Covid-19 Disease Outbreak Management - Nevada
NevadaCOVID-19Disease Outbreak ManagementStrategy and Concept of OperationsJune 1, 2020
This page is intentionally blank
Table of ContentsI.Purpose1II.Goal, Mission and Objectives1III.Concept of Operations2IV.Course of Action: PPE Stockpile4V.Course of Action: COVID-19 Sample Collection Supply Chain7VI.Course of Action: Community-Based COVID-19 Sample Collection9VII.Course of Action: Enhance Laboratory Testing Capacity14VIII.Course of Action: Outbreak Management (Contact Tracing)16IX.Course of Action: Mass Vaccination Operations21X.Nevada National Guard Support24Annex A: Laboratory Testing External Supply Order Form27Annex B: Community-Based Testing Resource Request Form29Annex C: Community Based Collection Site Development Handbook30
This page is intentionally blank
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of OperationsI.PurposeThe purpose of the Nevada COVID-19 Outbreak Management Strategy and Concept ofOperations (COP) is to develop an operations surge strategy and sustainment capability toprevent the spread of COVID-19 and mitigate any outbreak of COVID-19, and develop astrategy to transition state response to shared public and private partnership utilizing Nevada’spublic and private health care systems. This strategy will be a bridge from the current crisisresponse to an enhanced normal disease management process while being prepared for asignificant outbreak.Community-based testing, testing through the private sector, and disease outbreak managementwill be essential to reopening the Nevada economy. Transitioning to a more sustainable hospitalbased supply, in particular for Personal Protective Equipment (PPE), while maintaining a surgecapacity is key to ensuring the healthcare infrastructure is not overwhelmed in the case of futureCOVID-19 spikes or sustained future waves. As the state transitions from crisis management,Nevada has established five lines of effort as a bridge to a normal process: PPE Surge CapacityCOVID-19 Specimen CollectionLaboratory Testing PCR and AntibodyCase Investigation and Contact TracingMass Vaccination OperationsII.Goal, Mission and ObjectivesGoal:Bridge to a normalized process. While the State is still firmly in the response phase of theCOVID-19 crisis, the State’s goal is to establish processes which may be easily transitioned froman emergency logistics and response mission to a normalized process which does not require theSEOC intervention.Mission:The Mission of the Nevada COVID-19 Outbreak Management Concept of Operations is toenhance Nevada’s capacity to support community based test collection sites, streamline andincrease the capacity to meet statewide COVID-19 virus detection through PCR and antibodytesting needs, and increase the capacity of the state and local jurisdictions to epidemiologicallymanage the presence COVID-19 disease in the population.1
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of OperationsObjectives:1. Enhance and support the state and local capacity to manage COVID-19 outbreaks and torapidly respond to spikes of disease through increasing the outbreak managementcapability.2. Establish a Nevada PPE stockpile.3. Synchronize supply operations for COVID-19 specimen collection to supportcommunity-based testing missions and surge sample collection supplies to meet currentand anticipated needs.4. Establish a statewide best practice model for community-based testing and establish astatewide testing support capability.5. Enhance the statewide capacity to perform COVID-19 virus Polymerase Chain Reaction(PCR) testing and COVID-19 Immunoglobulin G (IgG) antibody testing.6. Prepare the state for mass vaccination operations to be able to inoculate 80% of the stateresidents.7. Establish performance measures for each line of effort in order to ensure systemaccountability and provide the Governor with decision-level information.III.Concept of OperationsConcept of OperationsBuild Capacity to Surge.Build Hospital and CommunityPPESurge Capacity2 Months Peak PPE Stoclq,ileCache 2 Weeks of PPE at Area Hospitals.Surge purchaseenough PCR specimencollectionkits for 200,000testsSurge purchasespecimencollectionsupplies for 680,000antioodytests.Support CBCS.Transition to a Sustained NormalProce ss.Aggressively Respond to Out breaks.Personal Protection EquipmentHospitals Stabilize Supply Chain2 Weeks of Additional hospital PPE on HandCommunitiesand BusinessesBuild PPE Cache.Comm unity Based Specimen CoUectioo.Surge purchase enough PCR testingkitsfor 200,000 testsSurge purchase Testing kits for 680,000anlloodytests.LaboratoryPCR and AntibodyTestingPrepare the tate to \-accinate 80% of thepopulation allocation. Surge i ,W sVaccinationcapaci tySurge public mei;aging for ;easonaJ:Du-.,accine .Retainenoughtestingsuppliesto test. 120,000per month for 2 months PCRtests and half the populationforAntibodyTests.Transition to medical providerpointof caretesting,commerciallaboratoryand hospitalbased laboratory testingISurge 450 Contact Tracerthio ugh directhire, \·olunteen and \·endor-basedstaffing.I 00 paid contact tracers at state, countyand tribal level/Retainenoughspecimencollectionsupplies to be ableto surge collect at /facilities,businessesor communitiesthat experiencesoutbreaksTransition to medical providerand hospitalbased specimencollectionIRelease State PPE Cache SupplementPPE from State Stoclq,ileYlaintainStoel-pile Le,·els uithSupplementalOrdering/I.Patient Contact TncingYlaintainI 00 paid contacttracer.; E\-eryposil:i\'4!test will be comcted by acomaa tracerwithin 24- houn .a comaatracer .Preparefor l\lass \"acdnationsPreparetraditional\·accinationsites for mas vaccination \ll gefor s.eas:onalflu andCOv1D-192.""'\1/i!biD24 bours ofidemif)ing a cloH comaa /of a case,.thosecomaaswill be contactedby!l,lassinoculate.80%ofthepopulationwith COVID-19vaccine./""'
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of OperationsThe Concept of Operations will be achieved based on the three overarching strategies listedbelow and executed with five main lines of efforts to achieve the execution of concept. Build Capacity to SurgeTransition to a Sustained Normal ProcessAggressively respond to OutbreaksBuild Capacity to SurgeThis strategy develops a Strategic Nevada Stockpile which includes hospital PPE, specimencollection supplies, PCR and antibody laboratory testing supplies, and vaccination capability,along with surge patient contact tracing capacity to prepare the state to immediately meet anyoutbreak of COVID-19 infection.Transition to a Sustained Normal ProcessThis strategy develops an orderly transition from state supported COVID-19 response, as supplychains normalize, to a public health and health care industry-based response through primarycare and acute care providers.Aggressively Respond to OutbreaksThe key to maintaining an open economy will be the capability of the State to effectivelyrespond to spikes or outbreaks of COVID-19 transmission. If a statewide outbreak occurs,Nevada will have the capacity to manage the outbreak without a significant impact on the healthcare system necessitating crisis standards of care.Statewide Unified Effort OrganizationOffice of theGovernorCOVID-19Response DirectorIII.Division of EmergencyManagem entComm uni ty B asedCo ll ection SitesPPE Stockp ileCoo rdinationNevada State Public HealthLabSpec im en Co ll ection KitsPCR TestingAntibody Testing.3I.Division of Public andBehavioral HealthContact TracingMass VaccinationOperations
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of OperationsNevada COVID-19 Response DirectorThe Nevada COVID-19 Response Director will coordinate resources and the work acrossmultiple state, local and federal entities to respond to COVID-19, including the following: Federal agencies, including the Federal Emergency Management Agency (FEMA) andthe U.S. Department of Health and Human Services (HHS); State agencies, including the Division of Public and Behavioral Health (DPBH) withinthe Nevada Department of Health and Human Services (DHHS), the Division ofEmergency Management (DEM), and the Nevada State Public Health Lab (NSPHL); and Local agencies, including local emergency management, public health authorities, andcity and county officials.Nevada Division of Emergency ManagementThe Nevada Division of Emergency Management supports the local Community BasedSpecimen Collection Sites (CBSCS) and mass vaccination operations including the following: Coordinates with the Nevada State Public Health Laboratory for specimen collection kits. Coordinates with the Division of Public and Behavioral Health (DPBH) to provide BattleBorn Medical Corps volunteers for specimen collection. Coordinates with the Nevada National Guard (NVNG) for collection support personnel. Coordinates with the local jurisdiction and DPBH for mass vaccination operationssupport. Coordinates the purchase of surge PPE stockpile.Nevada State Public Health LaboratoryThe Nevada State Public Health Laboratory will coordinate all specimen collection supplies andmanages all statewide testing.Nevada Division of Public and Behavioral HealthThe DPBH will coordinate and manage all patient case investigation and contact tracingoperations and support local health authority efforts. The DPBH also leads the statewide massvaccination operations.IV.Course of Action: PPE StockpileGoalWhile maintaining adequate PPE levels at hospitals, nursing care facilities, community firstresponders and essential government services, establish a two-month stockpile of PPE at peakCOVID-19 usage for future outbreaks or waves of COVID-19 or other novel diseases.4
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of OperationsStrategy Resupply the pre-COVID-19 state stockpile. Surge purchase 60 days of average peak PPE daily rates for hospitals and communities asa strategic stockpile.PPE Planning Criteria1. Resources required for state stockpileGLOVES N95 MASKSCOVERALLSFACE SHIELDSGOWNSPAPRs2. Establish Strategic Nevada Stockpile based on Strategic National Stockpile PPEquantities received and Pre-COVID 19 Nevada PPE cache.PRE-COVID STOCK &SNS PPE RECIEVEDQUANTITYPRICE/ITEMCOSTN95 53,64024054,624 5 2.15 0.18 15 103,363,000102,23345,6553,600546,240 4,060,7283. Surge stockage level 60 days @ peak consumption levels from original response.4. Peak usage levels per day (as reported by Nevada Hospital Association). Additional20% for “all other” care providersa. Gloves – 625,000 20% 750,000/dayb.Disposable face shields – 4,613 20% 5535/dayc. N95 masks - 7,100 20% 8,520/dayd.Gowns – 7,500 20% 9,000/daye. Coveralls – 106 20% 127/dayf. PAPRs – 8 20% 10/dayNVDEM SURGESTOCKPRICE/ITEMITEMS/DAYGLOVESDISPOSABLEFACE SHIELDSN95 MASKSGOWNSCOVERALLSPAPRs 0.18 10.00750,0005,535 5.00 2.15 15 800.00TOTAL8,5209,00012710ITEMS FOR60 DAYS45,000,000332,100511,200540,0007,620600COST FOR 60DAY SUPPLY 8,100,000.00 3,321,000.00 2,556,000.00 1,161,000.00 114,300.00 480,000.00 15,732,300.005. Establish Nevada Public Health System PPE surge stockpile 60 days ofconsumption.5
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of OperationsPUBLICHEALTHSYSTEMSURGE STOCKGLOVESDISPOSABLE FACESHIELDSN95 MASKSGOWNSCOVERALLSPAPRsPRICE/ITEMITEMS/DAYITEMS FOR60 DAYSCOST FOR 60 DAYSUPPLY 0.18 10.00772,99910,81146,379,940 8,348,389648,660 6,486,600 5.00 2.15 15.00 2,580 4,732,200 2,907,273 318,600 2,064,000 24,857,0626. State of Nevada public in person service / customer service state employees will requiremasks during the phased re-opening of government offices. The State has approximately18,000 employees. We estimate half will require masks to resume operations beforeimmunity is achieved. An initial one month’s supply will facilitate re-opening. Re-supplyof masks should be accomplished through normal departmental ordering processes usingthe good of the state contracts.PRICE/ITEMSTATECUSTOMERSERVICE INITIALSTOCKITEMS/DAYITEMS FOR30 DAYSCOST FOR 30 DAYSUPPLYMASKS1 per shift180,000 900,000 900,000 5.00TOTAL7. Total PPE Cost is 45,550,090.00 10% shipping and handling ( 4,555,009) 50,105,099Transition to a Normal ProcessAs the supply chain normalizes and the hospitals are able to resupply via their usual supplychain, hospitals will be expected to maintain a two-week cache of PPE which does notinclude the state cache.A Purchasing Desk at the SEOC was established to enable the transition from Statesupported response to local jurisdiction. The State will engage with traditional andnontraditional vendors to meet immediate needs while establishing long term contracts6
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of Operationsleveraging the States buying power. State Purchasing will serve as the resource by whichcontracts intended for statewide use are executed for PPE, collection materials, and testingmaterials and services.Aggressively Respond to OutbreaksIf a significant outbreak occurs which threatens to limit PPE usage to crisis standards of carelevels, the Governor may release the PPE caches and release PPE from the stockpile.V.Course of Action: COVID-19 Sample Collection Supply ChainGoalEstablish a supply chain using the Nevada Public Health Laboratories as a conduit for samplecollection kits. Surge purchase sample collection supplies enough to test 200,000 samples at anypoint of the crisis. 150,000 sample collection kits or components purchased within 1 month and 10,000 kitsor components will be purchased every month for the following 5 ngProcess Pi c k uparS te ps f or suc c essfulorde r i n g o f sam p ling suppl ies:1.Co mp l e t e th e " EXTER NAL SU PP LY O RDE R FORM - co mp l e t e ly.2.Ca ll, Fax or E m a il t h e fo rm to th e l a b in your j uri sdic t ion a l ar ea(2 4 / 7 in R e n o or L a.s V e ga s., b a s e d on t h e m a p provid ed )3.A n swer the l a b s qu es t ions . T he l a b will r e viewa ppr op ri at e n e s s pr-ior t o c ompl e t in g t h e k rts .4.P r epa r e t o p ick up y o ur o rd e r. Th e la bu p, Mon da y - Fr i d a y (8 0 0 - 1700 ).5.If youa r e un ab l e to p ic k up ,. youD E M f o r p o t e nti a l d e liv e ry optio\iV illt:t he labas ses s m e n t Comp le t eth e kits Beg insa m p lin g "'theno t ify y ou fo r p i ckwill n e ed t o co ord i n a t e w ithn s. - -Supply Chain Process The Nevada State Public Health Laboratories (NSPHL) in Reno and Southern NevadaPublic Health Laboratory (SNPHL) in Las Vegas will be the lead in all COVID-19collection sampling supplies.7
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of Operations Jurisdictions will order all collection sampling supplies from the public healthlaboratories using the External Supply Order Forms provided in Annex A.Normal ordering for routine collection sampling supplies for routine testing must befaxed to the NPHL every first, third and fifth Mondays of the month. For NorthernNSPHL the fax number is (775) 688-1460. For SNPHL the Number is 702-759-1444.The forms also must be either sent to the SEOC or placed into WEBEOC with thecomment, “Faxed to State Health Lab of this date.”Emergency Managers, County Health Officers, or Hospitals from Clark County, LincolnCounty and Pahrump in Nye County may order their collection sample supplies fromSNPHL in Las Vegas.Emergency Managers, County Health Officers, or Hospitals from all the rest of theNorthern Counties may order their collection sample supplies from NSPHL.Jurisdictions desiring supplies for mass community-based collection must submit theirrequest to the NPHL at least 2 weeks prior to the collection date so the Labs can ensureenough supplies are on hand and available to meet the request for supplies and ensuretimely turnaround of results.The State Emergency Operations Center (SEOC) will provide a Liaison to the publichealth labs to assist with the completion of supply orders and to facilitate deliverytransportation.The laboratories will supply DEM with a daily report on testing supplies ordered andsupplies distributed by facility. The reports will be used to facilitate statewideprocurement, management, and sustainment of COVID-19 testing in Nevada.Test Collection Supply SurgeThe surge collection and testing goal is to perform up to 4,000 diagnostic laboratory tests per dayand have the capability to test 2% of population each month. To achieve this goal, the state willneed 200,000 swabs and viral testing media (VTM) kits available for distribution.The strategy for the state will involve a surge purchase of six-month supply by procurementthrough purchase and donation to meet the needs of the State’s the Recovery Plan. The strategyfor the end user of this program will be to order your supplies for a two-week period or forestablishment of a Community Based Testing/Collection process. The sustained supply chainwill allow Nevada to continue and expand its testing capabilities, for both symptomatic andasymptomatic testing.The projected costs for supplying the public health labs with supplies to create collection kitsuntil December 31, 2020 are: 8,646,597, this includes: swabs, viral medium, and tubes. Theseprojections were derived through the costs per a unit sent to us by the NSPHL. With input fromThe Director of NSPHL, the same amounts were projected for the SNPHL.8
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of OperationsMonthly Collection Kit Construction (200,000 Kits)Unit Costs Q uantityNasopharyngeal swabFetal Bovine SerumMonthly Costs 2.14 200,000 swabs 428,000.00 432.50 20 bottles 8,650.00Hank's Balanced Salt Solution 36.99 1,200 bottlesGentamicin Sulfate (50mg/ml) 60.34 40 bottles 2,413.60Amphotericin B (250 ug/ml) 87.93 40 bottles 3,517.20Sheep's Blood Agar 25.45 1000 plates (45 packs of 10)Ethanol (70%) (gallon) 28.50 4.44 gallons15 ml conical, polypropylene (rack of 500)Biohazard transport bags (pack of 1000) 44,388.00 25,450.00 126.67 118.00 400 racks of 500 47,200.00 22.00 200 packs of 1000Total Monthly Costs:Months Until End of CY 4,400.00 564,145.477End of CY 20 Projection Northern Lab: 3,949,018.27w/Southern NV Health District 7,898,036.53w/Hologic Panther Units and Kits 8,346,596.53w/Refrigeration Units North and South Labs (O ne-time Costs) 8,646,596.53Transition to a Normal ProcessAs the technology advances to point of routine testing in primary care offices, hospital labs andcommercial diagnostic laboratories will take over the majority of the testing and the suppliesneeded for the testing will transition to point of care purchase. We fully anticipate that after 2021the majority of the COVID-19 testing will be performed by commercial laboratories.Aggressively Respond to OutbreaksThe public health laboratories in Nevada will maintain a stockpile of 200,000 specimencollection kits or combination of components to make the collection kits as a reserve to maintaina 30-day supply on hand in order to respond to an outbreak or wave of COVID-19VI.Course of Action: Community-Based COVID-19 Sample CollectionCurrently there are three systems for the collection COVID-19 specimens: Hospital testing of symptomatic patients, Private laboratory testing, and9
Nevada COVID19 Disease Outbreak ManagementStrategy/Concept of Operations Community-based mass testing or targeted testing among high risk groups.GoalThe goal for community-based testing is to build the capacity to obtain viral sampling materialsto collect up to 200,000 specimens at any time. Community-based testing should be coordinatedby the local or tribal health authority, local or tribal emergency management and the leadershipof the local government or tribe.The Nevada Division of Emergency Management utilized its expertise to develop a “BestPractice” COVID-19 Community Based Collection Site (CBCS) Development Handbook whichis Annex C of this D
Nevada COVID19 Disease Outbreak Management Strategy/Concept of Operations Objectives: 1. Enhance and support the state and local capacity to manage COVID-19 outbreaks and to rapidly respond to spikes of disease through increasing the outbreak management capability. 2. Establish a Nevada PPE stockpile. 3.
Outbreak vs Pseudo-outbreak Outbreak generally refers to situations in which there is clinical disease or clinically relevant culture results. Pseudo-outbreak is generally used to refer to situations in which there is a rise in positive culture
Atherosclerotic Disease is a Pan Vascular Process Coronary Artery Disease (CAD) Non-coronary Atherosclerosis -Peripheral Artery Disease (PAD) -Lower extremity -Upper extremity (subclavian stenosis) -Carotid artery disease -Renal artery disease -Mesenteric artery disease -Aortic aneurysm -Vasculogenic Erectile Dysfunction Vascular disease is
This Rapid Outbreak Assessment (ROA) covers the public health risk assessment for the contaminated food products related to this event. Multi-country investigations EU/EEA outbreak case definition The European outbreak case definition
Date of Issue: 6 October 2020 35,112,928 cases and 1,035,766 deaths Data sources: World Health Organization and African Union Member States Outbreak Update: Since the last brief (29 September 2020), 2,073,499 new confirmed 1. coronavirus disease 2019 (COVID-19)
Center for the Study of Traumatic Stress – COVID-19 Resources Covid-19: Grief, Loss of the Assumptive World and Meaning Making Covid-19 and Non-Death Loss Grief and COVID-19: Mourning our bygone lives How ‘Anticipatory Grief’ May Show Up During the COVID-19 Outbreak Self-Care through a Resilience Lens
A contracted Outbreak Rapid Response Team may be deployed to provide full onsite outbreak management. Support could include onsite assessment, clinical expertise, testing support, and service coordination. The team may provide some combination of supports, as appropriate:
COVID-19 Mental health impact COVID-19 Impact on Sleep COVID-19 Positive Impacts University of California, San Dr. Ariel J. Lang ajlang@health.ucsd.edu ID: 21877 COVID-19 Household Environment Scale (CHES) - English COVID-19 Household Environment Scale (CHES) - Spanish COVID-19 Social Distancing and Symptoms COVID-19 on Family .
with representatives from the Anatomy sector. These relate to the consent provisions of the Human Tissue Act 2004 (HT Act), governance and quality systems, traceability and premises. 3. The Standards reinforce the HT Act’s intention that: a) consent is paramount in relation to activities involving the removal, storage and use of human tissue; b) bodies of the deceased and organs and tissue .
