Zika Update #5

With the news this afternoon of two new cases of Zika in Miami Beach, the number of non-travel-related cases of the Zika virus continues to tick upward. As of yesterday, there were 33 such cases in the state, as well as 461 travel-related cases and 63 cases involving pregnant women.

As a healthcare organization, we’re working to ensure that we are providing our patients and community with adequate resources and information. This week, our community health team hosted a seminar on Zika at South Miami Hospital. A special thanks goes to Jorge Perez, M.D., Rafael Perez, M.D., and Tomas Villanueva, D.O., for taking part in the panel and to our community health team for organizing the event. More than 100 people were there to hear from our experts and ask questions. It was also a great opportunity to reach our community through the media. The Miami Herald, WLRN, Telemundo and Univision covered the event.

Per the governor’s direction earlier this month, all county health departments are now offering free Zika risk assessment and testing to pregnant women. At Baptist Health, we are conducting testing through the health department at our outpatient hospital labs as well as at several of our diagnostic imaging centers. The list of locations and testing information can be found at BaptistHealth.net/Zika. Patients are required to have a physician’s prescription as well as completed health department forms in order to be tested for Zika at a Baptist Health facility. Patients who are not pregnant must also have pre-approval from the health department.

As the situation evolves, I want to stress the importance of prevention. We are in a unique and critical position to encourage our patients and our community to take precautions in order to prevent a wider spread of the virus. While the virus is of most concern to women who are pregnant or planning to become pregnant, those who do not fall in that category should be encouraged to protect our pregnant community by taking precautions themselves. Each of us, when not protected, provides an opportunity for mosquito vectors to transmit the virus.

The CDC has great information on prevention. I encourage you to take a moment to read through it and ensure that you’re doing everything possible to protect yourself and your community. As Baptist Health South Florida employees, we are often looked to by friends and family for advice and expertise on any issue affecting the health of our community ­– including this one. That’s a good thing, and even if we aren’t experts in every area, we usually have access to the information. Here are the links to two simple handouts from the CDC with an overview and prevention information that I think will be useful to you when you get questions about Zika. You can print them out or forward them electronically (I texted them to my sons, who don’t know what paper is). Having 15,000 people pushing out facts to the community has a big impact.

Thank you,

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Zika Update #4

Dear Colleagues:

As you know, the Zika virus and its implications for South Florida continue to be an important topic of conversation for our community and for us as healthcare providers. The situation is changing rapidly, and we’re following it and making appropriate changes to our response and to our plans along the way. We remain at a level 3 activation, which means we’re closely monitoring the situation and are responding accordingly.

As of today, there are 406 cases of the Zika virus in the state of Florida. Fifteen of those cases involve local transmission in Miami-Dade County. The Florida Department of Health still believes that local transmission is only taking place within the identified one-square-mile area that includes Wynwood, north of downtown Miami.

Earlier this week, Florida’s governor instructed the health department to request a CDC Emergency Response Team. That team is now here in South Florida helping the health department with its investigation, outreach and mosquito control efforts.

At Baptist Health, we’ve assembled a Zika task force that includes physician leaders within our system, private practice physicians (including local OB physicians), entity leaders, infection control professionals and others to ensure that our response plan is well-rounded and well communicated. The expertise of these individuals has been extremely valuable as we prepare to respond to the needs of our community under various scenarios. With extensive media coverage of the Zika issue, Baptist Health’s experts have also been front and center in national and local media interviews, including the Wall Street Journal, LA Times, Boston Globe, NPR, Univision and the Miami Herald. Special thanks to Jorge Perez, M.D., Rafael Perez, M.D., Ellen Schwartzbard, M.D., and Jack Ziffer, Ph.D., M.D. for lending their expertise to the task force and for numerous media stories. Our nursing staff and leaders across the organization – and especially in labor and delivery, the labs, emergency rooms and urgent care centers – have been performing at their usual exceptional level during these special circumstances, and I thank them now, and will many times to come, as we help our patients and community work through this.

One of our priorities is community education. While patients with symptoms should always seek appropriate treatment, it is important for people with no symptoms who may be concerned about the virus to talk with their physician. Whether it’s a primary care physician or an obstetrician, it is important for concerned individuals to speak with their doctor. The doctor can then determine, along with the health department, whether the patient meets the testing criteria and can help manage the patient’s follow-up care.

We’ve added the latest information about the Zika virus to our website, BaptistHealth.net/Zika as well as our employee Intranet to keep everyone up to date. We’ll continue to update both as the situation changes.

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Monitoring Local Transmission of the Zika Virus

This morning, Florida Gov. Rick Scott confirmed that it is likely that Zika virus is actively being transmitted by local mosquitoes.  The Florida Department of Health gathered enough information as part of its ongoing investigation into non-travel related cases of the virus in Miami-Dade and Broward counties to conclude that a high likelihood exists that four cases are the result of local transmission. Two of those cases are in Miami-Dade, and two are in Broward.  The health department believes that active transmission is occurring in one area in Miami-Dade County, just north of downtown.  They’re working to test neighbors and increase mosquito control in the impacted area, and continue prevention efforts around South Florida.

At this time, Baptist Health is operating at a level 3 activation (our lowest level of alert), which means we’re monitoring and assessing the event and collaborating with health officials.  Our Emergency Preparedness and Security Department ― partnered with our Infection Control experts – is working closely with the local health department, which also links us to those at the state and federal levels.

As of yesterday, 383 cases of the Zika Virus have been confirmed in Florida.

Our blood provider resumed blood collection today, after being temporarily asked to suspend collections yesterday.  The provider currently tests all donors for the Zika virus.

As you are probably aware, many patients with Zika have few or mild symptoms that may include fever, rash, joint pain and conjunctivitis. Yet there can be some serious consequences of the disease. Babies born to mothers who are infected while pregnant are at risk of microencephaly, a birth defect that causes abnormally small heads and a number of health concerns. In addition, a few patients have also suffered from Guillain-Barré syndrome, a neurological disorder often accompanied by temporary paralysis. There is no vaccine to prevent Zika and no specific treatment for the illness. Patients are advised to rest, stay hydrated and take acetaminophen to reduce fever.

When patients come in to our facilities and meet the testing criteria, our infection control practitioners work quickly to receive approval for testing through the health department. Urine and blood tests that detect the virus are available, and results take several days to obtain. All positive results are reported as required to the county health department.

John Braden, M.D., our medical director for emergency preparedness, reports: “The number of cases continues to trickle in mostly being seen in the urgent care setting. We continue to closely follow any new developments through our health department contacts.”

The Centers for Disease Control and Prevention recommends that women who are pregnant or thinking of becoming pregnant postpone travel to areas with widespread Zika infection. Florida’s small case cluster is not considered widespread transmission. According to CDC guidance, providers should consider testing all pregnant women with a history of travel to a Zika-affected area. CDC recommends that a pregnant woman with a history of Zika virus and her provider should consider additional ultrasounds.

In addition, the Florida Department of Health suggests the following:

•   Remove any standing water from small pools, bird baths, fountains, buckets or other containers that are outside around your home. Mosquitoes breed in these waters.
•   Apply mosquito repellent and cover exposed skin, particularly when outdoors during times mosquitoes are most active.
•    In Miami-Dade County, call 3-1-1 to report mosquito infestations in your neighborhood. In Broward County, call 954-765-4062. In Monroe County, go to www.keysmosquito.org.
•    Consider postponing travel to countries where Zika is present.
•    Good sites for Zika information and background are: http://miamidade.floridahealth.gov/, which gives the daily report from the Department of Health and www.cdc.gov/zika/. Florida also operates a Zika Virus Information Hotline at 1-855-622-6735.

If you have questions about Zika that relate to the workplace or your care of patients, talk to a member of the Infection Control or Emergency Preparedness staff. Watch for updates in your entity newsletters and on Baptist Health’s blogs at https://baptisthealth.net/baptist-health-news/.

As always, we’ll continue to keep you updated as this develops.

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Hurricane Season is Here

Here we go again. We are privileged to live and work in South Florida with beautiful beaches in our own backyard. But, with the sunshine and the surf comes the yearly threat of storms. As we do each year on June 1st, today, we put our guard back up and begin to watch the tropics. My biggest concern is complacency. It has been a long time since we have had a hurricane and a really long time since a serious one like Hurricane Andrew. That was 1992. We have lots of people working here who were born after 1992! Fortunately, we still have a lot of institutional knowledge about hurricanes and a substantial percentage of people who have real-time experience.

Last week, the National Oceanic and Atmospheric Administration forecast 10-16 named storms, four to eight hurricanes and one to four major storms packing winds over 110 mph for this coming season. While that’s an “average” amount of storms, we Floridians know there is nothing “average” about hurricane season. Each year, and each storm is different. And, experts say predicting this season is particularly difficult due to several factors including whether El Niño that helped keep the 2015 season low has begun to fizzle and whether La Niña, which can fuel storms, will begin to form.

The first storm of the year has already happened and passed us by. Our state dodged any effects, but Charleston, South Carolina felt the effects over the holiday weekend. The storm brought heavy rain and flooding to the area. They don’t call it the Low Country for nothing. Jean Arias, R.N. (jeana@baptisthealth.net), who leads our Emergency Preparedness efforts, checked in with our colleagues at Roper Hospital in Charleston in case they needed our support. They were fine, and will reciprocate with us when the day comes. We have friends in low places!

This one missed us, but this is an early warning that the season is upon us, and we must all have our plan of action at home as well as at work. We know our patients and their families depend on us through all kinds of weather and events. We make it a point to review our plans and protocols as teams and across the organization each year, hoping we’ll never have to use them, but confident we’ll know what to do if we do. Do you know what your role is at work in the event of a hurricane, or where to call for updates? I urge you to take some time now to review this information with your team.

It is also crucial to have a plan at home. If you don’t have one, the National Hurricane Center has some great information on its website that can help, including contact numbers for reference and a list of supplies that you should have on hand. As always, we’ll keep you updated through this forum and others as we monitor storms or other situations and put our emergency operations in place.

“We’ve been meant for this, since we were born
No problems now, the coast is clear
It’s just the calm, before the storm
This must be just like livin’ in Paradise” – David Lee Roth

Wayne Brackin

Zika Virus Update #2

As you know, news around the Zika virus is evolving quickly. Today, Gov. Rick Scott signed an executive order to declare a public health emergency in four counties, including Miami-Dade, due to the Zika virus. At least nine cases of the mosquito-borne illness have now been confirmed in the state — four of those in Miami-Dade County. All of these cases are believed to have been contracted abroad, and none involve pregnant women. “Although Florida’s current nine Zika cases were travel-related, we have to ensure Florida is prepared and stays ahead of the spread of the Zika virus in our state,” said Gov. Scott in announcing the order. His action allows the state’s agriculture department to provide additional mosquito control measures in affected areas. It also directs the Florida Department of Health to make determinations as to what resources and information are needed in the state to combat the spread of Zika.

Earlier this week, health officials in Texas reported that the first known case of Zika contracted in the United States was a person infected after sexual contact with somebody who had become infected abroad. The CDC is working to learn more about how the virus can be transmitted.

Just as the state and CDC are taking measures to stay ahead of the virus and educate people as much as possible- so should we. Our community looks to us as a resource for education and reassurance, and I want you to know that we are doing all we can to learn about this virus and prepare for the safety of our employees and patients.

Personally, we can all take measures to protect ourselves by avoiding mosquitoes. To learn more about the CDC’s recommendations, click here. The most important thing about this declaration of a public health emergency is that it is based on the uncertainty of this situation. For example, when we communicated last on this, there was no documented person-to-person transmission, now there has been. Things are going to likely change from day to day and week to week for some time to come. As a system, we continue to follow national and international guidance, and work closely with the health department to ensure we have the latest information and protocols. At this point, we are not activating our incident command centers, but we are following this situation very closely. As always, we’ll keep you informed.

Wayne Brackin

Monitoring the Zika Virus

Zika, a mosquito-borne virus linked to birth defects including microcephaly in babies born to mothers who were infected during pregnancy, is causing concern among health officials from around the world, and continuing to make headlines. The virus has been widely covered in the media. And, as news about this virus evolves, we are responsible for focusing on the facts and making sure we are informed and prepared.

While we do not yet understand the full spectrum of outcomes that might be associated with infection during pregnancy, nor the factors that might increase risk to the fetus, here is what we do know:

Local transmission of the virus has not been documented in the continental United States, but has been identified in more than 20 countries in Latin America and the Caribbean. The Centers for Disease Control is recommending that until more is known and out of an abundance of caution, pregnant women should consider postponing travel to any area where Zika virus transmission is ongoing. Pregnant women, and women planning to become pregnant, who do travel to one of these areas should talk to their healthcare providers first and strictly follow steps to avoid mosquito bites. Symptoms include fever, rash, joint pain and red eyes (conjunctivitis); however, the CDC estimates 80 percent of people infected with the virus have no symptoms. There is no specific antiviral treatment for this virus.

“From a global perspective, the medical community has the technology to know where there is an outbreak and how it is spreading, so it gives us an opportunity to prepare,” said Dr. John Braden, Baptist Health South Florida’s Director of Emergency Preparedness. “We will continue to monitor and gather data to continue to manage this effectively.”

As a healthcare system, we are watching the spread of this virus and working closely with the health department to ensure we have the latest information. The CDC has developed guidelines for health care providers in the U.S. caring for patients during this outbreak. We are following those guidelines. As always, our patients go through a screening process which includes travel history. Based on travel information and symptoms, we work with the health department to determine whether or not patients need to be tested for the virus, and treat them appropriately.

Dr. Jorge Perez, medical director of neonatal intensive care at South Miami Hospital and chairman of South Miami Hospital’s Center for Women and Infants says: “we are looking at the protocols the CDC is recommending and keeping up to date with the data and the countries that are affected.”

Additional studies are planned to learn more about the risks of Zika virus infection. For more information, visit: http://www.cdc.gov/zika/.

As always, we will keep you informed as we learn more about the virus and its effects.

Wayne Brackin