DISCLAIMER Video will be taken at this clinic and potentially used - - PowerPoint PPT Presentation

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DISCLAIMER Video will be taken at this clinic and potentially used - - PowerPoint PPT Presentation

DISCLAIMER Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this photo and/or video. If you dont want


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Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this photo and/or video. If you don’t want your photo taken, please let us know. Thank you!

DISCLAIMER

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PHI includes, but is not limited to:

  • Patient name
  • Date of birth
  • Address
  • Occupation
  • Name of patient’s friends/family
  • Other identifiable features, i.e.

scars, tattoos, hair/eye color

Please DO NOT disclose any Protected Health Information (PHI)

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Conflicts of Interest

None – except a conflict with the virus

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COVID-19 Update #18 Aug 20, 2020

CHARLES KRASNER M.D. UNR SCHOOL OF MEDICINE SIERRA NV VETERANS AFFAIRS HOSPITAL

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Speakers

Mark Pandori, Ph.D. Director, Nevada State Public Health Lab Faisal Siddiqui, M.D. Pulmonary/critical care specialist, Sierra NV VA Hospital Jessica Thompson, PharmD, BCPS (AQ-ID) Renown Health

  • F. Kevin Murphy, M.D. Sierra Infectious Disease, Faculty

UNSOM Sara Healy, M.D. Pediatric Infectious Disease, Renown Health Kim Jacques, PharmD, BCIDP Sierra NV VA Hospital

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February 26- first COVID ECHO talk -53 cases/ 3 deaths in U.S.

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August 18- six months later - 5, 5,481 481,795 795 cases 171, 171,799 799 deaths

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New daily Nevada case numbers remain elevated with increased testing, but would expect a dec ecreas ease in daily positivity rate if simply due to greater availability of testing …

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But we continue to have a marked increase in recent positivity rates suggesting we are missing many cases…

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But fortunately, at least for now, we have ongoing decline in hospitalizations over last few weeks

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And daily deaths remain elevated as Nevada passes the 1100 death mark this week

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Case rate/1000 varies significantly by county

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Covid-19 Case- a study in frustration

72-year-old male with hematuria needs elective cystoscopy to evaluate for possible bladder cancer Day before procedure a screening COVID RT-PCR test is positive Patient is informed, denies any symptoms typical of COVID Repeat PCR test performed 4 weeks later- still positive RN calls patient, he has remained asymptomatic, RN requests my input on case Using CDC criteria, I cleared the patient as non-infectious and procedure rescheduled Day of procedure surgeon cancels it; states wants to delay procedure for another month

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His Cepheid test results both the initial and one month later tests show very high Cycle threshold (Ct Ct) results

JULY 15 RT-PCR TEST AUGUST 10 RT-PCR TEST

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Percentage of positive Viral cell cultures as a function of Ct Ct (Cycle cle th thres eshold ld value) Remember – higher the Ct Ct, the lower the viral load- takes longer to reach the positive threshold value)

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Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance- August 10,2020 update)

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Newsweek reports: “those infected with COVID-19 are immune for just 3 months, CDC says”. However :

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Duke University scientists tested 14 types of masks: what worked, what didn’t

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Simple set-up developed to cou

  • unt

aerosolized drop

  • plets

when speaking at normal volume with no mask on compared with wearing different types of face coverings

HTTPS://WWW.YOUT UBE.COM/WATCH?V= LEEBN4TTZZY

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The rundown on mask effectiveness –

#1 the bes

est t #2 the g good

#1 N95 RESPIRATORS The only mask type that best protects the wearer as well as others around them #2 SURGICAL MASKS Combine with a face shield or goggles for high risk procedures. A shield should never be used to replace a mask.( Tied masks may be more effective than ear-looped ones- JAMA Int Med 8/11/2020)

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#3 #3 the g goo

  • od

d #4 the po he pointless ess

COTTON/POLYESTER MASKS- 3 LAYER IN COMBINATION WITH DIFFERENT MATERIALS IS GOOD, BUT FIT IS MOST IMPORTANT BANDANAS

Little efficacy. The Mayo Clinic has recommended this an alternative to face masks

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#5 Th The B Bad #6 …and t the Really Ba

Bad

VALVE MASKS- PUTS OTHERS AT RISK, NOT INDICATED FOR PREVENTING SPREAD OF INFECTION NECK GAITERS

MADE OF FLEECE, WORSE THAN WEARING NO MASK, CREATED MORE LITTLE PARTICLES THAT LIKELY TRAVELED FARTHER THAN LARGER DROPLETS THAT FALL TO THE GROUND

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Do not use N95 masks with valves!!!

these masks protect the people wearing them but do not stop virus droplets from escaping and infecting

  • thers. May give false sense of

security to people around them The masks are designed for construction workers or fire-fighters to use to keep out dust and other particles.

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Quick and affordable saliva-based COVID-19 test developed by Yale scientists receives FDA Emergency Use Authorization- work financed by the NBA! No need for nucleic acid extraction kits, collection swabs or viral transport media. Patient collects their own sample. Non-profit,

  • pen source, can be done by various products already in use in most labs, cost about $1.50

to $4.00 to run. No proprietary equipment needed

SalivaDirect:

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