Kaweah Health Employee Huddle

April 9, 2021

Please Note: When time does not allow us to answer every submitted question, we answer questions at the next week KD Huddle. Submit a question now for next week by e-mailing dvolosin@kaweahhealth.org.

EMPLOYEE HUDDLE QUESTIONS AND ANSWERS FOR 4/9/2021

Should staff continue checking daily temperature?
We will continue this for at least two more weeks and assess if we can remove with reduced presence of COVID in the community and increased vaccinations. Shawn Elkin reached out to the health department earlier this week to ensure our plans to decrease these daily screenings align with their recommendations.

Will we ever get purple wipes back on floors?

We are still working to get back to PDI or purple top wipes on the floors. The supply is not consistent enough to switch back but once it is we will return to use of those over the QT3 spray. We are actively watching supply chain availability and will absolutely move back to PDI wipes as soon as possible.

Any chance Kaweah will ever consider 7:00-7:30 shifts instead of 6:00-6:30?

We can always consider it, we would have to look closely at how many people would be impacted by the change and what would have to change in workflows. Many of the policies around patient care are set up for the 6-630 time so adjustments would be needed. We will not likely undertake this type of change this year since making a schedule change of this magnitude impacts a lot of people and deserves a lot of dedicated time to vet out all the potential problems.

Have we seen the COVID variants in our County?

Last week was the first report of identifying COVID variants in Tulare County. KD has been providing positive COVID specimens to the Tulare County lab for continued genetic sequencing to identify variants. We will continue to send samples and are evaluating the need to send all inpatient samples for variant testing. Variant testing is unique in that the sequencing that is done can take 24-48 hours. We would not change treatment or care of the patients but the data related to the presence of the variant is good to have as we continue to track and trend this virus. I think the only thing that will affect reopening is a resurgence of COVID cases in general. Though we have seen the variant in some samples in this county, our positivity rate continues to decline.
In a report from the county epidemiologist, Sharon Minnick, she shared that they have sequenced 150 samples so far – Randy Kokka our lab director said most of these come from positive samples we have in our lab. They have detected some variants in these samples, mostly they are considered California variants. These California variants are variants of concern, which is a technical term and means they are thought to be more contagious or more severe. The health department is closely tracking these variants to validate their impact on the pandemic. Right now they think these variants are associated with a 20% increased transmission. Studies do suggest that the antibodies created through the vaccinations that are available are effective with these variants. More studies are ongoing to tell us about how wide spread the variants are, is the disease from these variants different and will the variants effect existing therapies, vaccines and tests.
Reopening and continuing to be protective using masks and distancing when able is still recommended, along with more vaccine distribution. While people are tired of hearing it, the same prevention or mitigation strategies exist and are effective for people to protect themselves and others. Wear a mask, wash your hands, physical distancing, vaccination and isolating if ill.

Any updates on when staff can stop wearing N95 masks if they are not on a COVID floor?

We are waiting to see what numbers do in the county in the two-week period post spring break, schools reopening and Easter gatherings. IF numbers continue to stay the same or decrease we plan to alter the PPE policy to move away from N95s and back to surgical masks. Stayed tuned for an update on this next week.

Any updates on our visitor policy?

The visitor policy will also change if we see the numbers continue the decline. Right now the plan is to expand to two visitors at a time at the end of the month. We are implementing visitor badging kiosks and software (trial basis to see if they work with our operations) to help with volume of people. The visiting hours have expanded to 10am-9pm in most areas. Our post-acute and congregate settings are also evaluating visitor restrictions and implementing changes in line with expectations from CDPH. We will also be expanding the number of people who can come to the bedside in a day for exception circumstances like end of life.

Will employees be able to utilize the new clinic in Tulare for lab draws even if their doctor is not in that clinic?

The Tulare Clinic will not have a commercial lab set up to allow for lab draws from other providers. The regulations around a rural health clinic limit their ability to do draws only on their own patients in the clinic, not able to set up lab draw services to fulfill other provider orders.

Why did we change the sick leave structure so that we have to use PTO for sick leave?

A number of years ago we did change our vacation, holiday and sick leave benefit program to a Paid-Time-Off, or PTO, benefit program to mirror that used by most companies and hospitals. Prior to the change, employees accrued 12 days of sick leave each year and would use it to cover all illnesses, no matter how minor or serious, beginning with their first day of absence. As you state, we had many, many employees who consistently used all 12 days of sick time every single year; while some employees were truly sick or injured, many employees simply viewed it as additional vacation time. As you would imagine, this became very expensive and very disruptive to staffing. This is why most companies moved away from this kind of structure.
Under the PTO plan, employees accrue two to three weeks of vacation every year, depending on their accumulated years/hours of service, and nine holidays. While every employee still accrues 12 days of “sick leave” each year, we put 3 of those days into an employee’s PTO bank and the other 9 days go into their Extended Illness Bank (EIB). This is why an employee must first use their PTO bank for the first three days of an extended illness before they start using their EIB bank. However, if you have inpatient or outpatient surgery or must be hospitalized, you immediately start using your EIB bank beginning the day of surgery or hospitalization.
I agree with you that employees who never call in sick are essentially receiving 3 extra days of “vacation” and that, as a result, some employees will come into work while sick so they can preserve those 3 extra days. This is obviously not our intention and employees who are too sick to work should stay home and rest and recover. EIB should really be looked at as a form of insurance; you hope that you never have to use it but your glad it is there in case you need it. I have more than a 1,000 hours in my EIB account and I hope I never use it. This all said, I do appreciate the question and the suggestion of applying only 2 days of an extended illness against your PTO bank and being allowed to start using EIB on the third day of an illness if you have seen a physician and provided evidence (a “doctor’s note”) of your illness. Like all of our employee benefit programs, we are continuously evaluating them to make sure they are competitive with other employers, remain modern and up-to-date, meet the needs of our employees, and are affordable over time.

Will the Covid-19 vaccine be a yearly shot or is that known yet? If so, when will know when it is time to get vaccinated again.

We don’t know but I suspect that scientists will have that answer for us sometime later this year as they continue to study this virus. SARS-Covid-1 was first discovered in China in November 2002 but was declared gone by July 2003; worldwide there were 8,000 reported cases and 700 deaths. Perhaps SARS-COVID-2, or COVID-19, will take the same route. Or it could become a seasonal virus that does require an annual vaccine like the flu. Only time will tell.

An employee read an article about Pfizer vaccine only lasting six months. Do we have info on this?

Both Pfizer and Moderna have continued to study the subjects that participated in their initial vaccine trials and believe that the immunity created by their vaccines does indeed last between six and eight months, which is similar to the immune period scientists believe are associated with immunity acquired through contraction of the virus.

Can we do a bar graph for employees on our daily snapshot?

I believe you are speaking about the particular graph on our daily dashboard that displays the number of Kaweah Health employees who contracted COVID-19—those that have recovered and those that are currently still positive. According to Doug Leeper, our Chief Information Officer and the architect of our dashboard, the size of the data points make it very difficult to display the information in a bar graph format. As such, he used a “space” format to display the information.

One of my coworker want to know if departments start returning to work in the offices and they don’t feel comfortable being in offices with over 80 employees in a small area would they get fired or would an option be put out there for the ones that would like to work from home and only go into offices as needed?

First and foremost, we will never ask an employee to work in an unsafe work environment. This was the reason why we arranged for so many of our employees to work from home where they wouldn’t be exposed to the virus in the hospital work environment. Now that our County has moved into the safer Tier 3 Orange category of transmission, kids are going back to the classroom, and the majority of our staff have now been vaccinated, we do believe it is time to start bringing our telecommuting staff back to our work facilities. We will also continue to follow the CDC’s guidelines around creating a safe work environment and we will expect employees to keep following safe infection prevention practices. If all of this is put in place and a telecommuting employee simply doesn’t want to return to the hospital because they like working from home, then it is possible that their employment with Kaweah Health would end. This all being said, we are currently rethinking how we might use telecommuting more permanently at Kaweah Health given everything we have learned about virtual meetings and deploying technology into the home that still allows employees to be highly productive and effective.

We are currently at a COVID infection rate of 3/100,000 per day. That sounds pretty small for a virus that has a death rate of 1.6% in Tulare County. We still would like a more apple to apple comparison of these numbers. During the 2019 flu season, what was the number per 100,000 per day who were diagnosed with flu?

Thank you for the great, complex question and the interesting observations you make. Here are some of my own: From the first documented case of COVID-19 in Tulare County, which occurred on March 11, 2020, through yesterday, April 8^th (a total of 394 days), there have been 49,202 reported cases of COVID-19. That equates to an average number of new daily COVID cases of 25.8 per 100,000 population. That is significantly higher than the 7-day average daily case rate of 3.1 per 100,000 people reported Tuesday by the County Health Department. While a daily new case rate of 3.1 is 72% lower than the average number of people per 100,000 that die in a car accident every year, the average number of daily COVID-19 cases over the entire pandemic is actually 135% higher than the automobile death rate.
To put things even in greater perspective, in 2018 Tulare County experienced 20.1 flu-related deaths per 100,000 people. This is quite a bit lower than the 36.7 flu-related deaths per 100,000 people that occurred back in the year 2000. Between 2000 and 2018, flu-related deaths per 100,000 people held pretty stable at between 23 and 25 deaths. In comparison, in comparison, there have been 817 total COVID-related deaths in Tulare County since the beginning of the pandemic. That would equate to 169 death per 100,000 people but that is over a 394-day period whereas the flu season generally lasts 5-6 months (November 1^st to the end of March or April). So, if the 2018 flu season lasted 394 days instead of say 182.5 days (365-day year divided by half for six months), the adjusted number of total flu-related deaths would be approximately 210 compared to 817 for COVID-related deaths ((20.1 x (484,000 people/100,000)) x (394/182.5)).

Why did the Tulare Clinic not open on Monday?

We were supposed to receive our new consolidated hospital license from CDPH, listing our new Tulare Health Clinic as a site of service, on Monday but it wasn’t received until just this morning, Friday, April 9^th. So, looks like we’ll start seeing patients on Monday.