Covid-19 Update for Housestaff and Program Directors, March 21, 2020

Dear Residents, Fellows and Program Directors:

I am certain many of you are feeling quite stressed and insecure during this chaotic time. Things are very fluid and change rapidly creating a significant sense of instability and make it difficult to communicate effectively. We (Hospital and University leadership) are working closely together to both ensure our preparedness for a potential COVID-19 surge and to ensure the safety and well-being of all of you. The clinical chiefs and hospital have put together the following updates, which we hope will be helpful to you. It is a lot of information (and you may also get it from your chair) so I have paired it down to what I think is most relevant to you as PDs and housestaff:

Info for Residents, Fellows and PDs:

  • Clinical Care and COVID:
    • COVID Testing: Many providers from several depts are sending patients to the ED for COVID testing that do not meet COVID testing criteria.  Providers are also ordering COVID testing on inpatients for screening before surgery, and for screening before accepting patients onto their service.  COVID testing is still limited to patients with symptoms (fever, SOB, cough) and a COVID exposure or significant travel exposure. Testing is not done on asymptomatic patients (poor test characteristics for rule out in this population) and not done to screen or exclude patients from certain units or services. BJH testing is ramping up as quickly as possible. Please follow the BJH/WUSM COVID testing guidelines which are updated regularly by Lab Medicine.
    • Use of Masks/PPE: Briefly: all patients with fever or respiratory symptoms (cough, SOB) should have a mask put on ASAP and put in private room with door closed. For persons under investigation for COVID, a mask, eye protection (face shield or goggles), gowns and gloves are used. N95s are not for routine use. N95s are used for COVID + patients and aerosol generating procedures (e.g.  intubation, extubation, bronchoscopy, nasopharyngeal procedures etc.). Please encourage careful stewardship of PPE and reuse where appropriate. Correct donning and doffing of PPE is illustrated here: https://fpp.wustl.edu/wp-content/uploads/2020/03/PPE-Sequence.pdf
    • Screening Patients: ongoing vigilance is needed to screen patients for fever, cough, SOB, COVID and travel exposure history. Patients should be screened over the phone before coming to clinics and procedures areas and screened again when they arrive. Arriving patients with fever or respiratory symptoms should have a mask placed on them ASAP. HCWs should wear a mask if screening patients. Early symptoms of COVID-19 include myalgias, sore throat, loss of taste, decreased appetite and loss of smell, in addition to the more significant fever, SOB and cough. 
  • Your Health and Safety:
    • Psychologic Support: Many of you have fear, anxiety and increased stress related to the COVID-19 pandemic. BJH has expanded their EAP and psychologic support for their employees and Wash U is working on trainee resources and guidance in addition to the availability of psychologic support. Information will be coming shortly from Jenny Duncan, Director of GME Wellness with more information.
    • Healthcare Workers with Health Conditions: Faculty and housestaff who are >65 years, are pregnant, in receipt of immunosuppressive therapy or who have underlying health conditions that increase risk of serious complications of COVID (such as prior organ transplantation; poorly controlled diabetes; current treatment (chemotherapy or radiation therapy) for cancer; chronic heart, lung, kidney, or liver disease) should not be assigned to active care of COVID-infected patients but should continue to work their regular schedules as assigned by their Department and/or Division/ Program. We understand the concerns faculty and staff may have with direct patient care of patients with known COVID-19.  Given the private nature of underlying health conditions, and HIPAA regulations, we suggest that individuals with concerns about their personal risk discuss their concerns with their relevant Program Director, Department Chair and/or Division Chief.  This policy will be reviewed on an ongoing basis to meet the needs of the medical center as the epidemic evolves.
    • Occupational Health: WU Occupational health with BJC occupational health policies are being aligned and processes rapidly improved. WU faculty/employees and BJH employees are screened for travel history using CDC guidance. They may be furloughed for 14 days, allowed to return to work with a mask or return to work without a mask based on their specific travel/exposure history. Advice will be given re: monitoring for symptoms. Returning travelers need to be screened by occ health before returning to work. They can call or email WU or BJH Occ health as appropriate to their employer. ID will be collaborating on all COVID exposure and screening cases and processes moving forward. If you have a work-related COVID exposure and are furloughed or become ill, you will not be asked to take vacation or work without pay.
    • Illinois Shelter in Place Rule: If you live in Illinois you must carry your badge at all times and to put the placard provided by the Deans office (Letter of Access, link above) on the dashboard of your car to facilitate essential work related travel.

Please feel free to send questions about this or needed clarifications directly to me. In addition, if you have suggestions for how to most effectively communicate, I am wide open to ideas.

Stay Well,

Eva

Eva Aagaard, MD (pronouns: she/her/hers)
Carol B. and Jerome T. Loeb Professor of Medical Education
Senior Associate Dean for Education
Washington University School of Medicine
660 S. Euclid Ave
Campus Box 8073
St Louis, MO 63110