April 28: COVID-19 Q and A – Full Conference Recording

On April 28, the PCMS Public Health Committee held a Q&A regarding COVID-19. You can listen to the session below, with a transcript written underneath.

 

 

Eileen Ryan (PCMS): So, the very first question that we received is actually a scientific one: What is the minimum number of virions needed to start an infection with the SARS COV-2 Virus? Jessica, do you want to make any comments or do any of the team members want to make a comment regarding this?

Jessica Caum (PDPH): Well it’s not a question I can answer, I think there may be some other people on the call who are physicians and have medical backgrounds who probably have a better chance to answer the question than I would.

E: Would anyone else on the call prefer to comment? If not, we will proceed to the next question and we will refer this to our next phone call. The next question is, where are we with flattening the curve in Philadelphia?

J: So, Eileen, if it’s okay with you, is it okay if I give a little bit of an update? Then I think I can take some of these questions in groups, rather than individual questions.

E: Absolutely, that’s the best thing. Yes, again, I apologize, Jessica wants to give an update first before we do the questions. Jessica, go right ahead.

J: Okay, so, just so everyone is up to speed on where we are in Philadelphia right now, as of this morning we’re at 13,486 cases, and there have been 521 deaths. I think there does seem to be a thought that we may be in the peak now and hopefully that’s true, then we’ll continue to see where that trend goes over the next couple of weeks.

A lot of the focus right now is on what we need to do now, what are the next steps in our approach to managing COVID-19? As folks on the call are aware, that the State of Pennsylvania has put out some planning guidance, and that planning guidance is being reviewed here by our health commissioner and by other people in the government, to determine how it will apply to Philadelphia. And then prior to that plan being put out, there was also a plan that was in development here that was more of a regional plan that addressed what our approach will be regionally—and in the city—to reopening and being able to safely do things. Right now, I think nothing is exactly firm, but both of those documents and those planning initiatives are being reviewed to see what will make the most sense in Philadelphia. What I can tell you is that there are a couple of initiatives that will definitely be high priority and will be a part of any planning going forward. One, as I’m sure everyone can guess, is testing and increasing testing capacity which continues to be incredibly challenging.

There was at least one question on this list that addressed what are the ongoing challenges. And the challenges right now, one—there are many, and I think they were probably all named in the question—there is a general lack of testing kits, a lack of the NP swabs, transport media, lack of reagents, and those continue to be very challenging issues locally and with national supply chains. I think we are not the only location that is struggling with being able to maintain a sufficient supply and material in order to be able to expand testing the way that we would like to.

So that being said, there has been work done through the health department to engage federally qualified health centers in order to expand their testing to be able to include their patients as well as non-patients who they might be able to enroll in order to provide testing. We’ll provide some support to be able to do that with what little supplies we have. We’re offering our support as long locations are willing to accept people who may not be affiliated with a particular health system and we really want to try as best we can to make testing more widely available throughout Philadelphia. And so that initiative is underway. Again, we are struggling with the lack of supplies in order to be able to do this as aggressively as we’d like to and we’re hopeful that we will see more testing capacity increasing and more supplies coming in in the coming weeks and months.

Another opportunity that we have which also has some of its own challenges is the availability of rapid testing. We do have some rapid testing capacity through Abbott ID Now technology and so our lab is in the process right now of validating some of the devices that they have and we’re hoping that will provide some additional capacity to other sites that are interested in doing rapid testing. We’re still in the validation process to make sure that the testing with those devices matches up well with the testing done through conventional PCR assays and so we’re hopeful that in the next week or two we’ll have some good testing validation studies completed and we’ll be able to deploy those rapid testing devices which will hopefully increase our testing capacity with some of the FQHCs.

So that’s been the effort right now, to work through some of those existing FQHCs in order to expand testing and hopefully make it more geographically available throughout the city. The one thing I would add on the rapid testing is that although we have the devices, the cartridges and supplies that are needed to operate those devices are also being doled out very slowly and so there is also going to be a supply limitation there. But I’m hoping that between the combination of the NP swabbing, traditional testing, and the introduction of rapid testing, that may help to increase our capacity overall over the coming weeks and months.

The testing obviously is going to be very important moving forward when we start to think about reopening or gradually reopening. It is going to be very important to continue that aggressive testing, really increase testing, so that we can then be aggressive in our containment measures.

I know that some of the questions that also came through, that you provided Eileen, also address some of the approach to contact tracing. I think that it’s well understood here that contact tracing has to be very aggressive, particularly as we might get into the reopening of Philadelphia. We have been very focused on outbreak response right now, particularly in the long-term care facilities and some of the other congregate settings where there have been outbreaks. And as we start to think about what the future will be and if we are passing through the peak now and there will be some gradual reopening in the coming months, that this contact tracing piece will be very, very important. There is a lot of thinking right now about what that will look like, how many people, how much staff that will require, what are some technologies that could be helpful in being able to really effectively do that contact tracing. All of that is being planned right now.

We are adding a whole group to our organizational structure that is going to focus specifically on contact tracing and how that will be organized because we do anticipate that is going to take many, many, many people in order to be able to do it effectively. A lot of our academic institutions have been in contact with my division director to see if there is a way that students might be able to support some of those efforts and so I think there is a lot of consideration about the entire workforce that we could put together, both health department staff, potentially students or other academic institutions might be able to contribute to this, and so that’s all being planned out and thought out right now.

There hasn’t been a definitive commitment yet to a particular technology, but our Epi Director is reviewing some of the different systems that are out there right now and so we’ll make some decisions about what would make the most sense for Philadelphia. I think that’s where we are on contact tracing, and of course testing and contact tracing really do need to go hand in hand to make this very effective.

E: Thank you

J: I just want to add one other thing, and that is, as far as workforce and volunteers. I did see there was a question about the need for volunteers. The need for volunteers is definitely still present. The question was directed specifically towards volunteering for hospitals, and I think while there is a need for that for some facilities, there also has been a pressing need to support long term care facilities and some of the staffing challenges that they’re experiencing right now and we definitely have been looking to use our Medical Reserve Corps to provide supportive services for that and then also to support other testing as able.

Our MRC volunteers have also been very helpful in supporting some of the activities that we’ve had at the Holiday Inn, which I think maybe people on the call are familiar has been used as an isolation and quarantine location for many persons who are unsheltered or don’t have a permanent housing arrangement. Our MRC volunteers have been there every day doing wellness checks and so that continues to expand and so just to address this question, I would say we’re very much in need of MRC volunteers across all these lines of effort, not just at hospitals, but in a lot of other areas as well.

E: Jessica, before we get off the call, if you do have it, if not you can certainly e-mail me, again that contact name and phone number so we have a line of communication with the person who is doing the scheduling and can be able to get everyone who wants to volunteer. If you can get us a name or names of individuals and a phone number that we can use, that would be so helpful, and again if you don’t have that information right now, if you e-mail me, I can get that out to everyone. I do have a question and that is, are we doing any contact tracing right now, and, I’m sorry, you may have mentioned this, do you have a team already in place, or are you putting a team in place for contact tracing?

J: Well I think there have been various levels of contact tracing that have been happening since the outbreak started, and so I think there has been a lot of focus on perhaps individuals who are in high risk settings. There has not been right now global contact tracing happening for every single case that comes in, but the hope would be that as the number of cases goes down and as we become more aggressive in testing that we will have a much larger complement staff who can more aggressively do contact tracing for every individual. We’re not there yet and with the number of cases right now, that would be a really, incredibly difficult effort, but we’re hoping as the number goes down, then it will be more manageable, but will still take a very, very, very large complement staff to be able to do that.

E: Sure, and I’m probably sure that Dr. Farley and you and the team will come up with a number that you really need to get to in order to do that. We completely understand, thank you. I’ll let you finish your update, go ahead.

J: Okay, so the one other item that I wanted to address, and I believe this also came up on the list of questions, is about PPE, and so I can tell you that the need for PPE is still very intense at the local hospitals, particularly gowns have been in shortage, everyone is having trouble getting gowns, and that’s not just a local issue, that’s a regional issue, that’s a national issue, and so that continues to be an ongoing challenge.

Other materials have been in short supply on and off. I think the hospitals seem to be managing with their own supply chains and things that they have received from us and from the state health department, but I would say PPE is really, really challenging also again in those long term care facilities that maybe didn’t have supplies to begin with and now that everyone is in shortage, they I think are really struggling to be able to keep up with their needs. Through some of the allocations that we have received from the state and what we had in our own supply, we have been distributing to long term care facilities as we’re able to do that on more of a global basis so that everyone is getting something based on their bed counts or their staffing numbers. We’re also dealing with a lot of urgent needs that come in every day and trying to provide those individual items as they’re requested. But that continues to be a struggle among the long-term care facilities.

There’s also a great need for PPE in other congregate settings—Inpatient behavioral health settings, shelters—and so right now we’re also starting to look more at what some of the needs might be among personal care homes, assisted living, we have not heard much from those types of organizations but we expect that the need is there as well, they might just not know how to reach us. We are looking to provide at least some minimal PPE like surgical masks to those types of organizations as well. PPE again continues to be a tremendous challenge for the hospitals, through the whole spectrum of healthcare and some other facilities who are also interacting with patients who have COVID. Those are my main updates and I can take other questions.

E: Sure. And Jessica, if you can take a look at the questions that I sent you, and if you highlighted the ones that you want to address, now would be an appropriate time if you want to take a look at some of the other ones. And if we can let everyone on the phone know that for those questions that we cannot answer, that we will have an answer for them on the next call. Is that okay with you?

J: Sure, that’s fine. So, the one question I do see is the third question—I did want to address this also—the question about serology studies. Right now, there is great interest in serology studies, but what we’re seeing is that there are a huge number of products that are out on the market right now. Many of them haven’t really been validated, so it’s hard to know what is the best serology study to use. And I think there are also some questions that are remaining about what the serology studies actually tell you. We know they can’t be used to make a diagnosis of acute COVID infection. How can they be useful? And there is a lot of thinking going in right now to how they could be used here, but also what is the best way to do this, which is the best test to use, so they’re all listed on the FDA website, at least those that have been applying or registering their products. Some of our clinical staff are considering what would be the best way to do this. So, it’s definitely in consideration. We haven’t committed to anything yet, but I know there is the desire to want to do serology studies, but it’s not there yet as far as how best to do it, which test to use, and how to bring that all together. But I think that’s something that we’ll definitely be seeing in the future.

E: Great, terrific.

J: I think I addressed some of the questions on contact tracing. There was a question around the next round of stimulus money. Some of the CDC funding that we are receiving will absolutely go towards hiring more contact tracers and definitely hiring supervisors of contact tracers because it will take a lot of effort to make this an organized system and to really be aggressive and efficient in doing it.

I touched on the technology question so again, our Epi Director and colleagues are reviewing some of the technologies that’s out there to determine what would be most appropriate.

Rights of privacy vs. the rights of neighbors, I don’t have a particularly good answer for this right now, I think this is something that is being considered by the folks who are looking at the technology platforms to determine what would make the most sense.

I think we touched on expanding testing and there was a question about if we get more tests, who will be the next group that you will encourage for testing. We’d like to expand testing to anyone who is symptomatic, so I don’t know that we’re necessarily looking for specific groups of essential workers, we are looking for people who are symptomatic, and then within those symptomatic groups, we certainly would want to make sure that anyone who is performing essential functions is able to get tested and I think a primary thought here is that people who are working, we really don’t want symptomatic people and people who have COVID to continue to work, you know, interacting with the public or coworkers. We definitely want to make sure that we would be able to test anyone who is symptomatic and hopefully expand this beyond healthcare workers and reduce some of the age restrictions that the health department has right now, although what I understand from other testing sites is that they have already incorporated some more expansive testing, limiting some of those age restrictions. But I think everybody is still on the same page as far as wanting to test people who are symptomatic given that we still have a limited supply of testing materials.

There is a question about prisoners who test positive and are being discharged, I assume this means being released from prison, and I think this is very situation dependent as to if they have a place to go, if they don’t have a place to go, then that gets explored through some of the housing options that have been established for people who need to be in isolation or quarantine, so I think it’s very situation dependent.

E: Are they using one of the hotels for the prisoners right now?

J: I don’t have a good answer for that, I don’t know how regularly that’s been happening or if it’s been happening at all.

E: Okay.

J: But I think when we are notified of a person who is symptomatic, has either been tested or been tested positive and they don’t have a housing option, that gets reviewed here to see if it makes sense for them to be housed in the Holiday Inn, and then I think there’s another site that’s going to be opening up soon, but I can’t actually speak to the census of persons who are at the Holiday Inn.

E: Jessica, I get questions every day regarding how we get from red to yellow, with the dense population of Philadelphia, you get all kinds of rumors that it’s going to take weeks, we have to get, you know, to a certain number in order for us to be able to open up completely. Do you have any information today on that and can you touch upon that and give us the formula?

J: I can’t give you a formula because I don’t think it’s been worked out yet but there is a group of the leadership who is working on this issue right now and trying to determine with this color-coded system that was developed by the state how that actually applies to Philadelphia and what that, in practice, actually means and they are still deliberating what that means and are looking at strategies that can be used once we make some determinations about what that means. Right now, this is very much still in consideration and there is a group of people who are at a high level in city government who are deliberating how best to make each determination.

E: So, is it safe to say that perhaps in a week or week in a half when we have another update meeting like this, we might have more information then?

J: It’s really hard for me to be able to say.

E: Okay. Alright. Well we’ll definitely touch base after the call to find out what would be the best update call again to handle this. For some of the other questions that are actually coming to me now, I’m sorry we cannot handle everything for everyone right now. We might be able to take one or two more from those of you on the call who have a particular question that needs to be answered immediately. Jessica, I’ll let you finish with the rest of the questions we gave you if there’s anything else you want to answer.

J: I think we touched on volunteers, we touched on PPE, and then the last question on here which is about golf courses and camp grounds, and I don’t have a definitive answer on this yet but I understand that there was an executive leadership meeting this morning in which there was debate about the opening of golf courses. I’m not sure if they came to any resolution about that but there is definitely a lot of debate about golf courses and other types of outdoor recreational locations and when it would be appropriate to reopen them. But I don’t know in Philadelphia if that has been a matter that’s been settled yet.

E: And Jessica, I take it that no decision has been made regarding the many, many events that we have on the Parkway.

J: I don’t think any decisions have been made yet as far as I know.

E: Okay. Dr. Walter Tsou, do you have anything you wish to say, and then I will open it up to one or two if someone wants to unmute themselves and ask Jessica a question. If we can’t answer it, it will be on our next call, we will be having another update. Dr. Tsou.

Dr. Walter Tsou: Thank you Eileen, sorry I wasn’t there at the beginning. Thank you, Jessica for all your hard work in answering things. You answered most of the questions I asked so I’ll let other people who may have other questions go forward.

Listener 1: Hi Eileen. I’m not sure just how this is being handled, but we’re hearing more and more about the mental health of our frontline healthcare workers, and my question for Jessica is, is this something that’s being looked at from a city perspective, or is it just truly being focused on at the organizational level?

J: I don’t know that anyone from the city has been involved in any conversations that might be happening at some of the acute care facilities or long-term care facilities as to the behavioral health needs of their staff. I do know that within our own division and within our department that is something has been something that has been addressed. I can’t speak to any involvement the city has had in what’s being experienced with the frontline health care workers in acute health care settings.

Listener 1: Thank you.

E: Does anyone else have a question for Jessica? At this time, I’d like to thank everyone of you. And if Jessica from Penn is still on the phone, thank you for all that you’re doing. You’re there on the front line. We appreciate all of you, we appreciate Jessica and the entire team from our Public Health Committee. Again, we will be having another update and I will have the final words from Dr. Walter Tsou, our chair.

Listener 2: Eileen?

E: Yes?

Listener 2: I had a question about the city’s position on face masks.

E: Jessica, are you still on?

J: The city’s position has really been to follow a lot of the guidance for people who are working in some of those essential businesses, and yes they should be wearing face masks, people entering should abide by the rules and wear face masks, so generally we have adopted wearing face masks. We’re wearing face masks within our own building here at Disease Control. I think the Department and the City are very favorable to the masking. That does seem to be a way to limit the spread of infection.

Listener 2: Thank you.

J: And I actually think we have posted or just recently updated some guidance, definitely on the public website and then I think there has also been some updated guidance listed in our Health Information Portal that speaks more to the PPE needs within the acute care and long-term care facilities.

E: Yes, and your website is absolutely excellent, and shoutout to the Philadelphia County Medical Society website, both of them update the information continuously. For the most up to date information, for all of you who are listening, please, please, please visit these sites. Does anyone else have any further comments? Dr. Tsou?

W: No, I don’t have any further comments.

E: Okay.

W: We want this to be brief and short.

E: That’s right, we’re three minutes over right now. Jessica, thank you so much. To everyone, have a wonderful, very safe day and stay healthy. Thank you everyone.

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