POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals, maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

Doctor, Did You Wash Your Hands?®  at  https://doctordidyouwashyourhands.com/

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#CoronavirusTracker   #CoronavirusRapidResponse

“Doctor” previously tracked Ebola and Zika. With Coronavirus it’s, as Yogi Berra said, “déjà vu all over again” without any  thoughtful differentiation about hospital capacity/ capability matched to patient severity. It seems, for the most part, whichever hospital you are taken to or go to for Coved-19 is where you stay. We don’t default like that for other “critical care” services such as cardiology/ cardiac surgery,  trauma, high risk obstetrics, maternal-fetal medicine, and neonatology.

Since we need to be prepared for future pandemics it’s timely to consider levels of care and hospital designations for “emerging viruses.” Back in the day of Certificate of Need this might have already been done. With years of deregulation it’s off the radar.

Here’s one way to look at it in Rapid Response mode.

‘When the first wave of coronavirus patients flooded New Jersey hospitals earlier this year, clinicians were heavily focused on ventilators. At the apex of the pandemic, one in four people hospitalized for COVID-19 needed these machines to breathe, and the state’s supplies were running short.

Six months later, the picture has changed dramatically. Ventilators are still critical for some patients — 10% of those hospitalized earlier this week depended on artificial respiration, according to state data — but clinicians now try to employ less invasive protocols first, like high-flow oxygen or repositioning patients to ease breathing, called “proning.”

“When the pandemic started, we intubated you at the drop of a hat,” said Dr. Lewis Nelson, who leads the emergency department at University Hospital in Newark, which was at the heart of the outbreak. Intubation generally requires the patient to be heavily sedated as a tube is then inserted into the windpipe and connected to the ventilator, which is calibrated to provide a specific oxygen concentration. The patient often requires a catheter to collect urine as well.

“There’s a sweet spot” in balancing who needs to be intubated and who could benefit more from other treatments, said Nelson, who also chairs the emergency medicine department at Rutgers New Jersey Medical School. “You have to use a good amount of clinical judgment.”

The shift in pulmonary treatment is just one example of how inpatient care for COVID-19 has evolved in New Jersey since the virus first emerged publicly in March and began spreading, sickening tens of thousands. Nearly 210,000 residents have tested positive for the virus, including more than 14,400 who have died.

While clinical research remains limited, physicians said some evidence is beginning to emerge about what treatments work best for coronavirus patients. There are a few medications that appear to reduce the related symptoms, they said, and medical providers are better able to identify problems and predict the course of the disease. There is no cure for COVID-19 and the quest for a vaccine continues.

“We’re still not making decisions based on high-quality evidence,” Nelson said. “It’s much better than it was before, but it’s still limited.”

Perhaps the biggest change in New Jersey is in the volume of COVID-19 patients at the state’s 71 acute-care hospitals. State statistics show that as the initial outbreak peaked in mid-April, more than 6,000 people were receiving inpatient treatment; one-third of these patients were in critical-care rooms and more than one in four were on a ventilator. As of Monday, hospitals were treating 445 coronavirus patients, with 29% in critical care and 10% on ventilators…

At times during the surge, multiple hospitals would be forced to temporarily suspend new admissions and divert ambulances to neighboring emergency departments, as coronavirus patients overwhelmed their bed or staff capacity. Several times officials shuttled ventilators from one facility to another to meet demand, and state and hospital leaders worked together to create a strategy to ration these machines and other scarce resources, should there not be enough for all patients. Shortages of nursing staff and personal protective equipment, or PPE — the masks, gowns and gloves designed to help stop the spread — were common in the early months.

While greater knowledge and treatment options have improved patient outcomes, health officials agree more research is needed to confirm the best-practice protocols for treating COVID-19 patients. They are also learning more about the long-term impacts of coronavirus infection, which can involve weeks or months of recovery at home. “It’s not a quick, rapid illness. It takes time,” Breen said.

At the same time, they are bracing for a second wave of the virus. “We do believe we’re going to have a resurgence. COVID has not just disappeared,” Nelson said.” (A)

“How do you choose a hospital?

Doctors at smaller community hospitals, regional medical centers, and the largest academic medical centers described the same general approach to care. This raises the question: Does it matter where you go?

Many doctors said probably not. “A lot of the management around COVID really involves a lot of things that we all have at our disposal in any health-care facility,” Hamilton said.

Some at larger hospitals, though, said that experience with complex intensive-care patients and more extensive resources may make larger health systems the better choice.

“The larger academic medical centers are probably better versed on how to take care of really sick patients,” Powell said.

Others, though, said there are advantages to community hospitals. Ronak Bhimeni, chief medical officer for Prime’s Lower Bucks Hospital, said his patients avoided the crush some larger hospitals experienced. Lower Bucks always had adequate supplies. “There was never a time when we felt that we couldn’t manage this,” he said.

One clear difference is that academic medical centers are far more likely to offer clinical trials. You can search clinicaltrials.gov to see what centers near you offer. If you’re the kind of person who wants to help make scientific progress and have early access to new — unproven — treatments, this may be important to you. Temple has a notably long list of trials, and Criner said more than half of the hospital’s coronavirus patients have joined one. “We try to have multiple options open so we can offer multiple things to people,” he said.

In general, current trials are looking at drugs with tongue-twisting names that might reduce inflammation, improve immune response, or combat cytokine storm…

Wayne Psek, a health-care quality expert at George Washington University’s Milken Institute School of Public Health, says there are not enough data available now to know which types of hospitals are doing a better job. Experience usually is helpful, but, in this case, “we just don’t know how to treat [coronavirus] well enough.” Some hospitals, he said, may be better staffed and better equipped to evaluate new information, but most are sharing now. He said he would make sure hospitals had beds available.

Albert Wu, director of the Johns Hopkins Center for Health Services and Outcomes, said coronavirus patients may benefit from the extra resources and research at larger facilities. Bigger places have more people to monitor and share study results. Practice often improves care. “In general, there is a volume-outcome relationship in almost anything that’s complicated,” he said. Treating HIV patients reinforced the value of clinical trials for him. “Access to clinical trials is an important element of quality care when there’s no agreed consensus treatment,” he said. Still, he said, many smaller hospitals now have easy access to advice from academic medical centers in their networks.

You can expect treatments to continue changing as doctors wade through what Hamilton says is already an “absolutely staggering” amount of research on COVID-19.” (B)

“El Centro Regional Medical Center was overrun with dozens of Covid-19 patients in May, with nowhere to send the critically ill. The only other hospital in Imperial County, Calif., also was swamped.

Chief Executive Adolphe Edward called the state’s emergency medical services director, asking him to intervene. “Please, please help us,” he pleaded.

Doctors and nurses at El Centro swapped text messages and made phone calls, blindly searching for openings at other hospitals.

In the emergency room, coronavirus patient Jose Manuel Abundis Gomez waited. It took 20 hours to find another hospital with a bed for the 71-year-old retired state administrator, said Alidad Zadeh, his primary care physician.

By the time Mr. Abundis was finally transferred, his oxygen levels had dropped. He later died.

During a pandemic, hospitals and local, state and federal agencies rely on a range of real-time metrics to respond to emergencies quickly. They need to know how many beds are available at each facility, whether hospitals need more nurses and the available number of ventilators and other critical supplies. That way, patients can get transferred quickly and medicine distributed to those in most need.

The U.S. has tried—and failed—over the past 15 years to build a system to share such information in a crisis. When the pandemic started, nothing like it existed. The limited and inconsistent access to data has been a major impediment to providing hospital care during the pandemic, according to interviews with industry and government officials and thousands of internal documents and emails.

Weeks after the coronavirus surfaced, administration officials began putting together a solution. It was riddled with mistakes and slowed by competing agency attempts to solve the problem, the interviews and documents show. Today, with some U.S. cities bracing for more cases, there is still no viable way to broadly track what’s happening inside hospitals.

“It’s staggering to most people how little visibility there is outside of a particular health system,” said Gregg Margolis, a former U.S. Department of Health and Human Services emergency health planning official. “Every time these things happen everybody throws their hands up and says, ‘I can’t believe these things don’t work more closely together.’ ”

At hospitals like El Centro, the data gaps meant patients couldn’t be moved to another facility quickly for treatment. Between May and August, hospital, county and California state administrators scrambled to transfer nearly 500 patients to about 90 hospitals outside Imperial County, transfer data and emails show. Some were moved as far as 600 miles…

Lawmakers and federal officials have warned for years that up-to-the-minute hospital data would be essential in emergencies. More than $100 million for the technology was cited in legislation but never formally appropriated. Resistance from hospitals and medical-record software companies to report the data has exacerbated the issue, former federal health officials and other experts say.

A spokeswoman for HHS defended the data-reporting system the Trump administration put in place as comprehensive and unprecedented, and said the government is “poised to go even further by making this system fully automated.”…

El Centro Chief Executive Adolphe Edward called the California Emergency Medical Services Authority director to intervene. ‘Please, please, help us,’ he said.

Transferring patients is a labor-and time-intensive process. Hospitals broker patient exchanges through a transfer center, a unit similar to air traffic control in an airport. Transfer centers rely on repeated phone calls to locate a bed. ‘Sometimes we’re out blind shopping,’ said Tara Mitchell, head of the case managers who coordinate transfers at El Centro.

Between May and August, nearly 500 patients from Imperial County were transferred by ambulance and helicopter to about 90 hospitals outside the county. Some were transferred as far as 600 miles. The helipad was quiet at El Centro Regional on Sept. 1.

Slow U.S. response

When the pandemic hit, government officials raced to put a makeshift system in place to track hospital data, including the number of beds occupied to ventilator inventory and Covid-19 admissions. From the start, there were competing efforts overseen by HHS.

The Centers for Disease Control and Prevention, an HHS agency, moved quickly to add Covid-19 questions to an existing hospital-disease surveillance system. Known as the National Healthcare Safety Network, the CDC system was used by about 6,000 hospitals to routinely report infection data to the agency…

In late June, White House coronavirus coordinator Deborah Birx admonished health-care industry executives on a call as Covid-19 cases surged across the South and West.

It is easier to get data from HIV clinics in Africa than U.S. hospital data, said Dr. Birx, a former ambassador for global AIDS coordination, according to people familiar with the call. Dr. Birx declined to comment through a spokesman.” (C)

“Older New Jerseyans are still wary of going to the hospital for non-COVID-related treatments despite a steep decline in patients with the virus and numerous health and safety measures in place, the New Jersey Hospital Association found in a survey released Thursday.

Hospitals statewide continue to care for approximately 350,000 non-COVID-19 cases, such as life-saving surgeries, births, trauma services and emergency care. And COVID-19 admissions represented less than 5% of total patients in the state’s medical facilities as of September, down from an April peak that had 20% of the hospital beds filled up with COVID patients.

The NJHA‘s Health Attitudes survey was initiated as part of the “Get Care Now NJ” consumer awareness campaign, which educates residents on the safety and security of hospitals.

The survey found that 84% of New Jersey adults are either “extremely concerned” (23%), “very concerned” (27%), or “somewhat concerned” (34%) about the risk of contracting COVID-19 if they need to visit a hospital.

Elective surgeries for June and July were down 24% year over year…

“These findings confirm our concerns: that our state’s older residents have been delaying surgical procedures and potentially putting their health at risk,” noted NJHA President and CEO Cathy Bennett.

“New Jersey’s hospitals are ranked the eighth safest in the nation and we’re committed to educating our residents through Get Care Now NJ that our hospitals are safe and secure, with compassionate care delivered by our health care teams,” she said.”  (D)

“PRESS RELEASE from BRIGHAM AND WOMEN’S HOSPITAL

On Sept. 22, our Infection Control team identified a COVID-19 cluster involving Braunwald Tower 16A and 14CD.

To date, 41 employees and 15 patients related to the cluster have tested positive for a total of 56.

All current inpatients are being tested for COVID-19, and this will be repeated every three days. This is in addition to the current hospital policy which requires testing for all patients upon admission and daily screening for symptoms. The Brigham has reached out to all staff members potentially exposed to the cluster, has facilitated testing for them and will continue to test those in the highest risk groups every three days.

Since Friday, Sept. 25, we have performed 10,213 tests on 7,751 unique employees and received 9,560 results. Of these results, 51 were positive. Of these 51 positive results, 41 are associated with the cluster, seven are not associated with the cluster and three are being investigated further.

We expect that as we continue to test, we will continue to identify a handful of positive employees. To this point, the overall prevalence rate of our non-cluster community is 0.1 percent, a fraction of the community, city and state rates.

As we continue to respond to this cluster, testing for asymptomatic employees will be available through Sunday, Oct. 18 or as long as necessary to support our testing needs. The primary focus of our testing is to ensure that those asymptomatic staff identified as needing ongoing testing can be tested as efficiently as possible.

It is important to stress that our Infection Control team believes that the cluster has been contained to two specific inpatient units (16A and 14CD in the Braunwald Tower).

If you are testing all admitted patients and screening all staff and visitors, how did this happen?

Our Infection Control team has investigated the source of the cluster through intensive contact tracing, testing, and staff interviews. Based on the information that we currently have, our Infection Control team is unable to determine whether the source of the cluster was a staff member or patient.

What did you do to stop the spread of this cluster?

There are a number of things we’ve done to address this issue.

We have reached out to all potentially exposed staff members, arranged testing for them, and will continue to test those in the highest risk groups every three days

We offered voluntary testing to all staff members working on the main campus since Sept. 14

Staff who are symptomatic and/or have tested positive have been sent home immediately and are not permitted to return to work until they meet our system’s return-to-work criteria

We are testing patients in the hospital every three days

We have run whole genome sequencing of all isolates in order to confirm the infections are related

We are reaching out to all patients discharged from the affected units to check on their health and to arrange testing for them

Environmental Services has performed a thorough cleaning of the affected areas

How did this spread? Was there a potential breach in infection control measures?

Our Infection Control team is conducting an ongoing investigation and has identified possible factors that may have contributed to the outbreak:

Many involved were very early in their infectious period, a time when they are most contagious

Many patients were not masked during clinical care/interactions with staff

Some patients had multiple risk factors for transmission, such as coughing, shortness of breath or use of nebulizers

Some providers were inconsistent in their use of eye protection during patient encounters

Lack of physical distancing of at least six feet among some staff while unmasked for purposes of eating…

How can you prevent this from happening again?

Our experience over the past few months demonstrates that we can create and maintain a safe environment by adhering to all of the elements of our Safe Care Commitment and our infection control policies. This includes:

Universal masking of both providers and patients

Frequent hand hygiene

Enhanced distribution of eye protection

Daily attestations of health for employees and visitors

Testing all patients on admission, rescreening all patients daily for new symptoms of COVID-19, and retesting if the screen is positive

Requiring patients admitted to the hospital to mask when staff enter the room

Practicing appropriate physical distancing, particularly when eating or drinking

Creating space optimization and seating capacities in all workrooms and breakrooms and enforcing this with increased monitoring measures

Opening up additional, safe eating areas

Is it safe to visit the hospital?

Yes. The Brigham is committed to creating and maintaining a safe care environment by testing all patients admitted to the hospital, requiring staff to attest to their health daily before working, requiring all staff, patients and visitors to wear hospital-issued masks while on campus, insisting on frequent hand hygiene, frequently cleaning the environment, and enforcing appropriate physical distancing.

It is important to note that our Infection Control team believes that the cluster has been contained to two specific inpatient units (16A and 14CD in the Braunwald Tower). This cluster is not impacting any other areas of the hospital or our outpatient clinics.

How is the hospital tracing those who might have been exposed?

Our Infection Control team is conducting intensive contact tracing using the electronic health record and staff interviews. Those individuals who have been exposed have been contacted directly and we have facilitated testing for them.

What is being done to address patients or visitors who had previously left the hospital and the potential for them exposing others to the virus?

Our Infection Control team is reaching out directly to patients and staff who have been exposed (including those patients who have been discharged) to facilitate testing. Each person will be individually advised by a member of our Infection Control team…

Will the hospital provide a free test for those who believe they were exposed?

Yes.” (E)

“Employees at Brigham and Women’s Hospital have sounded the alarm. The facility has a COVID-19 cluster of more than 40 positive cases. Now, a patient in a different part of the hospital has tested positive.

Brigham nurse Kerry Noonan says the virus “is clearly coming back with force in the hospital as well as in the community.”

Noonan also told WBZ-TV, “The hospital stepped up and did a universal testing for everyone. One time. Unfortunately, we know as soon as the test is done, and you walk out the building and go back into the community or you go back home, you could very well come in contact with it again.”..

Noonan says the hospital needs to continue to test routinely, or randomly, people in the building who are providing direct case, and he says those people should have “N95s and face shields.”

“I don’t know why we still have visitors,” Noonan said. “We need to restrict access to essential personnel only.”..

The hospital says with testing, it is likely there will be more positive cases connected to the cluster. So far, researchers have not identified the source of the infection. At this point, doctors do not believe the new case is related to the others.” (F)

“Boston area hospitals say they are preparing for a long winter as COVID-19 cases continue to spike in Massachusetts and across the globe

Over the past week alone, more than 4,000 new coronavirus cases have been reported in the state, including 1,226 over the weekend. The percentage of coronavirus tests coming back positive, on average, is at 1.1%, compared to the 0.8% it had been at in previous weeks.

Boston entered the highest-risk, category on the state’s COVID map last week, even as Gov. Charlie Baker is allowing Massachusetts to move ahead with the latest step in the reopening of its economy.

Those numbers are still not as high as what the state experienced in the spring, but health officials say they are concerned.

Lowell General Hospital told The Boston Globe they are seeing three times the number of coronavirus patients as they were as recently as a month ago. Lowell is one of the 23 communities currently included in the red, or highest-risk, categories on the state’s COVID map.

Southcoast Health said its hospitals have seen COVID-19 cases double in the last two weeks. And UMass Memorial Medical Center in Worcester has also seen a steady increase.

The number of patients hospitalized for COVID-19 in the state is now up to 438. Of that number, 83 were listed as being in intensive care units and 27 are intubated, according to the Department of Public Health.

The three-day average number of coronavirus patients in the hospital is up 41% from the lowest observed value.” (G)

“Wisconsin health officials announced Wednesday that a field hospital will open next week at the state fairgrounds near Milwaukee as a surge in COVID-19 cases threatens to overwhelm hospitals.

Wisconsin has become a hot spot for the disease over the last month, ranking third nationwide this week in daily new cases per capita. Health experts have attributed the spike to the reopening of colleges and K-12 schools as well as general fatigue over wearing masks and socially distancing.

“We hoped this day wouldn’t come, but unfortunately, Wisconsin is in a much different, more dire place today and our healthcare systems are beginning to become overwhelmed by the surge of COVID-19 cases,” Democratic Gov. Tony Evers said in a statement. “This alternative care facility will take some of the pressure off our healthcare facilities while expanding the continuum of care for folks who have COVID-19.” (H)

When Tammy Gimbel called to check on her 86-year-old father two weeks ago, he sounded weak. He was rushed to Sanford Medical Center in North Dakota’s capital, where doctors said he had the coronavirus. But all the hospital beds in Bismarck were full, his relatives were told, and the only options were to send him to a hospital hours away in Fargo, or to release him to be monitored by his daughter, who was herself sick with the virus.

Ms. Gimbel and her father hunkered down in a 40-foot camping trailer in her backyard to try to recover. He only got worse.

“There I sat in my camper, watching my dad shake profusely, have a 102 temperature with an oxygen level of 86,” Ms. Gimbel recalled. “I am sicker than I had been the whole time, and I wanted to cry. What was I going to do? Was I going to watch my dad die?”..

On Monday, hospitals in Bismarck reported that only six inpatient beds were open and just one intensive care unit bed. Across the entire state, 39 staffed I.C.U. beds were available…

Miles from Bismarck, smaller communities have long turned to city hospitals to handle cases they do not have capacity to manage, but that is shifting.

“In the past two weeks, my ability to send people to Fargo or to Bismarck has been nonexistent,” Dr. Sarah Newton of Linton Hospital, a facility in Emmons County, told her City Council last week.

Emmons County is dealing with the state’s worst level of infections per capita, and Linton Hospital has been completely full. Dr. Newton described spending hours calling around the state for a patient who needed emergency heart surgery. A bed finally opened in Fargo.

“We’ve had to scramble, and I think a lot of the other hospitals have had to scramble as well,” Robert Black, the chief executive of Linton Hospital, said…

In earlier months, some nursing homes with outbreaks had often sent residents with Covid-19 to a hospital for treatment and to help slow the spread of the virus inside the nursing home, according to Sandy Gerving, an administrator at Marian Manor Healthcare Center, a nursing facility an hour west of Bismarck. In the past month, though, she said, nursing homes have been turned away from some hospitals…

“We got to the point where we knew there was no one that would take them,” Ms. Gerving said of patients who were sick but not critically ill. “So then we started keeping them in our building. And then we started having an outbreak internally.”..

Public health officials say they have struggled to press for county-level masking mandates in the state. There is no state-level mask rule.” (I)

“Hospital administrators in Montana say the recent rise in COVID-19 infections statewide could strain the health care system in coming weeks as patients become more ill and cold and flu season picks up. Health experts are making a plea for Montanans to “do their part” after more than 700 people have been hospitalized with the virus since it arrived in the state…

Dr. Shelly Harkins, Chief Medical Officer at St. Peter’s Health in Helena, says while hospitalization rates may seem low now, she’s anticipating an increase soon that could max out St. Peter’s capacity.

“Typically it’s a few weeks following an increase in reported cases that we would see hospitalizations,” Harkins said during a press conference Wednesday, where state health officials, the governor and hospital administrators urged Montanans to take the virus seriously.

State data show 500 more cases were reported last week than the week prior, building on a curve that’s been trending upward since Labor Day.

Harkins says St. Peter’s is also facing staffing shortages as health care workers themselves are quarantined due to exposure or fall ill.

“When resources are strained at the local health system, all the patients, even those with non-covid medical conditions like heart disease, lung disease, kidney disease, many others, they become at risk of being left without adequate services to stay well. It is the morbidity and mortality from all the non-covid related diseases that we are concerned about, too,” Harkins says.

Harkins says four people with COVID-19 are hospitalized at St. Peter’s, more than their typical case load since the virus arrived in state.

Ellner says Billings Clinic’s capacity is a fluid number. He said 13 COVID patients are filling half of the downtown hospital’s intensive care unit beds. A total of 48 COVID patients from as far as Wyoming are hospitalized there.

Michael Skehan, St. Vincent Healthcare chief operating officer, said Wednesday the Billings-based hospital is treating 41 COVID-19 patients, with eight in critical care. Skehan says St. Vincent recently pulled in dozens of nurses, technicials and respiratory therapists from sister hospitals in Colorado.

State health officials said Wednesday that Benefis Hospital in Great Falls is at 115 percent capacity, with 37 COVID-19 patients, seven of whom are in intensive care units.

“There’s concern that those systems are going to be even further stressed,” Jim Murphy, the state’s chief epidemiologist, said.

Hospital administrators say they’re building out additional capacity, bringing in nurses and respiratory therapists, and transferring patients to regional partners as needed. Gov. Steve Bullock says the state has a 90-day supply of personal protective equipment available for hospitals and local agencies as needed, and testing is available for people with symptoms, known exposures and congregate care residents.

But Harkins at St. Peter’s in Helena says Montana is only headed into halftime of the pandemic bowl. She says everyone needs to double down on the basics: wash your hands, keep your distance, wear a mask.” (J)

“Nurses at Alta Bates Summit Medical Center in Oakland, Calif., were on edge as early as March, when patients with COVID-19 began to show up in areas of the hospital that were not set aside to care for them.

The Centers for Disease Control and Prevention had advised hospitals to isolate COVID-19 patients to limit staff’s exposure and help conserve high-level personal protective equipment that’s been in short supply.

Yet COVID-19 patients continued to be scattered throughout the Oakland hospital, according to complaints to California’s Division of Occupational Safety and Health. The concerns included the sixth-floor medical unit where veteran nurse Janine Paiste-Ponder worked.

Patients on that floor who had the coronavirus were not staying in their rooms, either because they were confused or disinterested in the rules. Hospital employees were not provided highly protective N95 respirators, says Mike Hill, a nurse in the hospital intensive care unit and the hospital’s chief representative for the California Nurses Association, which filed complaints to Cal/OSHA, the state’s workplace safety regulator.

“It was just a matter of time before one of the nurses died on one of these floors,” Hill says.

Two nurses fell ill, including Paiste-Ponder, 59, who died of complications from COVID-19 on July 17.

California Nurses Association members had complained to Cal/OSHA about COVID-19 patients being spread throughout the hospital where registered nurse Janine Paiste-Ponder worked. Colleagues say they suspect the practice was a factor in her illness and death.

The concerns raised in Oakland also have swept across the U.S., according to interviews, a review of government workplace safety complaints and health facility inspection reports. A Kaiser Health News investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID-19 patients from those not infected with the coronavirus, in some places fueling its spread and leaving staff unprepared and infected or, in some cases, dead…

Our investigation discovered that patients with COVID-19 have been commingled with uninfected patients in health care facilities in states including California, Florida, New Jersey, Iowa, Ohio, Maryland and New York.” (K)

POSTED ON May 15, 2017 (L) – perhaps this needs to be modified for Coronavirus and implemented?

Lesson Learned from recent EBOLA and ZIKA episodes. We need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

1. There should not be an automatic default to just designating Ebola Centers as REVRCs although there is likely to be significant overlap.

2. REVRCs 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 emerging viruses “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.

(A)‘A complete shift’: Not just ventilators, doctors now use a range of COVID-19 treatments, LILO H. STAINTON, https://www.njspotlight.com/2020/10/covid-19-new-treatment-options-medications-steroids-recovery-rate-ventilators/

(B) Hospital coronavirus treatment has changed. Here’s what it looks like now in Philadelphia., by Stacey Burling, https://www.inquirer.com/health/coronavirus/coronavirus-treatment-changes-hospitals-philadelphia-20201003.html

(C) Why Hospitals Can’t Handle Covid Surges: They’re Flying Blind, By Melanie Evans and Alexandra Berzon, https://www.wsj.com/articles/hospitals-covid-surge-data-11601478409

(D) NJHA: Older folks still wary of going to the hospital for non-COVID-19 treatment, By Gabrielle Saulsbery, https://njbiz.com/njha-older-folks-still-wary-going-hospital-non-covid-19-treatment/

(E) Statement for Media Regarding COVID-19 Cluster, https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=3684

(F) I-Team: Brigham And Women’s Employees Push For More Testing After Covid-19 Outbreak, By Cheryl Fiandaca, https://boston.cbslocal.com/2020/10/01/i-team-brigham-and-womens-employees-urge-hospital-covid-tests-covid-outbreak/

(G) Mass. Hospitals Preparing for Long Winter Amid Spike in COVID Cases, https://www.nbcboston.com/news/local/mass-hospitals-preparing-for-long-winter-amid-spike-in-covid-cases/2206798/

(H) Wisconsin activates field hospital as coronavirus keeps surging, https://www.foxnews.com/health/wisconsin-field-hospital-coronavirus-surging

(I) The Virus Surges in North Dakota, Filling Hospitals and Testing Attitudes, By Lucy Tompkins, https://www.nytimes.com/2020/10/07/us/coronavirus-north-dakota.html?referringSource=articleShare

(J) Coronavirus Strains Montana Hospitals Heading Into Flu Season, By NICKY OUELLET, https://www.mtpr.org/post/coronavirus-strains-montana-hospitals-heading-flu-season

(K) Some Hospitals Fail To Separate COVID-19 Patients, Putting Others At Risk, by CHRISTINA JEWETT, https://www.npr.org/sections/health-shots/2020/09/10/911165550/some-hospitals-fail-to-set-covid-19-patients-apart-putting-others-at-risk

(L) EBOLA is back in Africa. Is ZIKA next? Are we prepared?, https://doctordidyouwashyourhands.com/2017/05/ebola-is-back-in-africa-is-zika-next-are-we-prepared/