May 20, 2020

1. Promoting Risk Reduction in the
COVID-19 Environment
May 20, 2020

2. CME Credit
• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State
Medical Society to sponsor continuing medical education for physicians. The
Bridgeport Hospital Yale New Haven Health designates this live activity for a
maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only
credits commensurate with the extent of their participation in the various
activities.
• This activity has been planned and implemented in accordance with the Essential
Areas and policies of the Accreditation Council for Continuing Medical Education
through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and
the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited
by the Connecticut State Medical Society to provide continuing medical education
for physicians.
• The content of this activity is not related to products or services of an ACCME-
defined commercial interest; therefore, no one in control of content has a relevant
financial relationship to disclose and there is no potential for conflicts of interest.

3. Stephen J Scholand, MD
Infectious Disease Consultant
20 May, 2020

4. Objectives
- Celebrate National EMS week!
- Update on epidemiology (SARS-CoV-2,
COVID-19)
- Review any good news?
- Continue team efforts in risk reduction

5. COVID-19 in the United States
1,528,661 cases on 5/20/20 – up from 1,367,491 cases last week (5/12/20) -
https://coronavirus.jhu.edu/map.html

6. Any good news?
• S. Korea:
– “Wrong about re-infection” [lab error]
• False positives (PCR vs viral culture)
• Vaccine progress (~120 candidates WHO):
– 8 are in Phase 1/2 clinical trials:
• Oxford University vaccine, Pfizer vaccine
• Opening up the USA
– “Risk reduction”
• masks, hand hygiene, physical distancing, not touching of the
face

7. Stay safe -- Stay up to date
• https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• https://www.who.int/emergencies/diseases/novel-
coronavirus-2019
• https://covidactnow.org/
• https://coronavirus.jhu.edu/map.html

8. Dr. Veena Channamsetty, MD, FAAFP
Dr. Mary Blankson, DNP, APRN, FNP-C
Dr. Marwan Haddad, MD, MPH
Promoting Risk Reduction in
the COVID-19 Environment

9. Harm Reduction Principles
• Be pragmatic
– COVID-19 is here for the foreseeable future
– Limit the exposure/risk of infection
• Espouse humanistic values
– Respect individual’s rights and dignity
– Accept their decisions
• Focus on harms
– Minimize negative consequences
• Balance costs/benefits to individual/society
– Identify consequences of decisions and costs and benefits for
preventing these consequences
• Establish hierarchy of goals
– Address most immediate goals of patients
– Keep engaged in care

10. Main Recommendations in the COVID Era
• Hand Hygiene
• Physical distancing
• Masks
• Clean and Disinfect
• Quarantine and Isolation

11. Having the Conversation:
Challenging Patient Scenarios
• Unable to physically distance
• Does not believe or follow recommendations
• Must return to work
• Vulnerable patients
– housing insecurity/congregate living
– poor or no access to information
• Addressing misinformation

12. Unable to Physically Distance
• Family size, Housing size, Primary caretakers
• Harm reduction approach
– Use the resources available to best of ability
– Keep physical distance within household; separate
medically vulnerable
– Sleep reverse or rearrange rooms
– Artificial barriers
– Handwashing
– Disinfecting surfaces
– Cluster becomes your family unit; isolate as a cluster
– Create a sick plan

13. Patient Does Not Believe/Follow Recommendations
• Patients that do not think COVID is a problem and/or it
does not affect them
– Patients may not want to be labeled/stigmatized
– De-escalate the situation
– Use evidence/data of what we know
– Explain Herd immunity – without vaccine, will not get to
– It’s not the “me” it’s the “we”
• Patients that think it is too difficult to follow
recommendations
– Plan as best you can to stay within guidelines
– Know community recourses
– Organizations offering free masks/hand sanitizer

14. Work-Related Challenges
• Patients that are required to work, but do not want to
– Discuss what provisions are offered for protection
– Make decisions on a case by case basis, depending on
unique needs
– Consider note to be out of work – will patient lose job?
– Discuss if workplace can accommodate remote work;
however, support patients to work safely if they need to
• High-risk patients that want to return to work
– Understand if patient can work from home
– Discuss nature of what makes them high-risk and the risk
to themselves and others if they return to work (both at
work and at home)

15. Vulnerable Population
• More individualized plan needed
• Modify the “norms” of care pre-COVID-19
• Ensure they have a plan/means to reach you at all times
• May require more outreach
– Different types – go physically to the shelter, etc.
– Information session in community
• Prescribe longer duration of medication
• Consider behavioral health consequences of: re-
traumatization/isolation; practice physical not social
distancing
• Consider a plan to address domestic violence

16. Addressing Misinformation and
Information Overload
• Have difficult conversations without
demeaning patients
• Present facts only
• Discuss possible harms of misinformation
• Incorporate patient beliefs into overall
treatment plan, if appropriate

17. Opening Up
• When is it okay to visit family/friends?
• When is it okay to travel?
• How can you assess your own risk?
• Who is living with you that may be at risk?
• What support structures do you need?

18. 18
Free COVID-19 eConsults
• Web-based portal
• Free to all Safety Net Primary Care Practices
– FQHC, FQHC-look alike, Migrant Clinicians, Healthcare for the
Homeless, Free Clinics
• No Protected Health Information (PHI)
• Consults Addressed by:
– Infectious Disease Specialists
– Public Health Nurses
* This initiative is supported by

19. 19 * This initiative is supported by

20. Thank You!
www.weitzmaninstitute.org/coronavirus