Education event

Coronavirus Watch

To support member hospitals and health systems in their efforts to prepare and care for patients potentially exposed to and diagnosed with novel coronavirus, CHA has compiled the latest updates, guidance, travel alerts, and other information related to the virus. CHA has also coordinated with the California Department of Public Health (CDPH) to host a regular update call ; details from those calls can be found in the “CDPH Updates” tab.

CDPH Updates

Next CDPH Call: February 25, 7:45-8:45 a.m. (PT)

CDPH will send call-in information through the California Health Alert Network. CHA will also share the information, once available, through its Coronavirus Watch email. Hospitals that would like pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org. CDPH has broadened the call to include all health care facilities, given the potential for community transmission.

February 18 CDPH Call With Hospitals

On February 18, the California Department of Public Health (CDPH) hosted its third call with health care providers about novel coronavirus. Highlights included:

Updates

  • While risk of individuals contracting novel coronavirus is low, it remains a public health concern.
  • On Feb. 17, a plane arrived at Travis Air Force Base in Fairfield, with approximately 170 U.S. citizens who had previously been aboard the Diamond Princess cruise ship in Japan; 14 of the patients have tested positive for coronavirus and were appropriately managed and quarantined. The State Department and Department of Health and Human Services have issued a statement on repatriation specific to the cruise ship passengers.
  • While there are no antiviral medications available at this time, the Centers for Disease Control and Prevention is available for consultation for any hospitalized case, including clinical consulting on potential medications. 

Hospital supply issues

  • CDPH’s request to distribute the expired N95 masks it received during the 2009 influenza pandemic was sent to the National Institute of Occupational Safety and Health, which is part of CDC, but was informed that some of the masks did not pass testing. CDPH has ordered more than 300,000 additional masks, estimated to arrive beginning in April.
  • Additionally, CDPH is developing a query of health care facilities to determine how many masks and gowns they have, of which models, and length of available supply. 

February 11 CDPH Call With Hospitals

On February 11, the California Department of Public Health (CDPH) hosted its second call with hospitals on novel coronavirus. Highlights included:

Update

There are 13 confirmed cases in the U.S. and 13 patients under investigation (PUI) in California, with 26 pending test results.

Recommendations for hospitals

Supply issues: Hospitals are reporting supply issues for masks and gowns. While CDPH is working on solutions, hospitals are encouraged to request supplies from their counties, which can request from their regional Medical Health Operational Area Coordinator.

CDC has issued guidance about conserving supplies while protecting personnel. Isolation room access should be limited to only essential personnel (for instance, not having dietary staff deliver meals), which will allow supplies to be used only for essential personnel.

Diagnostic testing: Performance issues have been identified with some testing kits sent by the CDC. CDPH hopes to begin using the kits beginning February 12. Use of testing is restricted to patients that meet the CDC’s PUI specimen criteria.

Infection control guidance: On February 8, CDC released guidance on health care personnel exposure that categorizes personnel into high, medium, and low risk and offers recommendations based on that risk level for exclusion from work.

For health care personnel with travel or community exposure, the CDC’s travel and community exposure guidance applies. Hospitals should consider excluding from work any personnel who returned from China prior to quarantine date of February 3 if still in the 1- day window.

Key questions

Q: Do you recommend reception staff wear masks?

A: At this time, that has not been a recommendation. Patients with symptoms be provided a mask to limit their secretions.

Q: Should hospitals report high-, medium-, and low-risk exposures to local public health department?

A: Any time you have a case, you would be working with your local public health department is concert with CDPH.

Q: For counties that have increased numbers of confirmed cases, are you considering testing beyond PUI criteria? We think some patients are concealing information and are very close to the criteria. With testing in California soon, could we test beyond PUI criteria?

A: Local health officers will be able to test beyond PUI criteria at the discretion of the local health officer.

Q: Do local public health offices package and ship the testing specimens?

A: These are categorized as Category B, Diagnostic Specimen. If facility has a courier or arrangement with a public health laboratory with courier service, they can use that. Packaging and shipping would take place at the public health laboratory.

Q: Can anyone carry the specimen?

A: Any hospital staff can.

Q: Can hospitals bypass the local health department for testing?

A: No, hospitals still need to go through the local public health department.

Q: What PPE should employee health be wearing?

A: If personnel are asymptomatic, then PPE is not needed.

Q: Is Hong Kong considered mainland China, which is part of the travel associate exposure guidance?

A: No, Hong Kong, Macau, and Taiwan are not considered mainland China.

Q: What about work clearance for those have traveled?

A: People returning from parts of mainland China, besides Hubei Province, are being screened at the airport and given information on symptoms to watch for. Local public health is following up with these travelers.

News for February 10

Supply updates:

  • The state’s emergency cache of N95 respirators and pediatric surgical masks has been activated. If your hospital needs additional masks or other emergency supplies, submit a 213 Resource Request to the Medical and Health Operational Activity Coordinator and they will help obtain it through your county, region, or the state. Hospital disaster preparedness coordinators are familiar with this process.
  • CDPH, the Governor’s Office of Emergency Services, and the Emergency Medical Services Authority have formed a multi-agency coordination group to address scarce resource allocation of N-95 respirators.
  • CDPH has distributed a questionnaire to counties with outstanding resource requests from hospitals and others in order to assess the greatest needs.
  • The World Health Organization has issued a situation report on the supply of personal protective equipment, encouraging manufacturers to increase production and distribute supplies to countries most in need.

News for February 7

  • CDPH specimen testing: CDPH has announced it will begin testing specimens for suspected cases February 12. This has previously been limited to the CDC and testing has taken two to seven days. Once CDPH begins testing, it anticipates a turnaround time of two days.
  • Send emergency contact information: CHA encourages all hospitals to respond to a CDPH request to provide contact information for a designated emergency contact who is reachable and able to respond 24 hours a day. All information provided will be entered into the California Health Alert Network (CAHAN) system, which CDPH uses to send important notifications including emergency alerts, health notifications, information bulletins, and All-Facilities Letters.
  • CDPH summary: CDPH has released its detailed summary of the February 4 call with CDPH and hospitals.

    February 4 CDPH Call With Hospitals

    On February 4, the California Department of Public Health (CDPH) hosted its first call to update hospitals on the latest coronavirus developments, guidance, and answer questions. The next call is scheduled for February 11 from 7:45 – 8:45 a.m.

    CHA will send out the call-in information in advance of the call to CEOs, chief medical officers, chief nursing officers, chief operating officers, executive assistants, infection preventionists, human resources executives, quality & patient safety executives and staff, emergency preparedness coordinators, clinical education staff, in-house general counsel, and legal, risk, and compliance staff at CHA member hospitals and health systems.

    Update

    • California cases: So far, six cases have been confirmed — one in Orange County, one in Los Angeles County, two in Santa Clara County, and two in San Benito County. Person-to-person spread has been limited to close family members. The CDPH laboratory has received protocols and test kits, and CDPH is in the process of validating those materials in order to be able to test in California. To date, the only testing has been done by the Centers for Disease Control and Prevention (CDC).

    Recommendations for hospitals

    • Diagnostic testing can only currently be accepted at the CDC. Specimens should be collected as soon as possible after a patient is identified, and local health department contacted.
    • General laboratory guidelines include PPE — gown, laboratory coat, and eye protection. Standard laboratory practices should be observed when handling novel coronavirus specimens.
    • Providers concerned about a potential case of novel coronavirus should immediately contact the local public health department and report all patients who meet CDC Patient Under Investigation criteria to CDPH’s Licensing and Certification Program.

    Key questions

    • Q: What is the turnaround time for testing?
      • A: Two to seven days.
    • Q: Regarding employees who are cohabitants of returnees from China, are there any updates?
      • A: It’s important to work closely with your local health department, which are working closely with CDPH and CDC.
    • Q: What about people who came from China who are asymptomatic?
      • A: Public health messages will be disseminated directing patients to call ahead before showing up at a hospital so proper infection control protocols can be established. 

    Hospitals Encouraged to Complete Preparedness Survey

    On Jan. 27, CDPH issued All Facilities Letter (AFL) 20-10, requesting health care facilities to respond to a survey with information on their capacity to respond to a patient under investigation for novel coronavirus. CHA continues to encourage members to provide this information to CDPH if they have not already. 

    CDC Updates

    February 11 CDC Call With Hospitals

    On February 11, the Centers for Disease Control (CDC) hosted a call on novel coronavirus. Highlights included:

    Updates

    CDC has posted health care worker guidance and is working on strategies for:

    • Extending N95 use and limited reuse
    • Home health guidance when sending patients home for care
    • Use of N95s past expiration dates

    Recommendations for hospitals

    • Encourage patients to call ahead
    • Assess patients in an area that doesn’t expose others
    • Consider having patients wait in their car and be notified when to come inside, or conduct the assessment while the patient is in the car

    News for February 10

    • CDC releases health care worker guidance: The CDC released guidance on health care worker exposure, discussing exposure risk as high, medium, or low and recommending excluding from work for 14 days those who are high or medium risk. It also discusses exposure risk and recommendations for personnel who interact with a person under investigation, as well as those who triage patients in the emergency department. Finally, it reiterates that guidance about community and travel-associated exposure applies to health care personnel. 
    • CDC guidance on health care workers minimizing risk of exposure: On February 7, the CDC released guidance on how health care personnel can limit their risk of exposure. This brief document includes reminders such as using standard precautions, contact precautions, and airborne precautions and eye protection when caring for patients with confirmed or possible novel coronavirus. It also includes guidance on environmental cleaning and disinfection, which indicates management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures.
    • Supply updates:
      • The CDC, taking steps to make sure there are enough supplies and appropriate guidance to prevent spread of disease, released guidance on personal protective equipment usage.
      • The World Health Organization has issued a situation report on the supply of personal protective equipment, encouraging manufacturers to increase production and distribute supplies to countries most in need.
    • New requirement of airlines: The CDC and Department of Health and Human Services issued an interim final rule requiring airlines to provide phone numbers, email addresses, and home addresses for all passengers arriving from foreign countries into the U.S. “for the purposes of health education, treatment, prophylaxis, or other appropriate public health interventions, including travel restrictions.”

    News for February 6

    February 3 Call: American Hospital Association/Centers for Disease Control & Prevention 

    On February 3, the American Hospital Association hosted a call with the Centers for Disease Control and Prevention (CDC). The call included status updates, recommendations for hospitals, and a Q&A session. Highlights include:

    Update

    • Chinese outbreak: 17,000 cases currently, with 7-13% considered severe
    • U.S. cases: 260 patients under investigation in 36 states; 11 confirmed cases; seven people identified in airport screening (none yet confirmed)

    Recommendations for hospitals

    • The CDC is recommending to the public that potentially infected people call ahead to primary care providers and hospitals. When they arrive, the CDC recommends hospitals have them wait in a non-crowded area, away from other people, wearing a mask.
    • Personal protective equipment (PPE) should be used in airborne isolation rooms, if available, or in a room with the door closed. Airborne and eye protections are recommended. If an airborne isolation room is not available, hospitals are recommended to arrange for transportation to another facility that has one or home.
    • Stable patients that do not require a hospital stay can be sent home but should assessed on a case-by-case basis with the local public health department. They should also have prescriptions filled for the remaining period of their isolation.

    Key questions

    • Q: If an individual is identified at an airport, to which hospital or military site will they be taken and how and by whom is that determined? Is the receiving facility notified in advance?
      • A: State authorities, the federal Department of Health and Human Services Assistant Secretary for Preparedness, and the CDC are working together to make these decisions. Health care facilities will be notified if they are being considered.

    CMS Updates

    The Centers for Medicare & Medicaid Services has released two letters to state survey agencies (in California, CDPH):

    Resources

    The California Department of Public Health (CDPH), Centers for Disease Control & Prevention (CDC), Cal/OSHA, and the Centers for Medicare & Medicaid Services (CMS) have established sites and issued coronavirus guidance for health care providers. In addition, existing documents that guide emergency preparedness remain in effect, such as the state’s Public Health and Emergency Operations Manual. Resources include:

    California Department of Public Health Novel Coronavirus website

    CDC Novel Coronavirus Information for Health Care Providers

    Cal/OSHA Guidance on Requirements to Protect Health Care Workers from 2019 Novel Coronavirus

    Information for Healthcare Facilities Concerning 2019 Novel Coronavirus Illness (CMS)

    CDC guidance on personal protective equipment

    Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with 2019 Novel Coronavirus (2019-nCoV)

    Notification to Surveyors of the Authorization for Emergency Use of the CDC 2019-Novel Coronavirus Real-Time RT-PCR Diagnostic Panel Assay and Guidance for use in CDC Qualified Laboratories (CMS)

    California Public Health and Medical Emergency Operations Manual Note: This includes key information on how to request additional resources from your local Medical Health Operational Area Coordinator.

    CDC Patient Under Investigation Form Note: The local health department may request you complete this when you identify a patient under investigation for novel coronavirus.

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