Follow-up for Positive COVID-19 Cases and their Close Contacts Tools for LBOHs July 14, 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 • Long Term Care Facilities • Updated Guidelines & Resources from the MDPH Epi Program’s HAI Team (Healthcare Associated Infections) • Daycares – The Basics • Reopening Resources • Your Questions! 2
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 3 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
MAVEN Updates As of 7/14/2020 Scott Troppy, MPH, PMP, CIC, Surveillance Epidemiologist Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health 4
Updates for today, Tuesday, 7/14 • MAVEN Status Map – one town to go • 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. 5
MAVEN Status Map as of 7/14/2020 6
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 7 (Final Review)
MAVEN Help Section 8
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- 9 • 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
DAYCARES 10
Daycares Health and Safety Guidance • https://eeclead.force.com/apex/EEC_ChildCareEmergencyHealthGuidance • Updated 6/28: Frequently Asked Questions • https://eeclead.force.com/resource/1593433571000/FAQ_Min_Req • Updated 6/12: Minimum Requirements for Health and Safety • https://eeclead.force.com/resource/1592325278000/Min_Req • Massachusetts Department of Early Education and Care (EEC) • These documents describe the minimum requirements for health and safety and answer questions on how daycares can safely return to operations in the current pandemic. 11
Daycare Guidance • Topics addressed: • Note: These documents are and will be continually revised as appropriate or further clarification is needed. 12
Hillary’s Favorite Book • “ At some point, everything's gonna go south on you... everything's going to go south and you're going to say, this is it. This is how I end. Now you can either accept that, or you can get to work. That's all it is. You just begin. You do the math. You solve one problem... and you solve the next one... and then the next. And If you solve enough problems, you get to come home. All right, questions?” - Mark Watney (movie character) For Schools and Daycares: Take a step back and assess the details. The proper next steps may be obvious if you can clearly define the problem. 13
Daycare Guidance Q. What is the role of LBOH in follow-up and in implementing control measures in the daycare setting following an exposure? • A. The EEC guidance mentions LBOHs in a number of locations as being the primary contact for guidance on control measures, answering questions on exposures, and determining appropriate isolation and quarantine guidance: • Notifying Required Parties: In the event that a program experiences an exposure, programs must notify the following parties. (1) Employees and families about exposure but maintain confidentiality. (2) Local board of health if a child or staff is COVID-19 positive. ( 3) Funding and licensing agencies if a child or staff member has tested positive. • The program must consult the local board of health for guidance on quarantine for other children and staff and what additional precautions will be needed to ensure the program space is safe for continued child care services. 14 • Release from isolation is under the jurisdiction of the local board of health where the individual resides.
Daycare Guidance Documents Continued… • Additionally, the documents summarize contact here: • If you have questions about closure or quarantine in the event of a sick child or a positive COVID-19 case, please consult with your local Board of Health. If you are unable to reach your local Health Board for any reason, please consult with your licensor for more information. • For additional questions related to child care settings, please contact the state’s dedicated epidemiologist for child care: Dr. Katherine Hsu at Katherine.hsu@massmail.state.ma.us or 617-983-6948. 15
Daycares – The Basics • LBOHs are listed as the first mode of contact for questions by daycare facilities. • Let’s review some key talking points to help you in any possible future discussions with daycare facilities. 16
Daycares & LBOHs • The highest priority situations: • A Confirmed Exposure at a Daycare: A confirmed case attends the daycare and exposes others. • Transmission at a Daycare: A confirmed case attended daycare and exposed others. Exposed individuals later develop COVID-19 as well. • You will likely also receive calls regarding the following: • A child or staff member has tested positive. What to do? • A child or staff member at the daycare has been identified as a contact to a confirmed case. What to do? • A child develops symptoms of illness and is sent home. What to do? • Lots of other scenarios that do not always equate exposure at the facility. 17
Daycare Talking Points • We would still be using our definition for close contact to determine exposures in a daycare setting. • If proper social distancing and safety guidelines have been in place, we are hopefully not looking at a full facility for exposure. • Small children are not realistically going to maintain social distancing at all times, so other best practices in the facility will help to reduce the risk of spread. • Cohorting practices are key for limiting possible exposures. • If exposure is clearly defined and limited, facility closure may not be the appropriate response. 18
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