MUSC Health biweekly COVID-19 report (August 20)

CHARLESTON, S.C. (Aug. 20, 2020) – At MUSC Health, the safety of patients, families, care team members, students, faculty and staff remains the number one priority. The MUSC Public Affairs and Media Relations (PAMR) department issues regular COVID-19 updates on Monday and Thursday of each week. Please read the report in its entirety; information can change quickly.

The Path Forward / Recovery

COVID Vaccine Trial

As researchers from across the globe race to find a vaccine for the coronavirus, the Medical University of South Carolina has entered as a key player in that fight. Along with AstraZeneca and IQVIA, MUSC was selected to be part of a Phase III trial of a vaccine that has shown promise in battling COVID-19.

“The science behind it looks good,” said MUSC emergency medicine physician Gary Headden, M.D., who will be leading the trial. “So, I’d say I’m optimistic.”

FOR UPDATED DATA: The MUSC COVID-19 Epidemiology Intelligence Project is a digital dashboard that provides leading indicators related to the COVID-19 epidemic to enable informed decisions. An Institute for Health Metrics and Evaluation (IHME) chart from the website illustrates the level of the expected impact in South Carolina, and experts will continue to monitor the data and make adjustments to operations, as needed. MUSC’s goal is to deliver health care in a safe and reliable environment, while pushing forward to enable a rapid and successful revitalization of the economy. Current situation assessments for MUSC Health – Charleston (Charleston, Berkeley and Dorchester counties), MUSC Health Florence, and MUSC Health Lancaster divisions are available on this site.

HELPFUL WEB LINKS FOR THE GENERAL PUBLIC:

General information: http://muschealth.org/coronavirus or http://muschealth.org/covid

Information about testing options: http://musc.co/testing

MUSC Virtual Urgent Care: http://musc.care

Status of MUSC COVID-19 diagnostic testing

Like many clinical labs throughout the nation, MUSC Health is experiencing critical issues related to diagnostic-based (PCR) COVID-19 testing. As an organization, MUSC Health has been working diligently to overcome these issues on a daily basis in order to provide the testing needed for our state and community. Given the complexity of these continuing challenges and the increasing demand for testing, it is important and appropriate to provide more insight and depth of understanding for the community.

These issues include:

1.) critical supply problems,

2.) high demand for laboratory medical technicians to perform testing,

3.) limited biomedical technicians to repair lab instruments, and

4.) limited ability to rely on outside reference labs for additional testing.

The critical supply issue involves specialized pipette tips, which are required to produce accurate test results and are in high international demand; they are only manufactured by one company outside the United States. Supply chain, laboratory and health care leadership teams actively continue to monitor the issue and pursue alternative and innovative solutions, inside and outside the organization.

Worldwide, due to the demand for testing and a pre-COVID-19 tight supply of medical technicians, the ability to increase testing further is limited by personnel. To exacerbate this problem, many labs are also dealing with lab personnel absences due to community-acquired COVID-19 illnesses.

The heavy demand is also placing a strain and wear and tear on the complex lab instruments being used continually at a higher than usual level for testing purposes. There are a limited number of qualified biomedical service technicians and MUSC Health is competing with many other institutions and companies across the nation when an instrument requires repair or maintenance. This leads to delays and downtime for critical instruments.

Finally, many outside reference labs are no longer accepting samples from systems such as MUSC due to their own capacity issues, which reduces our overflow capacity.

Due to these challenges, MUSC Health is keeping a close eye on its capacity to test. Our goal is to maintain the quality, timeliness and volume of testing needed by our state and community. It is possible that one or all of these challenges may reduce our test volume capability. This could result in temporary changes to the testing paradigm in order to conserve tests for those requiring hospitalization, health care workers, and first responders. This would allow MUSC Health to focus testing on patients who need it the most. No changes have been made at this time. We will keep the public closely informed as to these changes.

MUSC Health would like to remind the public of the following:

· Individuals who have been exposed, but remain asymptomatic, do not require COVID-19 testing.

· Similarly, individuals who have had COVID-19 do not require a “test of cure”; instead, they should follow DHEC guidance on resuming normal activity based on resolution of symptoms.

· For individuals who have suspected or confirmed COVID-19 after 14 or more days, MUSC Health strongly encourages these individuals to seek antibody (blood) testing as a means to detect past infection. There are no lab critical issues regarding antibody testing.

We ask for the public’s understanding and patience as we respond as best we can to external factors beyond our system’s control.

MUSC COVID-19 mobile diagnostic testing

Rural and underserved communities experience disparities in access to COVID-19 screening, testing, prevention and treatment in South Carolina and nationally. MUSC Health, in partnership with the state legislature, is setting up mobile screening and collection sites in rural and underserved areas. Tents will be set up outside in designated locations to collect COVID-19 respiratory specimens from both walk-up and drive-through patients. Prescreening is not required, and the cost is free to patients. Patients will be contacted within 7 - 10 days with the results of their test, if not sooner. Patients are asked to bring photo identification and an insurance card if they have one. Insurance is not required to be seen, however, the CARES Act does require MUSC to bill insurance providers if patients do have insurance. Patients may email drivethruresults@musc.edu if they have questions regarding their results. If they do not have an email address, they may call 843-985-8888.

The mobile setup allows care providers to rotate sites, reaching underserved and rural populations experiencing barriers to health care access for COVID-19 screening. Collectively, the MUSC Health ambulatory, telehealth, information solutions, emergency management and operations, finance, laboratory and leadership teams were first in the nation to launch a combined virtual urgent care platform and drive-through specimen collection site; now, they’re taking a version of this successful model to more communities that need it.

Sites may close early or operate with reduced hours if heat/weather conditions become unsafe for care team members, or if volume exceeds site safety capacity.

The following locations will offer sites at these dates and times:

AIKEN: This site will open Thursday, August 27 from 9 a.m. to 1 p.m. at Citizens Park, 1060 Banks Mill Rd. SE, Aiken, S.C. 29801.

COLUMBIA: This site will open Friday, August 21 from 9 a.m. to 1 p.m. at the Refuge Temple, 4450 Argent Court, Columbia, S.C. 29203.

FLORENCE: This site will open Monday through Thursday (Aug. 17 - 20, and Aug. 24 -27) from 8 a.m. to 2 p.m. at Florence Medical Center - Cedar Tower, 121 E. Cedar St., Florence, S.C. 29506.

MANNING: This site will open Monday, August 24 from 9 a.m. to 1 p.m. at Weldon Auditorium, 7 Maple St., Manning, S.C. 29102.

MARION: This site will open in partnership withHealth Care Partners of South Carolina on Friday, August 28 from 8 a.m. to 12 p.m. at 145 Palmetto Pointe Rd., Marion, S.C. 29571.

MULLINS: This site will open Friday, August 21 from 8 a.m. to 12 p.m. at MUSC Health Marion Medical Center, 2829 East, US -76, Mullins, S.C. 29574.

RIDGELAND: This site will open Thursday, August 20 from 4 p.m. to 7 p.m. at the Jasper County Farmers Market, 9935 South Jacob Smart Blvd. Hwy. 17, Ridgeland, S.C. 29936.

Another site will open Saturday, August 22 from 9 a.m. to 1 p.m. at Jasper County Alternative School, 456 Grays Hwy., Ridgeland, S.C. 29936.

SPARTANBURG: This site will open Tuesday, August 25 from 4 p.m. to 6 p.m., and Wednesday, August 26 from 8 a.m. to 11 a.m. at Majority Baptist Church, 400 Hudson L. Barksdale Blvd., Spartanburg, S.C. 29306.

SUMMERVILLE: In partnership with Dorchester County and the Town of Summerville, this site will open on Tuesday, Aug. 25, and Thursday, Aug. 27 from 8 a.m. to 12 p.m. at Gahagan Park, 184 W. Boundary St., Summerville, S.C. 29485.

YEMASSEE: This site will open Monday, August 24 from 9 a.m. to 12 p.m. at the Yemassee Municipal Complex, 101 Town Circle, Yemassee, S.C. 29945.

In reporting on these important developments for these local communities, individuals (elected officials, community leaders, city employees, etc.) and media outlets are asked to adhere to these basic rules while engaging with these locations during operational hours:

NO FILMING OR PHOTOGRAPHY INSIDE THE SITE while patients are present and during the stated “open” hours for any given site. This is to protect patient privacy while undergoing specimen collection and for the safety of our care team members. The team needs to perform this service safely when vehicles are present.

The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) issued additional guidance on May 5 to covered health care providers (such as MUSC Health) that the HIPAA Privacy Rule does not permit them to give media and film crews access to facilities where patients’ protected health information (PHI) will be accessible without the patients’ prior authorization. The guidance explains that even during the current COVID-19 public health emergency, covered health care providers are still required to obtain a valid HIPAA authorization from each patient whose PHI will be accessible to the media before the media is given access to that PHI. Due to the complicated logistics and potential safety issues involved in trying to obtain this kind of consent in real-time at a walk-up or drive-through mobile collection site, there will be NO PHOTOGRAPHY OR VIDEO ALLOWED “INSIDE THE FENCE” DURING HOURS OF OPERATION AT ANY MUSC-AFFILIATED MOBILE COLLECTION SITE.

2. We ask that every effort be made to consider patient privacy, and request that photography or video taken from outside the site not involve real-time aerial, close-up/identifying or magnified lens use while patients are present.

3. We ask that every effort be made to follow all security protocols for the site so that patients, care team members and media professionals stay safe. Those who cannot follow these protocols will be asked to leave the area as appropriate.

4. We ask that all MUSC Health team member interviews related to this topic take place when the site is not in operation (before opening, during an individual’s lunch break or after closing via phone or Zoom at a later time) so that our team can focus on safety, patient care and making sure that things are going as smoothly as possible. All interviews should be coordinated through MUSC PR offices and are dependent on site location and care team member availability.

MUSC Health antibody testing

MUSC Health is offering voluntary COVID-19 serologic testing to care team members, first responders in Charleston, Florence and Lancaster divisions and within those local communities. This service was expanded for broader community access at the beginning of June, and is available through musc.care.

The serology test is a blood test that looks for the presence of antibodies, which are specific /proteins made in response to infections. Antibodies can be found in the blood and in other tissues of those who are tested after an infection. The antibodies detected by this test indicate that a person had an antibody response to SARS-CoV-2 (the virus that causes COVID-19), whether symptoms developed from the infection or the infected person was asymptomatic. These antibodies may help provide protection from future infection as well as identify those still at risk.

Antibody testing for COVID-19 is in its early phases. Hundreds of companies have developed these tests and more are coming on the market every day. There is no perfect test, but MUSC Health is committed to offering the best ones available. As MUSC Health validates and makes COVID-19 antibody testing widely available, it is important to make sure individuals and the media understand what the test results mean.

A positive result means that there is a high chance that an individual had a previous COVID-19 infection.
Positive results do not establish proof of long-lasting immunity for any future COVID-19 infection. It is likely that an individual may have some immunity, but we do not yet know the level of immunity given the presence of antibodies. We also do not know how individual characteristics might influence this immunity.

Therefore, positive results should NOT be considered a reason for individuals to stop protecting themselves from COVID-19 (at work or home) in terms of social distancing practices when possible, good health hygiene, use of PPE in high-risk environments, etc.

For populations, the test is very useful to measure how much COVID-19 is occurring locally by comparing how many people have antibodies now versus later, as COVID-19 becomes more common in South Carolina.

For individuals, it is difficult to make firm conclusions and work-home decisions, based on a single antibody test. However, it is important to start testing now, knowing that tests will improve over time. In addition, our knowledge will improve on which antibodies protect people from getting COVID-19, and how long these antibodies are likely to last in the body. As we are able to document who has had prior exposure to COVID-19, we will be able to understand whether individuals are at risk for developing a second infection and its severity.

Care team members or first responders who wish to be tested can use MUSC Virtual Urgent Care (musc.care) to complete a COVID-19 (coronavirus) visit. Select “yes” on the additional information question and enter #covidimmunity in the comments section. Virtual Care will determine medical eligibility for serologic testing.

Candidates for the serology test should schedule blood draw appointments through MUSC MyChart. Results will be available in MyChart within 48-72 hours. Testing is available at select locations in the Charleston, Florence, and Lancaster divisions and by appointment only. Repeat testing, for those who test negative, will be offered no more than every 30 days for qualified candidates. The cost of the test will be billed to insurance carriers. Based on the recent CARES Act, insured patients will not have an outstanding balance for this test.

MUSC COVID-19 follow-up story ideas:

MIS-C Increase

More than a dozen children in South Carolina have developed MIS-C, a rare COVID complication that can lead to long-term problems.

Pandemic Baby

MUSC Health strives for as normal an experience as possible for pregnant women during the coronavirus pandemic.

COVID Decline

New update from MUSC COVID tracking team shows daily case rate in Tri-county area dropping to 1/3 of July peak

COVID in Kids

A new report on COVID-19 finds the number of infected kids jumped by 90% in a month’s time.

Florence COVID Fighter

Alechia Broughton's path to becoming a nurse isn't the usual story. But then again, neither is what she's now facing in Florence.

Waterworks Back2Business

Mount Pleasant Waterworks has to keep running despite pandemic. So it gets expert advice from MUSC Health’s Back2Business team.

Basic stats / COVID-19 positive cases

Previously reported data points, such as the number of telehealth screenings, total number of specimens collected at the West Ashley specimen collection site, or the number of COVID-19 positive MUSC care team members are available upon request.

Total number of COVID-19 community screening tests completed by MUSC Health-Charleston: 132,141

(MUSC Health system-wide: 149,132)

Total Number of COVID-19 positive greater Charleston community screening tests: 13,129

(MUSC Health system-wide: 15,163)

It is important to understand, and to avoid duplication in reporting, that these cases are reported to, and included in, the DHEC statewide COVID-19 numbers.
The majority of these individuals may not require hospitalization in a South Carolina hospital.

Number of COVID-19 inpatients currently in the hospital (MUSC Health-Charleston): 34
- MUSC Health monitors this number to determine that we have current and future capacity in terms of health care providers, supplies, ventilators and PPE. Please see the IHME graph here. These numbers are consistent with the modeling and expectation that MUSC Health will have appropriate resources to manage these patients.
- Of the 34 patients currently in the MUSC Health-Charleston location, 12 are in MUSC Health COVID-19 intensive care, with 7 of the 34 total inpatients receiving ventilator care for disease progression at this time.

MUSC Health is currently using recently vacated, critical care space in the old Children’s Hospital, now known as University Hospital Extension, as well as ICU space in Ashley River Tower for approximately 150 extra beds. Individual units are brought online for care as patient volumes increase.

MUSC has worked with the Army Corps of Engineers and the S.C. National Guard to plan a field hospital/care facility on campus, should it be needed, for COVID-19 patients who do not require critical care. All chain of command protocols will be appropriately adhered to at local, state and federal levels. A REQUEST HAS NOT BEEN MADE AT THIS TIME. The Army Corps of Engineers and National Guard will proceed with any plans at the direction and discretion of the appropriate state agencies. This facility would be within the MUSC Wellness Center on Courtenay Drive should it be needed.

For a current list of supply requests, please visit this page.

For specific information about MUSC Health Florence or Marion Medical Centers, please contact Kim Geiger at geigerki@musc.edu. For information about MUSC Health Chester or Lancaster Medical Centers, please contact Ashley Shannon at shannona@musc.edu.

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About MUSC

Founded in 1824 in Charleston, MUSC is the oldest medical school in the South as well as the state’s only integrated academic health sciences center with a unique charge to serve the state through education, research and patient care. Each year, MUSC educates and trains more than 3,000 students and nearly 800 residents in six colleges: Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy. The state’s leader in obtaining biomedical research funds, in fiscal year 2019, MUSC set a new high, bringing in more than $284 million. For information on academic programs, visit musc.edu.

As the clinical health system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality patient care available while training generations of competent, compassionate health care providers to serve the people of South Carolina and beyond. Comprising some 1,600 beds, more than 100 outreach sites, the MUSC College of Medicine, the physicians’ practice plan and nearly 275 telehealth locations, MUSC Health owns and operates eight hospitals situated in Charleston, Chester, Florence, Lancaster and Marion counties. In 2020, for the sixth consecutive year, U.S. News & World Report named MUSC Health the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.

MUSC and its affiliates have collective annual budgets of $3.2 billion. The more than 17,000 MUSC team members include world-class faculty, physicians, specialty providers and scientists who deliver groundbreaking education, research, technology and patient care.