1/ Ok, I finally have a little time. I'm going to share what @StLukesHealth's Chief Medical Officer, Dr. Jim Souza, shared w/ @westadaschools board on the reopening of schools. Get a glass of ice tea, this is going to be a long one, or just watch it here:
2/ "This infection is rampantly spreading in some of our communities now...Our positivity rates are up from single digits to double digits in testing...People are largely now acquiring this in the community. Largely, I believe, in their backyard events and non-safe workplaces.”
3/ “It’s a BIG deal...Our ICUs are straining. They’ve been operating @ 110-130% their usual volumes for the past 3 weeks. Do we have bed capacity? Yes, however staffing is becoming a challenge."
4/ "We are actively seeking travelers, critical care RNs, to support our staffing because our staff are also acquiring this in the community. And that’s where they are acquiring it. They’re not acquiring it at work.”
5/ "We are, unfortunately, starting to see pediatric ICU cases now. These children are vulnerable kids. I believe you all teach vulnerable kids."
6/ "Survival from this disease is not a chip shot. It’s a heavy lift & recovery for those who do survive is measured in weeks & months from the complications from surviving critical illness. Deaths are most definitely occurring, including in the healthy."
7/ (THIS IS IMPORTANT) "To be clear, we don’t know enough about this brand-new infection and the narrative it’s just a cold is wrong and it frankly needs to stop!" (Can I get an Amen?)
8/ "We need to prevent infection as much as we can. Now, the good news is we know how to stop it. Follow the science, and hopefully that resonates with this audience because I know you’re in the business of teaching science to our children."
9/ "With that in mind, how has @StLukesHealth stopped it in our facilities, because we have? The answer is we redesigned our business from the ground up. We had to. We didn’t have a business we could shut down." Here's where Dr. Souza starts this thread:
10/ "We changed how people enter our buildings. We changes where they sit. We changed how far apart they sit. We changed what they wear. We changed what we wear. We created triggers and priorities for testing."
11/ "We created countless new clinical work flows to actually manage this disease or that disease. We implemented more than 200 new policies over a period of 8 weeks. We implemented contact tracing."
12/ "We decided how and when to send an employee home, how and when to bring them back, and by doing all of this we don’t have employees contracting #COVID19 in our facilities."
13/ "We have thousands of employees every single day that are interacting with #COVID19 positive patients and they’re not contracting COVID in our facilities. When we do our contact tracing, if they’ve acquired COVID, it’s been in the community."
14/ "Now, doing this well did not happen easily... I think you all know we botched it so badly in the first few weeks we had to close an entire acute care facility in Wood River.
We needed to move quickly, we needed to redesign our care from the bottom up. We’ve done that."
We needed to move quickly, we needed to redesign our care from the bottom up. We’ve done that."
15/ If you want to hear Dr. Jim Souza's direct message to @westadaschools & all schools for reopening in w/ the #COVID19 outbreak, bookmark this. It's powerful & critically important to sort through RIGHT NOW: This part is not to be missed. @StLukesHealth
16/ "For you guys, I’m sure w/the time you’ve had you’ve been formulating robust plans of your own. I would just ask you to shock test those if you haven’t already done it. I think you need to shock test your plans & maybe do some simple tabletop exercises w/real-life scenarios."
17/ "I’m assuming you’re already setting a plan for how people are going to enter/where they sit/how they move/how you clean/how often you clean/air exchanges/what they wear & all those things. I would ask you in the spirit of redesigning your business from the ground up..."
18/ (READ THIS!) "...to just walk through this scenario with me because I think every school that opens, if it opens, WITHIN ONE TO TWO DAYS is going to be faced with this very situation:"
19/ "You’re going to have a student that becomes symptomatic, or a student that discloses a high-risk exposure. So I’d ask you, do you have good answers to all of these questions: How will you identify that student? Who will you notify? Will your plan be to test or to isolate?"
20/ "If you test, where are you going to get a test? Do you know that they have the supplies, because we won’t. @StLukesHealth won’t. Who will pay for the test? What will a positive or a negative test mean to you knowing what we know about false negative rates?"
21/ "Who is going to do your contact tracing at the school to determine which other students were exposed? How will you handle the contacts, and specifically what I mean by that is are you going to test them? If so, again, who’s going to do the testing?"
22/ "Do they have supplies & what will a negative test mean to that group of students? Who will you isolate, the individual & contacts, the whole class? How long will you have the students out? What’s your return strategy? Is it going to be a test strategy or a symptom strategy?"
23/ "And what will you do differently after your 1st case?
Those are all the questions @StLukesHealth had to wrestle with & develop plans around in real-time, working on the plane while we were flying it, and now have those things in place.” -Dr. Jim Souza to @westadaschools.
Those are all the questions @StLukesHealth had to wrestle with & develop plans around in real-time, working on the plane while we were flying it, and now have those things in place.” -Dr. Jim Souza to @westadaschools.
24/ Ok... now I'll go watch the rest of his Q&A... I was just too pumped to share all of that with you that I couldn't wait. More to come shortly...
25/ Dr. Souza answers the question about younger versus older kids and whether they can be treated differently in the context of bringing kids back in the classroom:
26/ "The middle schoolers, they can acquire it/#COVID19. They can get quite sick. Our youngest healthy mechanically ventilated patient at @StLukesHealth so far was 17 years old. They survived, but after a big uphill battle.”
27/ "We have to start putting that first on the 3 Ws: WEAR YOUR MASK. Then watch your distance. Then wash your hands. In that order.” #WearAMask
28/ When talking about the 5-7 year old group and #COVID19: "I do believe the risk in that group is lower. It’s not zero, though. I think you need to take in to account your vulnerable teachers with that group."
29/ A member of the @westadaschools asked @StLukesHealth's Dr. Souza what targets he would look for when it comes to opening schools:
30/ "First, I’d look at community activity. We’re in the double digits in terms of the test positivity rates. I think the @WHO suggested that you ought to be seeing positivity rates in testing at less than 5% before you consider that and we’re well above that today.”
31/ (THIS IS IMPORTANT!) "What I would mostly want to see is actually a robust redesign of the practices from the ground up. Honestly, If you’ve got spaces where you can’t maintain distance AND wear a mask AND keep it clean, we shouldn’t be allowing it."
32/ "A well-educated population is one of the best things to drive the health of that population...At the same time, I keep seeing different parts of the world/countries/states... sort-of making the same mistakes and not learning from the advice of those who have been there.”
33/ "As one who’s been there, who didn’t design because we didn’t have time, in our defense we didn’t have time. That thing hit like a thunder clap in Blaine County, but we had not prepared. We hadn’t designed all of these processes from the ground up and it was a disaster."
34/ "If schools open, if you can’t shock test those question I asked and actually provide a robust answer for each one... you’re not ready. If you can, great. You’re ready potentially even with higher levels of community activity."
35/ "A really well-baked plan is the best defense against this virus." -@StLukesHealth's Dr. Jim Souza to the @westadaschools Board Tuesday night on plans for schools to reopen. You can watch it all here:
36/ For all my Dr. Jim Souza groupies: He'll be delivering this message again tomorrow morning on behalf of @StLukesHealth to the Vallivue School District and tomorrow night to the @Nampa131schools District.
