字幕表 動画を再生する 英語字幕をプリント >> Good afternoon. I'm Commander Ibad Khan And I'm representing the Clinician Outreach and Communication Activity, COCA with the Emergency Risk Communication Branch of the Centers for Disease Control and Prevention. I'd like to welcome you to today's COCA call Coronavirus Disease 2019 COVID-19 Update Information for Long-term Care Facilities. For participants using the Zoom platform to access today's webinar. If you are unable to gain or maintain access, or if you experience technical difficulties, please access the livestream of the webinar on COCA's Facebook page at www.facebook.com/cdcclinicianoutreach andcommunicationactivity. Again, that web address is www.facebook.com/cdcclinician outreachandcommunication activity. The video recording of this COCA call will be available immediately following the live call on COCA's Facebook page at the above address. The video recording will also be posted on COCA's webpage at emergency.cdc.gov/coca a few hours after the call ends. Again, that web address is emergency.cdc.gov/coca. Continuing education is not provided for this COCA call. After the presentation, there will be a Q&A session. You may submit questions at any time during the presentation, through the Zoom webinar system by clicking the Q&A button at the bottom of your screen and then typing your question. If we are unable to ask the presenters your question, please visit CDC's COVID-19 website at www.cdc.gov/covid-19 for more information. You may also email your question to email@example.com. For those who have media questions, please contact CDC media relations at 404 639-3286 or send an email to firstname.lastname@example.org. If you're a patient, please refer your questions to your healthcare provider. Also, please continue to visit emergency.cdc.gov/coca over the next several days as we intend to host COCA calls to keep you informed of the latest guidance and updates on COVID-19. In addition to our webpage, COCA call announcements for upcoming COCA calls will also be sent via email. So please subscribe to email@example.com to receive these notifications. Please share the invitations with your clinical colleagues. For instance, we intend to hold a COCA call this coming Monday, March 23 at 2 PM Eastern. Where the topic will be COVID-19 and guidance on underlying medical conditions. Additional information will be shared via email call announcements and should be posted shortly on the COCA call webpage at emergency.cdc.gov/coca. I would now like to welcome our two presenters to today's COCA call. Our first presenter is Dr. Brendan Jackson, a medical epidemiologist from the COVID-19 response clinical team at CDC. Our second presenter is Lieutenant Commander Kara Jacobs Slifka, a medical officer from the COVID-19 response clinical team. Now, our first presenter, Dr. Jackson, please proceed. >> Thank you and good afternoon. And thanks everyone for joining. So, over the next hour, we'd like to share what we know about preparing for and managing COVID-19 in long-term care settings. And as our country faces this unprecedented pandemic, we know that you're on the frontlines of protecting some of the most vulnerable people in society. So, our goal this afternoon is to summarize the best and most up-to-date information we have available to inform your decisions. I'm going to discuss clinical aspects of COVID-19, relevant to long-term care settings. My colleague Dr. Jacobs Slifka will then discuss how facilities should be preparing, including actions to prevent spread. So, over the next 15 minutes I'm going to cover a brief update on COVID-19, provide an overview on COVID-19 clinical presentation and course, including mortality and risk factors. Focusing specifically on long-term care. And discuss management and treatment. I should point out this next slide is my only slide, so please do not be concerned that the slides do not advance. So, if you could go to the next slide, that would be great. So, onto the brief update on COVID-19 in the US. As you all know, the coronavirus is now spreading in communities in many states. To date, thousands of cases have been reported in the United States, including from nearly every state. Although we know that many cases are probably going undiagnosed. We expect many more cases to occur in the coming days and weeks. Social distancing is now essential to reduce spread and save lives. For life example, the federal government now recommends that everyone avoid social gatherings in groups of more than 10 people and avoid discretionary travel. CDC has more guidance on community mitigation strategies and other topics including clinical management on the CDC website at www.cdc.gov/covid19. Please also consult your local and state health departments for more information. All right, well our experiences with long-term care facilities in Seattle and elsewhere suggests that the virus can spread rapidly in long-term care facilities and have a relatively higher mortality than among the general population. So, first I'm going to talk about recognizing possible COVID-19 to help protect residents and staff. So, in the clinical presentation, most of our information about how it presents, and progresses is based on reports from Asia and the early US experiences. So, first, how long does it take from someone coming in contact with the virus to getting symptoms, which is also known as incubation period. Typically, 4 to 5 days. But it can be as short as 2 days in some people and up to 14 in others. We don't yet know much spread happens from the asymptomatic people. But we do think that most transmission happens when people are having symptoms. All right. So, what about signs and symptoms? Some people, we don't exactly know what proportion never get symptoms and are asymptomatic. Others might have nonspecific symptoms, just not feel quite right. But for those who develop symptoms, COVID-19 is often a flu-like illness with over 3/4 having fever, over 1/2 having cough, and a smaller proportion having things like muscle aches, fatigue, and sore throat. A small percentage of people have experienced GI symptoms. Things like diarrhea and nausea before getting fever and respiratory symptoms. Now, based on what we know so far, most, or about 80% of people have mild symptoms. It's important to know the COVID-19 seems to progress to severe disease much more often than seasonal influenza. One thing to note is that most adults do not get a runny nose, known as rhinorrhea. That said, people might have a runny nose if they have COVID if they also have an infection with a virus that causes something like the common cold. Now for many, symptoms run their course in about a week, and then start getting better. But in others, things can get worse, leading to severe shortness of breath, pneumonia, and something called acute respiratory distress syndrome, known as ARDS, where the lungs fill with fluid. We want clinicians to know that people may not develop shortness of breath, until they've already been sick for several days. We've seen this on numerous occasions, where even into their second week of illness. In one report in China, the average patient wasn't hospitalized until day seven of their illness. And sometimes people may be fairly stable for about a week and more quickly develop respiratory failure. So be on the lookout for that. Now, people who have been in acute care hospitals, about 20 to 30% have required intensive care for respiratory support. Ranging from high-flow oxygen to noninvasive ventilation, like BiPAP, or even mechanical ventilation with a breathing tube. One thing to note is that noninvasive ventilation like BiPAP requires close monitoring, as some patients will eventually progress to needing mechanical ventilation or like intubation. So, moving onto mortality and risk factors, I think it's widely known that older people and those with serious chronic medical conditions are at a higher risk of death. Which is one of the reasons that long-term care facilities need to take COVID-19 so seriously. Now, among hospitalized patients in China, about 1 in 500 people in their 30s died. Versus about 1 in 12 people in their 60s, and about 1 in 7 people in their 80s. So, you can see that change with age. We need more information on which conditions, chronic conditions place people at the highest risk. But the following conditions here probably increase that risk. Things like chronic lung disease, heart failure, diabetes, certain neurologic conditions, weakened immune systems like including from certain drugs with biologics or from chemotherapy, cirrhosis of the liver, kidney disease, requiring dialysis, and potentially extreme obesity or a body mass index of over 40. But we're still learning more about these things. People who die from COVID-19 often have respiratory failure from pneumonia, ARDS as I was talking about. We're also seeing that some patients in addition to that may develop septic shock and damage to the liver, kidney, heart, and other organs. A few items on laboratory findings. There's nothing that's really clear early in the disease that says for sure whether this is COVID-19 or not. We do see that a low lymphocyte count is common in critically ill patients. But it might not always be present. Patients often, later in the illness, will have an elevated white blood cell count. But early on, they may be low, high, or normal. Again, later they might have things like elevated liver enzymes or lactate dehydrogenase, LDH. Those are maybe predictors of worse outcomes, but early on again, it's not as obvious. It's also important to know when it comes to laboratory testing that some studies have found that SARS-CoV2 infections, that's the virus that causes COVID-19 has been seen together with other respiratory viruses, including influenza. So, just because you have one doesn't mean you can't have another. Now, on imaging, patients often will have a normal chest x-ray early in their illness. If they're getting shortness of breath, they may develop other findings on x-ray like infiltrates, bilateral lung infiltrates, or even consolidation and ground-glass opacity on chest CT, although that's not universally seen. Okay, now here's a few special considerations when it comes to long-term care. First both residents and older visitors have had mortality rates substantially higher than the general population, making infection prevention and control all the more important. Second, when it comes to signs and symptoms, please educate your staff on what those signs and symptoms are and their critical role in protecting residents. And I mean not everyone with COVID-19 will have a fever. We all know that older adults, especially those with severe medical conditions don't always display typical responses to infection. So that said, the early symptoms of COVID-19 in these patients may be a little bit vague.