 Can everyone hear me? Wait, no, I'm testing out the mic. Everyone hear me? Yeah. Good morning, everyone. Welcome to... Pardon me, I'm going to fix this. Good morning, everyone. This is Donna Prosser with the Patient Safety Movement Foundation. We are ready to get started now. All right. Well, we are very excited today to welcome several panelists. And I am going to pause for one moment just to make sure that all of our panelists are unmuted and ready to go. So bear with us just a moment. All right. Well, it looks like we're still waiting for a few of our panelists to join. So we're probably going to just have everybody introduce themselves as they come on the line. But I do believe that Mike Durkin is with us. Mike, are you here? Hi, Donna. And good afternoon from the UK to everybody. And good morning to you all from the Pacific coast. But I'm sure different time zones across the whole of the webinar group. Thank you. Exactly. Exactly. Well, thanks for joining, Mike. And as I said, our other panelists will be joining as we move on here. So welcome to our fourth webinar about the COVID-19 pandemic. This is the fourth, the third week of the pandemic. And you can see that it is this map has definitely changed since our first week of doing this webinar. So we won't go into detail about this, but again, we've left the link here for you. So when we send out the PowerPoint presentations, you should have all of this information available to you. And so we were hoping that Ed Kelly would be able to join us for the international perspective. I believe he's going to be able to join us at about eight 30 Pacific standard time today. So we're going to come back to that. And we are, we're, we're also hoping to be joined by the Centers for Disease Control today to give us an American perspective of what's happening here. But moving on, we would like to talk a little bit about what's happening on the frontline. We're really very happy that today we were able to speak with Sarah Albalino and Julia Daliana from Tuscany, Italy. They are on the front lines there working for the, the World Health Organization collaborating center. And I was able to speak with them and do a little bit of a zoom interview this morning because they couldn't be with us for the actual webinar. So I'm going to show you some, just a few little snippets of what they had to say. The director of the patient safety center here in the Tuscany region, coordinating all the public and private hospitals for quality and safety activities. And I'm also coordinator of the W. Chocolaborating Center together with Julia Daliana that is here with me today. And my background is in social sciences and I have a PhD in high reliability organization. Thank you also from my side for this invitation. Okay, my name is Julia. I have been working at the center for clinical risk management efficiency of the Tuscany region since 2011 and the position of quality and safety manager. And along with Sarah, I am the coordinator of the W. Chocolaborating Center. To know one of the big problems is the lack of intensive care beds in order to receive all the sick patients. Here in Italy we have around 5,000 ICU beds considering both public and private hospitals. And this number is not sufficient for all the patients, the sick patients that need respiratory assistance for COVID-19. So one of the most critical aspects is related to the reorganization of the hospitals in order to reconvert beds from the world to be beds for the ICU. And in order to do so, it's very important to have a regional and also national coordination among the hospitals. There were some specific solutions that were implemented like the creation of pre-triage areas we have in each hospital before the emergency room in an area outside the hospital where all the patients can do pre-triage. Then the other solution that worked was to create some operational centers at the regional and national level to coordinate the counting of the ICU beds and also the conversion and the check of the availability of the ICU beds in the different hospitals. And also we reconverted some hotels and bed and breakfast, this kind of services to accept patients who are not critical anymore so they don't need the ICU anymore but they need to stay. The recovery time is very long. And so you need a place where patients can be isolated from their family because they can be still contagious but also where you don't need a lot of assistance from physicians and nurses. That is the possibility for healthcare workers to use hotels or as Sara said, the infrastructure that generally I use to welcome tourists that are converted also to welcome healthcare workers that are working in COVID units and don't feel safe in going back home. And also to prevent the spread of the virus within families. Then I will say some words regarding the importance of starting from the very beginning of the spread of the virus, the need for social distancing. Because we knew also from the experience in China that these measures are more effective if they are implemented very, very soon. As is very well known, the protective equipment has been a very important issue here. We had a problem in the management in the stock line also because several people use the protective equipment in an improper way. We have 90% of the total number of people infected were clinicians. And this is more than double compared to the Chinese clinicians who got infected. One of the most critical issues is communication, especially communication to the sharp end. It is very difficult to inform all the clinicians. You need very simple tools that can be used into the hospital, set the sharp end to describe what to do and when to do it. And also it is important to start producing PPEs like masks locally. And also consider a very important training and simulation of procedures to be done before this kind of emergency can happen. Thank you very much. Thank you. All right. Well, Mike, if you could take us through a little bit of the lessons learned there and kind of do a little debrief with us on that, would you? Okay. Thank you, Donna. So without recapping everything they talked about, Sarah and Julia, it's quite clear that there are a number of aspects that dealing on one which is echoed constantly from colleagues across the world is act early. So early triage is really important and early triage outside of the hospital. So if you can create an environment outside of the acute centre where you can do early triage, symptom management and control and then decision making with regard to whether or not those patients will proceed through. That's with or without testing, I think, at the moment in many places. So early triage is a quick key. The second point I think in terms of the clinical aspects is regional and national co-ordination of activities so that systems, so that mutual aid systems can be put in place right from the beginning rather than the challenge that is often presenting itself now across the world in trying to then create mutual aid systems and create regional and national coordination mechanisms. I think a third one on the organisation of care is the development of centres for COVID. So recognising that this is a specific area and where it is possible to create centres of excellence for COVID at a district or regional level if that's possible. And then within hospitals to developing into a COVID and an on-COVID system or within the healthcare facilities that are available like COVID and an on-COVID system. And then becoming increasingly important is the conversion of other facilities to support patients who are not critical, who are either on a path pre-critical path or actually a post-critical path for recovery. So conversion of other centres near to the healthcare facility. And in their case they've used a lot of hotels and that's a similar model around other parts. I think the other piece was the behavioural aspects and the important elements for healthcare workers in particular but also for others. So support for healthcare workers both in terms of creating separate housing for them because often shifts will be extended and healthcare workers may or may not want to go home they probably shouldn't be going home. And so have we got facilities to support our healthcare workers during this phase. The social distancing is absolutely key amongst us both within our work and across the healthcare system. So early implementation of that and maintenance of that is absolutely key to interrupt the chain of the viral spread chain. Communication campaigns, so communication not just across the piece for our public which is a key element to it but also communication chains amongst us as health professionals to help support us, to help create new rules to follow and as you heard from Julia I think it was saying really make things simple. Policies are inevitably complicated and we need to make things simple we need to have simple algorithms and simple approaches and the use of social media here has been very useful. PPP is an issue everywhere. It's an issue both in terms of the supply chain and how we create and use facilities we've already got but also the training in the use of PPE is absolutely critical for who, where and when. The international guidelines are great but they need to be reinterpreted at a local level and put in place simply. So simple guidelines. Supply chain may or may not now start to use local manufacturers for doing different elements of the supply chain and creating different aspects and different pieces of equipment that are required. Another piece that came through earlier was a dedicated phone number for local phone number, a dedicated phone number for access to the healthcare facility. And I think more and more the realisation that this is developing the new reality of how we will be working. This is not going to be over in a number of weeks. This is going to be continuing for a long time. So there is also more of a strategic context. There is a need for really seamless cooperation between and within systems particularly where there are multiple different systems working across a nation. Healthcare workers need to be put in the first place for support for provisions, for shopping. Their children need to be supported and looked after and we need to be able to have preferential access to PPE training and the use of and the facilities of PPE for all healthcare workers. At a national level there needs to be national and international planning between countries. We cannot survive on our own without mutual aid between us all. And I think probably more and more as we see the impact in China, Singapore, Hong Kong and now emerging in Italy the realisation that the exit is not easy. The exit needs to be coordinated and it will be difficult and we need to be vigilant in terms of the second and third phase of recovery. I think that's probably enough from me at the moment but happy to talk later, answer questions. Thank you. Thanks Donna. Thank you, Mike. That was great. Yes, and I really appreciate you setting up those interviews with us this morning. It is crucial to be able to hear from what's happening in Italy and Spain, South Korea and China and especially as we get into the second phase of this where we're beginning to come to a new normal. So we're looking forward to hearing more from Sarah and Julia about what's happening there. We wanted to bring your attention to our actionable patient safety solutions our apps here at the Patient Safety Movement Foundation just to remind you when as our capacity in our hospitals increases the safety of all of the patients in the entire organization is at higher risk. And so we've created links here for all of the apps that we know you may be interested in and so you'll have access to that when we send this out. Excellent. Okay. So is Robin Betz with us yet? Oh yes, I'm with you. Thank you. Hi Robin. Hi. You could, before you get started, just introduce yourself for the folks who haven't heard from you yet. Oh, thank you. Yes, I'm Robin Betz, Vice President of Quality, Clinical Effectiveness and Regulatory Services. I also have risk management and patient safety and infection prevention for Kaiser Permanente in Northern California. We're in one of the nation's hot spots and currently have, we're managing about 150 COVID positive patients in our hospitals with about that same amount that are under investigation right now. Those are admitted patients in the hospital. And then we have many of our patients that are, that have been tested but being managed at home. And I'm also on the board of the Patient Safety Movement Foundation and have been for really since the second year of their existence. So thank you for having me. I'm kind of bringing forward the perspective of the challenges of the healthcare delivery system, the hospitals particularly. So here in Northern California, I have 21 hospitals and I would say PPE is probably the biggest challenge. We actually have been able to continually procure enough PPE to provide the care and to follow the CDC and World Health Organization guidelines. The challenge is that there's a lot of societal fear and our labor unions and our nurses don't feel that it's enough. So it's trying to balance being a good steward with these recommended isolation precautions. And at the same time provide what our staff need. So if you want to just go to the next slide in working with many healthcare systems, they've kind of put in place a little more flexibility for the staff. So up at the top is here's the clinical use of like masks. So here's what we expect you to use. You use our equipment that is medical grade and tested and evaluated and approved by our infection prevention program. But at the bottom really easing up and allowing flexibility if people want to wear some sort of a physical barrier mask throughout the day just because it establishes confidence in the environment that we flex a little bit. So there's, you know, so people are wearing cloth masks or things that they brought from home that may be equally as good, but they just haven't been assessed and approved by our organization. So this is just an example of how we're responding and how organizations are responding to the needs of labor for their confidence and security. If you want to go to the next slide in anticipation for possibly running short, organizations are getting creative. This is an organization where partnered with the Carpenters Union to keep them employed and they developed face guards, kind of physical barrier guards, one disposable model and three reusable industrial grade models. And the disposable model actually, the organization are able to produce 1,300 a day with 30, with just 30 staff and the components of it are there on the bottom of how you do that. So they're doing this assembly line fashion and then because they're produced every day at this rate, they're able to give two to each employee every day and they can wear them throughout the day and have a disposable face shield. Again, it gives them more confidence in their work environment. They are being asked to put on the appropriate PPE when that matches the isolation protocol for the organization. But again, this is something people are doing. I don't know if in the end the supply chain does run out. This will provide something over nothing. So anyway, it's been really fun to see the market respond. But again, here in America, the federal government may push the development supplies much like we saw in World War II. So we do see actions around that. Do you want to go to the next slide? Stanford University, this was just something that popped up. They actually found ways to heat and disinfect and 95 masks through heat and publish their study. That link there just for organizations who are curious, I went to the link and it's all the work that there, the Stanford Engineering Department is doing around PPE and all of their current studies on how they can treat it in different ways to make it reusable. So that might be helpful. As again, your supply chain is running low and you want to look at what's been done and what has been the scientific outcomes that are really very open network to a lot of work being done in the background. I was very impressed that they were so transparent about what they were doing. So this was just really informational, not that we're endorsing it in any way, but just know that there is some evidence of work that's been done and so testing has been done and you can at least see the results. And there's lots of others using UV light. What was their findings with that and things like that. So that's in there. It's just a link of another scientific reference for extending the use of PPE. Do you want to go to the next slide? I would say that another big focus is increasing your bed capacity really looking at strategies to expand your capability to fold in the hospital and three fold for critical care. That's been kind of our targets here just by reducing elective surgeries and other elective procedures as well as kind of fear of the public who often come and use our emergency rooms unnecessarily. We've been able to decant our hospitals by about 40 to 45%. It's not quite 50%. But those things alone have helped a lot. But here lists some of the things that you can do as you think about surge that you really start with prioritize and maintain your ICU patients within the hospital when possible. Utilize all your existing ICU beds and then move to trauma, cardiovascular, neuro pediatric for patients up to 21 years of course for the pediatric. And then maximize your out of ICU for step down areas. So some of the things that we've done is looked at our PACUs and preop care areas and really set them up with the equipment, the supplies and the beds to convert them into extensions of our ICU. And then once those are maximized, but of course before you need them, expand your capability into alternative spaces. And there's some examples there. While we get focused on the expansion of our capability and that's all well and good, we also have to think about how do we staff those. And so really focusing on making sure that we do have the competency within those that come into this space who are not necessarily there all the time but highly capable. Our PACURNs are used to managing ventilators and high acuity post op patients. So we have created a skills assessment and kind of an individualized on adjusting time core education plan for those that join our teams in the critical care space. And then we pair them, our staffing model would be to have kind of a tiered staffing where you have a very experienced ICU RN partnered with maybe a PACU RN so that they can work as a team. And the person who doesn't necessarily always work there but has definitely knowledge and a high level of skills has someone they can turn to for questions and answers. And really doing your best to maintain appropriate staffing ratios. Some of the things that our governments are doing all around the world are really relaxing licensing restrictions. So in Europe they're offering returners those who have left clinical care and retirement to come back and loosen up probably based on some sort of time frame allow them to return and move back into the workforce. In the United States we have cross state boundaries. You generally are licensed to a state that they're honoring the licenses across states. And so easy in the way to bring in other providers from other areas as you see surges across the country. Around the world we're seeing the use of senior medical and nursing students and interns and residents and allowing them to practice more autonomously as these patients surge on our society. And then really looking at more volunteers to support non-clinical activities. But I mean I think the thing that's really important is to not do this willy-nilly but have a plan in advance. And so that takes me to the next slide. And this is just an example of a staffing model that it was published by the Society of Critical Care Medicine. That link actually takes you to their playbook as well as the critical care that the Ontario Health Plan critical care playbook during a pandemic. I will say this model here was referenced in both of these playbooks but it really gives you a framework to begin to strategize on how you'll build your rapid expansion of your medical facility, to support your existing inpatient and critical care capacity. And they use a framework of space. How do you plan your space? Stuff. What's the equipment supplies that you need to make sure are there in your space? And what does it look like? What are the cards you put together? Those kinds of things. And then staff. What's your strategy for staff? And then they give you ideas around that. So, you know, you're not alone. This has been forged before us. So really look to resources like this so you're not reinventing the wheel. And again, the patient safety movement foundation will make these slides available to all of us after this. Do you want to go to the next slide? I was asked like what are the real-time quality issues, but what are we seeing as unique challenges in this COVID environment for our quality staff and our quality oversight? And what we have seen is some drift from prior performance on various hospital acquired condition infections. So we've seen a little bit of elevation in C-diff and in our CAUTIs. Mostly, I think really the story here is seeing drift from a couple of things. When we have different providers coming into our spaces, there, when you look at the HAI apps for, from the patient safety movement foundation, the actual patient safety solutions, they have one on my, and on my probably all stewardship. And so sometimes when people are unfamiliar with the workflows, they do over testing and then over treating. And so really making sure that we have tight, practice around the standard work that we know prevents hospital acquired conditions and infections. But our greatest challenge has been a little emergence. And it hasn't been like excessive, but we've just seen a small increase in our hospital acquired pressure industry, sorry, injuries. For those that are non-clinical, this would be what used to be called a bed sore, but they're not necessarily the bed sores that you're thinking of like on the coccyx. These are really device pressure ulcers like on the face or other parts of the body for these patients that are on special beds because they are on, they are so sick that they need to be turned prone to help with their ventilation. And so they're on these, so roto prone beds that allow us to make patients prone without having to flip them. And also these patients that have acute respiratory distress syndrome, they also have displacement of fluid. So they're very, they get very edematous, which makes them vulnerable. So there's two wonderful references on how to manage these patients that don't tolerate repositioning well. And especially if you are fortunate to have a roto prone bed, it really, those roto prone beds set up the unique opportunity to develop different types of pressure ulcers, but also help us manage these patients very well. But these two links below, the one from Northwell and the other one are wonderful helps on how to manage and reduce pressure ulcers on these types of patients. So I highly recommend that they use the framework of choose cushion, inspect avoid, educate, be aware and confirm. I would say Northwell's resource is probably the most succinct and the easiest to share with your teams. Then there was this question to me about how can we manage these? And I think proactive monitoring of your quality and clinical staff, we're using to just beef up our observations and our support to clinical staff and education and, and, and even observing PPE to make sure people don't self-inoculate as they put, take off their PPE. We are using some of our search surgery nurses who are really great with PPE and infection prevention to enhance and support our infection prevention teams who are really managing on the outbreak surveillance and, and outreach to possible exposures and things like that. It's a very tedious work when you have an insurgent like this. And then really building in for those of you sense, who understand the science of high reliability, greater sensitivity to operations. So use your unit champions to really own the work and performance of their, their teams. So you're going to have a, a total board and reminders so that it was, as your teams huddle together daily that you are reminding them, you know what your current performances and reminding them of those activities that reduce, use your visual management to track so that your team knows exactly where they're at with both process measures and outcome measures so that you create that kind of collective mindfulness around safety. sharing stories. You know, hey team, yesterday we found a pressure ulcer on Mr. So-and-so and it was because we didn't use the cushion tape on the face on that prone bed. So let's really make sure we're using all of our preventive measures today and we're going to be doing rounding and inspecting all of our patients on Roto prone bed. So just something like that where just every day there's this engagement in safety and quality. So those are the things that my organization are doing and really welcome to share with you as well. I think that's that's it. So I'll turn it back over to Donna. Thank you. Thank you Robin. Thank you very much. Well we are very excited now to be joined by Ed Kelly from the World Health Organization. Ed, are you there? Yes I'm here. Can you hear me alright? I can hear you great. Thank you so very much for joining us today. I know that you are a very very busy man. Well you're very kind and I'm sorry that I was only able to join for 30 minutes here. I was writing a whole bunch of notes down to just as your some of your other panelists were talking. So it's very helpful very helpful for us too. Great. Excellent. Well Ed if you could would you share just a little bit about the international perspective. What are you seeing at the World Health Organization in terms of what's been working and what's not working? Yeah I mean quickly just to compliment some of the very very useful discussions that are happening on this webinar on a regular basis and I'm sorry that I wasn't able to join last week but certainly hope that we can be here on a weekly basis with you all is a couple of things. So first just some global perspective and then some thoughts about specifically for the US. You know we now have 193 countries states and territories that are that are reporting in with COVID cases. There's a big still probably about 80 percent I can get to the exact numbers 80 to 85 percent are from sort of the top 10 to 11 12 countries and so you have big parts of the world that where this has not hit yet if that seems possible given how long we've been talking about it but so for WHO that is really the big worry. The the shape of the curve though if you look across the world is very very similar and you know we just got off the call with Imperial College who came out yesterday and if folks haven't seen it it's I think it's a useful paper and they also have the model that was behind it that looked at the potential impact if nothing's done over the next months by countries which of course is not the case basically every country in the world is doing something and then what would be you know how many lives could be saved if we if we move quickly and move robustly. So I guess the we also had a review yesterday which if I'm able to get the revised slide to be very happy to share through the patient safety movement foundation of that maps out the measures that countries are taking and a lot of times we term these non-pharmaceutical interventions everything from you know asking for now WHO is terming this physical distancing the term social distancing anyway has has evolved unfortunately to have some negative connotations for people with COVID when there's many of us in the world it's many of them in the world and the to travel and trade restrictions and border controls etc basically if you wanted to get on a plane and go somewhere right now the only place with a couple exceptions you can go to Greenland for instance that is still open in case you're looking for a summer destination that's not closed yet but basically almost everywhere else has travel restrictions when you look at the impact of those travel restrictions you know anyway this is not an exact science but they they're having some impact if they're done early in you know WHO characterizes the disease in terms of the four C's of sort of isolated cases sporadic cases clusters and then community spread and if you are early in those that evolution institute travel restrictions it can delay by a couple weeks sometimes a wider community spread but usually if it's done later as as happened in Europe it has very little it has very little immediate effect in terms of the the shape of the curve we get there anyway this database looks at other measures that are that are there clearly asking people to try and stay home is one of the number one efforts we have put out a lot of guidance recently about and when working with countries about the potential impact of that on societies on businesses and then also on on the control of the disease and and also potentially on regular service delivery and obviously you need to keep those regular services open and figure out a way to do it in a safe way and that's one of the going to be one of the priorities certainly in New York Washington California these days and you know that that's a big priority as the as a caseload mounts and you know if you look at the the the Chinese experience we're doing a several webinars with our china office and i'm offering some and if we wanted to show a few of those experiences in more specificity next week i'd be very happy to come back and talk a bit more about it but they are many countries china included are preparing for not just the first wave the very big first wave of these cases but a potential rebound china did a very good job really they moved probably and by their own admission too slow in Wuhan and Hubei province and had a big explosion there but once but they were able to clamp down nationwide and that meant that many other provinces had had quite low uh infection rates relative to Hubei and Wuhan which then allowed for massive redeployment of health workers of bed capacity respirators and other supplies PPE to Wuhan so that they were able to surge and really deal with it one of the chief worries personally that i have this is not any um stance of WHO is that a number of countries the us included has adopted a um a more you know in line with the tele system more federal approach and letting the states having things go state by state which gives you very limited capacity for big redeployments um if you right now if we were facing if these were wildfires in new york city and california and other parts of the country we would be sending fire crews from colorado from idaho but um it's health care so we don't do that so i think we really have to think differently about this so um that uh work was effective in china they are preparing though for a potential rebound because in those areas where they had low infection rates they're they're susceptible to this so now they have only imported cases um now in china and uh they have said look between now and then when when the the second wave comes a rebound comes whether it's part of the colder weather next year or it's uh it's even later uh this year in the summer depending on what we've learned about the virus's evolution you will need again to flatten the curve wherever it comes um and then you also in the intervening time need to raise capacity both for hospitals but also um earlier on and testing capacity and in your primary care assist them to to help manage the vast majority of cases which are going to be mild cases and do so in a in a safe way that keeps vulnerable patients keeps vulnerable patients safe so i think some of those things are really going to be important and then making some of the detailed decisions about how you know your hospital and your hospital colleagues are going to manage the discharge for patients what what is the guidance and how how can you move people out um based on care requirements and then based on uh how long the you know you have um viral shedding which is an evolving picture at the moment and i think that's something that would be very good for us to come back and look at and the last bit that it's kind of a bit of an open call that we can take up later but one of the things that is we are really wrestling with in many parts of the world is around healthcare worker infections in Italy we have nine percent of the infections are healthcare workers and that's um yeah for for it's a high rate and uh and there's a lot of worry about um within the professional communities um it's a big worry in Italy where they've called back retired physicians uh just saw a super touching tweet about um one of the physicians who did one of the first open heart transplants um in Italy coming out of retirement uh he's in his late 70s to um to treat patients and you know it's uh really putting him in harm's way but there's no other choice so i think um uh that right now we have um everyone's focused on the mask um on the surgical n95 uh mask and you know as those of you who are listening know about infection prevention and control the vast vast vast majority of of infections in any type of setting whether it be routine um nosocomial infections quote unquote or in Ebola settings is about how you set up and manage your your patient flow and your service delivery it's not about which PPE you wear which a piece of PPE where it's how you use it and how you set up your patient flow and so uh we are looking um right now to look with partners who might be um tracking healthcare worker infections and the causes to to help contribute to global knowledge database on this so we can start to share some of that learning very quickly for for folks um and try to get off this debate about which mask to wear so anyway i could go on for a long time but those are just some of the pressing issues that are keeping me up during the few hours that i'm sleeping these days and it's really a pleasure to be here so back over to you well thank you ed that was very very helpful we actually just got a question that i wonder if you can answer for us you know there's a lot of a lot of research is being done right now there's a lot of papers being shared we obviously haven't had time for peer review of these um any any recommendations for clinicians out there that are reading some of these papers what what is what are some of the things that that they need to keep in mind so that they can rely on that data yeah that is a great point um maybe afterwards i mean i don't have an easy answer for that so i'll just say that right up front um you know like for instance just this imperial college paper that came out estimating the the um what's the impotential impact that was also not peer reviewed because people are just trying to get information out as quickly as possible um and even some of the peer reviewed stuff that i've seen uh sort of review on healthcare worker infections done in china i anyway personally there were some quality issues there so so these days it really depends because everyone's trying to rush stuff through um first off who does from our side anyway um who does have a clinical management uh um network that it runs and does a weekly call and we try to run through our the the lead on that um is fantastic colleague of mine janet bs and we'd be very happy to share the um the how to get linked into that for any of your uh clinical teams who want to have someone on the calls to hear the sort of latest about what's being talked about um and then uh there are a few other resources that we could point to that are trying to pull together some of the you know in a more a slightly more curated way some of the information uh out there but i think it's i think it's actually a gap and and um they'll be very interested if any of the people online have um have some potential solutions on that uh but the lancet has uh itself put together sort of a review of some of these which is really quite good and there's a couple others so maybe um after the call uh we could pull a few of those together as well as the the connection to our clinical management network and that could be at least the first step that would be fabulous thank you ed i think this is robin too it's important to note that um while uh we do know the coronavirus is part of a a family of coronaviruses there's been other coronaviruses as well and so um uh right now what we know is that it is spread by droplet it can be aerosolized and so like when you give a a nebulized treatment when you're intubating a patient and bagging them so that's when you need an n95 so there are circumstances and situations where you can aerosolize the uh the the virus but it is spread by by droplet so uh you do need a mask uh you know like wear a surgical mask or a medical mask for your PPE and then uh you as the cbc and world health organization support you use an n95 or what we call an enhanced uh uh PPE um uh when you're in situations where you're providing treatments that aerosolize the virus so with corona you do need n95s but it's circumstantial great well that's excellent don't know if i could don't know may i just say one one thing on this point i think i think it's uh it's obviously essential that we we manage the impact of our PPE in our for our healthcare workers i think the other element we need to really concentrate on as well is uh is the the impact on that on themselves that the clinical burnout that we need to prevent and the support we need to give them and their families so that they are able to concentrate on their work and not worry about other aspects of of life at the moment and i think that's another key issue for us uh as we move forward yeah great point well robin um you know you mentioned using volunteers to um to support your staffing any ideas on where volunteers are needed the most and where folks can get those volunteers from mm that's a great question i'm kind of having a hard time thinking off the the top of my head um so i think i need to think about that we've been using them more in administrative work managing some of the supply chain background work that happens on the back you know in but kind of behind the scenes but not necessarily public facing um so i i probably need to get more information about other uses and bring it forward because i think there's other creative ideas and i'm just not coming to my head so donna in in the uk you might have seen earlier this week we launched a a national program for to uh for volunteering uh to support the health system in in non-clinical areas and within three days we've uh had 600 000 uh sign up uh to this volunteer volunteering process and and those people will be using all walks of all walks of life uh to help and support the vulnerable uh in doing basic elements of care but also shopping also helping support pharmacists helping support all the the non-clinical activities that require manpower so it's a it's an incredible uh uh opportunity uh but but also an incredible response from across the country and i'm sure this this will be mirrored uh it is being mirrored in many other countries around the world yeah thank you michael i i thought about pharmacists like dropping off meds because they're trying to keep people from coming into our pharmacy to courier services supply chain support uh there's just a lot of process management right now just just trap just traffic really around and and even we're doing a lot more phone screening and uh kind of wayfinding by phone is sometimes helpful as well so yeah we'll we'll be learning from each other well and we also had a comment from nancy connelly to um to our panel recommending that we look at state and county medical reserve corps as another source of volunteers that's an excellent idea because as she she comments that they've already been background checked embedded so that's an excellent idea we did have a question i'm not sure if anybody knows the answer to this but is there any update since last week on any new clinical trials or new therapies that you've heard of i know there's again been a lot of conversation um but but at anything in particular that you've heard in the last week that we do you think would be helpful to share yeah we just um started and i can also send this to you i mean anyway uh there there are a couple out there but i'll just speak of one the um uh WHO solidarity uh uh trial that's looking at um the sort of four of the most prominent um uh therapeutics uh that are out there and and tracking um patients for it so that's one i won't take too much time going into it but um that is i think is very is going to be very interesting uh and um we hope to uh have uh some results and not not so so long but it were um the the dg had launched the this um on wednesday and the the work that we're going to be um moving on it uh they've had a bunch of countries that are already um uh signed up to it so that's um that'll be important one for us great great another question that we have um is about another covid pandemic um is it possible that we'll have additional epidemics and pandemics coming back around and outside of vaccinations is there anything that we can do about it yeah shall i comment on that but probably lots of folks on your panel will be very good um the uh is um uh just to reiterate what i said that a bunch of countries that are farther along china north korea singapore and then spot singapore hong kong that are planning for potential quote unquote rebounds the second wave of this um and uh but most most of the modeling that's out there is looking at sort of you know um what we we need to get to herd immunity and that was some of the analysis um i mean maybe mike can speak to the studio that was done for the uk in terms of uh measures that are needed um and balancing sort of the non-pharmaceutical interventions with uh with the herd immunity that would result from the 80 mild and moderate cases that are um that are uh coming around so um i again um the whole point of the novel aspect of this virus is that people you know no one can say with any predict uh predictability but i think it most of the discussions that we are in although it's all you know so focused on the response right now does um assume that there's going to be some um some potential second wave even if you're looking at a glow if you're looking at the sort of global wave of this moving through different parts of the world great well we also received a note from steve barker um to update us from the american society of anesthesiologists webinar last night he says that they now recommend n95 masks for all intubations and airway procedures and not just those on suspected infected patients so i imagine we'll will continue to see stricter guidelines uh as we as we move through right robin any thoughts on that no i think we'll just kind of wait and see as they they publish um i don't think it would be a bad idea so um i think it's good excellent well it doesn't appear that we have any other questions at the moment so that is very exciting i would like to share i'm very excited to let everybody know that we're hoping to be able to move more towards a uh on-demand type education format so rather than waiting until friday every week we're going to be doing some some zoom interviews and providing them to you on demand so ed i hope that um i could take you up on your offer and speak with you next week in some more detail about uh about the links that you were speaking about yeah i'd be happy to and uh we can um i don't know anyway we could talk about the logistics offline and some of these are from our uh china office but we've also got new learnings coming in from other countries too great well then we we are are going to be just like uh just like the front line that's out there and we're asking them to do just in time training and be very very nimble we're going to do the same thing here at the patient safety movement foundation well thank you to our panelists i appreciate your your time um and uh thank you to everybody who joined us today and for all of our great questions we will continue to solicit your feedback uh regarding what it is that you want to know about coronavirus and then we will do our best to bring that information to you in a very timely manner thank you i just mentioned really quickly i just uh put up the and you can share it afterwards the link um that's to the r&d section of the wto website so there's a there's a lot of information there on the different research uh research and development work that's going on so not just on the therapeutics but on the vaccines and also on diagnostics um there's a lot uh that can be very interesting folks great well we will be sure to post that on our resources website at the patient safety movement foundation well thank you everybody um then we we did extend the time frame to 915 because we thought we might go over but it looks like we got done just in time so this is very exciting and uh i hope that everybody enjoys your friday and your weekend thank you thank you don't thank you and thank you ed and thanks robin thanks everyone