Kaweah Health Employee Huddle

January 29, 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 29, 2021

1. Can you give us an updated employee COVID+ number? Do we still have hospitalized employees?

• As of 1/28/2021, we had 79 employees who are on leave of absence with COVID-19. Three of these employees are hospitalized.

2. Have our staffing demands gone down with our COVID positive patient numbers or are we still short?

• Demands remain high for staffing as we remain busy, but with our employees returning from leave and new travelers on boarded (about 85), we are feeling a bit better about our staffing. We hope our staff that have worked so hard and did many extra shifts can now take a bit of a break.

3. What do you think about Dr. Fauci saying it is best to double mask? If we do require it will additional masks be given to the staff?

• I think some of it has to do with the new COVID-19 variants we are seeing in the U.K., South Africa, Brazil and now the U.S. Scientists and others are concerned that they are much more contagious, more-easily spread and can better elude COVID vaccine antibodies. Single masks are generally made of porous layers of material that allow you to breathe but each layer is offset slightly so that the “holes” don’t line up exactly and create a web that prevents micro-molecules from reaching your mouth or nose. If you add a second mask on top of a first, usually a cloth mask over a surgical or medical mask, you create an additional barrier. While the CDC is not recommending “double masking”, Dr. Fauci is promoting it for the general public who does not have access to N95 masks or is reserving them for healthcare workers. Kaweah Health does not permit a second mask to be worn over an N95 mask as it interferes with the designed protection and filtration of the N95 mask. We will allow visitors to wear two masks as long as the base mask is a surgical/medical mask.
• If the CDC comes out and advocates for double-masking, we will provide additional masks to our employees.

4. We've seen a big drop in COVID-19 positive patients and employees. How big of a role does the vaccine play in this? What is our employee vaccine compliance rate as of now?

• At our high, we had over 230 employees out with COVID, so we are grateful that so many have recovered and are back to work. We have provided 3,184 vaccinations (first dose) and 2,397 second dose vaccinations. These clinic end on 2/10/2021 and we are planning to begin vaccinations in Employee Health for new hires and those returning from leaves on 2/15/2021. We may also be able to accommodate some who deferred, depending on supply and demand. It seems likely that the vaccine has played a role in reducing our employee infections.
• We want to support the County in their mass testing events.We are holding back sufficient amount of Pfizer vaccine but we have made arrangements to redistribute vaccines back to the County to support them in their mass vaccinations.We can conduct vaccines in all our clinic sites. We will continue to receive small allocations of the vaccines, most likely Moderna vaccine and will reach out to our patients who are the most vulnerable. This will start next week on a limited basis. This is just for the four rural health clinics, with established relationships with patients.

5. If an employee who deferred the vaccine wants to receive it now what do they need to do? Will there be a wait list?

• We are working on that process and will communicate it out to staff. Most likely this will be coordinated through Employee Health.

6. An employee was told you have to wait 90 days if you got COVID-19 before you received the vaccine. Is that true?

• No, that is not true. We have communicated that people who have had COVID-19 need to wait 10 days from the day of their last symptom.

7. Is it safe to gather with other fully vaccinated individuals without masks once you are at least two weeks beyond your second vaccination?

• The CDC would say no. The new COVID-19 vaccines from Pfizer and Moderna seem to be remarkably good at preventing serious illness. But it’s unclear how well they will curb the spread of the coronavirus. That’s because the Pfizer and Moderna trials tracked only how many vaccinated people became sick with COVID-19. That leaves open the possibility that some vaccinated people get infected without developing symptoms, and could then silently transmit the virus — especially if they come in close contact with others or stop wearing masks. If vaccinated people are silent spreaders of the virus, they may keep it circulating in their communities, putting unvaccinated people at risk.
• “A lot of people are thinking that once they get vaccinated, they’re not going to have to wear masks anymore,” said Michal Tal, an immunologist at Stanford University. “It’s really going to be critical for them to know they have to keep wearing masks, because they could still be contagious.” In most respiratory infections, including the new coronavirus, the nose is the main port of entry. The virus rapidly multiplies there, jolting the immune system to produce a type of antibodies that are specific to mucosa, the moist tissue lining the nose, mouth, lungs and stomach. If the same person is exposed to the virus a second time, those antibodies, as well as immune cells that remember the virus, rapidly shut down the virus in the nose before it gets a chance to take hold elsewhere in the body. The coronavirus vaccines, in contrast, are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill.
• Some of those antibodies will circulate in the blood to the nasal mucosa and stand guard there, but it’s not clear how much of the antibody pool can be mobilized, or how quickly. If the answer is not much, then viruses could bloom in the nose — and be sneezed or breathed out to infect others. This is why mucosal vaccines, like the nasal spray FluMist or the oral polio vaccine, are better than intramuscular injections at fending off respiratory viruses, experts said.
• The coronavirus vaccines have proved to be powerful shields against severe illness, but that is no guarantee of their efficacy in the nose. The lungs — the site of severe symptoms — are much more accessible to the circulating antibodies than the nose or throat, making them easier to safeguard.
• “Preventing severe disease is easiest, preventing mild disease is harder, and preventing all infections is the hardest,” said Deepta Bhattacharya, an immunologist at the University of Arizona. “If it’s 95 percent effective at preventing symptomatic disease, it’s going to be something less than that in preventing all infections, for sure.”
• Still, he and other experts said they were optimistic that the vaccines would suppress the virus enough even in the nose and throat to prevent immunized people from spreading it to others. “My feeling is that once you develop some form of immunity with the vaccine, your ability to get infected will also go down,” said Akiko Iwasaki, an immunologist at Yale University. “Even if you’re infected, the level of virus that you replicate in your nose should be reduced.”

8. When will we know if the vaccine prevents the spread of COVID-9 to unvaccinated people.

• See answer to #2 above.

9. There are several positions that are receiving extra shift bonuses and many that are not. Can you explain the process of how it is determined which positions receive them?

• The extra shift bonus is based on staffing needs (vacancies and the number on leave). I’ll follow up with the leader of this area to understand their needs.

10. An employee read that people with O– blood type are less likely to get COVID. Is there any truth to that?

• Patients with type O and rhesus negative (Rh-) blood groups may have a lower risk of COVID-19 infection and severe illness, according to a study published in the Annals of Internal Medicine. There have been two recent studies, one in Denmark and one in Canada, that showed that if you had blood group O (Rh negative or positive) you had a slightly lower risk of getting hospitalized for COVID-19 and you also had a slightly lower risk for getting on the ventilator if you did get COVID-19. However, there are also many articles out there that dispute these beliefs or findings. As such, people with all blood types should exercise all recommendation precautions to prevent infection.

11. Will our SNF and Rehab employees who are subject to weekly COVID-19 testing be tested/surveilled for Influenza? As recent as today, a SNF patient tested positive for both Influenza A and B.

• The short answer is no regarding surveillance for Influenza. If the SNF/Rehab employee is symptomatic, then they will be tested for both COVID-19 and Influenza A&B. We will continue the weekly COVID-19 surveillance testing.

12. An employee was recently out sick due to vaccine related symptoms. How should that absence be coded?

• The first 1-2 days after the vaccine we don’t want to count that as a liability. PTO PSL is the appropriate pay code from the occurrence being counted. If you are out of the PTO PSL pay code, then it is straight PTO.

13. On the dash board is there any way to add what nationality patients are?

• I haven’t seen Kaweah Health specifically capture or report on nationality or ethnicity of our COVID-positive patients or deaths but that information is captured and reported on at the County (cases only) and State (cases and deaths) level.