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COVID-19 Intelligence Report: Health Workforce

June 1, 2020

Title: How can airborne transmission of COVID-19 indoors be minimised?

Publisher: Environment International

Publication Date: May 27, 2020 URL: https://doi.org/10.1016/j.envint.2020.105832 Key Takeaway: Evidence is strengthening for airborne transmission of the SARS CoV-2 virus in addition to more widely recognized transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. This article outlines the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), as additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.

 

Title: Assessment of the Qualitative Fit Test and Quantitative Single-Pass Filtration Efficiency of Disposable N95 Masks Following Gamma Irradiation

Publisher: JAMA Publication Date: May 26, 2020

URL: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766200

Key Takeway: The use of cobalt-60 gamma radiation does work as a sterilization method for re-use of N95's, but there was significant degradation of the mask, and thus not recommended.

May 25, 2020

Title: Introducing the “Corona Curtain”: an innovative technique to prevent airborne COVID-19 exposure during emergent intubations

Publisher: Patient Safety in Surgery

Publication Date: May 13, 2020

URL: https://pssjournal.biomedcentral.com/track/pdf/10.1186%2Fs13037-020-00247-5

Key Takeaway:  The new “Corona Curtain” was designed to improve the safety of ED staff when performing urgent/emergent intubations during the current COVID-19 pandemic. The concept can easily be adopted to other patient care areas, including perioperative and intensive care units.

May 18, 2020

Title: Rapid Implementation of an Adult COVID-19 Unit in a Children's Hospital

Publisher: Journal of Pediatrics

Publication Date: April 28, 2020

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196893/

Key Takeaway:  Descriptive report of a surge-in-place at a NY children's hospital to meet the local demands of the COVID-19 pandemic. Instead of re-deploying pediatric providers to work with internist-led teams throughout a medical center in an unfamiliar setting/team structure, pediatric physicians and nurses staffed a 40-bed adult COVID-19 treatment unit within a children's hospital with a dedicated adult hospitalist available for consultation during the day and senior IM resident check-in call at night.

 

Note: This is more for informational purposes as Washington, DC Department of Health has developed surge-capacity at the DC Convention Center.

 

Title: Containment of COVID-19 cases amongst healthcare workers: the role of surveillance, early detection and outbreak management

Publisher: Infection Control and Hospital Epidemiology

Publication Date: May 11, 2020

URL: https://doi.org/10.1017/ice.2020.219 

Key Takeaway:  Descriptive report of surveillance and early detection strategy for 9,322 HCWs at a Singaporean hospital. Monitoring efforts included self-reporting respiratory symptom, twice daily temperature monitoring, isolation, and temperature/respiratory symptoms mapping to identify clusters. 14 cases of COVID-19 detected, 2 resulted from intra-hospital transmission. Swift containment allowed no onward transmission.

 

Title: Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

Publisher: eLife

Publication Date: May 11, 2020

URL: https://elifesciences.org/articles/58728

Key Takeaway: Large UK hospital screened 1,032 asymptomatic HCWs for SARS-CoV-2 from throat and nose self-swab. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with COVID-19 infection >7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards.

May 11, 2020

Title: The COVID-19 pandemic and healthcare providers: what does it mean psychologically?

Publisher: Advanced Journal of Emergency Medicine

Publication Date: 04 May 2020

URL: http://ajem.tums.ac.ir/index.php/ajem/article/view/419

Key Takeaway:  Medical personnel providing services to patients are exposed to increased levels of mental stress. This review article introduces these symptoms based on the experience of previous pandemics and the data available on COVID-19 pandemic, introducing the underlying and protective factors against mental distress. Evidence suggests that levels of stress, depression and anxiety symptoms increase in health care providers, and that options exist to effectively manage them at the individual and organizational level.

 

Title: Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals

Publisher: Nature

Publication Date: 27 April 2020

URL: https://doi.org/10.1038/s41586-020-2271-3

Key Takeaways: Researchers detected COVID RNA in aerosol and surface sampling in two hospitals and various public places in the city of Wuhan.  Although the paper does not establish the infectivity of the virus RNA detected in these hospital areas, they reasonably propose that SARS-CoV-2 may have the potential to be transmitted via aerosols.

Title: Can N95 Respirators be Reused after Disinfection?  How Many Times?

Publication: ACS Nano

Publication Date: 05 May 2020

URL:  https://pubs.acs.org/doi/pdf/10.1021/acsnano.0c03597

Key Takeaways:  Heating to 185 deg F at 30% humidity was found to be the most promising, nondestructive methods for various N95 masks, including respirators and those made from “meltblown” fabric.   UV was determined to be the next best option.  Steam, alcohol, bleach, and were also assessed and found to be more destructive to the masks.  UV was shown in a separate article, however, to potentially miss spots of both viruses and bacteria on masks intentionally contaminated in the laboratory setting and subsequently decontaminated.

 

Title: Facial Protection for Healthcare Workers During Pandemics: a Scoping Review

Publication: BMJ

Publication Date: 23 April 2020

URL:  https://gh.bmj.com/content/bmjgh/5/5/e002553.full.pdf

Key Takeaways:  This review of over 5000 articles determined that compared with surgical masks, N95 respirators perform better in laboratory testing, may provide superior protection in inpatient settings and are equivalent in outpatient settings; conservation strategies result in inferior protection but include extended use, reuse, decontamination of medical-grade masks or the use of improvised cloth masks, both of which may be combined with a face shield.  There is not much evidence on conservation strategies that could help conserve personal protective equipment during emergency shortages

May 4, 2020

Title: (REVISED) Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected Covid-19.

Publisher: Centers for Disease Control and Prevention

Publication Date: April 30, 2020.

URLhttps://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Fhcp-return-work.html

Key Takeaway: Revised criteria for return to work for HCP with confirmed/suspected Covid-19

  • Return to Work for Symptomatic:
    • Symptom-Based: Wait at least 10 days since symptom onset AND 3 days since recovery.
    • Test-Based: Resolution of symptoms AND two negative nasopharyngeal tests taken 24 hrs apart.
  • Return to Work for Asymptomatic:
    • Time-Based: 10 days since positive test
    • Test-Based: 2 consecutive nasopharyngeal swabs, at least 24 hrs apart.

 

Title: Infectious Diseases Society of America Guidelines on Infection Prevention in Patients with Suspected or Known COVID-19

Publisher: Infectious Disease Society of America

Publication Date: April 27, 2020

URLhttps://www.idsociety.org/COVID19guidelines/ip

Key Takeaway: Updated detailed recommendations for infection prevention among health care personnel caring for suspected or known patients with COVID-19.

  1. N95 masks or surgical masks are better than no mask.
  2. No recommendation on double vs single gloves
  3. No recommendation on shoe covers
  4. Use N95 respirators during aerosol-generating procedures
  5. Reused/extended use N95 respirators is better than surgical masks during aerosol-generating procedures
  6. Use face shield/surgical mask as a cover for the N95 respirator during aerosol-generating procedures to extend PPE life

 

Title: An Overlooked, Possibly Fatal Coronavirus Crisis: A Dire Need for Kidney Dialysis 

Publisher: New York Times

Publication Date: April 18, 2020

URL: https://www.nytimes.com/2020/04/18/health/kidney-dialysis-coronavirus.html   

Key Takeaway:  20 – 40% of I.C.U. patients with the coronavirus develop acute renal failure requiring hemodialysis. This is leading to shortages of machines, supplies and staff.

 

Title: Transforming ORs into ICUs 

Publisher: New England Journal of Medicine

Publication Date: April 24, 2020

URL: https://www.nejm.org/doi/full/10.1056/NEJMc2010853

Key Takeaway: Short report detailing how a NYC hospital transformed OR space into ICUs to treat COVID-19 patients

 

April 27, 2020

Title:  The AMA Medical education COVID-19 resource guide

Publisher: American Medical Association 

Publication: April 2020

URL: https://www.ama-assn.org/delivering-care/public-health/medical-education-covid-19resource-guide

Key Takeaway: 

  • A compendium of resources on the impact of the COVID-19 crisis on medical trainees, including guidance on graduations, exams, licensing, and employment. 

 

Title:  The ANA COVID-19 Resource Center

Publisher: American Nursing Association 

Publication: April 2020

URL: https://www.nursingworld.org/practice-policy/work-environment/health-safety/disasterpreparedness/coronavirus/ 

Key Takeaway: 

  • Resources by the American Nursing Association for informing and supporting nurses during the COVID-19 crisis. Includes resources on clinical care, continuing education, advocacy, well-being, ethics, and more. 

 

April 20, 2020

Title: CDC: Characteristics of Health Care Personnel with COVID-19 — United States, February 12–April 9, 2020 
Publication: CDC/MMWR, April 14, 2020
URL: https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e6.htm?s_cid=mm6915e6_w
Key Takeaway: Of 9,282 U.S. COVID-19 cases reported among Health Care Providers, median age was 42 years, and 73% were female, reflecting these distributions among the HCP workforce. HCP patients reported contact with COVID-19 patients in health care, household, and community settings. Most HCP patients were not hospitalized; however, severe outcomes, including death, were reported among all age groups. This is likely an underestimation because HCP status was available for only 16% of reported cases nationwide. HCP with mild or asymptomatic infections might also have been less likely to be tested, thus less likely to be reported. Overall, only 3% (9,282 of 315,531) of reported cases were among HCP; however, among states with more complete reporting of HCP status, HCP accounted for 11% (1,689 of 15,194) of reported cases.

Title: Joint Commission Statement on Use of Face Masks Brought From Home
URL: https://www.aaem.org/UserFiles/file/public_statement_on_masks_from_home.pdf
Key Takeaway: The Joint Commission supports allowing staff to bring their own standard face masks or respirators to wear at work when their healthcare organizations cannot provide adequate PPE.

April 9, 2020

Title: CDC Guidance – Mitigate Health Care Personnel Staffing Shortages

Web address: https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html

Key Takeaway: Guidance for health care system managers on two topics: (1) Contingency Capacity Strategies to Mitigate Staffing Shortages and (2) Crisis Capacity Strategies to Mitigate Staffing Shortages.  April 6, 2020

 

Title: CDC - Strategies to Optimize the Supply of PPE and Equipment

Web address: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

Key Takeaway: Guidance for health care system managers.  April 3, 2020

 

Title: Interim Additional Guidance for Outpatient and Ambulatory Care Settings: Responding to Community Transmission of COVID-19 in the United States

Web address: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ambulatory-care-settings.html

Key Takeaway: This guidance addresses how to:

  • Minimize disease transmission to patients, healthcare personnel (HCP) and others
  • Identify persons with presumptive COVID-19 disease and implement a triage procedure to assign appropriate levels of care
  • Reduce negative impacts on emergency department and hospital bed capacity and
  • Maximize the efficiency of personal protective equipment (PPE) utilization across the community health system while protecting healthcare personnel. April 7, 2020

 

Title: American Association of Nurse Attorney’s POSITION ON COVID-19

Web address: https://www.taana.org/resources/positions/covid19-2020.pdf

Key Takeaway: Policy position advocating for Nurses and other Healthcare Professionals licensed throughout the United States of America with focus on PPE and self-protection of HCW.  April 2, 2020

 

Title: NEJM Perspective: Ensuring and Sustaining a Pandemic Workforce

Web addresshttps://www.nejm.org/doi/full/10.1056/NEJMp2006376?query=featured_home

Key Takeaway: GW’s Institute for Health Workforce Equity and others outlining ways to support and sustain the health workforce: legal/licensing; the role of payers; potential roles for students, retirees and cross-discipline health care workers; targeted education/reeducation; and regional relocation to meet workforce needs.

 

Title: Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients

Website:  https://annals.org/aim/fullarticle/2764367/effectiveness-surgical-cotton-masks-blocking-sars-cov-2-controlled-comparison

Key takeaway: Surgical masks do not protect the spread of the virus during coughing/Valsalva. The outside of the mask can be contaminated with virus too.

April 4, 2020

Maximizing the Calm Before the Storm: Tiered Surgical Response Plan for Novel Coronavirus (COVID-19)

  • Journal of American College of Surgeons 
  • https://pubmed.ncbi.nlm.nih.gov/32240770/
  • This article offers a tiered plan for surgical department planning based on incident command levels. This includes Acute Care Surgeon deployment, infrastructure and transfer utilization, triage principles, as well as faculty, resident and advanced care practitioner deployment. March 30, 2020

April 2, 2020

Cheat Sheets: Strategies to Optimize PPE Equipment

Transmission Potential of SARS-CoV-2 in Viral Shedding Observed at the University of Nebraska Medical Center

Sustaining the Well-Being of Healthcare Personnel during Coronavirus and other Infectious Disease Outbreaks, CSTS | Department of Psychiatry | Uniformed Services University

March 31, 2020

Health Care Worker Exposure Guidelines         

Updated Emergency General Surgery Guidelines​ - American College of Surgeons Guidelines          

Updated advice for pregnant healthcare workers and employers during the coronavirus outbreak

COVID-19 in Pregnancy: Early Lessons

GW COVID-19 Inpatient Care Algorithm

Nursing Crisis Standards of Care (3 links)

Keeping the coronavirus from infecting healthcare workers

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