Title (Single Line)

Agenda for 5/20/2020

• Update on COVID-19 testing

• Caregiver wellness

• Reopening facilities

• Multi-organ System Inflammatory Disease

• Miscellaneous/Open Discussion

This activity has been designated for CME and

ABIM MOC credits and is being recorded There will be NO

Covide-19 webinar

Monday, 5/25, due

to Memorial Day

TEXT YOUR ATTENDANCEIts important that we know you are participating

Text Attendance Number:

(858) 247-3111

Today’s Activity Code:

13485

Skype Etiquette

• Mute your phone and computer during the call, as severe echoes can occur. Mute using either a mute button, or *6 which toggles mute on and off.

• Do not place the on hold, as many hold line play music or narratives which disrupts the call

• Once done talking, re-mute

• The chat box is monitored if you would like to submit questions or issues

• TAC is available for technical problems at the physician line

858-672-5202

County Health Department testing sites as of 5/18/20

With a doctor referral and appointment, testing sites are running in 3 locations.

A physicians referral is required for the county sites, and appointments are

mandatory. These can be made by calling 211

• San Diego County Credit Union Stadium in Mission Valley, 9am-3pm (NEW:

drive up site)

• NEW: The County’s Live Well on Wheels Mobile Office will being testing at

Euclid Health Center, 292 Euclid Ave. Appointment s available via 2-1-1

• Live Well Center, 690 Oxford St, Chula Vista, 91911

DO NOT SEND YOUR PATIENTS TO THE LAB FOR SWAB ACQUISITION,

AS THEIR PERSONNEL ARE NOT PERMITTED TO DO THIS

California State testing sites (New as of 5/18/20)

CA State Sites are in 5 locations, 7am-7pm. A physicians order is not required, but

appointments are required. These can be made online

at https://lhi.care/covidtesting, or 888-634-1123. The online site is compatible with

computers and Android devices, but not yet compatible with Apple devices.

• Grossmont College, 8800 Grossmont College Dr., El Cajon, CA 92020

• Former Sears Chula Vista, 565 Broadway, Chula Vista, CA 91910

• Live Well Center, 649 W. Mission Ave., Escondido, 92025, 10am-3pm

• NEW: Tubman-Chavez Center, 415 Euclid Ave

• NEW: San Diego County Assessor Office, 200 S. Magnolia Ave, El Cajon

SharpCare Sites available for Swab Test Acquisition

• SCMG Clinician screens and identifies patient needing to be tested, and calls the

appropriate SharpCare with patient details for scheduling (see below)

• SCMG Clinician enters order either to COMMUNITY CONNECT, or the Sharp Lab Portal in

their usual manner.

• CONNECT EHR Order: SARS-CoV-2 (COVID-19) Mol Amp

• Dx Code: Positive Exposure to COVID-19: z20.828, or

• Dx Code: No exposure screening z11.59

• Self-Swabbing appointments available:

• Spring Valley (M-F, 9am-10am, Cathy Faber, Supervisor)

• Ph 619-660-6003, fax 619-660-0296

• Eastlake (M-F 3pm-4pm, Marva Garcia, Supervisor)

• Ph 619-397-0866 fax 619-397-0816

SharpCare

• SCMG Office on CONNECT provides FN, LN, Mailing Address, phone # of

patient, ordering provider and contact #

• Non-CONNECT SCMG Office: Fax a copy of the paper Sharp Lab Order

requisition to the SharpCare site

• SharpCare will:

• Call your patient to schedule the swabbing, and instructions where to

park. Swabbing is done from the vehicle

• Advise your patient, per Sharp Labs that results will be available to

ordering providers in 48-72 hours

• Notify the ordering provider if patient does not schedule or show up

• SharpCare will not verify eligibility, receive or follow up patient results

• Remind patient the results will come from the ordering provider. They should

bring a picture ID, and wear a face covering

Update

• The County is submitting to the Governor, a plan to enter “phase 2” reopening, and possibly a rapid –pilot program into “phase 3” as well

• The Governor has signaled a lightening up of milestones, which are currently being met by the county. He dropped a requirement for no Covid related deaths for 14 days

• Imperial County had a surge of Covid cases, prompting transfer of 20 patients to sites in San Diego and Riverside

• For a comprehensive database of information from San Diego County Public Health , it can be found HERE.

Caregiver Wellness

• A recognition of the effects of stress and PTSD related to caregiving for Covid patients

led to creation of additional well support services

• It was noted that after the San Bernardino shooting, 50% of the healthcare workers

never returned to their job

• Caring for General Caregiver and Sharp Employee Resources from Sharp

• https://sharpnet.sharp.com/covid19support/index.cfm

• Sharp Employee Wellness Resources

• https://www.sharp.com/employees/caregiver-support-resources.cfm

• Physician Wellness Resources

• https://www.sharp.com/physicians/physician-support-resources.cfm

Update from San Diego County Health

• Racial disparities have been noted, with Latinos, African Americans, Native Hawaiians, and Pacific Islanders having higher mortality. Covid-19 deaths in African Americans is twice that of the average, while Hawaiians and Pacific Islanders are 4 fold higher

• County Public Health Officer stated May 10th healthcare providers shall:

• Take measures to prioritize resources

• Resume elective surgeries based on need and supply capacity

• Continue to provide preventative care

• Positive coronavirus test results should be reported to the San Diego County Epidemiological Unit, via fax 858-715-6458, or using the Confidential Morbidity Report Form. More information on reporting requirements can be found HERE.

Patient Home isolation Instructions for Covid-19

A helpful patient instruction

publication for self care at

home, along with warning signs

and symptoms that require

emergency assistance, can be

found HERE.

Multisystem Inflammatory Syndrome in Children (MIS-C)

• The CDC issued an official health advisory May 14th

• Appears associated with Covid-19, but may occur late in the disease course

• Kawasaki and toxic shock-like disease. Criteria:

• Fever, inflammatory markers, clinically severe illness requiring hospitalization,

and at least 2 organ systems involved, AND

• No alternative plausible diagnosis, AND

• Positive for SARS-CoV-2 by PCR, serology, or antigen within 4 weeks of

exposure

• Inflammatory markers: neutrophilia, elevated CRP, lymphopenia, d-dimer, ferritin

• Most also require oxygen, and have hypotension

Opening up – SCMG Practices

• SCMG has developed a “Roadmap to Increasing Patient Visits” That will be going out

today. It includes:

• Operation and financial management

• Staff protection strategies and disinfection protocol

• Patient Care

• Telehealth considerations and documentation requirements

• AMA published a specific guidance document for physician offices. CLICK HERE.

Necessary milestones must exist before stay at home orders can relax

Elective Procedures at Sharp

• Sharp did start doing some elective surgical cases May 11th

• All surgical cases are getting Covid PCR testing prior to procedures

• They are asking patients to self quarantine for 14 days prior to an elective procedure

• Use physical distancing from family members

• Patients and their household contacts should use masks when going outside

• Patients with Covid are at higher risk of post-op infections

• Suggested scripting to patients:

“As a result of the recent COVID-19 crisis we are asking all presurgical patients to comply

with a 14 day self-isolation protocol. This is important for your health and safety due to the

increased risk of complications for patients who are Covid (+) who undergo surgery. If you are

living with others we ask that these individuals please help in your presurgical preparation

process by wearing a mask whenever they are outside and maintain 6ft social distancing to

prevent any possible COVID-19 exposure.”

Sharp Covid PCR Positive or Suspected May 16

• Sharp Chula Vista 53 (up by 1)

• Sharp Memorial 49 (up by 1)

• Sharp Grossmont 31 (dec by 6)

• Sharp Coronado 4

• Sharp Mary Birch 0

Total: 107 positive Covid, down from 116,

and 32 Suspected cases

Last 10 days of New cases – seen in orange

Total SD Cases 6,026 (+190)

Hospitalized 1,136 (19%)

Intensive care 346

Deaths 222 (3.7%)

Covered in prior webinars, which are posted at SCMG.org

• The role of serology (antibody testing)

• Patient isolation instructions

• Second wave

• Support resources for physician well being

• Patient letter about physician availability

• County dashboard for coronavirus cases

• Financial resources

• County mandatory Social Distancing and Sanitation Protocol Mandate

• Plasma Donation after COVID infection, as treatment

• Where offices can submit requests to county public health for PPE

• Summary of precautions – droplet, vs contact or airborne

• Government and Sharp websites for Covid information for the public

Upending the Healthcare System

Things to consider, from STAT Multimedia

1) Covid-19 accelerated telemedicine by a decade

2) Increased pressure to step away from traditional employer-based health insurance

3) Less reliance on nursing homes, or assisted living facilities, and more in-home care

with home health aides

4) Uncovering of racial disparities, and access to healthcare, or vulnerabilities

5) Highlighting drug affordability, and the strain it puts on the system

6) Resourcing drugs and equipment in the U.S. rather than depend entirely on others

7) A new era on healthcare preparedness, including a “reserve” supply of doctors/RNs

8) Broader role of non-physicians, with advanced practice physician extenders

Open Forum and Questions

Reminder, There will be no Covid-19 webinar Monday, 5/25, due to Memorial Day

Reminder this activity

is being recorded

END

• The presentations can be found on the provider portion of the SCMG website at SCMG.org

• Financial Resources for Physicians. https://www.scmg.org/physician-

resources/covid-19-financial-resources-for-

physicians.cfm?utm_source=News2Know&utm_medium=Email&utm_campa

ign=COVID19

• CDC resource updated daily: https://www.cdc.gov/coronavirus/2019 nCoV/hcp/index.html

• www.Coronavirus.gov

• www.sharp.com/coronavirus

• www.cdph.ca.gov, click I am a Clinician

• SD County Resources:

https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs.html

TEXT YOUR ATTENDANCEIts important that we know you are participating

Text Attendance Number:

(858) 247-3111

Today’s Activity Code:

13485