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The Hospital and Healthsystem Association of Pennsylvania

April 26, 2024

Volume 12, Issue 9

 

What We Can Learn from a Once-in-a-Lifetime Hospital Fire

Are you reviewing your hospital fire, evacuation, and continuity of operations plans?

Recently, a Massachusetts hospital south of Boston was fully evacuated after a fire broke out in a basement transformer room. Due to safety concerns, power to the entire facility was discontinued.

 

Read HAP's new blog post written by Matthew Linse, 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

(STAT News) Marburg could soon become the second virus in the past year to have experimental vaccine candidates ready for testing under an emergency use listing. Until this point, no licensed vaccines or treatments are available for Marburg. That was also the case with the Sudan strain of Ebola, which caused an outbreak in Uganda with 164 cases and more than 55 deaths during the last quarter of 2022. In that instance, vaccines were shipped in a record 78 days, but the outbreak was brought under control before they could be tested for efficacy and made available. Currently, Equatorial Guinea and Tanzania are experiencing their very first Marburg outbreaks, and non-pharmaceutical control measures have so far struggled to contain this deadly hemorrhagic filovirus with a mortality rate of more than 50 percent.

 

(STAT News) Even though the Biden administration is ending its highest-profile COVID-19 emergency declaration next month, it’s still going to hold on to some pandemic-era powers. The Department of Health and Human Services (HHS) gave governors a heads-up recently that it is planning to keep pharmacists’ ability to administer COVID-19 and flu vaccines past the end of the public health emergency. The legal definition of the COVID-19 emergency is a complex web of different laws that control different areas of the pandemic response. The White House and HHS are in the process of winding those powers down, but they all operate separately from another.

 

(Very Well Health) A new COVID-19 Omicron sublineage, XBB.1.16, is slowly spreading in the United States. Also called “Arcturus,” the XBB.1.16 variant is causing different COVID symptoms like conjunctivitis (better known as “pink eye”) in some people who get infected. So far, XBB.1.16 does not seem to cause more severe disease than previous COVID variants.

National Preparedness News and Updates

COVID-19

(The Independent) The new COVID variant concerning experts worldwide has claimed its first victim, health officials have announced. The first death from the Arcturus strain, thought to be around 1.2 times more infectious than the last major sub-variant, was recorded in Thailand yesterday, amid a surge in cases across the globe. Dr Supakit Sirilak, director-general of the Medical Sciences Department, revealed that it was an unnamed elderly man died from the new variant. He told Thailand’s PBS news station that the man who died was “an elderly foreigner” with underlying health conditions.

 

(Washington Post - subscription may be required) A new coronavirus subvariant, XBB. 1.16, has been designated as a “variant under monitoring” by the World Health Organization (WHO). The latest omicron offshoot is particularly prevalent in India, where it has sparked a rise in infections, and a return to mask mandates in parts of the country. Here’s what you need to know about the subvariant called Arcturus, which has been documented in 29 countries so far.

 

(Washington Post) Millions of Americans gathered maskless in homes and houses of worship this month for Passover, Easter and Ramadan—the latest evidence that coronavirus has retreated from public view as the pandemic winds down. But retreat is not the same thing as eradication: federal health officials say that COVID remains one of the leading causes of death in the United States, tied to about 250 deaths daily, on average, mostly among the old and immunocompromised.

 

(NIH) Children with multisystem inflammatory syndrome (MIS-C)—a rare condition linked with the virus that causes COVID-19—have biochemical indicators of cell injury and cell death that are distinct from other children with COVID-19, according to a study funded by the National Institutes of Health. Using high speed, artificial intelligence-controlled molecular sequencing of blood-and-plasma RNA and plasma DNA, researchers found that children with MIS-C have biomarkers indicating damage to multiple organs, the lining of blood vessels and the nervous system. MIS-C usually occurs two to six weeks after SARS-CoV-2 infection, resulting in inflammation of the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal tract.

 

(CNN) Elementary students lined up behind a white curtain in the middle of a grand gymnasium at their school in northern California. They stood still as a dog handler walked a yellow Labrador along the other side of the curtain. Hidden from the children’s view, the 2-year-old female pup sniffed each child’s shoes from beneath that curtain barrier. After each sniff, the dog looked back up at the handler. Then the handler brought the dog to the next tiny pair of feet beneath the curtain, and the dog curiously brought her snout close to those toes, then a young girl’s lavender tennis shoes and then another child’s white high-tops. The dog was smelling for what are called volatile organic compounds that are known to be associated with COVID-19 infections.

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

(Reuters) The first case of mpox in Pakistan has been confirmed by the National Institute of Health (NIH) in the capital Islamabad. A traveler who recently arrived in Pakistan tested positive and has been isolated at a hospital in the capital, along with other individuals who are being tested, a health ministry press release said. There is no evidence of localized transmission of the viral disease in Pakistan, the NIH added.

 

(CNBC) The maker of the mpox vaccine is looking at ways to dramatically scale up its production capacity to prepare for a potential threat from smallpox. Bavarian Nordic CEO Paul Chaplin said the rapid spread of mpox last year was a wake-up call for the company, which is based in Denmark. Mpox is in the same virus family as smallpox. Bavarian Nordic’s Jynneos vaccine is approved by the U.S. Food and Drug Administration to protect against both pathogens.

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

(Axios) The World Health Organization (WHO) is warning that this summer could see alarming rates of dengue and chikungunya across the Americas. Climate change has worsened the spread of mosquito-borne illnesses in many parts of the world. Paraguay, where summer just ended, is facing what experts have called one of the worst chikungunya outbreaks in South America. At least 115 people have died in the country this year.

 

(CDC EID) The continuous evolution of avian influenza viruses (AIV) of subtype H3 in China and the emergence of human infection with AIV subtype H3N8 highlight their threat to public health. Through surveillance in poultry-associated environments during 2009–2022, we isolated and sequenced 188 H3 AIVs across China. Using full-genome analysis, we identified 126 distinct genotypes, of which the H3N2 G23 genotype predominated recently. H3N8 G25 viruses, which spilled over from birds to humans, might have been generated by reassortment between H3N2 G23, wild bird H3N8, and poultry H9N2 before February 2021. Mammal-adapted and drug-resistance substitutions occasionally occurred in H3 AIVs.

 

(New York Times - subscription may be required) A sample of avian influenza isolated from a Chilean man who fell ill last month contains two genetic mutations that are signs of adaptation to mammals, officials from the Centers for Disease Control and Prevention said on Friday. In experimental animal studies, the mutations, both of which are in what is known as the PB2 gene, have previously been shown to help the virus replicate better in mammalian cells. The risk to the public remains low, health officials said, and no additional human cases have been linked to the Chilean man, who remains hospitalized.

 

(Food Safety News) USDA’s Agricultural Research Service has begun avian influenza vaccination trials that might be effective against the deadly virus in another 18 to 24 months. Highly pathogenic avian influenza (HPAI), often referred to as “bird flu,” has been on a rampage for the past year resulting in the loss of 58 million birds and inflating egg prices. Fears are building around the possibility that HPAI will become a regular seasonal event and that the virus may be present in not only wild birds but domestic flocks. Also, it is increasingly being detected in mammals. USDA reports testing one vaccine from Zoetis, one from Merck Animal Health, and two of its own from the Agriculture Research Service.

 

(California Department of Fish and Wildlife) SARS-CoV-2, the virus that causes COVID-19, has been detected for the first time in free-ranging California wildlife. One hunter-harvested mule deer, a buck from El Dorado County, was confirmed to be infected with SARS-CoV-2. The deer was harvested during 2021 and sampled by the California Department of Fish and Wildlife (CDFW) for chronic wasting disease (CWD) surveillance. It was negative for CWD and did not show any outward signs of illness.

 

(ABC News) American Samoa has issued a public health emergency after an outbreak of measles has spread across the U.S. territory. Recently, the Department of Health reported one laboratory-confirmed case among an 8-year-old and 31 suspected and/or probable cases of the highly infectious disease.

 

(Reuters) Equatorial Guinea has confirmed 16 positive cases of Marburg disease since the beginning of the outbreak. Marburg virus disease is a viral haemorrhagic fever that can have a fatality rate of up to 88 percent, according to the World Health Organization. There are no vaccines or antiviral treatments approved to treat it.

 

(Scientific Reports) Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and mortality globally. Recent national data suggests increasing incidence and expanding geographic spread. Predictors of LF case positivity in Nigeria have been sparsely studied. We thus sought to determine the sociodemographic and clinical determinants of LF positivity amongst suspected cases presenting to health facilities from 2018 to 2021.

SUPPLY CHAIN

(FDA) The U.S. Food and Drug Administration (FDA) is announcing the availability of a draft guidance for industry entitled “Notification of a Permanent Discontinuance or Interruption in Manufacturing Under Section 506C of the FD&C Act.” The draft guidance is intended to assist applicants and manufacturers in providing FDA timely, informative notifications about changes in the production of certain finished drugs and biological products as well as certain active pharmaceutical ingredients (API) that may, in turn, help the agency in its efforts to prevent or mitigate shortages. The draft guidance also explains how FDA communicates information about products in shortage to the public.

 

(Supply Chain Brain) As industries reevaluate long-standing sourcing strategies and strive for greater flexibility in their distribution streams, the focus may shift to North America, with the U.S. becoming a more attractive location for manufacturing. Those companies that are the most agile, adaptable and quickest to take advantage of a regionally based product pipeline will come out on top. The COVID-19 pandemic and subsequent supply interruptions have shown the risk of an extended and concentrated supply chain. Business leaders have been forced to reevaluate supply chains, especially those with ties to China. Now, the best solutions may be closer, geographically speaking, than one might realize. It is time to capitalize on regionalization. Regionalized production has many competitive benefits over centralization, including less currency risk, reduced impact of geopolitical issues, and the ability to alter manufacturing capacity in various locations, depending on given situations. To regionalize production, companies must take an overarching look at larger swaths of the globe. They need to analyze detailed information about the location of suppliers, customers, and ship-to points.

CYBERSECURITY AND PHYSICAL SECURITY

Cybersecurity

CISA CYBER ALERTS:

 

April 21, 2023:

 

April 21, 2023:

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.

 

CISA strongly urges all organizations to reduce their exposure to cyberattacks by prioritizing timely remediation of as part of their vulnerability management practice. CISA will continue to add vulnerabilities to the catalog that meet the .

Cybersecurity updates: Subscribe to the weekly .

HEALTH SYSTEM PREPAREDNESS

Health Care

(STAT News) A new book on the U.S. response to the COVID-19 pandemic paints a picture of a country ill-prepared to cope with a dangerous biological foe, riven by partisan politics, and led by people who saw little political gain in taking ownership of managing the crisis. It also describes a country that remains ill-equipped to battle the next pandemic or major disease threat, though it lays out changes that could strengthen the country’s position. “Lessons From the COVID War: An Investigative Report,” which will be published recently, was written by a consortium of scientific and public health experts, many intimately involved in the pandemic response.

Are you reading a forwarded copy of Keystone Digest?

 

Education

World Health Organization EPI-WIN webinar

Chikungunya: Experiences from the current response to the outbreak in the Americas

Wednesday, May 3 at 7:00 am ET

 

Chikungunya is a viral disease transmitted to humans through the bites of Aedes mosquitoes infected with the chikungunya virus. It has been identified in nearly 115 countries in all the continents except Antarctica. The most common symptom is an abrupt onset of fever, often accompanied by joint pain, sometimes very severe that usually lasts a few days but can persist for months or even years. The name “chikungunya” comes from the African Makonde language and means "bent over in pain." This webinar will draw attention to chikungunya disease with the focus on the current situation in the Americas and the response from World Health Organization and Pan American Health Organization.

 

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Administration for Strategic Preparedness & Response (ASPR)

National Biodefense Science Board (NBSB)

Thursday, May 4 at 2 pm to 4 pm ET

 

NBSB members will discuss lessons learned from COVID-19 and present recommendations on additional topics, including collection, analysis, and sharing of operational health data; uses of virtual healthcare during disaster responses; and disaster response challenges specific to rural and underserved communities.

 

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National Heart, Lung, and Blood Institute (NHLBI)

Innovative Approaches to Improve Maternal Health

Monday, May 8 and Tuesday, May 9

 

NHLBI is hosting a hybrid event that brings together technology developers, medical device experts, small business innovators, implementation scientists, maternal mortality and morbidity (MMM) researchers, and academic, industry, and community-based partners. The goal is to connect the research community with small businesses that are developing new approaches to improve MMM and its associated health disparities.

 
New/Updated Resources from ASPR TRACIE

(New)

Mass casualty incidents (MCI) generally occur without warning. A concise, scalable surge response template can be a helpful quick reference for the hospital personnel tasked with expanding care capacity in the first hours of an MCI and can minimize ad hoc and potentially conflicting decisions about prioritization of space and strategies. This new toolkit includes four sections to guide emergency department, general inpatient, and critical care space expansion and basic additional staffing needs in the event of patient surge.

 

(Updated)

Resources in the updated ASPR TRACIE Topic Collection include lessons learned, education and training modules, results from studies conducted on the effectiveness of risk communications and plans, tools, and templates that can be tailored to meet the specific threats and needs of health care and medical professionals.

 

(Updated)

The updated ASPR TRACIE Topic Collection includes social media specific materials containing lessons learned and promising practices from incidents within the past decade and actionable resources specific the health care audience.

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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