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? 

Abhijay

Abhijay P. Karandikar, MD, MPH, FACOEM 
Chief - Section of Occupational Medicine


Sent from my Samsung Galaxy smartphone.


-------- Original message --------
From: "Barnosky,Sandra" <barnosky@uchc.edu>
Date: 3/20/20 7:39 AM (GMT-05:00)
To: 'MCOH-EH' <mcoh-eh@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@mylist.net] On Behalf Of Hodgson, Michael - OSHA via MCOH-EH
Sent: Thursday, March 19, 2020 4:32 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: Hodgson, Michael - OSHA <Hodgson.Michael@dol.gov>
Subject: Re: [MCOH-EH] Covid-19 restrictions for vulnerable healthcare personnel

 

*** Attention: This is an external email. Use caution responding, opening attachments or clicking on links. ***

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

-----Original Message-----
From: MCOH-EH <mcoh-eh-bounces@mylist.net> On Behalf Of Sumeet Batra
Sent: Wednesday, March 18, 2020 5:58 PM
To: mcoh-eh@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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The MCOH-EH List has always been moderated by members of the ACOEM Medical Center Occupational Health Section. It is currently moderated by Joe Fanucchi MD FACOEM.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh@mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc):   https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.mcoh-eh.net&amp;data=02%7C01%7CHodgson.Michael%40dol.gov%7C5761b235c58d412ae76b08d7cc333ac2%7C75a6305472044e0c9126adab971d4aca%7C0%7C0%7C637202392721305519&amp;sdata=qBU2r0gQLH8obO%2B44N8fLZepFqS9PXPQDv71osmr2pg%3D&amp;reserved=0
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