I hope this message finds you staying well and safe during this challenging and evolving time. As Commissioner and State Health Officer, I am reaching out to tell you how proud and impressed I am by the incredible innovation, service and dedication of healthcare personnel and public health partners across West Virginia. I know your lives have been disrupted as we navigate through this evolving, unprecedented time in our careers. Please accept my sincere gratitude for your inspiring service and dedicated care on the front lines of the Coronavirus Disease 2019 (COVID-19) pandemic.
You are working around the clock to protect our communities, here in West Virginia and around the world. Hardworking teams at the West Virginia Department of Health and Human Resources’ (DHHR) Bureau for Public Health (BPH) and across state government, in collaboration with the federal government, have also been working around the clock to increase system capabilities to combat this pandemic. We must work as partners to encourage public health practices while meeting critical operational functions throughout this event.
I clearly recognize the need to better and more closely communicate with our dedicated healthcare workforce around the state. As we continue to grow and further operationalize our pandemic response, my team and I will increase our efforts to more fully connect with you through various means. BPH is working to coordinate virtual town halls that will be recorded and posted to www.coronavirus.wv.gov, a website and resource that I encourage you to check frequently for updates.
My team and I will provide key updated information, but more importantly, we need to continue hearing from you in coordinated and ongoing ways. We are listening and we want to hear more. What is working? What is needed? How are we able to better serve you as you care for our communities? How do we most effectively operate and operationalize the safest and most effective response possible in a reality where some critical needs are abundant and others clearly insufficient? This will take all of us working together in new and creative ways. Below are a few key updates and resources I want to share with you.
Personal Protective Equipment (PPE)
#GetMePPE is a hashtag being used across media channels and one with which I absolutely agree. PPE is a critical component of response and we need more. In addition to federal resources being distributed, we are partnering with the West Virginia National Guard and Governor’s Office to identify additional vendors and purchase supplies where possible. We are committed to working tirelessly to purchase N95 and surgical masks, gowns, gloves, and additional PPE from a variety of sources and get it to you on the front lines.
PPE has been distributed each day this week, with counties having positive cases receiving priority, as well as distributing through local health departments for use across the healthcare system. This is only a start. We know more is needed and will continue to identify supplies and additional needs moving forward. Please continue to work creatively with your local communities to conserve appropriately, share and support each other where possible to sustain a system, and acquire more supplies as able. Communities want to help, and we have seen this in multiple ways, such as the production of cloth masks. Perhaps these can be items best used in communities by non-healthcare workers or the public to sustain the supply of traditional masks for healthcare workers.
Testing has been a challenging and frustrating issue nationally and in West Virginia. Testing capacity is expanding and will continue to improve as commercial and hospital diagnostic lab testing system capabilities grow. We all need to work together within the clinical diagnostic lab systems used daily as well as through our public health laboratory – labs traditionally with very different functions that have had to be blurred to respond to COVID-19.
The West Virginia Office of Laboratory Services (OLS) and others encourage and continue to assist hospitals and other clinical labs build more rapid testing capacity into clinical diagnostic laboratory infrastructure. We will not be able to test everyone as we have been able to do with infectious respiratory illnesses like influenza. Continue to use your clinical judgement to determine who needs tested and continue to care for patients. We recognize this means often needing to manage situations clinically with the presumption of disease being COVID-19. We should take presumptive vs. lab-diagnosed disease equally seriously in terms of management to prevent spread.
Yesterday we released updated guidance including a screening tool that can help guide decision-making regarding testing. OLS increasingly needs to prioritize testing for rare, urgent clinical situations and primarily for investigating cases and clusters that pose public health implications as we strive to mitigate outbreaks and reduce spread. As you and others are working to acquire needed reagents and specimen collection supplies, the US Food and Drug Administration (FDA) recently expanded the types of swabs that may be used. We have included this in specimen collection instructions for specimens sent to OLS. You can find the list of acceptable products at: https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimenshtml. In addition, a single NP swab is now acceptable rather than an NP and OP swab, conserving transport media, for most all receiving labs. Some commercial labs (not OLS) can take alternative specimens (nasal aspirates or washes) or use varied transport media. Be sure to stay up to date on guidance from your laboratory.
Helping You Do What You Do Best: Care for People
In addition to increasing efforts to acquire supplies, we are also working with partners to maximize use of your skills to care for patients in different ways. There are major changes at the Centers for Medicare and Medicaid Services (CMS) for Medicare and proposed changes by DHHR’s Bureau for Medical Services (Medicaid) via an 1135 waiver to make it easier to comprehensively take care of patients, including outpatient medical care, mental healthcare, substance use disorder treatment, easier medication access, Medicaid eligibility, DME access, etc. Many of you may have never widely delivered medicine through a phone or a computer screen, which may become the new normal. We are working to help develop telemedicine resources such as guidance on choosing software/device platforms, documentation, billing, coding, and payment issues. In the upcoming days, we will reach out through our partners with focused information, including webinars that can better help guide you through rapid changes, such as clinical practices for caring for patients with confirmed or suspected COVID-19.
As we journey through these uncharted times, please remember to take care of yourself. I know and appreciate that you and your loved ones are making great sacrifices which will have an impact on the days, weeks, and months to come. Thank you for all you do, especially in this unprecedented time.
I will continue to be in touch as developments unfold and we will continue to provide all the support that we can. Please stay safe, continue to support one another, and let me know how we can best partner together to work as a coordinated health system with the goals of both supporting you and together caring for our communities during this difficult and challenging time.
Catherine C. Slemp, MD, MPH
Commissioner and State Health Officer
Bureau for Public Health
350 Capitol Street, Room 702
Charleston, WV 25301
Assistant: Andrea Fisher
(304) 356-4410 direct line