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Follow-up for Positive COVID-19 Cases and their Close Contacts
Tools for LBOHs
Hillary Johnson, MHS, Infectious Disease Epidemiologist Scott Troppy, MPH, PMP, CIC, Surveillance Epidemiologist
Bureau of Infectious Disease and Laboratory Sciences MA Department of Public Health
June 23, 2020
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Topics Today • MAVEN Updates
• MAVEN Online Status Map
• Reminder to check the Immediate COVID workflow and your LBOH Pending Workflows
• Legionella and COVID-19 co-infection links
• How Does the Funded Interpreter Services Work?
• Antigen Testing
• The Outcome Variable in Clinical QP.
• Recovered & Died
• Travel & Vacation
• Reminder about the Cluster/Outbreak Line list Report – Updated and Better!
• Your Questions
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Updates for today, Tuesday, 6/23
• MAVEN Status Map – one town to go
• CTC Variable updates in the Wizard and QP#8
• Legionella and COVID co-infection link
• Reminder to send limited information when you are requesting a de-dup/merge of two events • All we need are the two event ID’s in your email to
• Don’t send names, DOB, phone numbers
• Updated LBOH Final Review Workflow – we have removed COVID-19 events
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MAVEN Status Map as of 6/23/2020
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CTC MAVEN updates
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CTC Variable Updates
Variables Completed Couldn't be reached
Partially Completed Refused to interview Referred to LBOH Contact Diagnosed with COVID-19
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• CTC Follow-Up Notes field: CTC will be able to send notes that
they take on each case and contact. You will see these in the COVID
Wizard and ECR#8 Question Package.
• CTC Case outreach outcome variable: Indicates the
interview status of the case/contact.
Variable Definition Awaiting Outreach No attempt has been made.
Outreach
Underway
Has been assigned to CTC staff and an attempt to contact is being made
for initial case investigation or contact tracing.
Monitoring and
Support
Home monitoring and Resource Coordinator follow up and ongoing
referrals. Starts when there is completion of case investigation or reaching
out to an exposed contact.
Closed When the COVID Community Tracing Team has closed the case and is no
longer responsible for following the case/contact. Closed reasons are
required for this status and are found in the Investigation Status variable in
ECR#8 Question Package. 7
• CTC Case outreach status variable: Case status variables that will show the administrative status of the case/contact.
Electronic Case Report (ECR) QP#8
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• CTC case information goes into ECR-QP#8 • Race & Ethnicity populates QP#2
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Legionella and Covid co-infection links
Immediate Notification workflow (COVID-19 Only)
• UPDATE: We have updated the COVID-19 Immediate Notification Workflow • This will allow proper notification of all new COVID-19 events
for your jurisdiction.
• Please review all events/cases in this workflow and complete your Step 1- LBOH Notification to “Yes” to clear out this workflow.
• If you are retaining ownership then complete Steps 2 (Investigation Started) & 3 (LBOH Investigator (name, lboh, phone number).
• When you are done then complete Steps 4 (CRF Complete) & 5 (Final Review).
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LBOH Final Review Workflow
• LBOH Final Review Workflow: We have updated the workflow to only show non-COVID-19 cases that are still pending. Please review this workflow and complete or close out any older events/cases.
• Once you complete Step 5 these non-COVID cases will be removed.
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LBOH Case Report Forms are Pending Workflow
• LBOH Case Report Forms (CRF) are pending: We have updated the workflow to only show non-COVID-19 cases that are still pending. Please review this workflow and complete or close out any older events/cases
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MAVEN Help
Section
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Tuesday & Friday Webinars for LBOHs
• Isolation of Cases and Quarantine of Contacts is the goal until that strategy changes/evolves.
• MAVEN is the main reporting source and where you should document your work. • Send Cases to CTC for follow-up if not:
• Hospitalized, Deceased, or linked to a Cluster Facility
• Focusing on Priority Activities
• Clusters in Facilities in your community need your help. • Call Epi Program to create cluster events.
Tuesdays & Fridays @ 11am
MAVEN Help has Guidance Documents and Previous Webinars: http://www.maventrainingsite.com/maven-help/toc.html
MDPH Epi Program: 617-983-6800 MDPH MAVEN Help Desk: [email protected] MDPH Food Protection Program: 617-983-6712 CTC Help Desk: 857-305-2828 14
Massachusetts Department of Public Health Telephonic Interpreter Services
Available to Municipalities for Coronavirus Response
June 2020 Vendor Update
• Massachusetts has a contract (PRF63) for telephonic interpretation services.
• Six vendors are shown on the next slide.
• Cities and towns should reach out to a vendor or vendors and set up an account with them, mentioning the state contract PRF63.
• Some vendors will bill DPH directly if they setup a group account for this purpose.
• When used for interpreters in response to coronavirus, monthly invoices from the vendors to cities and towns can be submitted to MDPH at the following e- mail address - [email protected]
• MDPH will pay the vendors directly for telephonic interpretation services utilized by municipalities for coronavirus follow-up through June 2021.
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Massachusetts Department of Public Health Telephonic Interpreter Services
Available to Municipalities for Coronavirus Response June 2020 – UPDATED VENDOR LIST
Vendor Contact Person Phone # Email
Certified Languages International Dickey McMath 503-484-2317 [email protected]
Interpreters and Translators, Inc. Pamela McMahon 860-730-6149 [email protected]
JRivera Associates, Inc. Jose R. Rivera 209-405-0951 [email protected]
Language Line Services Alisa Smith 831-648-7174 [email protected]
Lionbridge Technologies, Inc. John Drugan 978-964-9550 [email protected]
Telelanguage Manuela Villa 503-459-5655 [email protected]
No longer available via the state contract: Interpreters Unlimited, Inc. and TransPerfect Global.
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Molecular (PCR) and Antigen Testing
Antigen Test - Newer (still rare)
• Detects certain proteins that are part of the virus.
• Nasal or Throat swab to get a fluid sample
• Rapid Test - results in minutes on site.
• May be accompanied by additional PCR Test
• Only seeing them with two providers currently: • Carewell & SouthCoast
Molecular Test (PCR)
• Detects genetic material of the virus using a lab technique called polymerase chain reaction (PCR).
• Nasal, Throat, or Nasopharyngeal Swab or from saliva
• Test can be a Rapid Test (results in minutes on site)
• Or one to two days if sent to an outside lab.
• Some home test kits have also been FDA approved.
https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/covid-antibody-tests/faq-20484429
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Molecular (PCR) and Antigen Testing
Antigen Test - Newer (still rare)
• Listed in Lab Tab as follows:
• SARS-CoV-2 Ag (Antigen Test)
Molecular Test (PCR)
• Listed in Lab Tab as follows:
• 2019-nCoV Real-time RT-PCR (PCR)
• SARS coronavirus 2 RdRp gene (PCR RAPID)
Case Classification Manual: http://www.maventrainingsite.com/maven-help/pdf/case-classification-manual/COVID19__05282020_final.pdf
Positive Molecular Test: Case Classification = CONFIRMED
Positive Antigen Test: Case Classification = PROBABLE
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Case Classification Manual
• Pages 3&4
• Table on different Lab Reports
• Test Type
• Specimen Source
• Result possibilities
• What informatics terms to use for each lab (what you see in the Lab Tab & what the technical IT jargon means)
Case Classification Manual: http://www.maventrainingsite.com/maven-help/pdf/case-classification-manual/COVID19__05282020_final.pdf
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What is the Public Health Follow-up? • PCR, Antigen, & Serology NEGATIVE: (usually unclassified events in MAVEN).
No follow-up needed. But if they were a contact they should complete their quarantine. • Negative PCR or Antigen doesn’t end quarantine early.
Testing Interpretation Guidance Document: http://www.maventrainingsite.com/maven-help/pdf/Serology%20Interpretation%20for%20LBOH_ver3.0_June1.pdf
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Interpreting Antigen Testing • This table just describes likely “interpretation” and is not official case
classification. • PER CDC & CSTE Case definition, Antigen tests are still classified as
PROBABLE
• Antigen testing was most likely pursued for acute diagnosis, so we follow-up like we would for PCR test results.
• PCR or Antigen POSITIVE (serology doesn’t matter): Treat like a new case. Follow-up Accordingly.
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Flights & Cruises While Infectious
Key Demographic Data Needed:
• Case Name
• Date of Birth
• Full address
• Clinical Info:
• Symptom Onset Date & Specific Symptoms
Travel Information:
• Airline or cruise company,
• Flight number,
• Seat or cabin number,
• Departure and arrival locations and times,
• Reason for travel and if they traveled alone or with others.
If your confirmed or probable case traveled while infectious and may have exposed others via airplane or maritime vessel (cruise or cargo):
1. Update MAVEN notes 2. Call Epi program so MDPH can notify the Quarantine Station.
Do the best you can. Travel dates & flight numbers are key
even if you don’t have seat number.
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Question on Testing while on Vacation:
Q. To clarify- even if a case is on vacation and gets tested at vacation address, that case should still be reported at the home address?
• A. Yes. Vacationers should be counted by their permanent address, even if they seek testing due to illness while on vacation.
• MDPH generally uses this document. This should cover most scenarios. • Revised Guidelines for Determining Residency for Disease Notification Purposes
https://wwwn.cdc.gov/nndss/document/11-SI-04.pdf
Summary Bullets: • Cases should be reported by the jurisdiction of the person’s “usual residence” at the time
of disease onset. • If a case lives in one place most of the year but who regularly spend part of the year in
another town (e.g., snowbirds/vacation homes) should be reported by the jurisdiction of the residence where they live most of the year.
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Where to track “Recovered.” • Question Package 3: Clinical
Information
• Outcome:
• Died
• Recovered – Fill out when you release patient from Isolation.
• This variable can be seen in many of your reports:
• Confirmed & Probable Line List Report
• CTC Data Report
• Cluster/Outbreak Linelist Report
Remember: Contact Monitoring Status = Completed
is your other indicator.
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Tracking Clusters & their linked People Events
• Identify if someone belongs to a facility cluster. Find or create the cluster as needed and link the person event to the cluster.
• Use the Cluster Facility Event to track notes on overall facility follow-up, control measures, etc.
• Update/complete the MAVEN variables for each linked person (residents and staff).
• Run the Cluster/Outbreak Line List Report for a Cluster (use MAVEN ID for cluster) to see all the linked people and who still needs their MAVEN data entered.
• Report Instructions live on MAVEN Help.
• You will only see the linked people you have access to, so if they live in another town, they still need to be shared.
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Cluster Events – how to manage the linked people. • Instead of looking at the long list of linked events, you can run a MAVEN report called
BOH COVID‐19 Cluster/Outbreak Linelist Report
This report will pull all the linked events from a cluster into an excel
document and you can sort and see what events still need you to
enter data.
June 2020 UPDATE: This report has been updated to pull more of the key variables for each linked person – so you can see what data still needs to be completed on individual events!!! Yay!!!
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What’s in a Cluster Event?
General Facility follow-up Notes Link residents
and staff here.
Summary Variables
Key Contact Information (and towns affected (who can view this cluster). Add new towns if this cluster is shared (so LBOH of staff can read it).
If MDPH Epi is assigned
Can attach documents /lists here
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Cluster Events – how to manage the linked people.
There are pages of linked people. But you cannot tell much about them from this list of linked events. (Confirmed? Unclassified?) Is the data filled in for these people? Who do you still need to complete the MAVEN events for?
This is a great way to check if an individual is linked or to link an new person from this screen. You can sort by name or any of the columns.
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Cluster Events – how to manage the linked people.
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Cluster Events – how to manage the linked people. • Use the Cluster ID.
• Follow the MAVEN instructions.
• Run the report (set dates to cover earliest possible linked event and most recent).
• Select Excel for ability to sort the data in an excel worksheet.
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Cluster Events – how to manage the linked people. (Cluster Line List Report)
• You end up with a report (1 line per person).
• The columns are the MAVEN Variables so you can see who is missing information.
• You can sort (pull your confirmed cases and work on updating those events).
This report has been updated! Better (more applicable) data variables will be visible!
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Cluster Events – how to manage the linked people. (Cluster Line List Report) Event ID EmployedAdmit HCS
Type Where IS the facility located
Official City Facility type
County Other, specify
Event Date Is case a healthcare worker
Disease classification status Direct Patient Care
Contact Monitoring Worker Type
Specify other status Was case hospitalized
First Name Outcome
Middle Name Did case have symptoms
Last Name Symptom onset date
Gender Cough
Birth date Difficulty breathing/Shortness
Age (in years) Fever
Calculated Race Sore Throat
Is case Hispanic Loss of Smell/Taste
Employer name Diarrhea
Occupation Clinical Complications
Other (specify) Please specify
• You should be able to see each linked case and their data fields.
• You can see who still needs data completion.
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Best Practices for Noting Residents and Staff in your Clusters
• Make sure to note the profession in the drop down for Occupation.
• Use OTHER if you don’t see a match.
• Could use ‘Retired’ for residents if applicable.
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Best Practices for Noting Residents and Staff in your LTCF Clusters
QP5: Make sure to note the facility, location, and type for all residents & staff.
• Is Case a Healthcare Worker? • YES: for all staff (even housekeeping,
kitchen staff, admin, etc.)
• Direct Patient Care Responsibilities? • This can be “No” for facility staff not
performing clinical roles.
• Worker Type: • You can select “other” for facility staff that
do not perform one of the clinical roles listed
Because all facility staff are counted and
reported on, note them here as HCWs and make distinctions
below for worker type.
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