Long-Term Care Facilities and Visitation

Posted on 03/03/202106/07/2021

As we anxiously await guidance from CDC and CMS on changes, they will recommend and/or require of long-term care communities related to testing, visitation, quarantine, etc. – a reminder that homes should use previous visitation guidance to support opening up their communities to visitors. This week, the CMS spreadsheet of county positivity rates shows MO with 63 green, 49 yellow and 3 red counties. Homes in green and yellow counties should allow visitation according to the core principles of COVID-19 infection prevention and facility policies, if they are not in outbreak status. As soon we receive updated guidance, we will communicate the information via the long-term care facility listserv. Keep in mind DHSS has issued guidelines- not regulatory requirements related to visitation. You know your long-term care community and can best assess and make a plan to help residents reconnect with loved ones based on their wants/needs, availability of PPE, staffing, etc.

Additional guidance related to frequent questions we receive:

COVID recovered in past 3 months

If a resident has tested positive and has recovered (no longer on transmission based precautions) in the past 90 days, CDC guidance states they do not need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html Homes can use this guidance in developing policies related to visitation and quarantine for residents as well to help expand visitation within their communities and to allow residents to resume some normalcy in their routines.

For residents that have had COVID in the past 3 months and are off of transmission based precautions, they would not need to quarantine if they left for a home visit or went out for dinner- based on CDC guidance for quarantine. We encourage facilities, families and residents to continue to use the infection control practices outlined in the attached memo. Even though someone has had COVID- we do not know a lot about reinfections and those measures (mask, social distancing, and good hand hygiene) help protect from influenza as well.

Home Visits and Outings

If a resident chooses to leave the facility to visit family or for an outing, we recommend nursing homes use the recommendations from the holiday leave guidance when they return to the nursing home:

Screen and increase monitoring for signs and symptoms.
Test a resident for COVID-19 if signs or symptoms are present or if a resident or their family reports possible exposure to COVID-19 while outside the nursing home. A nursing home may also opt to test residents without signs or symptoms if they leave the nursing home frequently or for a prolonged length of time, such as over 24 hours. For more information on testing guidelines, see CMS memorandum QSO-20-38-NH.
Place the resident on transmission-based precautions (TBP) if the resident or family member reports possible exposure to COVID-19 while outside of the nursing home, or if the resident has signs or symptoms of COVID-19 upon return. Please note that residents and loved ones should report to the nursing home staff if they have had any exposure to COVID-19 while outside of the nursing home.
Consider placing residents on Transmission Based Precautions BP if they were away from the nursing homes for more than 24 hours.

https://www.cms.gov/files/document/covid-facility-holiday-recommendations.pdf

https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/ltcf-holiday-guidance.pdf

Vaccination and Infection Control measures

At this time, there are still many questions unanswered regarding vaccination that make infection control changes uncertain right now. Current CDC can be found here: https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/index.html.

Vaccination is one important tool (not the only) in our tool belt to address COVID-19 infections. Vaccinating healthcare personnel and residents is essential to helping prevent individuals (who may not be able to recover) from getting COVID-19. For long-term care facilities, vaccinations are vital to protecting healthcare capacity. Staff who are sick cannot work and provide the necessary case and services to residents to ensure their health and safety.

The toolkit includes some helpful information for staff and residents/loved ones regarding the vaccine as well.

https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/downloads/answering-staff-questions.pdf

https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/downloads/answering-residents-loved-ones-questions.pdf

Visitation Guidance 9-22-20
CMS Memo – Nursing Home Visitation – COVID-19

FREE COVID-19 Testing Events

Posted on 03/02/202106/07/2021

The Missouri Department of Health and Senior Services continues to offer FREE COVID-19 testing to Missouri residents. Individuals seeking this testing opportunity should visit our website at www.health.mo.gov/communitytest for a listing of events and a link to register. Residents are encouraged to visit this website frequently as new events will be added regularly. While registration guarantees testing, walk-ins to the event will be accommodated if registration slots are still available.

Upcoming events include:

Date	Time	City	County	Location
March 2, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
March 2, 2021	8:30AM – 2PM	Cuba	Crawford	Mace Supermarket
March 2, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
March 2, 2021	8AM – 12PM	Springfield	Greene	Old Price Cutter Building
March 3, 2021	8:30AM – 4PM	St. Louis	St. Louis County	NAACP St. Louis County Building
March 3, 2021	9AM – 3PM	Jefferson City	Cole	American Legion
March 3, 2021	9AM – 6PM	Kansas City	Clay	Worlds of Fun
March 3, 2021	8:30AM – 11:30AM	Florissant	St. Louis County	James J. Egan Civic Center
March 4, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
March 4, 2021	10AM – 4PM	St. Charles	St. Charles	Harvester Christian Church
March 5, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
March 5, 2021	9AM – 1PM	Joplin	Jasper	ACCESS Family Care
March 5, 2021	10AM – 4PM	Kansas City	Jackson	Kansas City Zoo (Cheetah Parking Lot)
March 5, 2021	8:30AM – 2PM	Cuba	Crawford	Mace Supermarket
March 8, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
March 8, 2021	9AM – 3PM	Kansas City	Jackson	Bruce R. Watkins Cultural Center
March 8, 2021	8AM – 5PM	Lexington	Lafayette	Health Care Collaborative of Rural Missouri
March 8, 2021	8:30AM – 11:30AM	Florissant	St. Louis County	James J. Egan Civic Center
March 8, 2021	9AM – 1PM	Branson	Taney	Cox Health
March 8, 2021	8AM – 10AM	Kansas City	Jackson	Bartle Hall (Front Entrance on 13th Street)
March 9, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
March 9, 2021	9AM – 3PM	Hannibal	Marion	Clemens Field
March 9, 2021	10AM – 6PM	Marshall	Saline	Katy Trail Community Health
March 9, 2021	8:30AM – 2PM	Salem	Dent	Salem Community Center @ the Armory
March 9, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
March 9, 2021	8AM – 12PM	Springfield	Greene	Old Price Cutter Building
March 10, 2021	8:30AM – 4PM	St. Louis	St. Louis County	NAACP St. Louis County Building
March 10, 2021	9AM – 6PM	Kansas City	Clay	Worlds of Fun
March 10, 2021	10AM – 6PM	Versailles	Morgan	Katy Trail Community Health
March 10, 2021	8:30AM – 11:30AM	Florissant	St. Louis County	James J. Egan Civic Center
March 10, 2021	1PM – 3PM	Camdenton	Camden	Mid-County Fire
March 11, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
March 11, 2021	10AM – 6PM	Warsaw	Benton	Katy Trail Community Health
March 11, 2021	10AM – 4PM	St. Charles	St. Charles	Harvester Christian Church
March 12, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
March 12, 2021	9AM – 1PM	Lamar	Barton	ACCESS Family Care
March 12, 2021	10AM – 4PM	Kansas City	Jackson	Kansas City Zoo (Cheetah Parking Lot)
March 12, 2021	10AM – 6PM	Sedalia	Pettis	Katy Trail Community Health
March 12, 2021	10AM – 2PM	St. Joseph	Buchanan	St. Joseph Aquatic Center
March 12, 2021	12PM – 3PM	Columbia	Boone	Moser’s Foods Parking Lot

FREE Covid-19 Testing Events

Posted on 02/18/202106/07/2021

Upcoming events include:

Date	Time	City	County	Location
February 18, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
February 18, 2021	10AM – 4PM	St. Charles	St. Charles	Harvester Christian Church
February 19, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
February 19, 2021	9AM – 1PM	Joplin	Jasper	ACCESS Family Care
February 22, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
February 22, 2021	9AM – 3PM	Kansas City	Jackson	Bruce R. Watkins Cultural Center
February 22, 2021	8AM – 5PM	Lexington	Lafayette	Health Care Collaborative of Rural Missouri
February 22, 2021	8:30AM – 3PM	Rolla	Phelps	Your Community Health Center
February 22, 2021	8:30AM – 11:30AM	Florissant	St. Louis County	James J. Egan Civic Center
February 22, 2021	9AM – 1PM	Branson	Taney	Cox Health
February 22, 2021	9AM – 11AM	Seymour	Webster	Between Twin Dragon Restaurant & Seymour Elementary School
February 22, 2021	8AM – 10AM	Kansas City	Jackson	Bartle Hall (Front Entrance on 13th Street)
February 23, 2021	9AM – 3PM	New London	Ralls	Forget-Me-Not Senior Center
February 23, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
February 23, 2021	8:30AM – 2PM	Salem	Dent	Salem Community Center
February 23, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
February 23, 2021	8AM – 12PM	Springfield	Greene	Old Price Cutter Building
February 23, 2021	12PM – 3PM	Fulton	Callaway	C&R Market (Parking Lot)
February 24, 2021	8:30AM – 4PM	St. Louis	St. Louis County	NAACP St. Louis County Building
February 24, 2021	9AM – 6PM	Kansas City	Clay County	Worlds of Fun
February 24, 2021	8:30AM – 11:30AM	Florissant	St. Louis County	James J. Egan Civic Center
February 24, 2021	1PM – 3PM	Camdenton	Camden	Mid-County Fire
February 25, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
February 25, 2021	10AM – 4PM	St. Charles	St. Charles	Harvester Christian Church
February 26, 2021	9AM – 11AM	St. Louis	St. Louis County	Riverview Gardens High School
February 26, 2021	9AM – 1PM	Lamar	Barton	ACCESS Family Care
February 26, 2021	12PM – 4PM	Kansas City	Jackson	Kansas City Zoo (Cheetah Parking Lot)
February 26, 2021	10AM – 2PM	St. Joseph	Buchanan	St. Joseph Aquatic Center
February 26, 2021	12PM – 3PM	Columbia	Boone	Moser’s Foods Parking Lot

Battelle CCDS™ Contract Ending

Posted on 02/11/202106/07/2021

Battelle CCDS™ was built as a temporary emergency program to help alleviate the critical PPE gap in the N95 supply chain. Battelle was recently notified by the Defense Logistics Agency (DLA) and the Department of Health and Human Services (HHS) that CCDS^TM operations will not be extended again and the program will officially end on March 31, 2021.

Please note the following critical dates:

The last day to send your N95 masks for decontamination to your CCDS™ sites will be March 18, 2021.
All FedEx return shipments to your facilities will be completed by March 25, 2021.

If you have any questions about the CCDS™ program ending, please contact Battelle at ccdscustomerservice@battelle.org.

Point of Care Test Reporting Trainings February 2021 Updates

Posted on 02/10/202106/07/2021

Information for NHSN users – Important Information for Long-term Care Facility Users

The NHSN team will offer trainings providing basic guidance for data entry for the NHSN Long-term Care Facility COVID-19 Point of Care (POC) Test Reporting Tool as well as tool updates released on February 4, 2021. The trainings may be a live presentation or a previously recorded presentation, but all sessions will allow for submission of audience questions with NHSN staff response. A recorded webinar will be posted for on-line viewing.

The NHSN option enables nursing homes to enter POC laboratory test data into the NHSN application. NHSN, in turn, will report the nursing home POC laboratory test data electronically to the public health agency, state or local, that has jurisdictional authority and responsibility to receive and use the nursing home’s data. Deidentified nursing home POC laboratory data will also be reported via existing public health reporting mechanisms to the US Department of Health and Human Services in accordance with the U.S. Coronavirus Aid, Relief, and Economic Security (CARES) Act requirements.

**Please note the webinars have the same link. Attendees will be able to choose which session they are able to attend. Both webinars are identical in content, so please plan to attend once.

Topic: Point of Care Test (POCT) Reporting Tool for COVID-19 – Updates
Date: Thursday, Feb 11, 2021
Time: 2:00 – 3:00 PM Eastern Time

Register in advance for this webinar:
https://cdc.zoomgov.com/webinar/register/WN_dp03SRQnSYeOfcBFy2CAmQ

After registering, you will receive a confirmation email containing information about joining the webinar.

Topic: Point of Care Test (POCT) Reporting Tool for COVID-19 – Updates
Date: Friday, Feb 12, 2021
Time: 1:00 – 2:00 PM Eastern Time

Register in advance for this webinar:
https://cdc.zoomgov.com/webinar/register/WN_dp03SRQnSYeOfcBFy2CAmQ

After registering, you will receive a confirmation email containing information about joining the webinar.

Please do not reply to this email. Responses to this email will not be received by the NHSN Team. To contact NHSN, please send a new email to: nhsn@cdc.gov.

Reimbursement for COVID-19 Outbreak Testing and Other Necessary Expenses – Deadline Extended to March 31, 2021

Posted on 02/08/202106/07/2021

All LTC facilities (SNF-ICF-RCF-ALF) may submit for reimbursement of outbreak testing through March 31, 2021.

All Skilled Nursing Facilities may invoice for other necessary COVID-19 expenditures up to a maximum cap of $345 per licensed bed. The previous cap of $303, which originally expired on December 30, 2020, has been extended to March 31, 2021 and the cap increased to $345 which is a $42 per licensed bed increase. Facilities cannot bill for expenses that have been previously invoiced.

All other facilities may submit invoices for other necessary COVID-019 expenses up to the previous existing cap of $330/licensed bed, which originally expired on December 1, 2020 and has been extended to March 31, 2021. Facilities cannot bill for expenses that have been previously invoiced.

If any facility previously submitted for reimbursement and did not get reimbursed up to the cap, they can submit for additional reimbursement up to the cap. If you have previously submitted invoices for reimbursement that meets or exceeds the cap, please do not resubmit those items. They are being re-reviewed at this time.

Please see this link for the portal and other additional information: https://apps.dss.mo.gov/LongTermCareCovid19Invoices/.

Community Testing Events Continue Throughout the State

Posted on 02/03/202106/07/2021

The State of Missouri is partnering with the Missouri Primary Care Association and MAKO Medical to continue hosting free COVID-19 testing events throughout the state.

Community testing events are scheduled in the following counties over the next two weeks: Adair, Barton, Benton, Cape Girardeau, Clay, Cole, Crawford, Dent, Greene, Harrison, Howell, Iron, Jackson, Jasper, Lafayette, Macon, Marion, Morgan, Pettis, Phelps, Platte, St. Charles, St. Louis City, and St. Louis County.

Missourians can register online for testing events at health.mo.gov/communitytest and continue to check back for future opportunities.

Missouri residency is the only requirement; individuals do not have to live in the county in which they are tested, and they do not have to be experiencing symptoms. Any Missouri residents who wish to be tested with an anterior nasal swab to determine if they have an active COVID-19 infection can do so at no cost to the individual.

Those experiencing symptoms of COVID-19 should seek testing at a community testing event or their nearest testing site. Those who have had significant contact with someone with confirmed COVID-19 should also consider being tested.

Why should a healthy person consider being tested for COVID-19?

To rule out the possibility that you have COVID-19 and don’t know it.
Make sure that you are not an asymptomatic carrier of the virus. Asymptomatic spreaders are a major reason containing this virus has been so challenging.
To take action early if you do have COVID-19.
If you are in the early stages of a COVID-19 infection, detecting it early allows you to quickly isolate, rest and recuperate, monitor your symptoms and seek medical care if needed.
To spend time with friends and family–especially those at high risk.
If you plan to spend a prolonged period of time with loved ones, especially older adults or those with underlying conditions, stay away from high risk activities for 10 days and then get tested.
To help get the virus under control.
Widespread testing among healthy people helps to stop the spread of COVID-19. Screening healthy people, staying on top of positive cases, identifying new outbreaks quickly, and being aware of how the virus spreads among people without symptoms, are powerful tools in our efforts to suppress the virus.

It is important to remember that a COVID-19 test is a one-time assessment, and will only show if you are infected at the time of the test. Everyday prevention measures, such as handwashing, physical distancing and mask-wearing should always be practiced, even after you have been tested.

To register for community testing events in Missouri, visit health.mo.gov/communitytest.

Vaccination Events

Posted on 02/03/202106/07/2021

Missourians in Phase 1A and Phase 1b Tiers 1 & 2 can access vaccinations through a variety of settings including their employer, health care providers, and mass vaccination events. Missouri’s latest press release with vaccine information can be found here. Below you can find information about a number of vaccine events that will be occurring during the month of February. Visit the websites for facilities listed below , watch your local news, talk with your medical provider, and/or visit the website of your local public health agency to get registered for these events. In addition, you can visit https://covidvaccine.mo.gov/events/ to register for some events as they become available. This site should be updated later in the week with new events, and regularly updated. PLEASE NOTE, events will fill quickly and some may already be filled due to sign ups through local channels such as local public health agencies and health care providers. Continue to watch for vaccine information from your local news, officials, and healthcare providers. Events will continue to be scheduled each week throughout the state.

For the month of February Missouri will be directing just over half of Missouri’s distribution of vaccine to selected hospitals across Missouri. These facilities will be able to vaccinate individuals in the activated Phases. Specific hospitals that will be hosting vaccine clinics are listed below.

In addition to these efforts, there will be Missouri National Guard supported events throughout Missouri. These events will continue on a rotating basis through the regions with additional locations added for subsequent weeks. Continue to watch for vaccine information from your local news, officials, and healthcare providers and check https://covidvaccine.mo.gov/events/. Events will continue to be scheduled each week throughout the state.

DHSS Led Events
Week of Feb 1-Feb 6
Region	Location
A	Henry County—Clinton Friday, February 5, 2021 8am-5 pm (or until supply is out) Clinton First Baptist Church 1531 N Vannsant Rd Clinton, MO 64735
B	Marion/Ralls County—Hannibal Friday, February 5, 2021 9am-6pm (or until supply is out) Hannibal Inn & Conference Center 4141 Market Street Hannibal, MO 63401
C	St. Francois—Farmington Thursday, February 4, 2021 8:30 am-7pm (or until supply is out) Community Civic Center 2 Black Knight Drive Farmington, MO 63640
D	Greene—Springfield Friday, February 5, 2021 8:30 am-5:30 pm (or until supply is out) Ozark Empire Fair Grounds 3001 N. Grant Ave Springfield, MO 65802
E	Pemiscot—Caruthersville Friday, February 5, 2021 9am-4pm (or until supply is gone) Centry Casino 777 E Third St. Caruthersville, MO 63830
F	Cole—Jefferson City Friday, February 5, 2021 8am-4pm (or until supply is gone) The Linc 1299 Lafayette St Jefferson City, MO 65101
G	Douglas—Ava Saturday, February 6, 2021 8am-5pm (or until supply is gone) MOCH Wellness Center 603 NW 10^th Ave Ava, MO 65608
H	Livingston/Harrison—Chillicothe/Bethany Site 1 Thursday, February 4, 2021 8:30 am-5:00 pm (or until supply is gone) Methodist Church 1414 walnut Street Chillicothe, MO 64601 Site 2 Saturday, February 6, 2021 8:30am-5:00 pm (or until supply is gone) South Harrison High School 3400 Bulldog Ave Bethany, MO 64424
I	Phelps—Rolla Thursday & Friday February 4-5, 2021 8am-5pm (or until supply is gone Phelps Health Respiratory Screening Station 1000 W 10^th St Rolla, MO 65401

Statewide Project to Test Wastewater for COVID Virus – Recruitment of 20 Long-Term Care Communities

Posted on 01/19/202106/07/2021

Since May 2020, the Missouri Department of Health and Senior Services (DHSS), Department of Natural Resources (DNR) and researchers at the University of Missouri – Columbia have been collaborating on a statewide project to test wastewater for genetic markers of SARS-CoV-2, the virus that causes COVID-19. The project recently received new funding through a grant from National Institutes of Health (NIH) to expand wastewater testing to additional congregate living facilities. Public health experts have identified wastewater testing as a useful tool for early detection of outbreaks, even as vaccination efforts progress and clinical testing improves. Please see the letter regarding information about this project and information on recruiting 20 congregate living communities to participate in an expansion of this testing. Ideally, communities would have 50 or more residents who contribute to the sewer system.

Please contact the Department of Health and Senior Services Environmental Public Health Tracking Team at EPHTN@health.mo.gov or 866-628-9891 or 573-751-6102 to express interest in the project or to ask any additional questions. Communities who are interested will receive a follow-up contact from the Missouri Department of Natural Resources to determine if their sewer system will work for this type of testing.

Standing Order to Administer BinaxNOW Rapid Antigen Test By Licensed Long-Term Care Facilities

Posted on 01/14/202106/07/2021

Dr. Randall Williams has signed a standing order for Long-Term Care Facility staff to receive Abbott BinaxNow testing at the facility they work in to ensure timely testing and isolation of positive employees who are caring for Missouri’s most vulnerable residents, the elderly and disabled. Long-term care facilities should continue to obtain orders for residents through resident personal physicians or facility medical director/physician.

Standing Order – BinaxNOW – LTCF – Symptomatic or Asymptomatic 1-12-21

COVID-19 Healthcare Quality and Worker Safety Information

Posted on 01/13/202106/07/2021

Please find this week’s review of CDC’s COVID-19 resources and information. We continue to highlight COVID-19 vaccine information in addition to resources specific to healthcare quality and worker safety and health.

COVID-19 VACCINE RESOURCES
CDC COVID Data Tracker — Vaccinations are now being tracked on CDC’s COVID Data Tracker. Numbers reported on CDC’s website are validated through a submission process with each jurisdiction and may differ from numbers posted on other websites. Differences between reporting jurisdictions and CDC’s website may occur due to the timing of reporting and website updates.

How to Report COVID Vaccine-Related Adverse Events — As Americans start receiving their first COVID-19 vaccines, additional data on potential adverse events are needed in real time. Healthcare providers will play a critical role in reporting vaccine-related adverse events through the Vaccine Adverse Event Reporting System (VAERS). Providers can also encourage individual patients to self-report potential adverse events as they occur through v-safe, CDC’s new patient reporting platform. Read more in this new CDC Medscape Expert Commentary by Dr. Tom Shimabukuro, CDC’s COVID-19 Vaccine Safety Team Lead.

Updated Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States — This guidance has been updated to include the following:

Additional information on antibody therapies and COVID-19 vaccination
Information on COVID-19 vaccination and outbreak management
Additional information on vaccination of immunocompromised persons
Updates to contraindications and precautions to vaccination
Information on COVID-19 vaccination and tuberculin skin testing

To learn more, please visit: mRNA COVID-19 Vaccines.

Frequently Asked Questions about COVID-19 Vaccination in Long-Term Care Facilities (LTCF) — Making sure LTCF residents can receive COVID-19 vaccination as soon as vaccine is available will help save the lives of those who are most at risk of dying from COVID-19. CDC updates frequently asked questions for Healthcare Infection Prevention and Control and Healthcare Professionals regularly based on feedback from professionals on the ground.

ADDITIONAL RESOURCES
US COVID-19 Cases Caused by Variants — The cases identified are based on a sampling of SARS-CoV-2-positive specimens and do not represent the total number of B.1.1.7 lineage cases that may be circulating in the United States and may not match numbers reported by states, territories, tribes, and local officials.

SARS-CoV-2 Transmission from People Without COVID-19 Symptoms — Researchers used a model to assess the proportion of COVID-19 spread that likely occurs from infected people who do not have symptoms. They found that more than 50% of new COVID-19 infections were estimated to have come from people without symptoms. These findings underscore the importance of measures such as wearing masks, social distancing, and washing hands to slow the spread of COVID-19. Strategic testing of people who are not ill, such as those who have been exposed to COVID-19 or those with frequent contact with the public, can also reduce the spread of COVID-19 until safe and effective vaccines are widely available.

Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages — This quick reference summarizes CDC’s strategies to optimize personal protective equipment (PPE) supplies in healthcare settings and provides links to CDC’s full guidance documents on optimizing supplies which provide additional strategies and details.

Summary for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during Shortages — This summary is intended to help healthcare facilities optimize supplies of disposable N95 filtering facepiece respirators when there is limited supply during the COVID-19 pandemic.

Updated People with Certain Medical Conditions — Revisions were made on December 23, 2020 to reflect recent data supporting increased risk of severe illness among persons with Down Syndrome from the virus that causes COVID-19. Revisions also include addition of sickle cell disease and chronic kidney disease to the conditions that might increase the risk of severe illness among children.

Morbidity and Mortality Weekly Report (MMWR) — Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020 — This report summarizes the clinical and epidemiologic characteristics of people in the U.S. with anaphylaxis and non-anaphylaxis allergic reactions following administration of a first dose of Pfizer-BioNTech COVID-19 vaccine during December 14-23, 2020. Monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination. Post-event follow-up indicates that the patients experiencing anaphylaxis fully recovered following treatment. You can learn more here: Morbidity and Mortality Weekly Report

Morbidity and Mortality Weekly Report (MMWR) — Rates of COVID-19 Among Residents and Staff Members in Nursing Homes — United States, May 25–November 22, 2020 — A federal mandate issued by the Centers for Medicare & Medicaid Services (CMS), required nursing homes to commence enrollment and routine reporting of COVID-19 cases among residents and staff members by May 25, 2020. This report uses the NHSN nursing home COVID-19 data reported during May 25–November 22, 2020, to describe COVID-19 rates among nursing home residents and staff members and compares these with rates in surrounding communities by corresponding U.S. Department of Health and Human Services (HHS) region. You can learn more here: Morbidity and Mortality Weekly Report

Morbidity and Mortality Weekly Report (MMWR) — Assessment of Day-7 Postexposure Testing of Asymptomatic Contacts of COVID-19 Patients to Evaluate Early Release from Quarantine — Vermont, May–November 2020 — On May 8, 2020, the Vermont Department of Health (VDH) issued a Health Update recommending shortening the duration of quarantine for persons exposed to SARS-CoV-2, the virus that causes COVID-19. Exposed persons who were in quarantine could be tested by polymerase chain reaction (PCR) on or after quarantine day 7. Those who had remained asymptomatic throughout quarantine and who received a negative SARS-CoV-2 PCR test result on or after day 7 could end quarantine. You can learn more here: Morbidity and Mortality Weekly Report

UPCOMING CALLS/WEBINARS
COVID-19 Partner Update Call: CDC COVID-19 Case Investigation and Contact Tracing Guidance and Tools – Thursday, January 21, 2021, 2:00 p.m. – 3:00 p.m. (Eastern Time) — Dr. Cliff McDonald, Acting Chief Medical Officer, and Dr. Melanie Taylor, Deputy, COVID-19 Contact Tracing Innovations Support will present. Ms. Michelle Putnam, Deputy, Policy Unit Partnerships & Risk Management Team will moderate. Dr. McDonald will share updates on CDC’s COVID-19 response, including the latest scientific information and what everyone should know about protecting themselves and others. In addition, Dr. Taylor will provide an overview on contact tracing guidance and tools. All questions will be collected in advance of the webinar. Click here to register

The call will be recorded and posted with previous Partner Update webinars here.

Clinician Outreach and Communication Activity (COCA) – Treating Long-COVID: Clinician Experience with Post-Acute COVID-19 Care — The Clinician Outreach and Communication Activity (COCA) will hold a call Thursday, January 28, 2021, from 2:00–3:00 p.m. (Eastern Time). During this COCA Call, presenters will share their firsthand experiences with treating long COVID, focusing on the pulmonary, neurologic, and psychological aspects. They will also describe their experiences with establishing clinics that provide care for patients with these long-term effects. For more information, please visit: COCA Calls/Webinars

IN CASE YOU MISSED IT — Clinician Outreach and Communication Activity (COCA) – COVID-19 Vaccines: Update on Allergic Reactions, Contraindications, and Precautions — The Clinician Outreach and Communication Activity (COCA) hosted a call Wednesday, December 30, 2020. During this COCA Call, presenters gave an overview of recommendations for use of COVID-19 vaccines in certain populations. Clinicians learned more about the recent reports of anaphylaxis following vaccination, as well as CDC’s updated clinical considerations around contraindications and precautions to vaccination. For the recording of this call, please visit: COCA Calls/Webinars

Abbott BinaxNOW Testing Supplies

Posted on 01/11/202106/07/2021

The federal government is sending Abbott BinaxNOW rapid antigen test kits to states for distribution. There is limited availability of these tests to Missouri Long Term Care Facilities (RCF, ALF, ICF, and SNF) and private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) with a CLIA certificate.

Department of Health and Senior Services (DHSS) and the State Emergency Management Agency (SEMA) will distribute available tests to LTCFs for use. Because there are a limited number of tests available, these tests are best suited for use with patients or staff who are symptomatic and who may have had a credible exposure to COVID-19.

Demand will be high and so we ask homes to only request what they will need for a 45 day timeframe- that is not covered by other testing capacities. Our understanding is that federal shipments will begin again next week in counties with high positivity rates. This effort is to supplement existing testing capacity- not to replace it.

APPLICATIONS FOR TEST KITS MUST BE RECEIVED BY JANUARY 22, 2021 at this link: https://arcg.is/1XvLeP.

COVID-19 Vaccine, TB testing, and Co-administration with other Vaccines

Posted on 01/11/202106/07/2021

We have received a couple emails regarding this, so passing along CDC guidelines on receiving COVID vaccine after/before flu vaccines, TB testing, etc.:

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

Interpretation of tuberculosis test results in vaccinated persons

Inactive vaccines do not interfere with tuberculosis (TB) test results. There is no immunologic reason to believe either a Tuberculin Skin Test (TST) (administered by intradermal placement of 0.1 cc of purified protein derivative) or blood draw for interferon gamma release assay (IGRA) would affect the safety or effectiveness of mRNA COVID-19 vaccines. We have no data to inform the impact of the COVID-19 mRNA vaccines on either TB test for infection (i.e., TST or IGRA).

For healthcare personnel or patients who require baseline TB testing (at onboarding or entry into facilities) at the same time they are to receive an mRNA COVID-19 vaccine:

Perform TB symptom screening on all healthcare personnel or patients.
If utilizing the IGRA, draw blood for interferon gamma release assay prior to COVID-19 vaccination.
If utilizing the TST, place prior to COVID-19 vaccination.
If vaccination has been given and testing needs to be performed, defer TST or IGRA until 4 weeks after COVID-19 vaccine 2-dose completion.
- All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their providers.

If a facility has a concern regarding delaying the TST or IGRA, because of vaccination- then they can rely on the state waivers currently in place to delay the TB test, if necessary.

Another question we have received has been regarding CDC guidance related to co-administration with other vaccines.

Coadministration with other vaccines

Given the lack of data on the safety and efficacy of mRNA COVID-19 vaccines administered simultaneously with other vaccines, the vaccine series should routinely be administered alone, with a minimum interval of 14 days before or after administration with any other vaccine. However, mRNA COVID-19 and other vaccines may be administered within a shorter period in situations where the benefits of vaccination are deemed to outweigh the potential unknown risks of vaccine coadministration (e.g., tetanus toxoid-containing vaccination as part of wound management, measles or hepatitis A vaccination during an outbreak) or to avoid barriers or delays to mRNA COVID-19 vaccination (e.g., in long-term care facility residents or healthcare personnel who received influenza or other vaccinations prior to/upon admission or onboarding). If mRNA COVID-19 vaccines are administered within 14 days of another vaccine, doses do not need to be repeated for either vaccine.

COVID Vaccinations and Infection Control

Posted on 01/08/202106/07/2021

SLCR has received many questions regarding COVID-19 vaccinations and the impact those vaccinations will have on infection control guidelines. At this time, there are still many questions unanswered regarding vaccination that make infection control changes uncertain right now. Current CDC can be found here: https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/index.html.

The toolkit includes some helpful information for staff and residents/loved ones regarding the vaccine as well.

LTCF Staff pdf
LTCF Residents & Loved Ones pdf

CMS Memo: QSO 20-31-ALL: Revised COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes

Posted on 01/06/202106/07/2021

CMS has revised the criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care. In addition, CMS has provided Frequently Asked Questions related to health, emergency preparedness and life-safety code surveys.

See the memo for details.

COVID-19 Vaccine Safety: A Fireside Chat with CMS, CDC, and front line staff and providers

Posted on 01/06/202106/07/2021

COVID-19 Vaccine Safety: A Fireside Chat with CMS, CDC, and front line staff and providers
Wednesday, 6, 2021, at 3:00 pm (Central Time)

Join The Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC) for a fireside chat on vaccine safety. This is the second discussion in a special series, a part of the CMS National Nursing Home Stakeholder Call Series, aimed at addressing staff questions and concerns about the new COVID-19 vaccines. Each session will be moderated by CMS with speakers from CDC and representatives of front line staff and providers.

This chat will continue to address myths surrounding vaccine danger with the following panelist:

Dr. Lee Fleisher, CMS Chief Medical Officer and Director, Center for Clinical Standards and Quality (CMS)
Dr. Amanda Cohn, Chief Medical Officer (Acting), Office of Vaccine Policy, Preparedness, and Global Health, Office of the Director (CDC)
Cassandra Lowe, Certified Nursing Assistant (CNA)

Preparing for the call:

Would you like to submit questions for the panel to discuss? Questions can be sent to COVID-19@cms.hhs.gov. There will not be a Q&A session during the call.
Resource: Long term Care toolkit: https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/index.html.

Target Audience: Nursing Home Frontline staff, Chief Nursing Officers

Register in advance for this webinar (After registering, you will receive a confirmation email containing information about joining the webinar): https://cms.zoomgov.com/webinar/register/WN_VQnfc77zTaOho3-yYrtGUAA

Monoclonal ECHO Mini-Series

Posted on 01/05/202106/07/2021

This series will provide a deep dive on new and emerging COVID-19 outpatient therapeutics, including monoclonal antibodies. The goal of this mini-series is to equip clinicians with the appropriate knowledge, resources, and tools needed to initiate and scale administration of these therapies and reduce strain on the U.S. healthcare system.

Registration is at https://hsc.unm.edu/echo/institute-programs/covid-19-response/us-covid19/hhs-aspr/miniseries.html.

The upcoming event on January 6, 2021 will discuss the recent and very successful experience with MABs in the State of Michigan.

Free COVID-19 Testing Opportunities Available Throughout Missouri

Posted on 01/01/202106/07/2021

Date	Times	City	County	Location
Jan. 4, 2021	12PM – 4PM	Tarkio	Atchison	Tarkio United Methodist Church
Jan. 4, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
Jan. 4, 2021	10AM – 4PM	Potosi	Washington	Great Mines Health Center
Jan. 4, 2021	9AM – 3PM	Kansas City	Jackson	Bruce R. Watkins Cultural Center
Jan. 5, 2021	10AM – 4PM	Farmington	St. Francois	Christian Life Church
Jan. 5, 2021	1PM – 6PM	Warsaw	Benton	Katy Trail Clinic Parking Lot
Jan. 5, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
Jan. 6, 2021	1PM – 6PM	Camdenton	Camden	Central Ozarks Medical Center
Jan. 6, 2021	9AM – 6PM	Kansas City	Clay	Worlds of Fun
Jan. 6, 2021	10AM – 5PM	Ste. Genevieve	Ste. Genevieve	Civic Center
Jan. 7, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
Jan. 7, 2021	1PM – 7PM	Warrensburg	Johnson	Johnson County Fairgrounds
Jan. 7, 2021	12PM – 4PM	Mound City	Holt	Northwest Health Services – Mound City Clinic
Jan. 7, 2021	9AM – 4PM	Kansas City	Jackson	Kansas City Zoo (Cheetah Parking Lot)
Jan. 8, 2021	12PM – 4PM	Maryville	Nodaway	National Guard Armory
Jan. 8, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
Jan. 8, 2021	10AM – 1PM	Osceola	St. Clair	Clearview Care Center
Jan. 8, 2021	9AM – 4PM	Kansas City	Jackson	Kansas City Zoo (Cheetah Parking Lot)
Jan. 9, 2021	9AM – 6PM	Cassville	Barry	ACCESS Family Care
Jan. 11, 2021	12PM – 4PM	Grant City	Worth	Worth County High School
Jan. 11, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health
Jan. 11, 2021	9AM – 3PM	Kansas city	Jackson	Bruce R. Watkins Cultural Center
Jan. 12, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
Jan. 12, 2021	10AM – 5PM	Cape Girardeau	Cape Girardeau	Agricultural Barn
Jan. 13, 2021	9AM – 6PM	Kansas City	Clay	Worlds of Fun
Jan. 13, 2021	11AM – 2PM	Kimberling City	Stone	First Baptist Church Ministry Center
Jan. 14, 2021	12PM – 3PM	St. Louis	St. Louis City	Affinia Healthcare
Jan. 14, 2021	12PM – 4PM	Stanberry	Gentry	Stanberry City Hall
Jan. 14, 2021	9AM – 5PM	Hermitage	Hickory	Ozarks Community Health Center
Jan. 14, 2021	9AM – 4PM	Kansas City	Jackson	Kansas City Zoo (Cheetah Parking Lot)
Jan. 15, 2021	9AM – 4PM	Kansas City	Jackson	Kansas City Zoo (Cheetah Parking Lot)
Jan. 15, 2021	9AM – 4PM	St. Louis	St. Louis City	CareSTL Health

NHSN Notification Message

Posted on 01/01/202106/07/2021

DHSS has received notification of an application error impacting NHSN COVID-19 data for the period of December 26-31, 2020. Steps for a work around are below.

Submission Deadline for SNF COVID-19 Related Expenses – Extended through 12/30/20

Posted on 12/21/202006/07/2021

The submission deadline for SNF “other” necessary COVID 19 related expenditure invoices has been extended through 12/30/2020. There has been no change testing invoices – the deadline for all facility types to send testing invoices to the state is still 12/30/2020.

Beginning December 18, 2020, the following will appear on the main web application page:

Important update: Please read!

All long term care facilities (SNF, RCF, ALF, ICF) have until 12/30 to submit “testing” invoices.

Skilled Nursing Facilities may resume submitting “other” necessary COVID-19 related expenditures until 12/30.

If you represent a SNF and you already submitted items that were not approved because you were over your allocated cost cap, please do not resubmit those items. Those are being re-reviewed at this time. Only submit new expenses since 12/01 and/or items not previously submitted.

In order to process all LTC invoices in a timely fashion and meet deadlines, it is imperative that facilities submit complete invoices with all the required information and documentation. This includes:

- The federal tax ID number
- Invoice to the State with a unique invoice number not already used
- Invoice/bill from the vendor who provided services/supplies
- Full address of the facility
- Signatures on all forms requiring signature
- Detailed explanation of how the expenditure is COVID-related
- Signed attestation if one has not already been uploaded to the State

If required documentation is not submitted, your invoice may not be approved.

Free COVID-19 Testing Opportunities

Posted on 12/21/202006/07/2021

Community testing events serve the residents of Missouri. DHSS is partnering with the Missouri Community Health Centers and MAKO Medical Laboratories to offer these free testing events. There is no eligibility other than to have a Missouri address. If you do not see any community testing events in your area, you can continue to check back with this page as new sites will be added as events are planned.

The test is a PCR test done by an anterior nares or midnasal swab to determine the presence of SARS-CoV-2, the virus that causes COVID-19. This is not an antigen or antibody test.

Registration Strongly Recommended:

Please register for an event by clicking on the registration link associated with each event. If you need assistance, you may call 919-351-MAKO (6256). Please double-check the spelling of your name and your date of birth. This information must be exactly correct to receive your results. Upon completing the registration, you will receive an email with your QR Code and booking ID number. Show this QR Code and booking ID number to the site attendant in order to proceed with your test.

Please allow at least 30 minutes for completion of testing upon arrival to the testing site. Delays may occur in the event of inclement weather. Walk-ins to the event without prior registration cannot be guaranteed a test.

Date	Times	City	County	Location
December 23, 2020	9AM – 6PM	Kansas city	Clay County	Worlds of Fun
December 28, 2020	9AM – Noon 1PM- 4PM	St. Louis	St. Louis County	CareSTL
December 29, 2020	Noon – 3PM	St. Louis	St. Louis County	Affinia
December 30, 2020	9AM – 6PM	Kansas city	Clay County	Worlds of Fun
December 31, 2020	11AM – 2PM	St. Louis	St. Louis County	Affinia
January 4, 2021	10AM – 4PM	Potosi	Washington	Great Mines Health Center
January 5, 2021	10AM – 4PM	Farmington	St. Francois	Christian Life Church
January 5, 2021	1PM – 6PM	Warsaw	Benton	Katy Trail Clinic
January 6, 2021	1PM – 6PM	Camdenton	Camden	Central Ozarks Medical Center
January 7, 2021	1PM – 7PM	Warrensburg	Johnson	Johnson County Fairgrounds
January 13, 2021	11AM-2PM	Kimberling City	Stone	First Baptist Church
January 14, 2021	9AM – 5PM	Hermitage	Hickory	Ozarks Community Health Center

More information regarding COVID-19 in Missouri can be found at health.mo.gov/coronavirus.

CDC COCA Call: Making Practical Decisions for Crisis Standards of Care at the Bedside During the COVID-19 Pandemic

Posted on 12/16/202006/07/2021

Date: Thursday, December 17, 2020
Time: 2:00 pm – 3:00 pm (ET)

A few minutes before the webinar starts, please click on the Zoom link below to join:

https://www.zoomgov.com/j/1613403966

Healthcare operations and healthcare services delivery change due to scarcity of required resources under pervasive (e.g., pandemic influence, COVID-19) and catastrophic disaster (e.g., earthquake, hurricane) conditions. The standards of care proposed under these unique and challenging conditions must be a reasonable approach to healthcare service delivery that merges public health, ethical, and medical care demands.

During this COCA Call, experts from Hennepin Healthcare and Bellevue Hospital will present background on the Institute of Medicine (IOM) framework, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations (IOM, 2009), and identify how Crisis Standards of Care apply to the current COVID-19 pandemic. Presenters will also highlight systems-level information sharing and coalition-level coordination activities to help clinicians plan for these potential situations and make medical decision during a crisis.

If you are unable to attend the live COCA Call, the recording will be available for viewing on the COCA Call webpage a few hours after the live event ends.

Federal Pharmacy Partnership for Long-Term Care Program – IMPORTANT INFORMATION FROM CVS AND WALGREENS

Posted on 12/08/202006/07/2021

For those communities that chose CVS or Walgreens for the Federal Pharmacy Partnership for COVID-19 Vaccine Program, CVS and Walgreens have started communicating with communities about the program. The information from both pharmacies can be found below. It is imperative that you follow the guidance and direction from CVS or Walgreens when your community receives this information. This will be key to your vaccination clinics running smoothly.

CVS

Walgreens COVID19 Vaccine – What To Expect Guide
Walgreens Facility Tip Sheet
Walgreens LTCF Welcome Email Body

If you have not been contacted, communication will likely continue over the next week. If your facility DID indicate CVS or Walgreens but have not heard from them yet, they you should go to the CVS or Walgreens website and fill out the contact information for your facility. CVS and Walgreens are still working through contacting all the communities assigned to them.

CVS website: www.omnicare.com/covid-19-vaccine-resource
Walgreens website: www.walgreens.com/covidvaccine

Please make sure the point of contact listed when you registered for the vaccine program is aware the call and/or email from the pharmacies will be coming. Also, please continue to check your junk or spam folders if you have not been contacted by a pharmacy.

Information regarding this program is developing rapidly. Please watch for further messages as information is available.

First Responder Provider Network

Posted on 12/04/202006/07/2021

The Missouri First Responder Provider Network, in partnership with the Department of Mental Health and Coalition for Community Behavioral Healthcare, can provide free behavioral health services for healthcare professionals who have been impacted by COVID-19.

See the flyer for more information.

COVID-19 Vaccine Information

Posted on 12/02/202006/07/2021

The website below contains useful facts about the vaccine that may be shared with residents, families and staff.

https://covidvaccine.mo.gov/

Category: COVID