Analyzing Pandemics The Role of Nurses

Analyzing Pandemics The Role of Nurses Global Interdependence Center: Executive Briefing December 3rd, 2020

Shelly Schwedhelm, MSN, RN, NEA-BC Executive Director, Global Center for Health Security, UNMC Executive Director, Emergency Management & Biopreparedness Nebraska Medicine

Previous Pandemics

1918 “Spanish Flu”

1968 “Hong Kong Flu”

• A (H1N1) • 50-100 M Deaths • 675,00 US Deaths

• A (H3N2) • 1-4 M Deaths • 100,000 US Deaths

1957 “Asian Flu”

2009 “Swine Flu”

• A (H2N2) • 1-4 M Deaths • 116,000 US Deaths

• A (H1N1) • 575,000 Deaths • 12,500 US Deaths

2019 COVID19

Emergency Management “All Hazards Plan(s)”: Pandemic • Team(s) • Triage and Crisis Standards of Care • Infection Prevention and Medical Counter Measures • Support Services • Behavioral Health Support • Communication Strategies • Research • Education

Pandemic Burden • The 3 S’s

Planning The burden of COVID-19 on Health System over time

FluSurge 2.0 is a modeling tool that allows one to assess the burden of a pandemic flu on their health system given their capacity, resource availability, and flu severity.

The resource information in the previous slides were used to model this table.

Illustrative Example ONLY- Planning Tool

FluSurge 2.0 and other CDC pandemic modeling tools can be found here:

https://www.cdc.gov/flu/pandemic-resources/pandemic-resources.html

Mitigate

Hospital Incident Command Structure(HICS)

Screening Testing Social distancing Universal masking

Cleaning practices Visitor Restrictions Telehealth and evisits Personal Protective Equipment (PPE) Vaccine Planning

COVID-19 Monitoring Dashboard

QUESTION:

What are safe, alternative versions of PPE if what you would normally use is not available?

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-mask s.html

Limited availability of PPE – Preferred: N95, face shield or other eye protection, single-use isolation gown Acceptable: surgical or procedure mask, face shield or other eye protection, isolation gown Crisis: Cover your nose and mouth (cloth better than nothing), protect with face shield if no mask of any kind is available, cloth mask and safety glasses or goggles, lab coat/patient gown/apron/surgical sleeves No PPE: prioritize at-risk HCW’s to non-COVID patients

Contact Gown + Gloves (one pair) Precautions

Airborne v. Droplet Mask or Precautions Respirator, Eye Protection

Not Required

Shoe covers, Hair covers, Impervious gown

Innovations

N95 decontamination

• First Initial and Last Name • Department/Unit Location

• Date of First use

Steri drape masks 3D printed swabs Pooling of tests PAPR adapter

• Tally Marks for Decontamination Cycles • These Marks are Added by the UVGI Staff

Drive Through COVID-19 Testing Clinic ”Swab Squad” Education/Hands-on Training Staff training focused primarily on the technique of nasopharyngeal swabbing Various types of education were used to support the training: • PowerPoint presentation • Demonstration Video • Hands On Swabbing practice with cross section manikin and simulation manikin • 'Real time' training support/feedback with actual patients

COVID-19 Early US Response

Quarantine Missions Camp Ashland – Quarantine Mission – 57 Americans and families from Wuhan China – 07 Feb – 20 Feb 2020 UNMC/Nebraska Medicine – Quarantine/Isolation/Biocontainment Mission – 15 Americans from Diamond Princess, Japan – 17 Feb –

Arrival at Airport

Camp Ashland

Joint Information Center UNMC Nebraska Medicine ASPR CDC ACF NDMS

0900 Briefing Daily

Diamond Princess Guests: Quarantine vs Isolation    

20 negative pressure~ 300 sq ft quarantine rooms Autoclave Exercise Equipment Technology equipped

COMMUNITY OUTREACH

Applying the Hierarchy of Controls in a Pandemic

https://www.cdc.gov/niosh/topics/hierarchy/default.html

Meat Packing Plants~ Technical Assistance • Team of Infectious Disease Experts from Global Center for Health Security at University of Nebraska Medical Center

https://www.unmc.edu/healthsecurity/

• Provided technical assistance to meat processing facilities in Nebraska • Onsite visits (15) and technical assistance calls (10) •

Observations and best practices have been collated to develop Guidelines and Recommendations for mitigating risks of COVID-19 in these facilities

Global Center Outreach: Technical Assistance ~ Schools  Invited by the Nebraska School Board Association to participate in a few Nebraska site visits of varying types of schools (small, consolidated, large, medium sized, middle, elementary and high schools)  Developed Guidance Document & Playbook along with Supplemental pediatric information  https://www.unmc.edu/healthsecurity/

1

Technical Consultations in Long Term Care The Gap

Development of Standard Operating Procedures

Execution of Standard Operating Procedures

Other Technical Assistance Global Center for Health Security COVID resources: https://www.unmc.edu/healthsecurity/covid-19/index.html Meat Packing Plant Playbook Court System Playbook Higher Education Playbook K-12 Playbook- in progress Early Childhood Development Playbook Big 10 Playbook Nebraska Extension Service & County Offices

Fast Forward to Now… Global Covid-19 Status (12.2.2020)

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Medical Emergency Operations Center (MEOC) MEOC Participants      

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Healthcare CMOs & COOs Coalition Coordinators CHI Transfer Center EMS State Representative ICAP Associations: o NE Hospital Association o Nebraska Healthcare Association o Leading Age Region VII Disaster Health Response Team (RDHRE) State and Federal Representatives (DHHS, NEMA; MEOC Role ASPR Region VII; VA)

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Statewide healthcare situational awareness (Info & Data) Problem Solving Coordinate Resources Provide Clinical Guidance if needed Consistent Guidance Implementation Statewide Planning & Mitigation

Ne MEOC Stakeholders & Tasks CMO & COO Leaders • Individual Healthcare Facility & Coalition/Regional Surge Strategy (Space, Stuff, Staffing) • Implementation of Crisis Standards of Care • Develop Transfer Center Rules of Engagement • Collaborate with Healthcare Coalition Coordinator in region Nebraska COVID Transfer Center • Administer rules of engagement- eg. rotation; out of state transfers, etc.

• Coordinate Crisis Standards of Care support if needed • Coordinate with Coalition(s) to define regional transport resources • Forward and Backward Movement Strategy Nebraska Associations (NHA; NMA; Leading Age; NHCA) • Convene groups as needed • Sponsor/support MEOC activities • Coordinate hospital association calls-Midwest

Coalition Coordinators-(6) *Coalitions represent diverse stakeholder group (Healthcare, Public Health; EMS, Emergency Mgmt, LTC, other non hospital based service providerseg. dialysis, ASCs, etc., Durable Medical Equipment, etc.)

• Response Plans- Unified Command • The 3 S’s • Mass Fatality Plans • Transportation Resources • Essential Elements of Information-data • Resource Sharing via Knowledge Center Crisis Standards of Care Team *represent diverse stakeholder group (Ethicists, CMO representatives, Legal, EMS, others) • Create Plan • Build agreement of the plan broadly • Define Implementation Plan for NE-triggers • Develop & Provide Education & Training and other Resources and Tools • Build capacity in coalition regions to support critical access hospitals

Vaccine Strategy

https://www.nytimes.com/interactive/2020/s cience/coronavirus-vaccine-tracker.html

Questions/Comments?