Coronavirus Response Newsletter

Today will be the last day of this regular email update. After today, CHA will provide regular updates related to the COVID-19 pandemic through its twice-weekly newsletter, CHA News. Staff at member hospitals who don’t currently receive CHA News may subscribe on the CHA website.

CDPH Updates Recommendations for COVID-19 Testing at General Acute Care Hospitals
On June 7, the California Department of Public Health (CDPH) released updated COVID-19 testing recommendations for both health care personnel (HCP) and patients at general acute care hospitals (GACHs). The revised All Facilities Letter (AFL) 20-88.1 reflects updated recommendations in light of HCP and patients now, in many cases, being fully vaccinated.

CDPH now recommends that hospitals may discontinue weekly diagnostic screening testing of asymptomatic HCP who are fully vaccinated if at least 70% of all HCP who work at the facility are fully vaccinated. CDPH has stated this threshold is based on modeling of workplace outbreaks. Previously, CDPH recommended weekly testing regardless of vaccination status. This is only a recommendation, and hospitals may decide to discontinue weekly diagnostic screening testing under different terms — for example, if an individual is fully vaccinated, regardless of the percentage of HCP who are fully vaccinated at the facility.

CDPH has also updated its recommendation for patient testing, now advising that hospitals may consider modifying testing protocols for fully vaccinated patients when vaccination status is known prior to, or upon, admission or procedure. Previously, CDPH recommended testing all patients prior to admission.

Finally, there is one requirement of hospitals in the AFL: that hospitals need to revise the GACH COVID-19 Mitigation Testing Plan they submitted in December 2020 to their local CDPH District Office. If a hospital has made any changes in providing COVID-19 testing to patients and HCP since then, it needs to update the plan to reflect current practice and have it available for CDPH upon request.

CDPH Issues Updated Guidance for SNF Personnel, Residents   
New guidance from CDPH for skilled-nursing facilities (SNFs) includes: 

  • AFL 20-22.8 includes guidance for group activities and communal dining, as well as for visitation.
  • AFL 20-32.3 provides advance notice that the temporary waiver of specified regulatory requirements will expire on July 17.   
  • CDPH has also revised AFL 20-53.4, which now advises that SNFs may discontinue routine diagnostic screening testing of asymptomatic HCP who are fully vaccinated and work in a facility where at least 70% of residents and HCP are fully vaccinated.

New COVID-19 Emergency Temporary Standard Issued by OSHSB
On June 3, after a tumultuous, multi-hour virtual hearing, the Occupational Safety and Health Standards Board (OSHSB) approved a new emergency temporary standard (ETS) for COVID-19. Coming on the heels of the governor’s announcement of a June 15 reopening of California and recent Centers for Disease Control and Prevention (CDC) guidance stating that vaccinated individuals do not need to wear a mask, the new COVID-19 ETS provides limited flexibility on mask wearing and social distancing requirements. Specifically, the new standard: 

  • Ends, after July 31, the requirement that all employees working indoors are separated by at least six feet or, if not feasible, physical barriers 
  • Requires, after July 31, that employers provide a face covering and ensure they are worn by all employees. The face covering must have multiple layers of material and can be woven material.  
  • Permits face coverings to be removed when an employee is alone in their office or in a meeting where the employer has documentation that all employees in the meeting are vaccinated  
  • Permits face coverings to be removed when employees are eating, provided that the employees are at least six feet apart 
  • Requires that, when an employer does not have documentation that an employee is fully vaccinated, the employer must provide N95 respirators for voluntary use  

While the COVID-19 ETS exempts employees at acute care hospitals who remain under the Aerosol Transmissible Disease Standardthe COVID-19 ETS applies to all other employees. For hospitals, this may include employees in separate buildings, such as administrative or billing staff. Additionally, staff may be considered fully vaccinated under the regulation only if the employer has documentation that the employee is fully vaccinated. Hospitals with questions should consult their labor counsel.   

According to the Department of Industrial Relations, the regulation is expected to take effect no later than June 15, pending Office of Administrative Law approval. Additionally, OSHSB may further refine the standard as new data become available, such as availability of vaccines or case rates. 

Monoclonal Antibody Treatment Protocols Revised for California
The Health and Human Services Office of the Assistant Secretary of Preparedness and Response (HHS/ASPR) has announced that, effective May 26, bamlanivimab plus etesevimab is not a recommended treatment in California and is no longer available for ordering. The changes are based on CDC findings that these monoclonal antibodies administered together are not effective against variants on the increase in California. The Food and Drug Administration (FDA) now recommends that health care providers in California instead use casirivimab plus imdevimab (i.e., REGEN-COV) therapy until further notice.

Additionally, the FDA has issued an emergency use authorization for the monoclonal antibody sotrovimab to treat COVID-19. HHS/ASPR has not yet shared how the product will be made available to providers. 

COVID-19 Critical Care Nursing Education Available Online 
Elsevier, a global clinical skills education provider, offers continued support and training for nurses via its COVID-19 online learning program, which is a joint venture with the California Emergency Medical Services Authority (EMSA) and the American Association of Critical-Care Nurses. This online program supports patients by giving nursing staff who don’t typically work in the ICU access to knowledge- and skills-based educational content. The newest COVID Critical Care Nursing Education packet offers up to 51 free continuing education units to California nurses. More information is available on the EMSA website.  

Today Marks Final Issue of Coronavirus Response
Corresponding with the state’s plan for reopening on June 15 and as hospitals continue to move toward the next phase of operations, today’s issue of Coronavirus Response will be its final publication. CHA will continue its advocacy on your behalf and provide key information and resources through CHA News, published every Monday and Thursday. Look for coronavirus-related updates under the “COVID-19” subheading in each edition of CHA News.

Next CDPH Office Hours: June 11
CDPH will hold a COVID-19 Vaccination Office Hours webinar for hospitals on June 11 from 9 to 10 a.m. (PT). To participate and for information about future webinars, visit this link.

Next CDPH Call for Health Care Facilities: June 15 at 9 a.m. (PT)  
Dial: (844) 721-7239  
Passcode: 7993227 

Summary of June 1 CDPH Call — Sign Up to Receive Weekly CDPH Meeting Summaries
CDPH has provided a summary of its June 1 call with health care facilities. As a reminder, you can sign up to receive these meeting summaries directly. Given that today’s Coronavirus Response is the final edition, we encourage you to sign up now to receive these meeting summaries ongoing. 

To do so, email [email protected] to request to subscribe to the CDPH Weekly Facility COVID-19 Update Call meeting summaries. Include your first and last name, work email, position title or role, department or organization name, work location facility type, work address, phone number, and county. 

Media Coverage
In case you missed them, here are recent stories that might be of interest:

Data Resources

  • State Resources: Monitor ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.