These are outstanding questions answered by the SHEA COVID-19 Town Hall experts based on their expert opinion. Special thank you to Drs. Mary Hayden, Sarah Haessler and David Weber for their contributions.  Please scroll further down for answers from special guests of the SHEA Town Hall. 

 

 

Question: If a spouse of HCW had COVID-19, separated from the HCW, then a child a few days later developed infection and the spouse (recovering) now takes care of the child, can that spouse exit isolation after day 10, or does their isolation + quarantine (due to ill dependent child) change?  What would that time length be for the spouse be - 10 day isolation plus child's 10 day isolation (minus overlap)?  --- The question impacts workforce:  the quarantine for HCW does shift, but if the spouse cannot come out of isolation and quarantine to assist with the rest of the family - impacts the HCW return to work date re: family support and quarantine period.  Thanks for your thoughts.

 

Answer: Exposure period starts last day of exposure (based on infectivity of contact) – we test HCP at day 6-7 after last exposure, allowed to return to work at day 10 is still asymptomatic

 

Question: Do you stop transmission-based precautions in immunocompromised patients with a vent/trach who are more than 20 days from onset of symptoms, whose symptoms are improving, and who have not had fever for more than 24 hours?       

 

Answer: We still use a test-based strategy for very immunocompromised patients (CART, BMT e.g.) but for most patients we use time-based strategy as described in question.

 

Question: Is there any evidence that remaining partial vaccine doses combined from more than one unexpired vaccine vial could be harmful?  If not, a revision of guidance to allow this would recover some otherwise wasted vaccine volume.

Answer: Risk of combining product from multiple vaccine vials is from the no preservative in vials – 6 hour shelf life after reconstitution – risk is vial contamination with subsequent infection.

 

Question: Could our faculty comment on the letter in CID from Drs. Plotkin & Halsey endorsing expanding vaccine usage and delaying the second dose (based upon experience with memory response from other vaccines).

Answer: Short-term delay (up to 6 weeks ok) – but 1 dose of mRNA vaccine only ~50% effective; durability of vaccine response unknown with single dose

 

Question: Can you please comment on the use of aspirin prophylaxis before COVID vaccine? Aspirin is not mentioned on CDC Website.            

Answer: Aspirin has anti-inflammatory effects and so I would think that the same theoretical concerns around NSAIDS apply to aspirin.

 

Question: What about masking over N95 respirators? I see that a lot. More is better and protecting the N95.

Answer: Double masking is a method of improving the fit of procedural masks. N95 respirators are fit tested so that they fit tightly to the face. Adding a second mask would therefore not improve the fit of the N95 respirator. Wearing a procedural mask over an N95 mask to extend the use of the N95 could be considered as a crisis strategy when N95 respirators are in short supply. Wearing a cleanable face shield over the N95 is preferred, though, as a means of protecting the respirator.

 

Question: We are seeing lots of CLABSI and CAUTI especially in COVID patients along with C. auris. Any comments?

Answer:  At our acute care hospital in Chicago, we have not seen an increase in C. auris infections, despite significant C. auris endemicity in area long term care facilities.

 

Answers below provided by our special guest, Mitchell J. Schwaber, MD, MSc.

Question: Have you had breakthrough cases? Related to variants or other pre-disposing conditions?

Answer: There have been documented cases of infection despite full vaccination (full vaccination = 2 doses of Pfizer vaccine + 7 days).  Some of these have been asymptomatic - detected due to institutional screening programs, but others have been symptomatic.  This is not unexpected, as the vaccine is not 100% effective at preventing illness, and we still don't know what its effectiveness is in preventing asymptomatic transmission.  Don't have data as yet as to whether and to what extent pre-disposing conditions enhance the risk of post-vaccination infection, but having a pre-disposing condition is clearly not a prerequisite.  Estimated that over 90% of circulating virus in Israel at present is B.1.1.7, so presumably most if not all cases of infection occurring now – among vaccinated and unvaccinated – is with this strain.

Don't have solid data as yet about risk of secondary infection from a vaccinated source.  Anecdotally, I believe there is reason for optimism on this point, and that optimism is further supported by one of the papers Dr. Weber presented  at the Town Hall (https://www.medrxiv.org/content/10.1101/2021.02.06.21251283v1), demonstrating reduction in viral load in those infected as of 12 days after the first dose of vaccine.  It would make sense that risk of secondary infection would be a function also of vaccination status among those exposed.

As to management – once confirmed SARS-CoV-2 positive, isolation requirements and contact tracing are identical for vaccinated as for unvaccinated.  Two caveats here – 1. A vaccinated contact does not need to quarantine as long as asymptomatic; 2. Due to concern about false-positives in populations with low pre-test probability of infection, in ongoing institutional routine staff screening programs among elderly and other care facilities, two consecutive PCR-positive swabs are required to diagnose infection if the screened asymptomatic staff member is fully vaccinated; and if contact tracing due to a positive result generates testing among asymptomatic vaccinated residents, they should be double-swabbed and considered infected only if both swabs are positive.

 

Question: Does the green card for vaccination expire after a certain time?

Answer: At present it is valid for 6 months.  Duration of validity to be further evaluated with gathering data.

 

Question:  Is Israel vaccinating long COVID-19 patients?

Answer: Not per se.  We are offering vaccination (single dose) to all recovered patients 3 months after infection, and residents of elder and other long-term care facilities were vaccinated en masse with 2 doses, including those recovered from COVID-19.

 

Question: What is Israel data on post vaccine reaction/complications?

Answer: Being gathered by MOH.  To the best of my knowledge, in line with data assembled worldwide, i.e., most reactions mild and transient.  Following reports of post-vaccination myocarditis, pericarditis and multisystem inflammatory syndrome in adults, data presently being gathered to determine whether related to the vaccine. 

 

Question: Any COVID19 lessons in preparation for the next influenza season in Israel?

Answer: For the first time in (at least my) memory, the current influenza season in Israeli has been essentially non-existent.  To the extent that this is related to human behavior (masking, distancing, crowd avoidance, reduced travel, etc), I suspect that we may not see such low numbers repeated next winter.  Hopefully, some of the healthy habits taken from pandemic-related behavior (for example, staying home when sick) will persist in a post-pandemic reality.

 

Question:  Could Dr. Schwaber comment on changes, if any, to preprocedural testing in vaccines.

Answer: This is determined at the local hospital, rather than the national, level.

 

Question: Any severe reactions in persons who have recovered from COVID and received 2 doses of vaccines?

Answer: None that I am aware of.  Most of those recovered will not receive 2 doses of vaccine, as they were initially not vaccinated and at present are offered a single dose if 3 months have passed since infection.  However, as noted, residents of elder and other long-term care facilities were vaccinated en masse with 2 doses, including those recovered from COVID-19.  I am unaware of reports of severe reactions among those recovered.

 

Question: Is there any clinico-epidemiologic basis for preference for mRNA vaccines for residents of skilled nursing and assisted living facilities Dr. Schwaber should Janssen vaccine be available in Israel?

Answer:   Not sure, but at present the question is largely moot in Israel as the overwhelming majority of residents of skilled nursing and assisted living facilities have been vaccinated with the Pfizer vaccine, with excellent results, and the Janssen vaccine is not currently available here.  Should it become available here in the future, and another round of vaccination be warranted, the question may be on the table.

 

Question: Do you think we will have definitive evidence about effectiveness against asymptomatic spread before the end of the year?

Answer: "Definitive" is a relative term with this virus, but I do expect that by year's end we'll have a lot more data than we do at present regarding vaccine effectiveness against asymptomatic spread.

 

 

   

 

 

 

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COVID-19 Update | December 24, 2020
Technical Guidance, Standards and Resources

Vaccine Manufacturer Information 

Guidance for Healthcare Personnel Immunization 

Guidance for Communicating with Patients about Vaccines 

Clinical Resources for COVID-19 Vaccines 

Vaccine Provider Training and Education 

Vaccine Allocation and Patient Safety Information 

Vaccine Information for Long-Term Care Facilities 

SHEA Education and Events

Converse & Convene: Vaccine Distribution Planning and Implementation 
Join us on Friday, January 8th from 11 am-12 pm ET for a moderated discussion with Marci Drees and David Weber. Participants will gain greater insights from both small and large group discussions. This event is not recorded so attendees are able to speak freely and candidly on the topic. This event is restricted to SHEA members only. Register today
 
SHEA Podcast Series - We’re All in this Together: COVID-19 Allies in Infection Prevention  
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Access the full podcast series on LearningCE. Tune in to the newest episodes on SoundCloud: 

SHEA Rapid Response Podcast - COVID-19 Update: What We Know Now 
Each episode provides COVID-19 news and guidance updates, relevant medical literature, and a discussion around a specific COVID-19 topic. Access the full podcast series on LearningCE. Tune in to the newest episodes on SoundCloud: 

 
SHEA Rapid Response Webinars  

Access on LearningCE  

SHEA COVID-19 Tool Kit 
Tools and resources include a quick implementation guide that includes a 7-worksheet Excel file with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances, and more. 

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COVID-19 Update | December 18, 2020
Important Highlights
FDA Statement on Vaccines and Related Biological Products Advisory Committee Meeting
(FDA, Dec. 17) 
An initial shipment of 2.9 million doses of the Pfizer/BioNTech vaccine occurred this past week, with the first doses administered on Dec. 14. FDA released a statement on Thursday, Dec. 17 that it is working rapidly “toward finalization and issuance of an emergency use authorization” for the Moderna mRNA COVID-19 vaccine, upon receiving the recommendation by the FDA Vaccines and Related Biological Products Advisory Committee (20-0, with one abstention). ACIP will meet on Saturday and Sunday (see "Events" for ACIP meetings).
 
*UPDATED* Strategies for Optimizing the Supply of Facemasks (CDC) 
This guidance has been updated to include the following:  
  • Added considerations for returning to conventional capacity practices  
  • Conventional Capacity Strategies  
    • Clarified healthcare personnel (HCP) use of facemasks for source control and as PPE to protect their nose and mouth from exposure to splashes, sprays, and respiratory  
  • Contingency Capacity Strategies  
    • Added clarifications on extended use of facemasks as PPE  
    • Added clarifications on restriction on facemask use by HCP as PPE rather than by patients for source control  
  • Crisis Capacity Strategies  
    • Revised section on limited re-use paired with extended use  
    • Deleted the strategies of designating convalescent HCP for the provision of care of patients with SARS-CoV-2 infection, use of expedient patient isolation rooms, and mechanical headboards
  • Incorporated reference to Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing  
  • Added recommendation, mirroring testing guidance for community exposures, to test asymptomatic healthcare personnel (HCP) with higher risk exposures to SARS-CoV-2 while at work. 
  • Added considerations for performing expanded screening of asymptomatic HCP without known or suspected exposure to SARS-CoV-2
  • Added links to Frequently Asked Questions addressing Environmental Cleaning and Disinfection and assessing risks to patients and others exposed to healthcare personnel who worked while infected with SARS-CoV-2 
  • Described recommended IPC practices when caring for patients who have met criteria for a 14-day quarantine based on prolonged close contact with someone with SARS-CoV-2 infection. 
  • Added reminders that: 
    • Double gloving is not recommended when providing care to patients with suspected or confirmed SARS-CoV-2 infection 
    • In general, HCP caring for patients with suspected or confirmed SARS-CoV-2 infection should not wear more than one isolation gown at a time.
SHEA Coronavirus News
*UPDATED* SHEA COVID-19 Vaccine Prioritization Statement (Dec. 11) 
SHEA aims to support the effort to promote the vaccine with posts of healthcare leaders who receive it. Help us do this by tagging @SHEA_Epi on Twitter when you receive yours!
Technical Guidance, Standards and Resources
MMWRs
Decline in SARS-CoV-2 Antibodies After Mild Infection Among Frontline Health Care Personnel in a Multistate Hospital Network — 12 States, April–August 2020 (CDC)  
 
The Advisory Committee on Immunization Practices’ Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020 (CDC)  
 
Trends in County-Level COVID-19 Incidence in Counties With and Without a Mask Mandate — Kansas, June 1–August 23, 2020 (CDC) 
 
Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions — New Jersey, February–July 2020 (CDC)  
 
Disproportionate Incidence of COVID-19 Infection, Hospitalizations, and Deaths Among Persons Identifying as Hispanic or Latino — Denver, Colorado March–October 2020 (CDC) 
 
Factors Associated with Positive SARS-CoV-2 Test Results in Outpatient Health Facilities and Emergency Departments Among Children and Adolescents Aged <18 Years — Mississippi, September–November 2020 (CDC)  

 
Vaccines
 
Special Settings and Populations
 
Clinical Care
 
Testing and Cases
 
Communication Resources
Information for Patients, Visitors, and the General Public
Event Announcements
Advisory Committee on Immunization Practices (ACIP) Meeting  
Saturday, December 19, 11:00-4:30pm and Sunday, December 20, 11:00-4:30pm  
AGENDA  
ACIP plans to meet to discuss draft recommendations for Moderna’s COVID-19 vaccine.
 
CDC/IDSA COVID-19 Clinician Call: COVID-19 Vaccine Update and Q&A 
Saturday, December 19, 3:00-4:00 pm 
REGISTER 
SPEAKERS: Dana S. Wollins, DrPH, MGC, Jay C. Butler, MD, FAAP, MACP, FIDSA, Hana Mohammed El Sahly, MD, Paul Spearman, MD 
Trade Press, Journal Articles and White Papers
SHEA Education and Events
Converse & Convene: Navigating the Multitude of Guidelines for Key Activities 
Converse and Convene is back! Grab your favorite morning beverage, turn on your camera and come have an open, candid hour-long conversation about how COVID-19 is impacting you, your work, and anything and everything in between. Join us on Friday, January 8 2021 from 11 am-12 pm ET for this virtual networking webinar around “Vaccine Distribution Planning and Implementation” moderated by Marci Drees and David Weber, who will lead and facilitate discussion and collaboration. This webinar will host virtual breakout groups allowing all to be fully engaged with others experiencing similar issues and challenges. Individuals will gain greater insights not only with their breakout groups but with a larger group discussion directly following and led by the moderators. This forum will not be recorded and is meant to be an open conversation. This event is available to SHEA members only, so be sure to register today!
 
SHEA Podcast Series: We’re All in this Together: COVID-19 Allies in Infection Prevention  
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now 
This series highlights changes in the COVID-19 outbreak and updates in medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE. Tune in to the newest episodes on SoundCloud:  
SHEA Rapid Response Webinars  
Access on LearningCE  
  • Implementation of Electronic Case Reporting (eCR) for COVID-19 
  • Healthcare Facility Outbreak Preparedness  
  • SHEA COVID-19 Town Halls 1-33 
  • SHEA COVID-19 Town Hall, Round 34: Sunday, December 20 | 3:00 pm ET
    REGISTER HERE
Tools and resources include a quick implementation guide that includes a 7-worksheet Excel file with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances, and more. 
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COVID-19 Update | December 11, 2020
Important Highlights
Electronic Case Reporting: Partner Toolkit (CDC) 
CDC, with APHL and CSTE, are working to expand the nationwide scale-up of electronic case reporting (eCR) for COVID-19 with a nationwide effort as part of a strategic initiative called eCR Now. As of December 3, 2020, more than 6,400 healthcare facilities nationwide have implemented eCR and have sent more than 3.9 million COVID-19 electronic initial case reports to 61 public health agencies.
SHEA Coronavirus News
Updated SHEA Recommendations for COVID-19 Vaccination – Practical Guidance for Healthcare Facilities
 
The FDA advisory panel recommended emergency use authorization for the Pfizer/BioNTech vaccine on Dec. 10, with potential for distribution to begin next week.
 
ACIP identified healthcare personnel and nursing home residents for Phase 1a.
 
SHEA updated its COVID-19 vaccination recommendations to give healthcare facilities practical and tactical advice for planning and administration:  
  • Important info for planning! 
    • Facilities must coordinate with their public health offices, who will receive initial allocations.
    • Stagger vaccination within departments/units/critical roles to avoid staffing shortages. A portion of recipients will need to call out afterwards due to systemic reactions and/or fever. Do not vaccinate whole departments/units at once.
    • These vaccines come in multidose vials, which are unfamiliar to some HCP. Train vaccinators and consider lining up pharmacy techs to help. Safe handling of multidose vials is essential.
    • Set up protocols for vaccinators to give recipients the info they need: details for their second dose (they're not interchangeable by manufacturer), how to register for V-SAFE, the safety monitoring system set up for these vaccines that also notifies VAERS, and the EUA fact sheet.  
  • Initial shipments may not be evenly distributed across the US to focus on areas with the highest need, but others are expected to arrive rapidly. 
  • Due to cold chain and storage requirements, be prepared to administer COVID-19 vaccine doses right away to Phase 1a recipients (HCP and LTC residents) in your purview. 
  • On a weekly basis, facilities, including nursing homes, will report to NHSN the COVID-19 vaccines they’ve administered. The module will be available in mid-Dec.
CDC has created a tool kit for facilities to communicate with HCP about COVID-19 vaccination, with fact sheets, posters, and other printables, including stickers for HCP to show they received the vaccine. 

Dr. Lee presented this information in the SHEA Dec. 6 Town Hall, available on Soundcloud and LearningCE.
 
Thank you to Drs. Marci Drees, Grace Lee, Deborah Yokoe, and David Weber for authoring the SHEA Statement.
Technical Guidance, Standards and Resources
MMWRs
 
 
Infection Prevention and Control 
 
Special Settings and Populations 
 
Testing and Cases
Information for Patients, Visitors, and the General Public
Event Announcements
Advisory Committee on Immunization Practices (ACIP) Emergency Meeting (CDC) 
Sun., Dec. 13, 12 pm-4pm  
ACIP will meet to discuss draft recommendations for COVID-19 vaccines.
AGENDA  
 
CDC COVID-19 Partner Update: Ten Truths about COVID-19 (CDC) 
REGISTRATION  
Mon., Dec. 14, 3 pm-4 pm  
CDC COVID-19 Response leaders will share the latest on the response and discuss ten important truths about COVID-19, providing the facts and data behind each one. 
 
Clinician Outreach and Communication Activity Call (COCA) (CDC) 
Mon., Dec. 14, 2pm-3pm 
Presenters from CDC will provide information for clinicians on COVID-19 vaccination education, monitoring, and how to report adverse events, including possible side effects, to the Vaccine Adverse Event Reporting System (VAERS). 
 
Making Practical Decisions for Crisis Standards of Care at the Bedside During the COVID-19 Pandemic (CDC)  
Thurs., Dec. 17, 2pm – 3pm 
Experts will present background on the Institute of Medicine (IOM) framework, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, and identify how Crisis Standards of Care apply to the current COVID-19 pandemic. 
News Highlights
SHEA Education and Events
SHEA Podcast Series: We’re All in this Together: COVID-19 Allies in Infection Prevention  
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now 
This series highlights changes in the COVID-19 outbreak and updates in medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE. Tune in to the newest episodes on SoundCloud:  
SHEA Rapid Response Webinars  
Access on LearningCE  
  • Implementation of Electronic Case Reporting (eCR) for COVID-19 
  • Healthcare Facility Outbreak Preparedness  
  • SHEA COVID-19 Town Halls 1-32 
  • SHEA COVID-19 Town Hall, Round 33: Sunday, December 13 | 3:00 pm ET
    REGISTER HERE   
Tools and resources include a quick implementation guide that includes a 7-worksheet Excel file with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances, and more. 
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COVID-19 Update | December 4, 2020
Important Highlights
Published in an announcement from CDC’s Washington Office… 
 
CDC Advisors Make Recommendations for Use of Vaccine Against COVID-19 
The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) today recommended vaccination in the initial phase of the COVID-19 vaccination program (Phase 1a) should be offered to both 1) healthcare personnel and 2) residents of long-term care facilities. Today’s vote was 13 to 1.   
 
ACIP, CDC’s independent vaccine advisory committee, traditionally develops vaccine recommendations that go to the CDC director for approval before becoming official CDC policy. The committee has been holding public meetings since June regarding COVID-19 vaccines.   
 
It is estimated there are 21 million people working in the healthcare industry and approximately 3 million people living in long-term care facilities. To date, more than 240,000 healthcare workers have contracted COVID-19 and 858 have died.  According to estimates, deaths in long-term care facilities account for 40 percent of all COVID-19 deaths nationwide. These factors contributed to the committee’s recommendation to prevent spread by protecting those on the front lines, healthcare workers treating COVID-19 patients, and protect the most vulnerable, those elderly persons living in long-term care facilities. 
 
The committee intends to meet again following U.S. Food and Drug Administration (FDA) authorization for vaccine specific recommendations. 
 
For more information on ACIP, visit the ACIP website. For the latest information on the outbreak, visit CDC’s Novel Coronavirus 2019 website
Technical Guidance, Standards and Resources
MMWRs 
Disproportionate Incidence of COVID-19 Infection, Hospitalizations, and Deaths Among Persons Identifying as Hispanic or Latino — Denver, Colorado March–October 2020 (CDC MMWR, Dec. 4)  
 
Multidisciplinary Community-Based Investigation of a COVID-19 Outbreak Among Marshallese and Hispanic/Latino Communities — Benton and Washington Counties, Arkansas, March–June 2020 (CDC MMWR, Dec. 4)  
 
Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions — New Jersey, February–July 2020 (CDC MMWR, Dec. 4)  
 
The Advisory Committee on Immunization Practices’ Interim Recommendation for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020 (CDC MMWR, Dec. 3) 
 
The Advisory Committee on Immunization Practices’ Ethical Principles for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020 (CDC MMWR, Nov. 27)  
 
Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020 (CDC MMWR, Nov. 27) 
 
Decline in SARS-CoV-2 Antibodies After Mild Infection Among Frontline Health Care Personnel in a Multistate Hospital Network — 12 States, April–August 2020 (CDC MMWR, Nov. 27)  
 
Infection Prevention and Control 
 
PPE
 
Vaccines and Clinical Care 
 
Special Settings and Populations 
 
Testing and Cases 
 
Incident Management 
Payment and Reimbursement Policy
 
Research 
Information for Patients, Visitors, and the General Public
Event Announcements
The Impact of Telehealth on Health Equity from the Perspective of Large Healthcare Systems during the COVID-19 Pandemic (CDC COCA)
Tues., Dec. 8, 2 PM – 3 PM 
Presenters: Jeffrey Hall, PhD, MSPH, MA, Edward Lee, MD, Matthew Rogers, PA, Leonie Heyworth, MD, MPH
SHEA Education and Events
Converse & Convene: Navigating the Multitude of Guidelines for Key Activities 
Converse and Convene is back! Grab your favorite morning beverage, turn on your camera and come have an open, candid hour-long conversation about how COVID-19 is impacting you, your work, and anything and everything in between. Join us on Friday, December 11 from 11 am-12 pm ET for this virtual networking webinar around “Navigating the many guidelines for key activities such as discontinuation of precautions in different settings and populations,” moderated by Bhagyashri Navalkele and Theresa Madaline, who will lead and facilitate discussion and collaboration.  This webinar will host virtual breakout groups allowing all to be fully engaged with others experiencing similar issues and challenges. Individuals will gain greater insights not only with their breakout groups but with a larger group discussion directly following and led by the moderators. This forum will not be recorded and is meant to be an open conversation. Space is limited and available to SHEA members only, so be sure to register before all spots are filled
 
SHEA Podcast Series: We’re All in this Together: COVID-19 Allies in Infection Prevention  
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE. Tune in to the newest episodes on SoundCloud: 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now 
This series highlights changes in the COVID-19 outbreak and updates in medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE. Tune in to the newest episodes on SoundCloud:  
SHEA Rapid Response Webinars  
Access on LearningCE  
  • Implementation of Electronic Case Reporting (eCR) for COVID-19 
  • Healthcare Facility Outbreak Preparedness  
  • SHEA COVID-19 Town Halls 1-31 
  • SHEA COVID-19 Town Hall, Round 32: Sunday, December 6 | 3:00 pm ET
    REGISTER HERE   
Tools and resources include a quick implementation guide that includes a 7-worksheet Excel file with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances, and more. 
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COVID-19 Update | November 21, 2020
Important Highlights
Antibody Therapy under New EUA - November 21 COVID-19 Real Time Learning Network 
This week’s Real Time Learning Network webinar will focus on antibody therapy under new emergency use authorization (EUA). Speakers include Dr. John Redd of ASPR and Dr. Janet Woodcock of FDA. Interested parties should register here. The COVID-19 Real Time Learning Network is a CDC-funded partnership with the Infectious Diseases Society of America (IDSA)  and support from SHEA and other societies to deliver rapid and up-to-date curated literature and clinical guidance from various subspecialties to frontline healthcare providers.
 
NIOSH Approves First Elastomeric Half Mask Respirator Without an Exhalation Valve 
NIOSH announced on November 16 the approval of the first elastomeric half mask respirator (EHMR) without an exhalation valve. This respirator is approved for use with either P95 or P100 particulate filters (NIOSH approval numbers: TC-84A-9260, TC-84A-9261, TC-84A-9256, TC-84A-9257). This EHMR can be used for both personal protection and source control. Exhalation is accomplished through the particulate filters meeting all NIOSH requirements, thereby allowing it to also serve as a means of source control since it will maintain the high level of filtration upon exhalation. This EHMR can be cleaned and disinfected as part of a respiratory protection program’s standard procedures. The particulate filters are available with an integrated splash guard to improve the ease of completing a user seal check, to help protect from liquids, and to aid in wiping down the filter housing with disinfectant. More information on NIOSH-approved respirators, including the first EHMR without an exhalation value, is available on the NIOSH Certified Equipment List. Respirators are an important resource in reducing the transmission of SARS-CoV-2, the virus that causes COVID-19. When workers wear respirators to protect themselves against workplace hazards, they also need to maintain source control to protect others in case they are themselves sick with COVID-19. Concerns were raised that respirators with exhalation valves may allow unfiltered exhaled air to escape into the environment, therefore not offering source control. NIOSH is working to identify solutions to address exhalation valve concerns in both filtering facepiece respirators and EHMR. Several research studies are underway on this issue. In parallel with the NIOSH research on exhalation valves, manufacturers have been conducting research and development to produce an elastomeric respirator that addresses the exhalation valve concerns.
SHEA Coronavirus News
SHEA Outreach to the New Biden Administration
President-elect Joe Biden has announced his transition team which includes an array of experts in healthcare and global health security. SHEA is in the process of developing a package of recommendations and expert guidance for delivery to the transition team which we anticipate will be delivered shortly. The transition package will be made available on the SHEA website.
 
SHEA Vaccine Planning and Priorities Statement
A succinct SHEA COVID-19 vaccine planning statement reviewed by ACIP and NHSN subject matter experts and approved by the SHEA Board guides facilities in how to work with their public health offices to plan for anticipated COVID-19 vaccine administration to healthcare personnel (HCP), including how to prioritize vaccine access. The statement provides necessary background followed by recommendations on: 
  • Policies for HCP vaccination (FDA EUA vs. full licensure) 
  • Training for staff and steps of administration 
  • Safety monitoring 
  • Prioritization, broken into Phase 1a and Phase 1b, and how to ensure healthcare equity in planning and implementation 
  • Managing vaccine hesitancy  
  • Maintaining infection prevention precautions despite vaccination status  
For questions or feedback, please email info@shea-online.org.
Technical Guidance, Standards and Resources
MMWRs 
 
Infection Prevention and Control
 
Occupational Health 
*UPDATE* Public Health Guidance for Community-Related Exposure (CDC, Nov. 16)  
Updated language to clarify what precautions exposed healthcare personnel should take when in the community setting.
 
Clinical Care and Vaccines
 
Special Settings and Populations

Suspected Reinfection

Testing and Cases 
Late Sequelae of COVID-19 (CDC, Nov. 13)
 
 
Research and Resources Development Funding Opportunities
Information for Patients, Visitors, and the General Public
Event Announcements
Advisory Committee on Immunization Practices (ACIP) November Meeting (CDC)
Mon., Nov. 23, 12-5pm EDT
AGENDA  
This month’s meeting will discuss the COVID-19 vaccines.
 
Federal Policy Updates
GAO Recommends HHS Clarify Plans for Dealing with Medical Supply Chain Challenges
Health and Human Services (HHS) is leading an effort to address U.S. medical supply chain issues related to the pandemic. However, a report published November 19 by the Government Accountability Office (GAO) says the agency hasn't clarified its plans and provided two recommendations in its report:

1) The HHS Assistant Secretary for Preparedness and Response (ASPR) should identify how the Defense Production Act and similar actions will be used to increase domestic production of medical supplies going forward; 
2) OMB should direct the Office of Federal Procurement Policy to develop appropriate agency reporting guidance to provide greater transparency on the use of DPA Title I authorities for COVID purposes.
 
SHEA Education and Events
Implementation of Electronic Case Reporting (eCR) for COVID-19
Electronic case reporting (eCR) is a key component of the data strategy for COVID-19 as well as routine disease reporting and outbreak management. eCR can eliminate manual reporting and decrease the burden on healthcare providers, allowing them to spend more time on patient care and other critical priorities. When COVID-19 presented, eCR was just being rolled out by the Council of State and Territorial Epidemiologists (CSTE), the American Public Health Laboratories (APHL), and the Centers for Disease Control and Prevention (CDC), and was in operation in a limited number of pilot sites. The eCR team developed a strategy, eCR Now, for rapid deployment to quickly meet COVID-19 reporting needs in the short term and to prepare participants for full electronic case reporting in real time.
 
Since COVID-19 reporting began, eCR Now has onboarded more than 6,100 clinical care facilities and has connected all state public health agencies to receive electronic case reports. In this webinar, we will discuss the value of making case reporting electronic, the eCR Now strategy for rapidly onboarding health systems, the eCR Now FHIR App for providing eCR capabilities to EHRs that otherwise do not have it, and the policy framework for operating eCR.

 
December 2, 2020 at 1:00 p.m. EST
Register here to attend live and ask your questions. A recording will be made post-event.
 
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE or tune in to listen on SoundCloud.
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episodes:
  • Implementation
  • Nursing Homes and Long-Term Care
    • Forms, notifications, and signage
    • Tools and templates for facilities and NIH collaboratives
  • Consulting during COVID-19 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
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COVID-19 Update | November 13, 2020
Important Highlights
Common Investigation Protocol for Investigating Suspected SARS-CoV-2 Reinfection 
CDC has released Common Investigation Protocol for Investigating Suspected SARS-CoV-2 Reinfection.   There is currently no widely accepted definition of what constitutes SARS-CoV-2 reinfection and the reports use different testing methods, making reinfection diagnoses difficult. This protocol is designed to support a common public health investigation into suspected SARS-CoV-2 reinfection cases across jurisdictions. Confirming SARS-CoV-2 reinfection requires advanced laboratory diagnostic support built upon advanced planning to implement this protocol, or a locally adapted version, with referral of specimens to supporting laboratory networks.  
 
COVID-19 Real Time Learning Network 
Check out the COVID-19 Real Time Learning Network and Twitter account. The COVID-19 Real Time Learning Network is a CDC-funded partnership with the Infectious Diseases Society of America (IDSA) to deliver rapid and up-to-date curated literature and clinical guidance from various subspecialties to frontline healthcare providers. SHEA is pleased to have representation on this and contribute to this effort.
 
ASPR Resources for investigational neutralizing antibody bamlanivimab  
Officials from the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) announced earlier this week the availability of bamlanivimab which is now authorized under an emergency use authorization (EUA) for the treatment of mild to moderate COVID-19 in non-hospitalized adults and pediatric patients 12 years and older weighing more than 88 pounds (40 kg) with a positive COVID-19 test, who are at high risk for progressing to severe COVID-19 and/or hospitalization. ASPR has published resources for bamlanivimab which can be found here, here and here. Officials acknowledge the initial roll out of bamlanivimab will encounter logistical challenges with distribution and outpatient administration. ASPR is working with a variety of stakeholder organizations in an effort to identify longer-term solutions. SHEA members are encouraged to send their concerns and questions to Lynne Batshon.
SHEA Coronavirus News
SHEA Outreach to the New Biden Administration 
President-elect Joe Biden has announced his transition team which includes an array of experts in healthcare and global health security. SHEA is in the process of developing a package of recommendations and expert guidance for delivery to the transition team which we anticipate will be delivered within the next several days. We will make the contents of that package available to SHEA members once completed.  
 
SHEA “The State-of-the-Pandemic" commentaries now available in ICHE 
If you missed it, please check out the “The State-of-the-Pandemic" articles in ICHE, written by the SHEA Board of Trustees to respond to the rapidly changing COVID-19 crisis. These short commentaries are designed to provide perspective for institutions facing challenges at various stages of the pandemic. 
Technical Guidance, Standards and Resources
MMWRs
 
Infection Prevention and Control
 
Occupational Health
 
Testing and Cases
 
SHEA Education and Events
Converse and Convene: COVID-19 Series 
This webinar networking program provides an opportunity for you to connect with your fellow colleagues and discuss important topics related to COVID-19. We will host virtual breakout groups allowing individuals to gain greater insights and engage with others experiencing similar issues and challenges. Be on the lookout for our next program more information soon. 
 
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
Tune in to the latest episodes:
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episodes:
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • Implementation
  • Nursing Homes and Long-Term Care
    • Forms, notifications, and signage
    • Tools and templates for facilities and NIH collaboratives
  • Consulting during COVID-19 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
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COVID-19 Update | September 18, 2020
Important Highlights
CDC Testing Guidance Revised as of September 18, 2020
In a teleconference with society stakeholder representatives held September 18, CDC representatives informed attendees that the guidance document, Overview of Testing for SARS-CoV-2 (COVID-19), has been updated to clarify that asymptomatic persons, including close contacts of a person with documented SARS-CoV-2 infection, should be tested. This update reverses a recommendation included in a previous version of this document
SHEA Coronavirus News
SHEA Executive Committee Comments on Recent Wall Street Journal Article 
In reaction to a Sept. 2 Wall Street Journal (subscription required) report on White House and HHS plans to publish the names of hospitals that fail to submit daily COVID-19 data to the Teletracking System, members of the SHEA executive committee submitted a letter to the editor
Technical Guidance, Standards and Resources
Nursing Homes
 
Infection Prevention and Control
 
PPE
 
Occupational Health
 
Clinical Care and Treatment
 
Pediatric and Maternal
Testing and Cases
 
Incident Management
Event Announcements
COVID-19: Optimizing Healthcare Personal Protective Equipment and Supplies (ASPR/TRACIE)  
Sept. 24, 2020, 2:30 pm – 4:00 pm ET 
*This webinar is currently full. Contact askasprtracie@hhs.gov for more information* 
Trade Press, Journal Articles, and White Papers
Prevalence of Surface Contamination With SARS-CoV-2 in a Radiation Oncology Clinic.  Jan I, Chen K, Sayan M, et al. JAMA Oncol. Published online August 27, 2020. doi:10.1001/jamaoncol.2020.3552  
 
What Happens When COVID-19 Collides with Flu Season? JAMA. Rubin R. Published online August 20, 2020. doi:10.1001/jama.2020.15260 
 
Attending to the emotional well-being of the health care workforce in a New York City health system during the COVID-19 pandemic. Ripp JA, Peccoralo L, Charney D.  Acad Med. 2020;95(8)(8):1136-1139. doi:10.1097/acm.0000000000003414.
News Highlights
C.D.C. Testing Guidance Was Published Against Scientists’ Objections (New York Times, Sept. 17) 
 
Trump contradicts health advisers on coronavirus vaccine timetable as death toll mounts (Washington Post, Sept. 17)  
 
Feds unveil COVID vaccine distribution plans amid HHS shakeup (CIDRAP, Sept. 16)  
 
Top health official echoes Trump’s Covid-19 views, drawing accusations of politicizing U.S. mental health agency (STAT News, Sept. 15) 
 
HHS chief overrode FDA officials to ease testing rules (Politico, Sept. 15) 
 
Pallone & Degette demand briefing from Azar following Alarming new reports of political interference (House Energy & Commerce Committee, Sept. 14) 
 
Trump officials interfered with CDC reports on Covid-19 (Politico, Sept. 11) 
 
Emails show HHS official trying to muzzle Fauci (Politico, Sept. 9) 
 
Vaccine CEOs issue safety pledge amid Trump’s quest for pre-election approval (Washington Post, Sept. 8)
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.

Tune in to the latest episodes:
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episodes:
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall 1-22
  • SHEA COVID-19 Town Hall 23 | September 20 at 3:00pm ET
    REGISTER HERE
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COVID-19 Update | September 1, 2020
Important Highlights
CDC wants to hear more about repeat positive COVID-19 tests
Providers continue to report seeing a number of patients with recurring positive COVID-19 test results beyond 90 days from initial infection. Confusions persists in trying to understand whether these are new COVID-19 cases. CDC is interest in hearing more from the field about these repeat positives which present challenges with institutional protocols that require re-testing of patients (e.g., nursing homes that require re-testing for residents returning from procedures such as dialysis; acute care settings requiring re-testing). You can send your feedback to info@shea-online.org. Please indicate in your response if you do not want your identity to be disclosed beyond SHEA staff.
Technical Guidance, Standards and Resources
New and Revised Guidance for Nursing Homes
 
 
 
 
Occupational Health
 
Clinical Care and Treatment
 
Testing and Cases
 
Research
Information for Patients, Visitors, and the General Public
Trade Press, Journal Articles, and White Papers
Genomic Evidence for a Case of Reinfection with SARS-CoV-2. TILLETT, RICHARD and SEVINSKY, JOEL and HARTLEY, PAUL and KERWIN, HEATHER and CRAWFORD, NATALIE and GORZALSKI, ANDREW and LAVERDURE, CHRISTOPHER and VERMA, SUBHASH and ROSSETTO, CYPRIAN and FARRELL, MEGAN and JACKSON, DAVID and Pandori, Mark and VAN HOOSER, STEPHANIE, THE LANCET ID-D-20-05376
 
Community-Level Factors Associated With Racial And Ethnic Disparities In COVID-19 Rates In Massachusetts. Figueroa, Jose F., et al. Health Affairs, 2020, doi:10.1377/hlthaff.2020.01040.
 
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.

Tune in to the latest episode: Challenges in Treating COVID-19 with SIDP 
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episode: COVID-19: Lessons Learned In Pediatrics
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall 1-21
  • SHEA COVID-19 Town Hall 22 | September 13 at 3:00pm ET
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COVID-19 Update | August 29, 2020
Important Highlights
CDC updated the Personal Protective Equipment FAQ for healthcare workers
The CDC’s most recent updates to the Personal Protective Equipment FAQ for healthcare workers includes information pertaining to elastomeric respirators. Respirators with exhalation valves protect the wearer from SARS-CoV-2, the virus that causes COVID-19, but may not prevent the virus spreading from the wearer to others (that is, they may not be effective for source control). Until data are available to describe how effective respirators with exhalation valves are in preventing the spread of SARS-CoV-2 from the wearer to others:
  • Wear a respirator without an exhalation valve when both source control and respiratory protection are required.
  • If only a respirator with an exhalation valve is available and source control is needed, cover the exhalation valve with a surgical mask, procedure mask, or a cloth face covering that does not interfere with the respirator fit. 
Therefore, elastomeric respirators with exhalation valves may be used in non-sterile procedural areas such as an endoscopy unit, bronchoscopy suite, and interventional radiology without covering the exhalation valve. However, if source control is needed, CDC recommends covering the exhalation valve with a facemask (surgical or procedure mask) that does not interfere with the respirator fit.
 
CDC wants to hear more about repeat positive COVID-19 tests
Providers continue to report seeing a number of patients with recurring positive COVID-19 test results beyond 90 days from initial infection. Confusions persists in trying to understand whether these are new COVID-19 cases. CDC is interest in hearing more from the field about these repeat positives which present challenges with institutional protocols that require re-testing of patients (e.g., nursing homes that require re-testing for residents returning from procedures such as dialysis; acute care settings requiring re-testing). You can send your feedback to info@shea-online.org. Please indicate in your response if you do not want your identity to be disclosed beyond SHEA staff.
SHEA COVID-19 News
Technical Guidance, Standards and Resources
Special Settings and Populations
 
Testing and Cases
 
 
Incident Management
Event Announcements
Nursing Home Best Practices During COVID-19 webinar series (AHRQ)
Sept. 2, 2020: Telehealth in the Time of COVID
Cheryl Phillips, MD, AGSF
Trade Press, Journal Articles, and White Papers
Understanding COVID-19 transmission, health impacts and mitigation: timely social distancing is the key. Kaur, S., Bherwani, H., Gulia, S. et al Environ Dev Sustain (2020).
 
Characterizing superspreading events and age-specific infectiousness of SARS-CoV-2 transmission in Georgia, USA. Max S. Y. Lau, Bryan Grenfell, Michael Thomas, Michael Bryan, Kristin Nelson, Ben Lopman. Proceedings of the National Academy of Sciences Aug 2020, 202011802; DOI: 10.1073/pnas.2011802117
 
A Pediatric Infectious Disease Perspective of SARS-CoV-2 and COVID-19 in Children. Journal of the Pediatric Infectious Diseases Society. Andi L Shane, Alice I Sato, Carol Kao, Felice C Adler-Shohet, Surabhi B Vora, Jeffery, J Auletta, Sharon Nachman, Vanessa N Raabe, Kengo Inagaki, Ibukunoluwa C Akinboyo, Charles Woods, Abdulsalam O Alsulami, Mundeep K Kainth, Roberto Parulan Santos, Claudia M Espinosa, Julianne E Burns, Coleen K Cunningham, Samuel R Dominguez, Beatriz Larru Martinez, Frank Zhu, Jonathan Crews, Taito Kitano, Lisa Saiman, Karen Kotloff.
 
News Highlights
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episode: COVID-19: Lessons Learned In Pediatrics
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall 1-20
  • SHEA COVID-19 Town Hall 21 | August 30 at 3:00pm ET
    REGISTER HERE
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COVID-19 Update | August 25, 2020
Important Highlights
CDC wants to hear more about repeat positive COVID-19 tests
Providers continue to report seeing a number of patients with recurring positive COVID-19 test results beyond 90 days from initial infection. Confusions persists in trying to understand whether these are new COVID-19 cases. CDC is interest in hearing more from the field about these repeat positives which present challenges with institutional protocols that require re-testing of patients (e.g., nursing homes that require re-testing for residents returning from procedures such as dialysis; acute care settings requiring re-testing). You can send your feedback to info@shea-online.org. Please indicate in your response if you do not want your identity to be disclosed beyond SHEA staff.
 
CDC Interim Guidance for Rapid Antigen Testing for SARS-CoV-2
This interim guidance is intended for clinicians who order antigen tests, receive antigen test results, and/or perform point-of-care testing, as well as for laboratory professionals who perform antigen testing in a laboratory setting or at the point of care and report those results. The purpose of this interim technical guidance is to support the most effective use of antigen tests for different testing situations. This guidance applies to all uses of antigen tests and is not specific to the application of antigen tests to any particular age group or setting. This guidance supplements and is consistent with CDC’s Overview of Testing for SARS-CoV-2 guidance.
Technical Guidance, Standards and Resources
Infection Prevention and Control
 
PPE
 
Occupational Health
 
Clinical Care and Treatment
 
Special Settings and Populations
 
Testing and Cases
 
Incident Management
 
Payment and Reimbursement Policy
Event Announcements
Advisory Committee on Immunization Practices (ACIP) August Meeting (CDC)
Aug. 26, 10 am – 4 pm ET
No Registration is required for the August ACIP Meeting. Registration is NOT required to watch the live meeting webcast.
MEETING BROADCAST
AGENDA
 
  • Aug. 25, 2020: Optimizing Clinical Care in the Time of COVID in Skilled Nursing Home Facilities
    Terry Fulmer, PhD, RN
    Kathleen Unroe, MD, MHA
     
  • Aug. 26, 2020: The Latest News on Testing, Cohorting, and Critical Infection Prevention Strategies
    Nimale Stone, MD
    Additional speaker, TBA
     
  • Sept. 2, 2020: Telehealth in the Time of COVID
    Cheryl Phillips, MD, AGSF
Trade Press, Journal Articles, and White Papers
Communication with patients and families regarding health care-associated exposure to coronavirus 2019: a checklist to facilitate disclosure. Sivashanker K, Mendu ML, Wickner PG, et al. Jt Comm J Qual Patient Saf. 2020;46(8)(8):483-488. doi:10.1016/j.jcjq.2020.04.010.
 
News Highlights
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episode: John’s Hopkins COVID-19 Map
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall 1-20
  • SHEA COVID-19 Town Hall 21 | August 30 at 3:00pm ET
    REGISTER HERE
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COVID-19 Update | October 16, 2020
Important Highlights
SHEA posted two new, time-sensitive resources this week:  
  • A "voting safely" video intended for all audiences to reassure and provide simple guidance for US voters. It is less than 2 minutes, written by SHEA leaders and Board members, and professionally animated and produced. Feel free to disseminate it widely. 

  • A succinct COVID-19 vaccine planning statement to help you work with your public health office on anticipated COVID-19 vaccine administration to healthcare personnel (HCP). The statement was approved by the SHEA Board and authored by experts engaged with NHSN and ACIP. It addresses:
    • Background on: 
      • FDA approval 
      • Short and long-term safety evaluation 
      • Distribution and storage
      • Tracking and reporting
      • Logistics
    • Recommendations for:
      • Policies for HCP vaccination (FDA EUA vs. full licensure)
      • Training for staff and steps of administration
      • Safety monitoring
      • Prioritization, broken into Phase 1a and Phase 1b, and how to ensure healthcare equity in planning and implementation
      • Managing vaccine hesitancy
      • Maintaining infection prevention precautions despite vaccination status
Technical Guidance, Standards and Resources
Infection Prevention and Control
 
 
 
 
PPE
PPE Preservation Planning Toolkit (ASPR/HHS, Oct. 13) 
 
Occupational Health
 
Clinical Care and Vaccines
Vaccines (CDC, Oct. 14)   
 
 
 
 
 
 
Special Settings and Populations
 
 
 
Testing and Cases
 
 
Incident Management
Rural Healthcare Surge Readiness (Rural Health Information Hub) 
 
Payment and Reimbursement Policy
 
Research
 
 
Information for Patients, Visitors, and the General Public
Event Announcements
CDC COVID-19 Partner Update October 19, 2020: Campus Guidebook – Slowing the Spread at US Colleges and Universities (CDC) 
Oct 19, 3 PM  
REGISTER  
Updates on CDC’s COVID-19 response, including the latest scientific information and what everyone should know about protecting themselves and others; review CDC COVID-19 guidance for Institutions of Higher Education in the presentation Campus Guidebook – Slowing the Spread at US Colleges and Universities. 
Speakers: Dr. Cliff McDonald, Dr. Greta Massetti, Dr. Lisa C. Barrios, LCDR Samantha Morgan 
 
Ensuring COVID-19 Vaccine Access, Safety, and Utilization: Building Vaccination Confidence in Communities of Color (Trust for America’s Health) 
Oct 21, 1 pm 
REGISTER  
The webinar will feature expert panelists to educate policymakers and stakeholders on the historical reasons for vaccine hesitancy in communities of color, highlight ongoing vaccination disparities and discuss policy recommendations to build vaccine confidence and access in communities of color. The webinar will include time for Q&A from the audience. 
Speakers: J. Nadine Gracia, MD, MSCE, Wayne A. I. Frederick, MD, MBA, FACS, Julie Morita, MD, Michelle Cantu, MPH 
News Highlights
Covid-19 herd immunity, backed by White House, is a 'dangerous fallacy,' scientists warn (NBC News) 
 
Facebook rolls out a new vaccine misinformation policy — but leaves out pages where falsehoods thrive (STAT News) 
  
Rising Covid-19 cases and an uptick in hospitalizations may be the start of a predicted surge, officials warn (CNN) 
 
As CDC’s Deadline for Submitting COVID-19 Vaccine Distribution Plans Nears, States Say They’re Still Short on Guidance (Morning Consult) 
 
Two Black university leaders urged their campuses to join a Covid-19 vaccine trial. The backlash was swift (STAT) 
 
Second wave of covid-19 in Europe leads to new restrictions but no national lockdowns (Washington Post) 
 
7 looming questions about the rollout of a Covid-19 vaccine (STAT) 
 
What to Expect When Covid-19 and the Flu Season Collide (Smithsonian Magazine) 
 
‘A Devastating Blow’: Virus Kills 81 Members of Native American Tribe (New York Times) 
 
Why So Many Americans Are Skeptical of a Coronavirus Vaccine (Scientific American) 
SHEA Education and Events
Converse and Convene: COVID-19 Series 
Grab your favorite morning beverage, turn on your camera and come have an open, candid hour-long conversation about how COVID-19 is impacting you, your work, and anything and everything in between.
This virtual networking webinar will be moderated by 2 SHEA Member Experts who will lead and facilitate discussion and collaboration. This webinar will host virtual breakout groups allowing all to be fully engaged with others experiencing similar issues and challenges. Participants will be able to share challenges and lessons learned from the frontlines. Individuals will gain greater insights not only with their breakout groups but with a larger group discussion directly following and lead by the moderators. This forum will not be recorded and is meant to be an open conversation. Space is limited and available on a first come, first serve basis, so be sure to register before all spots are filled! 
 
Our next session topic: Long Term Care  
Friday, October 30 at 11:00 a.m. ET  
REGISTER HERE
 
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
Tune in to the latest episodes:
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episodes:
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • Implementation
  • Nursing Homes and Long-Term Care
    • Forms, notifications, and signage
    • Tools and templates for facilities and NIH collaboratives
  • Consulting during COVID-19 
SHEA Rapid Response Webinars 
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COVID-19 Update | October 9, 2020
Technical Guidance, Standards and Resources
Infection Prevention and Control
Clinical Care and Treatment
Special Settings and Populations
Incident Management
Event Announcements
CDC COVID-19 Partner Update October 19, 2020: Campus Guidebook – Slowing the Spread at US Colleges and Universities (CDC)
Oct 19, 3 PM 
REGISTER
Updates on CDC’s COVID-19 response, including the latest scientific information and what everyone should know about protecting themselves and others; review CDC COVID-19 guidance for Institutions of Higher Education in the presentation Campus Guidebook – Slowing the Spread at US Colleges and Universities.
Speakers: Dr. Cliff McDonald, Dr. Greta Massetti, Dr. Lisa C. Barrios, LCDR Samantha Morga
Federal Policy Updates
CMS released new guidance on hospital reporting requirements for COVID-19
CMS published on October 6 new guidance on hospital reporting requirements for COVID-19 as a condition for their participation in Medicare and Medicaid. These new reporting requirements were included in an August 26 interim final rule with comment period which requires hospitals and critical access hospitals (CAHs) report data in accordance with a frequency and in a standardized format to be specified by the U.S. Department of Health and Human Services (HHS).
 
Enforcement of these requirements began on October 6. The guidance includes:
  • Required Data Elements for Reporting: The table on p. 3-11 displays the required data elements that facilities must report to satisfy the new conditions of participation requirements. Several data elements must be reported daily and include information such as the number of hospital beds, bed occupancy, total mechanical ventilators, number of suspected or confirmed cases of COVID-19, number of COVID-19-related deaths, etc. A second set of data elements pertaining to influenza can be reported daily on an optional basis, though CMS states it intends to make these data elements mandatory as well. A final set of data must be reported once per week on Wednesdays and pertain to medical supply counts.
     
  • Reporting Timeline: CMS states that facilities should complete reporting within one business day of the reporting period. The agency further clarifies that if a facility cannot report on weekends or holidays, it may submit data on the next business day.
     
  • Enforcement: On p. 11, CMS states facilities that fail to comply with the reporting requirements will receive a notification from their CMS Location. Three weeks after receiving an initial notification, facilities that remain noncompliant will receive a second notice stating that failure to comply may result in termination from the Medicare program. Facilities that remain noncompliant for six weeks will then receive their first enforcement notification letter and will have one week to demonstration compliance. If providers do not comply within that week, they will receive a second and a third letter and will again have one week to demonstration compliance.

    Failure to comply after that point will result in facilities receiving a fourth and final enforcement letter. Facilities will then have 30-days to demonstrate compliance. CMS states that failure to comply within this 30-day period may result in termination.

    CMS further clarifies that the initial parts of the enforcement process (i.e., the steps involving the noncompliance notifications during the first three-week period) are only applicable from October 7 – November 18, 2020. After this period, CMS states the enforcement process will begin at the stage where CMS delivers its first enforcement notification letter (i.e., after the first six weeks of noncompliance). 
CMS also includes information on an appeals process on p. 11-12. We hope this update is helpful and welcome any questions.
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episode: International Perspectives: South Africa
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
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COVID-19 Update | October 2, 2020
Important Highlights
SHEA testifies before the House Science Committee on COVID-19 Hospital Data Challenges 
Dr. Lisa Maragakis, MD, MPH testified on behalf of SHEA before the House Science, Space, and Technology Subcommittee on Oversight and Investigations on September 23 during the hearing, Data for Decision-Making: Responsible Management of Data During COVID-19 and Beyond. Dr. Maragakis answered questions about the challenges experienced by hospitals following the change from the National Healthcare Safety Network (NHSN) to the Teletracking System for hospital COVID-19 data collection.
Technical Guidance, Standards and Resources
Occupational Health
 
Special Settings and Populations
 
Testing and Cases
Event Announcements
COVID-19 Partner Update October 5, 2020: Wear It, Don’t Share It – The Art and Science of Cloth Masks (ASPR) 
REGISTER  
Mon. Oct. 5, 3 PM 
Updates on CDC’s COVID-19 response, including the latest scientific information and what everyone should know about protecting themselves and others. 
Speakers: Dr. Cliff McDonald, Dr. Nancy Burton, LCDR Samantha Morgan 
 
Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers (CDC)  
Thurs., Oct. 8, 2 PM – 3 PM ET 
During this COCA call, subject matter experts from the American Academy of Pediatrics (AAP) and CDC will discuss strategies primary care providers and medical subspecialists can use to improve flu prevention and control in children this season. 
Speakers: Fatimah Dawood, MD, Anne Kimball, MD, MPH, Flor Munoz, MD, MSc, FAAP
Trade Press, Journal Articles, and White Papers
Preventing and Responding to COVID-19 on College Campuses. Walke HT, Honein MA, Redfield RR. JAMA. Published online September 29, 2020. doi:10.1001/jama.2020.20027  
 
Infant Outcomes Following Maternal Infection with SARS-CoV-2: First Report from the PRIORITY Study. Valerie J Flaherman, MD, MPH, Yalda Afshar, MD, PHD, John Boscardin, PHD, Roberta L Keller, MD, Anne Mardy, MD, Mary K Prahl, MD, Carolyn Phillips, MD, Ifeyinwa V Asiodu, RN, PHD, W Vincenzo Berghella, MD, Brittany D Chambers, PHD, Joia Crear-Perry, MD, Denise J Jamieson, MD, MPH, Vanessa L Jacoby, MD, MAS, Stephanie L Gaw, MD, PHDClinical Infectious Diseases, ciaa1411.  
 
Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics. Peccia, J., Zulli, A., Brackney, D.E. et al. Nat Biotechnol 38, 1164–1167 (2020).  
 
Clustering and superspreading potential of SARS-CoV-2 infections in Hong Kong. Adam, D.C., Wu, P., Wong, J.Y. et al. Nat Med (2020).  
 
Change in Antibodies to SARS-CoV-2 Over 60 Days Among Health Care Personnel in Nashville, Tennessee. Patel MM, Thornburg NJ, Stubblefield WB, et al. JAMA. Published online September 17, 2020. doi:10.1001/jama.2020.18796 
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.

Tune in to the latest episode: Rising to the Challenge of COVID-19 with PIDS
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episode: COVID-19 International Perspectives: Brazil
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
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COVID-19 Update | August 21, 2020
Important Highlights
Removal of Position Statement: Preventing Nosocomial COVID-19 Infections as Organizations Resume Regular Care Delivery
The Joint Commission has posted a statement on their web site announcing the removal of the Position Statement, "Preventing Nosocomial COVID-19 Infections as Organizations Resume Regular Care Delivery." You can read the full statement here.
 
Fate of COVID-19 hospital data reporting is causing confusion
Multiple news reports over the last week have cited statements made by Dr. Deborah Birx suggesting HHS’ intent to shift oversight of COVID-19 hospital data reporting back to CDC and away from HHS Protect. In those reports, Dr. Birx is quoted as saying that HHS is working on building a “new revolutionary system” and that the switch to HHS Protect in July was intended to be an interim solution.
 
However, according to a tweet posted by Politico’s Dan Diamond and reporting from several local affiliate news stations owned by TEGNA, Inc., HHS Spokesperson Michael Caputo issued a statement saying the news stories about making a switch back to CDC were false. According to Diamond, three different HHS sources verified that there were no plans to switch COVID-19 reporting back to CDC. The “new revolutionary system” under development at HHS is part of a separate initiative to modernize public health IT systems. It appears that this new initiative also involves adding some automated functionality to HHS Protect which is intended to make reporting of COVID-19 data easier for hospitals because the new functionality will require less manual input by hospitals.
 
Prior to the confusing news reports, SHEA had been working very closely with several other public health professional societies and interest groups concerned about the burden and lack of confidence in COVID-19 data integrity caused by the abrupt switch to HHS Protect. We have been engaged in discussions with committees in both the House and Senate that interested learning more about the disruptions caused by the switch. We also know that several SHEA members have given press interviews on the matter, and several past and present HICPAC members sent a letter to HHS outlining their concerns. SHEA has heard from several members expressing their frustration with not having full access to data in HHS Protect once it's been entered and not receiving regular CDC reports based on HHS Protect data.  We also do now know how the data are being validated and analyzed and by whom at HHS.
 
SHEA will continue to pursue this matter. In the meantime, members are invited to send questions or share concerns by sending an email to grassroots@shea-online.org.
Technical Guidance, Standards and Resources
Infection Prevention and Control
 
 
PPE
 
Special Settings and Populations
 
 
Testing and Cases
 
Research and Resources Development Funding Opportunities 
Event Announcements
CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Homes: New Format
Starting Aug. 20, CMS will offer training in a new way:
 
Ethical Dilemmas in Rural Health (Office of Minority Health and Health Equity, Centers for Disease Control and Prevention; and National Center for Bioethics in Research and Health Care at Tuskegee University)
Fri., Sept. 11, 1 pm – 5 pm ET
REGISTER
The goal of the 2020 Public Health Ethics Forum is to examine ethical considerations relating to place-based public health approaches in rural areas and populations.
Trade Press, Journal Articles, and White Papers
Absence of nosocomial influenza and respiratory syncytial virus infection in the coronavirus disease 2019 (COVID-19) era: Implication of universal masking in hospitals.  Wong, S., Lam, G., AuYeung, C., Chan, V., Wong, N., So, S., . . . Cheng, V. (2020). Infection Control & Hospital Epidemiology, 1-14. doi:10.1017/ice.2020.425.
 
Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses.  Yonker, Lael M., et al. The Journal of Pediatrics, 2020, doi:10.1016/j.jpeds.2020.08.037.  
 
Severe Staffing And Personal Protective Equipment Shortages Faced By Nursing Homes During The COVID-19 Pandemic. Mcgarry, Brian E., et al. Health Affairs, 2020, doi:10.1377/hlthaff.2020.01269.
News Highlights
Featured Social Media
@ddiamond: “HHS is flatly denying the WSJ report that the administration is reversing course on how it collects hospital coronavirus data. There are no plans to have the CDC “take over again,” three sources tell me.”
Federal Policy Updates
Senate Republicans Share COVID-19 “Skinny Bill” 
Senate Republicans unexpectedly released on Aug. 17 a "skinny" coronavirus relief proposal, the "Delivering Immediate Relief to America's Families, Schools and Small Businesses Act." Below is a short overview of the bill's major provisions. It includes: 
  • $29 billion for vaccine, therapeutics, and diagnostic development, and vaccine distribution;
  • $16 billion for testing, contact tracing, mitigation and surveillance of COVID-19, of which $15 billion goes to states and $500 million to the Indian Health Service;
  • $105 billion in education funding to assist efforts to reopen schools;
  • A $300 per week federal addition for pandemic unemployment insurance until December 27, 2020;
  • Additional funding for PPP loans;
  • Liability protections for non-profits, hospitals, churches, schools, and businesses from opportunistic litigation;
  • The conversion of a $10 billion CARES loan to the USPS to a grant. 
While it does not sound like votes will happen quickly on this bill, we are hearing that the goal might be to attach it to a late-September fiscal year 2021 continuing resolution to keep the government funded. There are also reports that House Speaker Nancy Pelosi is open to exploring a slimmed down stimulus bill with the promise of a more complete package after the election
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episode: John’s Hopkins COVID-19 Map
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall 1-19
  • SHEA COVID-19 Town Hall 20 | August 23 at 3:00pm ET
    REGISTER HERE
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COVID-19 Update | August 19, 2020
Technical Guidance, Standards and Resources
PPE
 
Clinical Care and Treatment
 
Special Settings and Populations
 
Incident Management
 
Payment and Reimbursement Policy
 
Research
Event Announcements
2020-2021 Influenza Vaccination Recommendations and Clinical Guidance during the COVID-19 Pandemic (CDC COCA)
Thurs., Aug. 20, 2:00 PM – 3:00 PM ET
REGISTER
During this COCA Call, presenters will discuss updates to the Advisory Committee on Immunization Practices (ACIP) recommendations for the 2020-2021 influenza vaccination season. Topics will include the Standards for Adult Immunization Practice, flu vaccination planning, general vaccination guidance during the COVID-19 pandemic, and guidance for large vaccination clinics held in satellite, temporary, or off-site locations.
SPEAKERS: Lisa Grohskopf, MD, MPH, CAPT, USPHS, Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS, Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS
News Highlights
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episode: Changes in Obstetrics
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall 1-19
  • SHEA COVID-19 Town Hall 20 | August 23 at 3:00pm ET
    REGISTER HERE
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COVID-19 Update | August 11, 2020
Technical Guidance, Standards and Resources
Clinical Care and Treatment
 
Special Settings and Populations
 
 
Testing and Cases
 
 
 

Incident Management
 
 
Payment and Reimbursement Policy
Research and Resources Development Funding Opportunities
NIH-funded project seeks to identify children at risk for MIS-C
The opportunity seeks to support innovative research to develop novel or unique approaches to identify and characterize the spectrum of COVID-19 related illnesses, including MIS-C, in children, and predict the longitudinal risk of disease severity after COVID-19 exposure. Applications Due Sept. 30
Information for Patients, Visitors and the General Public
Event Announcements
COVID-19 and Mental Health: Spatial Distancing, not Social Distancing (American Lung Association)
Wed., Aug. 12, 3 - 4 p.m. CT
REGISTER
The limiting of face-to-face contact with others has helped reduce the spread of the novel coronavirus that causes COVID-19. Yet the physical distancing required to keep the virus at bay may invite unwanted emotions such as loneliness, anxiety and feelings of helplessness. Join us as top experts review coping strategies and techniques to manage your mental health while maintaining your physical health.
Speakers: Dr. Tyish Hall Brown, Ken Duckworth, MD, Jolene (JOJO) O’Neal, Albert Rizzo, M.D., FAC
Trade Press, Journal Articles, White Papers
ICHE Coronavirus and COVID-19 Article Collection 
The editors of ICHE have created a page for on the ICHE web site for COVID-19 related articles, commentaries, and letters to the editor. All COVID-19 manuscripts in their accepted form are freely available here. Check back frequently for updates.
 
Low-Cost Measurement of Facemask Efficacy for Filtering Expelled Droplets during Speech. Fischer, Emma P., et al. Science Advances, American Association for the Advancement of Science, 7 Aug. 2020. DOI: 10.1126/sciadv.abd3083 
  
Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea. Lee S, Kim T, Lee E, et al.  JAMA Intern Med. Published online August 06, 2020. doi:10.1001/jamainternmed.2020.3862 
News Highlights
Federal Policy Updates

W&M Chair Neal Urges CMS to Improve Reliability of COVID-19 Nursing Home Data

House Ways and Means (W&M) Committee Chairman Richard Neal (D-MA) called on Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma to improve the reliability of both staff and patient COVID-19 nursing home data.

 

As noted in Table 1 at the end of the letter, 12.4 percent of the Nursing Home COVID19 Public File data fields were missing (as of July 24, 2020). Chairman Neal notes that the Department of Health and Human Services (HHS) announced on July 22 that $4.9 billion of the Provider Relief Fund would be allocated to skilled nursing facilities but has not yet announced the methodology that will be used to distribute these funds. He further states: “Given the lack of reliability of both staff and patient COVID-19 nursing home data CMS has publicly reported, I am deeply concerned that the decisions related to the allocation of these funds may be informed by incomprehensive and unreliable data.”

 

Chairman Neal requests Administrator Verma to respond to a series of questions by August 21 regarding:

  • How CMS will use data to inform resource allocation;
  • What guidance CMS has provided to nursing homes regarding PPE shortages;
  • How CMS is ensuring facilities are reporting COVID-19 information to the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network; and
  • How CMS is training surveyors on the May 6th guidance titled, “Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes.”
     

President Trump Signs 'Buy American' Executive Order Directing Federal Agencies to Procure US-Made Essential Medicines, Countermeasures, Critical Inputs

Late today, President Trump signed an Executive Order directing federal agencies to undertake a variety of approaches to increase their procurement of yet-to-be-specified “essential medicines, medical countermeasures, and critical inputs” that are manufactured in the United States. The EO defers to the Food and Drug Administration (FDA) to identify a list of essential medicines, medical countermeasures, and critical inputs to which the stipulations apply. Critical inputs would include active pharmaceutical ingredients (APIs), API starting materials, or other drug ingredients or device components determined by the FDA to be critical to the safety and effectiveness of essential medicines and medical countermeasures.

 

Key provisions of today’s EO include:

 

Section 1. Policy – In order to be able to respond to the emergence of infectious diseases and chemical, biological, radiological, and nuclear (CBRN) threats, the EO states the U.S. must reduce its dependence on foreign manufacturers of essential medicines, medical countermeasures, and critical inputs.

 

Section 2. Maximizing Domestic Production in Procurement. The EO directs agencies to, as appropriate and in consultation with the FDA, only procure essential medicines, medical countermeasures, and critical inputs that are produced in the U.S. along with several other directives in support of this.

 

Section 3. Identifying Vulnerabilities in the Supply Chain. The EO requires that within six months, the FDA identify and take action to mitigate supply chain vulnerabilities

 

Section 4. EPA Regulatory Requirements. The EO calls on the EPA to identify requirements and guidance documents that can be revised to facilitate advanced manufacturing and expedite production of critical inputs. The EO notes this may include speeding approval of certain permits.

 

Section 5. Prioritization of Contracts for Essential Medicines, Medical Countermeasures, and Critical Inputs. Under the EO, HHS would leverage existing authority under the Defense Production Act to prioritize Federal contracts and orders for essential medicines, medical countermeasures, and critical inputs over other contracts and orders.

 

Section 6. Reporting Requirements.  Finally, the EO calls for annual reporting beginning on Dec. 15, 2021, by the heads of each applicable agency to the President on a variety of factors, including essential medicines, medical countermeasures, and critical inputs procured.

 

Agency Releases Fact Sheet on Operation Warp Speed and Describes Actions to Date

On August 7, 2020 the Department of Health and Human Services (HHS) released a fact sheet explaining Operation Warp Speed (OWS) and highlighting the actions taken to advance COVID-19 countermeasure development, manufacturing, and distribution to date.

In the fact sheet, HHS explains that OWS is a cross-agency and public-private initiative to speed development, production, and delivery of COVID-19 vaccines, therapeutics, and diagnostics. OWS involves an array of federal agencies:

  • HHS;
  • The Centers for Disease Control and Prevention (CDC);
  • The Food and Drug Administration (FDA);
  • The National Institutes of Health (NIH);
  • The Biomedical Advanced Research and Development Authority (BARDA);
  • The Department of Defense (DoD);
  • The Department of Agriculture;
  • The Department of Energy, and
  • The Department of Veterans Affairs.
     

Through OWS, these agencies are coordinating and working with private companies to advance COVID-19 countermeasure goals. HHS notes that OWS is also coordinating existing HHS-wide efforts, such as NIH’s Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) partnership, NIH’s Rapid Acceleration of Diagnostics (RADx) initiative, and work by BARDA.

 

Development

  • To streamline and expedite vaccine development, OWS is allowing steps to be taken simultaneously, such as large-scale manufacturing of a vaccine before the demonstration of efficacy and safety. HHS notes that this increases the government’s financial risk, but not the risk of the product, as vaccines must still be proven safe and effective before they can be approved or authorized and released.
  • Fourteen promising candidates have been chosen from more than 100 vaccine candidates currently in development. The 14 vaccine candidates will be narrowed down to the most promising 7 candidates. The remaining 7 candidates will go through further testing in early-stage clinical trials. Finally, the most promising candidates will enter large-scale randomized trials to demonstrate safety and efficacy.

Manufacturing

  • The federal government is facilitating investments in manufacturing capacity at its own risk. The capacity developed will be used to speed production of whichever vaccine is eventually successful, regardless of which firms developed the capacity.

Distribution

  • HHS intends to distribute vaccines and therapeutics using a tiered approach that builds on past pandemic flu methodology and is adjusted based on experience from the COVID-19 response to date, including data on:
    • The virus and its impact on populations;
    • The performance of a given countermeasure, and;
    • The needs of the essential workforce.
       
OWS is expanding domestic manufacturing and supplies of specialized materials and resources, such as glass vials, for distribution, and DoD’s involvement will support quicker distribution and administration.
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention
This series focuses on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. Each week's episode will include discussion around what different organizations are doing to address COVID-19, what have been the biggest challenges, what changes have been made, and what opportunities there are to work together to handle the pandemic. Access the full podcast series on LearningCE.
 
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now
This series highlights changes in the COVID-19 outbreak and updates in the medical literature. Each week's episode will include a summary of important news, a brief summary of medical literature and guidelines on infection prevention that have been published related to COVID-19, and discussion around the latest and most important questions surrounding the outbreak. Access the full podcast series on LearningCE.   
  
Tune in to the latest episode: Changes in Obstetrics
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall 1-18
  • SHEA COVID-19 Town Hall 19 | August 16 at 3:00pm ET
    REGISTER HERE
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COVID-19 Update | August 7, 2020
SHEA Coronavirus News
SHEA collaboration tackles aerosol generating procedures transmission risks 
SHEA is collaborating with APIC, IDSA and PIDS on guidance to address confusion and challenges with defining and determining aerosol generating procedure (AGPs) risks for transmission of SARS-CoV-2. A multidisciplinary workgroup has received input from over 20 hospital systems and conducted an environmental scan of AGP definitions across 15 plus healthcare societies, conducted a literature review and is currently working on a draft document  The overarching goal is to shift from binary discussion of what is or is not an AGP to a framework of principles for risk Assessment for procedures potentially resulting in infectious small particle aerosols.
Technical Guidance, Standards and Resources
Infection Prevention and Control
 
Occupational Health
 
Clinical Care and Treatment
Special Settings and Populations
 
Incident Management
 
MMRW
Trade Press, Journal Articles, White Papers
ICHE Coronavirus and COVID-19 Article Collection 
The editors of ICHE have created a page for on the ICHE web site for COVID-19 related articles, commentaries, and letters to the editor. All COVID-19 manuscripts in their accepted form are freely available here. Check back frequently for updates.
 
COVID-19 And Racial/Ethnic Disparities In Health Risk, Employment, And Household Composition. Selden, Thomas M., and Terceira A. Berdahl. Health Affairs, 2020, doi:10.1377/hlthaff.2020.00897.  
 
How Efficacious Must a COVID-19 Coronavirus Vaccine Be to Prevent or Stop an Epidemic by Itself. Bartsch, Sarah M, et al. 2020, doi:10.1101/2020.05.29.20117184.  
 
Expanding Telehealth and Telementoring During COVID-19: AHRQ’s Expertise Helps Identify Next Steps (AHRQ, Jul 1)  
 
National Academies of Sciences, Engineering, and Medicine. 2020. Rapid Expert Consultation on Staffing Considerations for Crisis Standards of Care for the COVID-19 Pandemic (July 28, 2020). Washington, DC: The National Academies Press.
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention 
ACCESS ON LEARNINGCE 

Episodes Available Now:
  • Dialysis in a Crisis with the American Society of Nephrology (ASN)
  • Anesthesiology During a Pandemic with the American Society of Anesthesiologists (ASA)
  • Knowledge Sharing with the Society for Hospital Medicine (SHM)
  • Collaborating with National Foundation for Infectious Diseases (NFID)
  • Partnering with Pharmacy with the American Society of Health-System Pharmacists (ASHP)
  • Challenges from Presentations to Diagnosis with the American College of Emergency Physicians (ACEP)
  • Front Line Perspectives from a Nursing Home Directors with the Society for Post-Acute and Long-Term Care Medicine (AMDA)
  • Front Line Acute Care Surgeon Perspectives from the COVID-19 Epi Center with the Surgical Infection Society (SIS)
  • Infection Prevention Adjustments for the Anesthesia Provider with the Anesthesia Patient Safety Foundation (APSF)
  • Working together to address COVID-19 challenges with Infusion Nurses Society (INS)
  • Critical Care Collaboration with the Society for Critical Care Medicine (SCCM)
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now 
ACCESS ON LEARNINGCE
 
Episodes Available Now: 
  • COVID-19 Frequently Asked Questions 
  • Environment of Care & PPE
  • Surge Planning & Testing
  • Diagnostic Testing, Part 1
  • PPE: Conservation & Shortages
  • Diagnostic Testing, Part 2
  • Involving Antimicrobial Stewardship Programs
  • Advocacy around COVID-19
  • PPE: Getting Resourceful with No Resources
  • Taking Care of Yourself
  • Tracing Contacts
  • Answeres to Town Hall Questions
  • Staff Policies
  • Overuse and Misuse of Antibiotics During COVID-19
  • Antibody Testing
  • NHSN Response to COVID-19
  • Reopening Ambulatory Practices
  • COVID-19 in Long-term Care Settings
  • Ready to be a COVID Consultant?
  • Lessons Learned From The Surge
  • Racial Disparities with COVID-19
  • Call the Healthcare Epidemiologist
  • Reopening Schools
  • Occupational Health
  • Changes in Obstetrics
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall 1-17
  • SHEA COVID-19 Town Hall 18 | August 9 at 3:00pm ET
    REGISTER HERE
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COVID-19 Update | July 21, 2020
Important Highlights
CDC – Critical Infection Prevention Guidance Updates
Last Friday, CDC issued several updates related to infection prevention in healthcare settings. The updates contained in these documents will also affect several other guidance documents that overlap with this content. 
SHEA Coronavirus News
SHEA Collaborates with Stakeholders in Advocacy of Scientific Integrity
Last week, SHEA joined other stakeholders in letters to the White House to the Executive Branch officials imploring them to protect the integrity of science throughout the COVID-19 pandemic. These messages include:
  • A July 14 letter on behalf of public health stakeholders to Vice President Mike Pence in defense of science and the best available data to guide the COVID-19 response which must include the leadership of Dr. Anthony Fauci;
  • A July 16 letter on behalf of SHEA and APIC to Vice President Mike Pence, Coronavirus Task Force Coordinator Dr. Deborah Birx, and HHS Secretary Alex Azar emphasizing the importance of using NSHN for reporting COVID-19 data;
  • A July 17 letter on behalf of public health stakeholders to Vice President Mike Pence, Coronavirus Task Force Coordinator Dr. Deborah Birx, and HHS Secretary Alex Azar recommending immediate reversal of the decision to eliminate the use of NSHN for COVID-19 reporting. 
Technical Guidance, Standards and Resources
Infection Prevention and Control
 
PPE
 
Special Settings and Populations
 
Testing and Cases
 
CDC MMWR
 
 
Incident Management
 
Communication Resources
 
Research
Research and Resources Development Funding Opportunities
Event Announcements
Coronavirus Disease 2019 (COVID-19) and Diabetes: The Importance of Prevention, Management, and Support (CDC COCA)
Tue., July 28, 2020, 2p.m. - 3p.m. ET
REGISTRATION
During this COCA Call, presenters will focus on current information about the impact and increased risk for COVID-19 complications in people with diabetes and the importance of diabetes prevention, management, and support.
SPEAKERS: Celeste Philip, MD, MPH, Ann Albright, PhD, RD, CDR Sharon Saydah, PhD (USPHS)
Trade Press, Journal Articles, White Papers
ICHE Coronavirus and COVID-19 Article Collection 
The editors of ICHE have created a page for on the ICHE web site for COVID-19 related articles, commentaries, and letters to the editor. All COVID-19 manuscripts in their accepted form are freely available here. Check back frequently for updates.
News Highlights
SHEA Education and Events
SHEA Podcast: We’re All in this Together: COVID-19 Allies in Infection Prevention 
ACCESS ON LEARNINGCE 

Episodes Available Now:
  • Dialysis in a Crisis with the American Society of Nephrology (ASN)
  • Anesthesiology During a Pandemic with the American Society of Anesthesiologists (ASA)
  • Knowledge Sharing with the Society for Hospital Medicine (SHM)
  • Collaborating with National Foundation for Infectious Diseases (NFID)
  • Partnering with Pharmacy with the American Society of Health-System Pharmacists (ASHP)
  • Challenges from Presentations to Diagnosis with the American College of Emergency Physicians (ACEP)
  • Front Line Perspectives from a Nursing Home Directors with the Society for Post-Acute and Long-Term Care Medicine (AMDA)
  • Front Line Acute Care Surgeon Perspectives from the COVID-19 Epi Center with the Surgical Infection Society (SIS)
  • Infection Prevention Adjustments for the Anesthesia Provider with the Anesthesia Patient Safety Foundation (APSF)
  • Working Together to Address COVID-19 Challenges with Infusion Nurses Society (INS)
SHEA Rapid Response Podcast: COVID-19 Update: What We Know Now 
ACCESS ON LEARNINGCE
 
Episodes Available Now: 
  • COVID-19 Frequently Asked Questions 
  • Environment of Care & PPE
  • Surge Planning & Testing
  • Diagnostic Testing, Part 1
  • PPE: Conservation & Shortages
  • Diagnostic Testing, Part 2
  • Involving Antimicrobial Stewardship Programs
  • Advocacy around COVID-19
  • PPE: Getting Resourceful with No Resources
  • Taking Care of Yourself
  • Tracing Contacts
  • Answers to Town Hall Questions
  • Staff Policies
  • Overuse and Misuse of Antibiotics During COVID-19
  • Antibody Testing
  • NHSN Response to COVID-19
  • Reopening Ambulatory Practices
  • COVID-19 in Long-term Care Settings
  • Ready to be a COVID Consultant?
  • Lessons Learned From The Surge
  • Racial Disparities with COVID-19
  • Call the Healthcare Epidemiologist
SHEA Podcasts - Are we meeting the needs of our members? Please fill out the short PODCAST FEEDBACK FORM
 
  • A "Quick Implementation Guide" 7-worksheet Excel file (xls download) with self-populating worksheets to apply implementation concepts and approaches by SHEA members to individual circumstances.
  • List of guidelines and statements from other organizations for insight into stakeholders’ points-of-view. Not comprehensive; not vetted or endorsed by SHEA.  
 
SHEA Rapid Response Webinars 
ACCESS ON LEARNINGCE 
  • Healthcare Facility Outbreak Preparedness
  • SHEA COVID-19 Town Hall 1-15
  • SHEA COVID-19 Town Hall 16 | July 26 at 3:00pm ET
    REGISTER HERE
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4040 Wilson Blvd, Suite 300, Arlington, VA 22203


 

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COVID-19 Alert | July 20, 2020
Critical Update – Infection Prevention Guidance Updates
On July 17, CDC issued several updates related to infection prevention in healthcare settings. The updates contained in these documents will also affect several other guidance documents that overlap with this content. 
Questions and inquires can be sent to info@shea-online.org.
 
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4040 Wilson Blvd, Suite 300, Arlington, VA 22203