new Covid wave

[seper]

HiI What are your admins doing 1) regarding RadOnc referrals 2)Exposed staff?
At my hospital center (3 LINACs) they have mandatory testing on all H&N consults, and the rest are at the MD's discretion.
Exposure here is defined as voluntary reporting of family member status. I have one physicist out due to her husband testing positive, and she is asked to use 7 of her her sick leave days.
We are employed by a large (>>500 staff) company.
Is there anything anybody doing, in addition to personal vigilance?

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[medgator]

Mandatory masking obviously, limit all otv/consult visits to patient only (one caregiver/spouse if requested).

 

[BobbyHeenan]

Mandatory masking obviously, limit all otv/consult visits to patient only (one caregiver/spouse if requested).

Same.

I test patients if I’m going to laryngoscope or do a procedure on them. Otherwise we only test symptomatic ones.

 

[Palex80]

Mandatory masking obviously, limit all otv/consult visits to patient only (one caregiver/spouse if requested).

Exactly the same at our department too in Europe, where numbers are currently rising.

If one of our co-workers gets tested positive, she/he is isolated at home
If one of our co-workers had contact with someone who tested positive outside home and was not using PPE at that time, she/he is quarantined at home by the authorities.

Isolation/Quarantine last 10 days.

Isolation cannot be cancelled.
Quarantine can be cancelled if personell are urgently needed in the hospital, it will require working with FFP2 at all times and a negative test.

Isolation/Quarantine are considered a "working-accident".

Exposure here is defined as voluntary reporting of family member status.

Does that mean your personell are not required to state if they are living with someone who was tested positive?

 

[Palex80]

Does that mean your personell are not required to state if they are living with someone who was tested positive?

I was on leave last week, so I got the chance to check our "COVID-manual" today. Actually, reporting being sick with COVID or having had contact to someone with COVID is mandatory in our hospital and if you do not disclose that fact (and you have to be proactive, not simply answer if you are asked) it can result into getting fired.

 

[Gfunk6]

Good times if you live or practice in North Dakota.

With North Dakota hospitals at 100% capacity, Burgum announces COVID-positive nurses can stay at work

In an attempt to alleviate some of the staffing concerns, Burgum announced that the state health officer has amended an order that will allow health care workers with asymptomatic cases of COVID-19 to continue working in hospitals' COVID-19 units. The Republican governor said hospital…

www.inforum.com

Hospitals at 100% capacity. Situation critical as defined by CDC. Hospital “administrators” (who are no doubt zooming from their palatial estates) have asked the governor for permission to allow asymptomatic COVID positive healthcare workers to keep on working.

The governor has agreed to do so, but still refuses to issue a statewide mask mandate viewing it as a “personal responsibility.”

 

[Mandelin Rain]

The systems in my area have gone to essentially a "whatever you do, don't get a test" type recommendation for employees.

I haven't done a deep dive on this, but at least initially, I thought there was some concern regarding repeated exposure of health care workers and increased likelihood of complication/death.

 

[Grubbe-a-dub-dub]

If a patient tests positive and quarantines, do you need to re-test?

I had a patient coming from a nursing home who tested positive roughly 2 weeks ago. I worry if I test again that it'll be positive (but not necessarily clinically relevant).

 

[elementaryschooleconomics]

If a patient tests positive and quarantines, do you need to re-test?

I had a patient coming from a nursing home who tested positive roughly 2 weeks ago. I worry if I test again that it'll be positive (but not necessarily clinically relevant).

Many of the healthcare facilities in my region are mandating repeat testing, and this was my exact concern. In debating this issue, I was eventually convinced by the argument that, from a medicolegal standpoint, if you don't test someone who was positive in the recent past, move them to a different location for treatment or whatever, and that person is identified as the cause of an outbreak, the liability could be placed on you. So, testing a patient like that and having them come up positive could 1) have no clinical relevance and 2) be deleterious to that patient's care, but 3) protect you and your associates from potential legal action. Is it paranoid? Yes. Is everyone paranoid in 2020? Also yes.

 

[Radonc 2013]

If a patient tests positive and quarantines, do you need to re-test?

I had a patient coming from a nursing home who tested positive roughly 2 weeks ago. I worry if I test again that it'll be positive (but not necessarily clinically relevant).

We're still going by symptoms based strategy to determine the duration of isolation as per CDC. We are only retesting patients that have required hospitalization for COVID (severe illness) and patients that we feel are immunocompromised (recent chemotherapy/immunosuppressive meds/etc),

Healthcare Workers

COVID-19 guidance, tools, and resources for healthcare workers.

www.cdc.gov

 

[ramsesthenice]

Many of the healthcare facilities in my region are mandating repeat testing, and this was my exact concern. In debating this issue, I was eventually convinced by the argument that, from a medicolegal standpoint, if you don't test someone who was positive in the recent past, move them to a different location for treatment or whatever, and that person is identified as the cause of an outbreak, the liability could be placed on you. So, testing a patient like that and having them come up positive could 1) have no clinical relevance and 2) be deleterious to that patient's care, but 3) protect you and your associates from potential legal action. Is it paranoid? Yes. Is everyone paranoid in 2020? Also yes.

Interesting. Ours is doing exactly the opposite. Once a patient is diagnosed they get a message that pops up in their chart specifically instructing that they are not to get another test within the next 3 months. They are considered COVID free when they have been asymptomatic for 14 days (or 14 days after a positive test for asymptomatic carriers).

I also don't really know what a healthcare worker has to do to get tested here. One of the staff members who assists me with T&O and interstitial cases tested positive about 6 weeks ago. We had been in very close contact for prolonged periods doing insertions multiple times a day the proceeding days and because I had been wearing a mask I was not eligible for a test. They can give me all the bull**** reasons they want about why I didn't need a test we both know they realize that if they test too broadly they run the risk of being unable to keep their clinics fully staffed. I wouldn't be so annoyed if these were not the same people constantly reminding us that robust testing and contact tracing in the community will be key to controlling this thing. I guess I am asking for it making them all those Benjamins...

 

[Palex80]

I haven't done a deep dive on this, but at least initially, I thought there was some concern regarding repeated exposure of health care workers and increased likelihood of complication/death.

The severity of the disease seems to be linked to the viral load you get passed on by the carrier that infected you (among other factors). A lot of fatalities among hospital employees (especially in Italy and Spain) during the first wave happened because of lack of masks. It seems that if you get passed on a high viral load by the patient (for example if a patient coughs at your face and you are not wearing adeqiate protective equipment) the virus overwhelms your immune system, leading to major complications. A smaller viral load will still get you sick, but you stand a better chance to beat it.

 

[Palex80]

If a patient tests positive and quarantines, do you need to re-test?

I had a patient coming from a nursing home who tested positive roughly 2 weeks ago. I worry if I test again that it'll be positive (but not necessarily clinically relevant).

Isolation ends at 10 days, provided that no typical symptoms persist 48 hours before the end of isolation.
Which means that if your patient has no symptoms at day 8 post-positive testing, it's safe for you to have him come after day 10.

 

[Palex80]

I also don't really know what a healthcare worker has to do to get tested here. One of the staff members who assists me with T&O and interstitial cases tested positive about 6 weeks ago. We had been in very close contact for prolonged periods doing insertions multiple times a day the proceeding days and because I had been wearing a mask I was not eligible for a test. They can give me all the bull**** reasons they want about why I didn't need a test we both know they realize that if they test too broadly they run the risk of being unable to keep their clinics fully staffed. I wouldn't be so annoyed if these were not the same people constantly reminding us that robust testing and contact tracing in the community will be key to controlling this thing. I guess I am asking for it making them all those Benjamins...

If you want to get tested, then just say you have a sore throat and a headache.

 

[seper]

I was on leave last week, so I got the chance to check our "COVID-manual" today. Actually, reporting being sick with COVID or having had contact to someone with COVID is mandatory in our hospital and if you do not disclose that fact (and you have to be proactive, not simply answer if you are asked) it can result into getting fired.

"Contact" is subjective so it appears that people in US often choose not to report Covid exposure.
I don't like it.

 

[seper]

I would re-test 2 weeks-old positive patient. Still may be contagious. I guess 4 weeks interval would safer
Edit: have not faced this situation yet. Thanks all for comments on this thread

If a patient tests positive and quarantines, do you need to re-test?

I had a patient coming from a nursing home who tested positive roughly 2 weeks ago. I worry if I test again that it'll be positive (but not necessarily clinically relevant).

 

[RickyScott]

"Contact" is subjective so it appears that people in US often choose not to report Covid exposure.
I don't like it.

Statistically, every couple days/week I must be coming into contact with someone that had covid?

 

[Palex80]

Statistically, every couple days/week I must be coming into contact with someone that had covid?

True.
Right now about 1/300 people in my city are positive and in isolation at home. We have a rather high positivity test rate right now, meaning that about 2-3 times more cases are probably out there, walking around, many of them asymptomatic other too ignorant to go get a test.
So about 1/100 people in the street have COVID. When you board a train, a bus or visit a restaurant chances are high that someone positive will be present too.

This is what applies here:

"Contact" is defined here as being closer than 2m to someone positive for over 15 minutes without wearing a mask.

This type of "contact" does not consider other factors.
For example you could be standing in a room 3m away from someone positive and only for 30 sec, but if that person sneezes into the air and you are not wearing a mask, you are probably screwed too...

 

[RickyScott]

True.
Right now about 1/300 people in my city are positive and in isolation at home. We have a rather high positivity test rate right now, meaning that about 2-3 times more cases are probably out there, walking around, many of them asymptomatic other too ignorant to go get a test.
So about 1/100 people in the street have COVID. When you board a train, a bus or visit a restaurant chances are high that someone positive will be present too.

This is what applies here:

"Contact" is defined here as being closer than 2m to someone positive for over 15 minutes without wearing a mask.

This type of "contact" does not consider other factors.
For example you could be standing in a room 3m away from someone positive and only for 30 sec, but if that person sneezes into the air and you are not wearing a mask, you are probably screwed too...

Over past few months have had a number of otv patients admitted for unrelated issues- neutropenia, chf etc who then tested positive. Feel like I would be in permanent quarantine by this standard.

 

[thecarbonionangle]

Policy is basically “don’t ask don’t tell”.
the virus is pretty much everywhere if you look for it

 

[dieABRdie]

Over past few months have had a number of otv patients admitted for unrelated issues- neutropenia, chf etc who then tested positive. Feel like I would be in permanent quarantine by this standard.

Yeah, I had a med onc tell me that our patient test positive a few days after she finished RT. I deleted the text.

 

[seper]

Geez, if this type of sentiment is prevalent even within oncology departments, this latest wave will burn until everyone's got it.

 

[RadOncMegatron]

Remember everyone, this is before the holiday season. I am worried we will be down therapists or have to bring in therapists who have been exposed. Yes, I asked admin for more therapists, but even if they wanted, it is tough right now to hire extra hands on their defense b/c everybody wants more employees right now...

 

[elementaryschooleconomics]

Remember everyone, this is before the holiday season. I am worried we will be down therapists or have to bring in therapists who have been exposed. Yes, I asked admin for more therapists, but even if they wanted, it is tough right now to hire extra hands on their defense b/c everybody wants more employees right now...

This is what we're starting to deal with now. I'm not sure what the plan is if we reach a critical mass of RTTs out with COVID exposure or diagnosis (well, there is no plan I guess...).

 

[Palex80]

This is what we're starting to deal with now. I'm not sure what the plan is if we reach a critical mass of RTTs out with COVID exposure or diagnosis (well, there is no plan I guess...).

The plan is simple: Asymptomatic employees who have tested positive or are quarantined because of having had contact with someone positive are supposed to keep working with full protective equipment to make sure they won't pass it on to the patients.
One many consider to change workflow, for example by putting one positive RTT on the console permanently, so she/he never actually has to interact with the patients and her/his colleagues.

 

[elementaryschooleconomics]

The plan is simple: Asymptomatic employees who have tested positive or are quarantined because of having had contact with someone positive are supposed to keep working with full protective equipment to make sure they won't pass it on to the patients.
One many consider to change workflow, for example by putting one positive RTT on the console permanently, so she/he never actually has to interact with the patients and her/his colleagues.

I wish you were my CMO

 

[Palex80]

I wish you were my CMO

We are actually hiring!

 

[RadOncMegatron]

This is what we're starting to deal with now. I'm not sure what the plan is if we reach a critical mass of RTTs out with COVID exposure or diagnosis (well, there is no plan I guess...).

Better learn how to drive the machine!

Edit: I want to make clear I have no idea how to run the machine lol

 

[elementaryschooleconomics]

Better learn how to drive the machine!

Edit: I want to make clear I have no idea how to run the machine lol

That was actually my first response when one of the therapists told me this morning that several RTTs were asked to quarantine - "So, uh, y'all looking for some moonlighters or...?"

 

[elementaryschooleconomics]

 

[seper]

I'm not at Mayo but there is a very similar problem at our hospital (a large Midwest operation).

Mayo Clinic: 900 employees at top US hospital catch Covid-19 in two weeks

Midwest hospital says most staff were not infected at work, with leading doctor saying: ‘It shows you how easy it is to get Covid-19 in the midwest’

www.theguardian.com

 

[RadOncDoc21]

I'm not at Mayo but there is a very similar problem at our hospital (a large Midwest operation).

Mayo Clinic: 900 employees at top US hospital catch Covid-19 in two weeks

Midwest hospital says most staff were not infected at work, with leading doctor saying: ‘It shows you how easy it is to get Covid-19 in the midwest’

www.theguardian.com

Do you think it’s more about geography or practices inside and outside of work? Just because there are protocols doesn’t mean people are following them and we all know that Midwest has a certain belief system in regards to the virus.

I know at my hospital, the staff can’t wait to take off their masks and live the pre-Covid lifestyle. I’m pretty sure we had a bunch of positive employees still working but PPE may have protected all of us in the end.

 

[scarbrtj]

Do you think it’s more about geography or practices inside and outside of work? Just because there are protocols doesn’t mean people are following them and we all know that Midwest has a certain belief system in regards to the virus.

I know at my hospital, the staff can’t wait to take off their masks and live the pre-Covid lifestyle. I’m pretty sure we had a bunch of positive employees still working but PPE may have protected all of us in the end.

Wondering what people think in regards to a Google of “Vinay Prasad Medpage Danish”

 

[seper]

Do you think it’s more about geography or practices inside and outside of work? Just because there are protocols doesn’t mean people are following them and we all know that Midwest has a certain belief system in regards to the virus.

I know at my hospital, the staff can’t wait to take off their masks and live the pre-Covid lifestyle. I’m pretty sure we had a bunch of positive employees still working but PPE may have protected all of us in the end.

Many hundreds of employees are out since 2 weeks ago; that made it harder to do brachy cases. Mask wearing is somewhat spotty so perhaps admins are right claiming that most employees contract Covid outside of the hospital.

 

[elementaryschooleconomics]

Man, I don't know about y'all, but my COVID+ patients seem to be skyrocketing.

This is straight up not fun.

 

[thecarbonionangle]

Is it just me or everyone in the clinic has a cough? I saw my chairman other day coughing up a lung, “just allergies” they said as i asked if they were ok. So we all “just have allergies”.

 

[Mandelin Rain]

Man, I don't know about y'all, but my COVID+ patients seem to be skyrocketing.

This is straight up not fun.

4 in the hospital currently.

 

[Mandelin Rain]

Is it just me or everyone in the clinic has a cough? I saw my chairman other day coughing up a lung, “just allergies” they said as i asked if they were ok. So we all “just have allergies”.

I've heard this time and again with staff/patients/etc..., a week later after coughing all over the place? COVID +, off 10 days.

 

[Radonc 2013]

Is it just me or everyone in the clinic has a cough? I saw my chairman other day coughing up a lung, “just allergies” they said as i asked if they were ok. So we all “just have allergies".

Until this year, I have never met so many people with seasonal allergies and now winter indoor allergies. I'm pretty sure I shouldn't be worried about these people in a hospital system reporting ~30-40% COVID positivity rates in patients with symptoms. I guess down some Zyrtec and move on?

 

[radOresident]

Me right now

 

[OTN]

Had my first on-treatment death the other day. GBM patient, got Covid from his wife, went downhill about halfway through treatment. He was only in the ICU for about 2 days.

We've rearranged our centers so that we have one treating ONLY Covid-suspect or known Covid-positive patients. Have more being treated there now than ever before.

 

[elementaryschooleconomics]

This has been discussed a bit on Twitter (and I think case reports?), but what are people doing with COVID+ lungs (Stage III or otherwise)?

 

[evilbooyaa]

We are treating COVID positive patients at end of the day. Thus far I believe we've had only one confirmed patient. Deep clean after that patient, prior to the next day.

 

[Palex80]

Is it just me or everyone in the clinic has a cough? I saw my chairman other day coughing up a lung, “just allergies” they said as i asked if they were ok. So we all “just have allergies”.

It's called "winter".

 

[OTN]

This has been discussed a bit on Twitter (and I think case reports?), but what are people doing with COVID+ lungs (Stage III or otherwise)?

Still treating at our Covid-only facility, though obviously decision to continue would depend on particular covid presentation, lung symptoms, volume of lung being irradiated, etc. All therapists have full gowns, gloves, N95s, and full face shields.

 

[metallica81788]

We are treating COVID positive patients at end of the day. Thus far I believe we've had only one confirmed patient. Deep clean after that patient, prior to the next day.

I tried to do this for a definitive lung patient who only had 5fx left and my institution wouldn't let me.

 

[medgator]

I tried to do this for a definitive lung patient who only had 5fx left and my institution wouldn't let me.

They make you put them on break?

 

[Mandelin Rain]

This has been discussed a bit on Twitter (and I think case reports?), but what are people doing with COVID+ lungs (Stage III or otherwise)?

Doing a few extra whole lung cone beams and curing that COVID.

 

[metallica81788]

They make you put them on break?

Policy was "10 days after symptoms or positive test" even though my entire team was comfortable treating him separately at the end of the day and deep clean afterward. I tried to just do it but administration stopped me. Very frustrating.

He did well and finished later, I got him back as soon as was "acceptable". My theory is he recovered quite quickly despite his performance status due to lack of functioning pneumocytes (this was third round of lung radiation and his lungs are awful).

 

[seper]

For those of you at hospitals “limiting elective procedures”, does RadOnc face any type of pressure to slow down? None whatsover at my place.