe CDC estimates that so far this season there have been at least 34 million flu illnesses, 350,000 hospitalizations and 20,000 deaths from flu. (0.06%)

The total number of flu cases per season: 9 million-49 million

In the US, mortality from the flu and pneumonia during this season was 6.9%.

Diagnosis and TreatmentPCR test results can be positive, negative and inconclusive.

It takes 6-11 days for the test to turn negative.

The first COVID-19 vaccine in China is expected to be ready for clinical trials by the end of April. In the U.S. and abroad, multiple vaccines are in various stages of development.

Favilavir is the first approved coronavirus drug in China. Multiple other drugs are showing promise, including an existing anti-malarial and an HIV medication.

Suggestions to Control the Spread of COVID-19 in the Workplace

● Actively encourage sick employees to stay home.● Separate sick employees.● Emphasize staying home when sick, respiratory etiquette and hand hygiene for all

employees.● Perform routine environmental cleaning.● Advise employees before traveling to take certain steps and consider avoiding all non-

essential travel, especially into level 3 risk countries.● Employees who are well, but who have a sick family member at home with COVID-19,

should notify their supervisor

We can break the chain of transmission!

What You Need to Do to Stay Healthy● Avoid close contact with people who are sick (mode of

transmission/portal of exit/entry)● Avoid touching your eyes, nose, and mouth (portal of entry)● Clean and disinfect frequently touched objects and surfaces-

survival on surfaces- few minutes - 9 days (reservoir)● Wash your hands often, especially after going to the bathroom;

before eating; and after blowing your nose, coughing, or sneezing (multiple links).○ Use soap & water for 20 seconds. Sing Happy Birthday!○ Use alcohol-based hand sanitizer. ○ Always wash hands with soap and water if they are visibly

dirty.

Should I Wear a Facemask to Protect Myself?● NO!● Follow the CDC’s recommendations for using a facemask.

a. The CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.

b. Facemasks should ONLY be used by:■ People who show symptoms of infectious respiratory diseases like COVID-19 to

help prevent the spread of the disease to others. ■ Health care workers who take care of people with infectious respiratory diseases.

What You Need to Do If You Get Sick ● Stay home when you are sick (multiple

links)● Cover your coughs & sneezes (portal of

exit/reservoir)a. Use your elbow or a tissue and NOT

YOUR HANDS and then throw the tissue in the trash.

Also...

● Call your doctor to discuss your symptoms.● Your doctor may suggest that:

○ You stay home until you are better ○ You call them back if you get significantly worse

● Your doctor may create a plan for your evaluation. To limit the spread of disease, you may be asked to:○ Go to a specific Emergency Department location○ Communicate with staff when you arrive. They will meet you,

give you a mask, and guide you to designated room.

,

Important to Note!

Based on an evaluation and recommendations from the CDC, you may (or may not) be tested for COVID-19.

HELP US FLATTEN THE CURVE

Middlesex Health Emergency Preparedness: COVID-19

● All Hazards Infectious Disease Triage Protocol is in place at all 3 Emergency Department locations

● Constant state of readiness maintained since protocol inception (2015) with regular activation (Triage Travel Stat)

● Annual staff education● Announced / Unannounced disaster exercises (including

pandemic exercises)

Middlesex Health Emergency Preparedness: COVID-19● Early discussion and collaboration between the Emergency Department,

Infectious Disease, Environmental Protective Services, Public Relations, and executive leadership

● Protocol update and system-wide dissemination ● Re-education for all staff on the proper use of personal protective

equipment● Fact-based communication with outpatient providers and offices● Creation of appropriate signage and scripting for patients ● Centralized BaseCamp for leadership communication● Medical staff education about symptoms and testing● Daily Emergency Department staff huddles with updates

Middlesex Health Emergency Preparedness: COVID-19

● Capacity management strategies to address a potential large volume of Emergency Department patient arrivals

● Creation of workflow algorithm with identification of patient placement locations and provisions of care at all 3 Emergency Department locations

● Attention to health system staff workforce health and safety● Maintenance of personal protective equipment supply chain needs● Awareness of CDC and DPH updates, local community impact● Meetings with local law enforcement and first response leadership

Emergency Preparedness Throughout the Health System

Building Resiliency Through Knowledge, Awareness, and Relationships

In 2010, the World Health Organization defined a pandemic as “the worldwide spread of a new disease” that affects large numbers of people. The CDC says it is “an epidemic that has spread over several countries or continents, usually affecting a large number of people.”

New York Times, February, 28, 2020

Pandemic Plan: Four Primary Goals

➢ Limit severe illness and death.

➢ Work with health care partners to support appropriate illness

evaluation and care.

➢ Maintain essential medical services.

➢ Work with public health agencies and the state Department of

Public Health to communicate rapidly, accurately, and frequently

with the public, the medical community, and others as needed.

The 4S’s of Emergency PlanningAll Hazards Planning and Continuity of

Operations

➢Safety➢Staff➢Supplies➢Space

SafetyHealth System Businesses

➢ You’re sick = Stay home➢ Flexible sick policies➢ Separate the sick➢ Emphasize handwashing and

cover your cough➢ Environmental cleaning➢ Travel restrictions

Keyword Search: Coronavirus and Business

StaffHealth System Businesses

➢ Communication, communication, communication

- How- What- When

➢ Involve staff in planning➢ Staff monitoring directions➢ Reassign at-risk staff➢ Postpone elective procedures➢ Utilize Employee Assistance

Program (EAP)

➢ Communication, communication, communication

- How- What- When

➢ Involve staff in planning➢ Cross-train➢ Educate staff on expectations and

protect our health systems

Keyword Search: Coronavirus and Business

Supplies - Supply Chain ResponseHealth System Businesses

➢ Critical personal protective equipment

- Security- Conservation measures

- Limiting supply access- Limiting who goes in a room- Task coupling

➢ N95 Respirators➢ Masks➢ Surgical gowns➢ Hand sanitizer➢ Pharmaceuticals

➢ What are your business processesses

➢ Supply chain transportation➢ Identify alternative suppliers➢ Prioritize customers➢ Temporarily suspend some of your

operations, if needed

➢ Run “What if” scenarios - tabletops

Keyword Search: Coronavirus and Business

Space - SurgeHealth System Businesses

➢ Isolate Patients- Emergency Department locations- Inpatient

➢ Negative air patient care areas

➢ Reverse surge

➢ Virtual business management

➢ Alternate physical business sites

Keyword Search: Coronavirus and Business

The End

ContactsDr. Alina Filozov: Section Chief, Infectious Disease; [email protected]

Jodi Parisi: Infection Prevention Manager- [email protected]

Dr. Jonathan Bankoff: Chairman, Department of Emergency Medicine

Jim Hite: Director, Environmental Safety and Protective Services [email protected]