Agenda for 07/29/2020

• Covid updates

• Rapid Antigen test

• Miscellaneous/Open Discussion

This activity has been designated for CME and

ABIM MOC credits and is being recorded

Today’s Activity Code:

13588

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Text Attendance Number:

(858) 247-3111

Today’s Activity Code:

13588

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“A pandemic paradoxically becomes

an opportunity to finally be able to

deal with ourselves, in a long interval

where the world has stopped and

everything around us starts to

function at a slow pace.”

…..Corina Negura, Medical Officer,

World Health Organization

Updates – July 27

• San Diego continue to fail 3 of the epidemiology triggers that are tied to the service

closures, but they are improving

• Imperial Country is finally starting to see a decrease in new cases, and impact on the

overburdened healthcare system; fewer hospital admissions

• FIT testing – the lab is testing samples they receive but are delaying patient

notifications for routine annual testing until January

• Cal/OSHA prohibits placing a standard procedural mask over an N95, due to mask

leaks, from increased pressure, and potential contamination of the N95 while doffing

the procedure mask

• CDC issued a health advisory regarding Methanol-based hand sanitizers. Advise the

public to seek medical attention and contact the poison center (1-800-222-1222) if its

swallowed, or symptoms develop from its use. Of 7 patients, 4 died, 1 had loss of

vision. A full list of the products can be found HERE.

Rapid antigen testing

• Abbots ID-Now, Quidel’s Sophia, Becton-Dickinson’s Veritor, Mesa Biotech’s Silaris

• Scalability better than PCR testing, with returns in 15 min, and cheaper machines

• PCR amplification tests reliably identify just a few copies of the virus with 98% sensitivity

• Antigen tests require more viral protein, then diluted to flow across test strips, and

sensitivity between 50% and 90%

• Low prevalence in a community amplifies the false negatives

• Antigen tests > 5d from onset of symptoms have to be repeated with a PCR test due to

low viral presence

• Not good for pre-op testing, due to false negatives, and will not be accepted by Sharp

• Summary, not good for acute Covid testing, most will have to get the PCR done anyway

• Sources: Science, May 22, 2020, Sharp Labs

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 – CDPH July 28

• CDPH: Hospitalization is trending upward in the 14 day average in CA

• The 7 days average of new cases in CA is 9,859/day

• There have been 24 cases of the childhood Multisystem Inflammatory Syndrome in

children (MIS-C), Includes:

• Fever that does not go away

• Abdominal pain

• Vomiting

• Diarrhea

• Neck pain

• Rash

• Bloodshot eyes

• Feeling tired

In the News

• “America’s Frontline Doctors”, a group of 10 doctors dressed in white coats

embroidered “America’s Frontline Doctors” spoke for 45 minutes in front of the

Supreme Court building.

• None of them have practices that would place them on the actual front lines of

the Covid pandemic

• Some don’t currently practice at all, one is no longer licensed

• Their website was created on July 16th and taken down July 28th

• Created a video that went viral,

• Organized by the Tea Party Patriots group, to raise support to open schools

• A Pediatrician (and minister) touted the use of Hydroxychloroquine, and

wearing masks is not necessary. Also that demons cause illnesses

Updates

• The stimulus bill continues to be debated, with a split in the Republican party that will

likely cause re-thinking of some benefits, another $1200 stimulus payment for lower

income persons. Unemployment benefit still hotly debated

• The Moderna vaccine study started Monday nationwide.

• Level 3 travel Health Notices are in effect for:

– Brazil

– China

– Iran

– Most European Countries

– United Kingdom and Ireland

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

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 7/28, with 8% of tests reported positive

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:

13588