Will Humble Disease Control, Wills Blog

Good News, Bad News on Remdesivir Treatment

Last Sunday I blogged about promising results for clinical trials for using remdesivir to treat COVID-19 illness.  Right after that, the WHO accidentally posted a report that showed there was no clinical improvement in patients severely infected with the disease who were given the drug.

Then, later in the week, the NIH announced that a different clinical trial found that the drug accelerated recovery among patients that had advanced disease. It was a randomized, controlled trial involving 1063 patients (decent sample size).

The study found that patients who got remdesivir recovered 31% faster than the people that got the placebo (p<0.001). The median time to recovery was 11 days for patients treated with remdesivir compared with 15 days for those who got the placebo. Results also suggested a survival benefit, with a mortality rate of 8.0% for the group receiving remdesivir versus 11.6% for the placebo group (p=0.059).

Finally, on Friday the FDA issued an Emergency Use Authorization for remdesivir to treat COVID. That means doc’s can now prescribe for patients without enrolling them in a clinical trial or getting compassionate use approval.

Will Humble Uncategorized, Wills Blog

ASU Health Talks Zoom: COVID-19: What does the science say about reopening?

“When can the U.S. reopen?” is the most important question facing government officials and health authorities alike as the stay-at-home order continues and the economy worsens in the face of the COVID-19 pandemic.

Join us as a panel of experts explores current data about the disease and discusses policy issues and projections about when the country can safely begin the process of emerging from the shutdown.

Panelists: 

Megan Jehn is an associate professor of epidemiology and a member of the global health faculty at Arizona State University’s School of Human Evolution and Social Change. She also holds affiliate appointments at the ASU Global Institute for Sustainability and the ASU Decision Theater.

Timothy Lant is the director of program development for ASU’s Knowledge Enterprise where he supports the identification and development of research funding opportunities for the Biodesign Institute and other university initiatives. He is an expert in pandemic modeling and response.

Heather Ross is a clinical assistant professor and policy fellow in the office of Phoenix mayor Kate Gallego. She holds a joint appointment with ASU’s School for the Future of Innovation in Society and the Edson College of Nursing and Health Innovation.

Here’s the Zoom Link https://asu.zoom.us/j/92672328437?status=success

Will Humble Disease Control, Wills Blog

Career Opportunity: COVID-19 Epidemiology Disease Investigator Positions (Maricopa County Department of Public Health)

ABOUT THE POSITION

Are you ready to make a difference in the community combating the spread of COVID-19?

You will be responsible for investigating and monitoring known or potential sources of suspected infections of COVID-19 or other diseases, determining original source, ensuring infection control, and assisting in the reduction of transmission.  Join the team that is making a positive impact every day. 

ABOUT THE DEPARTMENT OF PUBLIC HEALTH

Come work for Maricopa County Department of Public Health, the 3rd largest health jurisdiction in the U.S.!  Our Public Health staff live by our mission: to make healthy lives possible!

We aim to serve Maricopa County residents with a focus towards health equity and a data-driven approach to our work. We value our staff’s unique skills and differences, as well as the varied experiences and disciplines we represent. We come together to reach our vision of creating a healthy, safe and thriving community.

We recognize your time is valuable, so please apply if you meet the following required qualifications:
 
Education

  • Bachelor’s degree in Health Promotion, Public Health, Medical Technology, Health Sciences or health related field.

Combined education and experience qualifications

  • An equivalent combination of post-secondary education and/or experience conducting health field investigations, community outreach, and/or case management may substitute for the education requirement on a year per year basis.

Our Preferred Candidate has

  • Experience working with various socioeconomic groups.

  • Bilingual English/Spanish skills.

  • All employees, within one (1) month of hire, will be required to provide evidence of immunity or receive immunizations for vaccine-preventable illnesses for any position within the Maricopa County Department of Public Health. 

Essential Job Tasks

  • Performs investigations to determine disease origin method of contraction through contact with physicians, hospitals, and healthcare providers.

  • Interviews patients to obtain epidemiological information and determine contacts; may include conducting home visits and refer patients to medical provider for diagnosis, treatment, and care.

  • Maintains case documentation of patient and family encounters.

  • Collects specimens, submits samples for laboratory testing, and conducts laboratory procedures and testing.

  • Tracks and locates patients or contacts throughout Maricopa County who suffer from or were exposed to a communicable disease.

  • Provides related information and education to clients, medical providers, community, and staff.

Typically successful candidates are hired at a salary rate, up to midpoint of the range, based on applicable experience, internal equity and budgetary allowances.

Apply Here

Will Humble Uncategorized, Wills Blog

Dr. Joe Gerald’s Latest Modeling Shows Viral Transmission Slowing but Community Spread is Still Happening

Dr. Joe Gerald from the UA Mel & Enid Zuckerman College of Public Health just finished his latest model run for Arizona. The COVID ACT NOW group is now reporting the effective viral transmission value R0 by state and county. The R0 for Arizona is 1.12 indicating continued modest case growth with a peak daily case count projected at some future date. Our goal is to get the R0 to less than 1.

R0 is called the “R Naught” and it represents the number of people each infected person transmits the virus to. When an R0 figure drops below 1, it means that the number of new cases isn’t expected to grow. New cases will still occur, but the number wouldn’t be expected to increase.

Social distancing has slowed and continues to slow viral transmission; however, reported cases, hospitalizations, or ICU utilization has yet to clearly peak. Community-driven viral transmission remains in place suggesting that maintaining social distancing remains important in order to prevent a resurgence and a rebound of the R0. While current social distancing restrictions appear to be sufficient to prevent exponential growth, transmission is still occurring.

Dr. Gerald reports that “… COVID-19 testing remains constrained with inadequate testing for clinical and public health demands. Until this is overcome lifting social distancing restrictions risks a resurgence in active cases.”

Here is his latest analysis. Take a look. It’s an interesting analysis today.

Will Humble Disease Control, Wills Blog

Community Providers Offering Expanded Testing on Saturdays

Last week the state health department set a goal of testing an additional 30,000 to 60,000 people over the next three weekends for the SARS CoV2 virus. The goal is to test between 10,000 and 20,000 people starting yesterday and also the next 2 Saturdays (May 9 and May 16). 

They said testing will take place at drive-thru and onsite locations across the state. The testing locations, hours and registration information can be found at azhealth.gov/testingblitz.

The supply of test kits and specimen transport media must have gotten a lot better in the last week in order to make a commitment like this. Up until now, the availability of testing kits has been an impediment to wider testing.

It sure will be interesting to see the surveillance data that comes out of the Saturday testing.  While I expect that it’ll result in an increase in cases- I bet it also finds a lower percent positive rate because lower risk people are being tested.  The ADHS Data Dashboard hasn’t been updated yet this am… but you can check back on the dashboard to see how that blitz thing worked out.

Also, remember that the chart that shows new hospitalizations per day is really the most important surveillance tool because it’s less dependent on ephemeral testing capacity.

 

Will Humble Disease Control, Social Determinants, Wills Blog

Legislative Changes to TANF and AHCCCS

TANF: The Temporary Assistance for Needy Family (TANF) program provides many forms of assistance including cash assistance, childcare, transportation, mental health counseling, child abuse prevention, early intervention, job training and job placement services. This program received major changes to its eligibility in response to the coronavirus pandemic.

Before emergency legislation was passed, citizens were eligible for 60 months of TANF during their lifetime, with potential for a waiver for another 60 months if you met the limit as a minor. Additionally, families with one or more adult must have 20 hours of work, community service or educational training to be eligible.

After the passing of Senate Bill 1687,  these requirements are no longer in effect. As stated in this bill, all TANF time limits and work requirements have been waived for the duration of the emergency declaration.

AHCCCS: Senate Bill 1687 updated the AHCCCS program to authorize payments to behavioral health service providers who were not originally eligible and now authorizes payments to providers of services to individuals with intellectual and developmental disabilities that did not previously qualify. The AHCCCS program estimates that 43,000 have joined AHCCCS as a result of the coronavirus pandemic which accounts for a 2 percent increase in the total enrollment. These provisions will expire once the governor’s emergency declaration is lifted.

A shout out to AzPHA policy interns Desiree Jones, Dylan Miller and Caitlin Tillis for this post!

Will Humble Disease Control, Medicaid, Wills Blog

Medicaid’s Role in the Next Phase of COVID-19 Response: Part I

Across the nation, government, business, and community leaders are devising plans to re-open the economy and public spaces, while minimizing the risks associated with a second wave of infection. These plans necessitate a dramatic increase in targeted surveillance activities that involve: (1) widespread testing; (2) contact tracing; (3) isolation of infected individuals; and (4) supports to seniors and other high-risk populations.

This reality raises important questions about how to build surveillance capacity at the scale and speed necessary to phase down current restrictions without recreating the conditions that led to the initial surge in infection and mortality. State public health and Medicaid agencies are well-poised to leverage existing partnerships and complementary skillsets to collaborate on these efforts.

Historically, health surveillance activities have been the domain of federal, state, and local public health departments. While these agencies are experts in organizing crisis responses to public health emergencies, the scale of the current pandemic is extraordinary. Along these lines, the Centers for Disease Control and Prevention (CDC) recently discussed plans to re-purpose thousands of Census Bureau workers to augment contact tracing capacity. However, even with these supports, the magnitude of the current pandemic will require partnerships and resources from multiple sectors to create a response at a sufficient scale and within an acceptable timeframe to allow for safe restoration of public life.

Will Humble State Legislature, Wills Blog

State Legislature Might Reconvene (or maybe not)

Reports released earlier this week leaned towards the state legislature permanently ending on May 1. These plans were quickly changed as a closed caucus meeting revealed that some legislators wanted to continue the session’s work. State lawmakers may choose to further postpone their return date, return to work on legislation on May 1 or take advantage of a rule change that allows Representative Bowers and Senator Fann to approve legislators to work from home. Read the detail here.

Will Humble Disease Control, Wills Blog

Journal Article of the Week:

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

CONCLUSIONS: Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.

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