March 29: DAILY COVID-19 UPDATE

March 30, 2020  //  FOUND IN: Announcements

Sunday, March 29, 2020, 7 p.m.

NEW TODAY: Here’s the latest information about Michigan Medicine’s management of the COVID-19 pandemic:

  • DAILY STATS
  • RESPONSES TO TOWN HALL FAQs
  • ACUTE BONE/JOINT INJURY CLINIC
  • APPRECIATION FOR ENVIRONMENTAL SERVICES  
  • MASK AND GLOVE DISPOSAL

DAILY STATS

Today’s census for COVID-19 inpatients and those patients under investigation (PUI) are noted below: 

As of March 29, 2:30 p.m.



RESPONSES TO TOWN HALL FAQs

We are responding to FAQs generated during Friday’s virtual town hall. If you missed the town hall, you may view it here.

Treatments/Pharmacy

Is Michigan Medicine using hydroxychloroquine to treat or test treatment for COVID-19 patients?

Yes, Michigan Medicine is currently using and evaluating the efficacy of hydroxycholoroquine (Plaquenil). There are concerns that it may not be helping patients and that it has significant negative side effects; therefore, further assessment is ongoing.

What is the direction on filling prescriptions for Hydroxychloroquine? People with prescriptions (e.g. to treat autoimmune conditions) are being told they will not be filled.

LARA (Department of Licensing and Regulatory Affairs) for the State of Michigan issued the following on March 24: “Pursuant to Michigan Administrative Code, R 338.490(2), a pharmacist shall not fill a prescription if the pharmacist believes the prescription will be used for other than legitimate medical purposes or if the prescription could cause harm to a patient.” Patients already on the medication for an autoimmune condition should continue to receive their scripts. Patients with concerns or questions should reach out to their prescribing physician.

Are we using serum therapy?

There are reports of some attempts to use the plasma of patients who may have antibodies to COVID-19 as a treatment for the infection. We are not currently doing this, as there are significant potential risks and a limited ability to determine if someone has antibodies.

Should Advil/ibuprofen/Motrin be taken if tested positive?

The data on NSAIDS like ibuprofen connected to COVID-19 is extremely limited. There are concerns that it could affect a patient’s response to the infection, but it is also important to treat the dangerously high fevers which occur with COVID-19. For that reason, we are using acetaminophen (Tylenol) as the first-line treatment for fever, but still using ibuprofen and other NSAIDS when that is not enough.

General Operations

What is the strategy for choosing and retraining MDs to treat COVID-19 patients? 

This is managed by the clinical department chairs who know the individual faculty members and the requirements of the discipline.

Will we employ LOMBARY strategy for inpatient as we do for outpatient? 

For physician providers, we will be employing the LOMBARY strategy for both inpatient and outpatient as is feasible. For APPs, CRNAs, CNMs, NPS and PAs, we are trying to stay true to the principles of the Lombary strategy; however, this is not always possible in all cases. 


What measures are being taken to protect high risk providers, including those who are pregnant, breastfeeding and immunocompromised, as the number of patients and providers with coronavirus in the hospital increases? 

Workforce members caring for patients who are being tested for COVID-19 or who have confirmed COVID-19 should not:

  • Be pregnant
  • Be breastfeeding
  • Be immunocompromised
    • Persons with primary or acquired immunodeficiency
    • Persons on anti-rejection therapy following solid organ transplant or bone marrow transplant
    • Persons on biologic therapeutic agents such as tumor necrosis factor inhibitors. Last revised: 4 p.m. on March 22 
    • Persons with malignancy and ongoing or recent chemotherapy
    • Persons receiving systemic immunosuppressive therapy, including corticosteroids equivalent to 20 mg/day of prednisone for > 2 weeks
  • Be 70 years of age or older
  • Be unable to wear an N95 mask or powered air-purifying respirator (PAPR) if indicated
  • Be unable to don and doff personal protective equipment safely

Workforce members with the above conditions may continue to provide care for patients with respiratory illness who are not being tested for COVID-19.

PPE

Why can’t nurses and other staff be issued an N-95 for use? What is the plan for sterilizing N-95s for later use?     

Employee safety is our highest priority. Due to the limited supply of PPE in Michigan and across the country, PPE conservation is critical to maintain appropriate supplies for the duration of the pandemic. We are asking everyone’s efforts to preserve PPE by following IPE recommendations, which are determined by risk of transmission. Enhanced PPE is used in higher risk situations. More information here.

We are implementing limited reuse of N-95 masks in specific hospital areas. We will also be introducing the reprocessing of N-95 masks with heat and ultraviolet light to thoroughly disinfect. More details will be provided in these daily updates.

What is our supply of N-95s and projected inventory? 

The N-95 supply is constrained throughout the world.  To extend our supply, Michigan Medicine is validating a process to reprocess N-95 masks, as well as procuring other types of N-95s that will be deployed with fit testing in several areas to support the demand.

Can we make/wear our own fabric mask?

At this time, it is recommended that a medical mask be used in the health care setting.  It is important to be able to discard masks after care of patients in isolation precautions. In addition, medical masks have been tested for this use and currently, there is no detailed information on fabric masks.

Parking and Transportation

Why haven’t P1-5 been opened up for employee parking?

We have opened hundreds of parking spaces in decks near and around the medical campus, along with encouraging staff to drive instead of taking the bus. We are constantly monitoring parking deck utilization in P1-P5 to determine if further relaxation might occur.

BONE AND JOINT ACUTE INJURY CLINIC

In order to reduce exposure to patients and reduce the strain on our adult emergency services department during the global coronavirus epidemic, Michigan Medicine is setting up a provisional clinic for adult patients with bone and joint acute injuries at our Brighton Center for Specialty Care.

The clinic opens on Monday, March 30, and is designed to see adult patients with a range of acute injuries:

  • Acute injuries of the foot, ankle, hand, wrist, knee, shoulder, and elbow
  • Closed, simple fractures of the arm, elbow, hand, wrist, leg, foot or ankle
  • Ligament, muscle and tendon sprains and strains
  • Acute, severe back and neck pain

Pediatric patients (0-18 years of age) should be seen in the pediatric emergency department.

Adults who meet the following exclusion criteria should still be seen by the emergency department:

  • Fractures which are open, high energy and/or with severe soft tissue damage, active bleeding and/or associated with joint dislocation, and neck/spine fractures
  • Polytrauma cases or high energy injuries necessitating evaluation at a Level 1 Trauma Center
  • Concomitant, acute medical comorbidities

The clinic is available Monday through Friday, 8 a.m. to 5 p.m., and Saturdays 10 a.m. to 3 p.m.

Visit the clinic webpage to learn more.

APPRECIATION FOR ENVIRONMENTAL SERVICES

We would like to extend our sincere gratitude for the dedication of our environmental services team whose work on the frontlines allows us to do our jobs in a clean and safe atmosphere. You are essential partners in our efforts to prevent the spread of this virus and minimize the risk of exposure to our patients and employees. Thank you for your continued teamwork during this unprecedented time and your vital role in caring for patients.

MASK AND GLOVE DISPOSAL

With increased use of PPE, we need your help in keeping our facilities clean and safe. All masks and gloves should be removed and properly disposed in standard trash receptacles before leaving buildings.

Still have questions?


We are also posting all daily bulletins and policies on Michigan Medicine Headlines at https://mmheadlines.org/covid-19-updates/.  Please bookmark that site and refer to it throughout the day for the most up-to-date information. An FAQ for staff is also posted and updated frequently.

If you still can’t find what you’re looking for on these web pages, please email coronavirus-info@med.umich.edu and your question will be answered as quickly as possible.  Do not use this email for sharing patient health information.

Jeffrey Desmond, M.D.
Chief Medical Officer

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