Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Yale - Tulane ESF-8 Special Report COVID-19 04-14-2020

230 views

Published on

Contributors are students and faculty located in a variety of geographic locations. It provides information gathered from situation reports, government and non-governmental organization, media reporting, and a variety of information sources, and verifies and synchronizes the information and provide real-time information products to federal, state, local, and international response organizations.

Published in: Education
  • Be the first to comment

  • Be the first to like this

Yale - Tulane ESF-8 Special Report COVID-19 04-14-2020

  1. 1. YALE-TULANE ESF-8 SPECIAL REPORT CORONAVIRUS (COVID-19) AS OF 14 APRIL 2020 2200 HRS EDT US FEDERAL GOVERMENT • CORONAVIRUS.GOV • USA.GOV HHS COVID-19 CDC • CDC – COVID-19 NIH • COVID-19 NIOSH • NIOSH CORONAVISUS FEMA • FEMA DOD Coronavirus Response USAF _ COVID-19 NEWS SOURCES • New York Times COVID-19 Coverage • WASHINGTON POST • Reuters • CNN • Xinhua ASSOCIATION • NACCHO • AMERICAN HOSPITAL ASSOCIATION • NRHA PORTALS, BLOGS, AND RESOURCES • YALE NEWHAVEN HEALTH – COVID-19 • YALE MEDICINE • YALE NEWS _COVID 19 • JOHN HOPKINS UNIVERSITY COVID-19 GLOBAL CASES (CSSE) • COVID-19 SURVEILLANCE DASHBOARD • CIDRAP • H5N1 • VIROLOGY DOWN UNDER BLOG • CONTAGION LIVE • WORLDOMETER • 1POINT3ACRES BACKGROUND WHO • WHO –COVID-19 • ECHO • PAHO AFRO • EMRO • Western Pacific OCHA • ReliefWeb ECDC • European Centre for Disease Prevention and Control CCDC • China Center for Disease Control and Prevention INTERNATIONAL JOUNALS AND ONLINE LIBRARIES • BMJ • Cambridge University Press • Cochrane • Elsevier • JAMA Network • The Lancet 2019-nCoV Resource Centre • New England Journal of Medicine • Oxford University Press • Wiley SITUATION - US The virus that causes COVID-19 is infecting people and spreading easily from person-to-person. Cases have been detected throughout the United States and its territories . The United States is currently in the acceleration phase of the pandemic. RISK ASSESSMENT RISK TO GENERAL POPULATION RISK TO ELDERLY POPULATION RISK TO HEATHCARE SYSTEM CAPACITY MODERATE VERY HIGH HIGH GLOBAL CONFIRMED CASES DEATHS RECOVERED 1,980,003 126,557 485,917 UNITED STATES CONFIRMED CASES DEATHS RECOVERED 608,458 25,992 48,224 HEALTHCARE INNOVATIONS COVID-19 PROJECTIONS CASES IN US WHERE CASES ARE RISING TESTING UPDATES ON CLINICAL MANAGEMENT WITH CO-MORBIDITY EMERGING ISSUES SOURCE: JOHNS HOPKINS COVID-19 DASHBOARD (AS OF 14 APRIL, 2133 HRS EDT)
  2. 2. BACKGROUND WHERE: WORLDWIDE WHEN: DECEMBER 2019 - CURRENT SITUATION PANDEMIC OUTBREAK – COVID-19 BACKGROUND: At the end of December 2019, Chinese public health authorities reported several cases of acute respiratory syndrome in Wuhan City, Hubei province, China. Chinese scientists soon identified a novel coronavirus as the main causative agent. The disease is now referred to as coronavirus disease 2019 (COVID-19), and the causative virus is called severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2). It is a new strain of coronavirus that has not been previously identified in humans. The initial outbreak in Wuhan spread rapidly, affecting other parts of China. The International Health Regulations (IHR) (2005) Emergency Committee on the outbreak of COVID-19 was first convened on 22‒23 January 2020, and subsequently reconvened on 30 January 2020. PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN (PHEIC) The WHO Director General declared the COVID-19 outbreak to be a public health emergency of international concern (PHEIC) on 30 January 2020. The Emergency Committee provided recommendations to WHO, to China, to all countries and to the global community, on measures to control the outbreak. PANDEMIC On 11 March 2020. WHO declared COVID-19 a pandemic because of the “alarming levels of spread and severity, and by the alarming levels of inaction”. At that time, there were large outbreaks of the virus in Italy, South Korea, and the United States. In the US, the slow rollout of testing and limited testing capacity has crippled response to the disease. The declaration came after a 13-fold rise in the number of cases outside China in the two weeks prior to the declaration. The first known case of COVID-19 in the U.S. was confirmed on January 21, 2020, in a man in his 30s from Washington state, who traveled to Wuhan, is diagnosed with novel coronavirus. On 29 January 2020 the White House Coronavirus Task Force was established. On 31 January 2020 , Secretary azar declares a Public Health Emergency for United States for COVID-19. Travel restriction were put into place for those traveling from China . Later restriction were added for Iran and Europe (29 February 2020). On 26 February 2020 the Centers for Disease Control and Prevention (CDC) confirms the first case of COVID-19 in a patient in California with no travel history to an outbreak area, nor contact with anyone diagnosed with the virus. It's suspected to be the first instance of local transmission in the United States. Oregon, Washington and New York soon report their own cases of possible community transmission. The first COVID-19 death is reported in Washington state, after a man with no travel history to China dies on 28 February 2020 at Evergreen Health Medical Center in Kirkland, Washington. Two deaths that occurred 26 February 2020 at a nearby nursing home would later be recorded as the first COVID-19 deaths to occur in the United States. President Donald Trump declares a U.S. national emergency, which he says will open up $50 billion in federal funding to fight COVID-19 on 13 March 2020. By 17 March 2020 COVID 19 was present in all 50 states. COVID 19 IN THE UNITED STATES
  3. 3. SITUATION - UNITED STATES JURISDICTIONS REPORTING CASES: 55 (50 states, District of Columbia, Guam, Puerto Rico, the Northern Mariana Islands, and the U.S. Virgin Islands) (CDC) EOC ACTIVATION: All State / Territory EOCs activated (FEMA) 42 states, D.C., 4 territories and 37 tribes issued shelter-in-place orders (FEMA) Many states have closed schools and businesses; banned gatherings, meetings and sporting events; and, in some places, residents have been ordered to stay inside. COVID-19 ACTIVITY Different parts of the country are seeing different levels of COVID-19 activity. The United States nationally is in the acceleration phase of the pandemic. The duration and severity of each pandemic phase can vary depending on the characteristics of the virus and the public health response. (CDC) • The greatest number of cases have been recorded in New York, New Jersey, Massachusetts, Michigan, Pennsylvania, California, Illinois, Florida and Louisiana. • There is early evidence that the epi curve is beginning to flatten • Case numbers are expected to continue rising through the coming weeks, as more cases are identified through testing. RISK ASSESSMENT RISK TO GENERAL POPULATION RISK TO ELDERLY POPULATION RISK TO HEATHCARE SYSTEM CAPACITY MODERATE VERY HIGH HIGH UNITED STATES CONFIRMED CASES DEATHS RECOVERED 608,458 25,992 48,224 HOSPITALIZATIONS The overall cumulative hospitalization rate is 12.3 per 100,000, with the highest rates in persons 65 years and older (38.7 per 100,000) and 50-64 years (20.7 per 100,000). (CDC) SOURCE: JOHNS HOPKINS COVID-19 DASHBOARD (AS OF 14 APRIL, 2133 HRS EDT) HEALTH CARE PROFESIONALS The Centers for Disease Control and Prevention said on Tuesday that 9,282 health care professionals had contracted the coronavirus in the United States as of April 9, and that 27 had died from it. DEATH TOLL New York City, already a center of the coronavirus outbreak, sharply increased its death toll by more than 3,700 on Tuesday, 14 April 2020 after officials said they were now including people who had never tested positive for the virus but were presumed to have died because of it. The new figures, released by the city’s Health Department, drove up the number of people killed in New York City to more than 10,000 and appeared to increase the overall United States fatality rate by 17 percent.
  4. 4. CASES IN THE US SOURCE: NYT SOURCE:JOHN HOPKINS UNIVERSITY COVID-19 GLOBAL CASES (CSSE) SOURCE: NYT The number of known cases of the coronavirus in the United States has surged. As 14 APRIL, 2133 HRS EDT, at least 608,458 people across every state, plus Washington, D.C., and three U.S. territories, have tested positive for coronavirus, and at least 25,992 have died and 48,224 have recovered. Approximately 3,081,620 have been tested in the US Currently 101,017 are hospitalized
  5. 5. WHERE CASES ARE RISING SOURCE: NYT (AS OF 14 APRIL 2020, 2000 HRS, EDT
  6. 6. PROGRESS ON TESTING IN US NOTE: Data during the gray period of graph are incomplete because of the lag in time between when specimens are accessioned, testing is performed, and results are reported. The range was extended from 4 days to 7 days on March 26. (SOURCE: CDC) CURRENT CDC TESTING PRIORITIES PRIORITY 1: Hospitalized Patients and Symptomatic Healthcare Workers PRIORITY 2: Patients in long-term care facilities with symptoms, patients 65+ with symptoms, patients with comorbidities with symptoms, first responders with symptoms PRIORITY 3: critical infrastructure workers with symptoms, any other individual with symptoms, health care workers and first responders, individuals with mild symptoms in communities experiencing high COVID-19 hospitalizations NON-PRIORITY: Individuals without symptoms (CDC; COVID TRACKING) NUMBER OF SPECIMENS TESTED FOR SARS COV-2 BY CDC LABS (N=5,038) AND U.S. PUBLIC HEALTH LABORATORIES* (N=310,434)† TOTAL TESTED IN US As of 14 April 2020, approximately 3,081,620 COVID-19 tests have been administered in the United States. • 605,193 were positive • 2,459,268 were negative • 17,159 arepending
  7. 7. UPDATES ON CLINICAL MANAGEMENT WITH CO-MORBIDITY Preexisting heart conditions (hypertension and coronary heart disease) have been the most common category of comorbidity. While the focus of the COVID-19 pandemic has been on respiratory problems and securing enough ventilators, an initial study found cardiac damage in 1 in 5 patients, leading to heart failure and death even among those who show no signs of respiratory distress. This will require a need for new precautions in people with preexisting heart problems, new demands for equipment and, new treatment plans for damaged hearts among those who survive. The question of whether the emerging heart problems are caused by the virus itself or are a by-product of the body’s reaction to it has become one of the critical unknowns facing doctors. If doctors in New York, Washington state and other hot spots can start to tease out how the virus is affecting the heart, they may be able to provide a risk score or other guidance to help clinicians manage COVID-19 patients in other parts of the country. Initial Data From China In March, doctors from China published two studies that gave the first glimpse at how prevalent cardiac problems were among patients with COVID-19 illness. The larger of the two studies looked at 416 hospitalized patients. The researchers found that 19% showed signs of heart damage. And those who did were significantly more likely to die: 51% of those with heart damage died versus 4.5% who did not have it. RISK FACTORS Source: NYT, NCBI, JAMA PREEXISTING HEART CONDITIONS Comorbidities that have been associated with severe illness and mortality include: • Cardiovascular disease • Diabetes mellitus • Hypertension • Chronic lung disease • Cancer • Chronic kidney disease • Liver disease Knowledge of these risk factors can be a resource for clinicians in the early appropriate medical management of patients with COVID-19. In a study of 168 patients who died in Wuhan, 74.4% had 1 or more comorbidities. SOURCE: MYSTERIOUS HEART DAMAGE, NOT JUST LUNG TROUBLES, BEFALLING COVID-19 PATIENTS ASSOCIATION OF CARDIAC INJURY WITH MORTALITY IN HOSPITALIZED PATIENTS WITH COVID-19 IN WUHAN, CHINA Chronic comorbidities distribution among patients
  8. 8. EMERGING ISSUES IMPACT ON GROUP HOMES & CARE FACILITIES FOR THE DEVELOPMENTALLY DISABLED Across the U.S., group homes and care facilities for the developmentally disabled are experiencing disproportionately high numbers of COVID-19 cases and deaths compared to the general population. Additionally, exposure to infected patients has resulted in many staff/caregivers––the “direct care work force”––also contracting the virus, making it difficult for facilities to maintain adequate staffing levels. Developmentally delayed residents of these facilities are a particularly vulnerable group because, in addition to living in a congregate residential setting, many have underlying health conditions that make them exponentially more likely to contract and die from COVID-19. In New York York state, 1,100 of the 140,000 developmentally disabled people monitored by the state have tested positive, as well as 314 group home staff. As of April 10th, 156 of the 1100 have died. In New York City, residents of group homes and similar care facilities are 5.34 times more likely than the general population to develop the virus and 4.86 times more likely to die from it. Staff/caregivers have expressed concerns about facilities’ capacity to contain and control infection control and containment, including: • Staff lacking training on how to minimize infection transmission when providing patient care • Shortage of staff (due to infection or fear of getting infected) • Difficulty enforcing recommended prevention measures like hand- washing and social distancing among residents • Difficulty obtaining tests • Shortage of PPE and other critical supplies (e.g. oxygen) The widespread challenge of overwhelmed hospitals has also contributed to the increased toll of COVID-19 on group homes, with many facilities reporting that their residents who displayed symptoms were turned away by the hospital if their symptoms weren’t life threatening. As a result, these individuals returned to their group homes, likely infecting other residents and staff. SOURCE: NEW YORK TIMES SOURCE: NBC NEW YORK There is growing concern being expressed by caregivers, advocates and policymakers about the potential deprioritization of developmentally delayed COVID-19 patients for life saving treatments, namely ventilators. On April 4th, Disability Rights New York, an oversight organization, filed a federal complaint against Governor Cuomo’s administration, claiming that state policies treat the developmentally disabled as second-class citizens who will be deprioritized for access to ventilators, should there be a shortage. Similar complaints were also filed by advocacy groups in Alabama, Kansas, Tennessee, and Washington State. In order to prevent discriminatory care of COVID-19 patients in healthcare settings, leading advocates have proposed that [state] policy prohibiting discriminatory allocation of ventilators, and healthcare at large, be enacted immediately. SOURCE: NEW YORK TIMES PROTECTING COVID-19 PATIENTS WITH DEVELOPMENTAL DISABILITIES FROM DISCIRIMINATORY HEALTH CARE
  9. 9. EMERGING ISSUES - CORONAVIRUS IN RURAL AMERICA It’s common for viruses to trickle into rural communities after hitting big cities first. COVID-19 outbreaks in rural communities are becoming a concerning trend. When people are asked to quarantine or shelter-in-place, people tend to move out of cities to suburban and rural locations bunker down. (ABC News) There is less coronavirus testing in rural areas. In Louisiana, around 70% of tests have been conducted in urban centers. (LA Departrment of Health) Rural Americans may be more likely to have COVID complications. Rural populations are older on average, with more than 20 percent above the age of 65. Rural Americans also tend to have higher rates of cigarette smoking, higher blood pressure and higher obesity rates. They also have higher rates of poverty, less access to healthcare, and are less likely to have health insurance. (CDC) (Washignton Post) Rural counties have just 5,600 intensive care beds total, compared with more than 50,000 in urban counties. Half of U.S. counties do not have any ICU beds at all. (Washington Post) (NY TIMES) RURAL AMERICANS' HEALTH DEPENDS ON BROADBAND ACCESS Apr 13, 2020 - Discusses the need for increased broadband access in rural areas, especially with the healthcare access challenges posed by the COVID-19 pandemic. Includes data that shows a large percentage of rural counties are designated as medically underserved and highlights federal programs recently enacted to expand broadband services through rural America. Source: American Farm Bureau Federation RESOURCES TO HELP RURAL HOSPITALS AND HEALTH SYSTEMS NAVIGATE COVID-19 Apr 9, 2020 - The American Hospital Association (AHA) compiled a list of case studies highlighting strategies rural hospitals have taken to tackle the COVID-19 pandemic. Includes additional resources to assist rural communities in implementing their own solutions to help care for patients. Source: American Hospital Association CORONAVIRUS WAS SLOW TO SPREAD TO RURAL AMERICA. NOT ANYMORE Apr 8, 2020 - Discusses the increasing rate at which coronavirus has spread in rural areas of the country and the challenges these areas face combating the disease. Includes an interactive map with a timeline of when coronavirus reached rural counties across America. Source: The New York Time ONE-IN-FOUR U.S. RURAL HOSPITALS AT HIGH FINANCIAL RISK OF CLOSING AS PATIENTS LEAVE COMMUNITIES FOR CARE Apr 8, 2020 - Summarizes an analysis conducted before the coronavirus outbreak, that found a quarter of rural hospitals are at high risk of closing due to financial challenges. Describes how the migration of patients to care options outside the community has contributed to the situation, includes advice for rural hospitals to partner with other regional health systems and their communities. Source: Guidehouse SOURCE: RHIhub
  10. 10. EMERGING ISSUE HOSPITALIZATION RATES AND CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH LABORATORY- CONFIRMED CORONAVIRUS DISEASE 2019 — COVID- NET, 14 STATES, MARCH 1–30, 2020 A new report presents age-stratified COVID-19– associated hospitalization rates for patients admitted during March 1–28, 2020, and clinical data on patients admitted during March 1–30, 2020, the first month of U.S. surveillance. Among 1,482 patients hospitalized with COVID-19, 74.5% were aged ≥50 years, and 54.4% were male. The hospitalization rate among patients identified through COVID-NET during this 4-week period was 4.6 per 100,000 population. Rates were highest (13.8) among adults aged ≥65 years. Among 178 (12%) adult patients with data on underlying conditions as of March 30, 2020, 89.3% had one or more underlying conditions; the most common were hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%). These findings suggest that older adults have elevated rates of COVID-19–associated hospitalization and the majority of persons hospitalized with COVID-19 have underlying medical conditions. SOURCES: Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. ePub: 8 April 2020. CDC – DATA VISUALIZATION
  11. 11. EMERGING ISSUE HOSPITALIZATION RATES AND CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH LABORATORY- CONFIRMED CORONAVIRUS DISEASE 2019 — COVID- NET, 14 STATES, MARCH 1–30, 2020 In the COVID-NET catchment population, approximately 49% of residents are male and 51% of residents are female, whereas 54% of COVID-19-associated hospitalizations occurred in males and 46% occurred in females. These data suggest that males may be disproportionately affected by COVID-19 compared with females. Similarly, in the COVID-NET catchment population, approximately 59% of residents are white, 18% are black, and 14% are Hispanic; however, among 580 hospitalized COVID-19 patients with race/ethnicity data, approximately 45% were white, 33% were black, and 8% were Hispanic, suggesting that black populations might be disproportionately affected by COVID-19. These findings, including the potential impact of both sex and race on COVID-19-associated hospitalization rates, need to be confirmed with additional data. SOURCES: Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep. ePub: 8 April 2020. It's long been known that black Americans and Hispanic Americans are more likely to suffer from chronic health conditions that can detrimentally impact how their bodies handle an additional illness. These minority communities also have less access to health care. And early data suggest that a racial disparity has been playing out in the outcomes of coronavirus patients, with data from coronavirus deaths in Louisiana, Illinois, Michigan and New Jersey showing African Americans make up a higher percentage of the victims.
  12. 12. COVID-19 PROJECTIONS HOSPITAL RESOURCE - US 4 DAYS SINCE PEAK RESOURCE USE ON APRIL 10, 2020 RESOURCES NEEDED FOR COVID-19 PATIENTS ON PEAK DATE All beds needed: 56,831bed Bed Shortage: 3,498beds ICU beds needed: 140,823bed ICU Bed Shortage: 7,369 Invasive ventilators needed: 13,851 SOURCE: IHME COVID-19 projections assuming full social distancing through May 2020
  13. 13. VID-19 projections assuming full social distancing through May 2020 SOURCE: IHME
  14. 14. DIAGNOSTICS SOURCE : https://www.av.co/covid-diagnostics @vasudevbailey @zoeguttendorf HEALTHCARE INNOVATIONS TO FIGHT COVID-19
  15. 15. HEALTHCARE INNOVATIONS TO FIGHT COVID-19
  16. 16. SOURCE : https://www.av.co/covid-diagnostics @vasudevbailey @zoeguttendorf HEALTHCARE INNOVATIONS TO FIGHT COVID-19
  17. 17. SOURCE : https://www.av.co/covid-diagnostics @vasudevbailey @zoeguttendorf HEALTHCARE INNOVATIONS TO FIGHT COVID-19

×