Resources

COVID-19 NBS Response: Continuity Of Operations Plans (COOP)

Date
July 2020

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COVID-19 COOP Challenges, Practices and Resources: (refer to the COVID-19 web page

Practices 

Challenges

Resources/Strategies

Laboratory COOP                      
  • Handling of newborn screening filter cards with mothers who have known or suspected COVID-19 infections 
  • Handling of filter cards that may have been handled by many different people
  • Performing time critical testing with limited staff 
  • Laboratory staff must wear gloves and masks 
  • The Colorado Newborn Screening Program developed a guidance document for completing time critical testing with limited staff: 
  • Check in with COOP partners in case there is a need to assist with testing should laboratory staff be significantly impacted by COVID-19. 
  • Measures taken in Michigan for social distancing/ sanitizing at the laboratory: 
    • The NBS laboratory has switched to 4 x 10 hour shifts to reduce the number of people at the laboratory 
    • Seating arrangements/ cubicles have been rearranged to spread out staff 
    • Mailroom processing has been spread out to different areas of the laboratory as this is the most congregated activity in the laboratory 
    • Alcohol (ethanol) is available in every room and being used to clean common/ personal areas 
    • 1-on-1 training is being performed via phone or put on hold 
    • Reducing the amount of paper exchanges between scientists when doing result review by doing as much electronically as possible 
    • No in person meetings; only by phone 
    • Prior to coming to work the employee will monitor their temperature and symptoms of illness. If temperature is greater than 100.4 degrees F the employee should notify their manager and stay home
  • Minnesota NBS laboratory staff have laptops and will flex to work from home on an adhoc basis when activity and time permit. 
  • Tennessee NBS laboratory staff shifted to a 4 day work week and divided into two teams (teams alternate who comes in on Wednesdays). The laboratory supervisory team is still working in the laboratory 5 days per week. 
Short-Term Follow-Up COOP
  • Follow-up staff and genetic counselors are now required to work from home     
  • Some clinics are closed   
  • There are concerns about minimizing risk to families who have to seek confirmatory testing 
  • In the event that follow-up staff is descreased due to illness, there may be a need to triage repeat requests                                                                                                                                           
  • Send encrypted emails with reports for those health care providers working out of the office
  • Modify reporting strategies in concert with clinical working groups discussions 
    • For example, for Cystic fibrosis centers that are closed for routine visits, refer high risk newborns for a telephone consultation with specialists and track those cases until newborn can be evaluated. For any "referral" (i.e. high risk or questionable), facilitate discussion with the specialist. For example, a SCID specialist would do a telephone consult with the primary care physician, and if necessary, set up a special escort into the clinic. This will differ by state as some clinics remain open.
  • The Chilrden's National Medical Center (CNMC) in DC covers referrals for serveral states, and has shared an example of NBS follow-up protocols during the outbreak: 
  • Attempt to route families to "clean laboratories" for follow-up confirmatory testing. Designated laboratory sites that are not performing COVID-19 testing are considered safer options for families.
  • Enourage primary care providers (PCP) to obtain confirmatory testing in rural communities to avoid hospitals hit hard by COVID-19. In some cases, alter follow-up recommendations to ease the burden on PCPs (i.e. obtain only urine organic acids and forgo plasma acylcarnitine profile). 
  • Switch outpatient appointments to Telehealth unless clinical concerns dictate otherwise.  
  • State of Michigan IT has enabled the NBS follow-up staff to work at home while still accessing all necessary work drives through VPN. One staff person is in the building to monitor mail and faxes.
  • Triage follow-up based on time sensitive disorders for requesting repeats
  • For letters that need to be mailed, ensure pre-metered envelopes and Program Administrator have a printer to mail out letters to parents/ allow for continuity of operations
  • Assign a follow-up staff member to go to the office a couple days a week to mail newborn screening reports to providers and parents, as well as pick up mail. 
  • In South Carolina NBS, each follow-up staff have a work cell, laptop and VPN access to the agency network and NBS laboratory system. The admin assistant is still in the office to answer the NBS mainline, respond to fax requests and send/ retrieve snail mail daily 
  • Tennessee NBS data entry staff are working from home. Paper forms are scanned to a shared network drive that they have access to so they can key. Follow-up nurses are working from home and rotate one nurse coming in each day for 1/2 day to handle faxes and parent letters. All calls to the NBS follow-up are forwarded to the on call phone and are answered by case management staff daily. 
Staffing COOP
  • Staffing shortages 
  • Staff are at risk of exposure to COVID-19; it is difficult for the laboratory staff to practice safe-distancing while at work   
  • If staff are infected, but not showing symptoms, they could infect several other people before they realize they are infected.  
  • COVID-19 has resulted in school and daycare closings, making availability challenging for staff. Teleworking is not an option for most laboratory staff.                                                                                                                                                                                                                               
  • Lengthen shift duration to minimize the number of staff in the laboratory at a time (i.e. 4-10 hour shifts)
  • Practices for limiting exposure in the laboratory 
    • Scan for the presence or non-presence of a fever, and ask basic symptom-related questions prior to gaining entrance to the building (i.e new cough, shortness of breath, sore throat and flu-like symptoms)
    • Stay at least 6 feet away from each other 
    • Use conference calls instead of in-person meetings 
    • Frequently disinfect hands, door knobs, keyboards, phones, tap handles, work stations and instrument surfaces on a regular schedule 
    • Stagger shift/ work tasks 
    • Segregate work tasks so there is physical separation between teammates 
    • Avoid touching your face until you wash your hands
    • Divide NBS staff into distinct teams and maintain operations with skeleton crews 
    • Quarantine staff with close contact of confirmed COVID-19 cases for 14 days 
      • Close contact is defined as being within 6 feet of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case. Or, it is defined as having direct contact with infectious secretions of a COVID-19 case (i.e. being coughed on) 
  • The Washington Department of Health has developed the following documents (draft versions) 
  • The Georgia Newborn Screening program has come up with a priority listing of newborn screening tests in the event that several people are out. 
  • In order to meet mandated lower staffing levels, the Colorado Newborn Screening Program (CONBSP) is planning to remove Hemoglobinopathies testing from the second screen when the first screen was normal. This is to help comply with emergency staffing for COVID-19 and add a secondary cost savings benefit. CONBSP will be going to the Board of Health for a Request for Emergency Rulemaking to remove hemoglobinopathies on second screens. 
  • Establish connections and negotiate with local day care services to provide affordable options for staff so they can keep their families safe and cared for, while still coming to work. 
  • Maryland NBS implements staff rotations where each laboratory staff member works for one week on site (doing both pre-analytical and analytical procedures) and then is off for the next two weeks (this will cover the 14 day self isolation guidance). Conduct post-analytical and data entry work remotely, if possible. 
  • North Carolina NBS has a Team A & Team B working a rotating shift. Team A works Monday, Tuesday and Wednesday. Team B works Thursday, Friday and Saturday. They then rotate to balance the workload that is typically busy on Monday and Tuesday. 
  • The Texas NBS Program has been creating face masks for staff.
  • Engage staff in more cross-training efforts to allow for continuity of operations despite staff shortages.