Yale School of Public Health Partnerships With State And Local Health Departments For Covid-19 Response

Transcript

• 00:00Thank you very much, uh, I would now like to introduce our next Speaker,
• 00:07Professor Linda Nicholi. Doctor Nicholi is a professor of Epidemiology of microbial diseases at Yale.
• 00:13She's also the director of the Connecticut emerging infections program and the HP vaccine Working Group at Yale.
• 00:21Doctor Nicholi received her Master of Science at Harvard School of public health and her PhD at Tulane University.
• 00:28She has served as an advisor,
• 00:30an reviewer for the NIH and CDC conferences,
• 00:33and grant programs. Professor Nikolai thank you for being here.
• 00:37Thank you for having me,
• 00:39uhm, you can hear me,
• 00:40OK? Yes great OK thanks.
• 00:44So um, as noted in the title of this presentation.
• 00:47But I'd like to talk to you all about today is about the academic public health partnerships that have either been newly developed or existing partnerships that have been called
• 00:59action in response to COVID-19 next slide.
• 01:01Please thank you. So I'd like to begin with a really high level overview of what is the role of public health departments in outbreak or pandemic situations.
• 01:12I think most of us at the University recognize the really important need for research,
• 01:18and in many of us actively engage an important research that research questions that arise during outbreaks and now what has become a pandemic,
• 01:28questions about transmission, immune response,
• 01:30clinical presentation, treatment, all of these things are really,
• 01:34really important. What public health departments do?
• 01:37That's quite different is they play a real critical role in response activities,
• 01:42response activities, things we do to detect trends and patterns during the course of an outbreak,
• 01:48and pandemic. An implement control measures so public health department's really do this as outlined in this report from the Institute of Madison Public Health departments do this through epidemiological
• 02:00investigation. Surveillance are very important.
• 02:01Function is communicating with the public and strategic planning.
• 02:05So this is all again outlined in this IOM report.
• 02:08I really like the preface of this IOM report actually has a quote that I think very succinctly summarizes what public health systems do in times of emerging infections.
• 02:18In the quote you can read it there knowing is not enough,
• 02:22we must apply willing is not enough.
• 02:24We must do, and that's the critical role public health department's next slide please.
• 02:30So then what is the added value of public health academic partnerships?
• 02:34and I think there are several benefits to these partnerships during this time of pandemic,
• 02:40academic institutions can provide resources to public health efforts.
• 02:43I pretty sure I don't need to tell anybody at this workshop how.
• 02:49Woefully underfunded, our public health system,
• 02:51it is. It's a real,
• 02:53real modern tragedy even can't think of another word.
• 02:56So I'm not saying that academic institutions can provide actual dollars,
• 03:00but we do have access to resources that are public.
• 03:03Health system doesn't. And one of those resources would be a range of expertise.
• 03:09So academic centers, places like Yale have world renowned experts in basic and Clinical Sciences,
• 03:15population science, pop policy experts and these can bring added value to the public health response.
• 03:22And finally, I think it's really worth noting the academic institutions have an agility or nimbleness to mobilize in ways that public health Department may not be able to in
• 03:34terms of bureaucratic structures that exist.
• 03:37You know, sometimes we feel like.
• 03:39Our academic centers are highly bureaucratic,
• 03:41but I can tell you that public health systems can be even more so,
• 03:47so there are many, many Venice benefits to given the role of Public Health Department.
• 03:52There are many benefits to these academic partnerships next slide,
• 03:56please. So this is a really busy slide,
• 04:00and that's because we have been really busy over the past couple of months.
• 04:05On this slide, I'm just highlighting some of the different activities that we've been involved in.
• 04:11Partnerships between Yale and sitting in state health departments.
• 04:14So most of this work has been really facilitated by the presence of the Connecticut emerging infections program here at Yale.
• 04:22So this the EP is a CDC funded partnership between the Connecticut Department of Public Health.
• 04:28In the Yale School of Public Health,
• 04:30this is a program that has been at Yale continuously funded since 1995.
• 04:35So for over or just about 25 years now,
• 04:38the general function of the EP is to do public health surveillance and applied epidemiologic research for a variety of Infectious Diseases.
• 04:47And over the past six weeks,
• 04:49it's incredible to think that it's only been six weeks.
• 04:52It feels like a lifetime,
• 04:53but over the past six weeks or so for Cobain 19,
• 04:57we've done the following. So first of all,
• 04:59we have implemented surveillance for laboratory confirmed hospitalizations for COVID-19 and the results of the first month of surveillance have already been published in an MMWR that was released about
• 05:08a week and a half ago.
• 05:10We are currently in the planning phases of an epidemiologic investigation of healthcare personnel in terms of what are their risks and what are their exposures.
• 05:19We have already completed a rapid supplemental case series investigation of COVID-19 patients.
• 05:26We currently staff at the IP.
• 05:28It's incredible what they're doing.
• 05:30They are currently providing surge capacity for COVID-19 case reporting to DPH that includes follow up a positive lab reports gathering missing information and data entry,
• 05:40and that information is really critical is we need to monitor the spread of the epidemic.
• 05:46We also worked initially with DPH to develop and implement a volunteer contact tracing program in which we do rapid follow-up of case reports.
• 05:54Patients who are newly diagnosed with COVID-19,
• 05:57we identify who their Contacts are,
• 05:59people who potentially been exposed,
• 06:00and then we notify them about this exposure and provide them appropriate guidance so that effort is currently a partnership with the city of New Haven Health Department.
• 06:10We work closely with Marissa Bantus name.
• 06:12You've already heard handy all hell.
• 06:15So each of these activities is really worthy of their own presentation.
• 06:19But since I don't have time to do that today,
• 06:22what I'd like to do in the next 10 or 15 minutes or so is talk about our newest project,
• 06:27which is a partnership between Yale and the Connecticut Department of Public health,
• 06:31where we have set up an active daily monitoring system for COVID-19 in long term care facilities.
• 06:36So I'll just focus on that,
• 06:38but anybody wants to hear about any of these other activities.
• 06:41I'm happy to speak more about those later.
• 06:43Next slide, please. So I think everybody appreciates the significance of long term care facilities in this current pandemics.
• 06:52So one of the earliest signals of their significance was the devastating outbreak that occured in a long term care facility in Washington state in early March.
• 07:04So again, this is really one of the earliest occurrences as the COVID-19 came to the US,
• 07:11really devastating. Over 130 people were diagnosed with COVID-19,
• 07:14including more than 80 residents.
• 07:16Over 30 staff members and 20 three people died in this outbreak.
• 07:21So as noted in this MMWR,
• 07:24and I think what's clear to probably most people at this workshop is long term care facilities are really important setting because the residents tend to be older and have
• 07:35underlying or comorbid health conditions which make them vulnerable to infection and worse outcomes.
• 07:41And it's also a vulnerable.
• 07:43It's also vulnerable. Settings like this congregate nature of living.
• 07:47Furthermore, it's really important setting because it's this interface with the health care system and it really highlights the risks to the health care workforce and how important of a
• 07:58population that is and how hard we need to work to preserve our health care workforce at this time.
• 08:05So since this early report,
• 08:07long term care facilities are in the news locally and nationally,
• 08:10just about every day, so hopefully people can appreciate the significance of this population.
• 08:15Next slide, please. So what's going on in Connecticut?
• 08:20These are data from the Connecticut Department of Public Health.
• 08:24They are updated regularly on their website.
• 08:27This is a screenshot I pulled from April 13th where you can see that by April 13th,
• 08:3450% of long term care facilities in Connecticut reported having had at least one case of COVID-19.
• 08:41They also note a total of over 1500 residents had been diagnosed with COVID-19.
• 08:47Nearly 400 of them. I been hospitalised and 14%
• 08:50or over 200 of them had died.
• 08:53So these data, and of course these numbers are constantly changing,
• 08:57so these data are really important and they reflect the information that was coming from the existing surveillance that had been ongoing for Kobe 19 in long term care facilities.
• 09:07But some important limitations had been noted.
• 09:10In this surveillance system is as important as good as these data are that the Department of Public health realized there was some room for improvement.
• 09:17Next slide, please. So in the existing system diagnosis of COVID-19 in long term care facilities would be reported both to the local well into three places to the local
• 09:30health Department into two different groups.
• 09:33At DPH they would be reported to the infectious disease Epidemiology group into the facility licensing investigation section or less.
• 09:40So there was sort of triple reporting of cases from long term care facilities and is create some inefficiencies for an already overburdened staff both.
• 09:50At the long term, care facilities who do the reporting and at the public health,
• 09:55local and state level that was receiving these reports.
• 09:58There was also some concern that delays in reporting could allow a single case of COVID-19 to turn into larger outbreaks,
• 10:05so the need for real time data is just essential,
• 10:09so recognizing the need to revamp this system,
• 10:12the Department of Public health put out a call essentially to us at Yale for assistance so that emodi pH you can see them all listed there are folks who
• 10:22work in the healthcare associated infection group,
• 10:24folks who work in syndromic surveillance folks who work in information technology.
• 10:29You'll see, that's been a really important component to this.
• 10:32We're also very fortunate to have doctor Kevin O'laughlin in this group.
• 10:37He is ACDC signee to the state of Connecticut to help with COVID-19 so we're very grateful for his presence.
• 10:44Next slide, please. So essentially the ask from DPH to Yale was to assist with developing and implementing an active surveillance system for COVID-19 in long term care facilities that
• 10:55could do the following. Ultimately,
• 10:59the goal is to reduce the size and scope of Coben 19 outbreaks in long term care facilities by early detection.
• 11:05Early detection is really what's so important to improve data collection to meet the existing reporting needs,
• 11:11things need to be reported,
• 11:13but we wanted to improve the ways in which this could be done efficiently and accurately to provide timely information to leadership via daily reports to enable rapid intervention when
• 11:23suspected or confirmed outbreaks are identified an to triage prevention and control questions for response.
• 11:29So long term care facilities.
• 11:30Have a lot of questions and we wanted to be able to use this system to address those.
• 11:36Next slide, please. So we assembled a team at Yale and this is what it looks like.
• 11:41So there it is. Includes folks from school public health.
• 11:45Folks from the Institute for Global Health and from the school of Madison,
• 11:51the members of the team include faculty,
• 11:55staff, and students. Collectively, this group represents expertise in Epidemiology,
• 12:00public health, clinical Medison, Infectious Diseases,
• 12:03infection prevention, and really importantly,
• 12:05an outstanding student workforce. Next slide,
• 12:09please. So operationally, this is what it looks like,
• 12:13so we set up this electronic database of portal through flips.
• 12:16Again, the facility licensing investigation group at DPH on line reporting system.
• 12:20So the long term care facilities are supposed to enter their daily reports and I'll show you in the next slide what a daily report looks like every morning by
• 12:2910:00 AM. So every day there's supposed to complete a questionnaire on this portal.
• 12:35Up by 10:30 in the morning we have run a report identifying which long term care facilities have not entered their data.
• 12:44They are contacted by phone good old-fashioned telephone call that is either the student team at Yale makes these phone calls or staff at the pH make these phone calls,
• 12:54the facilities are also sent an email reminder at reminding them to report to the system.
• 13:00And if they don't then they get a phone call from us.
• 13:04And while we're on the phone with them.
• 13:07We complete the reporting worksheet and enter that directly into this portal so this all happens every day between about 10:30 and 2:30,
• 13:15so during the middle of the day we're actively calling log.
• 13:19Home care facilities and asking them some questions.
• 13:21Again, I'll show that on the next slide,
• 13:24then by three o'clock report of these data is run,
• 13:27any signals of an outbreak are identified.
• 13:30This is could include one case of COVID-19,
• 13:32and that's a signal that's an outbreak.
• 13:35This is communicated to the leadership at DPH,
• 13:37who can then implement appropriate response and control activities,
• 13:40and I'll show more of that on the next slide.
• 13:44So essentially yeah, so essentially the students that are calling from Yale collect these data and submit this to DPH.
• 13:52And what this really does is it frees up the frontline public health staff or other critical tasks.
• 14:00So realize this image is a little difficult to see.
• 14:04It's a screenshot from the online portal and it just gives you an idea of the data that we gather,
• 14:11so it's important to note this is a facility level surveillance system.
• 14:15We are not getting individual information about any residents or any patients were getting facility level information.
• 14:21So for example, survey asks if any residents currently have any symptoms of coded 19 weather.
• 14:27Any residents have been hospitalised with COVID-19.
• 14:30Like symptoms, whether any residents have died of these symptoms,
• 14:34whether anybody has tested positive for cocaine,
• 14:3619 weather, people have test pending for COVID-19,
• 14:39so all of the things that we can run a daily report on to identify signals for a potential outbreak.
• 14:47Next slide, please. So then if a signal is detected,
• 14:51if something is going on,
• 14:53this is when the infection prevention response team is activated.
• 14:56These are the clinical experts I showed you from most from school medicine at Yale.
• 15:02And they provide several important functions in this active surveillance system.
• 15:05So the first thing they can do is field some of the questions from the long term care facilities regarding prevention and control,
• 15:13and this is all done using CDC guidance,
• 15:16CDC, MD pH guidance. They will participate in calls with DPH and long term care facilities to assist in control and Prevention when indicated.
• 15:23Should there be a signal or an outbreak,
• 15:26they provide clinical expert guidance to DPH in long term care facilities,
• 15:30unrelated matters and importantly, going forward,
• 15:32they're going to be involved in a CDC LED initiative.
• 15:35To do more proactive work in this area rather than reactive work,
• 15:39so this is going to be a new area of work at CDC that's really looking to keep Cove it out of long term care facilities that have had no
• 15:48cases or a low number of cases.
• 15:52Next slide, please. So I just want to show you how quickly we launched this system.
• 15:58You know it's like the time frame we're all working on now is just really remarkable.
• 16:03So the initial request came to DPH came from DP.
• 16:06HTML came from the state epidemiologist Matt Carter Dr Mac harder on March 28.
• 16:11The A-Team at Yale of what's faculty,
• 16:13staff and students. The team at Yale was assembled the very next day on March 29th and we had our first call on April 1st.
• 16:22We then spent about a week figuring out the logistics of the program,
• 16:27including a lot of it logistics.
• 16:29You think about setting up the surveillance system,
• 16:32communicating with a long term care facilities that they need to enter into it,
• 16:37getting the students access to it so that they could enter the data.
• 16:41Again, being as efficient as possible,
• 16:43so a lot of it work.
• 16:46So then the student training began on April 9th,
• 16:50students have received training not only in this surveillance system,
• 16:54but also more broadly in infection prevention,
• 16:57so they can field questions possibly.
• 17:01And on April 13th. Yeah,
• 17:05that was just earlier this week.
• 17:06Just a few days ago this system was launched.
• 17:09It's just the timing is incredible.
• 17:12OK, next slide plays. So this just shows you the status of this program for the first 2 days we launched the system on the 13th and what we know
• 17:23from the first 2 days of active surveillance is at about 350.
• 17:27Phone calls have been made to long term care facilities together.
• 17:30This important information half of these calls have come from were made by DPH staff and about half were made by the student team.
• 17:38So this just really provides an idea of how great the need was for this program.
• 17:43The number of calls that are being made.
• 17:46Just shows you how much more quickly and how much more completely we can gather data in near real time from a long term care facilities.
• 17:56So it really just incredible.
• 17:57And it also I think signals that points to just how potentially impactful this program can be in terms of its ability to collect this information so quickly and so
• 18:09completely. We do expect that overtime the number of calls may go down as long term care facilities become.
• 18:16More able to enter the data on their own again,
• 18:19it's a new system for them as well,
• 18:21so we're all getting up to speed.
• 18:24So where do we go from here?
• 18:27Well, all of this work will continue and I'm sure it will evolve overtime.
• 18:31Will make improvements to the system and then at some point,
• 18:35I think some really important research questions can be can be answered from this program and from the data that we're collecting,
• 18:42whether it's from an implementation science perspective or about the effectiveness of infection control and Prevention programs,
• 18:47or about the effectiveness of being more proactive in keeping COVID-19 out in the first place will be a lot of really interesting questions.
• 18:55That we can answer and will have a tremendous amount of data to do that,
• 19:00and I think that's true for all of the public health academic partnership programs I talked about on a much earlier slide.
• 19:08Tremendous amounts of data that are being collected in such unique circumstances.
• 19:12I think there will be lots of opportunity for analyzing data in learning.
• 19:17Learning from this experience, but right now.
• 19:20The real priority is again,
• 19:22the public health response activity of identifying and controlling outbreaks.
• 19:28Next slide, please. So, to conclude,
• 19:32Jean Brown, use the word extraordinary in her introduction today and I'm using it here as well.
• 19:38I really want to acknowledge that during this incredibly extraordinarily difficult at frankly horrible time that I have been honored at truly honored and so lucky to be able to
• 19:50work with some of the most extraordinary people in the world.
• 19:54At each of these institutions,
• 19:56on all of these projects that I mentioned in the beginning.
• 20:01I, the commitment and the resilience and the effort and the way in which people do it in.
• 20:07Just stay calm and cool and collected in these just unreal times.
• 20:12It's truly inspiring really. Get choked up thinking about all of the people that I worked with on all these projects.
• 20:21And I will say it really,
• 20:23it does give me hope that the people at all of these institutions and organizations,
• 20:29tremendous hope that we will emerge sooner rather than later from this pandemic.
• 20:34and I think the ties between all these institutions will be strengthened throughout this process.
• 20:42Thank you.