COVID-19: The New Normal for Asthma, Schools & Business...Allergy & Asthma Network is a national...
Transcript of COVID-19: The New Normal for Asthma, Schools & Business...Allergy & Asthma Network is a national...
6/4/20
1
allergyasthmanetwork.org
Looking'for'help'with'your'asthma?Allergy1&1Asthma1Network1is1offering1Telehealth1Asthma1Coaching1–check1it1out1at11https://allergyasthmanetwork.org/telehealth>for>asthma>allergies/
June'Webinar:Biologic1Medications:1A1Whole1New1World>Dr.1John1OppenheimerThursday,1June118th – 7:001PM1Eastern1
New'Updated'Website!''''Check1out1our1refreshed1website1with1new1features1and1guidelines>based1information.1We’re%here%to%help!%
Allergy'&'Asthma'Network'Announcements
COVID&19:*The*New*Normal*for*Asthma,*Schools*&*Business*
Dr.*Purvi ParikhDr.*Jackie*Eghrari&Sabet
Tonya*Winders
6/4/20
2
Our$Speakers
Dr.$Purvi ParikhClinical$Assistant$Professor$of$Medicine,$George$Washington$School$of$Medicine$&$Health$Sciences
Medical$Director,$Telehealth,$Allergy$&$Asthma$Network$
Dr.$Jackie$Eghrari1SabetClinical$Assistant$Professor$of$Medicine$NYU$Langone$School$of$Medicine &$Director,$Allergy$and$Asthma$Association,$Murray$Hill
National$Spokesperson,$$$$$$$$$$Allergy$&$Asthma$Network$
Tonya$WindersPresident$&$CEO,$Allergy$&$Asthma$NetworkPresident,$Global$Allergy$&$Airways$Patient$Platform
Outline
• Current*State*of*COVID219• Testing*&*Asthma*Concerns*in*the*“New*Normal”• The*“ABCs”*of*School*Reopening• Business*&*Economic*Impact*
6/4/20
3
Current'State'of'COVID019
Tonya&Winders
6/4/20
4
US#Data#Report#
Total&Confirmed&
Cases1,827,425
Total#New#Cases 24,955
Total#Deaths 106,202
Total#New#Deaths 1045
Data$as$of$6/4/20
In#the#News
• COVID.19#fell#from#the#headlines#this#week• Cases#are increasing#rapidly#in#parts#of#Latin#America.
• Dr.#Fauci:##• A#vaccine#by#the#end#of#the#year#is#“aspirational”#but#“doable”
• We#should#have#a#100#million#doses#by#years#end
• We#will#have#limited#data#on#the#new#vaccines#when#they#are#deployed
• May#have#to#balance#saving#lives#with#the#possibility#of#adverse#events
6/4/20
5
COVID&19)Cases)in)US)by)Date)Reported
0
5000
10000
15000
20000
25000
30000
35000
40000
February28
March)6 March)13March)20March)27 Ap ril)3 Ap ril)10 Ap ril)17 Ap ril)24 May)1 May)8 May)15 May)22 May)29 June)2
New)Cases)by)Day
Cases
COVID&19)Information)Center)–Allergy)&)Asthma)Network)
• https://allergyasthmanetwork.org/health&a&z/covid&19/
• Webinar)recordings• Patient)program)with)ATS)recording
• Infographics• Fact)Sheets)and)Q)&)A’s• Managing)Pediatric)Asthma)during)COVID&19)
• What)coronavirus)looks)like• State)by)State)guidance)on)reopening
6/4/20
6
Testing(&(Asthma(Concerns(in(the(“New(Normal”
Dr.$Purvi Parikh
Three%Main%Types%of%Tests%for%COVID519
• Detects%nucleic%acids• Lets%you%know%if%you%HAVE%the%virus
PCR%5 Polymerase%Chain%Reaction
• Looks%for%proteins• Lets%you%know%if%you%HAVE%the%virusAntigens
• Detects%Antibodies• Lets%you%know%if%you%HAD%the%virusAntibodies
6/4/20
7
PCR$Testing
Diagnostics• Diagnoses$people$who$are$currently$sick
• Mucus$sample• Detects$nucleic$acids$– present$in$virus
Accuracy• Most$reliable$test• Detects$it$a$week$before$symptoms$start$until$a$few$weeks$after$symptoms$end$(range$of$approximately$4$weeks)
• Can$have$up$to$30%$false$negative
Timing• Sent$to$centralized$lab• Results$in$several$days• Testing$backlog$– can$cause$delays
• Rapid$PCR$Tests$–results$in$13$mins.
Antibody)Test
Diagnostics• Identify)people)who)have)been)previously)infected,)not)currently)infected
• Blood)sample• Tracks)the)virus)through)the)population
Accuracy• Are)not)as)reliable• Detects)it)1)– 3)weeks)after)infection
• Does)not)indicate)whether)you)are)protected)from)getting)virus)again
Timing• Results)in)a)few)minutes
• Elisa)test)more)accurate,)not)as)widely)available
6/4/20
8
Antigen'Test
Diagnostics
• Identify'people'who'are'currently'infected
• Nose'&'throat'secretions
• Looks'for'proteins'in'the'virus
Accuracy
• New'type'of'test• Not'expected'to'be'as'accurate'as'PCR'test
Timing
• Results'in'a'few'minutes
• Could'be'valuable'screening'tool
New$York$City$Update
• Cases$continue$to$decline
• Projected$Phase$One$opening$is$June$8th
6/4/20
9
Pediatric)Multisystem)Inflammatory)Syndrome
• Multisystem)Inflammatory)Syndrome)in)Children)(MIS8C))is)a)condition)where)different)body)parts)can)become)inflamed,)including)the)heart,)lungs,)kidneys,)brain,)skin,)eyes,)or)gastrointestinal)organs
• Don’t)know)the)cause• Many)children)with)MIS8C)had)the)virus)that)causes COVID819,)or)had)been)around)someone)with)COVID819
• Fever• Abdominal)pain• Vomiting• Diarrhea• Neck)pain• Rash• Bloodshot)eyes• Feeling)extra)tired• Not)all)children)have)all)the)same)symptoms
• Trouble)breathing• Pain)or)pressure)in)chest)that)doesn’t)go)away
• New)confusion• Inability)to)wake)or)stay)awake• Bluish)lips)or)face• Severe)abdominal)pain
What)is)it? Seek)Emergency)Care)For:Symptoms
Looking'Ahead'– So'Much'We'Still'Aren’t'Sure'About'8
Will'testing'bring'us'back'to'“normal”?• If'you'have'the'antibodies,'you'have'been'exposed'to'the'virus• You'can'conclude'that'you'are'immune'– but'immunity'can'wane• Critical'question:''After'6'months'to'a'year,'does'immunity'wane?• Need'answers'that'will'come'over'time• Testing'is'likely'here'to'stay'for'a'while
Will'antibody'tests'affect'who'will'get'the'vaccine'first?
6/4/20
10
Asthma'Guidance'from'CDC'during'COVID819
General'Information
People'with'moderate'to'severe'asthma'may'be'at'higher'risk'of'getting'very'sick'from'COVID819
COVID819'can'affect'your'respiratory'tract'(nose,'throat,'lungs),'cause'an'asthma'attack,'and'possibly'lead'to'pneumonia'and'acute'respiratory'disease
There'is'currently'no'specific'treatment'for'or'vaccine'to'prevent'COVID819. The'best'way'to'prevent'illness'is'to'avoid'being'exposed'to'this'virus.
Inhalers,*Triggers*and*Stress
• Know*how*to*use*your*inhaler• Avoid*your*asthma*triggers• People*are*feeling*concerned*and*stressed*–strong*emotions*can*trigger*an*asthma*attack*–take*steps*to*cope*with*stress*&*anxiety
6/4/20
11
Current'State'of'Asthma
• Asthma'is'getting'more'attention,'patients'are'increasingly'aware'of'the'importance'of'adherence'to'health'plan• Adherence'to'controller'medications'appears'to'have'increased'among'patients'with'asthma'&'COPD• Telehealth'visits'are'becoming'more'common'– patients'that'are'symptomatic'are'not'exposed'to'triggers'just'to'see'their'doctor• Racial'disparities'exist'and'have'been'brought'to'light'during'this'viral'outbreak
The$Future$of$Asthma$Care$(A$Bit$of$a$Wish$List)
• Improved$adherence• Patients$more$willing$to$use$controller$meds$to$stay$healthy
• Digital$Tools$provide$insight$into$patient$wellBbeing$between$office$visits
• Reliable$online$tools$more$commonly$sought$out$&$used
• General$health$hygiene$improves$– handwashing,$social$distancing$become$ingrained$habits$– keeping$people$with$asthma$in$better$general$health
• Racial$issues$in$healthcare$are$more$visible,$interventions$put$in$place$to$reduce$disparate$care
• Telehealth$– for$visits$&$asthma$education$– deliver$needed$care$without$disruption$to$schedule
6/4/20
12
The$“ABCs”$of$School$Reopening
Dr.$Jackie$Eghrari.Sabet
Risk%Levels%for%Schools%0 CDC
Lowest'Risk:'''''''''''''Virtual0only%classes,%activities%&%event%
More'Risk:'''''''''''''''''''Small,%in0person%classes,%
activities%&%events
Highest'Risk:Full%sized,%in0person%
classes,%activities%&%events
Students%stay%6%feet%apart,%don’t%share%objects.%%Have%same%teacher,%groups%don’t%mix.%%Hybrid%virtual%&%in0person%classes,%rotate%
schedule
Students%are%not%spaced%apart,%share%classroom%materials/%supplies,%mix%
between%classes%&%activities
A B C
6/4/20
13
Promoting)Behaviors)that)Reduce)Spread)6 CDC
STAY%HOME%WHEN%APPROPRIATE
Hand)Hygiene
Respiratory)Etiquette)– Cover)coughs,)sneezesWash)hands,)hand)sanitizer
Cloth)Face)Coverings
Students)&)staffDon’t)touch)face,)proper)use,)removal
Adequate)Supplies
Have)enough)soap,)hand)sanitizerTissues,)paper)towels
Signs)&)Messages
Promote)protective)measures,)announcements,)signsDescribe)how)to)stop)the)spread
School&Nurse&Leadership&Issues
Be&part&of&the&planning• You&are&the&expert&on&the&FRONT&LINE!• The&Network&is&here&to&help
Overseeing&disinfecting• Are&disinfectants&appropriate&around&children?&Asthma&triggers?
Ventilation• Asthma&triggers&with&open&windows?
Group&settings• Markings&in&hallways&to&promote&distancing?&&Stagger&use?
6/4/20
14
School&Nurse&Leadership&Issues
Food&Service•Bring&own&meals&when&feasible,&Pre=packaged&food&whenever&possible•CDC&guidance&is&to&eat&in&classrooms•Make&accommodations&for&students&with&food&allergies• Provide&those&that&supervise&lunch&with&food&allergy&symptoms&so&they&can&respond&quickly&if&needed• Reinforce&to&staff&to&build&bridges&in&talking&to&parents&– provide&safety&measures&for&students• Clean&placemat&for&eating&– cleaned&first&or&with&separate&cloth&to&avoid&cross=contact•Be&sure&epinephrine&auto=injector&is&easily&accessible&near&where&child&is&eating
Health'Office'Considerations
• Have'plenty'of'PPE'for'yourself,'staff'and'students'that'need'it• Use'vinyl'or'nitrile'gloves'– do#not#substitute'latex'gloves'
• Limit'number'of'students'in'Health'Office'at'one'time'• Get'administrative'support'&'assistance'as'needed'to'supervise'students'who'are'waiting'to'enter
• Stagger'medication'administration'times'to'reduce'number'of'children'in'Health'Office'at'a'time• Have'isolation'space'available'for'students'with'viral'symptoms'– be'sure'to'have'enough'supervisory'assistance• Develop'protocol'on'when'to'isolate'&'dismiss'students
6/4/20
15
Assessing'students'with'viral'symptoms'–is'it'a'COVID;19'or'
asthma?
Algorithm*Notes
6/4/20
16
Asthma'Treatment'Notes
• Asthma'care'is'not'what'it'was'10'years'ago!
• Nebulizers• Peak'Flow'Meters• Pulse'Oximeters
= Asthma = COPD = Generic Available
MEDICATIONSAvailable in sterile, unit dose vials – no measuring or mixing necessary.
Short-acting beta2-agonists (SABA)Relaxes tight muscles in airways and offers quick relief of asthma symptoms such as coughing, wheezing and shortness of breath for 3-6 hours
• AccuNeb® (albuterol sulfate) Inhalation Solution
• Xopenex® (levalbuterol hydrochloride) Inhalation Solution
Long-acting beta2-agonists (LABA)Relaxes tight muscles in airways and offers lasting relief of symptoms such as coughing, wheezing and shortness of breath for at least 12 hours
• Brovana® (arfomoterol tartrate) Inhalation Solution
• Perforomist® (formoterol fumarate) Inhalation Solution
CorticosteroidsReduces and prevents inflammation of airway tissue; does not relieve sudden symptoms of coughing, wheezing or shortness of breath
• Pulmicort Respules® (budesonide inhalation suspension)
Short-acting muscarinic antagonists (anticholinergics)Relieves cough, sputum production, wheeze and chest tightness associated with COPD for 4-6 hours
• Ipratropium Bromide Inhalation Solution Sold only as a generic
Long-acting muscarinic antagonists (anticholinergics)Relieves cough, sputum production, wheeze and chest tightness associated with COPD for at least 24 hours
• Lonhala® Magnair® (glycopyrrolate) Inhalation Solution Lonhala is the medicine; Magnair is the nebulizer system
• Yupelri® (revefenacin) Inhalation Solution
Combination medicationsContains both short-acting beta2-agonist (SABA) and short-acting muscarinic antagonist
• DuoNeb® (ipratropium bromide and albuterol sulfate) Inhalation Solution
Mast cell stabilizerPrevents coughing, wheezing and shortness of breath caused by exercise, cold and dry air, or inhaled substances such as pet dander, pollen, dust mites or chemicals
• Cromolyn Sodium Inhalation Solution Sold only as a generic
Respiratory ToolsAllergy & Asthma Network is a national nonprofit organization dedicated to ending needless death and suffering due to asthma, allergies and related conditions through outreach, education, advocacy and research.
AllergyAsthmaNetwork.org • 800.878.4403
VALVED HOLDING CHAMBERS AND SPACERSA device attached to metered-dose inhalers that extend the mouthpiece of the inhaler, trap and suspend particles of medication long enough to be inhaled, and help direct the medication into the lungs where it provides maximum benefit. Available with masks.
IN-CHECK DIAL INSPIRATORY FLOW METERA handheld device to assess inspiratory flow and help determine whether a patient is using correct inhaler technique by comparing the result and optimum result.
PEAK FLOW METERA handheld device to measure a patient’s Peak Expiratory Flow Rate (PEFR), the maximum speed you can force air out of your lung’s large airways; PEFR may indicate how well lungs are working and signal early signs of an asthma flare.
SPIROMETERA device (used primarily in a doctor office) to measure the volume and speed that air is pushed in and out of the lungs; the results assist in diagnosis and measure progress in treatment.
All ofthe time
2
More thanonce a day
2
4 or morenights a week
2
3 or moretimes per day
2
Not controlled at all
1
1
1
1
1
Most ofthe time
Once a day
2 or 3 nightsa week
1 or 2 timesper day
Poorlycontrolled
2
Some ofthe time
3 to 6 timesa week
Once a week
2 or 3 timesper week
Somewhatcontrolled
3
3
3
3
3
A little ofthe time
Once or twicea week
Once or twice
Once a weekor less
Wellcontrolled
4
4
4
4
4
None of the time
Not at all
Not at all
Not at all
Completelycontrolled
TOTAL
SCORE
5
5
5
5
5
2. During the past 4 weeks, how often have you had shortness of breath?
3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness
or pain) wake you up at night or earlier than usual in the morning?
4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?
5. How would you rate your asthma control during the past 4 weeks?
1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?
If your score is 19 or less, your asthma may not be under control. Be sure to talk with your
doctor about your results. The answers below should not be added to your total score.
These answers should be discussed with your doctor.
In the past 12 months, how many emergency department visits have you had due to asthma
(that did not result in a hospitalization)? ________
In the past 12 months, how many inpatient hospitalizations have you had due to asthma? ________
Asthma Control Test™ Is:
A quick test that provides a numerical score to assess asthma control.
Recognized by the National Institutes of Health (NIH) in its 2007 asthma guidelines.1
Clinically validated against spirometry and specialist assessment.2
References: 1. US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. Expert Panel Report 3: Guidelines for the Diagnosis and
Management of Asthma (EPR-3 2007). NIH Item 08-4051. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Accessed September 10, 2007. 2. Nathan RA et al. J Allergy Clin Immunol.
2004;113:59-65.
For Patients 12 Years and Older: 1. Answer each question and write the answer number in the box to the right
of each question.
2. Add your answers and write your total score in the TOTAL box shown below.
3. Discuss your results with your doctor.
Copyright 2002, by QualityMetric Incorporated.
Asthma Control Test is a trademark of QualityMetric Incorporated.
The Asthma Control Test is for people with asthma 12 years and older.
HM2630R0 May 2010
InspiraChamber®
Vortex®AeroVent Plus® MicroChamber®
Asthma Action Plan for Home & School
Name:
Birthdate:
Asthma Severity: Intermittent Mild Persistent Moderate Persistent Severe Persistent
He/she has had many or severe asthma attacks/exacerbations
School Staff: Follow the Yellow and Red Zone plans for rescue medicines according to asthma symptoms.
Unless otherwise noted, the only controllers to be administered in school are those listed as “given in school” in the green zone.
Both the asthma provider and the parent feel that the child may carry and self-administer their inhalers
School nurse agrees with student self-administering the inhalers
Asthma Provider Printed Name and Contact Information:Asthma Provider Signature:
Date:
Parent/Guardian: I give written authorization for the medications listed in the action plan to be administered in school by the nurse or other school
members as appropriate. I consent to communication between the prescribing health care provider/clinic, the school nurse, the school medical advisor
and school-based health clinic providers necessary for asthma management and administration of this medication.
Parent/guardian signature:
Date:
School Nurse Reviewed:
Date:
AAAAI-0416-085 Alpha
Asthma Triggers: (List)
Please send a signed copy back to the provider listed above.
JGreen Zone Have the child take these medicines every day, even when the child feels well.
Always use a spacer with inhalers as directed.
Controller Medicine(s):
Controller Medicine(s) Given in School:
Rescue Medicine: Albuterol/Levalbuterol puffs every four hours as needed
Exercise Medicine: Albuterol/Levalbuterol puffs 15 minutes before activity as needed
Yellow Zone Begin the sick treatment plan if the child has a cough, wheeze, shortness of breath, or tight chest. Have the
child take all of these medicines when sick.
Rescue Medicine: Albuterol/Levalbuterol puffs every 4 hours as needed
Controller Medicine(s):
Continue Green Zone medicines:
Add:
Change:
If the child is in the yellow zone more than 24 hours or is getting worse, follow red zone and call the doctor right away!
Red Zone If breathing is hard and fast, ribs sticking out, trouble walking, talking, or sleeping.
Get Help Now
Take rescue medicine(s) now
Rescue Medicine: Albuterol/Levalbuterol puffs every
Take:
If the child is not better right away, call 911
Please call the doctor any time the child is in the red zone.
NEBULIZERSNebulizers turn liquid asthma and COPD medicine into a fine aerosol that can be inhaled deep into the airways. They are powered by a compressed air machine and can be battery operated or plugged into an electrical outlet.
Many types of nebulizers are available – some are small enough for travel and most are quiet enough for silent nights. Available with masks.
Aerochamber Plus® Flow-Vu® and Aerochamber Plus® Z STAT®
ASTHMA CONTROL TEST ™
A quick test that provides a numerical score to assess a patient’s asthma control; discuss results with a doctor. An Asthma Control Test for children is also available.
ASTHMA ACTION PLANSA personalized document put together by doctor and patient spelling out how to manage symptoms daily and what to do when they worsen. Action plans are also available for COPD.
©2020 Allergy & Asthma Network
Business'&'Economic'Impact'
Tonya&Winders
6/4/20
17
Current'Economics'Compared'to'1929
1929'– “Great'Depression”
• Took'several'quarters'for'unemployment'to'reach'25%
• Warning'signs'– no'specific'event
• Stock'market'fell'43.7%
• Stock'market'moves'in'waves'–
crash'followed'by'correction
• Most'systems'on'gold'standard
• High'debt'levels
2020
• Took'several'weeks'for'unemployment'to'reach'25%
• Warning'signs'– pandemic'event
• Stock'market'– 36%'decline'
followed'by'36%'correction'–
series'of'declines'&'corrections
• Not'on'gold'standard• High'debt'levels,'less'limitations
How$will$the$Stock$Markets$Recover?
• Complex$Systems$– embedded$within$social$system
• Events$never$affect$the$stock$market$in$isolation• Probably$won’t$be$over$in$several$months• Almost$40$million$people$unemployed
• Lower$disposable$income• Lower$revenue$and$profit$for$companies• Bankruptcies?$$Bank$runs?
• The$stock$market$is$forward$looking,$economy$reflects$the$here$&$now
• Stock$market$will$recover$before$family$life$will$feel$a$positive$impact
6/4/20
18
Return'is'not'a'phase;'it’s'a'way'of'operating.'A'nerve'center'can'help'build'the'capabilities'that'businesses'need'in'the'“next'normal.”
New'Ways'to'Think• Businesses'around'the'world'have'faced'disruptions'at'a'speed'and'scale'unprecedented'in'the'modern'era
• Companies'everywhere'are'now'wrestling'with'the'question'of'how'to'reach'the'next'normal'safely
• The'best'possible'plan'today'is'merely'a'strawman'that'will'need'nearFcontinuous'recalibration'and'change.
Unknowns1. Hard'to'write'plans'
• Doubts'about'resurgences,'vaccines'&'immunity
2. Future'of'remote'work• Does'it'really'work'over'time?
3. Customer'behavior• Will'customers'still'embrace'online'shopping'or'return'to'their'old'ways?
From:''Return:(A(new(muscle,(not(just(a(plan.(((By Mihir'Mysore, Bob'Sternfels,'and'Matt'Wilson
The$“Next$Normal”
• Pandemic$has$shifted$demand$online
• Shopping,$Banking
• Consumption$has$fallen,$Economic$uncertainty
Shift$in$Demand
• Tens$of$millions$of$jobs$lost
• 1/3$of$workforce$–pay$cuts,$$furloughs,$layoffs
• Low$income$workers$hold$80%$of$those$jobs
Rapid$Changes$in$Workforce
• US$banned$gatherings,$Variation$in$states
• Consistency$is$difficult$when$businesses$span$multiple$
geographies
Shifts$in$Regulation
• Asymptomatic$workers
• Focus$on$seasonality,$resurgence$
• How$can$the$workplace$be$deemed$safe?
Increasing$information$about$
protocols$for$safety
6/4/20
19
Guidance)for)Businesses)– CDC)&)White)House
• Continue)to)encourage)telework• Conduct)daily)health)checks• Conduct)a)hazard)assessment)of)the)workplace)– close)common)areas• Encourage)employees)to)wear)cloth)face)coverings)in)the)workplace,)if)appropriate• Implement)policies)and)practices)for)social)distancing)in)the)workplace• Strongly)consider)special)accommodations)for)vulnerable)populations
• Improve)the)building)ventilation)system
Questions?
Please&record&your&questions&in&the&Question&box&on&your&webinar&control&panel
We&will&address&as&many&questions&as&we&can
6/4/20
20
COVID&19)&)Asthma:)The)Time)for)Equity)in)Healthcare)is)NOW
Join)us)on)June)24th at)3:00)PM)Eastern)for)the)7thwebinar)in)our)COVID&19)Webinar)Series)&
COVID&19:*The*New*Normal*for*Asthma,*Schools*&*Business*
Thank&you&for&listening!Get&guidelines5based&information&at&
allergyasthmanetwork.org