 Good morning everybody. This is Donna Prosser with the Patient Safety Movement Foundation. It's just at eight o'clock and we are getting ready to get started here very shortly. Give us just one more minute to get everybody else in that's waiting to get into the webinar. So we're good morning everybody. Right this is Donna Prosser with the Patient Safety Movement Foundation. Welcome to our second our second round of our webinar for the coronavirus update. We have several speakers here with us today. We're very excited to have everybody. Again my name is Donna Prosser and I'm the Chief Clinical Officer here at the Patient Safety Movement Foundation. Can everybody hear me okay? Yes I can hear you. Okay I'm sorry we just got a message that says that we're muted so my apologies there. Okay so let's go ahead and have everybody on the on the on the speaker panel introduce yourselves. Let's start with Mitch. My name is Mitchell Goldstein. I'm a Professor of Pediatrics at Loma Linda University Children's Hospital. Hi this is, do you want me to just start? This is Robin Betz. I'm the Vice President of Quality Clinical Effectiveness and Regulatory Services for Kaiser Permanente in Northern California. I'm also a board member of the Patient Safety Movement Foundation. Steve Barker, Anesthesiologist and former chairman at the University of Arizona. Also Chief Science Officer for Mass Smoke Corporation and board member of the Patient Safety Movement. Thanks Steve. Welcome. Art. Yeah thank you. Art Kanowitz. I am the founder of the Airway Safety Movement. I am on the chair of the Patient Safety Movement Foundation Airway Safety Work Group and I am the founder and Chief Medical Officer for Securescent Medical. Wonderful. Mike Durkin are you are are we able to hear you now? Mike? Okay we're going to come back to Mike in just a minute. We just need to get him unmuted and Jerica. Okay we have to get Jerica unmuted as well. So so we'll we will come back to to those folks. One exciting thing today that we are are happy to announce is that Dr. Ed Kelly from the World Health Organization is going to be joining us at about 8 30 to talk to us about what's happening in the in the rest of the world and and what we can do to prepare in those areas that have not been hit hard yet. Okay and Steve do you want to tell us about this map? We're not seeing a screen Donna. You're not seeing my screen? No no no you've got several chats nobody's seen it. Just a moment. Can you see me now? No we're getting there. Okay my thoughts everybody we we uh we bought a new program because last week we didn't have enough capacity for folks to join in so we've got a new program this week and our apologies we we're still working through some of the bugs but thank you very much Steve for letting me know that. I'm going ahead and talk about this slide. Sure this is my favorite updated screen on incidents and deaths. It's run by Johns Hopkins University through ArcGIS and it's updated about every two hours as you can see on the upper left the total number of confirmed cases is up to 137,000. You see the leading cases by country in that left hand column and you see a map which is a good visual of the total case incidents by region. You can also zoom that map by pinching and can you try that Donna do the you see that are you you're going to go to the my apologies my apologies I just hit the wrong thing it's coming okay yeah we're going to get the live screen on so you see the real thing and there it is hopefully can you see it now it's coming it's coming okay so if you have a touch screen you can pinch and zoom you can also good now make it larger and scroll over to the US as an example there you go and that'll fill in you can see the US incidents by region though the western states have kind of led but the eastern states are catching up if you look at the last several days back to the cases by country China obviously is is leading by far that's where this started in Wuhan. Iran was second for the first month or so and Italy is now taking over second place and you can see they're they're well into second place the questions are always why apparently there there is or at least was a lot of travel between Italy and China if you move over to the right hand columns you see the total deaths is over five thousand and again Italy has taken over second place by far in deaths they were behind Iran until fairly recently total recovered is growing rapidly and then the last thing I'll comment on is that graph on the lower right in fact if you if you double click on that it'll get larger well maybe not click on on the actual where it says actual at the bottom there yeah try that no sorry okay that's all right it's all right I'll just talk through it you see three curves there the orange curve the highest one is mainland China and as you can see that's leveled off if we can if the data are reliable then that's a good sign the yellow curve which is just really starting to go up exponentially is the rest of the world and if you blow that up you see the slope is now relatively constant so it's we certainly haven't started oh there you go good job all right so you see the the yellow curve is not even started to level off yet that's the one we're concerned with and we'll be hopeful but this I find is very helpful I I check it a couple of times a day it's updated I believe it's accurate the only thing you have to ask of course are all the are all the countries equally accurate in reporting and updating their data and I'm we don't have the answer to that but it's it's the best data we have so I recommend this site highly thank you thank you Steve I appreciate that all right all right and now I believe that Jerica should be unmuted Jerica are you able to hear me Jerica um and Mike how about you are you able to hear me yeah I can I can hear you Donna can you hear me I can hear you and so yes thank you so much can you just tell the group a little bit about yourself yeah so certainly so my name is Mike Durkin currently on the board of the patient safety movement foundation and a an advisor on patient safety policy and leadership at Imperial College London and also supporting WHO in in leading the global patient safety collaborative supporting lower middle and countries across the globe my previous substantive role was as the NHS director of national NHS director of patient safety for the NHS in the UK thank you Donna so yeah I I in terms of where we are in the UK and Europe you can see this from many of the websites that are going on at the moment but we have certainly now moved to a different position one of where we've we have been very conscious of trying to do a lot of testing for those with symptoms and usually testing in in sites that are convenient for local populations and those testings have demonstrated that we currently were tested over 20,000 we currently have are just over 600 known cases of coronaviruses and we have had 10 deaths to date although that might change daily what we've decided to do as of last night is to move that testing scenario to suggesting to all people who have demonstrated a a temperature rise a high temperature of of over 38 and symptoms to self-isolate so to stay at home and where they are within a family who also had symptoms to all stay at home together that seems to that's an element of change that we've introduced over the last 24 to 48 hours so in our suggesting that routine testing for our population will only carry out will only take place once people have been have gone to a healthcare setting or have been admitted to a healthcare setting otherwise out of hospital testing we will slow down but concentrate on asking people to stay at home remove themselves from work and carry out the usual processes for social distancing we've we've also introduced elements of change in terms of our sporting events but we have not yet introduced a closure of schools or colleges which I think is different from a number of other countries of similar size excellent thank you so much appreciate that um Jerica are you able to speak now yes hi everyone hear me yes oh i'm glad i i apologize for the technical difficulty uh yes um so just to echo what um what our previous uh colleague has mentioned in terms of the background of COVID-19 um as as we all know on march 11 the world health organization declared um this as a pandemic uh basically pushing the threat beyond the global health emergency um that it has announced in earlier times like in january and as we all know this is a result from the fact that at the time of this announcement the coronavirus has affected more than right now it is more than 130 000 people and has affected over 114 countries so the numbers are expected only to rise especially in the u.s as more testing kits become available and um what we found out is that because of the increase in clusters of COVID-19 cases social distancing which will be talked about further later in this lie deck is strongly recommended for everyone at least six feet from one another this also means that universities are moving on to online instruction public schools are closing as i hear this morning there are five states that have closed the public schools from k to uh to 12 the high school senior year uh in many of the states uh large gatherings have been canceled such as concerts we've heard about south by southwest in texas and cochella in california uh we've also heard about the travel ban that's coming down uh this this uh near midnight tonight from 26 countries in europe and uh cancellation of sports sporting events such as the nba games church services so i think that the takeaway from this is that it is definitely a pandemic and we should uh take a lot of precaution to make sure that we don't transmit this virus if if we're asymptomatic and uh are unaware and also put ourselves at risk for being infected yes thank thank you jerica i appreciate that and and i'm really i'm i'm hopeful that when ed kelly joins us we're going to be able to learn a lot more about what other what other countries have been doing um to to mitigate or to to be able to manage the social distancing that we need thank you next slide for you yes um so about two days ago governor gavin newsom of california has also issued a policy on gatherings to protect the public health and to slow the spread of covet 19 this is a state's public health uh issue not not like a mandate but more of a policy that basically all mass gatherings and large gatherings should be postponed or cancelled across california until at least the end of march non-essential gatherings must be limited to no more than 250 people while smaller events can proceed only if the organizers can implement social distancing of again six feet or these two meters per person gatherings of individuals who are at higher risk for severe illness from covet should also be limited to no more than 10 people while also following social distancing guidelines so the state's updated policy defines a gathering as any event or convening that brings together people in a single room or a single space at the same time such as in an auditorium stadium arena large conference room meeting hall even the cafeteria or any other indoor or outdoor space excellent thank you appreciate that jerica okay well and in addition to what jerica was talking about you know that some of the background recently has been talking about testing you can see here that in the united states we were a bit behind in testing but we're starting to pick up now and so there's expectation that that all of the testing that we need will be available moving forward mike mike jerkin tell us about what you guys are doing in the united kingdom for testing yes thank you as i said in my introduction donna we are up until this date we have been working our testing system through symptom management based on all people population having access to a phone number called 111 which is an advice phone number for health that supports the whole of the NHS and through that the idea was that you'd ring that number you'd describe your symptoms then you would be given advice by a call handler as to whether or not you should go to a local testing center and be tested for COVID-19 there we have been slowly increased or we've been increasing the numbers of call handlers as the as the as required by the numbers of people accessing the system and we've now moved also to an online approach so that people can describe their symptoms and then be directed through an algorithm approach down to whether or not they need testing or they should carry on or they should stay at home as i said earlier we've changed that process almost overnight and now we're very much recommending that people who have demonstrated that they have symptoms and have a measured temperature rise that they self-isolate and that they for seven at least seven days and but stay in touch through the 111 system online all by call if their symptoms worsen and in such cases then they would be redirected to be taken in and given further advice so we've moved that system quite clearly now thank you thank you mic appreciate that yeah so as you've heard we've had a you know significant community spread at this point we're we're beyond containment at now and and working on mitigation our hospitals in some of the hard hit areas across the world are quite overwhelmed so those that have not yet been hard hit are preparing for increased capacity and in a little bit we're going to talk more about what hospitals can do about this you've probably seen the the empty empty aisles and grocery stores which is is probably not necessary for people to be doing right now but again when you know later on in the in the program we're going to talk a little bit more about that the other thing that you know it's an interesting problem that we have now is that there is an acute blood shortage because we have limited donation at this point with with fewer people venturing out and an EMS is also beginning to become overwhelmed so and so as part of the our recommendations discussion we will we will address all of these Mitch you want to tell us about some basic recommendations for folks so one of the things that people need to recognize is that the disease can be mitigated the risk of its spreading and one of the important things is proper use of hand sanitizers or washing your hands one the first is a video which is from the and this goes into various techniques that you can use in terms of how to properly wash one's hands the other is I know I think we'll go through because that's that's going to be a minute and a half but I want people to have that link and the other is a simple 20 second countdown and people can use this if they want to get an idea of what 20 seconds really is we could show that I think and I'll talk over it and and so as you could see 20 seconds does represent a considerable amount of time people who are bored by this countdown can sing happy birthday twice or perhaps the alphabet song twice and that will get you through this 20 second interval which again seems like a short time but is at times long so we'll go back down to the slideshow you want to try to avoid touching your face this is something that's very very hard to do if you've ever tried not to do it but again it's something that we should cognizantly do and try to practice if at all possible staying home when it's not necessary to go out and again this is not something that's easy especially if you know there are things that you want to do or want to go or places you might need to be or really don't have to be again calling in teleconferencing webinars that's the more practical way of doing it don't wear a mask unless you're sick or caring for someone who is sick and again you've seen the proliferation of ads in media campaigns and on the web in some cases they're charging a premium on pricing but a lot of these masks are not the ones that are necessarily going to protect you against COVID-19 really you need a very high end end-95 mask in order for there to be true virus protection so that said given that you only really have three or four minutes before that map a mask becomes ineffectual you want to avoid using it unless it's really necessary there are other sites that are important this is the world health organization basic protective measures against the new coronavirus site which is a very good site to look at and it gives you general advice for the public the other is one on environmental cleaning now i want to emphasize that if you're washing your hands um a 60 alcohol solution is deemed adequate but if you're using um sanitizers for environmental cleaning uh there are some recommendations about using bleach and how to mix the bleach to effectively eradicate virus but also if you're using an alcohol-based solution you want to use one that's actually 70 percent as opposed to the 60 alcohol that you're using for your hands excellent excellent um and this is just a diagram showing how virus spreads we've talked a little bit about social distancing i'll talk a little bit more about it later but if you look at the droplet spread from someone who's sneezing and i believe that's what this guy is doing you see how the highest density is close in but really you can get a part of part of globalization or alice salization out to six feet so in social distancing you do want to try to work at home whenever possible and a lot of the companies a lot of the firms are trying to make it so that people have this as an option commuting by way of phone or by way of teleconference is oftentimes a perfectly acceptable way of getting business done avoiding large gatherings whenever possible and Governor Newsom in California as you saw has restricted gatherings to less than uh 250 people um and again at these gatherings if you're there wash your hands don't touch your face good practices uh for keeping social hygiene when you're at these places or when you have to be among people try to observe the rule of six feet of spaces around you so again this is something that's increasingly hard to do in a lot of these spaces that have seats one on top of another but again from a standpoint of reducing the risk and reducing the spread this is an important way to do it self-quarantine if you're worried that you were exposed or if you are feeling symptoms um and these symptoms may mimic the flu you may have GI symptoms as well as cough cold congestion it's like the common cold but you want to ensure that before you do this that you have a two-week supply of food and prescriptions we've heard of the runs on toilet paper and paper towels and hygienic type products but again this is something that people need to do within reason and again Amazon and other services which deliver by way of mail or by way of courier may be ways of getting the necessary supplies where do you quarantine well if you can you want to quarantine at home and one important thing about social distancing and a very important thing about this as well is that if you're sharing your home with other people you want to try to if at all possible to stay in a room by yourself if you can't again observe the rule about six feet distance you want to again obey all the things that we talked about in terms of washing your hands regularly and not touching your face and below is the CDC community mitigation strategy which includes these points and many others thanks Mitch and you want to talk about this slide I'm sorry do you want me to talk about it oh yeah I'm sorry um I certainly can if you don't if if you uh I'm sorry uh yeah this is and uh Mitch this is the 1918 influenza pandemic that um that uh was in the United States last this is really seriously the last time that we had a significant pandemic like we do now and so in the city of Philadelphia they practice social they did not practice social distancing but in the city of st louis they did and you can see here that there was a quite a spike and quite a significantly higher number of deaths in the city of Philadelphia than in st louis and so so this just goes to exactly what Mitch was just talking about about social distancing and why this is so important and and so it's not so much that we're staying home to prevent ourselves from getting sick as much as it is we're staying home to prevent this kind of peak in transmission in the in the world so again I'm looking forward to talking more about that in just a little bit and so um all right yes thank you Donna so populations that are high risk for more serious COVID illness um you know everyone is at risk for getting the virus um there are some populations that are at higher risk for getting the virus and and then those that get the virus you know many people have mild illness but um there are those populations that are at risk for getting much more serious illness including um severe respiratory compromise and death um those that are at higher risk are certainly the older adults based on early data from china and from the cdc the data suggests that older adults and typically we're talking age 65 or greater although that's not a hard number um are twice as likely to have a serious illness um and as we've seen in um washington state and many other places as well um you get older adults that are um near each other due to being in a senior care residence and many of them having underlying serious chronic illnesses um there are certainly those people who are in senior care homes um are certainly at higher risk for getting the disease and and and more severe um reaction to the virus um other groups that are at at higher risk are people with severe chronic conditions certainly um those with chronic lung disease especially those groups that have been hospitalized in the past with respiratory illness are at increased risk and then um those chronic lung disease like c o p g interstitial lung disease and asthma um certainly those groups that are either immunocompromised due to an underlying illness or immunosuppressed from medications those patients that are transplant patients uh all the autoimmune diseases like rheumatoid arthritis and lupus um and certainly those with weakened immune systems like hiv they're all at risk for more serious illness and then chronic medical conditions such as heart disease diabetes and and um uh chronic kidney disease as well are all again at increased risk for serious illness great thank you art next you want to talk about the next one short there are special considerations for certain vulnerable populations and although there hasn't been reports of large numbers of pregnant and lactating moms being involved um it's important to know some of the uh factors that may be of concern the virus has not been isolated from breast milk or for that matter from amniotic fluid and although um lactating mothers can continue to give their breast milk the procedures that they should follow should involve taking as much precaution as possible and so in so much as it would be nice for the baby to go to breast that might represent a risk of disease transmission while they're infected women are therefore recommended to um express and if possible at times to have somebody who is not infected perhaps aid them with expressing their breast milk for their baby or again another option is to formula feed if the mom is too sick or for some reason otherwise incapacitated and unable to provide breast milk um with respect to newborns and infants there have been at total cases of neonates being affected these babies are at risk especially if they are premature because of the fact that they may have an altered immune system but for some reason this seems to be affecting more people who are in the older age groups and again does not necessarily mean that there's not a risk because again you would expect that common um factors are being um provided uh newborns are also at risk for a number of the other seasonal viruses including flu and RSV so a lot of the neonatal intensive care units have put precautions in place which remain in place and have likely mitigated the spread of COVID-19 thank you appreciate that okay and and Robin can you tell us what hospitals need to be doing now to prepare yeah yeah but thank you I think you know first you need to assess your facilities infection control program and assess your personal protective equipment supplies and optimize them and really uh work with your infection preventionists to build a program based on what we know about the virology and and the epidemiology how it is spreading within your community I will say that the CDC has wonderful guidelines around potential mitigation activities that are linked to the level of your community transmission so going back to that original map you can see the bubbles where you have no spread to small spread to very large spread so in northern california we're one of the hot spots one of our counties got a personal mail a letter from the CDC yesterday to um to incorporate more restrictive and and tighten policies uh around how we are managing our patients currently um for patients that are suspected um of COVID and have respiratory infections or symptoms um that we evaluate for them them for hospitalization if they do not need to be hospitalized they're asked to be kind of self-isolate at home um if they are admitted to the hospital you place place a mask on those people it doesn't have to be an n95 but really to protect uh from the release of their droplets should they cough or sneeze because remember this is droplet transmission and it is recommended by the CDC that currently that we place them in rooms if you don't have um negative pressure rooms uh to place them in a room with the door closed um or if you do have um airborne isolation rooms that have negative pressure those should be and they're limited in supply so you're a smaller hospital you'd want to reserve those for patients who will be undergoing aerosol generated procedures another thing that you can do is cohort patients with like conditions so that you limit the number of your staff who are being who are caring for people who are suspected persons under investigation as they call them PUIs versus and COVID positive so you can designate portions of a unit or an entire unit uh to uh housing these individuals and that way you cohort them and limit the number of staff uh that are exposed to the virus itself um I know that uh especially smaller organizations that don't um have the buying capacity of large organizations there are concerns about supplies of respirators in in 95 masks and so again the CDC has provided some wonderful guidance of ways that you can preserve your stock holds um they uh they recommend using expired N95 masks under the guidance that they must be checked for integrity and and wear and tear and any um and do a seal check prior to using them so that's one way one thing that we did is we did check the integrity of the expired masks and we used those to do our fit testing and then use masks that were not expired for to keep them in within the supply of our caregivers um but another uh another uh I guess supply sparing opportunity that the CDC recommend is that during times of limited access to respirators or face masks facilities could consider having your healthcare providers remove only their gloves and gowns and perform and hygiene between patients with the same diagnoses while continuing to wear the same eye protection and respirator or face mask and then there would be instructions and guidelines around not touching your eye protection or your respirator equipment so there like I said there's there's tips to help in preserving your supply um one thing to consider is when you're moving patients around your your hospital to go for other tests or radiology or things like that that the patient should wear a face mask to contain their secretions during transport and then in the end of course we always want that to clean and so make sure that the the the room goes through a terminal cleaning at the end of a COVID patient and one of the things there there was a question I believe last time around how long do you wait to go in and clean to let the room settle and I in doing research we do not know how long yet the COVID virus will remain ambient in the air however you know have a policy around it so my organization has a policy that we close the room and we let it wait one hour before we go in and clean hoping that the virus will settle into the surfaces and be clean but I'm just a couple other things as you anticipate a surge is I think I think the keyword here is anticipate um so implement how you would triage individuals in a in a rapid cycle so you could establish a process to evaluate and test large numbers of patients um in in a in a external to your environment to screen if they actually need to come into your clinics or your hospitals so some of the things that we've done here in northern California is we have people call in and get triage based on their symptoms and then we have a drive-up testing center if they meet criteria they will have a prescription and be told to meet external to our buildings and they will be tested for the virus and then sent home to continue self-isolation unless their symptoms exacerbate and they have concern for their health and they would come back into the hospital so what would those kind of quick screening or triaging places what would they look like and where would you place them based on your regulations and I recommend getting your permits in advance also in your hospitals if you want to flex for instance we do have a hot spot we're getting a lot of patients so we're we had some shelled areas that were ready to build out an implant but we never licensed um on the space you can look at are we licensed it but we never opened it as a unit so you could look at um getting that flex and now um move patients into there since they are licensed space um we looked at um if we're moving from having elective surgeries could we use our post-op care areas to manage these patients and cohort them in a in a contained area again limiting or restricting the number of people that come in contact visitor restrictions are really important at this time to reduce transmission so it's really important that you have you revise your visitor policy that limits the number of visitors and it really you need to consider unit by unit because um for instance a laboring mother it's very exhausting sometimes if it's a long labor if they only have one support person who might want to allow um you know a a um you know their their spouse or they're a significant other and then they may have a nurse practitioner or a laborist who they've identified that they want with them in the room and so really allowing some flexibility based on on units so don't you know really think about your visitor policy um but have a way of screening them for their current conditions as well as um educating them on infection prevention and um you know the hand hygiene and and then also uh to restrict their movement really ask them to you know go from A to B and kind of hang there and then there's ways to bring nourishment to room you might think about how you bring nourishment to the rooms instead of having having large people congregating in your cafeterias so these are um just some of the the ideas of things that are happening now also just to limit the volume is think as a leadership strategy of what you can do to reduce your elective volume and so it's and those are really driven on your community transmission but um um in some places we are limiting elective procedures where we have some areas that are more remote and they have been um not impacted at all by this part so um I think that's that pretty much sums it up for me but I will just want to I just want to say I think getting those permits early so that you're not reacting when people come but you have a plan when the surge begins to happen or things begin to build and then you're in much better position than if you waited until um you began to feel the surge and you weren't able to support it I will also say that your infection prevention resources are usually just a few people in your organization and while they're managing this outbreak uh some I the eyes can come off the ball of your your infection prevention program so thinking about how you'll support those ongoing surveillance and audits and rigor around your regular program will be really important great thank you Robin I appreciate that great insight um all right well we we are very fortunate that Dr. Ed Kelly from the World Health Organization was able to to join us but we just have a few more things to talk about regarding treatment so Art and Jerica if you could just real quick go through what what we can expect in terms of of treatment for these patients and then I'd like to ask Ed Kelly some questions as well sure thanks Donna so um thank you to Robin for doing such an excellent job um on her um part she just did I'm going to skip the first bullet point since she did a great job on talking about personal protective equipment um just a couple other special considerations for healthcare workers who are treating whether it's suspected or known coronavirus patients um one of the things we don't think about a lot is are we carrying some viral particles out of the hospital on our clothing yes we try to do a great job on with our personal protective equipment but that doesn't always um totally isolate um our underlying clothing some hospitals actually have mechanisms for um you changing out of your clothing before you leave the hospital but if you're wearing your clothing home um I would be careful of trying to get that into the um washing machine or isolating it somehow very quickly so you're not moving that particle um onto your other places at home the other thing just real quickly is and we don't think about this a lot but there are some treatments like um using nebulizers certainly a lot of the patients who have um severe asthma or COPD and are requiring nebulized treatments their symptoms may overlap with those of viral patients um these nebulizers can offspray a lot of viral particles so these things should only be used in negative pressure isolation rooms or if you don't have such um certainly in in a single room I certainly would be really careful doing that in in a main emergency department and clearly we've seen a lot of the ambulance services throughout the United States who are now um use having their patients use their uh multi-dose inhalers rather than nebulizing them in the ambulance and waiting to get to the hospital similar kind of thing with non-invasive positive pressure ventilation like CPAP and BiPAP um same kind of considerations be careful that these things aren't spraying particles um and and putting other patients at risk great thank you Jerica yes hi um so another form of a treatment strategy just to segue from art's um great description earlier right now with respect to antiviral treatment there unfortunately there is no specific treatment for COVID-19 at this time what we know is that at the present we need to treat COVID-19 like a severe form of influenza or evironemonia where we should use high supportive tear and treatment as well as respiratory support with oxygen ventilation for those diagnosed and hospitalized in in various medical centers um specifically to to the antiviral agents there are current data out there but they're primarily in vitro data especially with chloroquine which is an anti-malarial drug we we have some in vitro studies that have demonstrated that chloroquine can interfere with endosomal trafficking and have worked against the coronavirus especially it was studied against SARS and MERS at the time however there's no human data yet so right now there's not a lot of evidence supporting this drug for COVID-19 the other one that is currently being in clinical trials there is one in the US it's called remdesivir and it's also being studied I believe in China and and also placed in Italy it was approved as treatment for Ebola infection last year and remdesivir is a novel nucleotide analog that has activity against the coronavirus COVID-2 in vitro data have demonstrated that it's pretty successful against that virus and also related coronaviruses such as SARS and MERS as well and again these are in vitro and animal studies so we don't have it's not prime time yet to use remdesivir for humans and it's not available for public access the one medication that I want to highlight which I apologize is not on the slide is an old protease inhibitor an HIV drug called calitra and it's a combination of lupinavir and rutinavir and it's also been used against SARS in 2003 there's a small trial held that was conducted in Singapore using calitra at low doses and the results as well as efficacy were unclear against against COVID-19 so what what we're suggesting right now is again supportive care and respiratory support for those who have been hospitalized excellent thank you Jerica okay and Ed Kelly are you can are you on the line now can you hear me Ed? Yes I can hear you I just had to take myself off off of mute no worry thank you so much for joining us I really appreciate your time today I think we're ready to move on to the question and answer session and we have lots of questions for you good I'm happy happy to be here and you know the just a quick word you know we've had a long relationship with the patient safety movement foundation and with Joe and the team and actually I was with on a call with Joe and Dr. Tedros our DG yesterday and which when I learned about the about the the webinars that were happening and so very happy to contribute and it's really just a repayment for everything that the foundation's done for the organization and the partnership we've had on on safer patients over the years so over to you wonderful wonderful thank you well there's I wonder if you could just kind of give us an idea of what it is that you're seeing across the world in terms of what countries are doing well and and what countries may not be doing well that we can all learn from? Yeah that there is some obviously each country has very different sort of society health system and approach I think it's it's obvious that the countries that are doing a good job in sort of in WHO's minds are the ones who who really jumped into their response on this robustly supporting frontline health workers supporting hospitals getting testing out there as quick as possible and you know really taking it seriously and understanding what the scope of the problem was and then you know considering measured approach you know WHO has this four C's approach where you have first you just have isolated cases then sporadic cases where you're spreading and then clusters of cases and then down to community spread and so obviously you know we're seeing we're given our in our current world we have we see stories of community spread even though we're living in a country where there's only still sporadic cases and people's reactions happen accordingly but I think as healthcare professionals we you know we're our job is to really let people know where we are um and let people know it's going to be a big wave that's definitely coming but that we're trying to uh to get ourselves ready as quickly as possible and there's definite ways to manage this as it goes forward so um Korea has done a has done a great job testing 20,000 people a day um they have very strict measures that are in place but they are not confining people to their homes they have a lot of cases but um they've been able to manage and people are getting on with their with their life even though um they didn't perhaps jump on things as early as possible now you have other countries that have been less able to get out in front of it and you can see that's the case in Italy and Iran where things are very difficult luckily and then I'll turn it back to you um some of the countries that had the first they got hit the hardest first have actually quite strong you know they're wealthy countries China is a wealthy country Korea Italy as well they've got really swamped and so you know it's given us lessons for the countries who are going to have a much harder time reacting excellent thank you thank you well we have a few questions from the audience um two questions in particular about working in hospitals how do we ensure the safety of healthcare workers um if if other folks are not following precautions was one of the questions and then another is about wearing surgical masks during working hours so um so I wonder if if if someone would like to to answer either of those about that how can healthcare workers keep themselves safe while they're working um Steve Barker just a quick comment my uh my wife actually works in primary care and the kind of sad thing is that all of these people with flu symptoms that are not acutely ill but they've got flu symptoms including fever are coming into doctors offices to be seen and the I know the recommendation from the CDC is that if you have symptoms but you're not terribly acutely ill you should just stay home and not expose other people I think that's an important message we got to get out to the public excellent thank you yeah and can I jump on that too I think this is um just a quick comment that it's um it is about how each individual health worker kind of understands um and on all levels of the of the healthcare team because obviously you're going to have contact with people as they come through the emergency room as they come into your outpatient clinics etc um understands appropriate um uh personal protective equipment and IPC procedures um but so it's chance like the earlier speak we're saying about really emphasizing that that IPC worker most of the successful setups are that even at primary care level you figure out some way of very early triaging anyone with flu like symptoms and that they're in one room and so there are ways there are ways of managing it in Italy for instance the people have a right to to see their the primary healthcare physician the day that they're there and and they had to rewrite the law to actually say that they have a right to see a triage person and first so I think that's that this role of of early triage and sometimes in some of these countries where you're seeing tons of cases that involves a new tent outside or a different structure outside the the regular triage area this is Mitchell Goldstein another thing that we've seen locally at a number of the area hospitals is running short of certain critical supplies like masks um and again when we look at it from a standpoint of engaging with patients and um in some cases having to restrict the activities of students and residents in terms of engaging so that we can save and conserve materials that would otherwise be used up at a larger pace so some part of it is just common sense in terms of recognizing when shortages of certain supplies are occurring and even at a local hospital level restricting access of care providers to those who are the ones who are absolutely necessary and what about elective surgeries um is it is there a recommendation to hospitals to cancel elective surgeries at this point I'm not aware of a recommendation like that are you Steve and do you do you know if uh if that's a recommendation I um ask for WHO uh we have just finished some work and by the way um both CDC I'm sure people have seen it CDC as well as some of the state public health agencies and also WHO and we'd be happy to share this with the with the foundation for for blasting out to folks who are on here there's um have tons of really really good resources on this from resources for the public as healthcare providers and and managers but um in the countries where you're moving from uh clusters of cases to to community spread um it's not a question of preventing infections in that in the healthcare setting necessarily it's really a question of capacity we have recommended to a bunch of countries um that they consider uh the sort of a very analytical and differential approach to uh elective procedures that could take up um bed space in your hospital so you have in a prediction by ecdc today um is that Europe most european countries will have issues managing uh bed capacity in in their hospitals given the the current their spread and places like france spain germany denmark etc so it's um it's definitely a real concern it's not something that the us is at that level now but it's something that you should have a plan for excellent and so then and can you then um talk a little bit about the whole concept of social distancing and and and how that relates to hospital capacity and yeah yeah but maybe that folks uh the other folks on the call would be would be definitely in a better place for that but i think that um uh this so i mean i think we do have to remember the way that we will manage the outbreak is by case identification and contact tracing i mean that's uh social distancing is an important thing to get the public involved also it's a good they're good procedures um in addition to you know good ipc good decontamination approaches in hospitals but um uh but it's only one anyway it's one one piece of it but i think there is um you know hospitals should send the message that is being sent out that businesses are doing all the other organizations out there are doing you know in terms you obviously can't work from home that's the whole point but you can set up ways of of examining you know where do you really have high high traffic areas and trying to to manage things differently okay great great yeah i'd like to add one comment to that you can't work from home but actually there there is the option that we need to explore more and that is telemedicine where um routine clinic type appointments primary care especially can be done remotely and you know in in in arizona that's very common because there are a lot of remote locations such as indian reservations where doctors especially specialists are not readily available so think about telemedicine yeah i think just to add to that that's um every you know every crisis like this presents us with opportunities for learning new ways of doing things and for sure we should have been moving this way a long time ago to reach hard to reach populations anyway but i think it'll really push um you know anyway looking how you can push some of your uh the geeks you have working for you and um in your it department to explore uh some ways to do this now it's difficult to roll out new ways of doing medicine in the middle of an outbreak but but at least to start to look at some of that is really important great great um a few a few last questions here um one question is regarding um covid and sepsis are our patients that have that are dying of co covid actually dying of sepsis or of some other respiratory situation um maybe art do you know the answer to that well i i i think in general um most of our sickest patients are dying from complications of um the pulmonary aspects of the disease um rather than what would be considered a true sepsis um but i i don't know that i have any facts to to support the um comparative number of people with covid that have sepsis versus um you know pulmonary failure okay excellent all right well we are right at the top of the hour and i want to thank everybody for joining and our panelists thank you so much to all of our panelists this morning um and all of the great information that you shared as as we did last week we will send out this powerpoint in a pdf version to everybody who who attended so that you can have the links that we shared and this information will also be put onto our our uh resources page or our coronavirus resource resources page at the patient safety movement foundation we will be here again next week and we'll be doing this webinar every friday at eight a.m pacific standard time until the coronavirus outbreak is under control so again thank you to our panelists i very much appreciate your participation today thank you very much donna thanks thank you thank you everybody thank thank you donna thank you thank you i have a good week bye bye