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Physicians

CHI Memorial has more than 650 physicians on medical staff. With a diverse assortment of medical specialties and sub-specialties, CHI Memorial is equipped to provide the highest quality health care for the vast majority of our community. Many patients from other areas of the country travel to CHI Memorial to seek treatment from our nationally recognized providers.

Your patients are important to us, and we understand your time is precious. We hope you find this physician communication hub on our website beneficial to your practice. 

COVID-19 resources and updates

Current COVID-19 Status:

  • Johns Hopkins Global Coronavirus Tracker: 18,364,694 confirmed; 10,965,634 recovered; 695,848 deaths. In the United States, 57,543,852 have been tested; 4,742,277 are confirmed; 1,513,446 have recovered. The United States has a population of 328.2 million people. 8/4/20, 3 p.m.) 
  • 112,441 confirmed cases in Tennessee; 73,259 recovered; 1,117 deaths. Tennessee Department of Health (TDH). 8/4/20  
    • 5,669 confirmed cases in Hamilton County, 4,155 recovered, 48 deaths; 674 cases/638 recovered/1 death in Bledsoe County; 1,739 cases/1,211 recovered/10 deaths in Bradley County; 102 cases/68 recovered/2 deaths in Grundy County; 209 cases/122 recovered/4 deaths Marion County; 493 cases/339 recovered/20 deaths in McMinn County; 99 confirmed/52 recovered in Meigs County; 511 cases/372 recovered/1 death in Rhea County; 96 cases/62 recovered in Sequatchie County
  • 197,948 confirmed cases in Georgia; 3,921 deaths. 8/4/20 Georgia Department of Public Health (DPH)
    • 572 cases in Catoosa County, 9 deaths; 581 in Walker, 16 deaths; 114 cases, 1 death in Dade; 3,272 cases, 27 deaths in Whitfield County; 1,039 cases, 23 deaths in Gordon County.
  • 4,649,102 confirmed cases in the U.S.; 154,471 deaths; 55 jurisdictions (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) 37 jurisdictions report more than 10,000 cases of COVID-19. CDC 8/3/20

CHI Memorial COVID-19 Response

Visit the resource bank on Mnet for all current COVID-19 information.

Key Actions and Updates

*New* COVID Isolation Protocol

Following updated guidelines, new isolation protocols have been developed for transferring COVID-19 positive patients out of the CDU and CCU, as well as clarifies the process for retesting patients who may need an aerosolizing procedure.  The new protocol becomes effective Wednesday, Aug. 5, 2020.  Click here to view the protocol.

*New* CommonSpirit Health COVID-19 Bulletin

Important information about the ministry’s response to COVID-19 is published in CommonSpirit Health’s Daily Bulletin. The July 30,  July 28, and Aug. 4 editions are most recent. Others can be found on the Mnet.

*New* Anderson Comments on Superspreaders

Mark Anderson, MD, Medical Director of Specialty Care and Director of Infection Control, was featured in a NewsChannel story about superspreaders. Read More

*New* Georgia Governor Extends Public Health State of Emergency

Governor Brian Kemp signed two executive orders extending the Public Health State of Emergency and existing COVID-19 safety measures. The current public health state of emergency was set to expire Aug. 10 and this executive order extends the State of Emergency to Sept. 10. The Public Health State of Emergency allows for enhanced coordination across government and the private sector for supply procurement, comprehensive testing, and health care capacity.

*New* AHA, AMA and ANA Release Public Service Announcement

Together, the American Hospital Association (AHA), the American Medical Association (AMA), and American Nurses Association (ANA) released a public service announcement (PSA) on Friday urging the American public to take three simple steps to help stop the spread of COVID-19: wear a mask, practice physical distancing and wash hands frequently. The PSA is the first element of a comprehensive campaign to increase public acceptance of these essential actions and builds on the groups’ open letter to the public released last month. Watch the PSA

*New* Article from physician e-news: Covid-19: ED Visits Declined in Early Months of Pandemic 8/3/2020 - By Scott Harris Contributing Writer BreakingMED™

Emergency department (ED) visits declined considerably in the early phases of the Covid-19 pandemic—and as a result, according to authors of a recent study, clinicians should make a concerted effort to encourage patients to visit the ED for serious illnesses and other conditions when needed, despite the ongoing pandemic.

"As the Covid-19 pandemic developed and intensified in the U.S. during the first 4 months of 2020, we found that ED visit counts decreased and the rates of hospital admissions from the ED increased in 5 health care systems in 5 states," wrote study first author Molly Jeffery, PhD, of the emergency medicine department at the Mayo Clinic in Minnesota, and colleagues, in JAMA Internal Medicine. "From their height in January to their lowest point in April, ED visits decreased by more than 40% in all the health care systems and by more than 60% in New York, where the pandemic was most severe."

In the pandemic’s infancy, experts recommended hospitals and patients reduce non-essential care to reduce transmission of the virus. Previous reports had shown evidence of declines, with reductions potentially spurred by patients failing to seek emergency care even under life-threatening (and non-Covid-related) circumstances.

The cross-sectional study from Jeffery and colleagues examined daily ED visit and hospitalization rates from January 1 to April 30. The data were gathered from 24 EDs in 5 large health care systems in Colorado (n=4), Connecticut (n=5), Massachusetts (n=5), New York (n=5), and North Carolina (n=5). Before the pandemic, average annual ED volume ranged from 13,000 to 115,000 visits per year.

Jeffery and colleagues unearthed major ED decreases across all 5 systems, with steeper declines beginning the week of March 11—a week when Covid-19 cases accelerated considerably around the country. In descending order, rates of decrease in ED use among systems in the study were 63.5% in New York, 57.4% in Massachusetts, 48.9% in Connecticut, 46.5% in North Carolina, and 41.5% in Colorado.

What’s more, rates of hospital admission from the ED held steady until local Covid-19 case rates began to climb, with admission rates increasing by 149% in New York, 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22% in North Carolina.

Although the study covered January and February—a time before the coronavirus spiked in earnest in the United States—the biggest ED declines in the study clearly occurred after Covid-19 gained higher levels of local, national, and global prominence.

"The weeks with the most rapid rates of decrease in visits were in March 2020, which corresponded with national public health messaging about Covid-19," Jeffery and colleagues observed. "Rates of hospital admission from the ED were stable until Covid-19 cases increased locally, suggesting lower patient volume and higher acuity in the ED as the Covid-19 pandemic spread…A possible explanation for these temporal associations is that the public responded more to national-level risk messaging about Covid-19 than to changes in the local situation with regard to reported cases."

According to Jeffery and colleagues, limitations in the study included the fact that the findings may not be generalizable outside the health care systems included in the study, and that the data did not capture diagnoses.

In an accompanying editorial, David Schriger, MD, MPH, an emergency physician with University of California, Los Angeles and associate editor of JAMA, but who was not affiliated with the study, wrote that a decrease in ED visits may be the result of not only a change in patient perceptions but a rapid expansion and acceptance of alternate options in anticipation of a potential crush of Covid-19 patients in the ED.

"Even if some sicker patients are not presenting to the ED, this does not mean that they are forgoing medical care altogether," Schriger wrote. "Many hospitals and clinics rapidly instituted better access to practitioners and care coordinators via the telephone or telemedicine, providing patients with alternatives."

Moving forward, Jeffery and colleagues said physicians and care teams should make a concerted effort to ensure patients felt comfortable seeking emergency care when necessary.

"These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the Covid-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings," the study authors wrote.

Schriger suggested the pandemic might ultimately provide a "silver lining" for learning more about ED use patterns and care delivery as a whole.

"At a time of great social discord in the U.S. and when funding priorities for various government functions are being rethought, a potential silver lining of the Covid-19 pandemic is the opportunity to consider how health care resources could be better used, particularly with respect to emergency care," Schriger wrote. "What might we learn from the patients who avoided or deferred ED care and who did not have a condition thought to benefit unambiguously from that care?"

Disclosures:

No source appearing in this report disclosed any relevant financial relationship with industry.

*New* Article from physician e-news: Avoiding Care During the Pandemic Could Mean Life or Death 8/2/2020 - By John McKenna Associate Editor BreakingMED™

These days, Los Angeles acting teacher Deryn Warren balances her pain with her fear. She’s a bladder cancer patient who broke her wrist in November. She still needs physical therapy for her wrist, and she’s months late for a cancer follow-up.

But Warren won’t go near a hospital, even though she says her wrist hurts every day.

"If I go back to the hospital, I’ll get Covid. Hospitals are full of Covid people," says Warren, a former film director and author of the book "How to Make Your Audience Fall in Love With You."

"Doctors say, ’Come back for therapy,’ and my answer is, ’No, thank you.’"

Many, many patients like Warren are shunning hospitals and clinics. The coronavirus has so diminished trust in the U.S. medical system that even people with obstructed bowels, chest pain and stroke symptoms are ignoring danger signs and staying out of the emergency room, with potentially mortal consequences.

study by the Centers for Disease Control and Prevention found that emergency room visits nationwide fell 42% in April, from a mean of 2.1 million a week to 1.2 million, compared with the same period in 2019.

A Harris poll on behalf of the American Heart Association found roughly 1 in 4 adults experiencing a heart attack or stroke would rather stay at home than risk getting infected with the coronavirus at the hospital. These concerns are higher in Black (33%) and Hispanic (41%) populations, said Dr. Mitchell Elkind, president of the American Heart Association and a professor of neurology and epidemiology at Columbia University.

Perhaps even more worrisome is the drastic falloff of routine screening, especially in regions hit hard by the virus. Models created by the medical research company IQVIA predict delayed diagnoses of an estimated 36,000 breast cancers and 19,000 colorectal cancers due to Covid-19’s scrambling of medical care.

At Hoag Memorial Hospital Presbyterian in Newport Beach, California, mammograms have dropped as much as 90% during the pandemic. "When you see only 10% of possible patients, you’re not going to spot that woman with early-stage breast cancer who needs a follow-up biopsy," said Dr. Burton Eisenberg, executive medical director of the Hoag Family Cancer Institute.

Before the epidemic, Eisenberg saw five melanoma patients a week. He hasn’t seen any in the past month. "There’s going to be a lag time before we see the results of all this missed care," he said. "In two or three years, we’re going to see a spike in breast cancer in Orange County, and we’ll know why," he said.

Dr. Farzad Mostashari, former national coordinator for health information technology at the U.S. Department of Health and Human Services, agreed. "There will be consequences for deferring chronic disease management," he said.

"Patients with untreated high blood pressure, heart and lung and kidney diseases are all likely to experience a slow deterioration. Missed mammograms, people keeping up with blood pressure control — there’s no question this will all cause problems."

In addition to fear? Changes in the health care system have prevented some from getting needed care.

Many medical offices have remained closed during the pandemic, delaying timely patient testing and treatment. Other sick patients lost their company-sponsored health insurance during virus-related job layoffs and are reluctant to seek care, according to a study by the Urban Institute.

study by the American Cancer Society’s Cancer Action Network found that 79% of cancer patients in treatment had experienced delays in care, including 17% who saw delays in chemotherapy or radiation therapy.

"Many screening facilities were shuttered, while people were afraid to go to the ones that were open for fear of contracting Covid," said Dr. William Cance, chief medical and scientific officer for the American Cancer Society.

And then there are patients who have fallen through the cracks because of the medical system’s fixation on Covid-19.

Dimitri Timm, a 43-year-old loan officer from Watsonville, California, began feeling stomach pain in mid-June. He called his doctor, who suspected the coronavirus and directed Timm to an urgent care facility that handled suspected Covid patients.

But that office was closed for the day. When he was finally examined the following afternoon, Timm learned his appendix had burst. "If my burst appendix had become septic, I could have died," he said.

The degree to which non-Covid patients are falling through the cracks may vary by region. Doctors in Northern California, whose hospitals haven’t yet seen an overwhelming surge of Covid-19 cases, have continued to see other patients, said Dr. Robert Harrington, chairman of the Stanford University Department of Medicine and outgoing president of the American Heart Association. Non-Covid issues were more likely to have been missed in, say, New York during the April wave, he said.

The American College of Cardiology and American Heart Association have launched campaigns to get patients to seek urgent care and continue routine appointments.

The impact of delayed care might be felt this winter if a renewed crush of Covid-19 cases collides with flu season, overwhelming the system in what CDC Director Robert Redfield has predicted will be "one of the most difficult times that we’ve experienced in American public health."

The health care system’s ability to handle it all is "going to be tested," said Anthony Wright, executive director of Health Access California, an advocacy group.

But some patients who stay at home may actually be avoiding doctors because they don’t need care. Yale University cardiologist and researcher Dr. Harlan Krumholz believes the pandemic could be reducing stress for some heart patients, thus reducing heart attacks and strokes.

"After the nation shut down, the air was cleaner, the roads were less trafficked. And so, paradoxically, people say they were experiencing less stress in the pandemic, not more," said Krumholz, who wrote an April op-ed in The New York Times headlined "Where Have All the Heart Attacks Gone?" "While sheltering in place, they were eating healthier, changing lifestyles and bad behaviors," he said.

At least some medical experts agree.

"The shutdown may have provided a sabbatical for our bad habits," said Dr. Jeremy Faust, a physician in the division of health policy and public health at Boston’s Brigham and Women’s Hospital. "We’re making so many changes to our lives, and that includes heart patients. If you go to a restaurant three times a week or more, do you realize how much butter you’re eating?"

While some patients may be benefiting from a Covid-19 change of regimen, many people have urgent and undeniable medical needs. And some are pressing through their fear of the virus to seek care, after balancing the risks and benefits.

In March, when the virus took hold, Kate Stuhr-Mack was undergoing a clinical trial at Hoag for her stage 4 ovarian cancer, which had recurred after a nine-month relapse.

Members of her online support group considered staying away from the facility, afraid of contracting the virus. But Stuhr-Mack, 69, a child psychologist, had no choice: To stay in the trial, she had to keep her regular outpatient chemotherapy appointments.

"We all make choices, so you have to be philosophical," she said. "And I thought it was far more risky not to get my cancer treatment than face the off-chance I’d contract Covid on some elevator."

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

*New* Article from physician e-news: Covid-19 Outbreak Among Georgia Campers Does Not Augur Well for School Openings 8/2/2020 - By Candace Hoffmann Managing Editor BreakingMED™

A report published in the CDC’s Morbidity and Mortality Weekly Report, which found that SARS-CoV-2 easily spread among attendees at a Georgia youth camp, may not augur well for school re-openings this fall.

"The overall attack rate was 44% (260 of 597), 51% among those aged 6–10 years, 44% among those aged 11–17 years, and 33% among those aged 18–21 years," Christina M. Szablewski, DVM, from the Georgia Department of Public Health, and colleagues reported.

There were 597 attendees in all, and the campers’ ages ranged from 6-19 years, with a median of 12 years. More than half of the attendees were female. Staff members were ages 14-59, with a median age of 17 years, and more than half of the staff were female. Of the test results available for 344 campers — 76% were positive for Covid-19, and the attack rate increased the longer people stayed at the camp, with staff members having the highest attack rate (56%).

While the camp implemented most of the CDC’s recommendations for Youth and Summer Camps to prevent or lessen the spread of Covid-19, it did not require cloth masks for camper or increasing ventilation in buildings by opening doors and windows. Masks were required for all staff members. However, being camp, attendees did engage in indoor and outdoor activities, including singing and cheering.

The researchers also noted: "During June 21–27, occupancy of the 31 cabins averaged 15 persons per cabin (range = 1–26); median cabin attack rate was 50% (range = 22%–70%) among 28 cabins that had one or more cases. Among 136 cases with available symptom data, 36 (26%) patients reported no symptoms; among 100 (74%) who reported symptoms, those most commonly reported were subjective or documented fever (65%), headache (61%), and sore throat (46%)."

The study authors did report three limitations to their findings:

  • The attack rates may be underestimated, as some people may not have been tested, or test results may not have been reported.
  • Some transmission may have occurred before or after camp attendance.
  • Adherence to prevention measures by individuals was not possible to assess between and within cabins, and masks were not required of the campers.

Nonetheless, with the U.S. teetering on school openings, this report adds to a growing body of literature regarding what is known and not known about Covid-19 transmission.

"Asymptomatic infection was common and potentially contributed to undetected transmission… This investigation adds to the body of evidence demonstrating that children of all ages are susceptible to SARS-CoV-2 infection and, contrary to early reports, might play an important role in transmission. The multiple measures adopted by the camp were not sufficient to prevent an outbreak in the context of substantial community transmission," Szablewski and colleague warned.

*New* Article from physician e-news: Covid-19: Obesity Ups Risk of Intubation, Death in Adults 65 or Younger 7/31/2020 - By Candace Hoffmann Managing Editor BreakingMED™

Obesity is associated with an increased risk of death or intubation in patients younger than age 65 who contract Covid-19, according to a retrospective cohort study published in the Annals of Internal Medicine.

This association was independent of age, sex, race/ethnicity, and comorbid conditions, Michaela R. Anderson, MD, MS, of Columbia University Irving Medical Center, in New York, and colleagues reported. They did note that the associations varied by age.

"Obesity was strongly associated with intubation or death among adults younger than 65 years, but not among those aged 65 years or older," Anderson and colleagues noted. "Our findings provide evidence to support recommendations from the Centers for Disease Control and Prevention in the United States and the National Health Service in the United Kingdom, which state that patients with a BMI of 40 kg/m2 or greater are at high risk for poor outcomes from Covid-19 and should therefore consider prolonged social distancing. As the United States and other countries begin to lift stay-at-home orders, these findings might inform discussions between health care providers and patients regarding advanced care planning and benefits of prolonged social distancing, particularly for younger adults with class 2 or 3 obesity."

Obesity is implicated as a risk factor for many diseases — cardiovascular disease, diabetes, cancer, osteoarthritis, and others, including, as the study authors point out, for pneumonia and acute respiratory distress syndrome. In their study, they wanted to find out the role obesity plays in Covid-19 and whether it is associated with intubation or death, inflammation, cardiac injury, or fibrinolysis.

The study included 2,466 hospitalized adults "laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection over a 45-day period with at least 47 days of in-hospital observation."

The cohort of patients had a median age of 67 years, 49% were Hispanic, and 58% were male. The median BMI was 29.7kg/m(IQR, 24.3 to 32.6 kg/m2), more than half of the patients had hypertension, and less than half (40%) had diabetes. The median number of comorbid conditions was two.

"Compared with all other BMI classes, patients with class 2 or 3 obesity (BMI >35 kg/m2) were younger, less likely to be male, more likely to be Black non-Hispanic, and less likely to have chronic kidney disease or a history of smoking," Anderson and colleagues wrote. "Patients with BMI less than 18.5 kg/m2 or greater than 35 kg/m2 were more likely than those in other BMI classes to have asthma, chronic obstructive pulmonary disease, or pulmonary heart disease."

Along with measuring BMI, the researchers also looked at other inflammation biomarkers on admission — C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), cardiac injury (troponin level), and fibrinolysis (D-dimer level)."

A composite of intubation or death was the primary endpoint of the trial.

"Over a median hospital length of stay of 7 days (interquartile range, 3 to 14) days, 533 patients (22%) were intubated, 627 (25%) died, and 59 (2%) remained hospitalized," the study authors wrote. "Compared with overweight patients, patients with obesity had higher risk for intubation or death, with the highest risk among those with class 3 obesity (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]). This association was primarily observed among patients younger than 65 years and not in older patients (P for interaction by age = 0.042). Body mass index was not associated with admission levels of biomarkers of inflammation, cardiac injury, or fibrinolysis."

Anderson and colleagues noted that their study adds to the current literature in its demonstration that obesity’s effect on outcomes in Covid-19 differs by age. They also noted that their findings are consistent with others in the literature showing an association between obesity and "bacterial and viral pneumonia, intensive care unit admissions for H1N1 influenza, and ARDS."

"In contrast to prior studies that demonstrate an association between obesity and lower mortality in critically ill patients with pneumonia and ARDS, known as the ’obesity paradox’, we found that obesity was associated with an increased risk for death among mechanically ventilated patients with Covid-19," Anderson and colleagues wrote. "We found that obesity is associated with intubation or death independent of several comorbid conditions, including diabetes and hypertension, which have been associated with adverse outcomes in Covid-19."

As to why they did not find the association between intubation and death in older adults, they noted that "may reflect a high mortality due to comorbidity, frailty, or worse immune function with older age, which can all occur independently of BMI. "

Among the limitations of the study were that data on BMI was missing for 28% of the patients, because of the way BMI was recorded, there may have been selection bias, and they were unable to determine if respiratory management differed between underweight or obese patients "including the likelihood of ’do not intubate’ or ’do not resuscitate’ orders." Anderson and colleagues also noted that the follow-up was short. Another limitation the authors noted, was likely due to the overwhelming number of patients during the study period, and while comorbidities were culled from the electronic medical record, the record might have been incomplete.

Disclosures:

This study was supported by grants from the NIH, the Stony-World Herbert Foundation, and the Parker B. Francis Foundation

*Reminder* New CDC Guidance & Antibody Testing

Matt Kodsi, MD, Vice President of Medical Affairs, sits down with Mark Anderson, MD, Medical Director of Specialty Care and Director of Infection Control, to discuss new guidance from the CDC and antibody testing. If you have questions you would like answered in the next video, please email COVID@memorial.orgWatch

*Reminder* PPE Supply Guide Alert

CHI Memorial has tracked its supply of PPE in real time, since the beginning of the COVID-19 pandemic, and measures par levels against documented usage.  This Guide is a confidential internal document and is not to be emailed or shared outside our organization.  Our intent is to make certain that all employees are informed on the exact product that will be stocked by type. Click here to review CHI Memorial’s PPE Supply Guide Alert from July 29.

*Reminder* Reporting When Sick

Employees must call Employee Health when sick.  We advise against getting a rapid COVID-19 test on your own as you will be required to repeat the test as it is ordered by Employee Health.

*Reminder* Antibody Test Does Not Exempt You from Wearing PPE

Many employees are seeking COVID-19 antibody tests on their own to determine if they have had an exposure and were asymptomatic.  Should you have a test and it is positive for COVID-19 antibodies, it does not exempt you from wearing appropriate PPE.  You must follow all protocols and standards for PPE.

As a reminder to all, make certain that patients and family members are wearing masks prior to entering a room.  Should you have a patient that is not capable of keeping a mask on, you will wear your N95 with a loop mask over, even if the patient is not a COVID-19 positive or PUI patient.  We must take adequate precautions in every instance.

*Reminder* Need Hours? Labor Pool Has Openings

There are empty slots available on all campuses. If you can cover a shift at Hixson or Glenwood, please call 495-2294 and for Georgia call 706-858-2761.

Fear less, hope more; eat less, chew more; whine less, breathe more; talk less, say more; hate less, love more; and all good things are yours. - Swedish Proverb

Please read the latest CHI Memorial COVID-19 updates, below.

Current COVID-19 Status:

  • Johns Hopkins Global Coronavirus Tracker: 17,116,702 confirmed; 10,002,167 recovered; 669,055 deaths. In the United States, 53,825,445 have been tested; 4,472,963 are confirmed; 1,389,425 have recovered. The United States has a population of 328.2 million people. 7/30/20, 3:30 p.m.) 
  • 102,871 confirmed cases in Tennessee; 64,234 recovered; 1,033 deaths. Tennessee Department of Health (TDH). 7/30/20  
    • 5,360 confirmed cases in Hamilton County, 3,857 recovered, 47 deaths; 656 cases/634 recovered/1 death in Bledsoe County; 1,593 cases/1,080 recovered/10 deaths in Bradley County; 94 cases/64 recovered/2 deaths in Grundy County; 190 cases/106 recovered/4 deaths Marion County; 452 cases/296 recovered/20 deaths in McMinn County; 87 confirmed/40 recovered in Meigs County; 466 cases/350 recovered/1 death in Rhea County; 89 cases/55 recovered in Sequatchie County
  • 182,286 confirmed cases in Georgia; 3,671 deaths. 7/30/20 Georgia Department of Public Health (DPH)
    • 513 cases in Catoosa County, 9 deaths; 521 in Walker, 14 deaths; 105 cases, 1 death in Dade; 2,961 cases, 24 deaths in Whitfield County; 958 cases, 23 deaths in Gordon County.
  • 4,405,932 confirmed cases in the U.S.; 150,283 deaths; 55 jurisdictions (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) 37 jurisdictions report more than 10,000 cases of COVID-19. CDC 7/30/20

CHI Memorial COVID-19 Response

Visit the resource bank on Mnet for all current COVID-19 information. 

Key Actions and Updates

*New* New CDC Guidance & Antibody Testing

Matt Kodsi, MD, Vice President of Medical Affairs, sits down with Mark Anderson, MD, Medical Director of Specialty Care and Director of Infection Control, to discuss new guidance from the CDC and antibody testing. If you have questions you would like answered in the next video, please email COVID@memorial.org. Watch

*New* CommonSpirit Health COVID-19 Bulletin

Important information about the ministry's response to COVID-19 is published in CommonSpirit Health's Daily Bulletin. The July 28 and July 27 editions are most recent. Others can be found on the Mnet

*NewPPE Supply Guide Alert

CHI Memorial has tracked its supply of PPE in real time, since the beginning of the COVID-19 pandemic, and measures par levels against documented usage.  This Guide is a confidential internal document and is not to be emailed or shared outside our organization.  Our intent is to make certain that all employees are informed on the exact product that will be stocked by type. Click here to review CHI Memorial's PPE Supply Guide Alert from July 29.

*New* Article from physician e-news: Covid-19: As Moderna Heads to Phase III Trial, Vaccine Shows Robust Results in Primates 7/28/2020 - By Candace Hoffmann Managing Editor BreakingMED™ 

Moderna announced that it is moving into phase III human trials of its Covid-19 vaccine candidate mRNA-1273 with a booster shot of funding from the U.S. government, which allocated another $472 million to its efforts.

The phase III trial, dubbed the coronavirus efficacy (COVE) study, will test the vaccine in 30,000 participants at 100 research sites. The trial is a collaboration between the National Institute of Allergy and Infectious Diseases (NIAID) and the U.S. Biomedical Advanced Research and Development Authority (BARDA).

The company also boasted robust results of tests of the vaccine in the New England Journal of Medicine, where the NIAID team tested mRNA-1273 in primates. 

"This important preclinical study shows that mRNA-1273 protected against a high dose SARS-CoV-2 infection in non-human primates and prevented pulmonary disease in all animals, further supporting the clinical advancement of mRNA-1273," said Stephen Hoge, MD, President at Moderna, in a statement. "We believe this is the first demonstration of control of viral replication within two days of challenge in both the nose and lungs in non-human primates by a vaccine against COVID-19. Given the similarity between the protective immune response generated by mRNA-1273 in this study and the immune response seen in humans in the recently published Phase 1 clinical data for the vaccine, we remain cautiously optimistic that mRNA-1273 will be able to prevent Covid-19 disease and may also slow the spread of SARS-CoV-2 by shortening the duration of shedding."

In the primate study, the participants were given 10 or 100 µg of mRNA-1273 vaccine, which is a vaccine encoding the prefusion-stabilized spike protein of SARS-CoV-2, and these primates were compared to primates who received placebo. The primates were Indian-origin rhesus macaques (age 3-6 years) and there were 12 male and 12 female who were stratified into one of the three study arms.

They were assessed for antibody and T-cell responses before being challenged with SARS-CoV-2, the virus that causes Covid-19.

They found that the vaccine candidate induced:

  • Levels of antibody that were greater than those seen in human-convalescent serum, "with live-virus reciprocal 50% inhibitory dilution (ID50) geometric mean titers of 501 in the 10-μg dose group and 3481 in the 100-μg dose group."
  • Type 1 helper T-cell (Th1)–biased CD4 T-cell responses and low or undetectable Th2 or CD8 T-cell responses.

"Viral replication was not detectable in BAL fluid by day 2 after challenge in seven of eight animals in both vaccinated groups," the research team reported. "No viral replication was detectable in the nose of any of the eight animals in the 100-μg dose group by day 2 after challenge, and limited inflammation or detectable viral genome or antigen was noted in lungs of animals in either vaccine group."

The study was funded by "Intramural Research Program of the Vaccine Research Center (VRC), NIAID, NIH, and the Office of the Assistant Secretary for Preparedness and Response, BARDA, Department of Health and Human Services (contract 75A50120C00034). "

*New* Article from physician e-news: Public Health Experts Fear a Hasty FDA Signoff on Vaccine 7/29/2020  - By Arthur Allen Kaiser Health News

The vaccine trial that Vice President Mike Pence kicked off in Miami on Monday gives the United States the tiniest chance of being ready to vaccinate millions of Americans just before Election Day.

It's a possibility that fills many public health experts with dread.

Among their concerns: Early evidence that any vaccine works would lead to political pressure from the administration for emergency approval by the Food and Drug Administration. That conflict between science and politics might cause some people to not trust the vaccine and refuse to take it, which would undermine the global campaign to stop the pandemic. Or it could lead to a product that is not fully protective. Confidence in routine childhood vaccinations, already shaken, could decline further.

"The fear is that you wind up doing to a vaccine what [Trump has] already done with [opening] school," said Dr. Joshua Sharfstein, a former FDA deputy commissioner and a professor at Johns Hopkins University in Baltimore. "Take an important, difficult question and politicize it. That's what you want to avoid."

On Monday at 6:45 a.m., the first volunteer in the landmark phase 3 trial for the Moderna Therapeutics vaccine received a shot at a clinic in Savannah, Georgia. Clinicians at 88 other sites, stretching from Miami to Seattle, were also preparing to deliver the experimental shot in a trial that aims to enroll 30,000 people.

Dr. Anthony Fauci, the country's leading infectious disease expert, told reporters he hoped 15,000 could be vaccinated by the end of the week, although he provided no information about progress toward that goal. All volunteers would receive a second shot 29 days after their first inoculation. (Half will receive a placebo containing saline solution.)

Another vaccine, produced by Pfizer with the German company BioNTech, also entered a large phase 3 U.S. trial this week. It's being tested independently of the National Institutes of Health, which is partially funding the Moderna trial as well as tests for an Oxford University/AstraZeneca vaccine trial, and others in the future. AstraZeneca has said some doses of its vaccine might be ready as early as September.

Fauci said he expects the Moderna trial to provide an answer about whether that vaccine works by the end of the year — and it's "conceivable" an answer could come in October. "I doubt that, but we are leaving an open mind that it is a possibility."

Such a fast pace worries some experts.

"I don't see how that's remotely possible unless the thing I most fear happens, a truncated phase 3 trial with just an idea of efficacy, an idea of common side effects, and then it rolls out," said Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia.

Pence downplayed such fears Monday, telling reporters: "There will be no shortcuts. There will be no cutting corners."

Officials are pressing for an open and transparent process.

Rep. Raja Krishnamoorthi (D-Ill.), chairman of the House Oversight and Reform Subcommittee on Economic and Consumer Policy, is preparing to release a bill requiring the FDA to have an expert panel review any Covid vaccine and issue a recommendation before FDA Commissioner Stephen Hahn makes a decision.

With past vaccines, the FDA has generally relied on such a committee, made up mostly of vaccine experts and appointed by the FDA commissioner. They typically conduct a painstaking examination of all evidence before voting on whether the FDA should approve a vaccine. The commissioner has rarely, if ever, gone against the committee's decisions.

Hahn undercut confidence in the FDA's independence earlier in the year, many observers felt, when he issued an Emergency Authorization Use declaration for hydroxychloroquine, a drug used to treat malaria that President Donald Trump and members of his administration have continued to tout, erroneously, as a cure for Covid-19. The FDA later revoked the authorization, which was made without consulting an independent committee.

"FDA's independence has been threatened, no question, by the hydroxychloroquine issue," said Dr. Jesse Goodman, a Georgetown University professor who led the FDA's biologics division and later was chief scientific officer.

The agency must give outside scientists and the public the opportunity to see the data and the FDA's reasoning before coming to such a decision, he said.

Concerns about political interference arose recently when Trump talked excitedly about a vaccine, and Treasury Secretary Steven Mnuchin confidently told reporters there would be a vaccine by the end of the year for emergency use.

To be sure, it's unlikely the FDA would be tempted to issue an emergency release without data that showed a vaccine was working and not causing serious side effects.

The massive coronavirus outbreaks in Texas and other hard-hit areas where the Moderna vaccine is being tested should provide an answer, although exactly when is an open question.

In theory, scientists might get a handle on a vaccine's efficacy before all 30,000 people are enrolled, vaccinated and studied.

In fact, an answer could become clear after only 150 to 160 cases of disease are reported among the trial participants, Fauci said. If roughly two-thirds of those cases occurred in non-vaccinated people, it would show statisticians that the vaccine had above-60% efficacy, he said.

If the vaccine is 80% to 90% effective and the annual rate of infection in the places where it's being tested is above 4%, scientists could get a signal of efficacy in such a trial with just 50 cases, or in as little as three months, said Ira Longini, a University of Florida biostatistician who designs vaccine trials.

The Moderna vaccine trial would hit that three-month threshold on Oct. 27.

The trial's fate is partly in the hands of its 30-member Data and Safety Monitoring Board, whose members can see unblinded data about the participants in real time — pinpointing who was vaccinated with the actual vaccine and got sick, for example. The board will alert the NIH and vaccine maker if it sees surprising data — either dangerous side effects or powerful efficacy. Some fear that if the vaccine seems to work in an early review, the FDA would be pressured to stop the trial.

Offit said NIH should not accept anything less than a completed trial of 30,000 people. Fifty cases "is a very small number" to use as evidence for releasing a vaccine that could be administered to tens of millions, he said.

The public might clamor for the release of any vaccine that seemed to work. Moderna said it has already begun producing millions of doses of vaccine "at risk," banking on the vaccine's success. The FDA could release those under powers provided when the country declared a public health emergency in March.

With more than half the country deeply mistrustful of Trump, according to recent polls, any federal decision could be resisted and lead to widespread rejection of even a promising vaccine. Sharfstein worries about a "knee-jerk" reaction against the vaccine by Democrats if Trump touts it before the election.

Experts also worry about releasing a vaccine that shows some positive effects but isn't robustly protective. A slide presented by FDA deputy director Philip Krause at the World Health Organization earlier this month said a weak vaccine could fail to protect the public adequately, leading to a false sense of security in those who've received it, while making it harder to test future vaccines.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

*New* Article from physician e-news: Covid-19: Closing U.S. Schools Resulted in 1.37 Million Fewer Cases Over 26-Days 7/29/2020  - By Salynn Boyles Contributing Writer BreakingMED™

School closures in the United States last Spring were associated with significant declines in Covid-19 incidence and death from the disease, according to a population-based time series analysis of data from all 50 states.

Between March 9 and May 7, school closure was associated with a −62% relative change in Covid-19 incidence per week, corresponding to a reduction in an estimated 424 cases per 100,000.

Modeling based on the analysis estimated that school closures may have been associated with 1.37 million fewer cases of Covid-19 nationwide over a 26-day period and 40,600 fewer deaths over a 16-day period during the Spring.

States that closed schools earliest saw the largest relative reductions in overall Covid-19 incidence and mortality.

The study findings were published online July 29 in JAMA, as state and local officials continue to wrestle with the question of whether their school systems can safely reopen in the coming weeks.

The Trump administration has pressed for full reopening of the nation's schools in the Fall, with the president only recently acknowledging that some schools in Covid-19 hot spots may need to delay on-site classes. On Tuesday, one of the country's largest teachers unions authorized its members to strike due to unsafe working conditions if adequate Covid-19 prevention safeguards are not put in place before schools reopen.

The 1.7-million member American Federation of Teachers (AFT) reportedly called for classes to remain remote only in areas where SARS-CoV-2 transmission rates remain above 1% and average daily test positivity rates remain above 5%.

As of Wednesday, 21 states were identified as Covid-19 "red zone" states by federal officials, meaning that new cases were above 100 per 100,000 population during the previous week.

The National Academies of Sciences, Engineering, and Medicine (NASEM) recently weighed in on school reopening in a report calling on school officials to prioritize reopening schools full time, especially for younger children (grades K-5) and those with special needs. NASEM officials also called for federal and state funding to ensure that schools have adequate resources to keep children and adults safe.

While the writing committee noted that less than 5% of reported cases of Covid-19 have occurred among children younger than 18 years, they concluded that the evidence remains insufficient "to determine how easily children and youth contract the virus and how contagious they are once they do."

"These myriad decisions facing education leaders and state and local policy makers are made more difficult by gaps in the evidence base related to Covid-19," NASEM writing committee member Kenne A. Dibner, PhD, and colleagues, wrote in JAMA.

"Currently there is no scientific consensus on the role of children in transmitting Covid-19 either to one another or to adults. Better evidence on this point would offer much needed guidance for decision makers," they wrote.

Dibner and colleagues argued that gaining a better understanding of the impact of reopening schools on Covid-19 transmission must be a research priority in the coming months.

In their newly published analysis, Katherine Auger, MD, of Cincinnati Children's Hospital, and colleagues tracked Covid-19 incidence and death in all 50 states following pandemic-related school closures last Spring, finding that all school systems in the U.S. ceased in-person classes during a 10-day period between March 13 and March 23.

"The cumulative incidence of Covid-19 at the time of school closure ranged from 0 to 14.75 cases per 100,000 population," wrote.

Their population-based time series analysis, conducted between March 9 and May 7, allowed for at least 6 weeks of data collection after school closure in each state. States were examined in quartiles based on state-level Covid-19 incidence per 100,000 residents at the time of school closure. Models were used to derive the estimated absolute differences between schools that closed and schools that remained open and the estimated cases and deaths if states had closed schools when cases were in the lowest versus highest quartile of Covid-19 incidence.

Among the main findings:

  • School closure was associated with a significant decline in the incidence of Covid-19 (adjusted relative change per week, −62%; 95% CI, −71% to −49%) and mortality (adjusted relative change per week, −58%; 95% CI, −68%to −46%).
  • States with the lowest incidence of Covid-19 had a −72% (95% CI, −79% to −62%) relative change in incidence compared with −49% (95% CI, −62%to −33%) for those states with the highest cumulative incidence.
  • In a model derived from this analysis, it was estimated that closing schools when the cumulative incidence of Covid-19 was in the lowest quartile compared with the highest quartile was associated with 128.7 fewer cases per 100,000 population over 26 days and with 1.5 fewer deaths per 100, 000 population over 16 days.

Auger and colleagues wrote that the findings "complement evolving evidence on the role of children in the transmission of SARS-CoV-2."

"Recent studies suggest school closure may have only modest effects on COVID-19 deaths," they wrote. "School closure in this study was associated with a −62% relative change in Covid-19 incidence per week. A decline of 62% was equivalent to 39% of the projected value with schools open. So, per week, the incidence was estimated to have been 39% of what it would have been had schools remained open."

In an accompanying editorial, Julie M. Donohue, PhD, of the University of Pittsburgh, and Elizabeth Miller, MD, PhD, of the University of Pittsburgh School of Medicine, wrote that while the study findings suggest a role for school closures in reducing Covid-19 spread, "school and health officials must balance this with academic, health, and economic consequences."

They wrote that "the harms associated with school closures are profound."

"A key challenge is that these other outcomes are likely more diffuse, accrue over a longer time horizon, may have consequences that last decades, and are more difficult to count than Covid-19 outcomes, including cases, hospitalizations, and deaths, which are measured in real time and are widely reported," they added.

Donahue and Miller wrote that the decision to reopen schools for on-site learning during the fall of 2020 "is among the greatest challenges that the U.S. has faced in generations."

"This decision will have life-long implications for millions of children and their families. In many parts of the country this has become a contentious issue, with children, their families and teachers expressing strong opinions about what is best for them," they wrote. There has rarely been a more important time for open discussion and collaboration with a goal of reaching consensus on reopening schools, while protecting the health and well-being of students and educators during the Covid-19 pandemic."

Disclosures:

Funding for the study by Auger et al. was provided by Agency for Healthcare Research and the National Center for Advancing Translational Sciences, National Institutes of Health.

Funding for the NASEM report was provided by the Brady Education Foundation and the Spencer Foundation.

All researchers and the editorial writers reported no relevant relationships with industry related to the submitted work. 

*Reminder* Reporting When Sick

Employees must call Employee Health when sick.  We advise against getting a rapid COVID-19 test on your own as you will be required to repeat the test as it is ordered by Employee Health. 

*Reminder* Antibody Test Does Not Exempt You from Wearing PPE

Many employees are seeking COVID-19 antibody tests on their own to determine if they have had an exposure and were asymptomatic.  Should you have a test and it is positive for COVID-19 antibodies, it does not exempt you from wearing appropriate PPE.  You must follow all protocols and standards for PPE. 

As a reminder to all, make certain that patients and family members are wearing masks prior to entering a room.  Should you have a patient that is not capable of keeping a mask on, you will wear your N95 with a loop mask over, even if the patient is not a COVID-19 positive or PUI patient.  We must take adequate precautions in every instance. 

*Reminder* Mask Hygiene

Carlos Baleeiro, MD, Pulmonologist with CHI Memorial Buz Standefer Lung Center shared the following mask hygiene information with physicians.

As physicians, we understand the importance of wearing a mask to help prevent the spread of COVID 19. Yet there is a seemingly endless thread of conflicting information about the need for wearing a mask as well as unsupported claims on social media that masks contribute to – rather than protect against – the spread of infection. One recent anonymous Facebook post asserted that a healthy 19-year-old developed a lung infection as a result of wearing a mask. Viral posts like these reinforce a negative perception, particularly in those who already find masks uncomfortable or stressful. 

To those who are opposed to wearing a mask, these stories feed into their preferred narrative and provide excuses to skip it. There is no evidence that wearing a mask is harmful to healthcare workers or to those who need to wear a mask for long periods. It is important to share both the reasons for face coverings with patients as well as the steps they need to follow to keep masks clean and safe. 

Q: How should you communicate to patients the importance of wearing a mask in stopping the spread of COVID 19?

A: Most of my patients have chronic lung problems which make them more vulnerable and therefore at higher risk for contracting COVID 19. There's not a switch that flips instantaneously when a person becomes contagious, and very early in the course of the disease it is easy to spread the infection without knowing it. 

Wearing a mask serves two purposes – protecting yourself and others, particularly in the event you're getting sick and aren't yet aware of it. When a person with COVID 19 is wearing a mask, their risk of transmission to another person wearing a mask is about 1.5%. Those who develop the disease and that experience symptoms may not recognize those immediately, especially if they already suffer from conditions like a chronic cough or seasonal allergies. 

Cloth masks aren't perfect, and they aren't appropriate for a high exposure setting like at a hospital. But in the grocery store or when you're in a crowd of people, wearing a mask offers protection for the person wearing it while also providing community protection to those who are more vulnerable. 

Q: Who shouldn't wear a mask? 

A: We recognize that prolonged face mask use may be difficult for those who have significant breathing difficulties. However, breathing difficulty alone is not an indication for not wearing a mask. Even individuals who are on oxygen can wear a mask over their nasal canula, with the caution that it may make breathing feel more challenging. Anyone who has physical or neurocognitive limitations who may not be able to put on and take off a mask easily without assistance should not wear a mask. Children under age 2 are also exempt. 

Q: What is proper mask hygiene for those outside of a healthcare setting?

A: A cloth mask should completely cover the nose and mouth. Remove it by the handles or straps, not the front of the mask where your hands may be contaminated. If you touch your face before washing your hands thoroughly, you could inadvertently spread the disease. Cloth masks should be washed after every use on a warm or hot setting. You can also use a diluted bleach solution to disinfect it thoroughly. Any mask that is stained or too loose to fit securely on the face should be replaced. 

When talking with patients it is important to acknowledge the inconvenience of wearing a mask – we all feel that way. Even though masks are required in Hamilton County, it's important for patients to understand why masks are beneficial. In my conversations, I stress that face coverings shave the odds of contracting COVID19. By making small personal sacrifices to decrease the spread, you're also protecting those potentially more vulnerable than yourself.

*Reminder* Need Hours? Labor Pool Has Openings

There are empty slots available on all campuses. If you can cover a shift at Hixson or Glenwood, please call 495-2294 and for Georgia call 706-858-2761.

Though perseverance does not come from our power, yet it comes within our power. – St. Francis de Sales

Please read the latest CHI Memorial COVID-19 updates, below.

Current COVID-19 Status:

  • Johns Hopkins Global Coronavirus Tracker: 16,540,137 confirmed; 9,616,147 recovered; 655,300 deaths. In the United States, 52,252,334 have been tested; 4,309,230 are confirmed; 1,325,804 have recovered. The United States has a population of 328.2 million people. 7/28/20, 3:30 p.m.) 
  • 99,044* confirmed cases in Tennessee; 57,239 recovered; 978 deaths. Tennessee Department of Health (TDH). 7/28/20  *The total COVID-19 case count for Tennessee is 99,044 as of July 28, 2020. TDH has encountered a technical disruption that has delayed the reporting of other data points.
    • 5,203 confirmed cases in Hamilton County, 3,675 recovered, 46 deaths; 649 cases/629 recovered/1 death in Bledsoe County; 1,492 cases/974 recovered/10 deaths in Bradley County; 87 cases/62 recovered/2 deaths in Grundy County; 175 cases/90 recovered/4 deaths Marion County; 460 cases/262 recovered/20 deaths in McMinn County; 81 confirmed/36 recovered in Meigs County; 450 cases/315 recovered/1 death in Rhea County; 83 cases/48 recovered in Sequatchie County
  • 175,052 confirmed cases in Georgia; 3,563 deaths. 7/28/20 Georgia Department of Public Health (DPH)
    • 470 cases in Catoosa County, 8 deaths; 490 in Walker, 14 deaths; 100 cases, 1 death in Dade; 2,812 cases, 24 deaths in Whitfield County; 891 cases, 23 deaths in Gordon County.
  • 80,309 confirmed cases in Alabama; 1,446 deaths. 7/28/20 Alabama Department of Public Health (669 cases, 3 deaths in Jackson County; 1,523 cases, 9 deaths in Dekalb. 
  • 4,280,135 confirmed cases in the U.S.; 147,672 deaths; 55 jurisdictions (50 states, District of Columbia, Puerto Rico, Guam, Northern Marianas, and US Virgin Islands) 37 jurisdictions report more than 10,000 cases of COVID-19. CDC 7/27/20

CHI Memorial COVID-19 Response

Visit the resource bank on Mnet for all current COVID-19 information.

Key Actions and Updates

*New* CommonSpirit Health COVID-19 Bulletin
Important information about the ministry’s response to COVID-19 is published in CommonSpirit Health’s Daily Bulletin. The July 23 is the most recent edition. Others can be found on Mnet COVID-19 page.

*New* Reporting When Sick

Employees must call Employee Health when sick.  We advise against getting a rapid COVID-19 test on your own as you will be required to repeat the test as it is ordered by Employee Health.

*New*  Antibody Test Does Not Exempt You from Wearing PPE

Many employees are seeking COVID-19 antibody tests on their own to determine if they have had an exposure and were asymptomatic.  Should you have a test and it is positive for COVID-19 antibodies, it does not exempt you from wearing appropriate PPE.  You must follow all protocols and standards for PPE.

As a reminder to all, make certain that patients and family members are wearing masks prior to entering a room.  Should you have a patient that is not capable of keeping a mask on, you will wear your N95 with a loop mask over, even if the patient is not a COVID-19 positive or PUI patient.  We must take adequate precautions in every instance.

*New* Mask Hygiene

Carlos Baleeiro, MD, Pulmonologist with CHI Memorial Buz Standefer Lung Center shared the following mask hygiene information with physicians.

 

As physicians, we understand the importance of wearing a mask to help prevent the spread of COVID 19. Yet there is a seemingly endless thread of conflicting information about the need for wearing a mask as well as unsupported claims on social media that masks contribute to – rather than protect against – the spread of infection. One recent anonymous Facebook post asserted that a healthy 19-year-old developed a lung infection as a result of wearing a mask. Viral posts like these reinforce a negative perception, particularly in those who already find masks uncomfortable or stressful.

To those who are opposed to wearing a mask, these stories feed into their preferred narrative and provide excuses to skip it. There is no evidence that wearing a mask is harmful to healthcare workers or to those who need to wear a mask for long periods. It is important to share both the reasons for face coverings with patients as well as the steps they need to follow to keep masks clean and safe.

Q: How should you communicate to patients the importance of wearing a mask in stopping the spread of COVID 19?

A: Most of my patients have chronic lung problems which make them more vulnerable and therefore at higher risk for contracting COVID 19. There’s not a switch that flips instantaneously when a person becomes contagious, and very early in the course of the disease it is easy to spread the infection without knowing it.

Wearing a mask serves two purposes – protecting yourself and others, particularly in the event you’re getting sick and aren’t yet aware of it. When a person with COVID 19 is wearing a mask, their risk of transmission to another person wearing a mask is about 1.5%. Those who develop the disease and that experience symptoms may not recognize those immediately, especially if they already suffer from conditions like a chronic cough or seasonal allergies.

Cloth masks aren’t perfect, and they aren’t appropriate for a high exposure setting like at a hospital. But in the grocery store or when you’re in a crowd of people, wearing a mask offers protection for the person wearing it while also providing community protection to those who are more vulnerable.

Q: Who shouldn’t wear a mask? 

A: We recognize that prolonged face mask use may be difficult for those who have significant breathing difficulties. However, breathing difficulty alone is not an indication for not wearing a mask. Even individuals who are on oxygen can wear a mask over their nasal canula, with the caution that it may make breathing feel more challenging. Anyone who has physical or neurocognitive limitations who may not be able to put on and take off a mask easily without assistance should not wear a mask. Children under age 2 are also exempt.

Q: What is proper mask hygiene for those outside of a healthcare setting?

A: A cloth mask should completely cover the nose and mouth. Remove it by the handles or straps, not the front of the mask where your hands may be contaminated. If you touch your face before washing your hands thoroughly, you could inadvertently spread the disease. Cloth masks should be washed after every use on a warm or hot setting. You can also use a diluted bleach solution to disinfect it thoroughly. Any mask that is stained or too loose to fit securely on the face should be replaced.

When talking with patients it is important to acknowledge the inconvenience of wearing a mask – we all feel that way. Even though masks are required in Hamilton County, it’s important for patients to understand why masks are beneficial. In my conversations, I stress that face coverings shave the odds of contracting COVID19. By making small personal sacrifices to decrease the spread, you’re also protecting those potentially more vulnerable than yourself.

*New* Today’s Article from physician e-news: The Color of Covid: Will Vaccine Trials Reflect America’s Diversity? 7/27/2020  - By JoNel Aleccia Kaiser Health News

When U.S. scientists launch the first large-scale clinical trials for Covid-19 vaccines this summer, Antonio Cisneros wants to make sure people like him are included.

Cisneros, who is 34 and Hispanic, is part of the first wave of an expected 1.5 million volunteers willing to get the shots to help determine whether leading vaccine candidates can thwart the virus that sparked a deadly pandemic.

"If I am asked to participate, I will," said Cisneros, a Los Angeles cinematographer who has signed up for two large vaccine trial registries. "It seems part of our duty."

It will take more than duty, however, to ensure that clinical trials to establish vaccine safety and effectiveness actually include representative numbers of African Americans, Latinos and other racial minorities, as well as older people and those with underlying medical conditions, such as kidney disease.

Black and Latino people have been three times as likely as white people to become infected with Covid-19 and twice as likely to die, according to federal data obtained via a lawsuit by The New York Times. Asian Americans appear to account for fewer cases but have higher rates of death. Eight out of 10 Covid deaths reported in the U.S. have been of people ages 65 and older. And the Centers for Disease Control and Prevention warns that chronic kidney disease is among the top risk factors for serious infection.

Historically, however, those groups have been less likely to be included in clinical trials for disease treatment, despite federal rules requiring minority and elder participation and the ongoing efforts of patient advocates to diversify these crucial medical studies.

In a summer dominated by Covid-19 and protests against racial injustice, there are growing demands that drugmakers and investigators ensure that vaccine trials reflect the entire community.

"If Black people have been the victims of Covid-19, we’re going to be the key to unlocking the mystery of Covid-19," said the Rev. Anthony Evans, president of the National Black Church Initiative, a coalition of 150,000 African American churches.

Evans and his team met in mid-July with officials from Moderna, the Massachusetts biotech firm that launched the first Covid vaccine trial in the U.S., to discuss a collaboration in which NBCI would supply African American participants. But that was less than two weeks before the start of a phase 3 trial expected to enroll 30,000 people, and Evans said the meeting was his idea.

"It’s not that the industry came to me," he said. "I went to the industry."

Blacks make up about 13% of the U.S. population but on average 5% of clinical trial participants, research shows. For Hispanics, trial participation is about 1% on average, though they account for about 18% of the population.

When it comes to trials for drug treatments and vaccines, diversity matters. For reasons not always fully understood, people of different races and ethnicities can respond differently to drugs or therapies, research shows. Immune response wanes with age, so there’s a high-dose flu shot for people 65 and older.

Still, the pressure to produce an effective vaccine quickly during a pandemic could sideline efforts to ensure diversity, said Dr. Kathryn Stephenson, director of the clinical trials unit in the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston.

"One of the questions that has come up is, What do you do if you’re a site investigator and you have 250 people banging on your door — and they’re all white?" she said.

Do you enroll those people, reasoning that the faster the trial progresses, the faster a vaccine will be available for everyone? Or do you turn away people and slow down the study?

"You’re accelerating development of a vaccine, and if you hit a milestone, what is the meaning of that milestone if you don’t know if it’s very safe or effective in [a given] population? Is that really hitting the milestone for everyone?" she said.

Including people who are elderly or have underlying medical conditions is vital to the science of vaccines and other treatments, even if it’s more difficult to recruit patients otherwise healthy enough to participate, advocates said.

"We have to admit that older adults are the ones who are likely to develop side effects" to treatments and vaccines, said Dr. Sharon Inouye, director of the Aging Brain Center and a professor of medicine at Harvard Medical School. "On the other hand, that is the population that will be using it."

People with kidney disease, which affects 1 in 7 U.S. adults, have been left out of clinical research for decades, said Richard Knight, a transplant recipient and president of the American Association of Kidney Patients. Nearly 70% of more than 400 kidney disease patients the organization surveyed in July said they’d never been asked to join a clinical trial.

Excluding from the vaccine trial such a large population vulnerable to Covid doesn’t make sense, Knight contended. "If you’re trying to manage this from a public health standpoint, you want to make sure you’re inoculating your highest-risk populations," he said.

New guidance from the federal Food and Drug Administration, which regulates vaccines, "strongly encourages" the inclusion of diverse populations in clinical vaccine development. That includes racial and ethnic minorities, elderly people and those with underlying medical problems, as well as pregnant women.

But the FDA does not require drugmakers and researchers to meet those goals, and will not refuse trial data that doesn’t comply. And while the federal government is rushing billions of dollars to fast-track more than a half-dozen leading candidates for Covid vaccines, the pharmaceutical firms producing them are not required to publicly disclose their demographic goals.

"This is business as usual," said Marjorie Speers, executive director of Clinical Research Pathways, a nonprofit group in Atlanta that works to increase diversity in research. "It’s very likely these [Covid] trials will not include minorities because there’s not a strong statement to do that."

The vaccine trials are being coordinated through the Covid-19 Prevention Network, or CoVPN, based at the Fred Hutchinson Cancer Research Center in Seattle. It draws on four long-standing federally funded clinical trial networks, including three that target HIV and AIDS.

Those trial networks were chosen in large part because they have rich relationships in Black, Latino and other minority communities, said Stephaun Wallace, director of external relations for CoVPN. The hope is to leverage existing connections based on trust and collaboration.

"Our clinical trial sites are prepped and ready to engage diverse people," Wallace said.

Wallace acknowledged, however, that attracting a diverse population requires investigators to be flexible and innovative. There can be practical problems. Clinic hours may be limited or transportation may be an issue. Older people may have problems with sight or hearing and require extra help to follow protocols.

Distrust of the medical establishment also can be a barrier. African Americans, for instance, have a well-founded wariness of medical experiments after the infamous Tuskegee Study and the exploitation of Henrietta Lacks. That extends to suspicion about recommended vaccines, said Wallace.

"Part of the consideration for many groups is not wanting to feel like a guinea pig or feel like they’re being experimented on," he said.

Moderna, which plans to launch its phase 3 trial Monday, said the company is working to ensure participants "are representative of the communities at highest risk for Covid-19 and of our diverse society."

However, results of the company’s phase 1 trial, released in mid-July, showed that of 45 people included in that safety test, six were Hispanic, two were Black, one was Asian and one was Native American. Forty were white.

Phase 1 and phase 2 clinical trials aim to test the best dose and safety of vaccines in small groups of people. Phase 3 trials assess the efficacy of the drug in tens of thousands of people.

Investigators at nearly 90 sites across the U.S. are preparing now to recruit participants for Moderna’s phase 3 trial. Dr. Carlos del Rio, executive associate dean at the Emory University School of Medicine, will seek 750 volunteers at three Atlanta-area sites. Half will receive the vaccine; half, placebo injections.

Del Rio has had marked success recruiting minorities for HIV trials and expects similar results with the vaccine trial. "We’re trying to do our best to get out to the communities that are most at risk," he said.

Meanwhile, vaccine volunteers like Cisneros just want the advanced trials to start. He signed up for the CoVPN trials. But earlier, he also signed up for 1 Day Sooner, an effort to launch human challenge trials, which aim to speed up vaccine development by deliberately infecting participants with the virus. Such trials can be completed in weeks rather than months but risk exposing volunteers to severe illness or death, and federal officials remain leery.

Cisneros is willing to take that risk to help halt Covid-19, which has killed 143,000 Americans. He said it’s a way to take action at a time when the U.S. government has failed to protect minorities, the elderly and other vulnerable people.

"Government is supposed to help those who can’t protect themselves," he said. "It appears to me the only thing they want to protect is people with money, people with guns — and not brown people like me."

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente

*Reminder* * FAQ with Drs. Anderson and Kodsi

Matt Kodsi, MD, Vice President of Medical Affairs, sits down with Mark Anderson, MD, Medical Director of Specialty Care and Director of Infection Control, for question and answer session on masking. Watch.  If you have questions you would like answered in the next video, please email COVID@memorial.org.

 

*Reminder* A Message from the CEO

On Wednesday, July 22, Janelle Reilly, Market CEO, shared COVID-19 organizational updates. Watch

 

 

*Reminder* Need Hours? Labor Pool Has Openings

There are empty slots available on all campuses. If you can cover a shift at Hixson or Glenwood, please call 495-2294 and for Georgia call 706-858-2761.

The stillness of prayer is the most essential condition for fruitful action. Before all else, the disciple kneels down. – Saint Gianna Beretta Molla.

Expanding access to virtual visits for our physicians, APCs, and patients is one of the most important ways we can respond to the public health crisis caused by COVID-19. It is also a critical way that our communities will seek care in the future.

Over the past few months CHI Memorial’s parent corporation, CommonSpirit Health, rapidly expanded the use and adoption of virtual care throughout the Physician Enterprise. Now, as part of an effort to support best practices for the benefit of the communities we serve, a virtual care website (www.CommonSpiritVirtualCare.org) that is accessible to our independent and network physician community has been launched. 

This website includes a comprehensive set of tools and resources to help independent and network physicians adopt a licensed and HIPAA-compliant Zoom platform. The information and training is presented in multiple learning formats and includes:

  • Interactive and document learning
  • Video training
  • Supplemental resources including AMA quick guide to telemedicine, billing and coding best practices, and more

Visit CommonSpiritVirtualCare.org to learn more. 

Physician e-newsletter

Stay current. Save time. MedNews Plus, a free physician e-newsletter, provides breaking medical news by specialty, plus important CHI Memorial news, with the opportunity for nearly 500 hours of AMA PRA Category 1TM CME credit annually. Courtesy of CHI Memorial. Click the link below to log in or subscribe today.

Subscribers will receive a morning email from CHI Memorial's Chief of Staff, when there is breaking medical news in the specialty(s) to which you subscribe. Subscriptions can be edited at anytime.

Microscope

Microscope, a journal for physicians published by CHI Memorial Marketing and Communications provides information to help physician navigate patients through illness and disease. Click here to read the latest edition.

Previous editions:

microscope magazine April 2019

If you have suggestions for improving this site, please email marketing@memorial.org.


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