MemorialCare has sent us this great, sensible data that will really help everyone better understand how to stay healthy, and without fear.
You will also get a sense of how we will be managing things in our offices — with great care, courtesy, and common sense.
Keep washing those hands!

Dr. Sam Sunshine

Dear Colleagues,

A number of you have approached me with questions as to MemorialCare’s response to and readiness for the spread of COVID-19 infections. As you know from listening to or watching the news, this is a rapidly evolving situation, changing literally on a daily basis. The progressive rise in cases in the U.S., along with the appearance of cases as a result of community transmission, make it clear that we must be fully prepared to encounter patients with or suspected of having COVID-19 infection.

Because this situation poses a threat to our patients, our communities, and also to all who provide care to patients, weeks ago MemorialCare leadership instituted regular system-wide calls with representatives from each of our entities to assess our readiness and to plan for the potential of our receiving “PUIs”, or Persons Under Investigation. As the COVID-19 situation has evolved, we have increased the frequency of those calls to the point that we are now having daily calls Monday through Friday. We are listening in to weekly California Department of Public Health calls, and to CDC calls whenever they are held, and are monitoring both Public Health and CDC websites as well as published peer-reviewed journal articles as they appear.

We recognize the challenges this situation creates, and the concerns that it raises. The attached communication serves as a status update on the situation and our response thus far, and we will strive to keep you updated as the situation evolves. Importantly, steps are being taken to ensure up-to-date training of front-line staff on the use of PPE for those with likely involvement in care of PUIs, and to ensure that patients with respiratory illness are masked immediately upon entry to our facilities.

Please take a few minutes to read through the attached update. Please also remember that the primary personal protection for all of us comes from the simple measures of 100% compliance with hand hygiene before and after any patient contact or entry into a patient room, and on covering your coughs and sneezes (elbows, not hands).

Lastly, for those of you who may encounter patients in your ambulatory practices who you suspect might have COVID-19, unless the patient is sufficiently ill to require admission to the hospital, the California Department of Public Health (CDPH) recommends that patients NOT be referred to the ED simply for testing. Instead, on a statewide call this morning, CDPH recommended:

  • When a patient is suspected, place a mask on the patient and either keep them in a separate room with the door closed or send them home while you call local public health to arrange for / approve testing. Do not send patients unnecessarily to a healthcare facility just to get tested.
  • Contact your local health department to request / approve testing
  •  If testing is approved, what happens next will differ based on the circumstances and available supplies and PPE.
  • The message was very clear that the person who would collect a specimen (Nasopharyngeal or Oropharyngeal swab) must be wearing full PPE (gown, gloves, eye protection and N95 or PAPR)
  •  Details of how a specimen is to be collected and transported to the public health lab is to be worked out with the local public health department.

Los Angeles County PHD: (213) 240-7941 (8am-5pm Mon-Fri) – (213) 974-1234 (After Hours Emergency Operator). Orange County PHD: 714-834-8180

If you have questions about the attached document, please contact your hospital’s Infection Prevention Practitioners, or email me at jleo@memorialcare.org. I’ll respond as quickly as I’m able.

Jim
James D. Leo, MD, FACP, FCCP
Chief Medical Officer, MemorialCare

March 2, 2020

Dear Staff,

We know that over the last few weeks you have all seen or heard much about the 2019 Novel Coronavirus, also known as COVID-19. The recent outbreaks in multiple countries have naturally resulted in many questions regarding our state of readiness at our clinics and hospitals. The first and most important thing we can do is be educated and informed, so we want to provide updates regarding what we have done to prepare, and the resources available to support you.

What is different about the 2019 Novel Coronavirus (COVID-19)?

COVID-19 is a new or novel type of virus that was first identified in December 2019. It is a coronavirus, which means it is a similar type of virus to the common cold and similar to the viruses that caused the previous “SARS” and “MERS” outbreak.

At this time it appears that COVID-19 is transmitted in a similar fashion to other respiratory illnesses, specifically via respiratory droplets produced when someone coughs or sneezes. As with the common cold, we do not yet have a specific treatment for COVID-19 but the outcome of any patient can be significantly improved by providing management of complications.

What are the common symptoms?

COVID-19 is a respiratory illness with symptoms similar to the flu, including fever, shortness of breath, and cough. In most cases, patients have a very mild course and recover after a few days. In more severe cases, the infection can cause pneumonia, severe acute respiratory illness, severe acute respiratory distress syndrome, kidney failure, and in the most severe and rare cases, death.

Based on the Center for Disease Control (CDC) guidelines, a patient who meets the following criteria should be evaluated for COVID-19 and considered:

What steps should I take if I suspect a patient or visitor may have COVID-19?

  • Any patients or visitors with fever and respiratory symptoms, regardless of travel history, should be given a mask to wear.
  • Patients who are categorized as “Patient Under Investigation” (PUI) should be placed promptly in a private room (negative pressure, if available), give a mask to wear, and the door to the room should be closed. The patient should be evaluated by a healthcare provider wearing appropriate personal protective equipment (PPE). Anyone entering the room should wear an N-95 mask, face shield or eye protection and gloves. If not available, wear a surgical mask, eye protection and gloves.
  • Healthcare providers should obtain a detailed travel history as well as sick contact history (any individual the patient comes in contact with who has been sick) for all patients presenting with fever and respiratory symptoms.

Immediately contact your Infection Control department. On weekends and after hours, notify the House Supervisor.
Either the House Supervisor or Infection control will contact the County Department of Public Health to assist you with the care of the patient.

What Can I do to protect myself?

Like more other illnesses, you can protect yourself from COVID-19 by maintaining the same practices that you use during flu season or whenever you encounter a patient with respiratory illness.

  • Practice good hand hygiene
  • Cover your cough
  • Avoid close contact, when possible, with anyone showing symptoms of respiratory illness
  • Wear proper PPE when indicated
  • Stay at home if you are ill

What has our organization done to prepare for COVID-19?

We have activated a multi-disciplinary, systemwide team including our infection preventions experts and representatives from each entity. They are in constant communication and learning/sharing from experts in the field including the Center for Disease Control, CDPH and others. As you may have read, the majority of people who contract this are experiencing mild respiratory symptoms of fever, cough and shortness of breath, but with some developing severe illness requiring hospitalization.

Tools, tips and frequently asked questions/talking points:

Intranet site  – the team has created a new intranet button with related content and updated links for easy access: The first site is the Physician Society intranet (must be on the network to view).

  • You’ll find it on the home page on the left hand side under Initiatives and Campaigns.
  • Once you click on “Read More”, another window will open up with all the tips, tools and resources.
  • A summary information sheet for clinicians

Clinician Information – a checklist/tool has been developed:

  • This provides a one-page succinct view of what to watch for and what to do (including recommended isolation precautions).
  • Note that lab testing is currently sent out via public health and our Infection Prevention team will assist.

Travel screening

  • The team has assessed and confirmed that our Epic and other HER (NextGen) tools currently facilitate the gathering of travel screening information.
  • Our Eds/Urgent Care locations have identified specific rooms for any suspicious cases. See note on posters below.
  • Posters – our Marketing team had created updated travel alert posters for our patient entry points (ED, urgent care, clinics, other locations).
  • Masks/Supplies – and the Materials team has assessed our supplies of N95 masks and PAPRs which are in stock and will be closely monitoring stock levels, should they be needed.
  • Team meeting daily

We know that situations such as this can create fear and anxiety and our best way to address that is through communication, education, and preparation. As always, you and your teams play an important role in how we deal with any infectious disease in our community. Our success will come from remaining vigilant, following our detailed infection control practices, and demonstrating compassion and kindness to our patients and each other during this stressful time.

We will provide additional updates as the situation develops. In the meantime, feel free to reach out to your Chief Nursing Officer or Infection Prevention team if you have any immediate questions or concerns.


If we can be of service in any way, or if you’d like to ask us questions on our Direct Primary Care and memberships, please reach out! At OC Sports and Wellness you can actually text or video-chat your doctor, as well as schedule a visit. Let’s talk! 949-460-9111


 

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