December 11 Employee Huddle

December 11, 2020

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

Can you give us a high-level overview of where we are with the vaccine and which groups are represented on the vaccine committee?
We have been working on the plan the last 3-4 weeks. We have a strategy around how to administer the vaccine that has been established by a multi-disciplinary team working through the details. This team includes doctors, nurses, pharmacists, ancillary service lines, and infection prevention. Vaccinations will be provided in the Acequia Wing Lobby.

We will be getting a limited amount of vaccine for our employees. Do we have a plan in place for how those are going to be dispersed? When is that plan going to be shared with the employees?

There is a strategic plan for vaccinating all employees which follows the guiding principles provided by Federal and State Agencies. Those employees at highest risk for COVID exposure are first to be vaccinated. Vaccine quantities are limited. The plans will be shared with departmental leadership on Friday 12/11/2020 who will share specifics. The first dose will be in the initial shipment and the second dose will come later.

Are we getting the Moderna or Pfizer vaccine at our facility?

In an effort to offer COVID-19 vaccines to all employees as quickly as possible, Kaweah Health will perform an expedited evaluation of all COVID-19 vaccines authorized by the FDA based on their available safety and efficacy data. If Moderna and Pfizer are both authorized by the FDA and pass the institutional expedited review process, then we would carry both vaccines as long as they are allocated to Kaweah Health. We likely will receive Pfizer vaccine first the week of December 14^th. Moderna may become available before Christmas and we will be getting a shipment of that when approved.

I have read some articles on the Moderna vaccine and while it seems very effective, it was quite common for people to feel sick for a day or two after getting it, which may result in them missing work. Will vaccinations be staggered within the departments so that multiple employees aren’t calling out sick on the same day.

This committee discussed this at length. The side effects so far have been more similar to the shingles vaccine. Staggering immunizations within a given department or workgroup should be consideration during vaccination planning for that very reason. Departmental leadership will work with employees’ schedules to stagger vaccinations whenever feasible. Could also be ideal to schedule the vaccine when you have days off coming up.

There has been some news coming out that there have been some issues with people that have food allergies taking the Pfizer vaccine. Is this something that we are looking into when distributing the vaccine to employees?

Much of the information that will be used for screening questions, vaccine information sheets, etc, will not be available until an Emergency Use Authorization is issued by the FDA. The UK and Canadian labeling do not mention these reactions as they occurred after the product approval. The Medicines and Healthcare Products Regulatory Agency (UK version of FDA) stated that people with a “significant history of allergic reactions” should not receive the vaccine. We will have to wait and see what information is approved / distributed by the FDA.

With Kaweah Receiving the Pfizer vaccine soon are they concerned with the safety of the vaccine with this company?

Pfizer pharmaceutical products do not appear to be any more unsafe than those of other pharmaceutical manufacturers. Kaweah Health routinely use many injectable products throughout the district that are manufactured by Pfizer.
We encourage Kaweah Health employees to be actively engaged in their own health care and to do their own part in researching the vaccine and deciding for themselves whether it is right for them at this time.

Do we know how long COVID-19 antibodies last in someone’s system? How long are they expected to last once they receive the vaccine?

We know from currently available data that antibodies / immunity continue for 2 months after the second vaccine dose for both Pfizer and Moderna products. Data beyond the 2-month mark will be forth coming. Patients involved in the clinical trials are being followed for several years to evaluate long-term safety as well as the duration of protection. Additional data will be released as these trials continue.

If a person gets the vaccine and gets tested for Covid a few days later could the test come back positive?

According the FDA, if you take a COVID test you will not show up positive after you have a vaccine but you could show up positive for antibodies.
The CDC states:
“Vaccines currently in clinical trials in the United States won’t cause you to test positive on viral tests, which are used to see if you have a current infection.”
“If your body develops an immune response, which is the goal of vaccination, there is a possibility you may test positive on some antibody tests. Antibody tests indicate you had a previous infection and that you may have some level of protection against the virus. Experts are currently looking at how COVID-19 vaccination may affect antibody testing results.”

Will the COVID-19 Vaccine shed the virus? Is there any risk having a baby around someone who just got vaccinated?

The mRNA vaccines contain no pieces of the virus and the proteins created from the mRNA are harmless as well. As a result, there is no viral shedding that could occur due to the vaccination itself.

I understand that we will prioritize how our staff receive the vaccine. Is there any consideration of giving some level of priority to staff over the age of 60 regardless of their job type?

No, age and comorbidies was not taken into consideration.

If you have had COVID-19 do you need to get the vaccine?

For those who are not working at full capacity, are there any areas where we can volunteer help?

Yes, please contact Raleen Larez in Human Resources for the Labor Pool if you are not working at full capacity. We will resend the labor pool area out to everyone to contact if you have availability. As we continue working through this, we will need additional assistance.

With the surge happening, will Kaweah Kids be offering the social distancing credit again?

Early in the pandemic and with the fear of the unknown, we had a number of employees remove their children from Kaweah Kids. With additional capacity, we opened up slots and discounted our tuition rates. We’ve not reviewed this again, but will take it up for consideration.

If an employee goes out of state will they have to Quarantine when they return?

Travel is strongly discouraged, but there is no required quarantine in effect. Employees are expected to monitor for symptoms.

Once an employee tests positive, do they get tested again to make sure they are negative before returning to work? If no, why not?

The CDC has not recommended a negative test for some time as a condition to return to work as people can carry trace amounts of the virus for some time even though not contagious. The newest guidelines are as follows:

If Covid positive, employees may return to work after 10 days from the onset of symptoms if they have no fever for 24 hours and there is an improvement in symptoms.
If an employee is quarantined because of a covid positive person in the home with an employee, the return to work is now 10 days v. 14 days (as long as symptom free). This is 10 days from C-19 + test collection, and the employee has no symptoms. Employee needs to come to EHS for clearance.

Can you explain the COVID 80 hours that are available to every employee?

Can we have HR review the 80 hours COVID time?
The Supplemental Paid Leave is a California State requirement, with up to 80 hours as the maximum amount, depending on full-time, part-time or per diem status. There are daily and cumulative dollar limits as well.
What are appropriate uses for those 80 hours?
If an employee has symptoms of COVID and calls Employee Health and is sent for testing, the SPL will be paid as eligible. The SPL ends when the test is reported as negative. If the test is positive, the employees receives SPL up to the maximum amount of eligibility. The SPL is also paid for quarantine if an individual they live with is positive.
- How does quarantine time vs positive time work?
  It’s treated the same, up to the 80-hour or dollar limits.
- How about testing time?
  Yes, after calling Employee Health, the SPL is paid.
- What happens once your 80 hours are used up?
  If on a leave of absence due to being positive, then the employee would apply for State Disability Insurance or Workers’ Comp if deemed work related. If the employee uses up their SPL while quarantined, then the employee would use PTO.
- Is your job at risk if you go beyond the 80 hours?
  If on a protected leave of absence, then no. If an employee has multiple times of quarantine along with a prior history of a lack of reliability, we’d have to review their situation. In all cases, we want to be fair.
- Do you need a doctor’s note for time beyond 80 hours?
  Yes, if on a leave of absence for being COVID positive, an employee would need a doctor’s note. If taking quarantine leave beyond 80 hours, we’d need to understand why it was needed.
- There is such variability from employee to employee, it’s best to contact the LOA team at the time the leave or time is needed. They can assist.

Do we have any hospitalized COVID+ staff at this time?

Yes, unfortunately three employees are hospitalized due to COVID as of today.

Can retired nurses be used to help with vaccinations, etc?

Yes, if someone is interested that would be great. Kent Mishler is the contact for all volunteers.

Is Kaweah Health able to guestimate how many employees may become COVID positive during this surge?

There are 170 positive employees today. In early November, we had 20 employees out on leave. The vaccination is coming out soon, but we do not yet know how many employees will take the vaccine. It is hard to predict, but we could potentially see a couple hundred more employees contract COVID-19.

If an employee tests positive but is asymptomatic, are they able to work remotely during their quarantine period if their role allows remote work?

Yes, but we do talk to them about the supplemental leave hours available to them.

We all have friends who question the seriousness of the virus and quote statistics showing death rate for many other causes are down and that the overall number of deaths is on track as previous years. Is there an easy way to counter the belief that total deaths are very similar to other years?

You can share that in 2019, the US had 22,000 deaths due to the flu. Every year we have about 140,000 people who die from a stroke. Every year we have about 650,000 deaths due to Heart Disease. In the last 11 months, 293,000 people have died of COVID-19 and we do not know that they would have died this year just because they have comorbidities. Share what you know, but understand that you will not be able to convince everyone.

Is there an update on clinical staffing? Are we pursuing travelers and have we asked for reinforcements from the state?

We have many staff out due to having COVID or being quarantined due to someone they live with testing positive. We have made a request to the state as well as eight different travel agencies to request staffing assistance, but none of the 3-4K requests usually but this year they have more than 30,000 requests. The over hiring that we did in the summer has helped, staffing is still challenging. We are continuing to hire about 25 new staff a week. The extra shift bonuses have also been extended.

Will non-bedside nurses be pulled back to the bedside? Asking specifically about Case Management, as we are short staffed.

We have done this, but we cannot do it to the extent we did in August because those teams are also short.Last weekend we had several gaps and we had several staff come in and work extra shifts.

Can you share a comparison of flu season admissions vs. COVID admissions?
11/2017-4/2018 3539 total flu cases detected, 426 hospitalized

11/2018-4/2019 2673 total flu cases detected, 277 hospitalized
11/2019-4/2020 4273 total flu cases detected, 339 hospitalized
3/2020-12/2020 we have had over 1300 COVID patients hospitalized
We are moving forward with a plan to start testing all patient admissions. Now we are going to find people who are COVID positive who did not come in because of COVID. This is necessary now because it is so widespread and we have the ability to do the testing.
We had 111 inpatients with 9 in ED yesterday morning, today we have 143 inpatients. 6 weeks ago we only had 14 inpatients.

How many cases of the flu are we currently seeing being admitted to the hospital? Have we had any cases at Kaweah Health of dual infection with flu & COVID?

To date, KD has seen 93 cases of the flu with only one hospitalization. There have been zero RSV cases. We have had 21 patients tested positive for flu and COVID.

Is it possible to be fit tested again for a N95 mask if we want to switch the type of N95 we use regularly?

Yes, it is dependent on the supply and Employee Health’s ability to manage this. If the mask is causing you a lot of problems, absolutely reach out and we will do what we can to make this happen. Employee Health is really impacted with all of the employee who are positive and calling daily to be tested.

Is a COVID positive employee who is asymptomatic allowed to return to work (not remotely), before the 10-day mark?

Not currently, but could be considered in the future.

Can you give us an update on the Visitor Policy?

On Tuesday, the visitor policy changed to two 2- hour slots in the morning and evening and we are only allowing the same visitor throughout the entire stay. Visitors are no longer allowed to accompany surgical patients. We appreciate the positive impact that they have on patients, but with the continued increase in inpatients and positive staff we are continuing to have discussions. The most important factor is safety for our patients and employees.

With the new Stay at Home Order in effect and no enforcement being carried out to the public; Can the District survive financially if our COVID funding is cut off due to non-compliance of the public in Tulare County?

We have never received any COVID funding from the state, it has come from the Federal Government. Some of the funding will be allocated by the State. Tulare County has received $47 million. The County has provided several million to help us to purchase testing equipment and help with staffing. There are a lot of counties/states/cities that will not have strict law enforcement for COVID-19. If any city officials come out and directly voice that we will not follow the order, it could affect our funding. We had additional federal funding come in that has brought us to break even in November. We are not sure if we will receive any additional funding. There has been an additional $40 million for hospitals being considered which we could receive a portion of. Kaweah Health was very strong financially coming into this and continues to be strong.
We have restricted elective surgeries again during this time. Further restrictions will go into effect on Monday. We usually schedule about 25 non-emergent surgeries and we are going to lower this to six. Yesterday we only did five enon-emergent surgeries.

Does the surgery restriction affect already scheduled surgery at the surgery center?

This could affect surgeries that are already scheduled. We are continuing to do lifesaving and non-emergent surgeries that impact quality of life.

I love seeing Theodore’s COVID-19 dashboard every day. I think that it’s fairly new, but I really appreciate the comorbidity chart. I was wondering if we could see the mortality rates on the chart, especially if it could be linked to age and comorbidity.

We will be adding State and County metrics onto the report. With the new regional stay-at-home order that takes into consideration the percentage of ICU beds available, we will also include this information on the website.