PART 7. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
The Hospital was in a small town at the intersection of many major highways. It could be easily secured since it had no immediately contiguous neighbors. It had a helicopter pad. Its patients could be easily transferred. And it could be managed by the Public Health Service or military medicine if necessary.
It didn’t happen!
In 2014, I suggested several anchor principles for Ebola preparedness in New Jersey, as hospitals of all sizes and scope “marketed” their Ebola readiness, only to learn that it took well over 20/ 25 full time staff to care for one Ebola patient (and 50 in Dallas!).
These recommendations included that every hospital that certified its Emergency Room as ready for Ebola be subject to at least three separate drills using a standardized format, and then be subject to random “secret shopper” inspections;
that anyone with a confirmed or suspected Ebola diagnosis be immediately transferred to a regional center hospital designated by national standardized criteria which could demonstrate that it has sufficient nursing staff “volunteers” to care for a least five patients round the clock;
and that isolation hospitals be readied for instant activation, whether a closed hospital prepared for Ebola now and standing by, or a “virtual” hospital ready-to-go in military fashion.
Also there was a need to minimize Ebola patients walking into an ER unannounced, and suggested a statewide 800 number be established so patients can call ahead and be transported by a prepared ambulance team and taken to a regional center.
The Federal government, later than sooner, did exclusively designate three national bio containment facilities hospitals as Ebola Centers.
In 2016 I suggested that similar organizing principles were urgently need to be established for tiered Zika hospital preparedness by designating Zika Regional Referral Centers. More specifically:
1. There should not be an automatic default to just designating Ebola Centers as ZRRCs, although there is likely to be significant overlap.
2. Zika Centers should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and Zika-related “reading” expertise).
3. National leadership in clinical trials.
4. A track record of successful, large scale clinical Rapid Response.
5. Organizational wherewithal to address intensive resource absorption.
6. Start preliminary planning for Zika care out of the initial designated ZRRCs.
7. Zika protocols will be templates for are other mosquito borne diseases lurking on the horizon, such as Chikungunya, MERS, and Dengue.
“The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe, according to many of the world’s leading infectious disease experts.
The prospect is daunting. A pandemic — an ongoing epidemic on two or more continents — may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.
Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.
The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.
“It’s very, very transmissible, and it almost certainly is going to be a pandemic,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease. But will it be catastrophic? I don’t know.”…
At the moment, it seems unlikely that the virus will spread widely in countries with vigorous, alert public health systems, said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University Medical Center.
“Every doctor in the U.S. has this top of mind,” he said. “Any patient with fever or respiratory problems will get two questions. ‘Have you been to China? Have you had contact with anyone who has?’ If the answer is yes, they’ll be put in isolation right away.”..
But even if an outbreak fades in June, there could be a second wave in the fall, as has occurred in every major flu pandemic, including those that began in 1918 and 2009….
“In God we trust,” Dr. Schaffner said. “All others must provide data.”” (A)
“A comprehensive study of more than 72,000 confirmed and suspected cases of the novel coronavirus by Chinese scientists has revealed new information about the deadly infection which has brought much of the country to a halt.
Carried out by a group of experts at the Chinese Center for Disease Control and Prevention and published in the Chinese Journal of Epidemiology on Monday, the study is the largest and most comprehensive examination of coronavirus cases so far.
It found that the novel coronavirus is more contagious than the related viruses which cause SARS and MERS. While the resulting disease, Covid-19, is not as fatal on a case-by-case basis, its greater spread has already led to more deaths than its related coronaviruses.” (B)
“Numbers have a certain mystique: They seem precise, exact, sometimes even beyond doubt. But outside the field of pure mathematics, this reputation rarely is deserved. And when it comes to the coronavirus epidemic, buying into that can be downright dangerous….
Constant on-the-nose reporting, however much it seems to serve transparency, has limitations, too.
It’s a short-term, and shortsighted, approach that’s difficult to resist, especially when people are afraid and the authorities are taking draconian actions. It’s only natural to compare and contrast whatever hard facts are available. And yet it’s especially dangerous to do that precisely because people are so anxious, and fear can trick the mind.
A view from a loftier perch — a month’s, or even just a week’s, perspective — would, and will, produce far more reliable information.” (C)
“One of the enduring images of the current coronavirus outbreak is a space-age looking thermometer pointed at an airplane passenger.
Eleven airports in the United States are using these temperature checks as part of expanded screening for novel coronavirus, and those measures might seem reassuring. If someone doesn’t have a fever, it seems like they’re fine — right?..
Earlier this month, British researchers published a study showing that temperature checks will fail to detect a coronavirus infection nearly half the time….
Since mid-January, the US Centers for Disease Control and Prevention has been employing temperature checks at selected airports, at first on people flying in from Wuhan, China, the epicenter of the outbreak, and now on all passengers who’ve been anywhere in mainland China in the past 14 days.
The temperature checks are part of an overall screening effort that includes giving passengers cards telling them to watch out for fever, cough and trouble breathing, all symptoms of the novel coronavirus disease, also called COVID-19.
“Finding sick people who are at risk for COVID-19, alerting asymptomatic travelers who may develop COVID-19 symptoms after arrival, and rapidly responding to any suspect COVID-19 illness, we can most effectively protect the health and safety of the American public,” said Dr. Martin Cetron, director of CDC’s Division of Global Migration and Quarantine.
Some experts say it’s that card — a simple card listing symptoms in English and Chinese — that holds the key to detecting coronavirus infection — not a thermometer.” (D)
“On Wednesday, the initial 14-day quarantine aboard a coronavirus-stricken cruise ship docked in Yokohama, Japan, officially ended. But the grueling saga seems far from for over for the ship’s 3,711 passengers and crew…
Japanese health officials are facing international criticism for their handling of the quarantine on the ship, the Diamond Princess. The quarantine was intended to curb the spread of disease by keeping people aboard, isolated from each other and from the public on land. But as cases mounted over the two weeks, it became clear that the control efforts only enabled the new coronavirus to spread. In fact, the 621 cases include at least three Japanese health officials, who were there to support the quarantine efforts but ended up becoming infected themselves….
Just before Dr. Hopland and his wife planned to board an evacuation plane chartered by the US State Department on Sunday, test results came back indicating his wife had contracted the virus. She was moved to a local hospital, and Dr. Hopland remains on the ship in an extended quarantine.
The chartered flights, meanwhile, repatriated over 300 other American cruise ship passengers, 14 of whom tested positive for the virus en route to the US.
“I was surprised I was negative because I knew the virus had swept through this boat like wildfire,” Dr. Hopland told the Journal. “My analogy is they put us in a petri dish to get infected.” (E)
“Nebraska’s specialized medical care has handled Ebola. Now it’s taking on the novel coronavirus
“They’re in the chicken soup stage right now,” Rupp said. “It’s really just watching them and giving them supportive care that you would probably get at home from a loving provider.”
The US Office of the Assistant Secretary for Preparedness Response asked UNMC early Monday morning to take in a total of 13 patients who had either tested positive, or had a high likelihood of testing positive, for the novel coronavirus.
The patients had been on a cruise ship docked off the cost of Japan for two weeks. The center said it was prepared.
“We’re having them under surveillance in quarantine until we know that they are not a danger to the public,” Rupp said, adding that most units have an exercise bike or a treadmill as well as a TV and WiFi so they’re able to communicate…
UNMC was commissioned by the US Centers for Disease Control and Prevention in 2005 to create the biocontainment unit where one patient currently is. The rest of the patients are in a separate federal quarantine center on the campus, that UNMC built through a private-public partnership.
In 2014, UNMC successfully treated three patients with Ebola, and the medical facility has the capacity to manage other highly infectious diseases like SARS, monkeypox and multidrug-resistant tuberculosis.” (F)
“In addition to the biocontainment unit, the hospital’s campus has the only federal quarantine unit in the country.
“We do a huge amount of research in these areas,” said Dr. Jeffrey P. Gold, chancellor of the University of Nebraska Medical Center, citing work on infectious diseases and research on countermeasures to weapons of mass destruction.
“What — heaven forbid — happens if an employee or staff member gets exposed to one of these agents, or even worse than that, gets infected, where are you going to put them? You can’t just call up a local hospital and say, ‘I’ve got somebody who has anthrax, make up a bed,’” he said. “You need facilities that can do everything from air and water handling to the complexities of waste disposal.”” (G)
“The Center for Disease Control does not recognize surgical masks as a means of protection from viruses. Health professionals use N95 respirators that are formed tightly around the nose and mouth. Dr. Seery says N95s are expensive and not practical for the public.
“Surgical masks aren’t bad. If you’re stuck in something like a plane, I don’t think it’s going to do you much good,” Dr. Seery says. Unfortunately, it doesn’t stop all the air that you breathe in around the mask, but if you’re out and about in a community that has the flu, for example, it might reduce your chances of coming into contact with that flu virus while walking through someone’s sneeze cloud.”” (H)
“The director of a Chinese hospital at the epicenter of the coronavirus outbreak became one of its victims Tuesday despite “all-out” efforts to save his life, Chinese health officials said…
Liu Zhiming, president of Wuhan Wuchang Hospital in Hubei province, died of coronavirus-related pneumonia, China Daily reported. The hospital, one of the seven designated for the epidemic in Wuhan, treated thousands of people a day…
“Unfortunately he became infected and passed away at 10:54 Tuesday morning after all-out efforts to save him failed,” the commission said.” (I)
“An Oregon comedian who had been stranded on a Holland America cruise ship in Cambodia due to COVID-19 virus concerns managed to get a flight back home by breaking quarantine in a hotel where ship’s passengers were being held pending test results…
“There was no official ‘you can’t leave’ (at the hotel) but if you tried to go out the front door with your luggage, security would stop you,” King said. “But if you went out with your backpack and you were sightseeing, not a problem.”..
He says he chose to fly back on his own on a more full-service airline, even purchasing a full-price, upgraded ticket as not to raise suspicion that he was trying to quickly leave the country at the last minute as cheaply as possible.
King said he sailed through the airports on his three connecting flights, only being asked if he had been to China, and had a rental car reserved in Seattle to get home to Eugene if he couldn’t fly from here.
King said somebody asked him if it was “kind of selfish to self deport?” He said while the results of his virus test weren’t back, he’s confident he’s OK since he has not shown any symptoms, nor fever, and says he had been essentially in quarantine for 14 days.” (J)
“In one school district, families are pulling their kids out of school. In others, students show up in face masks.
Educators in another Southern California community agreed to suspend an exchange program to keep visiting Chinese students out of quarantine.
School districts across the U.S., particularly those with large Asian American populations, have scrambled to respond to the outbreak of the coronavirus, which has killed more than 1,500 people and sickened tens of thousands more, almost all in China.
At least 15 cases have been confirmed in the U.S., mostly in California, home to about one-third of the nation’s Chinese immigrants.
The districts find themselves in uncharted territory as they apply new federal travel rules to their student bodies. And in some cases, administrators are making decisions to address parental fears – not actual disease – with no official guidance. They’re weighing whether to allow students to work from home, even if they haven’t traveled abroad recently, or let them wear face masks in class.
Balancing these requests against broader public health needs often leads to different conclusions.
“We’re just doing our best to comply” as the rules and outbreak evolve, said Jenny Owen, spokesperson for the Duarte Unified School District, about 20 miles northeast of downtown Los Angeles. About 6% of the district’s students identify as Asian…
To prevent the virus’s spread in the U.S., the federal government has issued rules for returning travelers: U.S. citizens and legal permanent residents who visited the epicenter of the outbreak in China, Hubei province, in the previous 14 days must undergo a mandatory two-week quarantine at a government-run facility. Those who visited other parts of China must stay home and “self-quarantine” for two weeks.
The policies began Feb. 2, and as a result, an exchange program that brought children from China to Duarte schools has been temporarily halted to prevent the students from being quarantined, Owen said.
State public health departments are using the federal rules to draft guidelines for school districts.
The policies made a “night and day” difference in clearing up confusion, especially for families who had recently traveled from China and were wondering whether to send their kids to school, said Don Austin, superintendent of the nearly 12,000-student Palo Alto Unified School District in the Bay Area, where about 36% of students identify as Asian.
“When I first heard of the concept of self-quarantine, my first instinct was, this could be problematic if we’re alone on that and trying to create some of these policies and practices on the fly,” he said.
But school districts and local health departments still have to make quick decisions in cases that fall outside federal guidelines.” (K)
“As the U.S. responds to a growing threat of the 2019 novel coronavirus, CMS and other organizations are clarifying how to code for testing and treatment of the disease.
Six things to know:
1. CMS created a new Healthcare Common Procedure Coding System code for providers and labs testing patients for SARS-CoV-2, or severe acute respiratory syndrome coronavirus 2.
2. Providers can use the HCPCS code U0001 to test patients for coronavirus using the CDC’s 2019 novel coronavirus real-time RT-PCR Diagnostic Test Panel.
3. Medicare’s claims processing system will start accepting the code April 1 for dates of services Feb. 4 onward.
4. Audrey Howard, senior outsource services consultant with 3M Health Information Systems, reviewed in a blog post the current ICD-10-CM codes providers could use to code for the virus.
5. For classifying coronavirus not associated with SARS, providers could use:
Pneumonia due to coronavirus: J12.89 and B97.29
Sepsis due to coronavirus: A41.89 and B97.29
Other infection caused by coronavirus: B34.2
Contact with and (suspected) exposure to other viral communicable diseases: Z20.828
6. For classifying the SARS-associated coronavirus, providers could use:
Pneumonia due to SARS-associated coronavirus: J12.81
Sepsis due to SARS-associated coronavirus: A41.89 and B97.21” (L)
“Staff at NYU Langone Health in New York City has designated the new virus as a “level 1” priority.
“A big part of this level is communication,” said Dr. Jennifer Lighter, hospital epidemiologist there.
“We are trying to communicate to NYU staff and patients in our medical center how to best protect themselves from the flu or COVID-19,” Lighter said. “That’s just general info like basic hand hygiene, sneezing into the end of your elbow and practicing safe distance from someone who is sick.”
NYU is also preparing for a level 2 or 3 scenario, she added, where there is transmission in the city and it begins to impact hospital operations. The health-care system has implemented a conservation plan and medical supplies, especially respirator masks, are only given to staff as needed, she said.
“If a team needed more, they would have to be infection-prevention approved or manager approved before someone would get more,” she said, adding staff is already feeling the brunt of the flu season.
The hospital is also recommending patients with more mild symptoms to stay at home, she said. The hospital has been ramping up its virtual urgent care, including training doctors and purchasing more iPads and other machines. “If you’re shortness of breath, obviously, please come in,” Lighter said.” (M)
- A.Wuhan Coronavirus Looks Increasingly Like a Pandemic, Experts Say, by Donald G. McNeil Jr., https://www.nytimes.com/2020/02/02/health/coronavirus-pandemic-china.html?referringSource=articleShare
- B.Chinese CDC study finds Covid-19 virus to be more contagious than SARS or MERS, by James Griffiths and Nectar Gan, https://www.msn.com/en-us/health/health-news/chinese-cdc-study-finds-covid-19-virus-to-be-more-contagious-than-sars-or-mers/ar-BB108Z9X
- C.Constant on-the-nose reporting, however much it seems to serve transparency, has limitations, too, by John Allen Paulos, https://www.nytimes.com/2020/02/18/opinion/coronavirus-china-numbers.html
- D.No US coronavirus cases were caught by airport temperature checks. Here’s what has worked, by Elizabeth Cohen and John Bonifield, https://www.cnn.com/2020/02/19/health/coronavirus-airport-temperature-checks/index.html
- E.Americans on coronavirus cruise ship barred from US after failed quarantine, by BETH MOLE, https://arstechnica.com/science/2020/02/americans-on-coronavirus-cruise-ship-barred-from-us-after-failed-quarantine/
- F.Nebraska doctors are providing coronavirus patients with chicken soup and Tylenol, by Amir Vera and Nick Watt, https://www.cnn.com/2020/02/18/health/nebraska-coronavirus-unmc-chicken-soup/index.html
- G.First Ebola, Now Coronavirus. Why an Omaha Hospital Gets the Toughest Cases, by Sarah Mervosh, https://www.nytimes.com/2020/02/18/us/coronavirus-omaha-nebraska-medical-center.html
- H.Do surgical masks protect against illness?, by Kristen Boxman, https://www.kwch.com/content/news/Do-surgical-masks-protect-against-illness-567967131.html
- I.Coronavirus 20 times more lethal than the flu? Death toll passes 2,000, by John Bacon, https://www.usatoday.com/story/news/nation/2020/02/18/wuhan-china-coronavirus-hospital-director-dies-covid/4792597002/
- J.Hotel getaway: Oregon comedian quarantined amid cruise ship virus sneaks flight to Seattle, https://komonews.com/news/local/man-stranded-on-coronavirus-infected-cruise-ship-arrives-at-sea-tac-airport
- K.School districts grapple with coronavirus quarantines, face masks and fear, by Anna Almendrala, https://www.usatoday.com/story/news/nation/2020/02/17/coronavirus-forces-schools-grapple-quarantines-masks-and-fear/4775522002/
- L.Coding for coronavirus: 6 things to know, by Morgan Haefner, https://www.beckershospitalreview.com/finance/coding-for-coronavirus-6-things-to-know.html
- M.Hospitals across the US prepare for coronavirus outbreak to become global pandemic, by Berkeley Lovelace Jr., https://www.cnbc.com/2020/02/19/hospitals-across-the-us-prepare-for-coronavirus-outbreak-to-become-global-pandemic.html