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  • >> 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 coca@cdc.gov.

  • For those who have media questions,

  • please contact CDC media relations at 404 639-3286

  • or send an email to media@cdc.gov.

  • 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 coca@cdc.gov

  • 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.

  • Things like confusion, or just general malaise

  • and not feeling that well.

  • So, here's a couple of things that you can do.

  • If the virus that causes COVID-19 is spreading

  • in your community, consider checking

  • on residents more frequently than you otherwise would.

  • You can ask residents if they feel feverish or have symptoms

  • of respiratory infection on admission.

  • And then at least daily.

  • In skilled nursing units,