[MCOH-EH] Covid-19 restrictions for vulnerable healthcare personnel
Barnosky,Sandra
barnosky at uchc.edu
Fri Mar 20 04:38:25 PDT 2020
We are following CDC and employees can ask to be reassigned based on the following:
For this guidance, we are utilizing the CDC guidance for the definition of severe immunocompromised based on medical conditions and medications, which may be found at:
https://wwwnc.cdc.gov/travel/yellowbook/2020/travelers-with-additional-considerations/immunocompromised-travelers
1.AGE: If you are age 65 or older, you may be considered for re-assignment.
2.PREGNANCY: If you are pregnant, you may ask for an assignment that would limit your exposure to confirmed or suspected COVID-19 patients during higher risk procedures, e.g. aerosol generating procedures.
3.UNDERLYING MEDICAL CONDITIONS: If you have any of the following medical conditions, you may be considered "severely immunocompromised":
*Active leukemia or lymphoma
*Generalized malignancy
*Aplastic anemia
*Graft-versus-host disease
*Congenital immunodeficiency
*Recent radiation therapy or checkpoint inhibitor treatment *Solid-organ transplant recipients and who are on active immunosuppression *CAR-T cell transplant recipients within 2 years of transplantation or still taking immunosuppressive drugs *Hematopoietic stem cell within 2 years of transplantation or still taking immunosuppressive drugs *Human Immunodeficiency Virus infection and a CD4 count < 200 cells/mm3
4.MEDICATIONS: If you are taking any of the medications listed below, you may be considered "severely immunocompromised."
If you meet any of the above criteria you may request to be voluntarily re-assigned.
List of Medications that Constitute Severe Immunocompromise *High-dose corticosteroids
o defined as a dose of either >2 mg/kg of body weight or ≥20 mg per day of prednisone or equivalent in people who weigh >10 kg, when administered for ≥2 weeks
*Alkylating agents(such as cyclophosphamide) *Antimetabolites(such as azathioprine, 6-mercaptopurine, methotrexate).
*Transplant-related immunosuppressive drugs(such as cyclosporine, tacrolimus, sirolimus, everolimus, azathioprine, and mycophenolate mofetil) *Cancer chemotherapeutic agents *Tumor necrosis factor (TNF) blockers(e.g. etanercept, adalimumab, certolizumab pegol, golimumab, and infliximab) *Lymphocyte-depleting agents (thymoglobulin or alemtuzumab) *Other biologic agentsthat are immunosuppressive or immunomodulatory including the following:
GENERIC NAME TRADE NAME
Abatacept Orencia
Adalimumab Humira
Alemtuzumab Campath
Anakinra Kineret
Atezolizumab Tecentriq
Avelumab Bavencio
Basiliximab Simulect
Belatacept Nulojix
Bevacizumab Avastin
Certolizumab pegol Cimzia
Cetuximab Erbitux
Dasatinib Sprycel
Dimethyl fumarate Tecfidera
Etanercept Enbrel
Fingolimod Gilenya
Glatiramer acetate Copaxone
Golimumab Simponi
Ibritumomab tiuxetan Zevalin
Ibrutinib Imbruvica
Imatinib mesylate Gleevec, STI 571
GENERIC NAME TRADE NAME
Infliximab Remicade
Interferon alfa Pegasys, PegIntron
Interferon beta-1a Avonex, Rebif
Interferon beta-1b Betaseron
Natalizumab Tsabri
Nivolumab Opdivo
Ofatumumab Arzerra
Panitumumab Vectibix
Pembrolizumab Keytruda
Lenalidomide Revlimid
Rilonacept Arcalyst
Rituximab Rituxan
Sarilumab Kevzara
Secukinumab Cosentyx
Sunitinib malate Sutent
Tocilizumab Actemra
Tofacitinib Xeljanz
Trastuzumab Herceptin
Ustekinumab Stelara
Vedolizumab Entyvio
From: MCOH-EH [mailto:mcoh-eh-bounces+barnosky=up.uchc.edu at mylist.net] On Behalf Of Hodgson, Michael - OSHA via MCOH-EH
Sent: Thursday, March 19, 2020 4:32 PM
To: MCOH-EH <mcoh-eh at mylist.net>
Cc: Hodgson, Michael - OSHA <Hodgson.Michael at dol.gov>
Subject: Re: [MCOH-EH] Covid-19 restrictions for vulnerable healthcare personnel
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The venerable Dr Teichman appropriately defends a non-discriminatory practice... But here CDC has uttered a new warning. In fact, since language ambiguities made some people interpret their warning that all employees over 65 should stay home and not enter Federal buildings even if they are essential staff. Sigh
>From a 70-year old...
________________________________
From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> on behalf of Teichman, Ron F <Ron.Teichman at bannerhealth.com<mailto:Ron.Teichman at bannerhealth.com>>
Sent: Wednesday, March 18, 2020 9:05:26 PM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] Covid-19 restrictions for vulnerable healthcare personnel
At this point the first question that must be asked is why does an immunocompromised HCW feel they cannot be around someone potentially infected with COVID-19, but has no such concern over potential infections with measles, TB or influenza? If they are immunocompromised they should avoid contact with potentially infectious patients, but should not pick an dchoose which disease they don't want to work around (remind anyone of GRIDS?).
Ron Teichman, M.D., M.P.H., FACOEM, FACP
Division Medical Director
Banner Occupational Health and Wellness
1300 N. 12th Street, Suite 610
Phoenix, AZ 85006
602-747-7294
Ron.teichman at bannerhealth.com<mailto:Ron.teichman at bannerhealth.com>
-----Original Message-----
From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Sumeet Batra
Sent: Wednesday, March 18, 2020 5:58 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: [EXTERNAL] [MCOH-EH] Covid-19 restrictions for vulnerable healthcare personnel
Hello,
I am interested in what my colleagues at other institutions are doing with vulnerable HCP, such as HCP over 60, pregnant, immunocompromised. At this time my institution has not recommended changes in work practices, such as not assigning these workers to known or suspected Covid cases but we are getting a lot of pushback from employees and physicians who feel unsafe. I am wary of the legal/ethical/logistical issues that could arise from creating these restrictions but would be very interested in how others are handling this.
Sumeet Batra, MD, MPH
Medical Director of Occupational Health
Cook Children's Healthcare System
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