Remember to Wear Face Coverings and Maintain Social Distancing

COVID-19 Epidemiology

At Denver Health, COVID-19 hospitalization numbers have remained stable over the past week, and much lower than our peak of 71 patients on 5/3/20. We have a total of 12 patients- 7 on general medicine, 5 in ICU (3 vented).

Our laboratory positivity rate among those tested is 4%, which stable/ decreased over past week.

Denver Cases:

There have been 10,931 confirmed cases of COVID-19 in Denver, including 426 deaths- none of which were reported in this past week. Community case rates remained stable for most of week, but numbers of new cases bumped up a little in the last couple of days. After an increase to 153 cases/day on July 27 from a low of 30 cases/day on June 11, we are at 54.6 cases/day as of August 24 (7 day moving average) which is slightly higher than what I reported last week. In Denver, most cases are diagnosed in the 20-40 year age group, but most hospitalizations occur in those older than 50. https://storymaps.arcgis.com/stories/50dbb5e7dfb6495292b71b7d8df56d0a

Colorado Cases:

There have been 55,341 confirmed cases of COVID-19 in Colorado, including 1,919 deaths among those patients. Hospitalizations across the state continued to decrease over the past week, but are still increased from a low of 127 on June 27 to 143 as of Aug 24. Highest activity (per 100,000 persons) in the past week has shifted to the Southwestern part of CO (Ouray and Mineral counties). https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 5,715,567 confirmed cases of COVID-19 in the U.S., including 176,617 deaths. Over the past week, there have been a 7-day average of 42,065 cases per day, a continued decrease this week from the high of 74,818 on July 24. The percentage of laboratory tests positive for SARS-CoV-2 have continued to decrease nationally since mid-July, but some parts of the Central US are seeing increases in the % of positive tests. Weekly hospitalization rates attributed to COVID-19 also continue to decline in all US regions. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

I like this figure of new cases per 100,000 persons from the last week. Go Colorado!

Source: CDPHE August 25, 2020

Worldwide:

Globally there have been 23,518,343 confirmed cases of COVID-19, including 810,492 deaths reported to the World Health Organization (WHO). Over 1.7 million new COVID-19 cases and 39 000 new deaths were reported to WHO for the week ending 23 August, a 5% decrease in the number of cases and 12% decrease in the number of deaths compared to the previous week. While the Americas remains the most affected region worldwide in the past seven days, accounting for >50% of all newly confirmed cases and 62% of reported deaths, this region experienced the largest decrease compared to the previous week. South-East Asia continues to report an increase in cases and is currently the second most affected region. https://covid19.who.int/

PPE Supply Updates

With last week’s increase in our allocation of nitrile gloves we’re now in balance where our weekly use is very close to our purchases. Disposable isolation gown usage has continued it’s steady decline. Our current usage is now running about half the amount that we are buying each week. We have backup stock of Halyard gowns of approximately 70,000. This will only continue to increase as we move to the Image First reusable gowns. Our second wave of about 3,000 Image First gowns is scheduled, though we can hold off on putting these into circulation as we don’t need them yet. These gowns can be washed one hundred times before needing to be replaced. As people who have used the gowns may have noticed, they have an embedded microchip that records each time that they are washed so we know exactly how many washes any gown has had! N95 respirators continue show good stock levels and we are receiving products at our allocation level or have equivalents on site. We also have significant quantities of approved alternates. We continue to see an increase in issues of the regular duckbill. We were able to trade for an additional 1,200 from UCHealth this week and have identified another 2,000 we can buy next week, so stock will be in a better position. This is the only respirator where our usage is outstripping our regular weekly purchase allocation. With the increased volumes in the hospital we have been able to maintain a supply of our regular Halyard procedure mask of over 200,000 and have been stockpiling alternate, approved masks. Purple top wipes usage is steady, is under our weekly allocation quantity. As we roll out face shields, we will be watching our usage of these wipes very closely.

Face Shield Preferred over Goggles When Entering Patient Room

The Centers for Disease Control (CDC) has recently updated their guidelines to recommend eye protection for staff who enter the room of patients in the course of their work. The CDC notes that face shields are the preferred method of eye protection, as goggles or glasses may not protect the wearer from all splashes or droplets and it protects your mask from possible droplet contamination. Denver Health now recommends a face shield (or other eye protection) in addition to your mask for all patient-facing staff members in both inpatient and outpatient settings. Click here for further information, including answers to frequently asked questions.

Adult Bed Capacity Expanding

During COVID-19, to accommodate the surge of patients requiring acute care beds, Denver Health has been able to utilize the beds in our designated Rehabilitation Unit for adult med/surg patients. Under normal operations, that would not have been allowed, because of its status as a designated Rehabilitation Unit. While there are clear advantages to having a designated Rehabilitation Unit, the disadvantages are that those beds must only be used for rehabilitation patients, even when there are no rehabilitation patients who need the bed, and even when other patients do need the bed. It is clear that COVID-19 will be with us for a long time, and demand for acute care adult beds continues to increase.

Denver Health has a need for greater flexibility in our bed allocation to accommodate the increased demand for adult acute care patients.

Beginning sometime the coming weeks ahead, Denver Health will no longer commit any beds exclusively for use as part of a designated rehabilitation unit. We don’t envision this changing much for the day to day work for our Rehab service or for our patients. For patients requiring inpatient rehabilitation services, the PM&R team will still be the primary managing service. Instead of a discharge and readmission to the service, inpatients instead will be transferred to the service. The care teams should remain the same. Whenever possible, these patients will be housed on the 6th floor, near the gym and other key services. We expect the same high quality care, without the restraints of specific bed designation. We will send out more information as we get more clarity on timeline and other specifics.

Denver Health Physicians Named “Top Doctors”

Fifty-nine Denver Health doctors made the list of 2020 Top Doctors in 5280 magazine. The honor recognizes some of the best physicians in Denver. The local magazine asked doctors across the city to vote on which physician they trust most for the health care of themselves and their loved ones. Congratulations to the winners of this year's Denver Health Top Docs! See who made the list here.

Policy Reminders

Universal Masking

Remember that the universal masking policy applies to all staff, patients and visitors across all Denver Health locations. This includes while in hallways and transporting patients.

· Clinical staff members are required to wear at all times a mask or a respirator that is appropriate to their environment of care. See the details here.

· Non-clinical staff members are required to wear a face covering when within entering or moving around indoor spaces and when within 6 feet of another person. Learn more here.

· Patients and visitors are also required to wear a mask or a face covering. Supplies are available at hospital entrances.

Hand Hygiene

· All employees and contractors who have direct patient contact must follow the Hand Hygiene Policy.

· Wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizer provided by Denver Health.

Social Distancing

Social distancing is critical to reduce the risk of transmission. It’s also important that we lead by example. Remember to stay at least six feet away from others unless it’s required for patient care while using appropriate PPE. Staying six feet away also means skipping the handshake.

Infection Prevention Best Practice Quick Reference

COVID-19:

· N95 Mask Options and Mask Labeling

· PPE Algorithm

· Donning and Doffing Instructions

· Specialized Respiratory Isolation

· Other Personal Protective Equipment (PPE) Questions

· Centers for Disease Control (CDC) and Colorado Department of Public Health & Environment (CDPHE) Resources

Policies:

· Hand Hygiene

· Standard Precautions

· Isolation/Transmission-based Precautions

Quick Videos:

· World Health Organization (WHO): How to wash hands with soap and water

· WHO: How to wash hands with alcohol-based hand sanitizer

Denver Health Coronavirus Resources:

· Denver Health External Website for Staff

· Denver Health Pulse Subsite

· RISE Virtual Group Support

· Weekly Mindfulness WebEx

Helpful Links:

· Colorado Department of Public Health and Environment Coronavirus Information

· Denver Department of Public Health and Environment Coronavirus Information

· Centers for Disease Control and Prevention Coronavirus Information

· Denver Public Health Website

Thank you for everything you do for Denver Health!

Connie Savor Price, MD

Chief Medical Officer

Denver Health and Hospital

Professor of Medicine

Division of Infectious Diseases

University of Colorado School of Medicine

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