Interview with Edward Jasper by Mike Gregg, Editor
(1) Could you please briefly introduce yourself and explain what your role is at Jefferson Health?
I am an Emergency Medicine physician and medical director of emergency management for Jefferson.
(2) The current coronavirus (COVID-19) outbreak is now of international concern, has Jefferson Health ever dealt with such a high-profile infection before?
There have been other threats, like SARS in 2003 and H1N1 influenza in 2009, so we have been preparing for a pandemic possibility for years. COVID-19 is more severe than those in some ways, less severe in others, but it has clearly had a major impact on the U.S. and the world.
(3) What techniques do you use to minimize exposure of external patients to others before they arrive for a scheduled appointment?
We have been using telemedicine to try to prevent patients from arriving at doctor’s offices or the ED, if they can be safely cared for at home. For those who do arrive at private offices, urgent care centers or the ED, signage directs patients to put on a mask and they are put in a private room or negative pressure room.
(4) How will you ensure that mixing of potential patients with COVID-19 is prevented within the waiting rooms at ED?
Similar to the above answer, we use signage to direct patients to put on masks in the waiting room. We have also initiated a triage process in a tent placed outside the ED entrance to identify possible COVID-19 patients. These patients are given a mask and directed to a specific area of the ED to avoid exposing other patients.
(5) Please could you explain the process that you implement to screen potential patients for COVID-19? What is the current screening test and how accurate is it?
If the decision is made to screen patients, which is based on current CDC guidance, nasal swabs are drawn and sent to our hospital lab for processing. The sensitivity of the current tests is not completely known, and they can be falsely negative especially if done early in the disease, or if the sample does not contain an adequate amount of viral material. However, the specificity is excellent, so if the test is positive, it does likely indicate that the patient has the disease.
(6) How do you ensure patients with infections such as COVID-19 are quarantined to prevent the transfer to other patients within the hospital?
Patients would be admitted to negative pressure isolation rooms just like we do with diseases like tuberculosis. These types of rooms bring in air from outside the room to make them negative pressure compared to the exterior of the room, so no air escapes into the hallway. Patients with the disease are isolated, while those without the disease are quarantined, so there is a difference in terminology. Only those sick enough to require admission are actually admitted, while the rest are self-isolated or quarantined at home.
(7) Are you taking any additional precautions to prevent the spread of COVID-19 to immunocompromised patients?
Actually, our current negative pressure room isolation procedure protects every patient from exposure, whether immunocompromised or not.
(8) What steps are you taking to train your staff to deal with an outbreak such as this?
A variety of different training is taking place. These include educational updates via e-mail and in-person training on the use of personal protective equipment, or PPE. In addition, meetings with staff from various departments to review infection control procedures have already taken place and will continue as needed.
(9) How long do you expect Jefferson Health to have to implement screening and quarantine measures for coronavirus?
That question is very difficult to answer given all the uncertainties around this new disease. We, of course, hope this will be something like what happened to SARS and that it will begin to fade out as isolation and quarantine procedures are implemented on a global scale. However, we are prepared to continue current procedures for as long as necessary.
(10) How does the response to COVID-19 differ to SARS-CoV and MERS-CoV? What protocols did Jefferson put in place to deal with these back then?
While there are many more cases of COVID-19 than with SARS or MERS-CoV, the principles of preparing for a potential pandemic are similar. We purchased additional PPE over time, and staff have been trained on the use of advanced level PPE called Powered Air Purifying Respirators (PAPRs) when we developed our response plan for Ebola. Jefferson is, in fact, one of 8 state designated Ebola treatment canters in Pennsylvania, so we have done a lot of training and preparation in the area of highly infectious diseases.
(11) What wider obstacles or challenges do you expect will need to be overcome in order to control the virus now that it is widespread in the US?
For now, social distancing measures as well as isolation and quarantine of individual cases seems to be helping in the U.S. and other countries to slow the progression of this disease. We don’t know how long these measures will be needed or if there will be second waves of cases as social distancing measures are relaxed.
(12) Given your experience, what do you think the prognosis is for this infection?
Actually, no one has any experience with this disease, so making a prediction is very difficult. The good news is that strict social distancing measures have demonstrated effectiveness and a variety of new drug treatments and vaccine candidates are currently being investigated. Hopefully, we will have effective treatments soon as well as an effective vaccine.
Disclaimer
The opinions expressed in this interview are those of the interviewee and do not necessarily reflect the views of Taylor & Francis.
Declaration of interest
The interviewee has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.