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Newswise — The COVID-19 pandemic has hit some nursing homes especially hard – including in the hotspot state of Michigan. Hundreds of deaths of residents in homes from Seattle to Boston have raised concerns about how well facilities are protecting the 1.3 million older Americans who live in them. Those concerns have prompted new federal and state requirements about testing and transparency. But it might have been worse. New data suggests that at least in Michigan, nursing homes that responded to a survey were far better prepared for this pandemic than they were for the last one. The study includes responses from130 nursing homes to a survey during the week the state announced its first documented case of COVID-19. It shows that nearly all had a pandemic plan in place. That’s compared with just over half of the 280 nursing homes that answered the same survey in 2007. Nearly all said they now have at least one staff member in charge of pandemic preparedness. The findings are reported in the Journal of the American Geriatrics Society by a team from the University of Michigan that has studied and worked to improve nursing home infection prevention for years. Members of the team have several other recent publications with direct or indirect relevance to the COVID-19 pandemic, including putting forth recommendations for nursing homes and other housing facilities for older adults to use in planning how they will respond to pandemics such as COVID-19. Lona Mody, M.D., M.Sc., a geriatrician at Michigan Medicine, U-M’s academic medical center, and the VA Ann Arbor Healthcare System, is senior author of both of the new publications. She’s a professor of internal medicine, the associate director for clinical and translational research at the U-M Geriatrics Center, and director of the Infection Prevention in Aging research group. “Our nursing homes house some of the most vulnerable in our society,” says Mody. “This virus unfortunately is very contagious, the disease it causes has incredibly poor outcomes in older adults with comorbidities, and nursing homes are communal settings with shared spaces and resource limitations. This creates a perfect storm of sorts.  Being novel, we learn as go and have to learn really quickly.” Mody heads the PRIISM, or Preventing Resistance and Infection by Integrating Systems in Michigan, project, which partners with skilled nursing facilities, hospitals and public health agencies across the state to perform research and create and test education and training materials for nursing home staff. The program’s website has many free materials for use by nursing homes everywhere. Pandemic planning The new survey data show Michigan’s nursing homes have done a lot to prepare for pandemics since the last time the U-M team performed the survey. That previous survey was taken before the H1N1 influenza pandemic of 2009, but after the H5N1 “bird flu” pandemic of 2005 raised national awareness of the importance of pandemic preparedness. Mody and colleagues published pandemic preparedness guidance for nursing homes at that time. In mid-March of this year, 85% of nursing homes said they had stockpiled supplies before COVID-19 hit, compared with 57% after the H5N1 pandemic. Most of those that had stockpiled supplies had focused on surgical masks, gloves and hand sanitizer. Less than half had stockpiled N95 respirator masks, which are recommended by national and global health authorities for health care workers performing certain types of care on a COVID-19 patient. Still, 42% of the nursing homes that answered a question about COVID-19-specific concerns said they were worried about running short of personal protective gear. “Although the size and severity of COVID-19 outbreaks in some nursing homes have taken everyone by surprise, just as so much about this pandemic has, in general nursing homes knew exactly what their challenges were going to be in a pandemic – PPE shortages, staff shortages and worries that they did not have the capacity to care for COVID patients after their hospital stay.” Nearly all now said they had trained staff on how their facility would respond in a pandemic, up from 42% in 2007. But only one-third had conducted a pandemic drill. And Mody notes that nursing homes have a much higher rate of staff turnover than hospitals – meaning that training on infection prevention and pandemic response has to be offered whenever a new person joins the organization. Michigan’s nursing homes appear to have gotten better connected to the broader health care system in the past decade, with significantly more saying they now have communication lines established with local hospitals and public health departments. Many also said they were drawing COVID-19 guidance not just from the Centers for Disease Control and Prevention, but also from state and local health departments. Half also received guidance from their home’s corporate parent. And while half of the nursing homes surveyed this year said they expected significant staff shortages due to COVID-19, most of them said they had a plan to deal with that. Most planned to ask existing clinical staff to work more hours, and to redeploy non-clinical staff. Two-thirds expected they’d need to require staff to work overtime. The survey also explored the potential for nursing homes to relieve the burden on hospitals. In all, 82% said they’d be willing to take non-pandemic patients from overburdened hospitals now, compared with 53% in 2007. But the percent that said they’d be able to accept patients with the pandemic disease stayed the same, at one-third of responding homes. Additional guidance Mody and her colleagues John P. Mills, M.D. and Keith Kaye, M.D. from the U-M Division of Infectious Diseases recently published some recommendations regarding COVID-19 and older adults in the journal JCI Insight. Mody and Kaye are members of the U-M Institute for Healthcare Policy and Innovation. They note that it’s not just nursing homes with long-term residents that need to be ready to care for vulnerable older adults during pandemics. In fact, the trend over the past decade to use nursing homes more often for short-term stays by patients who have been discharged from a hospital, and to create state and local programs that allow older adults to ‘age in place’ instead of moving to nursing homes for the long-term, have led to potential gaps for pandemic responses to help older adults. They call for policymakers to address those gaps, by creating pandemic-specific plans for community-dwelling older adults, especially those with health needs. As for nursing homes, they recommend that in areas where COVID-19 is spreading widely in the community, facilities should take these steps, and others: place patients with known or suspected disease in the same area of the facility, away from others perform rapid COVID-19 tests on all patients, both short-stay and long-stay screen healthcare workers and other staff for symptoms including checking temperatures limit visitors and group activities require everyone wear a surgical mask require additional protective gear for clinical staff The limits on group activities tie in to other research by Mody and her colleagues, published in JAGS in December. That study sampled surfaces, and the hands of patients and staff, in the common areas and rehabilitation gyms with in nursing homes, and looked for drug-resistant bacteria that can cause dangerous infections. Though the team didn’t look for the presence of viruses in these areas, they did find that half of the samples taken in rehab gyms contained at least one type of bacteria that was resistant to several types of antibiotics. In addition to stockpiling PPE and cleaning supplies, the recommend that nursing homes should use “burn calculators” to predict how quickly they’ll use those supplies based on their patient population. If nursing homes and other residential facilities for older adults haven’t already done so, they should establish lines of communication with local health departments in advance of any outbreak of COVID-19 in their facility. They should also focus on staff retention, including providing for generous sick leave policies so that staff can stay home when ill, and hazard pay for those who can come to work. And, the team says, nursing homes should make sure they have an infection prevention plan in place for staff when a patient has died of COVID-19. Another gap in preparedness that the COVID-19 pandemic is revealing, Mody says, is a gap in communication with patients and their families. Keeping families informed, and enabling them to connect virtually with their loved ones when they can’t visit in person, is crucial, she says.
Florida Atlantic University Joseph G. Ouslander, M.D., an internationally renowned geriatrician, a professor of geriatric medicine, and a senior advisor to the dean, FAU’s Schmidt College of Medicine. Newswise — As the coronavirus disease (COVID-19) pandemic advances so does the uncertainty and evolution of the pandemic as it relates to nursing homes and long-term care facilities (LTCF). Early reports suggest the case fatality rate for those over 80, which constitutes nearly half of LTCF residents, is more than 15 percent. In areas where there is a shortage of ICU beds and respirators, even the most carefully thought out ethical approaches to rationing these resources will place older patients at a lower priority. LTCFs must be prepared to manage patients who have had or have COVID-19 infection.  In an editorial published in the Journal of the American Geriatric Society, Joseph G. Ouslander, M.D., an internationally renowned geriatrician, a professor of geriatric medicine, and a senior advisor to the dean at Florida Atlantic University’s Schmidt College of Medicine, provides key updates and resources for front-line nursing home staff and clinicians. “Until more rapid COVID testing is available to enable us to test all nursing home patients and staff, cases of COVID-19 infection are likely to continue to increase in the long-term care facility setting,” said Ouslander. “To complicate matters, long-term care facilities will be asked to accept patients with possible or known COVID-19 from hospitals if the local or state government has not required the suspension of admissions during the presence of active COVID-19 cases.” Ouslander recommends developing an emergency plan that addresses patient/resident placement and staffing considerations before a cluster infection or outbreak occurs; employing intensive infection control practices; behaving as if all patients and staff are potentially infected with the virus; and continuing to carefully screen staff, recognizing that some may be asymptomatic carriers of the virus and pass the screening. In addition to restricting visitors, communal dining and cancelling other group activities, Ouslander advises providing therapy in the patient/resident room when feasible; if not, then safe social distancing should be used in therapy areas. Staff should wear plain surgical masks at all times and use N95 masks if available when performing high-risk procedures such as respiratory treatments. Full personal protective equipment (PPE) should be used when appropriate and available based on patient/resident symptoms and signs. Staff who are quarantined based on symptoms and want to return to work must be tested to confirm they are not shedding the virus; returning health care workforce should be a priority for rapid testing. In addition, clinicians should monitor vital signs at least daily and more frequently if indicated; and even subtle changes in a patient’s condition should be taken seriously and further evaluated when clinically indicated. Because LTCF patients/residents cannot have visitors or participate in group activities, their isolation may have adverse effects on their mental health. Morale of staff may also be affected. Experience in China suggests that half or more of health care workers treating patients with COVID-19 infection had symptoms of depression, anxiety, insomnia or distress. Ouslander suggests that LTCFs provide as much psychosocial care and support as feasible and use social media and video phone call options. Grief counseling for families and staff, as well as assistance with burial arrangements may be needed. In the United States, of the approximately 1.2 million registered nurses employed outside of hospital settings, 24 percent are ages 55 to 64 years and 5 percent are age 65 years or older. Of the approximately 1.2 million physicians, an estimated 230,000 (20 percent) are ages 55 to 64 years and an estimated 106,000 (9 percent) are age 65 years or older. Many hospitals and health care systems are developing strategies to use these health professionals in productive ways that may not necessarily involve direct patient contact. The U.S. Centers for Medicare and Medicaid Services has issued many waivers that could help bolster the health care workforce and the capacity of the nation’s health care system to care for older COVID-19 patients. “During this challenging and unprecedented pandemic of our lifetimes, we should be thankful for all of the front-line nursing home staff and clinicians who are risking their health and that of their families to care for the most vulnerable among us,” said Ouslander. “Shortages of these professionals are anticipated, and the aging of our health care workforce makes many of us even more susceptible to acquiring COVID-19 and its complications. We all have a role to play, and we should support our geriatric health care workforce, our patients, and their families in whatever ways we can contribute to meet this daunting challenge.”
Newswise — Rockville, Md. (April 16, 2020)—A new review suggests that higher-than-normal levels of an enzyme involved in blood clot prevention may be a common risk factor for developing COVID-19—a respiratory disease caused by the novel coronavirus SARS-CoV-2—in some populations. The review is published in Physiological Reviews. People with diabetes, high blood pressure and heart, lung or kidney disease have a higher risk of developing COVID-19. In addition, people with preexisting medical conditions typically become sicker when infected with SARS-CoV-2 than those in otherwise good health. Research has found that one of the leading causes of death from COVID-19 is hemorrhage or bleeding disorders and that one of the characteristics of the disease is overactivity of the system responsible for removing blood clots (hyperfibrinolysis). Elevated levels of plasminogen and plasmin have been found to be a common factor in people with diabetes and preexisting heart, lung and kidney conditions. Plasminogen is an inactive substance in the blood. When substances in the cells of the blood vessels activate plasminogen, it generates plasmin, an enzyme that removes blood clots from the blood. Higher-than-normal levels of both of these chemicals can lead to severe bleeding. Studies report that more than 97% of people hospitalized with COVID-19 have increased levels of D-dimer, a protein in the blood that is produced when a blood clot dissolves. D-dimer levels are associated with the amount of virus detected in the body and continue to rise as the severity of COVID-19 increases. This is particularly true in people who develop the often-fatal complication of acute respiratory distress syndrome (ARDS). “In contrast, D-dimer levels decreased to control levels in [COVID-19] survivors or non-ARDS patients,” the review’s authors wrote. “The time [period] for the elevated D-dimer [to go] down in mild [cases] or survivors is dependent. Generally, it takes at least one week for mild [cases] but longer for severe patients,” explained Hong-Long Ji, MD, PhD, corresponding author of the review. “Measurements of plasmin(ogen) levels and its enzymatic activity may be important biomarkers of disease severity” in people with COVID-19, the authors wrote. In addition, treating hyperfibrinolysis “may prove to be a promising strategy for improving the clinical outcomes of patients with [additional medical] conditions,” they added. Read the full article, “Elevated plasmin(ogen) as a common risk factor for COVID-19 susceptibility,” published in Physiological Reviews. This article is part of a special, freely accessible coronavirus-related collection of articles published in APS journals.   Physiology is the study of how molecules, cells, tissues and organs function in health and disease. Established in 1887, the American Physiological Society (APS) was the first U.S. society in the biomedical sciences field. The Society represents 9,000 members and publishes 15 peer-reviewed journals with a worldwide readership.
Newswise — PHILADELPHIA — A new trial led by the Perelman School of Medicine at the University of Pennsylvania will evaluate whether the use of medications to treat high blood pressure affect outcomes among patients who are prescribed the medication and hospitalized with COVID-19. As part of the multi-center, international trial called REPLACE COVID, investigators will examine whether ACE inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs)—two classes of medications to treat high blood pressure—help to mitigate complications or lead to more severe symptoms and worse outcomes. The study (NCT04338009) is enrolling patients now.                                                                   Through the trial, investigators will randomly assign patients who are hospitalized with COVID-19 to either stop or continue taking their prescribed medication. The team will closely monitor the patients to evaluate the effect of temporarily stopping the therapy. Julio A. Chirinos, MD, PhD, an associate professor of Cardiovascular Medicine, and Jordana B. Cohen, MD, MSCE, an assistant professor in the division of Renal-Electrolyte and Hypertension, are the study’s co-principal investigators.  “While some data suggests patients with underlying health conditions, like heart disease and high blood pressure, have a higher risk of developing a more severe form of COVID-19, we don’t know whether ACE inhibitors or ARBs are beneficial or harmful,” Chirinos said. “There’s an urgent need to understand how these medications may alter the disease course so we can better guide our treatment for patients who are prescribed these therapies and infected with COVID-19.” High blood pressure, defined as a top reading of at least 130 or a bottom one of 80, affects nearly half of American adults. If left untreated, the condition increases one’s risk for severe complications, including heart attack and stroke. More than one-third of people with high blood pressure are prescribed ACEIs or ARBs. Past research has shown that these medications may enhance the virus’ ability to bind to cells in the body. However, separate studies have found that the medications may, in fact, result in an improved response in the kidney, lung, and heart to protect against the virus. For this trial, investigators plan to enroll 152 patients who are hospitalized with a suspected diagnosis of COVID-19 and who already use one of the medications. The team, which also includes Thomas C. Hanff, MD, MPH, a Cardiovascular Medicine fellow at Penn, will perform the study on a pragmatic intent-to-treat basis, meaning clinicians can change the dose or discontinue the medications if there is a compelling clinical reason. Ultimately, investigators aim to develop a global risk score that ranks patient outcomes based on four factors: time to death, the number of days supported by mechanical ventilation or extracorporeal membrane oxygenation (ECMO), length of time on renal replacement therapy, and a modified sequential organ failure assessment score. “Many people are changing their usual medical management right now based on limited or incomplete information,” Cohen said. “Until we have high quality evidence, we recommend that patients continue to take these medications as prescribed unless they are told to stop them by their medical provider.” Given the study’s expedited timeframe, investigators are pursuing a variety of funding mechanisms. The team also established a social fundraising campaign to help support the study. Jesse L. Chittams, managing director of the Biostatistics Analysis Core at the University of Pennsylvania, is also an investigator on the study.
Photo by James Zanewicz The new COVID-19 testing being done at the medical school will save time from having to ship samples to the state lab in Baton Rouge. The goal is to do about 100 tests a day, with results available within 24 hours. Newswise — Tulane University has added a second avenue for COVID-19 testing, this one taking place at a Tulane School of Medicine repurposed research lab where results can be processed within a day. The test is identical to the PCR test being used by the Centers for Disease Control (CDC) and is another way that Tulane is working to ease the testing crisis and stop the spread of COVID-19, which has hit the New Orleans area especially hard.Earlier this week, a laboratory based at Tulane Medical Center in partnership with LSU and UMC-LCMC began conducting a different new test for COVID-19 that can yield results within four hours. Researchers at the HCA-TMC Laboratory ran its first set of tests using the Cobas 6800 analyzer over the weekend and is now capable of running nearly 200 tests a day on patients at both Tulane Medical Center and University Medical Center. The testing being done at the medical school will save time from having to ship samples to the state lab in Baton Rouge, where because of demand, results can take days, rather than hours, to obtain. “Tulane’s efforts could help more quickly triage patients to the appropriate section of the hospital, speed up recruitment into clinical trials for interested patients, and even, over time, provide the ability to determine whether viral loads are affected by various interventions,” said Dr. Dahlene Fusco, an infectious disease specialist at Tulane University School of Medicine.  “This information is crucial in our understanding of how to best treat patients.”The School of Medicine test was developed by Tulane virologist Bob Garry and his team in collaboration with Drs. Xiao-Ming Yin and Di Tian in the Department of Pathology. It is based on the PCR (Polymerase Chain Reaction) test being used by the CDC, which determines a positive or negative diagnosis through a nasal swab. For now, the test is available only to members of the Tulane medical community who show symptoms of COVID-19, such as coughing, respiratory struggles and fever. They include patients, health care providers, faculty, staff, residents and students. The goal is to do about 100 tests a day, with results available within 24 hours. Eventually, Tulane hopes to double the number of tests and, if possible, extend their availability to the community.Garry, who played an integral role in test development during the Lassa and Ebola crises, said Tulane’s ability to offer the test is a significant achievement, given the complex and ever-changing regulatory environment under which the nation’s medical community is operating.“Because it’s an in-house test, we don’t need to send samples to a central lab to wait for the result,” Garry said. “It’s not rocket science but it does take a supply chain which is challenging but getting better.” Garry facilitated the test in collaboration with the Pathology Department, which has validated and is administering the test in a lab certified by the Clinical Laboratory Improvement Amendments (CLIA) which ensures quality lab testing. Patrice Delafontaine, executive dean of the School of Medicine, said the availability of CLIA-certified lab in pathology was essential in getting the COVID-19 testing lab up and running.  “Dr. Lee Hamm (dean of the School of Medicine) and I felt it was critical to organize this effort very quickly,” he said, “and the extraordinary expertise in virology at Tulane, in particular through Bob Garry and his program, provided the most efficient method to get this done.”
Numerical data sometimes reveal facts that are otherwise concealed within an onslaught of information from an overwhelming number of sources. Prof. Ron Milo and research student Yinon Bar-On of the Weizmann Institute of Science’s Department of Plant and Environmental Sciences, together with American colleagues Prof. Rob Phillips of Caltech and Dr. Avi Flamholz of the University of California, Berkeley, have now employed an original research method to organize the flood of coronavirus information in an orderly framework. The scientists examined hundreds of studies from around the world. The first stage of the project required the scientists to understand the different measurement and estimation methods so that they could coordinate and translate all the findings into the same “language” – a complex task requiring great care. The scientists’ experience helped them in this task, as they translated and consolidated a wealth of data and findings that they accumulated in previous studies: the number of cells in the human body, biomass distribution on Earth, and more. (For example, see: http://book.bionumbers.org/.) The research was fast-tracked to publication in the journal eLife. One of the interesting findings highlighted by the collected data is the similarity between the coronavirus genome and the genome of other viruses. For example, the genome of the coronavirus is:  96% identical to a coronavirus genome that infects bats 91% identical to a coronavirus genome that infects scaly anteaters (pangolins) 80% identical to the SARS virus that erupted about two decades ago 55% identical to the MERS virus that erupted eight years ago 50% identical to the coronavirus that causes “common colds” The scientists also present numerical data on the coronavirus’s attachment to various organs in the body (bronchi, lungs, different types of cells, and more). The study presents the number of copies and other quantitative features of virus “targets,” which are relevant for developing vaccines and pharmaceuticals that block the virus’s ability to adhere to and penetrate a human cell. An additional part of the team’s research relates to the virus’s mutation accumulation rate. This value is related to the chance (risk) that the virus will bypass vaccines developed against it – and return to attack humans. The coronavirus’s mutation accumulation rate is relatively slow compared to influenza viruses; Prof. Milo cautiously estimates that this may indicate that drugs and vaccines developed by scientists will be more durable in curbing this virus over time. Prof. Ron Milo’s research is supported by the Mary and Tom Beck – Canadian Center for Alternative Energy Research, which he heads; the Zuckerman STEM Leadership Program; Dr. and Mrs. Brian Altman; the Larson Charitable Foundation New Scientist Fund; the Ullmann Family Foundation; Dana and Yossie Hollander; and the European Research Council. Prof. Milo is the incumbent of the Charles and Louise Gartner Professorial Chair. The Weizmann Institute of Science in Rehovot, Israel, is one of the world’s top-ranking multidisciplinary research institutions. The Institute’s 3,800-strong scientific community engages in research addressing crucial problems in medicine and health, energy, technology, agriculture, and the environment. Outstanding young scientists from around the world pursue advanced degrees at the Weizmann Institute’s Feinberg Graduate School. The discoveries and theories of Weizmann Institute scientists have had a major impact on the wider scientific community, as well as on the quality of life of millions of people worldwide.
Experts from Seattle Cancer Care Alliance share lessons learned from early experiences treating people with cancer during COVID-19 outbreak via free online article in JNCCN—Journal of the National Comprehensive Cancer Network Newswise — PLYMOUTH MEETING, PA [March 18, 2020] — Experts from the Seattle Cancer Care Alliance (SCCA)—a Member Institution of the National Comprehensive Cancer Network® (NCCN®)—are sharing insights and advice on how to continue providing optimal cancer care during the novel coronavirus (COVID-19) pandemic. SCCA includes the Fred Hutchinson Cancer Research Center and the University of Washington, which are located in the epicenter of the COVID-19 outbreak in the United States. The peer-reviewed article sharing best practices is available for free online-ahead-of-print via open access at JNCCN.org. “Responding quickly and confidently to the COVID-19 crisis is the health care challenge of our generation,” said co-lead author F. Marc Stewart, MD, Medical Director, SCCA. “Our overarching goal is to keep our cancer patients and staff safe while continuing to provide compassionate, high-quality care under circumstances we’ve never had to face before. We are working around the clock to develop new guidelines and policies to address situations that we couldn’t have imagined several weeks ago. When the pandemic ends, we will all be proud of what we did for our patients and each other in this critical moment for humanity.” “The COVID-19 pandemic is impacting every facet of our global and domestic societies and health care systems in unprecedented fashion,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “People with cancer appear to be at increased risk of COVID-19, and their outcomes are worse than individuals without cancer. The NCCN Member Institutions are rapidly gaining experience in preventing and managing COVID-19. As is the nature of the NCCN Member Institutions, they are sharing their experience in organizing and managing institutional and care systems responses and best practices in this rapidly evolving global effort.” The article stresses the importance of keeping channels of communication open between administrators and staff, patients, caregivers, and the general public. The authors recommend forming an Incident Command Structure (as illustrated in included image) to provide early coordination of institution-wide efforts and to rapidly respond to changing information. They highlight the need to remain flexible and ready for unexpected challenges. Some of the anticipated challenges include: Staff shortages due to potential exposure and/or school closings Limitations of resources such as hospital beds, mechanical ventilation, and other equipment Impact on treatment from travel bans, including reduced access to international donors for allogeneic stem cell transplantation The authors recommend mitigating some of these concerns through proactive measures that include: Providing patient information via handouts, signs, web-based communication, and a dedicated phone line for questions and triage Rescheduling “well” visits and elective surgeries, and deferring second opinion consultations (where care is already appropriately established) Increasing hours of general hospital operations to reduce the unnecessary use of emergency department resources Reinforcing a strict “stay at home when ill” policy and insuring staff have access to testing Restricting travel and enabling work-from-home wherever possible Prioritizing the use of soap and water over hand gel Limiting the number of team members who enter patients’ rooms Considering lower thresholds for blood transfusions Moving some procedures from inpatient to outpatient Adopting a no visitor policy with rare exceptions such as end-of-life circumstances Having upfront, proactive palliative and end-of-life conversations with cancer patients who may become infected with COVID-19 The article also addresses the importance of self-care within and beyond the medical community. The authors call for the prioritization of measures to protect health and frontline staff and assure a safe work environment in order to prevent provider burnout. Those measures include compensation policies, reassignments to administrative roles for immunocompromised staff, and the creation of a back-up labor pool. NCCN is also gathering documents and links from the leading cancer centers that comprise the nonprofit alliance, and sharing them all online at NCCN.org/covid-19. These include print outs for patient information, screening tools, visitation policies, and other essential forms. Hospitals worldwide are free to use or adapt these resources immediately. The site will be continuously updated as new resources become available. The entire article can be read at https://jnccn.org/fileasset/jnccn1804-Ueda_20118_preprint.pdf, or via a link at NCCN.org/covid-19. # # # About the National Comprehensive Cancer Network The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world. The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT. Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news. Follow NCCN on Twitter @NCCN, Facebook @NCCNorg, and Instagram @NCCNorg.
Hospitals can quickly and safely implement free reporting tool to manage utilization of critical supplies and avoid stockouts during high-volume COVID-19 response EAGAN, MN (March 18, 2020) — The rapid spread of the novel coronavirus (COVID-19) has placed unique pressures on the hospital supply chain, forcing facilities to maintain a detailed picture of what inventory they have available, where it’s located, and how fast it’s moving – all of which is essential to treating the high volume of patients with COVID-19 symptoms. To help hospitals achieve this critical balance and to ensure health care providers have the proper personal protective equipment (PPE) to safely perform their jobs, Jump Technologies announced today it will temporarily open it’s inventory management platform up to all hospitals at no cost to help them ensure they have the proper PPE and related COVID-19 supplies available for hospital workers.   “At times like this, it’s vitally important for hospitals to have the supplies their employees need to stay safe. To do this, they need a clear picture of  PPE inventory so they understand the resources available to them and whether they are at risk of running out of essential supplies before their next shipment,” said John Freund, CEO of Jump Technologies. “Because we understand the challenges this pandemic creates for hospital supply chain, we are waiving our fees to ensure as many hospitals as possible have access to tools that will give them insight into high-demand supplies that are essential to their employees.”   According to Freund, the Jump Technologies’ solution runs in the cloud and does not require any special hardware, so it can be set up quickly and with no disruption to hospital operations. Supply chain staff can be up to speed on using the system with just a 30-minute training session. Key elements of the reporting tool include: Using JumpStock, hospitals can easily see where existing supplies are located (in hospital storage or in a warehouse); track consumption by department, clinic, or user; and forecast potential stockouts. The new solution does not require integration into the hospital ERP or EMR and does not require access to sensitive data such as patient information or pricing. Because it is a cloud-based solution, it is safe, simple, and secure for hospitals.   Hospitals and health systems can access the Jump Technologies solution by filling out a form at www.jumptech.com/covid19. A representative from Jump Technologies will contact the hospital to discuss setup options, configure the account, and upload data.
By Dr. Charles Herrick, Chair of Psychiatry, Nuvance Health Newswise — Does the COVID-19 pandemic have you feeling anxious and worried? If yes, please know that you’re not alone! Being nervous about the chances that you, a loved one, or a friend may come down with this novel coronavirus is common. These feelings can be intensified by the seemingly nonstop news coverage on the topic. While meant to provide information and, to some degree, to reassure the public, such round-the-clock coverage can lead to panic, especially as the COVID-19 outbreaks are now closer to home. Thankfully, there are a number of ways to deal with these feelings, including that old favorite, taking a deep breath. Doing so enables more air to flow into your body and can help calm your nerves while also reducing stress and anxiety. So let’s start there. Deep breath in … deep breath out … Here are answers to common questions and more tips to help you during this stressful time: What can we do to manage anxiety and fear during this COVID-19 pandemic? Recognize it’s normal to panic: As human beings, we’re susceptible to panic during unknown and stressful events. Having this awareness can actually help to manage the panic because you know it’s not uncommon. If you already have existing anxiety, focus on the coping strategies you regularly practice when there are triggering events like this outbreak of COVID-19. Stick to the facts: Focusing on facts is a better way to judge the risk, rather than relying on peers and social media. Even with standard media, make sure the sources of your information are from trusted sources. The Centers for Disease Control and Prevention (CDC) is an excellent and sound source for factual, current information, as well as your state and local health departments and hospitals. Stick to what you can control: Keep to your routine as best you can, while following the guidelines provided by the CDC, state and local health departments, and your local hospitals. Routines can be soothing because they are familiar. Remember to exercise, eat well, stay hydrated, and get enough sleep to keep your immune system strong, which is important to reduce the risk of getting sick with other illnesses (we’re still in cold and flu season) and to help manage stress. Remember that you’re not alone: Touch base with loved ones, family, and friends through your usual daily activities; if that doesn’t include in-person get-togethers, try phone calls or video chats. Keep in mind that everyone is going through this now. With all of us in essentially the same situation, you can achieve a sense of “we’ll figure this out together.” This mindset can be empowering and uplifting. Put things in perspective: The vast majority of viral infections are not from this new coronavirus; they continue to be common cold and flu. Refrain from thinking that anyone who has a cough or fever must have COVID-19. The risk of serious illness from COVID-19 remains low. Most infected people will experience mild upper respiratory symptoms, including cough, nasal congestion, and a fever. As of this writing, more people have died from flu this year in just the United States alone, compared to deaths from COVID-19 worldwide. The CDC estimates that from October 1, 2019 to February 29, 2020, between 20,000 and 52,000 Americans died from flu, and predicts that at least 12,000 Americans will die from the virus in any given year. Consider opioids too, which were involved in a staggering 47,600 overdose deaths in the United States in 2017, according to the latest data from the CDC. Continue to enjoy life: The sun is still shining. Babies are still being born. People are still producing great work, such as your care teams and staff at Nuvance Health who are continuously working to keep you safe as we fight against COVID-19. So continue to enjoy your life, and feel good when you follow guidelines to reduce your risk of possible exposure to COVID-19. Is there anything we can look forward to? Yes! Every crisis is an opportunity. If you end up in self-isolation, and your routine changes in some way, find something positive in that. For example, take up a new home-based hobby that you’ve been wanting to do, such as meditation or yoga; start that book you’ve been wanting to read. Strong bonds are formed during times like these that probably wouldn’t have formed under normal circumstances. Remember that we’re facing adversity together, and that strong social connections are how we survive these types of events. Again, fear — and even panic — are normal emotions to experience during events like these. Accept that, stay informed with accurate facts, and remember that we’re all in this together. And, yes, take a deep breath. Nuvance Health is keeping the communities informed on our website at nuvancehealth.org/coronavirus, and on social media @NuvanceHealth, or search for your hospital’s name.
Newswise — The Families First Coronavirus Response Act (H.R. 6201) represents swift action by the House of Representatives to bolster federal responses to the spread of coronavirus and aims to reduce the pandemic’s impacts on Americans’ safety and financial security, while addressing an ongoing COVID-19 testing backlog. The Infectious Diseases Society of America, however, is alarmed that the bill only allows coverage for in vitro diagnostic test kits and laboratory developed tests that have already received Emergency Use Authorization by the U.S. Food and Drug Administration, excluding tests from developers that are in the process of finalizing EUA applications. This runs counter to the updated Feb. 29 policy allowing immediate use of tests that have been validated by developers, reduces patient access to urgently needed diagnostic tools and leaves patients open to surprise billing for tests administered under current policy. The current bill language will potentially exclude thousands of tests that can be used to identify transmission and stanch the outbreak. With the bill now heading to the Senate, IDSA strongly encourages Congress to provide accessible testing for all Americans who require it by amending the current bill language to cover tests that have been validated in accordance with existing policy. This will ensure broad and sustained rollout of lifesaving testing, even in the event of delays in the EUA process.