October 2 Employee Huddle

October 2, 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.

Questions and Answers from the Kaweah Health Employee Huddle on October 2

1. If we have patient contact, why are we not qualified for hazard pay?

That’s a question that has come up since the beginning. We have not paid hazard pay here at KD. We are mindful of and watch what other organizations are doing.

2. Why are annual evaluations not associated with raises this year?

We did experience layoffs due to the financially challenges associated with the loss of revenue. In order to maintain our financial strength there were hard decisions that had to be made.

3. In one of the last huddles it was mentioned that there was a possibility that the biometric screening for discounted insurance was not going to be applied this coming year. Has there been any further discussion or decision on this?

Yes, in fact all decisions have been made to our benefits for 2021. We are actively putting together the communication plan for that and will be rolling it out in the next few weeks. We are not offering biometrics screening next year but the new plan designs are pretty exciting.

4. If someone was waiting to retire this year, will they still receive their match?

The requirement for the match is that you are employed on December 31. I would encourage all employees who are looking to retire to hold off until January. I always recommend that every person continue to contribute to a retirement plan even if Kaweah Health is not able to match.

5. Will the Guild gift shop ever return?

There will probably be a gift shop in the future, but, where it will be located and what it will look like in the future are still be discussed.

6. Other gyms are opening and are open, when is the Lifestyle Center opening?

We are following the County/State mandates and are following the letter of the law.

7. With flu season coming, will the flu show up as a positive result on a COVID test? Since we have to wear a mask anyways due to covid-19 protocols, is the flu shot still required? In the past if we filed declination paperwork we had to wear a mask. Since we are wearing a mask already, is it still required?

Great question and true dilemma. No, the flu will not show up on a test that is designed just for COVID, but we are planning to receive test kits that will test for Flu A & B as well as COVID. While we are wearing masks mostly in public, with the inevitable creep toward reopening, which we all know is necessary, there will be more opportunities for interactions and the public in general has not been practicing with constant mask wearing for seven months like we have. The flu vaccine is another layer of protection against illness that we should recommend people still get to keep flu rates low this year. While we do not know what the coming months will bring with reopening and relying on social behaviors as the only protection against COVID, we do not want people to avoid the flu vaccines and add to the potential volumes of people sick in the county and needing additional health care. The flu vaccine is still required for our team members and I recommend everyone get the vaccine to continue to add every level of protection possible to yourself and your patients. When you are working to educate others in the community, tell them the flu vaccine is another layer of protection to go along with the masks. Even when people get the flu, the antibodies created by the vaccine help the body fight the virus. The masks are effective but you are relying on the community being just as vigilant in their use around not just you but your family and close friends too. You let your guard down around these people in your life and could still contract the flu from them.

8. What is this CDC guideline for not have patients on airborne precaution if still testing positive for COVID 19, because they are asymptomatic?

The CDC evidence to date shows that people who are positive and have mild COVID-19 symptoms are infectious for no longer than 10 days. Those people with more critical illness or who are severely immunocompromised are infectious no longer than 20 days after symptom onset. The SARS-CoV-2 RNA from the virus can still continue to be present in the upper respiratory areas for up to 3 months after illness, leading to a positive result when testing is done. The CDC recommends that isolation can be removed from individuals who tested positive with mild sx ten days after symptom onset and critically ill twenty days after symptom onset. These are both dependent on the absence of a fever for at least 24 hours without any medications or other fever reducing measures. For patients who are asymptomatic and unable to identify specific symptoms, we use the date of the test.

9. When do you think we will be opening for all surgeries? (non-emergent, elective)

We are carefully adding to our census week by week. We are still focusing on procedures that are emergent or urgent, necessary based on a quality of life impact. Each week we have been increasing our inpatient cases to accommodate more surgeries and try to catch up the backlog of procedures that were postponed for our community members. We have had a very high census for several weeks and were ensuring no major surge occurred after Labor Day. Now that we are almost four weeks past the holiday and past the start of school day camps we have started to increase the inpatient surgery case volumes and open up to more inpatients cases being scheduled. Where we see the most restriction still is the elective outpatient cases. Ask me again in two weeks and I will see if I can give you a more specific date for a return to full services inpatient and outpatient.

10. There seems to be a lot of supplies on backorder due to COVID. Do we have a process for knowing this early/promptly, approving substitute items and alerting staff? It may be nice to have a streamlined process now that there is a larger volume of supplies going on backorder.

We do get alerted from our vendors when supplies will not be available to be delivered. Since COVID started, our main suppliers are giving us weekly allocation notices. This give us more time to find alternative products. The supply chain team works with the appropriate nurse leaders, infection prevention and/or education in order to validate an appropriate sub. If there is a delay in finding a sub, Central Logistics will look for a borrow supplies from department that may have extra available. Also we have moved to purchasing and storing high quantities of PPE equipment but normal supply chain processes typically are set up with routine deliveries of projected volumes. You see this in restaurants, grocery stores and health care organizations since the volume of supplies would overwhelm the storage capacity of normal facilities. As soon as we are alerted we try our other vendors but if it is an item we have not been routinely purchasing from them then their first priority is to their routine customers. If one vendor is experiencing a shortage, it is most often related to raw materials not being available to all vendors for manufacturing of the items. During routine times you will see supplies be back ordered and a substitute put in its place, even with medications. We are seeing this on a more frequent scale now due to the high usage of medical services across the world and the impact of the shortages is more acutely felt. The process is set up but the availability of the supplies still remains a challenge.

11. If an employee refuses to get the flu shot, will they be terminated?

No. We have a declination process that will still be honored and put in place. Anyone who declines has been required to wear a mask to ensure some protection is in place in the absence of the vaccine but the flu vaccine is still a critical step in preventing spread of illness even if people are wearing masks.

12. Can you explain exactly how herd immunity works and if a vaccine is needed before her immunity can even be considered?

Herd immunity occurs when enough people become immune to a disease to make its spread unlikely. As a result, the entire community is protected, even those who are not themselves immune—called “indirect protection” or “herd protection”. Herd immunity is usually achieved through vaccination, but it can also occur through natural infection. Depending on how contagious an infection is, usually 50% to 90% of a population needs immunity to achieve herd immunity.
Chickenpox is a disease that parents used to intentionally expose their children to before the varicella vaccine was developed; this was a way of creating herd immunity through “natural infection”. But the consequences of contracting chickenpox are relatively mild and rarely result in death. Viruses like COVID-19 carry a much higher risk of severe health consequences and death. Trying to create “natural infection” herd immunity for COVID-19 would overwhelm hospitals and cause many deaths before we ever reached the 50% to 90% immunity we would need to have “herd immunity”. In the case of COVID-19, we really need to depend on an effective vaccine to create herd immunity.

13. Where are we seeing the latest positive cases in regards to age, location, and type of transmission?

Over the past 14 days, our age distribution has been as follows for percent of patients testing positive and patients admitted to Kaweah Health Medical Center:

	COVID+ Tests	COVID+ Inpatients
Age	Percent	Percent
0-9	7.8%	0.0%
10-19	10.9%	6.7%
20-29	18.1%	6.7%
30-39	15.0%	9.3%
40-49	14.0%	5.3%
50-59	13.5%	16.0%
60-69	7.8%	24.0%
70-79	7.3%	13.3%
80+	5.7%	18.7%

Recent case distribution: Tulare (198); Porterville (177); Dinuba (95); Visalia (93); Farmersville (29); Lindsay (25); Orosi (23); Strathmore (22); Cutler (18); Exeter (15); everyone else below 11.
Tulare County ranks 14^th out of 58 counties in terms of number of cumulative confirmed cases and deaths but ranks 4^th in confirmed cases per 100,000 people and 5^th in deaths per 100,000 people. Over the past seven days, Tulare County ranks 14^th in percentage increase in new cases and 17^th in percentage increase in deaths.
Overall the state continues to head in a good direction, exemplified by 6 of the Top 23 counties (those 23 counties with the most cumulative total cases) advancing to less restrictive stages Tuesday. Fresno, Sacramento, San Joaquin, Contra Costa, and San Bernardino moved from purple to red, and San Francisco moved from red to orange. While Tulare County did not advance this week, she did make progress as the positivity rate went from 7.7% to 6.0%, and the adjusted daily case rate went from 11.7 to 9.2 per 100,000 people. The state’s overall positivity rate is at 2.9% this week, up very slightly from last week’s 2.8%.

14. How will we know when things are safe again?

The word “safe” is a relative term. We are “safe” right now if we, and others, consistently and constantly practice good behaviors of masking, hand-washing and social distancing. But if we want to stop doing these things, then we will only be safe in that kind of environment if we have widespread immunity created by an effective and safe vaccine or natural immunity through exposure.