Weekly Healthcare Facilities Coronavirus Update Conference Call February 18, 2020 7:45 am - 8:45 am
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Weekly Healthcare Facilities
Coronavirus Update Conference Call
February 18, 2020
7:45 am – 8:45 am
Key Points:
• Emergency Pharmaceutical Services Unit (EPSU) is currently developing a questionnaire that will
be sent to all the Regional Disaster Medical Health Specialists (RDMHS) and Medical Health
Operational Area Coordinators (MHOAC) by the end of today. The questionnaire will include
questions about the amount and number/models that facilities currently have, including all
Personal Protective Equipment (PPE), and the current burn rate of the PPE items. This
information is necessary to determine what models are being requested and are acceptable for
facilities
Persons Under Investigation (PUI) for COVID-19: Quick Reminders
• Initial testing for all persons under investigation should include a nasopharyngeal swap and an
oropharyngeal swap, and sputum only if the patient has a productive cough.
o Please refrigerate specimens until they can be shipped on ice packs.
o Work directly with your local health department to package and ship the specimens to
Centers for Disease Control and Prevention (CDC).
o A CDC specimen shipping form is required (Form 50.34). Please DO NOT handwrite this
form.
• All persons under investigation must be assigned a COVID-19 ID number (often referred to as a
PUI ID) by CDC. Please seek out this number early on, and make sure it is listed on all forms and
correspondence related to the patient! Your local health department will work with CDPH and
CDC to obtain this number.
o The COVID-19 number is essential for processing specimens and linking results to a
patient. Failure to include this number on the 50.34 and other correspondence could
cause significant delays in processing specimens and returning results to you.
o Every person under investigation must have a PUI form filled out. This brief form is
available from your local health department and captures key clinical and exposure
information. It should be completed by the clinical team in collaboration with the local
health department.
Update:
• Update from Doctor Sonia Angell, CDPH Director: On February 17, repatriation flight landed in
Travis Air Force Base at approximately 12:30 A.M. the passengers will be quarantined for 14
days.
• Center for Infectious Disease Update – Doctor Kathy Harriman:o Worldwide, there have now been over 72,000 cases and 1,800 deaths
o China’s daily new confirmed cases outside of Hubei province have dropped for the 12th
consecutive day.
o Almost 900 additional cases have been reported in 28 other countries.
o 454 cases have been reported among Diamond Princess passengers.
o There are now 15 reported cases in the US (not including cases among Americans who
were passengers on the Diamond Princess).
o To date, 156 “persons under investigation” have been identified in California; 8 tested
positive and are cases, 144 have tested negative, and have 4 pending test results.
o China Centers for Disease Control published a report on over 44,000 cases of COVID-19.
o Most cases ranged from 30-79 years old, had mild symptoms, and were confirmed in
Hubei province with the majority having exposure related to Wuhan.
o The estimated case fatality ratio was 2.3%.
o There have been 1,716 cases among healthcare workers; 87% from Hubei province. Six
healthcare workers have died.
• Laboratory Update – Doctor Deb Wadford:
o Diagnostic testing is still only available at CDC; local testing at Public Health labs has
been delayed due to a manufacturing issue with testing kits
o Health care providers with persons under investigation of the 2019 novel coronavirus
must contact their Local Health Department (LHD) for testing approval and guidance on
specimen submissions for testing at CDC; specimens must be accompanied by required
CDC submittal forms which will be completed by the LHD or local public health lab.
o Health care providers should be familiar with CDC biosafety guidelines for handling and
processing novel coronavirus specimens
o CDC requests respiratory specimens, including both NP swab (in VTM) and OP swab (in
VTM); NP and OP swabs should be placed in separate viral transport medium (VTM) vials
o Specimens must be packaged and shipped according to US Department of
Transportation and International Air Transport Association (IATA) regulations which
your local Health Department/Public Health Lab will facilitate
o Ensure that the sample type is included on the specimen vial and that patient
information is clearly indicated on the specimen tube; CDC may reject samples if not
labeled correctly
• EPSU – Dana Grau, Pharm. D.
o California Department of Public Health (CDPH) sent a request to the Assistant Secretary
for Preparedness and Response (ASPR) to use N95s, which was then forwarded to
National Institute for Occupational Safety and Health (NIOSH). Expired N95 that local
health departments have stockpiled are not approved by NIOSH.
o Los Alamitos staging area currently has approximately 18,000 N95s model 3M 8511 that
were purchased during the October wildfires
o CDPH ordered a total of 600,000 N95 respirators (different models)
o Currently developing a questionnaire that will be sent to all the RDMHS and MHOACs by
the end of today. The questionnaire will include questions about the amount andnumber/models that facilities currently have, including all PPE, and the current burn
rate of the PPE items. This information is necessary to determine what models are being
requested and are acceptable for facilities
o CDC.gov conducted a webinar on Friday regarding information on PPE
o The anticipated delivery date for the first State order of 300,000 N95 respirators (model
8511) is not until April 2020. There is no anticipated arrival date the second order of
300,000 N95 respirators.
o Dana recommends calling customer service of the supplier to expedite the order if
possible
Q: What is the current survival time on surfaces? Is there any solid research on the actual surface time?
A: Kathy stated she has not seen any research on this specific coronavirus. The current survival time is
based on similar viruses. Deb stated that it could be several hours to days.
Q: Reports are stating that there is surveillance going on in five cities, including two cities in California.
What is the scale and timing of that?
A: Yes, there will be a surveillance project aimed at detecting community transmission. Specimens from
a sample of patients with ILI who test negative for influenza will be tested for the novel coronavirus.
This has not started yet, but should be soon.
Q: Can laboratory personnel do the packaging and mailing for the lab specimens, or does it have to be
the Public Health department?
A: As long as you are coordinating with the lab, the lab personnel can do the packaging and mailing.
Please include correct forms needed.
Q: Gina Newman, from Sharp Healthcare San Diego – regarding the patients who test positive in flight
from the Diamond Princess Cruise ship, where are they located?
A: There was one flight that came to California. Five of the positive cases stayed in California (located in
healthcare facilities) and three went on to Nebraska. A second flight went directly to Texas.
Q: Is regular hand sanitizer containing alcohol suitable for preventing/protecting against coronavirus?
A: Yes, CDC is recommending alcohol sanitizer that contains at least 60% alcohol.
Q: Linda Knowles, Kaiser Manteca – what are the requirements for handling waste? What if the vendor
is requiring special waste handling? Also, is the period of time for surveillance increasing to 21 days?
A: There is no special handling of waste at this time. CDC feels confident with the 14-day period; and are
not considering extending it at this time.
Q: Is there an update on the severity of cases in California?A: In California, most cases have not been very sick although some have required hospitalization. However, some have been hospitalized primarily for isolation. Q: Is there any suspicion of the virus circulating? A: Although it’s not known to be occurring, this is the reason for the surveillance project mentioned earlier. Q: Jeremy baker, LA County Providence Health – are there any notification or coordination protocols for moving patients over county lines? A: There is currently a workgroup with CHA leadership, OSHA, and other leadership to discuss this. They are working with LHDs to discuss these planning and coordination efforts. Q: What does CDC recommend for PPE for HCWs transporting known or suspect cases in a healthcare facility? A: Please see guidance at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-prevention- control-faq.html Q: There are reports that an American disembarked a cruise ship in Cambodia, and later tested positive. Any information or updates on this? A: Kathy: CDC is trying to identify American passengers who may have been exposed. Q: Ted, Adventist Health, Paradise, California – What is recommended for using N95’s, as the coronavirus particles are smaller than the filters. A: Kathy: The most penetrating particle size for an N95 respirator is 0.3 microns. This means that particles smaller and larger than that size are filtered with greater efficiency. This means that particles smaller than 0.3 microns are filtered effectively. Q: Regarding the 6 healthcare worker deaths in China. How should we communicate risk to our healthcare workers? A: Kathy: There has been a shortage of PPE in China. It is possible that people were not adequately protected, but we have no additional information right now. Q: The Westerdam cruise ship chartered a flight that took 100 passengers to Malaysia. This contained Americans who then flew back to the U.S. These passengers are considered low risk who are home quarantined. If that status changes, or any other potential cases occur, how would we be aware of this increased risk? A: The Epi-X system sends notifications about persons arriving in the US who may have been exposed. CDPH sends this information to the LHDs where the potentially exposed persons reside. Currently
working with LHDs currently and will reach out if we have updated guidance or new information to provide. Q: Ray Rosario from Santa Clara – any updates on the new antiviral drug in China? A: There are currently 80 clinical trials right now in China. CDC is available for clinical consultations on ill cases. Q: Daniel Beasley from Twenty Nine Palms – our procedures are if a patient has been to China, we move them to an airborne isolation area in their hospital. What is the recommended PPE for staff transporting them and patients in the hallway? A: Please see information above. Q: If there are language barriers and patients are unsure when symptoms showed, what is the recommendation of isolation? A: You can be more conservative if timing of symptom onset is unclear. Q: Does CDC know of any false negatives? Have there been any pediatric cases or pediatric deaths? A: We are unaware of any falsely negative test results although this is a possibility. CDC is currently not aware of any pediatric deaths. The pediatric cases have been mild so far.
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