MAY 1: DAILY COVID-19 UPDATE

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
• NO ON-SITE COMMAND CENTER STAFFING THIS WEEKEND
• PRE-PROCEDURAL TESTING
• UPDATED UNIVERSAL MASKING GUIDANCE
• EMPLOYEE ENTRANCE REMINDERS
• PLANNING CONTINUES FOR EMPLOYEE TESTING
• VISITOR RESTRICTIONS CONTINUED
• RE-INSTILLING PATIENT CONFIDENCE ABOUT SAFELY RECEIVING CARE AT MICHIGAN MEDICINE

DAILY PATIENT STATS

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

Discharges: 396 COVID-19 discharges to date; 6 in the last 24 hours. These numbers include patients discharged to skilled nursing facilities but exclude deaths and discharges to hospice.

DAILY TEAM MEMBER TESTING STATS*

*Data from 3/10 through 5/1. The testing stats reflect just Michigan Medicine employees, not all University of Michigan employees. It also reflects only those who sought testing at or were hospitalized at Michigan Medicine or reported their testing to Occupational Health Services. Some Michigan Medicine employees may have been tested outside our system.

No On-Site Command Center Staffing this Weekend

There will be no on-site hospital command center staffing, including no on-site meetings or calls, this weekend, May 2-3. On-site staffing will resume on Monday, May 4. Global messages will not be sent unless there is an urgent matter. For any emergency issues this weekend that would otherwise be escalated to the command center, contact the Incident Commander on Call at 734-881-6803.

PRE-PROCEDURAL TESTING

Given increased capacity for testing and expected increased procedural volumes in the future, we are now recommending testing for asymptomatic individuals for COVID-19 prior to ALL procedures performed in the OR or procedural areas.

Below are FAQs about this change:

Is it safe to use standard PPE in an asymptomatic COVID-19 negative patient?

When combined with negative symptom screening and exposure assessment, negative COVID-19 test results have a higher negative predictive value. COVID-19 test results should drive decisions around isolation, PPE usage, and eligibility for surgery. In most cases, asymptomatic patients with negative test results should be managed with standard OR and procedural practices and do not require enhanced PPE. This includes when performing high-risk aerosol generating procedures. We will be sharing what we’re learning about testing on an ongoing basis. For additional details now, watch our “Behind the Scenes of Testing” live stream.

How will my patient get tested?

Each procedural area will be responsible for reviewing their upcoming schedule, contacting patients, and ordering Covid-19 Drive Through testing which can be performed at whichever site the patient selects (Canton, Brighton or West Ann Arbor). The attending performing the procedure will receive a result in their inbox.

When does my patient need to be tested?

We are asking that your patient get tested 48-96 hours before their procedure. This allows enough time for patients to get a test and have a result in time for their planned procedure. It also is close enough to the procedure time that we can minimize the chances of the patient being infected with COVID-19 in the community after the test is completed. We highly recommend that patients self-isolate between their test and their procedure date; this will be increasingly important to emphasize with patients as social distancing and stay-at-home restrictions are lifted.

For how long is a negative test considered valid?

Because your patient is in their community and susceptible to community infection, we strongly recommend that they self-isolate before their procedure, and if time allows, for two weeks before the procedure. We also want to make sure that the test is as temporally valid as possible at the time of the procedure, so we will consider a test valid for 4 days (96 hours) at this time. This is different from the thought around a negative test in an inpatient- we consider this a negative test unless symptoms occur while they remain an inpatient.

What happens if my patient cannot get tested in time for their procedure date?

Our guideline provides direction as to how to manage patients who present without a test by using appropriate PPE to protect our teams while providing timely procedural care to a patient in need (view here). That said, we expect this to be an uncommon occurrence as our testing expands. If a patient cannot come to Michigan Medicine to be tested before their procedure, they can be tested closer to home; it is the responsibility of the procedural attending to make sure that this test status is known and available in the chart if this is the case. If a patient has a special circumstance, like living in a congregate living facility or prison, please work with the MPLAN team or ASC/MPU leadership to plan for testing the day of procedure. This is not yet a widely available option as we continue to validate shorter turnaround testing, so please encourage your patients to get outpatient testing if at all possible.

If your previously untested patient will be admitted post-procedure, they will get a test at the time of admission, though this will not likely be available to impact surgical or procedural decision making. We are working on those workflows now.

UPDATED UNIVERSAL MASKING GUIDANCE

We have updated our universal masking guidance to address the use of cloth masks and distinguish guidance between clinical and non-clinical buildings, and between patient-facing and non-patient-facing activities.

Clinical buildings: Cloth masks are not permitted for patient-facing activities in clinical buildings, though workforce members may wear cloth masks when they are not involved in patient-facing activities. Those patient-facing activities include face-to-face interactions such as triage or check-in, providing a service in the patient room (such as EVS, tray delivery, maintenance in the patient room, and medication delivery in the patient room). Medical masks (with ear loop) will be used for patient-facing activities. All health care workers should wear the same standard facemask (not N-95) continuously throughout their shift, unless caring for a patient in Special Pathogens Precautions or Droplet Precautions. All visitors will be given a face mask or molded mask. For more detail, visit the Infection Prevention & Epidemiology page.

Non-clinical buildings are defined as buildings in which patient care does not occur. In non-clinical buildings, cloth masks or non-medical masks are acceptable. Workforce members are encouraged to wear a cloth mask from home. Masks may be removed when social distancing of at least six feet is possible (e.g., after entering a private office, or when barriers such as cubicles are in place). In order to ensure staff can take off masks for meals and breaks, scheduling and location for meals and breaks should ensure that at least a six-foot distance can be maintained when staff members need to remove their mask.

It is recommended that cloth masks be laundered daily, and bandanas are not permitted as masks.

Employee Entrance Reminders

Employees are asked not to attempt to enter or exit via the Adult and Children’s Emergency Services entrances. Emergency Services entrances are open 24/7 for patient use only. A full list of entrances and entrances with limited access is available here. Thank you for your flexibility and help to keep our environment safe and secure.

PLANNING CONTINUES FOR EMPLOYEE TESTING

Questions have been raised about the testing of asymptomatic essential workers, following the Michigan Department of Health and Human Services’ announcement of expanded COVID-19 testing eligibility criteria. We are currently prioritizing testing of symptomatic patients and employees as well as universal testing of all admissions. We are continuing to work on getting more testing supplies in order to expand our capacity for testing all essential workers.

Visitor Restrictions Continued

We recognize that Governor Whitmer’s executive order prohibiting hospital visitors expires on May 3 at 11:59 p.m.; however, we do not anticipate a change in our visitor policy at this time.

Re-instilling patient confidence about safely receiving care at Michigan Medicine

Information about what Michigan Medicine is doing to keep patients safe from exposure to COVID-19 has been added to UofMhealth.org: https://www.uofmhealth.org/coronavirus/keeping-patients-safe

Additional messaging about safety and how patients can make decisions about seeking medical care is in development and will be shared via portal messaging, social media and email.  

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