Berks County Medical Society Medical Record Summer 2020 - 24

Coronavirus Chronicles: Berks Responds

ADDRESSING AN ONGOING EPIDEMIC DURING A PANDEMIC:
How an addiction treatment facility is dealing with
the COVID - 19 pandemic
by Olapeju Simoyan, MD, MPH, BDS, FAAFP, FASAM; Erin Deneke, PhD;
Joseph Garbely, DO, DFASAM, Caron Treatment Centers, Wernersville, PA
The last issue of Medical Record featured an excellent review
of the COVID - 19 pandemic.1 Unfortunately, since then, the
numbers of cases and deaths have skyrocketed (see Table 1). As of
this writing, over 1.6 million cases have been reported in the US,
with over 98,000 deaths.2
Until proven treatments and/or a vaccine are available, we must
rely on basic prevention strategies such as hand hygiene, use of
personal protective equipment, social distancing and quarantine.
The situation is further complicated by the pre-existing
epidemic of substance use disorders. In 2018, there were 67,367
drug overdose deaths in the U.S. and 69.5% of these involved
opioids.3 In Pennsylvania, there were 5,456 drug-related overdose
deaths in 2017.4
Unfortunately, several states, including Pennsylvania,
have reported increases in opioid-related mortality during the
COVID-19 pandemic.5 Social distancing and self-isolation, while
essential from a public health perspective, increase the risk of
relapse in individuals struggling with substance use disorders. It
is therefore of utmost importance to ensure that treatment for
substance use disorders is available to those who need it. At Caron
Treatment Centers, we recognized the need to remain open in order
to continue caring for our patients. Significant changes were made
to our routines and policies in order to ensure the highest quality of
care while prioritizing patient and staff safety.

Caron's Pandemic Response
The crisis management team, made up of multi-disciplinary
department heads, prepared a pandemic response plan, the
objectives of which were to: 1) prevent COVID-19 transmission
among workers, patients and visitors 2) safely maintain patient
care capabilities and essential business operations and 3) maintain
ongoing communication with stakeholders. Specific areas of impact
that were considered in planning include staffing, procurement,
contracted services, operations and infection control.
A COVID-19 task force consisting of both clinical and
nonclinical staff was also formed to guide the organization's
response. The task force held daily phone calls to discuss new and
evolving policies and daily updates were provided regarding the
status of COVID-19 testing for patients and staff. Updates to local,
state and federal guidelines were also discussed.
After the stay at home order was put in place by Governor
Wolf, decisions were made at our residential treatment facility
in Wernersville, PA regarding which employees were required to
be on campus. This included those providing direct patient care
and services critical to operations. They were advised to have their
employee identification badges with them at all times and given
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proof of employment letters to present in the event that they
were questioned by law enforcement while in transit. In person
meetings were largely replaced by virtual meetings (via Cisco
Webex). Remote access and phone stipends were provided for staff
members who were directed to work from home. Patient visits in
our outpatient facilities in Atlanta, Georgia, in Wyomissing and
Plymouth Meeting, Pennsylvania, and in Arlington, Virginia were
conducted via telehealth.
For employees who were required to take time off work
for COVID-19 related reasons and unable to work remotely,
catastrophic pay for up to two weeks was made available.

Surveillance procedures
Daily screening of staff with direct patient care responsibilities
began in March 2020. On arrival at work, employees reported to
a central location to have their temperatures taken and respond to
screening questions. Any employee with COVID-19 symptoms or
a temperature of 99.5 degrees Fahrenheit or above was sent home
and their human resources representative notified. The affected
employee was instructed to call their primary care doctor. In order
to minimize the wait time for screening, start times were staggered
by the various departments. Clinical staff members were advised to
"self-monitor" for signs and symptoms of COVID-19 when not at
work, including temperature checks while not on duty.
Employees without direct patient contact were instructed to
take their temperatures prior to reporting for work and a separate
procedure implemented for tracking their readings. They were
to follow the same procedures as patient-facing staff if they had
symptoms.
The human resources department kept track of employees
who were off from work and contact tracing was performed when
indicated. If an employee had a positive COVID-19 test, they
were to notify their recent contacts of the need to self-quarantine.
Deep cleaning of work areas was performed when indicated.
The guidelines provided by the Centers for Disease Control and
Prevention (CDC) were followed regarding clearance to return to
work.6
At the start of the outbreak, prospective patients were asked
about COVID-19 symptoms and potential exposures as part of
the routine screening process prior to admission. Those who were
high risk were screened for COVID-19 and placed in isolation on
admission. As the pandemic progressed, a decision was made to
perform COVID-19 screening tests on all patients who were being
admitted. They were then kept in isolation till test results were
available and isolation discontinued if the results were negative.



Berks County Medical Society Medical Record Summer 2020

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