[MCOH-EH] Respirators & testing

[Abhijay Karandikar]

1. When there is such a shortage of N-95s and the importance of PPE for healthcare workers is clear, is anyone using other respirators in health care:N-99, N-100 or even the R and P series? Elastomeric reusable respirators? 2. We have been asked by a vendor to consider a "rapid coronavirus test" that will be available from 4/1. It is not FDA approved since there are exceptions on that currently. Anyone has any more information on this? AbhijayAbhijay P. Karandikar, MD, MPH, FACOEM Chief - Section of Occupational MedicineSent from my Samsung Galaxy smartphone.
-------- Original message --------From: "Barnosky,Sandra" <barnosky at uchc.edu> Date: 3/20/20  7:39 AM  (GMT-05:00) To: 'MCOH-EH' <mcoh-eh at mylist.net> Subject: Re: [MCOH-EH] Covid-19 restrictions for vulnerable healthcare personnel 

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>
 on behalf of Teichman, Ron F <Ron.Teichman at bannerhealth.com>
Sent: Wednesday, March 18, 2020 9:05:26 PM
To: MCOH-EH <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 

-----Original Message-----
From: MCOH-EH <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
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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List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh at mylist.net
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