COVID-19 Physician Advisory Group

COVID-19 Physician Advisory Group

 

MAY 14, 2020 - UPDATE

The ND Dept. of Health Coronavirus (COVID-19) Physician Advisory group continues to meet twice weekly to discuss emerging issues for physicians and other health care workers.

The group is chaired by 6th district President Joan Connell, MD. This week’s discussion focused on:

The ND Dept. of Health Physician Advisory Group is diligently working on improving the COVID-19 systems throughout North Dakota. The group is chaired by Dr. Joan Connell. Following are some highlights from the May 14th meeting:
Summarized Minutes for 5-14-20 Physician Advisory Group Meeting  

Smart Restart Travel Guidelines and Guidance for Health Care Workers Who Recently Traveled or have Travel Plans
PAG members will review the health care worker travel guideline to determine if guidelines should be continued, modified, or discarded.

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019
ND Health Alert Network issued advisory on request for reporting. PAG will continue to conduct research on the similarity to Kawaskai.

Remdesivir Guidance/Administration 
Several doses were administered at Sanford Fargo. Altru, Trinity, and Bismarck Sanford have not used any doses yet. Primary goal is to establish a protocol that increases the likelihood that patients at greatest risk for dying have access to the medication and PAG will continue to review the protocols.

Facility Allocation: requests for Remdesivir are coming from more critical access hospitals, such as Dickinson, Williston, Devils Lake & Jamestown

Hydroxychloroquine Inventory 
Given recent negative results in studies and patients discontinuing this medication due to QT prolongation, the PAG recommendation was given to cancel the order for 500,000 doses.

Abbott Rapid COVID-19 Test Results
A study shows up to 48% of Abbott tests showed false negatives with lots of hospitals using it. Altru and Sanford Fargo have had good success with machine (>=85% sensitivity, with false negatives thought maybe due to sample prep). PAG will continue to watch for more information about this and provide guidance if concerns are valid.

Note that this is a summary. Read complete details of the 5-14-2020 meeting minutes here.

 

MAY 7, 2020 - UPDATE

The ND Dept. of Health Coronavirus (COVID-19) Physician Advisory group continues to meet twice weekly to discuss emerging issues for physicians and other health care workers.

The group is chaired by 6th district President Joan Connell, MD. This week’s discussion focused on:

The ND Dept. of Health Physician Advisory Group is diligently working on improving the COVID-19 systems throughout North Dakota. The group is chaired by Dr. Joan Connell. Following are some highlights from the May 7th meeting:

Summarized Minutes for 5-7-20 Physician Advisory Group Meeting

Outpatient Covid Monitoring Protocol: shared with Unified Command for approval

Oxitone/project: tie in of this project with homeless - hotel project and need for nursing/paramedic and physician teams

Pre-op testing: physician concerns that facilities plans are not safe for patient or staff due to insufficient PPE/testing and was forwared to the Unified Command

Personal Protection Equipment (PPE): concerns of having a definitive source for PPE and recommendations were made to limit N95s to providers caring for Covid patients and/or patients requiring essential procedures. Current inventory shows 1 million N95s between hospitals and state cache; surgical masks have 1.6 million in medical cache and 734K in hospitals.

Battelle Critical Care Decontamination System may be ready by May 15th with ability to decontaminate 60K masks/24 hours. Go online to register for services:https://www.health.nd.gov/battelle-critical-care-decontamination

Mass vaccination plan: discussions will be held in June to review potential Covid vaccines and also discuss the need to increase flu vaccination rates.

Travel Recommendations: PAG agrees on recommendations to create Smart Travel guidelines that help people optimize their safety while travelling.

Resource Allocation Strategy: discussions on recommendations to move away from using age cut offs for prioritization of resources and to create a triage committee to separate this from being made by the front line workers.

Separate guidance discussing advanced directives (Covid-e-POLST): see NDDOH Covid website entitled Smart Guidelines for Vulnerable Populations/Smart ACPs.

Distribution of Remdesivir: Cody Schulz from ND Homeland Security contacted FEMA who will be responsible for allocating Remdesivir now that FDA has approved an emergency use authorization (EUA) regarding ND’s interest in acquiring this medication for our hospitalized patients. The Governor assigned the task of distribution to PAG. More information will follow.

Note that this is a summary. Read complete details of the 5-7-2020 meeting minutes here.

 

APRIL 30, 2020 - UPDATE

The ND Dept. of Health Coronavirus (COVID-19) Physician Advisory group continues to meet twice weekly to discuss emerging issues for physicians and other health care workers.

The group is chaired by 6th district President Joan Connell, MD. This week’s discussion focused on:

The ND Dept. of Health Physician Advisory Group is diligently working on improving the COVID-19 systems throughout North Dakota. The group is chaired by Dr. Joan Connell. Following are some highlights from the April 30th meeting:

Testing Priorities & CDC guidance
Physician Advisory Group recommends adopting the current (April 27) guidelines for testing prioritization, with the caveat of including First Responders with direct contact exposure in the Priority Group with recommended PCR testing on day 5-7 post-exposure.

PAG concurred that PCR testing priority should follow the CDC guidelines, particularly targeting symptomatic patients for testing and agree with the Governor’s priority of testing staff and residents of nursing homes in point-prevalence surveys to establish a baseline of current infection and transmission. 

In addition, we would encourage the Governor’s testing strategy group to assist long-term care facilities in developing a plan to allow serial testing of staff to identify healthcare workers that are asymptomatically infected and potentially shedding virus to vulnerable LTCF residents.

Serology testing
While serology testing may be useful in predicting protective factor of herd immunity (starts to take effect when 67% of citizens in a region are immune), current low prevalence indicates we are far away from this (prevalence is 2-4% in CA, up to 20% in some regions of NY).

Roche test is likely the best option, but still not useful due to prevalence.

Preop testing, patient safety and healthcare worker safety were also discussed in detail

Travel quarantine does not have an end date: 
Mylynn Tufte, ND Dept. of Health health officer, is suggesting to release the travel quarantine on May 15. This gives people time to plan and allows for the impact of reopening and supports MN and Canada start dates. The Physician Advisory Group recommends that we observe consequences of reduction of restrictions prior to announcing end date of the travel ban.

Note that this is a summary. Read complete details of the 4-30-2020 meeting minutes here.

 

 

APRIL 27, 2020 - UPDATE

The ND Dept. of Health Coronavirus (COVID-19) Physician Advisory group continues to meet twice weekly to discuss emerging issues for physicians and other health care workers.

The group is chaired by 6th district President Joan Connell, MD. This week’s discussion focused on:

The ND Dept. of Health Physician Advisory Group is diligently working on improving the COVID-19 systems throughout North Dakota. The group is chaired by Dr. Joan Connell. Following are some highlights from the April 27th meeting:

 

Personal Protective Equipment (PPE)
Monitoring PPE continues to be a priority as it is identified as a likely rate-limiting step for the ND Smart Restart. The Physician Advisory Group proposes that the state's medical cache is reserved for essential facilities that primarily rely on the cache for their supplies.

Institutional supply and access to PPE varies. Following are some guidelines:

Current supply and prospects for replacement/site-driven repurposing MUST be tied to facility’s smart restart plan

ACS/ASA recommends that elective surgery start decision based on PPE supplies that are adequate for the second wave of a Covid-19 outbreak.

Discussions will be held with institutional leaders to discuss best practice strategies of safety/PPE conservation in the ND Smart Restart of Elective Surgery plans.

Based on limited supplies of PPE in the state's cache and at institutions, PAG recommends aggressive rationing of PPE from medical cache and recommends against availability for non-emergent dental visits, optometrist visits, etc.

Dual (Polymerise Chain Reaction (PCR)/Serology) Antibody Testing Strategy

PAG agreed with the proposal from last week that involves surveillance testing. The ND Dept. of Corrections will determine a baseline measurement for new infection/recurrent infection, similar to surveillance testing in correctional facilities in North Carolina and Ohio. Statistics showed that 2/3 of residents and staff in NC facilities and 78% in Ohio facilities were positive for COVID, but only 10% of these were symptomatic.

Once we have proven that antibodies are protective, we can begin using the antibody test.
 

Additional Proposed Priority Sites for dual-type surveillance testing are as follows:

  • Long Term Care Facility Workers (direct pt contact>no pt contact)
  • Long Term Care Facility patients
  • Hospital Workers (direct pt contact>no pt contact)
  • Essential businesses/Intermediate care facilities
  • Communities with high/medium/low incidence

Proposed Expansion of PCR testing as available:

  • Asymptomatic Contacts (could couple this with serology test)
  • One symptom

Proposed Expansion of Serology Testing-ONCE POSITIVE SEROLOGY IS PROVEN PROTECTIVE:

  • All essential employees
  • Teachers
  • Elderly and other vulnerable
  • General public

Proposal for Location of Care for Long Term Care Facilities for COVID-19 Positive Patients

The State was suggesting to hospitalize all COVID-19 POSITIVE Long Term Care Facility patients, regardless of their criteria for hospitalization. The PAG had many concerns with the plan and how it would impact long term care residents. Through negotiations, PAG, the ND Medical Association, ND Hospital Association, and the ND Long Term Care Association, a satisfactory plan was worked out to form a win-win situation. See plan  details here.

Read complete details of the 4-27-2020 meeting minutes here.

 

 

APRIL 16, 2020 - UPDATE

The ND Dept. of Health Coronavirus (COVID-19) Physician Advisory group continues to meet twice weekly to discuss emerging issues for physicians and other health care workers.

The group is chaired by 6th district President Joan Connell, MD. This week’s discussion focused on:

The ND Dept. of Health Physician Advisory Group is diligently working on improving the COVID-19 systems throughout North Dakota. The group is chaired by Dr. Joan Connell. Following are some highlights from the April 16th meeting:
 
Determination of Death
Monitoring the emergence of Coronavirus Disease 2019 (COVID-19) and guiding public health response requires accurate and timely mortality data. The Physician Advisory Group recommended that the CDC Coronavirus Disease (COVID-9) Death Data and Reporting Guidance should be provided to every North Dakota physician and coroner.

Conservation of ND Personal Protective Equipment (PPE) – Tim Wiedrich, Emergency Preparedness & Response Section Chief

If PPE gets to 40% of cache, permit only necessary procedures
 
Inventory in Cache-
N95 respirators- we had 1.6mil, now we have 600K. A great deal of inventory has been distributed

Gowns - estimates about 650-700K gowns

Decontamination Strategy Update
Many hospitals are using the vaporized H2O2 process but recommend against use of ethylene oxide. The Physician Advisory Group is exploring UV light trailers with UV light kitting that should arrive next week to set up six trailers/permanent institution- will process 400 N95/ hr at 24/7.

John Hagan has devised a steam operation in the correction facility’s kitchen for decontaminating masks and can share the process upon request – the Physician Advisory Group will review this proposed policy and respond in favor or against.
 
Advance Care Planning for Managing Acute Respiratory Distress During the Covid 19 Pandemic
There are two documents that outline advanced care planning: The AMDA Advanced Care Plan tool and the Honoring Choices ND document. Either approach could be an option for providing this information. The Physician Advisory Group agreed to review the process and documents, then advise.
 
NDDOH Recommendations to Prevent and Respond to COVID-19 In Long Term Care, Basic Care & Assisted Living Facilities
The document will continue to be discussed by the Physician Advisory Group and will determine acceptance of the guidance. (download here)

Convalescent Plasma Update
Outpatient and inpatient physicians should be discussing and recommending convalescent plasma donation to Covid patients. 

Plasma donations can be made by patient eligible for blood donation at Vitalant.

  • lab-confirmed Covid 19 dx (PCR or antibody) AND
  • completely symptom free for 14-27 days OR >= 28 days AND
  • negative PCR test to prove noninfectious that is attached to the application

NDDOH will be contacting those with positive tests to encourage plasma donation
Download the donation form here.

Read complete details of the 4-16-2020 meeting minutes here.

 

APRIL 9, 2020 - UPDATE

CDC guidance for return to work for essential employees: At this time, ND critical infrastructure workers, excluding first responders and health care workers (HCW) should continue to abide by the ND executive order for two weeks of quarantine if meeting the criteria for close contact with a COVID-19 patient. Exemption considerations will be considered by the ND Dept. of Health on a case-by-case basis when it prevents a critical infrastructure business from functioning due to excessive absence of critical employees.

Health care workers working in multiple facilities and testing: Recommend that ND develop a COVID-19 + Facility List, similar to Minnesota, that could be used by facility administration is aware when a HCW may have been working in another COVID+ environment. Guidance will need to be developed for facilities with cross-working HCWs to come off of the list.

Allocation of medical cache resources: Medical cache resources should be allocated based on need of facilities (considering census of COVID-19 patients/number HCWs in the facility etc., and perhaps using the CDC estimator used during the Ebola crisis, with modification of calculation to account for current personal protective equipment (PPE) conservation practice recommendations). The Physician Advisory Group is interested in participating in the decision-making process.

Convalescent plasma update: Dr. Joan Connell encourages passing relevant email information onto those within this group’s facilities who may be interested in using convalescent plasma, along with contact information, so Dr. Connell can add the contact to the distribution list. She also encourages facilities to share information/progress on this project to meet the goal of the convalescent plasma being available to all patients who may benefit, no matter where they are being hospitalized.

Antibody testing: the ND Dept. of Health State Lab ordered rapid antibody test kits; however, kits are not FDA-approved but are approved in other countries. ND Dept. of Health Officer Mylynn Tufte reports that according to the U.S. Dept. of Health & Human Services tests are not reliable at this time and recommends waiting a few more weeks when tests are expected to be FDA to approved.

This committee continues to meet at a minimum twice weekly or more often as the COVID-19 situation rapidly changes. NDMA extends a huge shout out to the physicians involved in the advisory group.

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