January 1 Employee Huddle

January 1, 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 FROM JANUARY 1, 2021

1. Vacation time is very limited right now and per our department, there are no vacation requests until further notice. What about just single days off that we would like to request for combo time and we have the PTO to cover it? Is this manager discretion or does HR weigh in?

• This is a challenging balance right now and likely will be for a few months yet. For someone who works three or four days a week, we would ask that you use your other days off to regroup for now. For someone who works five days a week, we should try to allow a day off when needed for family or self. Please communicate to your leader what you need or you can reach out to HR for further discussion.

2. The testing center at the South Campus is being moved to the Lifestyle Center next week.
   1. How is this going to affect our children being at the Distance Learning center and what precautions are being taking to keep our children safe?

• We will continue to do our best to provide a safe, learning environment for the kids.Most are in the gym and away from windows.

2. What times will the testing center be open?
   8:00 a.m. – 4:00 p.m.

• The below message was sent on 12/30/2020 to the parents whose children are enrolled:
• Dear Families,
• The purpose of this email is to notify you that starting Thursday January 7^th Kaweah Health will provide a drive through specimen collection site at the Lifestyle Center parking lot. This is a testing site for those individuals that have a physician order. Once the physician order is received Kaweah Health staff make an appointment for the individual and a drive through process takes place to collect the specimen.
• With this additional traffic at The Lifestyle Center, we want to assure you that the safety of your children and our staff at The Lifestyle Learning Center remains a top priority and concern. We have no plans to change our hours of operation or the services already being offered to our families.
• The general public will not be allowed inside the building. The Kaweah Health staff working the specimen collection site will be based in the “Drop Zone” area which has its own entrance. Those staff will also have a different set of restrooms they will be using and will be working in different areas than where the students are located.

3. We have remote staff, that is staff that are employed by the District, but working long distance from our facility, some as far as Los Angeles, and even out of state, Tennessee, New Mexico, and as far away as Florida. The question is, are those remote employees eligible to receive the COVID vaccine, via the online registration process?

• We will not provide the vaccine to these individuals. To do so would require travel, which we strongly discourage. This effects less than 10 remote employees.

4. If an employee tests negative for COVID but need to quarantine and you have a family member who was just admitted in the hospital. Are you still required to work or should you remain quarantined?

• Assuming that the family member is COVID positive, the need to be quarantined would depend on when the employee was last exposed. The timeframe for quarantine is 10 days from the last exposure of a COVID positive individual living in the home.

5. If our tier has been opened to receive the vaccine, but we choose to defer getting the COVID vaccine, can we change our mind in a few weeks and then sign up for the next time the vaccine is being given or do we lose our spot and have to wait for the rest of the District to have their chance and then sign up for the vaccine after everyone gets a chance?

• If an employee defers to some months in the future, there will likely be additional vaccine availability. In the short term, the next first-dose vaccinations clinics are 1/5 and 1/6, where we will be primarily focused on patient care staff.

6. As workers of the hospital we get priority to get vaccinated for Covid-19, because we are considered an essential worker. Is Kaweah planning on vaccinating family members of employees?

• We are required to follow the eligibility process from Tulare County. At this time, we are limited to our employees and credentialed providers. We are working on including contracted staff who work in our acute care setting.

7. What is the percent of our employees that have received the COVID Vaccine?

• About 2,300 of our 5,000 employees have received the vaccine, not quite 50%.

8. Is there an option to which vaccine we receive? Does the hospital have both vaccines for COVID available? If not, then when will the Moderna be offered?

• We need to finish up the supply of our Pfizer vaccine and then determine with the County if we can begin administering the Moderna vaccine. At this point, employees don’t have an option on which vaccine to receive. We will continue to update on if and when we can administer the Moderna vaccine.

9. Is there a requirement that both vaccinations must be taken, both the initial dose, then the second dose to be scheduled on or after 21 days from the first?

• The studies are indicating that protection from the first vaccine is about 40% to 50% and after the second dose, about 95%. An employee may choose not to receive the second dose knowing they will not receive the additional protection.

10. Some staff are being directed to quarantine for different lengths of time, when they are either positive for COVID or they have a family member in their household that is positive for COVID. Can you please elaborate on guidelines or protocol used to determine the length of quarantine time as employees are expected to return without testing at times?

• For a COVID positive employee, the minimum quarantine time is 10 days since symptoms first appeared and at least 24 hours have passed since last fever without using medications and other symptoms have improved.

• In the case that the family member is COVID positive, the need to be quarantined would depend on when the employee was last exposed. The timeframe for quarantine is 10 days from the last exposure of a COVID positive individual living in the home.

11. Can you also elaborate regarding the reason staff are not required to test if they have someone in their household that is COVID positive, it appears that staff are being directed to test only if they develop symptoms?

• The CDC has changed protocols over time as more is learned about the virus.
• In April 2020, testing was no longer required per the CDC to return to work. In December 2020, the CDC updated the timing on the return to work protocols. For a COVID positive employee, the minimum quarantine time is 10 days since symptoms first appeared and at least 24 hours have passed since last fever without using medications and other symptoms have improved.
• In the case that the family member is COVID positive, the timeframe for quarantine is 10 days from the last exposure of a COVID positive individual living in the home.

12. The Quick Reference about Pay Codes and COVID LOA mentions that employees “should carefully consider whether they are infectious and if so, should not report to work.” Given that staff have not been receiving call backs from EH – does this mean we should self-triage? It is unfortunate that staff will have to decide “whether they are infection or not” versus utilizing their personal PTO.

• This is consistent with protocols in place pre-COVID. If employees feel ill or have a fever, they should contact Employee Health for COVID testing. After testing negative, it has always been the responsibility of the employee to determine if they feel well enough to work or if they should seek help from a provider.

13. If an employee has had COVID within 90 days and someone in their home is now positive, do they have to be quarantined?

• No, in this case, a quarantine would not apply.

14. What happens now with employees’ pay since the California State mandated COVID Supplemental Pay ended 12/31/2020? This was paid by Kaweah Health?

• Yes, the State required that employers provide up to 80 hours of COVID Supplemental Pay from 9/20/20 through 12/31/2020. Since this has ended, we will apply the same practice that we did before 9/20/20. If an employee feels ill with COVID-like symptoms, they are to call Employee Health, will be placed on Paid Admin Leave and sent for testing. If positive, the Leave team will assist the employee with applying for State Disability Insurance that is effective day one and the pay will be coordinated with any accrued EIB or PTO at the employee’s choosing. If negative, the employee will code PTO/PSL to the annual maximum limits, then accrued PTO.

15. What kind of air filters are being used through-out the air vent system and how often are they changed?

• We have standard air filters for the various systems throughout the organization.They are not hepa-filters but they are hospital approved filters that are changed routinely per manufacturer guidelines.The air filter systems in the north and south wings of Mineral King have one system per room.These are changed every three months.

16. With ICU full, and many ICU-qualifying patients on 3W, where will COVID ICU patients overflow to? We are telling the public that we have 41 ICU beds, but in reality only 21 are COVID ICU. So does that mean CVICU will start taking COVID ICU-level patients?

• As ICU beds fill up our COVID patients needing ICU will flow into 3W. We did assess if we needed to use CVICU but are still able to contain the COVID patient care to the ICU and 3W. We may put patients in negative airflow rooms on 3T, 4T and 5T. We have developed ICCU pods on 2N and we will create ICCU beds in Broderick Pavilion if the demand continues to grow. As we continue to surge, there is the possibility of COVID units in the Acequia Wing but we are trying to avoid that need.

17. In Outpatient PT we have been wearing surgical masks and goggles throughout this COVID-19 pandemic and have not had any issues with getting COVID-19 from our patients so far. We now have N95 masks to wear which obviously are not as comfortable. If we get both doses of the vaccine do we still have to wear an N95 mask in our setting or can we go back to our regular surgical masks?

• We will follow recommendations from the CDC and public health on the best use of masks for patient care team members. We have posed this question to public health already and still waiting on a response. The move to using the N95s is that we are seeing more widespread presence of COVID-19 in our community members and the risk is higher for patient care areas, including our outpatient clinics.

18. Why are we not giving N95 masks to family of comfort care COVID patients?
    Only simple mask, gown and shield is what I was told. They sit with the COVID patient for hours, sometimes in a double room, and then go home to mourn with their families, probably many outside their own household.

• N95s are still not easily attainable and shipments are irregular. Without knowing what the future holds with needs we are not using the N95s without careful considerations. Our visitors for those patients with COVID are given the surgical mask, gown and a shield as well as asked to distance and avoid contact.

19. There are studies coming out showing the importance of Vitamin D with COVID. Has Kaweah Health seen any trends in the patients with more severe symptoms having low Vitamin D levels?

• Variable vitamin D levels are typically noted in critically ill patients without consistent connection to deficiency syndromes or known causes other than the disease process.All types of diagnoses in patients have worse outcomes with vitamin D deficiency, this is not unique to COVID.It may also be a marker of poor health and comorbidities rather than due to the disease state.It is recommended to supplement Vitamin D deficiency when noted in treating patients and we do this in our treatment plans.

20. News outlets throughout the country are talking about hospitals having to ration care to patients in highly impacted areas like Los Angeles. Because of staff shortages, the allocation of resources may change, and that those not like to survive would not receive the same level of care they would during a non-crisis situation.

• Do we anticipate our hospital may be in the same situation as Southern California hospitals?
  • Yes we do anticipate this is where we can end up.
• If so, would care also be rationed to patients outside of COVID needs like strokes and car accidents?
  • Yes, we would triage care if critical care resources needed to be allocated using a triage team. The process is outline in Administrative Policy 182.

20. After we have had the second vaccine, may we obtain an antibody test to see how well we are covered from the vaccine?

• Yes, you can ask your PCP to order you an antibody test.It does not tell you the strength of protection though, only if antibodies are present.
• How long should we wait after the second vaccine to obtain the antibody test.
  • At a minimum two weeks.
• Do we get an order from our PCP?
  • Yes, arrange with your PCP.
• Is it covered by our insurance or covered through Kaweah Health?
  • Yes, if your PCP orders it for medical reasons it should be covered. Post vaccine if indicated would be a good reason, but check with your PCP too.

21. Do we know when the general public will be receiving the COVID vaccine or if families (elderly parents) of KDDH employees get access thru the Clinics?

• The state and the county have not released guidelines or plans for how we can get the vaccine to our community.We have received very firm warnings this week that we are to follow administration guidelines of the vaccine from the state without deviation or risk penalties so we are working closely to follow the state and county directions with this. Our clinic teams are working to develop our own processes for community vaccine administration for the time when they do allow us to administer the vaccine.We will share with our KD team what those guidelines are and how to get access to it for your families as soon as we get the okay to administer to those high risk people.

22. Are we doing enough education with our staff members who get COVID to help them avoid becoming an inpatient.

• Employee Health follows up routinely with our employees on LOA.They also have access to an advanced practice nurse for more needs.We can definitely assess if anyone feels we need more information.This is a good area to explore further.

23. Why are our state numbers higher than states, such as Florida, when those states are open and they have similar demographics?

• California has 40 million people.That is the most of any state.The next state in ranked population size is Texas at 30 million.Florida and New York both have around 20 million people.Also, states like Florida, Maine and Hawaii have the highest percentage of people over age 65 in their populations.We have seen our over-65 population being more cautious in response to the virus spread.

24. What are your thoughts on the recent article that said asymptomatic spread was a myth?

• I do not think asymptomatic spread is a myth.Even the study noted that asymptomatic spread occurred among participants.What I do think happens is that people ignore their symptoms, attribute them to something else and spread the virus while thinking they are experiencing something else.

25. The FDA authorized an at-home antigen test for COVID-19 a couple of weeks ago. (The Ellume COVID-19 Home Test is the first COVID-19 test that can be used completely at home without a prescription). For those of us employees who are subject to weekly and biweekly testing, do you think Kaweah Health will eventually allow employees to have access to and do at-home testing?

• We can watch this as an option. We are regulated by CDPH and OSHA with our employee testing and use of the results in making decisions about the health and wellbeing of the team and the patients. The company is not yet mass producing the kits and not sure if the supply will be enough to put this in place.