echo session: update on covid- 19 in nm & social isolation … · 2020-03-19 · 1190 s. st....
TRANSCRIPT
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
ECHO Session: Update on COVID-19 in NM & Social Isolation Precautions to slow risk of
transmission
Secretaries Kathy Kunkel (Dept. of Health) &
David Scrase, MD (Human Services Dept.)
March 19, 2020
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 at a Glance: Global
Total confirmed new cases, last 24
hours (as of 3/18/20)
Region Cases Deaths
Western Pacific 289 23
Europe 8506 428
Southeast Asia 124 2
Eastern
Mediterranean
330 3
Americas 2,234 18
Africa 42 1
Global 11,525 475
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Source: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200317-sitrep-
57-covid-19.pdf?sfvrsn=a26922f2_4
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 at a Glance: US
• Total cases: 4,226
• Total deaths: 75
• Cases in all 50 states and DC
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 at a Glance: NM
• Cases as of 3/18: 28
• Bernalillo County
• Sandoval County
• Santa Fe County
• Socorro County
• Taos County
• Bookmark DOH COVID-19 website: https://cv.nmhealth.org/
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Flattening the Curve NM Style
• In 1918, Gunnison, CO was one of only a handful of communities worldwide that survived the Spanish Flu epidemic without a single case.
• Flattening the curve of the pandemic is key to ensuring health and safety of New Mexicans.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Flattening the Curve NM Style
StateFirst Date
Case
Public Health
Emergency
Declaration Date
Interval between
First Case and
Declaration (Days)
Washington 1/21/20 2/29/20 39
California 1/26/20 3/4/20 38
Massachusetts 2/1/20 3/10/20 38
Georgia 3/2/20 3/16/20 14
New York 3/1/20 3/7/20 6
Colorado 3/5/20 3/10/20 5
Louisiana 3/9/20 3/11/20 2
Florida 3/1/20 3/1/20 0
Michigan 3/10/20 3/10/20 0
New Mexico 3/11/20 3/11/20 0
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Flattening the Curve NM Style• Governor Lujan Grisham has
taken decisive actions, including:• Declaring health emergency.• Limiting large public gatherings.• Recommending self-isolation for
two weeks after out of state travel and/or COVID-19 exposure.
• Directing large numbers of state employees to work from home.
• Temporarily closing public schools.
• Issuing an order to nursing facilities to prohibit almost all visitors.
• State is preparing for possibility of community spread.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Flattening the Curve NM Style
• Aggressive and evidence-based social distancing interventions slow the spread of the virus in a manner that will NOT overwhelm our healthcare system.
• Mortality rates are much higher when people do not have access to an effective healthcare system.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Flattening the Curve NM StyleSocial distancing includes:
• Encouraging people to stay at
home;
• Avoiding mass gatherings (10+);
• Closing schools, libraries,
museums, and eateries;
• Limiting public transportation; and,
• Quarantining individuals with mild
and asymptomatic COVID-19
infection.
The goal is to prevent people with
asymptomatic infections from
spreading the disease.
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A baseline simulation with case isolation only (red); a simulation with social
distancing in place throughout the epidemic, flattening the curve (green), and
a simulation with more effective social distancing in place for a limited period
only, typically followed by a resurgent epidemic when social distancing is
halted (blue). These are not quantitative predictions but robust qualitative
illustrations for a range of model choices. Source:
https://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(20)30567-5/fulltext
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Flattening the Curve NM Style
We believe NM is one of the safest places to weather COVID-19, because we are ahead of the curve. How you can help:
1. Keep your distance. 2. Buy local. 3. Make an appointment to donate
blood. 4. Help elders. Email ALTSD-
[email protected] with subject: READY TO HELP.
5. Check on vulnerable acquaintances.
6. Buy only what you need; don’t hoard.
7. Donate supplies to shelters. 8. Donate to foodbanks. 9. Practice self care.
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Source:
https://twitter.com/opsargentina/status/123963884919166
1569?s=20
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Questions and Comments
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
ECHO Session: How to obtain necessary COVID-
19 testing for your patient
Secretaries Kathy Kunkel (Dept. of Health) &
David Scrase, MD (Human Services Dept.)
March 19, 2020
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Clinician COVID-19 Information• Clinician information is
available at https://cv.nmhealth.org/clinicians/.
• Guidance re: clinical care, infection control, and PPE.
• Facilities seeking PPE should call 505-231-5506, requesting PPE and/or COVID-19 testing kits.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19: Testing per capita
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 Testing
CountryPopulation (millions)
Number of Tests
Tests per Million
First Case Date
As of Date
US 329 7,695 23 1/21/20 3/11/20
Japan 127 8411 66 1/20/20 3/4/20
UK 67.8 23,513 347 1/31/20 3/8/20
Netherlands 17.1 6,000 350 2/27/20 3/7/20
Israel 8.6 3,451 401 2/21/20 3/8/20
Taiwan 23.8 14,635 615 1/21/20 3/10/20
New Mexico 2.1 1720 618 3/11/20 3/17/20
Italy 60.5 49,937 826 1/31/20 3/8/20
Guangdong, China 113.5 320,000 2820 1/19/20 2/28/20
South Korea 51.3 189,236 3692 1/20/20 3/8/20
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Testing Symptomatic Patients: 4 Steps
1. Perform risk evaluation (COVID-19 contact, travel history, medical history)
2. Conduct clinical evaluation re: testing
3. Acquire sample via nasopharyngeal swab;
4. Conduct COVID-19 testing in reference lab
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Source: https://www.youtube.com/watch?v=ar2Grm_t8X8
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 Testing Criteria Special Populations
• Older adults (age ≥ 65 years),
• Immunocompromised individuals
(e.g. cancer, solid organ transplant,
immunosuppressive drugs, chronic
lung disease, hemodialysis,
advanced HIV)
• Pregnant people
• People who are homeless or live in
congregant settings (e.g. dorms,
shelters, corrections, skilled nursing
facilities, adult family homes).
• CDC Level 3 Travel Advisories:
Europe, China, South Korea, Iran
• US Community Transmission: CA,
Chicago, New York City, Seattle
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 Testing Sites in NM
• EDs and urgent care facilities, including referral-only and open-to-all sites
• Drive-thru sites (commercial and DOH)
• Laboratories (DOH and commercial)
• Will be updated on DOH COVID-19 website, https://cv.nmhealth.org/
Sites to open by ~7 days
Sites currently open
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 Testing: EDs, Urgent Care & Laboratories
Emergency Departments & Urgent Care Centers
• When possible, patients should make initial contact by telephone before arrival.
• Signs posted outside entrance with phone number to call for assistance
• Initial screening and assessment done through the window of the patient’s car
• If more thorough evaluation and treatment is indicated, patient is moved to isolation room
• Can be referred by Primary Care Providers and by self -referral
• COVID-19 testing is obtained only as clinically indicated after assessment
Laboratories
DOH State Lab
• 500-600 tests/day
• Receive overflow from Tricore and vice versa
• Turn around time 1-3 days
Tricore (increased capacity in near future)
• 300 tests/day; turn around time 1-3 days
• Serves UNMH, Presbyterian, Lovelace, others
Quest
• 3,000 tests/day nationwide, 10,000
tests/day by end of week
• Serves IHS and clinical sites in S. NM
• Turn around time 1-2 days
LabCorp
• One test site in North Carolina
• Turn around test 3-4 days
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 Testing: Drive-Thru Sites
Referral Only Sites
• Christus St. Vincent’s (Entrada
Contenta, Santa Fe)
• Sample collection by clinician
referral
• No on-site assessment
• Española Presbyterian Hospital
• COVID-19 testing upon referral
• Add’l screening at test site
even with referral
Open to all Sites
• Patients screened before testing with medical questionnaire and on-site assessment (e.g. symptoms/signs of significant upper respiratory infection)
• COVID-19 test collection as indicated by clinical assessment
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 Testing: Drive-Thru Sites
Commercial
• Lovelace (ABQ) • Closed, but will reopen• 760/day capacity on one day• DOH collaboration in future
• Presbyterian (ABQ)• Online registration; provider • Referral by Provider• Additional screening onsite
• San Juan Regional (Farmington)
• Christus St. Vincent Medical Center (Santa Fe)
• Holy Cross (Taos)
• Gallup Indian Medical Center
DOH Public Health Offices
• Referral from M.D. or DOH needed;
screening via questionnaire
• Available in Roswell, Las Cruces
(partnership with Burrell College),
Socorro, Las Vegas
• Open daily with regular hours
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 Case Study (Fictitious)
Alex (retail worker)
• Alex interacted with a customer, who recently traveled out of the country and was sick and coughing. Customer returned to the store 2 days later.
• Alex started feeling symptoms 2 days later, followed by chills, and lung pains. Later, experienced sore throat, muscle aches, waking up at night, and difficulty breathing.
• Tested negative for influenza.
• Alex is asthmatic.
What would you do?
A. Send Alex to the ER.
B. Have Alex come to your office, wait in vehicle, complete evaluation, and undergo nasopharyngeal swab, sending specimen to reference lab.
C. Send Alex to a Covid-19 testing site.
D. Nothing, instructing Alex to self-isolate for a total of 14 days.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
COVID-19 Case Study (Fictitious)
Kellan (retiree)
• Kellan is 76 years-old and calls your office to report a temperature of 101.0 F.
• He also is experiencing a dry cough as well as mild shortness of breath with activity.
• He returned on a plane from NYC 5 days ago and is self-isolating at home.
• He is unaware of any direct contact with COVID-19 positive individuals, but reported "there sure were a lot of people coughing on the plane.”
What would you do?
A. Send Kellan to the ER.
B. Have Kellan come to your office, wait in vehicle, complete evaluation, and undergo nasopharyngeal swab, sending specimen to reference lab.
C. Send Kellan to a Covid-19 testing site.
D. Nothing, instructing Kellan to self-isolate for a total of 14 days.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Questions and Comments