Title (Single Line) Today’s Activity Code: 13586 · Skype Etiquette • Mute your phone and computer during the call, as severe echoes can occur. Mute using either a mute button,

Title (Single Line)

Agenda for 07/22/2020

• Covid updates

• Eye protection

• Isolation discontinuation

• Miscellaneous/Open Discussion

This activity has been designated for CME and

ABIM MOC credits and is being recorded

Today’s Activity Code:

13586

TEXT YOUR ATTENDANCEIts important that we know you are participating

Text Attendance Number:

(858) 247-3111

Today’s Activity Code:

13586

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

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Updates – July 22

• Eye protection was recently added by the CDC as part of routine PPE. This is in the

form of goggles or face shields. Regular prescription glasses are not sufficient. If you

are separated from the patient by a barrier (Plexiglas, clear curtain, etc), no need for

the additional eye protection.

• There are 400 patients with Covid in area hospitals, which is an increase

• The Office of Civil Rights issued guidance 7/20, prohibiting discrimination during the

Covid pandemic. There were no changes to their usual guidance, but wanted to

reinforce that they continue

• California overtakes New York, as the State with the most Covid cases since the

pandemic began, with > 409,000 confirmed cases, and 9,000 cases /day

• All US airline carriers now require face coverings during check-in, boarding, in-flight,

and when departing

Discontinuation of Isolation, not in Healthcare Settings

New guidance, 7/19/20, CDC

• A test-based strategy is no longer recommended (some exceptions)

• Changed from “at least 72 hours” to “at least 24 hours” have passed since last fever

(without the use of fever-reducing meds)

• DC isolation once its been 10 days since onset of symptoms, and 24 hours without fever

• For Immunocompromised patients, DC after 20 days from onset of symptoms (+24hr)

• For persons who never develop symptoms, isolation and precautions can be

discontinued 10 days after the date of first positive PCR test

• For patients previously with Covid-19, If new positive PCR test and its been 3 months

since their initial infection, treat as a new infection

• These recommendations include persons living in congregate facilities and healthcare

workers

Updates

• A total of 233 Sharp staff members have tested positive for Covid-19, year to date

• Employee exposure sources were patients in 69%, other employees 28%, and all

others 3%

• The American Society of Hospital Pharmacists developed an assessment of evidence

to COVID-19 treatments, updated 7/16/20. It can be found here:

https://www.ashp.org/-/media/assets/pharmacy-practice/resource-

centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table.ashx

• Public Health Hotels are still available at no cost if needed for stable independent

COVID patients needing temporary housing. Call 858-715-2350, 7am-9pm

• More than 100,000 people have signed up for a clinical trial with Pfizer

• Congress is debating a new Covid funding stimulus bill

• President Trump for the first time, recommended wearing masks and physically

distance. Most countries have mandated them for months

Current Situation in SD – Triggers – July 13

• We are currently failing 3 triggers, that resulted in reinstitution of restrictions, but all 3

have improved a little

• Case rate trigger 149.2 cases/100k (goal <100), and down from 157.2 Monday

• Community outbreak trigger 14 in last 7 days (goal <7), down from 16 Monday

• Case Investigation trigger - initiated within 24 hr 10% (goal >70%) up from 7%

• County ICU capacity is 34%

• Hospital capacity is at 68%

• PPE Supply is at 72%

This activity is being recorded

Healthcare Workplace Exposure

• Eye protection was added July 9th to the CDC recommendations, based on the level of

sustained Covid transmission in the community

• Eye protection is commonly referred to as goggles of face shield.

• Exposures to staff in the office are guided by the CDC, and largely dependent on 2

things: whether they were wearing proper PPE, and the extent of exposure.

• https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-

recommendations.html

• https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

MIPS for 2020

• CMS announced that physicians will have the option to op out completely or partially,

from Medicare’s 2020 MIPS program and be held harmless from payment

adjustments

• The physician needs to apply for a hardship exemption and indicate on the application

that it is due to the COVID-19 public health emergency.

• Deadline for submitting this application is 12/31/2020

• You can request reweighting of one or more MIPS performance categories, or opt out

completely

• To complete the hardship application you need to log into your QPP account here:

https://qpp.cms.gov/login

Testing for PCR (nasal Swab) – new CDPH Guidelines 7/14

• Tier One Priority

• Hospitalized individuals with COVID-19 symptoms.

• Investigation and management of outbreaks, under direction of state and local

public health departments (includes contact tracing).

• Close contacts of confirmed cases.

• Tier Two Priority

• All other Individuals with COVID-19 symptoms, or:

• Asymptomatic persons Live in higher risk congregate care facilities

• Those who work in the health care sector who have frequent interactions with

the public or with people who may have COVID-19 (includes doctor offices)

• Who provide care to a person with a disability in the home

• Who are pre-op, or being discharged from the hospital

Testing Priorities - CDPH

• Tier Three Priority

• Individuals who work in the retail or manufacturing sectors, food service

industry, transportation sector, education sector, agricultural or food

manufacturing sectors who have frequent interactions with the public or who

works in an environment where it is not practical to maintain at least six feet

of space from other workers

• Tier Four Priority

• Implemented by the state when testing turn around is < 48 hours, and

includes other who are asymptomatic, but believe they have a risk of being

actively infected

There is no need for return to work testing (San Diego County Coronavirus Update July 15)

County Health Department testing sites

COVID-19 Resources

More than 100 community testing sites also offer free, confidential testing: Find a

COVID-19 Testing Site.

For more information about what Californians can do to prevent the spread of

COVID-19, visit Coronavirus (COVID-19) in California.

California continues to issue guidance on preparing and protecting California from

COVID-19. Consolidated guidance is available on the California Department of

Public Health's Guidance web page.

New cases

Reported 7/21, with 4% of tests reported positive

Hospitalizations 9.2%

Intensive Care 2.4%

The CMA developed templates regarding re-opening

• The California Medical Association (CMA) has developed sample communications to

help physicians inform and educate patients that it is safe to resume routine and non-

urgent medical visits, and to notify patients what their practices are doing to keep

patients and staff safe.

• These templates—available free to all physicians—are intended to be general

guides, and should be adjusted based on the needs of an individual practice or patient

group. It includes signage, email templates, social media, referral network and

medical group.

CMA is also developing video PSAs and other materials as part of a larger campaign on

this issue.

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

Open Forum and QuestionsReminder this activity

is being recorded

TEXT YOUR ATTENDANCEIts important that we know you are participating

Text Attendance Number:

(858) 247-3111

Today’s Activity Code:

13586