March 10 CDPH Call With Hospitals
On March 10, the California Department of Public Health (CDPH) hosted a weekly call with health care providers. Highlights included:
- COVID-19 is being transmitted to a limited extent in some communities.
- CDPH is looking at moving to mitigation from containment.
- CDPH recently distributed a survey on surge capacity and noted that hospitals might also be contacted by its licensing and certification staff if there is a surge in their area.
- CDPH continues to look at alternate sites for patients with COVID-19, rather than only hospitals.
- Section 10 of the Governor’s State of Emergency declaration includes information about health care facilities and what can be waived or flexed.
- Facilities can send Form 5000 to their local district office, which will send it to the state’s Medical and Health Coordinator Center. Some situations don’t require a program flex, but rather a consultation (e.g., doesn’t require a waiver of regulation, but something that must be put in policies and procedures). Questions about this process can be emailed to email@example.com.
Guidance on droplet precautions
CDPH anticipates releasing an AllFacilities Letter on droplet precautions tonight.
- Hospitals have three routes to get COVID-19 test results:
- Public health labs: Send the specimen to their local health department. The lab will provide a person under investigation number and either conduct the test — if it is one of the 18 labs that have Centers for Disease Control and Prevention (CDC) testing kits — or send the specimen to one of those labs. Additional labs are awaiting test kits.
- In-house: Test the specimen themselves with a test that they have developed by “cloning” the CDC’s test.
- Commercial labs: Send the specimen to a commercial lab (e.g., LabCorp or Quest), which does not require approval from the local health department before testing.
- Laboratories will now also report COVID-19 cases to CDPH and local health departments; regulations are underway. Any hospital laboratory conducting COVID-19 testing should also report.
- Any lab that develops its own tests must have the first five negative and first five positive samples tested with a public health lab.
- The CDC has developed new respiratory swab testing guidance. Separate vials are not required for nasal and pharyngeal specimens.
Webinar for skilled-nursing facilities (SNFs)
CDPH will provide a webinar for SNFs later this week and will disseminate information for that webinar soon. At a minimum, facilities should plan to cohort multiple patients and suspend communal dining and group activities.
Health care worker exposure
The CDC has updated its guidance on health care personnel exposure to remove active verification. Health care personnel should be self-monitoring.
March 6 CDPH Call With Hospitals
On March 6, the California Department of Public Health (CDPH) hosted a weekly call with health care providers about novel coronavirus. Highlights included:
AFL provides guidance for health care facilities
See March 3 All Facilities Letter (AFL) with key guidance for health care facilities on preparing for COVID-19.
CMS guidance on licensing surveys
In accordance with a memo from the Centers for Medicare & Medicaid Services (CMS), CDPH will not conduct re-licensing surveys for Medicare Conditions of Participation, and will instead focus on facility-reported incidents and complaints; will batch and contact through phone and email to minimize impacts to hospitals; and may also conduct offsite investigations. In addition, CDPH will continue to reassess the certification and licensing workload on a case-by-case basis by county.
CDC updates guidance for health care worker exposure
Updated guidance from the Centers for Disease Control and Prevention (CDC) stated that facilities could consider allowing asymptomatic health care workers who have had exposure to a COVID-19 patient to continue working after consultations with their occupational health program. Note: The CDC revised this again on March 7, and it now allows this only “after options to improve staffing have been exhausted.”
March 3 CDPH Call With Hospitals
On March 3, the California Department of Public Health (CDPH) hosted a weekly call with health care providers about novel coronavirus. Highlights included:
Cal/OSHA will be issuing interim guidance on the efficient use of respirator supplies. CDPH and Cal/OSHA will issue FAQs, including how hospitals can request expired N95 masks in the state’s emergency cache.
CDPH is open to offering program flexibility related to COVID-19 related to space if the hospital has an immediate need.
- Testing is first done at the local public health lab. Based on that result, confirmatory testing then is done at the CDC. This week, 13 laboratories this week will be online for confirmatory testing in California.
- CDPH will be releasing guidance on electronic reporting of COVID-19 testing.
- CDPH notes that patients not requiring hospitalization should not be referred to the emergency department. Options are to either send the patient home or keep the patient in a private room and work with the local health department.
Guidance for long-term care
The Centers for Disease Control and Prevention will be clarifying that long-term care facilities ought to use the same infection control protocol as other health care facilities.
New weekly call
The Department of Social Services will be hosting a 10 a.m. call on Wednesdays, beginning March 4, with its licensed facilities (e.g., assisted living, home health agencies, child care).
February 25 CDPH Call With Hospitals
On February 25, the California Department of Public Health (CDPH) hosted a weekly call with health care providers about novel coronavirus. Highlights included:
- CDPH noted that it can take up to a month for a positive patient to complete viral shedding.
- In addition, CDPH is in the process of approving outpatient clinic guidance and will be releasing it soon.
- A hearing on whether the Fairview Developmental Center in Costa Mesa can be used for isolation patients will take place March 2.
- The Centers for Disease Control and Prevention (CDC) is still the only entity authorized to conduct testing.
This past week, the CDC issued an update on the potential for community transmission; travel notices that suggest health care professionals screen for travelers from South Korea, Italy, Japan, and Iran; and a two-page checklist for hospitals to assess their preparedness for patients exposed to coronavirus.
Multiple health care providers raised concerns about supplies and asked about flexibility on fit testing for N95 respirators. CDPH responded that it is communicating closely with Cal/OSHA on the issue of fit testing. Additionally, CDPH stated that it ordered 300,000 masks that will be delivered in April, with another 300,000 expected to be delivered in May.
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:
- 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:
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.
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.
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.
- 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.
- 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.