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The Hospital and Healthsystem Association of Pennsylvania

April 19, 2024

Volume 12, Issue 7

 

What Comes After COVID-19?

“Ramping Up” and Down Your Preparedness

As emergency managers, we are prepared and ready to go where disaster strikes. If we were driving an ambulance, the last few years have felt like constant lights and sirens, but even ambulances idle down when they’ve reached their destination.

 

 

Read HAP's new blog post written by Ryan Weaver, MBA, BSN, RN, CPPS, manager, emergency management.

 

 

 

 

HAP’s EM team helps Pennsylvania's hospitals and health systems prepare for public health emergencies and serves as a national model for best practices.
HAP's Emergency Management Team

Emergency Preparedness Hot Topics

(CNN) U.S. officials are weighing whether to offer people who are at high risk of severe COVID-19 the chance to get another bivalent booster, according to a source familiar with the deliberations, who asked not to be named because they were not authorized to share the details of ongoing discussions. While most Americans have gladly put pandemic precautions—including vaccines—in the rear view, some who are trying to protect themselves or their loved ones from severe illness have been anxiously wondering how soon they can get another shot.

 

(HHS) The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA) awarded $250,000 in emergency funding to Community Action Agency of Columbiana County, a HRSA-funded health center in Lisbon, Ohio, a neighboring town to help support emergency response efforts and follow-up care for people affected by the East Palestine train derailment. This funding will support key response activities, including direct health care services, patient screenings, outreach, and enrollment.

 

The emergency funding will assist health care professionals providing care to affected residents. This represents another important step in the Biden-Harris Administration’s whole-of-government response to the train derailment—building on CDC’s Assessment of Chemical Exposure investigation and additional support provided by HHS and sister federal agencies. HRSA stands with the residents of East Palestine during this critical time.

National Preparedness News and Updates

COVID-19

(CNBC) People who take Pfizer’s COVID antiviral treatment Paxlovid shortly after infection may reduce their risk of developing long COVID, regardless of their age, vaccination status, or infection history, new research suggests. The study, published in the journal , found that people who took Paxlovid within five days of a positive COVID test saw a 26 percent lower risk of long COVID compared with those who didn’t receive it. More than 35,000 people took the oral COVID pill in the study, while 246,000 did not.

 

(Associated Press) President Joe Biden’s order that federal employees get vaccinated against COVID recently was blocked by a federal appeals court. The 5th U.S. Circuit Court of Appeals in New Orleans rejected arguments that Biden, as the nation’s chief executive, has the same authority as the CEO of a private corporation to require that employees be vaccinated.

 

(The Lancet) COVID-19 magnified the polarization and persistent social, economic, and racial inequities that already existed across U.S. society, but the next pandemic threat need not do the same. U.S. states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society were able to match the best-performing nations in minimizing COVID-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises.

Centers for Disease Control and Prevention COVID-19 Data Tracking and Resources

 

  • : Monitor the rise and fall of COVID-19 cases, deaths, testing volume and percent positivity, nationally and by state.
  • : Use the interactive tool to explore observed and forecasted weekly reported COVID-19 cases and cumulative and incident COVID-19 deaths in the United States.
  • in COVID-19 Cases and Deaths in the U.S. Reported to the CDC by State or Territory; Maps, charts, and data provided by CDC, updates Weekly

Resources

offers a searchable, open-source database of COVID-19 and SARS-CoV-2 publications, clinical trials, protocols, datasets, and epidemiology data. This resource can be found on .

The Hospital and Healthsystem Association of Pennsylvania also has a .

Mpox

(Business Wire) Cue Health (“Cue”), a health care technology company, announced it has received Emergency Use Authorization (EUA) from the United States Food and Drug Administration (FDA) for its molecular test to detect the mpox virus. This nucleic acid amplification test (NAAT) is run on a Cue Reader, can be performed at any CLIA-waived facility and delivers results in 25 minutes, significantly expanding access to fast and accurate testing for patients.

 

(The Lancet Microbe) The risk of airborne SARS-CoV-2 exposure in public indoor spaces, in addition to hospitals, has been debated but experimental evidence is scarce. We monitored SARS-CoV-2 and MPXV genomes in the air in six bar areas and one dark room (sex room) in Madrid nightclubs frequently visited by men who have sex with men (MSM) during four weekend days during 2022 (July 8, July 16, Aug 8, and November 5). To our knowledge, this is the first evidence of airborne SARS-CoV-2 and mpox virus (MPXV) in nightclubs.

 

(CIDRAP) In an update covering the past twp weeks, the World Health Organization (WHO) said recently that it has received reports of 323 new mpox cases and 11 more deaths. Cases are slowly declining in most regions but with no clear downward trend in Africa, where the virus spreads with a mixed pattern of both human-to-human and zoonotic spillovers. Outside of Africa, countries continue to report sporadic cases and small clusters.

 

(BMJ Global Health) We have analyzed the video content, information quality, and audience engagement of mpox-related videos on TikTok. Of the 85 videos, two assessed all content topics and highlighted 33 percent of all content items in clinical guidelines. The overall average score for the videos was 39.56 of 80 on the DISCERN instrument and 1.93 of 4 on the JAMA criteria. No video met all JAMA criteria. Overall scores were higher for videos produced by doctors and science communicators than for those made by institutional users, nurses, and the general public. Multiple linear regression analysis showed that having people in the video and including information on treatment choices were significant, independent determinants of audience engagement. Public-directed TikTok videos on mpox frequently provide incomplete, inaccurate information, highlighting the potential risks of using TikTok as a health information source.

Additional Mpox Resources

  • The U.S. Food and Drug Administration (FDA) announced the availability of a draft guidance titled, “” The draft guidance provides the FDA’s current thinking regarding nonclinical, virology, and clinical considerations for mpox drug development programs.
    • The purpose of this guidance is to assist sponsors in the clinical development of drugs for the treatment of mpox. Comments and suggestions regarding this draft guidance within 60 days of publication in the Federal Register of the notice announcing the availability of the draft guidance.

INFECTIOUS DISEASES

Emerging Disease

(CDC EID) We report the spillover of highly pathogenic avian influenza A(H5N1) into marine mammals in the northeastern United States, coincident with H5N1 in sympatric wild birds. Our data indicate monitoring both wild coastal birds and marine mammals will be critical to determine pandemic potential of influenza A viruses.

 

(Nature) Bird flu is adapting to wild mammals. Tamiru Alkie at the Canadian Food Inspection Agency in Winnipeg and his colleagues sequenced the genomes of bird-flu strains isolated from 40 infected foxes, skunks and mink from across Canada. The isolated viruses—all variants of the H5N1 strain that’s been wreaking havoc around the world—fell into four categories: one closely related to strains circulating in Europe, and three that seem to have evolved in North America. Viruses found near individual bird-migration routes tended to fall into the same category.

 

(Reuters) Some of the world's leading makers of flu vaccines say they could make hundreds of millions of bird flu shots for humans within months if a new strain of avian influenza ever jumps across the species divide. Executives at three vaccine manufacturers—GSK Plc, Moderna Inc, and CSL Seqirus, owned by CSL Ltd—told Reuters they are already developing or about to test sample human vaccines that better match the circulating subtype, as a precautionary measure against a future pandemic. Others, like Sanofi, said they "stand ready" to begin production if needed, with existing H5N1 vaccine strains in stock.

 

(NBC News) Babesiosis, a tick-borne disease that can be fatal in rare cases, is becoming more prevalent in the Northeast, the Centers for Disease Control and Prevention (CDC) said in a recent report. The findings show that among the 10 states that reported babesiosis cases from 2011 to 2019, eight saw their numbers rise, while just two—Minnesota and Wisconsin—observed declines.

 

(STAT News) Even before COVID-19 arrived, the public health response to diseases transmitted to humans by vectors like fleas, ticks and mosquitoes—including West Nile, Zika, dengue fever, Lyme disease, and others—was muted, perhaps because the number of reported cases has been relatively low, and the public largely unaware of the health risks such diseases pose. With climate change accelerating, however, shifting the ranges of many disease-carrying species and sharply increasing infections, scientists and others warn that the nation’s public officials, as well as hospitals and doctors, are underprepared for a potentially devastating surge in infections.

 

(CDC MMWR) On November 7, 2022, dengue virus (DENV), which is not endemic in the continental United States, was identified in a Maricopa County, Arizona, resident by reverse transcription–polymerase chain reaction (RT-PCR) testing at Arizona State Public Health Laboratory (ASPHL). Maricopa County Environmental Services Department (MCESD) conducted retrospective testing for DENV in samples collected from 21 mosquito pools located within 5 miles (8 km) of patient A’s residence during October 1–November 3. A sample collected from one mosquito pool (pool A) on October 5 was positive for DENV. Whole genome sequencing by CDC’s Dengue Branch later revealed that closely related DENV-3 strains not known to be circulating in the patient’s travel region were identified in both patient A and pool A, suggesting local DENV transmission.

 

(CIDRAP News) Following several weeks of little new information on Equatorial Guinea's first Marburg virus outbreak, which began during January, the country is reporting more cases and more extensive transmission of the virus, according to a recent from the World Health Organization (WHO). Eight more confirmed cases have been reported, bringing the total to nine. Seven people among the nine confirmed cases have died from their infections. There are also 20 probable cases, all fatal.

 

(WHO) On March 21, 2023, the Ministry of Health (MoH) of the United Republic of Tanzania declared an outbreak of Marburg virus disease (MVD) in the country. As of March 22, a total of eight cases, including five deaths (case fatality ratio [CFR]: 62.5%) have been reported from two villages in Bukoba district, Kagera region, United Republic of Tanzania. Two of these cases were health care workers, one of whom has died. This is the first Marburg virus disease outbreak reported in the country. As response measures, Rapid Response Teams have been deployed to investigate and implement interventions in the affected areas, including contact tracing and risk communication activities. WHO assesses the risk of spread as very high at the national level, high at the subregional level, and moderate at the regional level due to cross-border movements between Kagera region and bordering countries including Uganda in the north, Rwanda and Burundi in the west. The risk at the global level is assessed to be low.

 

(NBC) For the first time since October 2022, the New York State Department of Health confirmed that polio had been detected in local wastewater from Rockland County. In a recent release, the county said that there was a single positive result that had been collected during February, and that so far, no other samples have had any detection of the virus. County officials said that any residents who are unvaccinated should act quickly to best protect themselves.

 

(UN News) Health authorities in Burundi recently said that they had detected eight samples of polio, officially declaring the landlocked African nation’s first outbreak in more than 30 years. Heath authorities said there was a confirmed case in an unvaccinated four-year-old child in Isale district, in western Burundi, as well as two other children with whom he had been in contact. “Additionally, five samples from environmental surveillance of wastewater confirmed the presence of the circulating poliovirus type 2”, said a press release issued by the World Health Organization.

 

(Fox News) Four sea otters in California died from toxoplasmosis through a rare strain of the Toxoplasma gondii parasite, and researchers warn that the strain could pose a threat to humans. The unusual strain of Toxoplasma gondii that was studied had not been detected in California before. The findings of a study, which was conducted by scientists at California Department of Fish and Wildlife and University of California, Davis, was published in the Frontiers in Marine Science journal this week.

 

(STAT) Early duiring the COVID-19 pandemic, new diagnoses of tuberculosis dropped like a stone in the United States. Data released by the Centers for Disease Control and Prevention (CDC) suggest the pandemic effect has pretty much worn off; TB is nearly back to pre-2020 levels. The 2022 TB estimates were published in the CDC’s online journal, . Their publication coincided with World Tuberculosis Day.

 

(Lancet Regional Health - Americas) Although malaria control investments worldwide have resulted in dramatic declines in transmission since 2000, progress has stalled. In the Amazon, malaria resurgence has followed withdrawal of Global Fund support of the Project for Malaria Control in Andean Border Areas (PAMAFRO). We estimate intervention-specific and spatially explicit effects of the PAMAFRO program on malaria incidence across the Loreto region of Peru, and consider the influence of the environmental risk factors in the presence of interventions.

SUPPLY CHAIN

(New York Times) An increase in shortages of inexpensive yet critical medications is forcing hospitals to make “horrible” choices and is amounting to a national security threat, according to a recent report and testimony at a Senate homeland security hearing. A report prepared for the hearing found that drug shortages increased by nearly 30 percent last year compared with 2021, with an average shortage lasting 18 months and some spanning 15 years. They include common antibiotics, anesthetics, and sterile fluids used to keep intravenous drug tubes clean.

CYBERSECURITY AND PHYSICAL SECURITY

Cybersecurity

(Health Sector Cybersecurity Coordination Center) Emotet—historically a prolific threat to the health sector—recently went operational again after being offline for three months, which is following its pattern of going operational for several months and carrying out attack campaigns and then going offline for several months in order to retool and refine its capabilities. It reemerged during early March. The operators started to reconstitute their command and control infrastructure during late January. It's epochs began going back online on January 25 and they immediately began to show activity. It was on March 8 that epoch 4 resumed delivery of phishing emails—their standard practice of malicious office documents in zip archives. One of the things they appear to be doing slightly differently with this campaign, at least early on, is a form of binary padding. They appear to be inflating both the dropper and the Emotet dynamic link library to a size of 500+ megabytes to avoid detection. They're likely doing this to exceed the size limitations imposed by anti-malware solutions such as sandboxes and scan engines. After the payload is successfully downloaded, Emotet does a check to ensure the file is either zip or a PE (portable executable). And this seems to suggest they may be preparing to leverage other file formats outside of zipped archives in the future.

 

(HSCC) The Health Sector Coordinating Council (HSCC) is a public-private partnership between industry and the U.S. government working to reduce cybersecurity threats and vulnerabilities in the health system. The HSCC Cybersecurity Working Group has produced a series of eight 6–7 minute videos collectively titled “Cybersecurity for the Clinician.” The videos follow a logical sequence focusing on cybersecurity concepts with which frontline health workers should become conversant. The Internet-posted videos are available without charge and are certified for Continuing Medical Education and Continuing Education Units credits.

 

(CISA) Drupal has released a security advisory to address an access bypass vulnerability affecting multiple Drupal versions. An attacker could exploit this vulnerability to take control of an affected system. CISA encourages users and administrators to review Drupal security advisory for more information and apply the necessary updates.

Latest CISA Vulnerability Summary The latest provides a summary of new vulnerabilities that have been recorded by the NIST National Vulnerability Database (NVD) in the past week. In some cases, the vulnerabilities in the bulletin may not yet have assigned CVSS scores. Please visit NVD for updated vulnerability entries, which include CVSS scores once they are available.

Receive HPH Sector Cyber Notifications directly by subscribing to the HPH Sector bulletins. HPH Sector bulletins inform stakeholders about the most significant issues facing the sector including cybersecurity, medical supply chains, COVID-19, and more. If you are interested in receiving cyber notifications or other HPH Sector bulletins, visit the .

HEALTH SYSTEM PREPAREDNESS

Health Care

(ABC News) On the third anniversary of COVID-19 being declared a global pandemic, public health experts can point to clear instances where the United States succeeded in beating back the virus and others where it didn't. Even as the virus continues to spread, data from the Centers for Disease Control and Prevention show that weekly cases, hospitalizations, and deaths are declining, and the nation survived its first winter since the pandemic began without a true winter wave.

 

(CDC Newsroom) Candida auris (C. auris), an emerging fungus considered an urgent antimicrobial resistance (AR) threat, spread at an alarming rate in U.S. health care facilities during 2020–2021, according to data from the Centers for Disease Control and Prevention (CDC) published in the Annals of Internal Medicine. Equally concerning was a tripling during 2021 of the number of cases that were resistant to echinocandins, the antifungal medicine most recommended for treatment of C. auris  infections. In general, C. auris is not a threat to healthy people. People who are very sick, have invasive medical devices, or have long or frequent stays in health care facilities are at increased risk for acquiring C. auris. CDC has deemed C. auris  as an urgent AR threat, because it is often resistant to multiple antifungal drugs, spreads easily in health care facilities, and can cause severe infections with high death rates.

 

(STAT News) Even before the COVID-19 pandemic, urgent and emergency department visits were on the rise. With more than 130 million visits per year during 2020, hospitals are struggling to provide timely, cost-conscious, high-quality care to their patients. As a possible bridge to this gap, many hospitals have expanded their use of advanced practice providers like nurse practitioners and physician assistants, and staffing groups have sought to grow the number of emergency medicine doctors by increasing the number and size of training programs. While we used to be hopeful that reinforcements were coming, the 2023 Match results made it clear that this is no longer the case.

 

(BMJ Open) This scoping review was based on the main research question, ‘What are the implementation strategies, challenges and opportunities in managing the field hospital during the COVID-19 pandemic?’ and aimed to consolidate all recent evidence on COVID-19 field hospital implementation approaches, challenges, and potentialities. Eighty-five records were reviewed and 25 studies were included. For the field hospital implementation strategies, ‘surge capacity’, namely space, human resource, supply and system, was discussed in addition to the preparation and workflow of other services such as pharmacy, rehabilitation, food, and nutrition. The management of COVID-19 field hospitals is challenging with respect to staff and resource shortages, inability to anticipate patient load and poor communication.

Are you reading a forwarded copy of Keystone Digest?

 

Education

The 2023 Preparedness Summit

April 24 through 27, 2023

Virtual attendance available; in person program is full

 

As we recover from the prolonged pandemic response and begin to define the endemic phase of COVID-19, natural disasters, emerging infectious diseases, terrorist threats, climate issues, and maintenance of all-hazards plans can now be reexamined. The theme for the 2023 Preparedness Summit is Recover. Renew: Reprioritizing All-Hazards Preparedness, and it will provide an opportunity to revisit pressing issues in preparedness and share resources, shape policies, and build skills to mitigate a variety of threats.

The Centers for Disease Control and Prevention (CDC) Learning Connection Highlights Free CE Credit Opportunities helps public health and health care professionals stay informed about quality trainings from the CDC, other federal agencies, and federally funded partners. This month, CDC Learning Connection is offering the following CE credit opportunities:

for the CDC Learning Connection newsletter.

Training Opportunities—Ongoing

ASPR’s (CIP) offers a variety of newsletters to keep stakeholders informed during emergency response and steady state. The newsletters inform stakeholders of the most significant issues facing the Healthcare and Public Health Sector including cybersecurity, healthcare supply chains, COVID-19, and more. If you are interested in receiving CIP newsletters, visit the

The National Center for Disaster Medicine and Public Health (NCDMPH) is offering a . This is a modular, online course covering the 11 core competencies in disaster medicine and public health.

 

Suspicious Activity Reporting (SAR) Training for Health Care Workers: The Nationwide SAR Initiative's (NSI) online training module, , was developed to teach workers to recognize suspicious behavior associated with pre-incident terrorist activities. The training also discusses civil rights, privacy, and how and when to report suspicious activity. NSI also offers a two-page resource: . This training module could easily be added to any in-house training for new employees or yearly refresher training for established personnel.

 

The Centers for Disease Control and Prevention Clinical Outreach and Community Activity .

 

FEMA Emergency Management Institute

 

: This interactive, online training has broad utility for response and health care partners as well as those in existing leadership roles. The training takes about 90 minutes to complete.

 

: The Department of Health and the Pennsylvania Emergency Management Agency have established TRAIN PA, the Pennsylvania affiliate for the Public Health Foundation’s learning management system and network. TRAIN PA is a free, collaborative resource for public health organizations and academic institutions across the state to assist in their educational and workforce development efforts.

 

for TRAIN PA allows access to thousands of trainings provided by public health agencies at all levels of government, schools of public health and other academic institutions, and other related organizations. If you already have a TRAIN account through TRAIN National, MRC TRAIN, or CDC TRAIN, you can log in to TRAIN PA using the username and password you use at these other sites.

 

Resources

 

. HAPevolve’s Portable Response Emergency Plan (PREP) is a web-based, mobile app created to house health care facilities’ emergency plans. HAPevolve, a subsidiary of HAP, is offering a temporarily modified COVID-19 version of PREP at no-cost to health care facilities for the global pandemic. COVID-19 PREP has a single-point access to up-to-date pandemic information and resources.

 

 

Items of Interest

 

: The health care supply chain is complex, supporting patient care on a daily basis by producing and delivering medications as well as products ranging from gloves and gowns, to diagnostics, to pharmaceuticals and biomedical equipment, to surgical supplies. During disasters or catastrophic events, the health care supply chain can experience distinct strains depending on the nature of the event and the impact on surrounding infrastructure. These resources provide an overview of the emergency planning and response considerations of health care supply chain owners, operators, and end users, as well as insights for health care coalitions working with health care supply chain partners on preparedness, response, and recovery.

 

This fact sheet addresses several frequently asked questions regarding the Emergency Medical Treatment and Labor Act (EMTALA) and disasters, and provides links to more resources. Note: This document is not intended to be used as regulatory guidance or in place of communications with or guidance from the Centers for Medicare & Medicaid Services (CMS) who oversees EMTALA compliance.

 

Webinar: Dialysis During Disasters: The Kidney Community Emergency Response Program webinar recording, .

 

The Centers for Disease Control and Prevention’s covers topics to take into consideration when preparing for a public health emergency:

(Centers for Disease Control and Prevention) Provides information about bites from mosquitoes, ticks, and fleas, which can spread pathogens and vector-borne disease, discusses what state and local public health agencies can do, and provides a video and sections about Overview, Problem, Infographic, What Can Be Done, and Issue Details.

 

The Centers for Disease Control and Prevention’s (CDC) provides crucial information to use during the first few moments and hours of a response to a potential bioterrorism incident. Designed for first responders, FBI agents who work with weapons of mass destruction, and any other person who might encounter biological agents, the app describes how to recognize signs and symptoms of disease associated with eight biological agents. The app also provides information to obtain expert help quickly with the contact details for the CDC's Emergency Operations Center, FBI field offices, and state public health laboratories.

 

, ASPR blog

 

, The California Emergency Medical Services Authority

 

The Pennsylvania Department of Health Bureau of Public Health Preparedness’

 

HHS emPOWER Map NEW GIS REST Service Link—Partners must connect to the newly named REST service to consume the layer in their GIS System: Connect to the . In doing so, partners will be able to continue to gain population-level situational awareness of electricity-dependent populations in their own GIS applications. Please send any questions you may have to and .

 

Active Shooter Resources

 

From the Department of Homeland Security’s : Action guides that align with the dynamic threat environment and include resources that provide the critical infrastructure community with information regarding attack vectors used by terrorists and other extremist actors as well as corresponding suggested protective measures.

The action guide, , supports the general public’s understanding of the immediate actions that can be taken to increase the probability of survival and also can serve as a poster for the critical infrastructure community to use during events.

 

This standard for active shooter and/or hostile events addresses all aspects of the preparedness, response and recovery process, from identifying hazards and assessing vulnerability, to planning, resource management, incident management at a command level, competencies for first responders, and recovery. It was developed in concert by experts from a wide range of specialties and sets forth requirements for communities to establish a unified planning response and recovery program, long before an active shooter/hostile event occurs.

 

Produced by the Healthcare and Public Health Sector Coordinating Council, this may be a helpful teaching adjunct to the guidance document. OSHA resources include guidelines, successful case studies, and a road map to building a culture of safety in health care.

 

More from the Centers for Disease Control and Prevention

 

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