Follow-up for Positive COVID-19 Cases and their Close Contacts - - PowerPoint PPT Presentation

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Follow-up for Positive COVID-19 Cases and their Close Contacts - - PowerPoint PPT Presentation

Follow-up for Positive COVID-19 Cases and their Close Contacts Tools for LBOHs June 23, 2020 Hillary Johnson, MHS, Infectious Disease Epidemiologist Scott Troppy, MPH, PMP, CIC, Surveillance Epidemiologist Bureau of Infectious Disease and


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

Tools for LBOHs

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

June 23, 2020

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Topics Today

  • MAVEN Updates
  • MAVEN Online Status Map
  • Reminder to check the Immediate COVID

workflow and your LBOH Pending Workflows

  • Legionella and COVID-19 co-infection links
  • How Does the Funded Interpreter Services

Work?

  • Antigen Testing
  • The Outcome Variable in Clinical QP.
  • Recovered & Died
  • Travel & Vacation
  • Reminder about the Cluster/Outbreak Line

list Report – Updated and Better!

  • Your Questions

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Updates for today, Tuesday, 6/23

  • MAVEN Status Map – one town to go
  • CTC Variable updates in the Wizard and QP#8
  • Legionella and COVID co-infection link
  • Reminder to send limited information when you are

requesting a de-dup/merge of two events

  • All we need are the two event ID’s in your email to

isishelp@state.ma.us

  • Don’t send names, DOB, phone numbers
  • Updated LBOH Final Review Workflow – we have removed

COVID-19 events

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MAVEN Status Map as of 6/23/2020

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CTC MAVEN updates

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CTC Variable Updates

Variables

Completed

Couldn't be reached

Partially Completed

Refused to interview

Referred to LBOH

Contact Diagnosed with COVID-19

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  • CTC Follow-Up Notes field: CTC will be able to send notes that

they take on each case and contact. You will see these in the COVID Wizard and ECR#8 Question Package.

  • CTC Case outreach outcome variable: Indicates the

interview status of the case/contact.

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Variable Definition

Awaiting Outreach No attempt has been made. Outreach Underway

Has been assigned to CTC staff and an attempt to contact is being made for initial case investigation or contact tracing.

Monitoring and Support

Home monitoring and Resource Coordinator follow up and ongoing

  • referrals. Starts when there is completion of case investigation or reaching
  • ut to an exposed contact.

Closed

When the COVID Community Tracing Team has closed the case and is no longer responsible for following the case/contact. Closed reasons are required for this status and are found in the Investigation Status variable in ECR#8 Question Package. 7

  • CTC Case outreach status variable: Case status

variables that will show the administrative status of the case/contact.

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Electronic Case Report (ECR) QP#8

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  • CTC case information goes into ECR-QP#8
  • Race & Ethnicity populates QP#2
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Legionella and Covid co-infection links

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Immediate Notification workflow (COVID-19 Only)

  • UPDATE: We have updated the 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

(Final Review).

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LBOH Final Review Workflow

  • LBOH Final Review Workflow: We have updated the workflow to only show

non-COVID-19 cases that are still pending. Please review this workflow and complete or close out any older events/cases.

  • Once you complete Step 5 these non-COVID cases will be removed.

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LBOH Case Report Forms are Pending Workflow

  • LBOH Case Report Forms (CRF) are pending: We have updated the workflow

to only show non-COVID-19 cases that are still pending. Please review this workflow and complete or close out any older events/cases

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MAVEN Help Section

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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.

  • 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.

Tuesdays & Fridays @ 11am

MAVEN Help has Guidance Documents and Previous Webinars: http://www.maventrainingsite.com/maven-help/toc.html

MDPH Epi Program: 617-983-6800 MDPH MAVEN Help Desk: isishelp@state.ma.us MDPH Food Protection Program: 617-983-6712 CTC Help Desk: 857-305-2828 14

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Massachusetts Department of Public Health Telephonic Interpreter Services

Available to Municipalities for Coronavirus Response June 2020 Vendor Update

  • Massachusetts has a contract (PRF63) for telephonic interpretation services.
  • Six vendors are shown on the next slide.
  • Cities and towns should reach out to a vendor or vendors and set up an account

with them, mentioning the state contract PRF63.

  • Some vendors will bill DPH directly if they setup a group account for this purpose.
  • When used for interpreters in response to coronavirus, monthly invoices from the vendors

to cities and towns can be submitted to MDPH at the following e- mail address - sli.invoices@state.ma.us

  • MDPH will pay the vendors directly for telephonic interpretation services utilized by

municipalities for coronavirus follow-up through June 2021.

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Massachusetts Department of Public Health T elephonic Interpreter Services Available to Municipalities for Coronavirus Response June 2020 – UPDATED VENDOR LIST

Vendor Contact Person Phone # Email

Certified Languages International Dickey McMath 503-484-2317 dmcmath@certifiedlanguages.com Interpreters and Translators, Inc. Pamela McMahon 860-730-6149 pmcmahon@ititranslates.com JRivera Associates, Inc. Jose R. Rivera 209-405-0951 mrr@jriva.com Language Line Services Alisa Smith 831-648-7174 asmith@languageline.com Lionbridge T echnologies, Inc. John Drugan 978-964-9550 John.Drugan@lionbridge.com T elelanguage Manuela Villa 503-459-5655 mvilla@telelanguage.com

No longer available via the state contract: Interpreters Unlimited, Inc. and TransPerfect Global. 16

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Molecular (PCR) and Antigen Testing

Antigen Test - Newer (still rare)

  • Detects certain proteins that are

part of the virus.

  • Nasal or Throat swab to get a

fluid sample

  • Rapid Test - results in minutes on

site.

  • May be accompanied by

additional PCR Test

  • Only seeing them with two

providers currently:

  • Carewell & SouthCoast

Molecular Test (PCR)

  • Detects genetic material of the

virus using a lab technique called polymerase chain reaction (PCR).

  • Nasal, Throat, or Nasopharyngeal

Swab or from saliva

  • Test can be a Rapid Test (results

in minutes on site)

  • Or one to two days if sent to an
  • utside lab.
  • Some home test kits have also

been FDA approved.

https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/covid-antibody-tests/faq-20484429 17

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Molecular (PCR) and Antigen Testing

Antigen Test - Newer (still rare)

  • Listed in Lab Tab as follows:
  • SARS-CoV-2 Ag (Antigen Test)

Molecular Test (PCR)

  • Listed in Lab Tab as follows:
  • 2019-nCoV Real-time RT-PCR

(PCR)

  • SARS coronavirus 2 RdRp gene

(PCR RAPID)

Case Classification Manual: http://www.maventrainingsite.com/maven-help/pdf/case-classification-manual/COVID19__05282020_final.pdf

Positive Molecular Test: Case Classification = CONFIRMED Positive Antigen Test: Case Classification = PROBABLE 18

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Case Classification Manual

  • Pages 3&4
  • Table on different Lab Reports
  • Test Type
  • Specimen Source
  • Result possibilities
  • What informatics terms to use for

each lab (what you see in the Lab Tab & what the technical IT jargon means)

Case Classification Manual: http://www.maventrainingsite.com/maven-help/pdf/case-classification-manual/COVID19__05282020_final.pdf

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What is the Public Health Follow-up?

  • PCR, Antigen, & Serology NEGATIVE: (usually unclassified events in MAVEN).

No follow-up needed. But if they were a contact they should complete their quarantine.

  • Negative PCR or Antigen doesn’t end quarantine early.

Testing Interpretation Guidance Document: http://www.maventrainingsite.com/maven-help/pdf/Serology%20Interpretation%20for%20LBOH_ver3.0_June1.pdf

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Interpreting Antigen Testing

  • This table just describes likely “interpretation” and is not official case

classification.

  • PER CDC & CSTE Case definition, Antigen tests are still classified as

PROBABLE

  • Antigen testing was most likely pursued for acute diagnosis, so we follow-up like

we would for PCR test results.

  • PCR or Antigen POSITIVE (serology doesn’t matter): Treat like a new case.

Follow-up Accordingly. 21

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Flights & Cruises While Infectious

Key Demographic Data Needed:

  • Case Name
  • Date of Birth
  • Full address
  • Clinical Info:
  • Symptom Onset Date & Specific

Symptoms

Travel Information:

  • Airline or cruise company,
  • Flight number,
  • Seat or cabin number,
  • Departure and arrival locations and

times,

  • Reason for travel and if they

traveled alone or with others.

If your confirmed or probable case traveled while infectious and may have exposed others via airplane or maritime vessel (cruise or cargo):

  • 1. Update MAVEN notes
  • 2. Call Epi program so MDPH can notify the Quarantine Station.

Do the best you can. Travel dates & flight numbers are key even if you don’t have seat number.

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Question on Testing while on Vacation:

  • Q. To clarify- even if a case is on vacation and gets tested at vacation address, that

case should still be reported at the home address?

  • A. Yes. Vacationers should be counted by their permanent address, even if they seek

testing due to illness while on vacation.

  • MDPH generally uses this document. This should cover most scenarios.
  • Revised Guidelines for Determining Residency for Disease Notification Purposes

https://wwwn.cdc.gov/nndss/document/11-SI-04.pdf

Summary Bullets:

  • Cases should be reported by the jurisdiction of the person’s “usual residence” at the time
  • f disease onset.
  • If a case lives in one place most of the year but who regularly spend part of the year in

another town (e.g., snowbirds/vacation homes) should be reported by the jurisdiction of the residence where they live most of the year.

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Where to track “Recovered.”

  • Question Package 3: Clinical

Information

  • Outcome:
  • Died
  • Recovered – Fill out when you release

patient from Isolation.

  • This variable can be seen in many of

your reports:

  • Confirmed & Probable Line List Report
  • CTC Data Report
  • Cluster/Outbreak Linelist Report

Remember: Contact Monitoring Status = Completed is your other indicator. 24

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Tracking Clusters & their linked People Events

  • Identify if someone belongs to a facility cluster. Find or create the cluster as

needed and link the person event to the cluster.

  • Use the Cluster Facility Event to track notes on overall facility follow-up, control

measures, etc.

  • Update/complete the MAVEN variables for each linked person (residents and

staff).

  • Run the Cluster/Outbreak Line List Report for a Cluster (use MAVEN ID for cluster) to

see all the linked people and who still needs their MAVEN data entered.

  • Report Instructions live on MAVEN Help.
  • You will only see the linked people you have access to, so if they live in another town, they

still need to be shared. 25

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Cluster Events – how to manage the linked people.

  • Instead of looking at the long list of linked events, you can run a MAVEN report called

BOH COVID‐19 Cluster/Outbreak Linelist Report

This report will pull all the linked events from a cluster into an excel document and you can sort and see what events still need you to enter data. June 2020 UPDATE: This report has been updated to pull more of the key variables for each linked person – so you can see what data still needs to be completed on individual events!!! Yay!!! 26

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What’s in a Cluster Event?

General Facility follow- up Notes Link residents and staff here. Summary Variables Key Contact Information (and towns affected (who can view this cluster). Add new towns if this cluster is shared (so LBOH of staff can read it). If MDPH Epi is assigned

Can attach documents /lists here

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Cluster Events – how to manage the linked people.

There are pages of linked people. But you cannot tell much about them from this list of linked events. (Confirmed? Unclassified?) Is the data filled in for these people? Who do you still need to complete the MAVEN events for? This is a great way to check if an individual is linked or to link an new person from this screen. You can sort by name or any of the columns. 28

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Cluster Events – how to manage the linked people.

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Cluster Events – how to manage the linked people.

  • Use the Cluster ID.
  • Follow the MAVEN

instructions.

  • Run the report (set dates

to cover earliest possible linked event and most recent).

  • Select Excel for ability to

sort the data in an excel worksheet.

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Cluster Events – how to manage the linked people. (Cluster Line List Report)

  • You end up with a report (1 line per person).
  • The columns are the MAVEN Variables so you can see who is

missing information.

  • You can sort (pull your confirmed cases and work on updating

those events).

This report has been updated! Better (more applicable) data variables will be visible! 31

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Cluster Events – how to manage the linked people. (Cluster Line List Report)

Event ID EmployedAdmit HCS Type Where IS the facility located Official City Facility type County Other, specify Event Date Is case a healthcare worker Disease classification status Direct Patient Care Contact Monitoring Worker Type Specify other status Was case hospitalized First Name Outcome Middle Name Did case have symptoms Last Name Symptom onset date Gender Cough Birth date Difficulty breathing/Shortness Age (in years) Fever Calculated Race Sore Throat Is case Hispanic Loss of Smell/Taste Employer name Diarrhea Occupation Clinical Complications Other (specify) Please specify

  • You should be able to see

each linked case and their data fields.

  • You can see who still needs

data completion.

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Best Practices for Noting Residents and Staff in your Clusters

  • Make sure to note the

profession in the drop down for Occupation.

  • Use OTHER if you don’t see a

match.

  • Could use ‘Retired’ for residents if

applicable.

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Best Practices for Noting Residents and Staff in your LTCF Clusters

QP5: Make sure to note the facility, location, and type for all residents & staff.

  • Is Case a Healthcare Worker?
  • YES: for all staff (even housekeeping,

kitchen staff, admin, etc.)

  • Direct Patient Care Responsibilities?
  • This can be “No” for facility staff not

performing clinical roles.

  • Worker Type:
  • You can select “other” for facility staff that

do not perform one of the clinical roles listed

Because all facility staff are counted and reported on, note them here as HCWs and make distinctions below for worker type. 34

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