April 14: Daily COVID-19 UPDATES

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

• DAILY PATIENT STATS
• DAILY TEAM MEMBER TESTING STATS
• PPE/N95 MASK FAQs
• CARE PACKAGES FOR EMPLOYEES
• SHARE YOUR STORY

DAILY PATIENT STATS

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

Discharges: 213 total COVID-19 discharges to date; 11 in the last 24 hours.

DAILY TEAM MEMBER TESTING STATS*

* Data from 3/10 through 4/13. The testing stats reflect just Michigan Medicine employees, not all University of Michigan employees.  

PPE/N95 MASK FAQs

New FAQs have been developed to address questions around personal protective equipment, including N95 masks:

Are health care providers at Michigan Medicine, including nurses, being provided appropriate personal protective equipment (PPE) for care of patients with COVID-19 infection?

Yes. Michigan Medicine follows the guidelines of the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). These guidelines are based on research published in leading medical journals.

Under what conditions do WHO and CDC recommend use of N95 masks and why?

N95 masks are only recommended for care of COVID-19 positive patients when these patients are undergoing aerosol-generating procedures. Both WHO and CDC recommend medical facemasks for health care workers caring for all other COVID-19 patients.  COVID-19 is spread by droplet and contact transmission in most situations, for which a standard mask provides protection.  Aerosol-generating procedures may create risk for airborne transmission; therefore, N95 masks are recommended during those procedures.

Don’t the Joint Commission, the American Medical Association and others support more broad use of N95 masks?

No. The Joint Commission published a “Position Statement” on March 31, 2020. In that statement, the Joint Commission supported the use of facemasks brought from home only in circumstances where nurses and others could not obtain recommended PPE. Several other organizations, including the American Medical Association, republished this “Position Statement” supporting use of personal PPE only when unavailable and not provided by their employer.

Because of the confusion around its “Position Statement,” on April 8, 2020, the Joint Commission published a “Frequently Asked Questions” document (also attached) that clearly states that the Joint Commission does not advocate for routine use of N95 masks and describes advocated uses in alignment with the WHO and CDC.

How are N95 and medical facemasks different?

The standard medical masks used by healthcare workers at Michigan Medicine meet ASTM (American Society for Testing and Materials) Level 1 standard for masks.  This means the mask material meets bacterial filtration efficiency of ?95% (percentage of aerosolized particles filtered at a size of 3 microns) and Particle Filtration Efficiency ? 95% (percentage of submicron particles filtered at 0.1 microns).  These masks are loose fitting and create a physical barrier between the mouth and nose of the wearer and the immediate environment and are recommended for care of COVID-19 patients who are not undergoing aerosol-generating procedures. 

Properly fitted N95 masks seal tightly around the wearer’s face and filter >95% of 0.3 micron test particles.  Improperly fitted, poorly manufactured or damaged N95 facemasks do not provide an increased level of protection against aerosols compared with medical facemasks and, if manufacturing does not meet medical standards or if the mask has been damaged, the level of protection offered by an N95 mask may be less than that provided by the standard medical masks provided to health care workers at Michigan Medicine.

Why not allow health care workers to bring in their own masks and then use them as they wish?

Hospitals must provide for the safety of their patients and care providers. Michigan Medicine was one of the first major hospitals to require use of medical facemasks by all employees and visitors at our hospitals. Medical facemasks, as described above, and as shown to be safe in many clinical studies of respiratory viruses, are used by all health care providers except in the situation where a COVID-19 positive patient is at high risk of aerosolized virus.

We use FDA authorized respirators (N95s).  Unfortunately, many manufacturers do not meet these high standards, nor is it possible to do so with homemade masks. In the instance that an N95-like mask fails, if the person wearing that mask is caring for a COVID-19 positive patient undergoing procedures that result in the release of aerosolized COVID-19, they would be at high risk of infection. Not only that, if a nurse or other care provider had been exposed to COVID-19 in a non-work setting and was asymptomatic, use of a defective or poorly fitted N95-like could result in increased risk of virus transmission to their patients and their co-workers.

This is exactly what we all are trying to avoid. The only way we can confirm that unapproved N95-like masks meet FDA standards is to test them and to make sure that the fit is correct.

Is Michigan Medicine the only hospital that mandates use of N95 masks as recommended by the WHO and CDC and does not allow health care providers to bring in their own masks and other PPE?

No. In a recent survey of over 30 top-tier hospitals like Michigan Medicine and across the U.S. the vast majority reported that they follow WHO/CDC guidelines and do not allow nurses or other health care providers to use masks or other PPE brought from home.

For additional guidance and information on Michigan Medicine’s PPE masking rationale, click here or see attached “PPE masking rationale” document.

CARE PACKAGES FOR EMPLOYEES

The COVID-19 Employee Support Team has assembled packages of appreciation for faculty and staff. These care packages are available today in the UH cafeteria and Support Team members are also distributing them to inpatient units and open ambulatory care clinics.  These packages are intended to brighten someone’s day.

The Employee Support Team can be contacted by emailing VictorsDonation@med.umich.edu. The team is also coordinating food donations and will respond to specific needs or food requests.

If you have questions on how to help or want to direct donations (food and otherwise) please refer people to our donations website at https://giving.medicine.umich.edu/covid-19, and select option 2.

SHARE YOUR STORY

As Michigan Medicine rises to the extremely difficult challenges of COVID-19, share your experiences during this unprecedented pandemic by sending a story, photo, video or audio file to headlines@med.umich.edu. We are hoping to archive this time in history and to help us reflect on our resiliency.

Team members can also recognize colleagues by posting a message of gratitude and encouragement on social media using #HailToTheFrontline. Alternatively, messages can be uploaded directly at www.UofMHealth.org/frontline by clicking on “Add your message of encouragement” or sent to headlines@med.umich.edu to be posted on the Headlines Thank You Corner.

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