1.
Weitzman ECHO on
Coronavirus
March 18, 2020

2.
A Further Primary Care Perspective
Stephen J Scholand, MD
Infectious Disease Consultant
18 March, 2020

3.
Objectives
- Review latest information on novel coronavirus (2019-
nCoV, SARS-CoV-2) epidemiology in the USA
- Heighten awareness of clinical clues and laboratory
features of this disease
- TEST, TEST, TEST
- Coordinate healthcare delivery in partnership with local
health department and healthcare leadership
- Advocate and practice protection: Patient, Family, Staff,
Self
- Remain highly vigilant
- Take care of oneself!

4.
As of March 18, 2020 - https://coronavirus.jhu.edu/map.html

5.
Avoiding the Surge

6.
What to do if you have a
potential patient?
Person Under Investigation (PUI)?

7.
Is it a “real case”?

8.
Can the patient stay at home?
• Stay at home except to get medical care
• Stay away from others ‘sick room’, separate
bathroom
• Wear face mask; cover coughs/tissues
• Avoid visitors; avoid sharing (cups etc)
• Clean surfaces
• Call ahead if going to PCP
• Avoid NSAIDs (Motrin), use Tylenol

9.
Keep in mind…

10.
Real World
vs

11.
Test every suspected case
• “You cannot fight a fire blindfolded. And we
cannot stop this pandemic if we don’t know
who is infected. We have a simple message for
all countries: test, test, test.
Test every suspected case. ”
- WHO Director-General Dr. Tedros Adhanom Ghebreyesus

12.
Summary
• New virus spreading
– Expect to see patients
– ECHO Public Health messages
• Make sure preparations are in place
– Office / Clinic protocol
– PPE: Masks! Gloves…
– TEST, TEST, TEST!
– Hand Hygiene; surface disinfectant; equipment
• COMMUNICATION
– Colleagues, other health care facilities
– State and local health departments
Dr. Li Wenliang

13.
Staying up to date – Trusted sources
• https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/callinfo_030520.asp
• https://www.who.int/emergencies/diseases/novel-
coronavirus-2019

14.
NEMS COVID-19 Preparation
Jerry Jew, MD, MBA
Given: 3/12/20

15.
Contents
Entrance Screening Workflow
Live Chat/ TeleVisit
HR Policy – Multi Tier Contingent Plans
Education/ Communication to Staff
Controlling Inventory and Supplies

16.
Entrance Screening Workflow
Patient Goes to NEMS
Entrance Security
conducts:
- Questionnaire
- Patients sanitize
Hands
If Positive, Patient Will
Proceed To MA
Screening
If questionnaire
confirmed, patient will
receive a mask and
proceed
If patient is deemed at
highest risk, they will
be directed to
isolation room
Follow NEMS
procedure for
isolation
If Negative Patient
Will Proceed Inside

17.
Live Chat/ TeleVisit
To better serve patients and protect Staff, NEMS has started
LiveChat/TeleVisit options:
NEMS has a virtual Live Chat platform on their home
page NEMS.org.
Live Chat with patients to allow for screening and ability
to schedule patients with a provider for Televisit.

18.
HR Policy - Multi Tier Contingent
Plans
Tier 1; In Full Effect
•All employees should follow PPE guidelines and was hands
frequently.
•Increase physical spacing between our staff
•Employees will stay home if they are sick and have a fever.
•If employee has respiratory symptoms but does not have a
fever, they must wear a mask
•Employees may return to work fever free after 24 hours
without the use of medication
•NEMS may require employees returning from travel to self-
quarantine for 14 days.
Tier 2 and 3
(if needed) by Executive Team discretion with guidance
from CDC and DPH
• Certain clinics will close, and employees may be
rotated based on patient needs.
• Policy for Non-patient facing staff and working from
home:
• No more than 1/3 of each department will
telecommute at the same time.
• Tier 3 discusses furlough and order of operational
closures.

19.
Education/Communication to Staff
•Communication as needed with at minimum of weekly announcements
•Formed COVID 19 internal team meets daily – Lead by our Chief Health Officer
•Transparency to all employees about current number of patients tested and results
•Updating staff on all local and larger picture news
•Reminder on our policies
Weekly announcements to staff
•Testing best practices and workflows
•Running drills and trainings for staff ( proper PPE, workflows for pt isolation)
COVID-19 Preparations

20.
Controlling Inventory and Supplies
Centralize Requests/Ordering
Distributions Goal for sensible and timely distribution
while increase need for accountability
Usage Rates Calculating burn rates of various
departments/clinics
Inventory Replenishing Rates Modeling projections at various
replenishing rates

21.
Nurse Interview Guide
Mary Blankson, DNP, APRN, FNP-C

22.
COVID-19 Nurse Interview Guide
• All Patients who answered “Yes” for Symptoms or Travel
should be triaged by a Nurse
• Travel Risk: Traveled outside of the state
– If yes: where? Consider highest risk areas
– If highest risk area, assess
• Have you been implementing social distancing?
• If yes, please describe efforts
• Contact Risk: Contact with someone who is ill?
– If yes: What were their symptoms? Official diagnosis?
– If COVID-19 contact, were you within 6 feet? Contact with secretions?

23.
COVID-19 Nurse Interview Guide
• Symptom Discussion
– Describe Symptoms you are having
– When did they start
• Confirm if symptoms started before or after any potential
high-risk contact for COVID-19
– Are you treating your symptoms currently with
medication
• If yes, what medication, when was last dose?
– Proceed as per selected protocol for symptoms while
also considering above documented risks, if any

24.
COVID-19 Nurse Interview Guide
• Disposition by phone
– No red flags, advise patient to stay at home
– Progressing symptoms that may not warrant hospitalization, but may
require medical intervention, patient may need evaluation. Consult with
PCP
– If emergent symptoms, call 911 to transport to nearest emergency
department, call ahead to alert the facility of PUI
• Disposition in person
– No red flags, advise patient to return home and remain at home
– Progressing symptoms, consult with PCP
– Emergent Symptoms, call 911 to transport to emergency department, call
ahead to alert the facility of PUI

25.
26
Free COVID-19 eConsults
• Web-based portal
• Free to all Safety Net Primary Care Practices
– FQHC, FQHC-look alike, Migrant Clinicians, Healthcare for the
Homeless, Free Clinics
• No Protected Health Information (PHI)
• Consults Addressed by:
– Infectious Disease Specialists
– Public Health Nurses
• ConferMED.com
* This initiative is supported by

26.
Thank You!
For questions or to join our
mailing list:
Contact us at
WeitzmanLearning@chc1.com
www.weitzmaninstitute.org/coronavirus