150th Historical Exhibit Opens at Fort House Museum

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MCMS COVID-19 Updates 7/2/2020

The McLennan County Medical Society in partnership with physicians from the Family Health Center, Baylor Scott and White Hillcrest, Ascension Providence and representatives from the McLennan County Health District met virtually on Thursday July 2nd to discuss the “Current Status and Future Strategies” regarding COVID-19 in Waco, Texas.  

Please see the attached presentation if you would like to listen again or share with colleagues unable to attend.

Resources

  1. Copy of slide presentation
  2. COVID-19 information sheet for physicians from Dr. Verner
  3. DSHS Strategies for releasing from isolation or quarantine (time-based or test-based) – 2 pages
  4. Self-isolation instructions — for patients awaiting their test results or their call from the Health Department.
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COVID-19 Current Status and Future Strategies

The McLennan County Medical Society in partnership with physicians from the Family Health Center, Baylor Scott and White Hillcrest, Ascension Providence and representatives from the McLennan County Health District met virtually on Thursday evening to discuss the “Current Status and Future Strategies” regarding COVID-19 in Waco, Texas.  This physician oriented lecture covered a variety of topics including local data and testing, how contact tracing works, developing a unified testing strategy and prediction models for the coming months and years.  

Please see the attached presentation if you would like to listen again or share with colleagues unable to attend.

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Waco COVID-19 Update 4/2/20

As the acuity and incidence of cases increase locally, we continue to need to work together to communicate and care for our community.  
 

Situation Update as of 4/2/20

  • Worldwide Cases – 1,007,997 confirmed cases.  52,771 deaths. US, Italy, Spain, China and Germany have the highest confirmed cases. US now ranks 1st worldwide in total cases.
  • US Cases – 238,820 confirmed cases. 5,758 deaths. New York, New Jersey, California, Michigan and Louisiana have the highest confirmed cases. Texas ranks 12th nationally in total cases. 
  • Texas Cases – 4,669 confirmed cases. 70 deaths. Harris, Dallas, Tarrant and Travis counties have the highest confirmed cases. McLennan County ranks 18/254 counties. 50,679 tests completed in Texas at state and private labs with 9.2. 

               https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83  

  • McLennan  – 49 confirmed cases. 1 death. 6 cases hospitalized. 12 recovered.

*Note for case counts – We are reporting case counts from the CDC website. Due to increasing testing capacity at State and local labs around the country, the count may be lower than the numbers reported by media. 

 

Message from Dr. Verner:

“Locally our epidemic curve is still fairly linear.  Of note is that the number of cases without an identifiable exposure risk is definitely increasing indicating community spread.  Containment efforts with case finding and contact tracing can still be of real benefit.  While still important to test those with history of travel to high incidence areas as well as those with high risk comorbidities, if testing availability will allow, we would want to identify as many cases of community spread as possible.  This means testing more symptomatic patients without high risk factors hoping to identify cases occurring despite social distancing, hygiene and shelter in place efforts.  The message to symptomatic patients unable to be tested would be to act as if their test were positive and home isolate.

There is now data showing that the pre-symptomatic infectious period is probably around 2 days.  This makes social distancing especially important. Experience from other countries indicates that a significant portion of infections are transmitted by those unaware that they have it.”

 

Local Update

  • PPE – Visit covidwaco.comor email logistics@wacotx.govto request PPE for your clinic or facility.   Facilitation of resources is coordinated by the EOC in collaboration with multiple local entities including the McLennan County Medical Society.  MCMS will not be making final determinations regarding who receives which supplies nor storing any supplies; however, we will advocate for you if needed and please let us know of any special circumstances or critical needs in PPE. CDC has adapted some guidelines for reuse of PPE in certain circumstances.  https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
  • Plans have been made to accommodate surge capacity up to 130% in the coming days and weeks at both hospitals.  
  • Providence, Hillcrest and the Family Health Center have all adapted and are offering specially dedicated clinics for drive through testing and/or “Fever/URI” clinics.
  • Testing availability remains limited, but improved and is now being offered for more symptomatic patients.  
  • Telehealth continues to perform well and is being adapted by several local physicians and patients to see some chronic and acute care illnesses. Multiple resources are available online.
  • We are pushing for more transparency in testing data and epidemiological information available for physicians.
  • The MCMS is actively working to prepare confidential, local psychological support for our physicians via telehealth. We all realize that this is a stressful time and want to help provide a valuable resource for our members.  More information and details will be forthcoming.
  • The Waco City Council has voted to extend the local state disaster order to April 21 and postpone local elections until as late as November. 
  • Governor Abbott has announced that Texas schools will remain closed until May 4 and social distancing guidelines have been extended until April 30.  

 

See the CDC website for more information:
https://www.cdc.gov/coronavirus/2019-nCoV/summary.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html  
 
Again, this is a consolidation of physician specific information from the Waco-McLennan County Public Health District, CDC, BS&W Hillcrest, Ascension Providence and DSHS communications.  We advise following the guidelines distributed from your hospital system if applicable. More information and updates will follow as the situation continues to evolve.
 
*Please reply to this email with any COVID-19 management criticisms and/or suggestions that we can bring to city and healthcare officials.*
 
William McCunniff, MD, MBA                                                Farley Verner, MD
McLennan County Medical Society                                       County Health Authority 
President                                                                               Infectious Disease Specialist

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Waco COVID-19 Update 3/25/20

Situation Update as of 3/25/20
·  Worldwide Cases – 468,523 confirmed cases.  21,192 deaths. China, Italy, US, Spain and Germany have the highest confirmed cases. US now ranks 3rd worldwide in total cases.
·  US Cases – 66,048 confirmed cases. 944 deaths. New York, New Jersey, California, Washington and Michigan have the highest confirmed cases. Texas ranks 11th nationally in total cases. 
·  Texas Cases – 974 confirmed cases. 12 deaths. Dallas, Travis, Harris and Tarrant counties have the highest confirmed cases. McLennan County ranks 9/254 counties. 13,325 tests completed in Texas at state and private labs.
               https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83  
·  McLennan  – 28 confirmed cases. 0 deaths. 3 cases have been hospitalized. 1 recovered.
*Note for case counts – We are reporting case counts from the CDC website. Due to increasing testing capacity at State and local labs around the country, the count may be lower than the numbers reported by media. 
 
·         Community spread is occurring and increasing in Texas. McLennan County announced that we do have apparent community spread.
·         This is a Critical point in this pandemic. Collective actions for preventing and mitigating infection will help slow the spread and help the healthcare system continue to treat and manage this surge.
 
Message from Dr. Verner:
 
“A week into the epidemic the curve is still linear.  Exponential growth as seen in areas with high activity can be expected unless we learn from the experience of those already being devastated.  Hopefully we are early enough on the curve here to avoid mirroring their outcome.  An early and aggressive social distancing policy has been instituted here with the current shelter in place order and a strong social distancing message.  Epidemiologists at the health district are investigating all positive cases and instructing them regarding self-isolation.  Close contacts are notified and instructed on self-isolation (quarantine) and actively monitored regarding onset of symptoms.  This capability becomes more difficult with large numbers of cases. What may have the greatest effect on the extent of person-to-person spread is reducing the time when a person with COVID-19 is contagious and not yet self-isolating.  Those that present with COVID-19-like symptoms would ideally be tested.  The availability of testing is unfortunately, currently limited.  Hopefully this time of shelter in place can significantly impact the number of new infections for a time until the anticipated increased availability of testing can happen.  For now and until rapid testing is widely available, we are recommending that those who cannot be tested act as if they tested positive.  Guidelines for self-isolation are available from the CDC website as well as the health department and are part of instructions to patients in the EMR  of the larger clinic systems. According to the current CDC recommendations, persons with COVID-19 can discontinue home isolation when all of the following conditions are met: No fever for 3 days (72 hours) without use of fever reducing medications and improvement in respiratory symptoms (e.g. cough, shortness of breath); and at least 7 days have passed since symptoms first appeared.
 
Resist requests for prescriptions for hydroxychloroquine or chloroquine for non-approved use. Hydroxychloroquine is being used to treat hospitalized patients. There is unfortunately already a shortage developing due to hoarding.
 
Onset of anosmia and aguesia as symptoms of COVID-19 is being recognized. Still very uncommon but unusual enough to dramatically raise the suspicion if present.”
 
Local Update

  • PPE – You will hear tomorrow (3/26) of a centralized location for donation and requests for PPE (coordinated by the EOC in collaboration with multiple local entities including the McLennan County Medical Society).  More information will be posted on the city’s website as well.  Requests for PPE will be directed to email logistics@wacotx.gov.   Please be considerate and respectful in requests.  MCMS will not be making final determinations regarding who receives which supplies nor storing any supplies; however, we will advocate for you if needed and please let us know of any special circumstances or critical needs for PPE.
  • The Medical Society has teamed with the Waco Chamber along with the Texas Medical Association to request PPE from local businesses and industries.  These unused products will be available by emailing the aforementioned email address. We have requested surgical masks, N95 masks, disposable gloves, bleach, disinfectant and cleaning supplies, disposable medical gowns and protective shoe covers.
  • Telehealth continues to perform well and is being adapted by several local physicians and patients to see some chronic and acute care illnesses.
  • The Family Health Center, Ascension Providence, and BS&W Hillcrest have all (in different states of adaptation) created specially dedicated clinics to either accommodate some drive through testing and/or “Fever/URI” clinics.  See each entities’ website for more information.
  • Testing availability continues to be restricted.  Leaders from all levels of government are hearing our requests to increase availability.  

 
See the CDC website for more information:
https://www.cdc.gov/coronavirus/2019-nCoV/summary.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html  
 
Again, this is a consolidation of physician specific information from the Waco-McLennan County Public Health District, CDC, BS&W Hillcrest, Ascension Providence and DSHS communications.  We advise following the guidelines distributed from your hospital system if applicable. More information and updates will follow as the situation continues to evolve.
 
William McCunniff, MD, MBA                                  Farley Verner, MD
McLennan County Medical Society                        County Health Authority 
President                                                                Infectious Disease Specialist

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Waco COVID-19 Update 3/18/20

Fellow McLennan County Physicians,

The time has arrived where we have our first confirmed cases of COVID-19 in Waco.  The confirmed local presence of this will create additional public concern, thus it remains pivotal that we all remain united, with good communication, in order to best relay data, treat, limit and help prevent further cases locally.  Dr. Farley Verner, local Health Authority and Infectious Disease specialist, has joined with me to start sending out these additional updates, Q&A and local information.  As always, we want to keep this relevant.  Let us know if you have any additional issues, suggestions or questions that you think would be helpful for the entire McLennan County Medical Society.  Please continue to follow CDC recommendations and any hospital issued recommendations for those employees of the hospitals.

Situation Update as of 3/18/20
·  Worldwide Cases – 217,977 confirmed cases.  8,800 deaths. China, Italy, Iran and Spain have the highest confirmed cases. US now ranks 6th worldwide in total cases.
·  US Cases – 9,371 confirmed cases. 153 deaths. New York, Washington, California, and New Jersey have the highest confirmed cases. Texas ranks 10th nationally in total cases.
·  Texas Cases – 83 confirmed cases. 2 deaths. Harris County, Fort Bend County and Dallas County have the highest confirmed cases.
·  McLennan  – 6 confirmed cases. 0 deaths. All with travel history.
*Note for case counts – We are reporting case counts from the CDC website. Due to increasing testing capacity at State and local labs around the country, the count may be lower than the numbers reported by media.

Local Update
·  The City of Waco issued a Disaster Declaration on Tuesday, March 17th. That Declaration included the closure of restaurants and other public facilities, as well as prohibiting gatherings of 50 people or more. Questions about those closures can be found here: https://www.waco-texas.com/information-release-2.asp
·  Both hospital systems and the Family Health Center have implemented some form of drive thru testing. Patients need to be screened on the phone or online prior to going to these locations for testing
·  Weekly meetings are occurring with members from both hospitals, the Family Health Center, city leadership, the health department, the medical society and Dr. Verner.
·  An iPhone app option through BSWH and Providence are both available for patients to receive local tele-consultation and guidance for further testing.
·  Both hospitals are prepared to provide care for any patients who ultimately test positive and need hospitalization.
·  Activation of the EOC/MOC will occur this week, Thursday afternoon at the earliest. It will be a mostly virtual activation with daily IAPs and Sitreps distributed.
·  Up until a week ago all local tests were performed at the CDC or at the Texas DSHS state lab. These specimens are submitted with the coordination of the Health District. Baylor Scott and White system laboratory has begun performing its in-house test for its Waco affiliates. During the week of March 9 local commercial laboratories began accepting specimens for testing. The ascension Providence system, The BS&W system and the Family Health Center are each developing specific sites for use in obtaining specimens within their systems.  They give all details to their providers.
·  Laws/TMB regulations have been relaxed for tele-health visits and many local physicians have transitioned to offering some of these visits when applicable.

Q: At what point do we consider “possible” domestic exposures as a potential exposure to pursue testing?  Which locations nationally are considered?

A: Sustained community spread has occurred in California, in two places, Oregon and Washington.  The criteria for testing has been expanded to include more symptomatic persons, even in the absence of travel to affected areas as the ability to access testing is improving.

Q: Should post-exposure prophylaxis be used for people who may have been exposed to COVID-19?

A: There is currently no FDA-approved post-exposure prophylaxis for people who may have been exposed to COVID-19.

Q: What do I do if I have concerns about a patient being infected?

If patient calls your clinic with a concerning history for infection and meets screening criteria:
Advise patients to contact their PCP’s office for further direction in the evaluation and testing.

If patient is in your office:
If you work at a BS&W Hillcrest or Ascension Providence facility, follow the protocols designated by your hospital.  Several clinics have been trained to test at point of care after proper screening if needed.
If independent, follow “Screening Questions” in previous email or on CDC website, contact the health department at 750-5411 (physician line only) and/or contact local EMS.

Q. Are there any guidelines regarding cancellation of surgeries or non-emergent chronic follow up appointments?

A: Many factors are involved with these considerations.  See American College of Surgeons recommendations.
https://www.facs.org/about-acs/covid-19/information-for-surgeons/triage

Q: If someone from our office staff is potentially exposed either by a positive case or family member/friend, what are the recommendations?

A: This will become a more relevant question as the confirmed cases become more prevalent.  More information to come. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html

Q: What if we do not have any N-95 masks or have a shortage of PPE?

A: The TMA has a resource where physicians can contact their Regional Advisory Committee. There is anticipation of a greater shortage in the coming days. We advise early recognition and planning. Contact the health department for further questions and plans to obtain additional PPE.

Q: Are there any new treatment guidelines?

A: Corticosteroids are not routinely recommended for viral pneumonia or ARDS and should be avoided unless they are indicated for another reason (e.g., COPD exacerbation, refractory septic shock following Surviving Sepsis Campaign Guidelines).  There are no antiviral drugs licensed to treat COVID-19 at this time. Vaccinations are also in the works but will not be available in the near future.

The Lancet published an article on 3/17/20 showing no clinical evidence of a connection between ACE inhibitors and ARBs with worsened symptoms of COVID-19.

Mixed information has been disseminated from France about avoiding ibuprofen usage in the presence of COVID-19. There has not been an official American recommendation given at this time due to limited evidence.

See the CDC website for more information:
https://www.cdc.gov/coronavirus/2019-nCoV/summary.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html

Again, this is a consolidation of physician specific information from the Waco-McLennan County Public Health District, CDC, BS&W Hillcrest, Ascension Providence and DSHS communications.  We advise following the guidelines distributed from your hospital system if applicable. More information and updates will follow as the situation continues to evolve.

*Please reply to this email with any COVID-19 management criticisms and/or suggestions that we can bring to city and healthcare officials.*

William McCunniff, MD, MBA                Farley Verner, MD
McLennan County Medical Society       McLennan County Health Authority
President                                               Infectious Disease Specialist

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Waco COVID-19 Update 3/14/20

Fellow Physician Colleagues,

As the response to COVID-19 continues to affect us all, we have an even greater responsibility to our patients in order to provide them accurate information and guidance during this pandemic.  There have been multiple task forces and guidelines produced nationally and on the state level.  The McLennan County Medical Society will continue to help you in distributing local response measures that affect us here in Waco should you encounter any patients with symptoms or questions about COVID-19.  Please continue to follow CDC recommendations and any hospital issued recommendations for those employees of the hospitals.

Situation Update as of 3/14/20

  • Worldwide Cases – 155,371 confirmed cases.  5,802 deaths. China, Italy, Iran and South Korea have the highest confirmed cases. US ranks 8th worldwide in total cases.
  • US Cases – 2,572 confirmed cases. 51 deaths. New York, Washington, California, and Massachusetts have the highest confirmed cases. Texas ranks 10th nationally in total cases.
  • Texas Cases – 51 confirmed cases. 0 deaths. Harris County, Fort Bend County and Dallas County have the highest confirmed cases. Bell county is the closest county currently with a confirmed case.
  • McLennan County does not have a confirmed case currently.

*Note for case counts – We are reporting case counts from the CDC website. Due to increasing testing capacity at State and local labs around the country, the count may be lower than the numbers reported by media.

COVID-19 continues to be more harmful to individuals over 65 years old compared to younger individuals.  Those with underlying health problems make them more susceptible to complications from pneumonia.

  • Risk factors – diabetes, heart disease, lung disease, immunosuppression, renal and liver disease, pregnancy, blood disorders

Per the DSHS, a recent report found that the virus can live for 2-3 days on stainless steel and plastic and in the air for up to 3 hours following aerosolization.

Local Update
Plans are in the works for 2 “drive through” testing locations in the community for specific patients and will likely be implemented early next week.  Once locations and openings are confirmed, we will send out further information.

Specific clinics and locations for patients suspected to be positive will also be opening next week. Further information is pending.

Greater Waco schools have delayed re-opening until March 20 and March 27 tentatively.  Keep in mind that this may affect your staff availability in the coming weeks.

Weekly meetings are occurring with members from both hospitals, the Family Health Center, city leadership, the health department, the medical society and Dr. Verner our local health authority and ID specialist

An iPhone app will be released early next week for patients to receive local tele-consultation and guidance for further testing. More information to come.

Both hospitals are prepared to provide care for any patients who ultimately test positive.

Community mitigation strategies have been pushed to employers, schools and others to help slow the transmission of the virus.  https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdf

Stockpiling has been occurring throughout the nation with several local stores sold out of specific goods.  HEB has implemented adjusted hours to allow time for restocking.

COVID-19 Testing

Testing availability has improved drastically with testing done at all state labs and within Central Texas early next week.  Turnaround on testing (nasopharyngeal swab) has improved to 6 hours once the sample is received while some testing facilities are still reporting 48 hour turnaround time.

No testing can be done for asymptomatic patients at this time.

Texas can perform 273 tests per day with next week the ability to test 500 or more.

Influenza activity continues to be elevated.

What do I do if I have concern a patient may be infected?
If you work at a BS&W Hillcrest or Ascension Providence facility, follow the protocols designated by your hospital.
If independent, follow “Screening Questions” in previous email or on CDC website, contact the health department at 750-5450 or 750-5472 and/or contact local EMS.

COVID-19 Treatment
There is no specific antiviral treatment recommended for COVID-19 infection. People infected with COVID-19 should receive supportive care to help relieve symptoms.

COVID-19 Prevention
Utilize standard airborne, contact and eye protection (gown, gloves, and N-95 respirator or surgical mask (when N-95 not available), goggles or face shield)

  • Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and isolating them in an Airborne Infection Isolation Room (AIIR), if available
  • Use Standard PrecautionsContact Precautions, and Airborne Precautionsand eye protection when caring for patients with confirmed or possible COVID-19
  • Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use soap and water if hands are visibly soiled
  • Practice how to properly don, use, and doffin a manner to prevent self-contamination

See the CDC website for more information:
https://www.cdc.gov/coronavirus/2019-nCoV/summary.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html

 

Again, this is a consolidation of physician specific information from the Waco-McLennan County Public Health District, CDC, BS&W Hillcrest, Ascension Providence and DSHS communications.  We advise following the guidelines distributed from your hospital system if applicable. More information and updates will follow as the situation continues to evolve.

 

William McCunniff, MD, MBA

McLennan County Medical Society

President

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