COVID 19 Webinar for Case Investigation and Follow up Tools for - - PowerPoint PPT Presentation

COVID‐19 Webinar for Case Investigation and Follow‐up

Tools for LBOHs

Hillary Johnson, Infectious Disease Epidemiologist Scott Troppy, Surveillance Epidemiologist Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health

April 21, 2020

Contact Tracing Update

Academic Public Health Volunteer Corps

A partnership between MDPH, MHOA, and MA Academic Institutions Update to LBOH on April 21, 2020

Academic Partners working with MDPH

1.

Boston University, School of Public Health

2.

Harvard University T.H Chan School of Public Health

3.

Holyoke Community College

4.

MCPHS University (Massachusetts College of Pharmacy and Health Sciences)

5.

Northeastern University, Program in Public Health

6.

Northern Essex Community College, Associates in Public Health

7.

Regis College

8.

Simmons University, Program in Public Health

9.

Tufts University, School of Public Health

10.

UMass Amherst, School of Public Health

11.

UMass Lowell, Public Health Program

12.

UMass Worcester, Medical School, Public Health Program

As of Monday, April 20

Component of Volunteer Assignment Process *Note that some neighboring LBOHs have chosen to share a team of volunteers Number of individuals or towns

# of volunteers 1,900 # of LBOH enrolled with APH Volunteer Corps (deployed or planning) 132 # of LBOH doing contact tracing with APH Volunteers 82 # of LBOH* with deployed APH Volunteers (includes 4 county‐ level assistance requests) 89 # of APH Volunteers deployed 560

Towns currently served

Acushnet Ashland Avon Barnstable County Bedford Belchertown Bellingham Belmont Beverly Boston Bourne Brewster Brookline Burlington Cambridge Carlisle Carver Chatham Chelsea Concord Danvers Dedham Dennis Dennis (county assistance) Dighton Eastham Easton Fairhaven Fall River Falmouth Franklin Freetown Georgetown Gloucester Harwich Holyoke Hopedale Hudson Ipswich Kingston Lakeville Lawrence Lexington Lincoln Marion Marshfield (county assistance) Mashpee Mattapoisett Maynard Medway Mendon Milford Nantucket Natick New Bedford Newbury North Reading Northborough Northbridge Norton Norwood Orleans Paxton Peabody Pelham Plympton Provincetown Randolph Sandwich Saugus Sheffield Somerville Sudbury Taunton Tewksbury Truro Uxbridge Waltham Ware Watertown Wellfleet Wellfleet (county assistance) Wenham Westborough Westfield Westminster Westwood Wilbraham Yarmouth

Towns in planning stage

Andover Attleboro Auburn Barnstable Clinton Cohasset Dover Dukes County Duxbury Framingham Gosnold Greenfield Hadley Haverhill Holbrook Lowell Lynn Lynnfield Mansfield Marion Rochester Regional Health District Medford Methuen Milton Nashoba Newburyport Newton Northampton Orange Palmer Plymouth Raynham Revere Rochester Sharon Shutesbury Springfield Swansea and Somerset Wales Webster Weymouth Whately Winthrop Worcester

Changes to Scope of Services from Student Volunteers

as of April 23

Contact Tracing Cases will no longer go to REDCap. LBOHs will begin work with Community Tracing Collaborative (CTC). Existing cases in REDCap will continue with student volunteers until they are closed out. Other Public Health Assistance The following services will continue to be available to LBOH: health communications, social media, data and policy analysis, translation assistance.

APH Volunteers ‐ Areas of Support

• Social media
• Policy and data
• Research strategies
• Phone support
• Translation
• Admin support

Other ideas…? ...It never hurts to ask.

How to request Academic Public Health Volunteers

1.

Every LBOH is different. Volunteers can assist with health communications, data and policy, translation, and other needs. Please discuss with the Team Lead so we can assign a volunteer team for you.

2.

Team Lead acts as single point of contact/project manager with LBOH

Fill out MHOA Survey APHV will contact you for brief phone call Phone consult with your Team Lead Volunteers are assigned

Thank you!

We are open to feedback.

Follow‐up for Positive COVID‐19 Cases and their Close Contacts

Tools for LBOHs

Scott Troppy, Surveillance Epidemiologist Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health

April 21, 2020

Community Tracing Collaborative (CTC) sites as of 4/21/2020

• Andover
• Attleboro
• Belmont
• Billerica
• Boston
• Brockton
• Chelmsford
• Danvers
• Dracut
• Greenfield
• Ipswich
• Leominster
• Lowell
• Methuen
• Milford
• Norwood
• Plymouth
• Randolph
• Revere
• Salem
• Shrewsbury
• Taunton
• Walpole
• Worcester

N=24

What’s Ahead? |Roll‐Out Timeline

MAVEN Misc. for today

• Please enter your clinical information in the Clinical Question

Package NOT the notes section

• Please don’t request a merge/de‐duplication for your event in

the Notes section. You need to email isishelp@state.ma.us with your request. Please let us know the Event ID and which

• ne you want as the preferred Event ID.
• Please update addresses in the participants tab and

demographic question package (tip sheet in MAVEN help).

• Workflows are not functioning due to volume of cases.
• Complete your Steps 1‐5 to move cases out of the workflows

MAVEN Housekeeping Items

• Due to the volume of confirmed and contact COVID‐19 events, some MAVEN events are not

appearing in their appropriate MAVEN workflows. These events may seem to “disappear” between workflows, as well. One way that you can find them is by running the COVID‐19 Confirmed Case Line List or the COVID‐19 Contact Line List reports under the MAVEN report

• feature. For confirmed cases you will still receive email notifications of immediate disease

events.

• We plan to create a COVID‐19 Wizard where all of the questions for your investigation are in
• ne place – we will demonstrate the wizard on the webinar tomorrow.
• We plan to add additional variables to track cases that have been sent to the Community

Tracing Collaborative (CTC) in MAVEN. Some variables under consideration are: event/contact has been contacted, event/contact has been updated. We hope that these two variables can help you to better track information for your CTC events.

• You will notice that COVID‐19 Confirmed Case Line List now has death data listed in this

report (Outcome, Death Date, Location of Death). Look to the right side of the report to see these variables.

Electronic Lab Reporting Issue

• Multiple Local Boards of Health and Public Health nurses flagged an issue with

reports not entering Maven last week. We found after investigation that all of these tests had been performed by Quest. Our ELR team has been pushing Quest very hard for a response. This morning we were informed by Quest that there was an internal coding issue in their LIMS that prevented a subset of tests from being sent to states. This has affected many facilities across several states. Quest have found and resolved the issue, and have assured us that reports will be sent through this evening/tomorrow morning.

• Thank you to all of those who pointed out to us that there was an issue; if you had

not raised the alarm, there would have been further delay.

Reporting your data

Towns are able to report their own data, however; to protect patient confidentiality, the Bureau of Infectious Disease and Laboratory Sciences employs a strict policy whereby case counts of less than five are suppressed in populations of less than 50,000.

COVID 19 Questions

• COVID19CommunityTracingCollaborativeQuestions@mass.gov

COVID Requested Assistance as “Yes” or “No”

MAVEN functionality refresher

• Help Section on MAVEN
• http://www.maventrainingsite.com/maven‐help/toc.html
• Race/Ethnicity in the Demographic Question Package #2
• Additional variables added to Risk/Exposure Question Package
• Question: Employed at, admitted to, or visited a healthcare setting?
• Address updates/Demographic updates (gender, dob, address, city/town)
• Communication events in MAVEN for 351 towns/city
• Reports
• Searching for Events or Cluster

MAVEN Help Section

Race/Ethnicity

Select Official Address hyperlink to update the event Official City

Search for your Communication Event

City: Your town/city Event: Communication

Follow‐up for Positive COVID‐19 Cases and their Close Contacts

Tools for LBOHs

Hillary Johnson, Infectious Disease Epidemiologist Scott Troppy, Surveillance Epidemiologist Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health

April 21, 2020

Topics Today

• Update from Volunteer Corps & CTC
• New Case Definitions are Here!
• Confirmed Vs. Probable (NEW)
• Updated Interview Tool (paper based)
• Use for CONFIRMED & PROBABLE cases
• Contact Monitoring Question Package – a Review
• UPDATE on Asymptomatic HCWs returning to work
• Cluster Events in Facilities – What to Do?
• Tips for Staying Organized
• Your Questions

Tuesday & Friday Webinars for LBOHs

• 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.

• Focusing on Priority Activities
• Clusters in Facilities in your community

need your help.

• Call Epi Program 617‐983‐6800 to

create cluster events.

Now Tuesdays AND Fridays at 11am!!

Community Tracing Collaborative (CTC)

• Live Webinar TODAY.
• You are invited to join a live webinar where various leaders of the Community

Tracing Collaborative (CTC) will explain the initiative in detail and will be ready to answer your questions.

• Here are the details:
• When: Tuesday April 21st; Line opens at 2:45PM EDT, the webinar starts promptly at 3PM.
• Duration:

90 minute

• Register:

Copy‐and‐paste the following URL in your web browser:

• https://statema.webex.com/statema/onstage/g.php?MTID=e252939b797e6a

9b314d6cc904e17ad82

• Submit Questions: COVID19CommunityTracingCollaborativeQuestions@mass.gov

New Case Definition

CONFIRMED

 Meets confirmatory laboratory evidence

Probable

 Meets clinical criteria AND epidemiologic linkage with no confirmatory laboratory testing performed for COVID‐19 OR;  Meets presumptive laboratory evidence AND clinical criteria OR Epidemiologic linkage. OR;  Meets vital records criteria with no confirmatory laboratory testing performed for COVID19.

PCR Test (swab)

Clinical Criteria:

• At least two of the following symptoms: fever

(measured or subjective), chills, rigors, myalgia, headache, sore throat, new olfactory and taste disorder(s); OR

• At least one of the following symptoms: cough,

shortness of breath, or difficulty breathing; OR

• Severe respiratory illness with at least one of the

following: clinical or radiographic evidence of pneumonia

• r acute respiratory distress syndrome (ARDS) AND no

alternative more likely diagnosis.

Presumptive laboratory evidence:

• Detection of specific antigen in a clinical specimen
• Detection of specific antibody in serum, plasma,
• r whole blood indicative of a new or recent

infection* *serologic methods for diagnosis are currently being defined

(blood tests)

New Case Definition – What does this mean?

• CONFIRMED and PROBABLE COVID‐19 MAVEN Events should be

interviewed.

• Data Collection & Contact Notification
• Prioritize CONFIRMED cases (PCR+)
• Symptomatic & Asymptomatic Cases should be isolated & interviewed.
• Probable Cases – symptomatic cases should still be isolated and we

look at symptoms to establish all the timeframes for Isolation (case) and Quarantine (contacts).

• Asymptomatic Cases with serology tests – more to come.

Key Documents for COVID‐19 Follow‐Up

1. COVID‐19 Interview Tool for Confirmed Cases and Identifying Their Contacts (April 19, 2020)

• Paper‐based interviewing tool to guide your interview with confirmed cases.
• Updated to include some new symptoms, updated infectious period and address Probable Events.

2. Close Contact Identification Form (March 16, 2020)

• Paper‐based tool to assist in identifying and tracking close contacts.
• Space for 5 contacts per page.

3. Isolation Guidance (For Cases)

• MDPH Guidelines – give these to Confirmed Cases

4. Quarantine Guidance (For Contacts)

• MDPH Guidelines – give these to quarantined contacts

5. MAVEN Tips Sheet

Now available in additional languages!

Use the Interview Tool to Guide You

• We are trying to determine risk,

severity of illness, and if there are certain affected populations.

• Page 1 Covers The Confirmed (or

Probable) Case and their Clinical Symptoms, Complications, and possible source of exposure.

THINK ABOUT THE CASE.

4/19 Updated to include symptoms: Anorexia Loss of taste and/or smell

Use the Interview Tool to Guide You

• Page 2 helps describe what is considered

“Close Contact” and helps you and the Case brainstorm different categories of interactions with people that might have led to exposures.

• We are trying to determine who should

be notified. Where might this case have exposed others?

THINK ABOUT CONTACTS.

4/19 Updated to include expanded Infectious Period (2 days before symptom onset).

Use the Close Contact Identification Form to Make Notes on Individual Contacts

• This is just a tool to help you collect

sufficient identifying information on Close Contacts (not a required form)

• Keep copies of this form (tracks 5

contacts per page).

You can add these named contacts to MAVEN.

How do you add a contact if they are already in MAVEN?

1. If the Contact already has a COVID event, you don’t need to add them again, you just want to LINK your Index Case to the Contact’s COVID event. 2. Search for the contact to see if they already exist in MAVEN.

• They could already have a contact event.
• They could already be a Confirmed COVID event in MAVEN.
• They could already be in MAVEN for an older disease event (different from COVID).
• (just clarifying ‐ do not link to other disease events.)

3. If you find a COVID event already exists for your contact – Write Down the MAVENID#. 4. Go back to your Index Case that named them.

• Go into View Linked Events.
• Link to EXISTING Event.
• Search by MAVEN ID & Select.

Contact Monitoring Question Package

Key Variables:

• Contact Monitoring Status
• In Progress, Completed, Lost to

Follow‐up, Transfer, Other

• Last potential Exposure

Date

• Exposure date – to calculate

quarantine.

• First/Last Day of Required

Monitoring

• Quarantine Period

Contact Monitoring Question Package

What are these Variables?

• Risk Status – based upon an
• ld risk table assessing
• exposure. Not required.
• Assessment Date
• Repeatable Fields. You can

enter health checks. Not required.

Contact Monitoring Question Package

Tracking Temps for Contacts?

• This is not required by the

State at this point, but you can use this question package for this purpose.

• Assessment Date‐ insert

date and the other questions will drop down.

• Repeatable Fields. You can enter

health checks. Not required.

Contact Monitoring Question Package

What are these Variables?

• Contact Established in 72

hours?

• Did you notify the contact w/i 3

days?

• Did contact receive official

notification of I&Q requirements?

• Were you able officially notify the

contact about their exposure? (MDPH I&Q guidance helpful)

• Date arrived in the US
• For returning travelers. This is

probably no longer applicable for 90% of contacts.

HCWs Returning to Work – an update

• There is specific guidance on HCWs returning to work following COVID‐19

Diagnosis:

• Symptomatic COVID‐19 Positive HCW: use test or non‐test based strategy.
• Asymptomatic HCWs : UPDATE on return to work policy.
• Asymptomatic COVID‐19 HCWs are excluded from work for 10 DAYS after Specimen

Collection.

• (Update from 7 days for asymptomatic COVID+ HCWs)
• Official wording of this guidance is in the works.

Facility Clusters & their residents – what to do in MAVEN

Residents at LTCFs – what to do?

• Link confirmed events to the associated cluster.
• Many residents are being reported with their old ‘permanent’ address so they

might not show up in your town’s cases.

• Call Epi & we can help switch to the correct current address.
• If you get a case that lives in a facility in another town, let the other town know.
• Update to the correct address (call Epi & we can help)
• Call or email MAVEN ID to the new LBOH. Otherwise they might not see it.

Clusters

• A facility or location based event that you then link individual patient events to

for tracking purposes.

• LTCF, Rest Homes, Nursing Homes, Group Homes, etc.
• Finding one in MAVEN
• Link individual people events to the cluster

SEARCH Update Type to “Outbreak” (from Normal)

Clusters – Events for Facilities in MAVEN

• If you identify a facility (LTCF, Nursing Home, Rest Home, Assisted Living Facility,

Jail, state or federal facility, etc.) with positive COVID cases, we want to create a Facility Cluster.

• Use the SEARCH Feature to Look for clusters in MAVEN (it’s called an Outbreak

Event in MAVEN)

• Call Epi Program 617‐983‐6800 to create the cluster.
• Link individual confirmed Events to the cluster.
• Don’t create lots of MAVEN suspect events for residents prior to being confirmed.

(Positive labs will auto create MAVEN events. Then you just have to link them.)

• Keep general notes or updates in MAVEN until new confirmed events come in.
• Provide advice on Control Measures, Staffing, PPE, Cohorting, etc.
• Epi program will assign an MDPH Epi to help consult.

Questions on Clusters (Outbreak Events)

• How do I find a cluster event in MAVEN?
• Remember to change “Type” from Normal to Outbreak in the Search Screen.
• How do I create a cluster in MAVEN
• Recommend that you call 617‐983‐6800 and an Epi will do it with you on the phone.
• What if residents have other addresses listed that differ from the Cluster Facility?
• This has been happening. We want to update the address to where they are currently

living.

• Call Epi program and we can find the MAVEN event (if it isn’t your town but you know the

name/DOB) and we can change the official address to your town. Then you will see it.

• The same if you find a case is actually living in a facility NOT in your town. You can update the

address or call Epi program and we will help change the patient & link event to cluster.

Questions on Clusters (Outbreak Events)

• What is expected if a Case I’m working lives in a facility? (LTCF, ALF, Nursing

Home, Group Home, etc.)

• Make sure to link them to the correct cluster facility event.
• Call Epi Program if you cannot find a cluster or think one needs to be made.
• You (most likely) don’t have to interview the patient for contact tracing, HOWEVER:
• Even confirmed events for residents at clusters – need you to do admin question package 5 steps

to move them through workflows & sign off.

• You should try to fill out as much of their clinical symptoms/risk/race/ethnicity as
• possible. Usually the nurse manager or the medical director at the facility can answer these

questions.

• Healthcare Workers DO need to be interviewed.
• Remember they have household contacts, other activities. They will need direction on

quarantine, etc.

• Link HCWs to the Facility Cluster where they work.
• If they are not in your town, you may need to call Epi program with their name and we can help share &
• link. ‐ this would be a great scenario where sharing events across towns is ideal.

Clusters in Facilities – your role

• First and foremost – we want to stop the spread of COVID‐19 across these

facilities.

• LBOHs help provide advice on control measures. Epi program staff can help.
• LBOHs assist in identifying Confirmed MAVEN events associated with a

facility.

• Link those cases to the facility clusters.
• Complete Question Packages as best you can with the help of the facility.

Time Saving Tips

• Use the Interview Tool to help guide your questions.
• Don’t worry too much about the questions about how they may

have gotten COVID‐19 (bottom of page 1).

• We want to make sure and capture if they are a HCW or if they

live in a facility/group home.

• Look for contacts in MAVEN before trying to create your
• wn.
• The contact may already be in the system. If they are, you only

need to link the two events.

• Don’t try to create Clusters. Call Epi Program and we will

create them with you on the phone.

• With Workflows not working well (due to volume), run

your reports to get lists of new cases or contacts.

Send us your time saving tips to share!

Your Questions: