Follow ‐ up for Positive COVID ‐ 19 Cases and their Close Contacts Tools for LBOHs July 7, 2020 Hillary Johnson, MHS, Infectious Disease Epidemiologist Scott Troppy, MPH, PMP, CIC, Surveillance Epidemiologist Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health
Topics Today • MAVEN Updates • MAVEN Online Status Map • MAVEN On ‐ Call & Help Desk Stats • Vital Records and COVID ‐ 19 as Cause of Death • These cases are created as ‘probable’ if no lab is obtained. • Updated Testing Guidance is Here! (July 3) • Repeat PCR+ Cases and Next Steps • An evolving guidance • Your Questions! 2
MAVEN Updates On ‐ Call Help Desk Statistics As of 7/7/2020 Reed Sherrill, Surveillance Epidemiologist Scott Troppy, Surveillance Epidemiologist Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health
Updates for today, Tuesday, 7/7 • MAVEN Status Map – one town to go • MAVEN On ‐ Call and Email Statistics • LBOH Immediate Workflow – COVID ‐ 19 event only • Staff updates – please email isishelp@state.ma.us if any staff needs to be removed from MAVEN. If users have not logged into MAVEN in 30 days their accounts will be deactivated and a retraining will have to take place. 4
MAVEN Status Map as of 7/7/2020 5
MAVEN User Requests & Training 3/1/2020 ‐ 6/30/2020 Status Count N ew Users (added week of 7/6/2020) 10 In Training 32 Trained Users 958 Total New Users Trained Or In Process 1000 Total System (MAVEN) Users 1,527 New Users = Received user requests and forwarded to the VG for user account creation (2 day process) In Training = The VG account has been created and waiting on MAVEN Training (Mondays from 11 ‐ 12:30) Trained Users = Trained internal and external staff with VG MAVEN accounts created and MAVEN accounts created by ISIS staff and then access granted appropriate access 6 Total System (MAVEN) Users = Includes MDPH, LBOH, Infection Prevention and other trained staff *these data is accurate as of 7/06/2020 at 8:30PM.
MAVEN On‐Call Events 6/1/2020 – 6/30/2020 Program Area Count Division of Global Populations 10 Epidemiology 351 Immunization (COVID ‐ 19) 995 Informatics and Surveillance (ISIS) 218 Total On ‐ Call MAVEN Events 1,574 7 *these data is accurate as of 7/06/2020 at 8:30PM
MAVEN On‐Call Events 3/1/2020 – 6/30/2020 Program Area Count Division of Global Populations 29 Epidemiology Program 1,121 Immunization Program (COVID ‐ 19) 19,011 Informatics and Surveillance (ISIS) 943 Total On ‐ Call MAVEN Events 21,104 8 *these data is accurate as of 7/06/2020 at 8:30PM
Pre‐COVID‐19 MAVEN On‐Call Volume Year Total On ‐ Call Events Created 2015 6,739 2016 12,830 2017 12,605 2018 9,296 2019 10,652 So far in 2020 23,699 9 *these data is accurate as of 7/06/2020 at 8:30PM
Questions and Requests received through isishelp@state.ma.us 3/15/2020 – 6/30/2020 Month Count March 2,383 April 7,816 May 6,403 June 6,602 Total Emails received 23,204 10 *these data is accurate as of 7/06/2020 at 8:30PM
Immediate Notification workflow (COVID ‐ 19 Only) • UPDATE: COVID ‐ 19 Immediate Notification Workflow • This will allow proper notification of all new COVID ‐ 19 events for your jurisdiction. • Please review all events/cases in this workflow and complete your Step 1 ‐ LBOH Notification to “Yes” to clear out this workflow. • If you are retaining ownership then complete Steps 2 (Investigation Started) & 3 (LBOH Investigator (name, lboh, phone number) • When you are done then complete Steps 4 (CRF Complete) & 5 11 (Final Review)
MAVEN Help Section 12
Tuesday Webinars Going Forward Tuesdays @ 11am will continue in July • Isolation of Cases and Quarantine of Contacts is the goal until that strategy changes/evolves. • MAVEN is the main reporting source and where you should document your work. Send Cases to CTC for follow‐up if not: • Hospitalized, Deceased, or linked to a Cluster • Facility • Focusing on Priority Activities • Clusters in Facilities in your community need your help. • Call Epi Program to create cluster events. MDPH Epi Program: 617 ‐ 983 ‐ 6800 MDPH MAVEN Help Desk: isishelp@state.ma.us MAVEN Help has Guidance Documents and 13 Previous Webinars: MDPH Food Protection Program: 617 ‐ 983 ‐ 6712 http://www.maventrainingsite.com/maven ‐ help/toc.html CTC Help Desk: 857 ‐ 305 ‐ 2828 COVID19CommunityTracingCollaborativeQuestions@mass.gov
Summary of Key Guidance & Tools Date: July 3, 2020 ‐ Testing of Persons with Suspect COVID ‐ 19 • https://www.mass.gov/doc/covid ‐ 19 ‐ testing ‐ guidance/download Updated Testing Guidance saying who should be tested. • Includes language stating we should test CONTACTS to COVID‐19 right away. • Still states antibody testing needs more data. • BUT, if you ARE going to get serology (antibody) testing, get a PCR at the same time. • Date: June 1, 2020 ‐ COVID ‐ 19 PCR and Antibody Testing Public Health Response Recommendations • Table describes different Public Health Actions based upon different testing results. • Big take home: For serology positive individuals, ask about recent symptoms. Those individuals should be isolated and their • contacts quarantined. Serology positive but no recent symptoms do not require further public health follow‐up at this time. http://www.maventrainingsite.com/maven ‐ help/pdf/Serology%20Interpretation%20for%20LBOH_ver3.0_June1.pdf Date: May 11, 2020 ‐ Recommendation for Routine Molecular Testing of People Identified as Close Contacts to • COVID ‐ 19 Cases Recommendation to Test Contacts identified through contact tracing – regardless of symptoms. • They still need to isolate a full quarantine period, even if their test comes back negative early in quarantine. • https://www.mass.gov/doc/notification ‐ to ‐ test ‐ contacts ‐ regardless ‐ of ‐ symptoms ‐ 0/download Date: May 7, 2020 – Occupational Exposure & Return to Work Guidance • HCW & Non‐HCW discontinuation of Isolation Guidance. • https://www.mass.gov/doc/healthcare ‐ personnel ‐ occupational ‐ exposure ‐ return ‐ to ‐ work ‐ 14 Describes strategies for ending isolation for cases. • guidance/download Also outlines requirements for quarantine for contacts • (While there are two documents (HCW & non‐HCW), the key table on the front page is identical and tells key information) • https://www.mass.gov/doc/non ‐ healthcare ‐ workers ‐ occupational ‐ exposure ‐ return ‐ to ‐ work ‐ guidance/download
Vital Records & COVID ‐ 19 Related Deaths • Vital records without matching labs in MAVEN that have COVID listed as a cause of death are considered probable cases. • These cases have been imported on an ‘irregular’ basis to try and cut down on duplicate reporting. • Now that vital records ID is in MAVEN, it is easier to identify records that have not matched. • We will be creating these cases more regularly and in a more timely way. • What do LBOH need to do: • If it is a recent death due to COVID (<2 weeks old), it should be treated as a case and close contacts should be identified • If it is an old event (which should happen less often) no follow up is necessary • Update any data or notes if you have them. 15 • You can mark CRF completed = No.
Updated Testing Guidance (Diagnostic Testing & Serology Guidance) for Providers is here! https://www.mass.gov/doc/covid ‐ 19 ‐ testing ‐ guidance/download • Date: July 3, 2020 • RE: Testing of Persons with Suspect COVID ‐ 19 • Guidance about appropriate use of laboratory testing for COVID‐19. • No MAJOR Changes from May guidance, but some clarifications • Individuals should be tested for presence of the virus using a molecular diagnostic test such as PCR: • Symptomatic Individuals • Close Contacts • Admissions to Healthcare Facilities 16 • Asymptomatic Individuals (as recommended) • Previous cases with new symptoms
Updated Testing Guidance (Diagnostic Testing & Serology Guidance) for Providers is here! • Date: July 3, 2020 https://www.mass.gov/doc/covid ‐ 19 ‐ testing ‐ guidance/download • RE: Testing of Persons with Suspect COVID ‐ 19 COVID ‐ 19 Testing for current infection: • To evaluate individuals for current infection, a molecular diagnostic test to detect the presence of the virus by polymerase chain reaction (PCR) or other nucleic acid amplification methodology is preferred. • Molecular Test like PCR is Preferred • A second method to detect the presence of viral proteins is a diagnostic antigen test. Although the newer diagnostic antigen tests are faster to run, they are less sensitive and a negative antigen test result still requires a molecular test to confirm a negative result due to their decreased sensitivity 17 • Antigen Tests are fast but may miss some positives. • Negative Antigen Test needs a PCR test for follow ‐ up.
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