Agenda for 10/14/2020

• Covid update

• Traveling

• Duration of Immunity

• Herd Immunity

• Miscellaneous/Open Discussion

This activity has been designated for CME and

ABIM MOC credits and is being recorded

Today’s Activity Code: 13706

TEXT YOUR ATTENDANCEIts important that we know you are participating

Text Attendance Number:

(858) 247-3111

Today’s Activity Code:

13706

“Whenever you find yourself doubting how far you can go, just remember how far you have come. Remember everything you have faced, all the battles you have won, and all the fears you have overcome.” Anonymous

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858-672-5202

Update Oct 14

• Epidemiologic triggers are updated weekly on Tuesdays. As of yesterday, our adjusted

case rate increased to 6.8, allowing San Diego to stay in the red tier, without new

restrictions. Adjustment is made when the total number of tests exceed a threshold

• The Great American Shake Out is an annual practice all across the state, where

healthcare systems simulate the effects of an earthquake, to test readiness. This year it

occurs tomorrow at 10:15am

– Of note, everyone in San Diego lives within 6 miles of an earthquake fault

• The number of hospitalized patients with Covid dropped slightly, but new cases continue

to surge, both in San Diego, and across the nation

• Covid vaccine deployment plans are underway, to prioritize those with direct patient

contact and first responders – 1 application fro all of Sharp Healthcare. The vaccine will

be distributed by the federal government, to the states, and prioritized from there

Updates Oct 14

• Johnson & Johnson has paused their vaccine trial, due to a patient care event

• Eli Lilly has paused their monoclonal antibody drug for the same reason

• Astra-Zeneca remains paused in the US, but Pfizer continues its Phase 3 trial

• CDC Director, Dr. Robert Redfield, stated small gatherings are becoming a growing

source of Covid-19 spread, in a call with the nation’s governors yesterday

• This makes it important to use mitigation strategies during the upcoming Thanksgiving

holiday. Outdoor celebrations are encouraged when possible, per CDC

• This as there is a surging of new cases, with the daily average at 51,000, and 48%

higher than a month ago, nationwide

• Several states are reporting all available ICU unit beds and ventilators are in use

• A team in Denmark reported 38.4% those with blood type O have tested Covid +, while

type O makes up 41.7% of the population. In Canada Blood type A was associated with

a higher rate of mechanical ventilation than type O or B (84% vs 61%)

https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html

Traveling During the Pandemic (CDC)

• The CDC lists travel recommendations for destinations around the world, as well as

restrictions for travelers

• Recommendations remain, including the use of face coverings, physical distancing,

hand hygiene, avoiding contact with those who appear sick, and avoid touching the

eyes, nose and mouth

• Airline air is HEPA filtered, and moves downward from the air nozzles to the floor

• Public transportation and ridesharing can increase chances of virus exposure

• Car or RV travel may involve making stops alone the way, putting you in contact with

frequently-touched surfaces

• Consider bringing your own food, and hand sanitizer

• Many companies are using contactless reservation, payment, and check-in systems

https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html

Update Oct 14 – Duration of Immunity

• The University of Arizona College of Medicine reported in the Journal Immunity Covid

antibodies after infection can last 5-7 months. In addition to the neutralizing

antibodies that decline early, activated B cells mature into plasma cells, later in the

course of disease

• Those infected with the first SARS virus still have evidence of immunity 17 years

later. They speculate immunity to SARS-CoV-2 may last up to 2 years

• Last week, researchers at Massachusetts General found elevated IgG antibodies to

SARS-CoV-2 for up to 4 months. IgM and IgA spiked and crashed within 2 months

• A Canadian group in the Journal Science Immunology reported at least 3 months

antibody response, using saliva-based tests

https://www.cell.com/immunity/fulltext/S1074-7613(20)30445-3https://immunology.sciencemag.org/content/5/52/eabe5511

New Metric – Health Equity

• Starting last week, the state started focusing on the most disadvantaged communities

• This new Health Equity metric will be used in addition to the case rate and positivity rate

to determine a county’s epidemiologic tier, but only to help move a county into a lower

tier, not to move into a more restrictive tier

• This is in response to the disproportionately affected groups of low-income

neighborhoods, essential workers, and people of color, that together make up 40% of

Covid cases

• The metric is defined as positivity rate being on the lowest quartile of the Healthy Places

index census tracts, to ensure it doesn’t fall behind the overall county positivity rate

• The Healthy Places Index is a composite measure of socioeconomic opportunity applied

to census tracts, with 25 indicators, including housing, social, & transportation sectors

Halloween Guidance from CDPH – Oct 13

• In all cases, practice physical distancing, hand hygiene, mouth coverings, minimize

mixing of different households

• CDPH strongly discourages traditional trick-or-treating

– Alternatives suggested: candy scavenger hunt at home, online pumpkin carving

and costume contests, and car-based tours of Halloween displays

– Other alternatives: scary movie night, outside meal for your household or 2

households, dressing up homes and yards with Halloween decorations, Halloween

basket for your own children or Halloween hunt in your backyard

• Same guidance for Dia de los Muertos

– Traditional indoor alters moved outside, create virtual altars, and short cemetery

visits limited to household members

New Sharp Guidance on Masks – Oct 7

• Guidance for Medical Building Staff (Hospitals, Clinics, Urgent Cares and Laboratory Areas):

– Upon facility entry patients, vendors, support persons, volunteers, law enforcement officers and other visitors should

wear a procedure-type mask.

– Screeners/greeters will provide this specific Medline face mask for patients, vendors, support persons, volunteers, law

enforcement officers and other visitors wearing gaiters, bandanas, single-layer cloth masks or masks with exhalation

valves.

– Clinical staff or those with direct patient interaction will continue to be offered and wear a medical grade procedure

mask.

• Guidance for Non-Medical Building Staff (e.g., Copley, Ruffin, Spectrum, Tech Way and Non-

patient-facing Buildings on Hospital Campuses):

– Persons in non-clinical buildings may wear their own multilayer face coverings.

– If employees are wearing gaiters, bandanas, single-layer cloth masks or masks with exhalation valves, the

screener/greeter should provide guidance on acceptable face coverings and provide this specific Medline mask to the

employees.

– Screeners/greeters will provide this specific Medline face mask for facility vendors, volunteers, law enforcement

officers, and other visitors wearing gaiters, bandanas, single-layer cloth masks or masks with exhalation valves.

Reminder on Obtaining Influenza Vaccine

• Very important this year to vaccinate, due to potential effect on patients, and on the

healthcare system capacity – a “twindemic”

• The patient can just show up any of the Vons/Albertsons locations and let the pharmacy know that they are with SCMG. It would help if they brought their insurance card. No prescription is required and no copay for HMO members. Fluzone HD may not be available at all locations, so the member would need to call around to see which locations have it in stock.

• https://providers.scmg.org/news/news2know/2020-2021-Influenza-Season.cfm• Consent forms are available here, to shorten wait times

– Albertsons– Vons– Pavilions

https://providers.scmg.org/news/news2know/2020-2021-Influenza-Season.cfmhttps://albertsons.medrefill.com/abweb/#/immunizationFormhttps://vons.medrefill.com/vnweb/#/immunizationFormhttps://pavilions.medrefill.com/pvweb/#/immunizationForm

Herd Immunity

• Occurs when a large portion of a community (the herd) becomes immune to a

disease, making the spread of the disease from person to person unlikely. As a result,

the entire community becomes protected

• The threshold proportion is that percentage of a population susceptible to a disease.

If the proportion of the population that is immune to the disease is greater than this

threshold, the spread of disease will decline – aka the herd immunity threshold

• The percentage of a community that needs to be immune to achieve herd immunity

varies by the disease. The more contagious it is, the greater the population needed to

be immune to stop it. For measles for example, 94% of the population must be

immune to interrupt the chain of transmission

• You achieve immunity via having the disease, or through vaccination. Opposition to

vaccines can pose a real challenge to achieving herd immunity

Herd Immunity and Covid-19

• A major problem is the uncertainty of immune status after Covid infection

• Estimates are that 70% of the population would need to be Covid immune to achieve

herd immunity – more than 200 million people

• Assuming a 1.5% mortality rate, that’s 3 million deaths to achieve herd immunity, minus

those willing to get a Covid vaccine

• That many people getting Covid infection would rapidly overwhelm the healthcare system

• Recent Gallup poll indicates only 50% of people say they would take a Covid vaccine,

leaving approximately 160 million unprotected, and just under 8 million have been

infected so far. To achieve herd immunity, that means an additional 32+ million people

would have to become infected, and an additional 480,000 deaths, assuming 100%

effectiveness of the vaccine. At 70% effectiveness, additional 685,000 deaths to immunity

COVID testing at SharpCare

• The Eastlake site is still doing testing, but due to staffing shortages, providers and

patients should know that a test may not be available same day or next day.

• The Spring Valley site is unable to do Covid testing at this time

Current Testing Recommendations

• Priority Level 1: High-Risk Symptomatic Individuals and Public Health Investigations

– Symptomatic individuals not diagnosed with COVID-19 in past 3 months who are

hospitalized, in congregate facilities, older adults and those with chronic or

underlying medical conditions, or in a vulnerable population.

– Persons identified for testing by public health investigations and disease control

activities including those in potential outbreak settings.

• Priority Level 2: Other Symptomatic Individuals and Hospital and Procedure Testing

– Symptomatic persons who do not meet above symptomatic criteria, including

healthcare workers and first responders, not diagnosed with COVID-19 in past 3

months.

– Hospital admission testing for patients who do not exhibit COVID-19 symptoms.

– Scheduled surgical procedures, especially those that are aerosol generating.

https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/cahan/communications_documents/Priority%20Level%20for%20Testing%20Criteria%20REV%2008%2017%202020.pdf

Current Testing Recommendations

• Priority Level 3: Asymptomatic Individuals from High-Risk Settings & Close Contacts– Screening of asymptomatic individuals not diagnosed with COVID-19 in past 3 months who are residents or

employees of congregate living facilities, such as skilled nursing facilities, assisted living facilities, homeless

shelters, substance use disorder residential facilities, correctional facilities, and detention centers.

– Asymptomatic close contacts not diagnosed with COVID-19 in past 3 months at 5-7 days after last exposure

to a known COVID-19 case

• Priority Level 4: Asymptomatic High-Risk Individuals – Asymptomatic healthcare workers and first responders not diagnosed with COVID-19 in past 3 months in

direct patient contact roles

– Asymptomatic individuals in vulnerable populations not diagnosed with COVID-19 in past 3 months who are

not in other categories above

– Asymptomatic persons not diagnosed with COVID-19 in past 3 months in other essential occupations. This

includes occupations such as utility workers, grocery store workers, food supply workers, and other public-

facing employees including childcare and school workers.

https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/cahan/communications_documents/Priority%20Level%20for%20Testing%20Criteria%20REV%2008%2017%202020.pdf

New cases

Reported 10/13, with 3% of tests reported positive

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.

Another site that shows all the sites is available through the 211SanDiego 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.

https://www.arcgis.com/apps/Nearby/index.html?appid=43118dc0d5d348d8ab20a81967a15401https://211sandiego.org/resources/health-wellness/covid-19-testing/https://www.covid19.ca.gov/https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Guidance.aspx

Additional Resources – Recently Added

•Behavioral Health Resources Flyer (September 2, 2020)

•Hands-Only Adult CPR During COVID-19 Safety Bulletin (September 1, 2020)

•Mental Health Action Guide (August 27, 2020)

•Dental Requirements Summary (August 26, 2020)

•Dental-Specific Frequently Asked Questions (August 26, 2020)

•Caring for your Mental Health During COVID-19 for Healthcare Personnel (August

13, 2020)

•NIH Covid treatment guidelines

https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/covid19/Community_Sector_Support/HealthcareProviders/BH%20Resources%20for%20Public_2020-09-02%20V2.pdfhttps://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/covid19/Community_Sector_Support/HealthcareProviders/Safety%20Bulletin%20-%20LEO%20CPR%20and%20COVID.pdfhttps://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/covid19/Community_Sector_Support/HealthcareProviders/mental-health-action-guide.pdfhttps://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/covid19/Community_Sector_Support/HealthcareProviders/Dental%20Requirements%20Summary.pdfhttps://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/2019-nCoV/CommunitySectors/Healthcare_Providers_Community_Clinics_Hospitals_and_Pharmacies/dental-healthcare-personnel--dhcp--faqs.htmlhttps://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/covid19/Community_Sector_Support/HealthcareProviders/Mental%20Health%20Resources%20HCP.pdfhttps://www.covid19treatmentguidelines.nih.gov/

Resources

• Clinician On-call Center is a 24 hr hotline with trained CDC clinicians standing by

to answer healthcare personnel questions, at 800-CDC-INFO (800-232-4636)

• National Institutes of Health: Coronavirus Disease 2019 (COVID-19) Treatment

Guidelinesexternal icon

• California epidemiologist on call # 916-328-3605

• Guidelines for healthcare worker exposure at work

• https://www.sandiegocounty.gov/coronavirus.html

• California Health Alert Network (CAHAN)

• Sharp specific coronavirus site (sign in with your citrix (Cerner) password

• The reopening continues, with the following, while observing physical distancing:• https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/commun

ity_epidemiology/dc/2019-nCoV/reopening.html

https://covid19treatmentguidelines.nih.gov/introduction/https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.htmlhttps://www.sandiegocounty.gov/coronavirus.htmlhttps://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/cahan_san_diego/Alerts.htmlhttps://sharphealthcare.sharepoint.com/sites/HID-forCoronavirus/SitePages/HID-Steering-Committee.aspxhttps://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/2019-nCoV/reopening.html

Open Forum and Questions

Let me know if there is a topic you would like to have presented

Reminder 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:

13706