MUSC Health biweekly COVID-19 report (January 4)

CHARLESTON, S.C. (Jan. 4, 2021) – 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-19 Vaccination Update

MUSC Health is aligned with CDC and DHEC recommendations for distribution of COVID-19 vaccines, and is currently offering the Pfizer vaccine to Phase 1a health care personnel and first responders in addition to the MUSC Health workforce as of Jan. 2. This began with ~700 doses administered in the Charleston area, including firefighters, EMS providers and school nurses.

MUSC Health has proactively reached out to hundreds of Phase 1a organizations across the state to ensure we are vaccinating all Phase 1a teams near any MUSC Health location; plans are in place to expand to as many locations as possible to ensure community vaccine needs are met. The community is encouraged to monitor muschealth.org for COVID-19 vaccination updates as we continue to open more phases of vaccine distribution.

As supply becomes more readily available, MUSC Health will offer the Pfizer vaccine to Phase 1b (community essential workers and patients ≥age 75) in early 2021. The community is encouraged to monitor muschealth.org for COVID-19 vaccine availability criteria, updates and FAQs.

Total number of COVID-19 vaccinations received/in process of distribution/distributed: 13,960
- Percent MUSC Health employees vaccinated across MUSC divisions:
  - Charleston – 63.64%
  - Florence – 44.81%
  - Lancaster – 42.45%
  - System Average – 59.62%
MUSC Health is receiving the Pfizer vaccine exclusively at this time, due to our sub-zero freezing storage capacity.
- Shipments have been arriving approximately once a week and are administered as quickly as possible while also monitoring closely supply dynamics.
  - Two of the three shipments received thus far arrived a day later than scheduled and one held 80% of the requested doses.
  - Our process was designed to allow for a day’s worth of doses to remain “in-hand” in case a shipment arrived late, to ensure no vaccination appointments have to be canceled or rescheduled.
  - The first shipment was a day late, so the plan to keep a day’s worth of vaccine in-hand was confirmed as a sound approach
  - We keep ~ 1,000 doses (one day, across health system) “in-hand” on any given day so that we do not have to slow down our process due to shipping issues.
  - MUSC Health has opened evening and weekend clinics to accommodate health care worker schedules and to accelerate completion of Phase 1a.

MUSC Health continues to encourage COVID-19 diagnostic testing. This high-sensitivity, nasopharyngeal swab test is available for everyone, including those who are asymptomatic. Surveillance testing does help stop the spread of the virus, particularly for those who are asymptomatic but still contagious. For more information, please see the sections “MUSC COVID-19 mobile diagnostic testing” or “MUSC Health diagnostic saliva-based COVID-19 testing” below.

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

MUSC Health diagnostic saliva-based COVID-19 testing

MUSC Health is prioritizing diagnostic COVID-19 saliva testing for symptomatic and asymptomatic patients (by appointment only) at select locations in the Charleston, Florence and Lancaster communities. Results will be available in MyChart in less than 24 hours (per internal data reports). The test is not a “rapid” point-of-care test and results must be processed within a clinical laboratory. The cost of the test will be billed to insurance carriers. Based on the recent CARES Act, insured or uninsured patients will not have an outstanding balance for this test.

Published and unpublished evaluations of various saliva collection testing methods have yielded vastly different testing characteristics, which is why MUSC has worked diligently to validate its saliva testing results and protocols.

The saliva test used at MUSC Health underwent a rigorous validation process before becoming available to patients. This critical step compares it to the “gold standard” nasopharyngeal (NP) swab tests used within the clinical laboratories at MUSC since the pandemic began. High levels of accuracy were reported for MUSC Health saliva tests, thanks to continued interdisciplinary collaboration and expertise sharing among clinical care and bench research teams. It is important to note that the current saliva test has lower sensitivity in asymptomatic individuals, and MUSC Health continues to work on improvements to the saliva test assays to improve test performance for these patients. As MUSC Health validates and makes COVID-19 saliva testing more widely available, it is important to make sure individuals understand the details related to saliva testing:

Saliva is much easier to collect for the patient and providers involved, so it provides another tool in the testing tool box.
NP swabbing and saliva-based testing will continue in parallel at MUSC and take about the same amount of time to process; one method does not replace another.
MUSC Health is pursuing point-of-care “rapid” saliva-based testing, but it is not available at this time.
PCR-based saliva testing is not necessarily faster in terms of time to process results within the lab, nor is it less expensive to process than NP swab testing.
Saliva is not an acceptable specimen type for any other respiratory virus except SARS-CoV-2. If there is potential to test for any other respiratory viruses, a NP swab is the only acceptable specimen type.
Collection volume required for testing is 2 ml of saliva and patients should not eat, drink, or smoke for 30 minutes prior to saliva collection.

Status of MUSC COVID-19 diagnostic testing

Like many clinical labs throughout the nation, MUSC Health previously experienced critical issues related to diagnostic-based (PCR) COVID-19 testing. As an organization, MUSC Health has worked diligently to overcome these issues on a daily basis in order to provide the testing needed for our state and community. In the last eight weeks, we no longer have significant issues which would delay either the scheduling of a test or delivering the results of tests to patients. Individuals who are symptomatic or have had a significant exposure to someone with COVID-19 should seek testing.

MUSC Health is keeping a close eye on its capacity to test and as of Dec. 28, we are not experiencing capacity issues. Our goal is to maintain the quality, timeliness and volume of testing needed by our state and community. As the current wave of COVID-19 infections develops, 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 provide timely notification to the public if any changes occur and ask for understanding and patience as we respond as best we can to external factors beyond our system’s control that may arise.

MUSC Health would like to remind the public that 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.

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 rotating mobile screening and collection sites in rural and underserved areas throughout the state. 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 two 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.

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

CHESTER: This site will open Wednesday, Jan. 6 from 9 a.m. to 2 p.m. at the MUSC Health Chester Medical Center, 1 Medical Park Dr., Chester, S.C. 29706.

NORTH CHARLESTON: The Charleston International Airport and MUSC Health have collaborated to offer a mobile COVID-19 diagnostic testing site. The site will open on Wednesday Jan. 6, Thursday Jan. 7, Monday, Jan. 11, Wednesday, Jan. 13, and Friday, Jan. 15 from 2:30 p.m. to 5:30 p.m. and is located on the 4th floor of the airport’s Daily Parking Garage, 5500 International Blvd., North Charleston, S.C. 29418. “Rapid’ nasopharyngeal swab testing is now available at this site, with results available via email within 30 minutes of the test.

(Information related to Healthy Me — Healthy SC free mobile testing sites for each week can be found here.)

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:

1. 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.

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 through musc.care. 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.

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.

MUSC Health is committed to offering the best tests 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 helps 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.

MUSC COVID-19 follow-up story ideas:

New Strains

New coronavirus strains that may spread more easily are showing up. Expert explains why and what steps you need to take now.

Extra vaccine

It turns out vials of the Pfizer-BioNTech COVID-19 vaccine – each of which was supposed to contain five doses – has as many as one or two more in them.

Monoclonal Antibodies

A new treatment for certain high-risk patients who've contracted COVID-19 is now available at MUSC Health.

V Day

MUSC received its first shipment of the Pfizer COVID-19 vaccine on Tuesday. In less than three hours of receipt it was going in the arms of front line workers.

SC Cases Climb

South Carolina’s COVID case rate takes off but state still relatively low compared to national numbers.

Basic stats / COVID-19 positive cases

Previously reported data points, such as the number of telehealth screenings, total number of specimens collected at various mobile sites, or the number of COVID-19 positive MUSC care team members are available upon request. Information related to vaccinations is at the top of this release.

Total number of COVID-19 community screening tests completed by MUSC Health-Charleston: 248,971

(MUSC Health system-wide: 288,316)

Total Number of COVID-19 positive greater Charleston community screening tests: 22,411

(MUSC Health system-wide: 27,000)

Number of COVID-19 inpatients currently in the hospital (MUSC Health-Charleston): 53
- 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 53 patients currently in the MUSC Health-Charleston location, 17 are in MUSC Health COVID-19 intensive care, with 9 of the 53 total inpatients currently receiving ventilator care for disease progression.

MUSC Health can use 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.

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 325 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.