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Additional Guidance

Updated 11/25/2020

Monoclonal Antibody Therapies Available at UConn Health Beginning the Week of 11/30

Dear Faculty,

I am writing to alert you that starting on Monday, November 30 you can begin to make referrals of your qualifying COVID-19 positive outpatients for infusions of investigational monoclonal antibody therapies. Qualifying patients include those with mild to moderate disease at highest risk for severe disease progression or hospitalization. More detail about inclusion and exclusion criteria is included below.

Background 

UConn Health will offer qualifying non-hospitalized COVID-19 patients bamlanivimab or a combination of casirivimab and imdevimab, monoclonal antibody therapies approved earlier this month through FDA emergency use authorizations (EUA). These laboratory-designed proteins work by mimicking the immune system to help fight off the COVID-19 virus by specifically blocking its attachment and entry into cells. While investigational, clinical trials show these therapies may reduce COVID-19-related hospitalization, emergency room visits, and disease severity in high risk patients.

Which Patients Qualify to Receive These Therapies?

Prior to a clinical provider’s referral of a COVID-19 positive patient to the Division of Infectious Diseases, please carefully review UConn Health’s patient inclusion and exclusion criteria, which is outlined below. Of particular note: these medications are indicated for patients with a symptom onset of ≤ 7 days and documented PCR test positivity within 5 days of anticipated administration.

Please note that in addition to the inclusion criteria, availability of the monoclonal therapies will be based on our drug supply, which may be severely limited at times. Also, some patients may be ultimately excluded following further onsite clinical assessment. 

Currently, our supply is severely limited and is restricted to Group A as described below.

Steps for Providers to Take if They Have a Qualifying Patient

Step 1: Talk to your patient first about his or her positive test result.

Step 2: Verify the patient’s inclusion criteria for monoclonal antibody therapy before discussing the treatment possibility with him/her. Be sure to discuss UConn Health’s new therapy offering is on a limited basis and reinforce that even if eligible the patient may not be able to receive the medication due to limited supplies. Notify the patient that, should he or she be able to receive the therapy, they will receive a phone call from UConn Health and will be asked to come in the following day for the infusion. If the patient does not receive a call, it means that she/he will not be able to receive the therapy, either because it was determined that she/he did not meet the qualifying criteria, or because supplies were not sufficient.

Step 3: Once you have confirmed patient eligibility and interest in the infusion therapy, enter a referral order in Epic for “Ambulatory Referral for COVID Therapeutic Infusion.” This will place the patient on a report for follow up by the infection disease nurse.

Where Will the Therapies be Provided?

While infusion patients will arrive at the Emergency Department, the experimental therapy’s single dose infusion will be administered by nurses in the newly established Therapeutic Infusion Center on the 4th floor of the University Tower. Each qualifying outpatient will receive the one hour infusion and a minimum observation of one hour post-infusion.

Additional Information

These FDA fact sheets provide important information about bamlanivimab for health care providers and patients and caregivers, and for casirivimab and imdevimab for providers and patients and caregivers.

As supplies of any other promising investigational monoclonal antibody therapies become available our Division of Infectious Diseases will be incorporating them into the Therapeutic Infusion Center’s outpatient care offerings.

For any patient referral or referral assessment questions, contact the Therapeutic Infusion Center’s Katharine (Kate) Falotico, R.N., Infection Control, Department of Epidemiology, falotico@uchc.edu or 860-679-5199.

Sincerely,
Kevin Dieckhaus, M.D.
Chief, Infectious Diseases

Casey Godshall, M.D.
Assistant Professor, Infectious Diseases


Bamlanivimab EUA and Casirivimab and Imdevimab EUA Criteria for Usage at UConn Health

Inclusion Criteria:

  1. 18 years of age and older and weighing at least 40kg
  2. Within 7 days of the onset of symptoms of COVID-19 from the anticipated date of bamlanivimab or casirivimab and imdevimab administration
  3. Have a documented positive result of a direct SARS CoV-19 viral test (SARS-CoV-2 RNA PCR) within 5 days of the anticipated date of bamlanivimab or casirivimab and imdevimab administration

And must meet the following clinical criteria listed below:

Group A for patients at the highest mortality risk and the number of bamlanivimab casirivimab and imdevimab doses are severely limited:

  1. Patients > 75 years of age
  2. Patient less than 75 years of age AND have one of the following co-morbidities:
    1. Chronic Kidney Disease, Stage III or higher or receiving dialysis
    2. Congestive Heart Failure NYHA Class III or higher
    3. Severe pulmonary disease defined as one of the following:
      1. COPD with continuous home oxygen
      2. Pulmonary hypertension or pulmonary fibrosis
      3. Cystic fibrosis
    4. One of the following hematologic/oncologic diagnoses:
      1. S/P stem cell transplant
      2. Active chemotherapy for acute leukemia, lymphoma, or myeloma
    5. S/P solid organ transplant
    6. Immunosuppressive therapy defined as:
      1. Receiving or have received lymphocyte depleting monoclonal antibody therapy (e.g., rituximab, ofatutumab, ocrelizumab, alemtuzumab, etc.)
    7. Parkinson’s disease

Group B if limited bamlanivimab or casirivimab and imdevimab supply available:

  1. All patients included in group A
  2. All Patients > 65 years of age
  3. Patients < 65 years of age AND have one of the following co-morbidities
    1. Diabetes mellitus (requiring medication)
    2. BMI > 35

Group C if bamlanivimab or casirivimab and imdevimab supply is not limited:

  1. All patients included in groups A and B
  2. All patients with one of the following risk factors:
    1. Diabetes
    2. BMI > 35
    3. Immunosuppressive condition or therapy not listed in group A or B
    4. Sickle cell disease
    5. > 55 years of age AND have one of the following conditions:
      1. COPD or other chronic respiratory disease
      2. Cardiovascular disease
      3. Hypertension

Exclusion Criteria:

  1. Patients hospitalized due to COVID-19
  2. Patients who require oxygen therapy due to COVID-19 at the time of medication infusion to maintain oxygen saturation ≥ 94%
  3. Patients who require an increase in baseline oxygen flow rate due to COVID-19 in those on chronic oxygen therapy due to underlying non-COVID-19 related comorbidity.

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Communications Archive

2020-10-07 Latest Health and Safety Guidelines for All Employees and Learners

Updated 10/7/2020

Latest Health and Safety Guidelines for All Employees and Learners

The health and safety of our patients, visitors, partners, colleagues and community remains our top priority. Protect yourself and others from COVID-19 by following these guidelines.

  • Enter through an approved access point only and follow all signage and screening instructions.
  • Visibly display UConn Health ID badge whenever you are on premises for work or academic purposes.
  • Wear an approved mask covering your nose and mouth in any public area. See Universal Mask Protocol.
  • Wash your hands often for at least 20 seconds. Use hand sanitizer when hand-washing is not possible.
  • Maintain safe physical distancing, at least 6 feet from others.
  • Clean and disinfect high-touch surfaces often.
  • Adhere to all visitation restrictions and protocols.
    • Access by vendors, partners and guests remains restricted to essential or critical business only.
    • See Current Visitor Restrictions.
    • Patient visitation remains restricted. See Patient Visitor Information.
    • No facility access for non-healthcare related purposes, such as dining, shopping and ATM use.

Entry Screening  

  • Screening is required. Please plan for delays during peak arrival times.
  • Monitor yourself for COVID-19 symptoms and risks daily.
    • If you are not feeling well at home do not report to UConn Health for work, business or academic purposes. Contact the COVID Call Center at 860-679-3199.
  • At patient care entrances, in-person screening is conducted.
  • Present your ID badge to the screener, verbally respond to screening questions and complete a no-contact temperature scan. Reentry passes are available upon request.
  • At select locations, self-screening is required.
    • By reporting for work, business or academic purposes at these locations, you are formally attesting that you cannot answer yes to any of the posted screening questions.

Changes Effective 9/28/2020

Connecticut Travel Advisory: New rules have been issued regarding quarantining after returning to Connecticut from affected (red-zoned) states. For information on return to work, please see Updated Guidance.

  • List and map of red-zoned states is updated weekly on the CT.gov website.

Questions have been updated. Please carefully review the following:

Have You: 

  • Been diagnosed with COVID-19 in the last 21 days?
  • Had close contact with someone with COVID-19 in the last 14 days?
  • Traveled from any of the red-zoned states listed in the CT state travel advisory in the last 14 days?

Are You:

  • Currently under investigation with COVID-19 due to symptoms (had a test ordered and/or are awaiting a test result)?
  • Having any of these new or worsening symptoms without a clear explanation?
    • Fever
    • Cough
    • Chills
    • Shortness of breath or difficulty breathing
    • Muscle pain
    • Headache
    • Sore throat
    • Loss of taste and smell
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea

9/18/2020: Drive Through Sampling Site Moved to Garage 1

In preparation for the change in seasons and inclement weather, the drive through COVID sampling site has been moved from Lot 3 to Garage 1. Effective September 18, testing will no longer take place in Lot 3, but will take place in Garage 1. Testing will not be interrupted during the transition. There is no charge for parking in the garage for those who are going through the sampling site.

  • The Level 2 entrance to Garage 1 will be for COVID testing and ambulances only
  • Level 1 Entrance/Exit will be for patients, including surgery, and staff
  • Level 6 Entrance/Exit will continue to be for staff only
  • Level 2 exit can be used by all traffic
  • Beginning September 18, approximately 75 parking spaces on level 2 of Garage 1 will be blocked off for the COVID drive-through testing area.
  • During Testing Hours:
    • All traffic entering the Garage 1, level 2 entrance will be limited to COVID testing, ambulances and oversize/wheelchair vans.
    • All patient traffic for clinical appointments in the lower campus will use the Garage 1, level 1 entrance and exit.
    • Staff, students and residents should plan to use the level 6, rooftop entrance and exit of the garage, and park on the upper levels 4 through 6, while avoiding the use of patient parking areas. Parking operations and Public Safety will monitor the level 6 traffic flow and raise the gates as needed.

The testing hours range from 7:30 a.m. to 2 p.m., Monday through Saturday, and may vary based on the number of daily appointments. If the ‘COVID Testing’ signs are displayed on the campus roads, testing is underway.

Employee testing will continue to take place in the tent outside the Emergency Department.

5/15/2020: Resuming Regular Services at UConn Health – General Guidelines

As we begin to resume our regular services interrupted by the COVID-19, pandemic below are some guidelines and resources for your information.

Bookstore: The UConn Health Bookstore is closed until further notice. Until further notice, please contact Len Oser at SM8207@bncollege.com. Shop online for your UConn merchandise.

Cafés: Meals will continue to be served in our cafeterias. Cafeterias will continue to restrict self-service options and will increase grab n’ go selections. Cafeterias in the Musculoskeletal Institute and Outpatient Pavilion 5th floor continue to run regular hours. Munson Café and Outpatient Pavilion 3rd floor café will open at a later date. Starbucks will reopen on June 1 with Starbucks core menu and limited hours. Please be sure to maintain a social distance of 6 feet while eating in the café or outside when weather improves.

Childcare: We will resume regular operations, including fees, on June 1 at the Creative Childcare Center.

Cleaning: Facilities Operations cleans all Public/Common areas with appropriate disinfectants on a nightly basis and is disinfecting high-touch points frequently throughout the day. Facilities is also monitoring air ventilation rates and increasing the amount of outside air that can be brought in. Departments/Units are responsible for cleaning individual offices, their conference rooms, shared equipment, and other high-touch areas in their units throughout the day. The Office of Logistics Management (OLM) will provide disinfecting wipes and hand sanitizer to departments based on the number of office/lab/clinical spaces. Due to limited supplies each one will need to service multiple employees in one or more spaces. Empty containers should be retained for OLM to pick up when the next delivery is made.

Conference Rooms/Lounge Area: Employees should continue to use teleconferencing whenever practical and effective. If you need to use a conference room, we are asking that you book no more than 25% of maximum capacity, and in no case shall a room be booked to include more than 50% of allowable capacity for the room. Social distancing of 6’ should be able to take place. If you are unsure of the capacity, check with your department administrator. Please remember to wear masks and to clean high-touch areas such as tabletops, chairs, doorknobs, touch screens, key boards, etc. before and after each meeting. All IT/Telecomm screens need to be cleaned with wipes that have a 70% Alcohol base (White Top). Departments should order cleaning supplies from central supply for each conference room under their purview and make such supplies available for this purpose. 

Masking: Masks must be worn at all times. If you are eating or drinking please adhere to a strict social distance of at least 6'. Also, if you see colleagues or patients without a mask please respectfully remind them of the importance of wearing one, as doing so protects us all. Masks have been provided to department heads for their staff. If you don’t have a mask, contact your manager. Masks, along with other essential PPE products including wipes, will be issued by Office of Logistics Management using the email address PPE@uchc.edu. Emails received will be filled within 1-2 workdays. Weekend orders should be received no later than noon on the prior Thursday.

Parking Areas and Parking Garages:

Patient Parking

  • Self-Park Garages – The patient gates in Garage 1 and Garage 3 will be lowered in mid-June. At this time the posted fees will be required.
  • Valet Parking – Normal valet service and the associated fees will resume in mid-June, at the same time that the patient gates are lowered in the garages. Until that time valet staff will continue to greet and assist with arrivals and departures, manage the valet drive traffic flow, direct cars to use the adjacent self-park areas, and offer a limited valet service to patients with mobility challenges.

Employee Parking

  • Lower Campus – Due to the COVID-19 sampling operations in Lot L3 we will continue to provide temporary parking accommodation for employees who work in the lower campus. At this time employees with an Area 3 permit may use the upper levels (levels 4, 5 and 6) of Garage 1 as needed when Lots L2 and L4 are full. Employees should use the level 6 entrance and exit of the garage.
  • Upper Campus – Employees will continue to park in their assigned permit areas.

Screening Stations and Entry Points: To protect our patients and colleagues, we will continue to have designated screening entrances. Before reporting to work each day, you will need to undergo temperature screening and answer questions about possible COVID-19 symptoms and risks. Please use a designated entrance and be sure you are wearing your mask as you enter. Select offsite locations will develop their own employee screening methods.

Shuttle Service: We will resume limited service to 400 Farmington Avenue on May 20. Shuttle service will begin to increase in frequency to pre-COVID times. Check the website/app for time changes.

Social Distancing: Social Distancing should be practiced at all times. Please do not relax your social distancing even within your own department and colleagues. It is important that we continue social distancing and encourage others to do so. We have taken numerous steps to ensure proper social distancing throughout our facilities. For example, we have put up signs on chairs in all waiting areas so people will be spread out. You will see Plexiglas at all front desk areas and large red arrows that are in place to guide patients and staff through the facility in a managed directional flow in order to limit congestion. We have restricted elevators to a maximum of two people and three people in the Outpatient Pavilion. Please give courtesy to patients at the elevator when there are more than the maximum at one time. Employee workstations should be properly distanced as well. Departments in need of assistance in modifying work areas should contact Facility Operations.

Telecommuting: Based on assessment and approval of managers/directors, employees who are able to perform the essential functions of their jobs from home should continue to work from home. Check with your manager or director to update your telecommuting letter/agreement accordingly.

Webex: Continue to use Webex as your primary conferencing tool. Everyone who has a uchc.edu email has access to Webex. If you need help with the technology, please call 860-679-4400.

Wellness Center: The Wellness Center is currently still closed. Stay tuned for further updates.

As always, if you are experiencing symptoms or have concerns of COVID-19, please contact your healthcare provider or our COVID-19 Call Center for further instruction.

The health and safety of our employees, patients, learners and visitors is our primary concern. We will continue to assess our policies and practices and to make modifications based on available information, data, and evolving scientific knowledge, including newly established federal and state guidelines.

4/22/2020: Guidance to UConn Health Providers in Caring for Patients with COVID-19 Returning to Ambulatory Settings

As the COVID-19 outbreak evolves this document provides guidance to healthcare providers in order to protect our patients, healthcare personnel, and community at large. It is essential that our healthcare teams continue to provide quality care, at the appropriate level for all patients, in order to preserve a functioning healthcare system. Robust public health measures will be required to reduce transmission of COVID-19, protect healthcare personnel and ensure patient safety.

Published data suggests that SARS-2-CoV viral shedding, and thus the period of suspected contagiousness, is highest during periods of acute illness and then subsequently declines over time[1],[2],[3].  The decline is likely variable based on the severity of illness and patient-related factors[4].

Patients Diagnosed with COVID-19 Returning to the Community from Home Isolation

Patients with newly diagnosed COVID-19 in the outpatient setting or those individuals recently admitted and discharged home, should be provided with detailed isolation recommendations. Detailed guidance from the CDC can be found on their website. Patients with confirmed COVID-19 should be advised to continue home isolation until they are no longer contagious, based on a non-test-based strategy or a test-based strategy (two negative SARS-COV-2 RNA PCR tests separated by 24 hours).

Using the non-test-based strategy home isolation may be discontinued under the following conditions:

  • Patient has been afebrile for at least 72 hours (without the use of fever reducing medications) AND
  • other respiratory symptoms have improved AND
  • at least 7 days have passed since symptoms first appeared

Patients with COVID-19 Presenting for Care in UConn Health Ambulatory Care Settings

For patients recently diagnosed with COVID-19 either in the inpatient or outpatient setting, recommendations regarding scheduling/coordinating their future healthcare visits at UConn Health are detailed below:

At this time, it is recommended to delay non-urgent healthcare visits for 21 days from date of diagnosis of COVID-19. In particular, this guidance should pertain to following:

  • Non-urgent ambulatory care visits, including outpatient Radiology
  • Non-urgent admissions
  • Non-urgent surgical and procedural cases
  • Routine dental and eyecare visits

If a patient has recently been diagnosed with COVID-19 and requires urgent outpatient evaluation within 21 days of their diagnosis, the healthcare provider should contact Infection Control for guidance on the anticipated encounter, including determining the optimal environment of care and the appropriate personal protective equipment needed for the encounter. Individuals who are highly immunocompromised (medical treatment with immunosuppressive drugs, bone marrow or solid organ transplant recipients, inherited immunodeficiency, poorly controlled HIV) may warrant special infection control measures in recovery after COVID-19. Please call Infection Control for additional guidance for these patients.

[1] Chang D, et al.  Time Kinetics of Viral Clearance and Resolution of Symptoms in Novel Coronavirus Infection. Am J Respir Crit Care Med. 2020 Mar 23.

[2] Zou L et al.  SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med. 2020;382(12):1177-1179.

[3] He X. et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nature Medicine 2020 https://doi.org/10.1038/s41591-020-0869-5

[4] Zhao F et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054–62.

3/30/2020: Guidelines for the Asymptomatic Healthcare Worker with Exposure to an Individual with COVID-19 with Prolonged Contact in the Healthcare or Community Setting

Individuals with prolonged, close contact with an individual with COVID-19 may be at increased risk for infection with SARS-CoV-2, the virus that causes COVID-19. For the purpose of this evaluation, exposed prolonged contact is defined as being within 6 feet of the infected individual for > 15 minutes.

Several factors, including the type of exposure as well as the use of any personal protective equipment dictate the overall risk to the exposed healthcare worker.

High-Risk Exposure

The following categories meet the criteria of a High-Risk Exposure

  1. A Healthcare Worker not wearing a facemask or respirator is exposed to a patient with COVID-19 who is not wearing a facemask.
  2. A Healthcare Worker not wearing a mask or respirator is exposed to a patient with COVID-19 and one of the following has occurred:
    1. The Healthcare Worker had extensive body contact with the patient or
    2. The Healthcare Worker was present during an aerosol generating procedure such as intubation/extubation, bronchoscopy or sputum induction without wearing a respirator
  3. Living in the same household as or providing direct care for a person with symptomatic, laboratory-confirmed COVID-19 infection without using the recommended precautions.

Individuals with High-Risk Exposure should contact the COVID-19 Call Center and report their exposure to Employee Health. If the criteria are met a 14-day quarantine will be recommended.

Low-Medium Risk Exposure

All other scenarios not classified as High-Risk Exposure generally meet the criteria for Low-Medium Risk Exposure.

These may include but are not limited to:

  1. A Healthcare Worker who was in prolonged close contact with a patient with COVID-19 while wearing a facemask at all times even though the patient was not wearing a mask.
  2. A Healthcare Worker who was in prolonged close contact with a patient with COVID-19 while the patient was wearing a mask at all times.
  3. A Healthcare Worker who has recently traveled to a country with widespread community COVID-19 transmission.
  4. Close contact with an individual with symptomatic COVID-19 infection outside a healthcare setting that does not meet criteria for High-Risk Exposure.

A healthcare worker who has had Low Risk exposure may continue to work, provided they remain asymptomatic, following the guidance below. A healthcare worker who has had Medium Risk exposure may continue to work, if they remain asymptomatic, if staffing needs reach critical levels, under the guidance of Employee Health and/or an Employee Health designee. In doing so, he/she must adhere to the following requirements:

  1. A procedure or surgical mask must be worn at all times in all settings for 14 days from the date of exposure.
  2. The healthcare worker must take their temperature twice daily and record this value on a temperature log and check in with their supervisor daily. If the healthcare worker has a temperature > 100 F they must notify Employee Health through the COVID-19 Call Center immediately.
  3. If the healthcare worker develops any new onset of cough, shortness of breath, subjective fever, chills, body aches they must notify Employee Health through the COVID-19 Call Center immediately.

Please call the COVID-19 Call Center if there are any questions about a potential COVID-19 exposure.

3/12/2020: Large Group Meetings

Effective immediately, no events larger than 100 people will be permitted at any UConn Health site. This includes all events and meetings. If possible, alternatives such as teleconference or virtual conferencing methods should be used to hold large events; otherwise they should be cancelled or postponed. In addition, UConn Health strongly recommends the postponement or cancellation of any non-essential live gatherings and meetings of large groups, even those smaller than 100 people.