COVID-19 Daily: Virtual March for PPE, Rural Hospitals Prep for Micro-outbreaks

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MAY 02, 2020 -- Here are the coronavirus stories Medscape's editors around the globe think you need to know about today:

Marching (Virtually) for Masks

Healthcare professionals led a nationwide "virtual march" today to demand adequate supplies of personal protective equipment (PPE). The organizers of the event, called Need Masks Today, called for President Donald Trump to expand the use of the Defense Production Act (DPA) to require immediate manufacturing of masks and other PPE, as well as their equitable distribution.

"For lack of a 75-cent piece of equipment, we're losing lives and putting more lives at risk," said Lisa Lattanza, MD, chair of the Department of Orthopaedics and Rehabilitation at the Yale School of Medicine in New Haven, Connecticut.

While the Trump administration has used the DPA to ramp up production of some supplies, such as ventilators, the law has not been fully extended to PPE. The DPA gives the federal government substantial authority over the supply chain, from compelling companies to manufacture certain items to distributing them. Some state officials have said they need the federal government to take action because the current system forces them to compete with each other for necessary supplies.

Rural Hospitals Brace for Multiple Scenarios

In normal times, many rural hospitals are stretched thin financially and chronically understaffed. Now comes COVID-19, and rural hospital administrators are facing another challenge: How do they prepare for a surge that isn't one-size-fits-all? While some hospitals are responding to micro-outbreaks, others are more likely to see slower, more sustained outbreaks that could linger for months.

"As one of our doctors put it, it feels like we're waiting for a tsunami of molasses," Kimber Wraalstad, CEO of North Shore Hospital in Grand Marais, Minnesota, told Medscape Medical News. "We don't know if it's going to be up to our ankles or our knees or over our head. Are we going to be a hot spot? We don't know, so the planning has to be for the worst-case scenario."

Medscape talked to rural-health experts about their preparation and their biggest challenges. First on most to-do lists is taking stock of available beds and PPE. All supplies must be counted and compared to estimates for a possible surge. Experts are also trying to predict which areas may be most vulnerable to micro-outbreaks, such as towns with meat-packing facilities where employees may work in close proximity to one another. Hospital administrators are also lining up staff to respond over a prolonged outbreak while simultaneously trying to figure out how to prevent staff burnout.

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And finally, preparing for a surge will look different at critical access hospitals, which have fewer than 25 acute-care beds. For those facilities, surge preparation is more about setting up transportation to a larger facility than adding beds and ventilators.

COVID-19 Data Remains Elusive

Electronic health records (EHRs) seem like a fertile source for comprehensive data on the COVID-19 pandemic, particularly on which treatments are working and should become standard of care. But the reality is that this information is stuck in electronic "silos," largely because of software built by rival technology firms that can't be shared between health systems.

But one group is looking to break down those silos. Kaiser Health News reports that a new coalition has engaged some of the top EHR manufacturers to work on how to bring data together across health systems, even when those systems don't share the same technology vendors.

The COVID-19 Healthcare Coalition "is the first attempt at this that I'm aware of where inherently competitive EHR vendors have come together to work together with clinical researchers," said Brian Anderson, MD, chief digital health physician with the MITRE Corp, a nonprofit technology group that formed the coalition in late March.

The coalition is looking at the effectiveness of a number of potential COVID-19 treatments, including convalescent plasma, remdesivir, and hydroxychloroquine.

Defining a Rare Childhood Syndrome

Pediatricians in the United Kingdom have released a working definition of the newly identified inflammatory syndrome in children that may be linked to COVID-19.

Medscape News UK reports that the working definition includes:

  • A child presenting with persistent fever, inflammation, and evidence of single- or multi-organ dysfunction with additional features. This may include children fulfilling full or partial criteria for Kawasaki disease.

  • Exclusion of any other microbial cause.

  • SARS-CoV-2 PCR testing may be positive or negative.

In a statement, the UK's Royal College of Paediatrics and Child Health noted that over the last 2 months a small number of children with COVID-19 have developed a "significant systemic inflammatory response," but that most children are asymptomatic or have mild symptoms.

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PCPs Reshuffle Their Lives

Prior to the COVID-19 pandemic, Robert Hopkins Jr, MD, spent part of his time seeing patients in the main hospital of the University of Arkansas Medical Sciences College of Medicine in Little Rock, but most of it in an outpatient clinic.

Now, the clinic is conducting 80% to 90% of patient visits by video conferencing or telephone, and he and some colleagues have been redeployed to assist with the hospital's surge unit for the inpatient facility. He also pitches in at a drive-through COVID-19 screening clinic. Hopkins and other primary care physicians shared their experiences with MDedge.

"I'm trying to keep an eye out on my team members — physicians, nurses, medical assistants, and folks at the front desk — trying to make sure that people are getting rest, trying to make sure that people are not overcommitting," Hopkins said. "Because if we're not all working together and working for the long term, we're going to be in trouble. This is not going to be a sprint; this is going to be a marathon for us to get through."

Neurologists Join the Front Line

Daniella Sisniega, MD, a neurology resident at Mount Sinai Medical Center in New York City, recently joined the front lines of the COVID-19 pandemic. It turns out she's part of a growing group of neurologists who are brushing up on their critical care skills to aid in the response effort.

Emergency care is a far cry from the long-term care provided by most neurologists, Sisniega explained.

"To say the least, working in the ED in the middle of a pandemic is very different from a normal day in neurology, but it makes me appreciate what my ED colleagues do," she told Medscape Medical News.

Does the Genome Offer COVID-19 Answers?

The Centers for Disease Control and Prevention has launched a national effort to use whole genome sequencing to help guide the public health response to COVID-19.

The SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology and Surveillance (SPHERES) consortium is a national network of sequencing laboratories that will work on getting SARS-CoV-2 sequencing data into the public domain quickly. Specifically, the consortium will monitor changes to the virus as it circulates and provide insights on transmission dynamics, host response, and the evolution of the virus.

Consortium members include several federal agencies and laboratories, state and local public health laboratories, academic institutions, and several private corporations.

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