Care-coordination activities are especially important to reconnect persons with disabilities to their communities when they are discharged after a COVID-19 related hospitalization, isolation, or quarantine. Ensuring that persons with disabilities have meaningful access to community life requires nurses, medical social workers, case managers, and other discharge professionals to overcome additional obstacles presented by the public health emergency including limited staff, support services, and the changing needs of persons with disabilities who are recovering from COVID-19.
The HHS Office of the Assistant Secretary for Preparedness and Response in partnership with the HHS Centers for Medicare and Medicaid Services and the HHS Administration for Community Living developed the Discharge Planning and Care Coordination tool to address discharge planning during an emergency.
Throughout the discharge process, care coordinators need to remember to put the needs of the patient first. In order to translate this somewhat broad concept into an actionable plan, the Discharge Planning and Care Coordination tool takes a person-centered approach to planning and leverages the CMIST Framework (Communication, Maintaining Health, Independence, Support, and Transportation) to help providers find discharge solutions.
While a framework to guide discharge planning decisions is helpful, there is no one-size-fits-all solution. Providers need to take a person-centered approach and work with the patient to determine what he or she wants their post-discharge environment to look like. Working together, the patient and the provider should develop a plan to optimize the patient’s quality of life, taking into account his or her preferences, needs, and wants. The goal of person-centered planning is to create a plan that would accommodate the person’s self-defined quality of life, choice, control, and self-determination.
The CMIST Framework outlines the considerations required to select the most appropriate discharge setting from a multidisciplinary perspective. The resource takes a comprehensive approach to discharge planning and assists planners as they identify the most appropriate settings for persons with disabilities after a COVID-19 diagnosis and during an active public health emergency.
Journey Map for COVID-19 Positive Individuals with Disabilities Who Live in Community-Based Settings
Depending on their disability-related needs and COVID-19 recovery, people with disabilities may be discharged to three common settings: home, temporary care (nursing homes or swing bed hospital), or new housing.
While a return home is preferable and may be appropriate for those who have tested negative for COVID-19, some persons with disabilities require additional services found in a more supportive living environment as they recover from a COVID-19–related illness. A decline in health related to the COVID-19 diagnosis or loss of community support services due to the emergency may necessitate the reevaluation of living arrangements and support services. Others may find that they are able to transition to a more independent community setting upon release from the hospital.
The tool includes a number of planning resources for professionals, such as a journey map and resources detailing national and state programs and federal contracts that support care coordination activities.
Right now, nurses, medical social workers, case managers, and other discharge professionals are facing tough decisions every time COVID-19 patients are discharged. Ultimately, the goal is to empower persons with disabilities to return to a setting that is as independent and integrated as possible when it is safe to do so after a COVID-19 diagnosis. Using a standardized framework, to make more informed decisions can help people with disabilities receive appropriate care while still protecting clinicians, staff and others. To get started, check out the Discharge Planning and Care Coordination during the COVID-19 Pandemic.
As the coronavirus pandemic continues around the world, the need for rapid, accurate testing remains critical. Testing leads to the identification of active cases, helps spur more rapid treatment of people who are infected, and allows you and your doctor to take immediate action, such as isolating people who are ill.
COVID-19 is highly contagious, and the virus that causes COVID-19, SARS-CoV-2, can be transmitted by people who do not show any symptoms. Many who are infected do not know they are carrying the virus; others might have just very mild symptoms. As people continue with their daily routines, they can infect others inadvertently. To support the American people, schools, employers, healthcare providers, and public health officials in this whole-of-America pandemic response, BARDA is committed to the rapid development and production of test kits across the United States.
It might seem obvious, but testing exponentially increases not only our knowledge but also our ability to act on that knowledge. Knowledge empowers patients, healthcare providers and public health officials. In addition to isolating people who are infected, test results help officials trace contacts of confirmed cases if needed; identify hot spots or flare ups within communities which helps direct local, state and federal healthcare resources; conduct disease surveillance to track COVID-19 infections; and better understand how the disease behaves.
To meet this need, BARDA began supporting development of diagnostic tests as soon as the pandemic spread to the United States and we now have a diverse COVID-19 diagnostics development portfolio which currently contains more than 30 diagnostic tests for a variety of commercially available platforms. Traditional laboratory systems are important in the diagnostic landscape because they perform sophisticated tests with established quality assurance plans while processing a large number of samples.
The BARDA portfolio began with tests that run on platforms commonly available in the United States. Sixteen of these BARDA-supported tests have received emergency use authorization from the U.S. Food and Drug Administration, and BARDA’s partners have shipped more than 50 million tests. By investing in tests that work with the existing infrastructure in laboratories, hospitals, and clinical settings, we are helping increase the chances of fast and widespread use of the tests.
To enable testing in non-traditional laboratory settings, BARDA’s portfolio also contains tests that are small, portable, and easy to use too, such as the Cue Heath test and even in-home tests. Among the portfolio’s point-of-care systems, you’ll find a
rapid mobile test designed for hospitals, long-term care facilities, urgent care centers, and doctor’s offices. Using an easy-to-use handheld reader, healthcare professionals can test patients at the first point-of-contact. Another
BARDA-funded research project aims to bring COVID-19 testing into people’s homes and could become the first such test for use at home in the United States, if authorized by FDA.
These point-of-care tests are less complex than laboratory systems’ but offer faster results, which empowers patients and providers to make informed decisions regarding diagnosis and treatment. They can be performed by personnel with little clinical laboratory training, and and individuals may even be able to administer the test in their own home.
As the part of the pandemic response, BARDA also supports development of serological tests that measure antibodies. Unlike tests that detect the presence of the virus itself, antibody tests measure the amount of antibodies in the blood to help determine whether the body has responded to a specific infection caused by a virus. As people across the country continue to demand COVID-19 tests, laboratories need diagnostic testing systems that can quickly process a large number of tests in a short period of time.
On May 29, the first two BARDA-supported antibody tests received emergency use authorization (EUA); one that can run over 400 tests per hour with results in 10 minutes. The symptoms of influenza and COVID-19 are similar and with influenza season starting in the northern hemisphere, healthcare providers, public health professionals, and patients need accurate diagnosis to make sound health decisions. To meet this need, BARDA is supporting four combination tests to provide simultaneous testing of Flu A/B and COVID-19. Often referred to as multiplex tests, these combo tests are important not only to conserve reagents and supplies but also to maximize test capacity. Because symptoms can be similar for both types of respiratory infections, a single test that requires just a single sample from the patient makes sense.
Looking toward the future, another innovative approach is a wearable device that creates an early warning algorithm to identify early symptoms of COVID-19. The device generates de-identified, patient-generated health data. BARDA is supporting a study of the effectiveness of this device to enhance current disease surveillance systems to detect respiratory infections prior to the onset of symptoms. Such a device could be extremely helpful for healthcare workers and others in the U.S. workforce whose jobs must be done in person.
BARDA is supporting another collaboration in a Veterans Health Administration (VHA) nursing home where a patient wears a biosensor to remotely monitor individuals during the COVID-19 outbreak for deterioration of health indicators, including but not limited to respiratory rate, body temperature, blood oxygen levels (SpO2) and heart arrhythmias, to improve patient outcomes. Residents in the VHA facility volunteered to participate in the study.
BARDA’s support of a large and diverse development portfolio of COVID-19 diagnostic technologies heightens our nation’s ability to respond more effectively to the current pandemic. BARDA also is funding development of six diagnostic technologies through
RADx, a partnership with the National Institutes of Health (NIH). The technologies represented in BARDA’s portfolio and in RADx have the potential to fulfill current clinical needs, optimize treatments, and improve outcomes.
There is no single product—in diagnostics, treatment, or vaccines—that alone can end the COVID-19 pandemic. Diagnostic tests are part of a broader strategy to fight the virus and one component of BARDA’s COVID-19 portfolio. We continue to support development of vaccines to help stop the spread of the coronavirus as well as the development of therapeutic medicines to treat patients. All of the medical countermeasures in this portfolio ultimately work together to help save lives.
You can learn more about
our COVID-19 medical countermeasures development programs by visiting
BARDA’s COVID-19 Portfolio.
An already active wildfire season in the American west was put into overdrive when wildfires spread across large parts of Oregon. This spread caused a significant change in the air quality index (AQI)—in some cases climbing above a 300 AQI value which can cause health problems within communities.
To combat the rapid spread of these dangerous fires, thousands of wildland firefighters and first responders from across the United States have leapt into action to protect communities and control the fires. Throughout 2020, wildland firefighters’ inherently hazardous job has become even more dangerous with the ongoing COVID-19 pandemic. Wildland firefighters and others who live and operate out of the Incident Command Post (ICP) or fire camps can be particularly vulnerable to COVID-19 because of the traditional setup of fire camps and the hazardous pollutants in wildfire smoke. Preventing the spread of COVID-19 among wildland firefighting personnel will be integral in keeping first responders healthy and limiting additional exposure within the communities they serve.
A few cautionary and proactive measures can be taken to help firefighting personnel be more aware of how the ongoing pandemic can impact their response. Before wildland firefighters and other personnel arrive at fire camps, they should be educated with a basic understanding of COVID-19: how the disease is thought to spread, what symptoms are associated with infection, and what measures can be taken to prevent or minimize the transmission of COVID-19. Wildfire agencies should also be ready to provide non-punitive flexible leave policies that are consistent with public health guidance. Below is key guidance from the U.S. Centers of Disease Control and Prevention (CDC) and the National Wildfire Coordinating Group (NWCG) to prevent the spread of COVID-19 and keep our wildland firefighters and support personnel healthy.
Just one COVID-19 case can cripple an entire unit, so preventing the spread of COVID-19 starts when fire personnel arrive at duty stations. If possible, personnel should isolate for 14 days in a separate space provided by management prior to deployment. This will help newly arrived firefighters avoid common spaces. If or when a suspected or confirmed COVID-19 infection appears, units should follow the guidance outlined in the Medical Unit COVID-19 Concept of Operations Plan for the fire community.
Face-to-face contact should be limited and maintaining six feet of distance is still one of the best ways to reduce the spread of COVID-19. Fire camps should be structured in a way that encourages and enables social distancing and they should rely on remote units and virtual technology when possible for incident management team meetings, and other communications.
Fire personnel often work together as a group in crews, units, or modules’. This year crews and modules should use the “Module as One” or “isolate as one” approach to help keep crews and the general public healthy. Units or modules will have the same people travel in the same vehicle for the entire season, no crew hopping. By isolating as a unit, crews and modules can limit outside exposure to COVID-19. This may also allow crews and modules to safely complete operational tasks in closer proximity to one another, and/or could ride in vehicles without cloth face masks when working within their “Module as One” crew. However, cloth face masks should always be worn when members of the module are in fire camps or are among the general public.
Trained fire support personnel need to take steps to keep common areas disinfected and clean at all times. Common areas such as bathrooms need to cleaned twice a day and dining facilities should be cleaned before and after each meal, both with U.S. Environmental Protection Agency approved disinfectants. Wash stations should be set up throughout the grounds especially outside of or in very close proximity to bathrooms, portable toilets, and dining facilities. If the resources exist, individual bottles of hand sanitizer should be provided to all camp personnel. Firefighters should also look to disinfect firefighting personal protective equipment using guidance released by the Federal Healthcare Resilience Task Force.
Maintaining a healthy workforce should be a priority throughout the fire season. Units should ensure all crew members are getting proper rest, hydration, and nutrition to help prevent cumulative fatigue. Specifically to limit the spread of COVID-19, cloth face masks should be worn around fire camps and all personnel should use the Wildland Fire COVID-19 Screening Tool daily. If possible, management should mitigate smoke exposure for firefighting personnel when tactics can be adjusted and operational objectives can be met.
The Centers for Disease Control and Prevention (CDC), the National Wildfire Coordinating Group (NWCG), and the U.S. Fire Administration (USFA) have developed resources, protocols, and guidance for fire personnel and fire managers.
HHS/ASPR’s Division of Critical Infrastructure Protection (CIP) continues to actively track wildfires and other emerging issues at the intersection of disaster health and critical infrastructure protection. To receive information on the latest resources and tools to optimize your organization’s ability to respond, recover, and prepare for threats and incidents impacting the nation’s health critical infrastructure, subscribe to the ASPR CIP mailing list.
Earlier this summer, a burn patient received a minimally invasive skin graft using two BARDA-supported burn care products in tandem, an enzymatic debridement product and a product that promotes skin regeneration. Together these products helped a patient with second degree burns covering much of his body recover quickly – so quickly that he was back to working in his garden after just a few weeks.
Photo courtesy of the Medical University of South Carolina
he patient was admitted to the burn unit at the Medical University of South Carolina in Charleston. He had sustained second degree burns over 17 percent of his body. Most patients with burns of this magnitude would require surgical debridement of the deep burns and a skin autograft using some of the patient’s remaining skin from another part of the body to cover the wound. Steven Kahn, M.D., and a team of burn care experts at the Medical University of South Carolina took a different approach.
First, Dr. Kahn used an enzymatic treatment that is currently under BARDA-supported clinical development to remove the dead tissue. Then, he used the RECELL system, a product that received FDA-approval in 2018 after receiving support from BARDA, to promote skin regeneration using only a small sample of the patient’s skin. By using both products, he was able to avoid the use of traditional surgical excision debriding and skin graft procedures, both of which can be time consuming and painful, and require the skills of highly trained burn care specialists.
At ASPR/BARDA, we are committed to developing medical countermeasures and technologies that can save lives and promote the recovery of people who are injured or develop an infection during a disaster or emergency. Burn injuries are debilitating and a direct result of many of the potential incidents that threaten our nation’s health security.
Since 2013 BARDA’s collaboration with the American Burn Association has been instrumental in identifying opportunities for improvement across the continuum of burn care. After extensive analysis, BARDA identified two critical bottlenecks that could hamper care during a mass casualty incident (MCI): (1) limited treatment capacity, and (2) inherent inefficiencies in procedures.
Accordingly, BARDA has invested in a portfolio of cutting-edge technologies of medical countermeasures (MCMs) which specifically improve treatment across the burn care continuum ranging from wound assessment, debridement, through skin coverage and regeneration. BARDA’s investments in novel products are directed at specific steps in the progression and treatments in the burn care continuum. In doing so they introduce new ways to be efficient and expand capacity, the bottlenecks in the delivery of burn care in our national context.
Current burn care always requires a highly skilled surgeon to debride and excise the wounds, which is the process of carefully removing the dead tissue. With limitations in the number of surgeons in the country who are trained to perform these procedures that are both time consuming and traumatic for the patient, investing in alternatives is imperative.
BARDA has invested in a novel enzymatic debridement product that is both easier to administer than the current practice and it is incredibly precise. This promising enzymatic debridement product can remove dead tissue without damaging the surrounding live tissue. This level of precision is hard to achieve surgically. If the product receives FDA approval, many believe it has the potential to change the resource and surgical needs and enable clinicians to treat more patients quickly which is especially important during an MCI. BARDA is supporting its advanced development for introduction in the U.S. and is currently under Biologics License Application (BLA) review by the Food and Drug Administration (FDA).
To address the second bottleneck, BARDA is supporting innovative approaches to increase efficiency and reduce the need to harvest a patient’s own skin, a procedure known as autografting. Typically, skin grafting requires a donor site from another part of the patient’s body. The procedure is often quite painful and can result in additional scarring. BARDA’s support to Avita’s RECELL Spray on Skin technology received FDA approval in 2018. Like autografting, this technology requires the removal of a small patch of skin from the patient, which is then converted into a spray solution that can cover a much larger wound surface area than a standard skin graft could.
In the photo above, the three rectangles on the patient’s back are the donor site. Dr. Kahn estimated that the following conventional approach of care would have needed most of the skin from the front of the patient’s thighs. RECELL can be used to produce a skin cell spray that can cover 80 times the area of the donor site. In this case, those three small rectangles of skin were enough to treat the burns that covered 17 percent of his body. By using RECELL Spray on Skin, the burn surgeon was able to help the patient’s wounds heal with a minimally invasive procedure that was less painful and regenerated skin tissue quicker.
Just a couple of weeks after this burn injury, the patient reported that he was feeling great. He explained that the pigmentation of his new skin is even; his skin isn’t tight, itchy or painful. He has gone out and done some yard work - while covering up and keeping out of full sunshine. That is an outstanding patient outcome for a person who had second degree burns covering 17 percent of his body
For BARDA, there are key metrics to measure from the benefits these new MCMs targeted within the continuum of care program. One is whether the MCMs shorten the hospital stays for the patients. Dr. Kahn estimated that he normally would have kept such a patient in the hospital for 19 days. This patient was able to be discharged after only 12 days. This information is important for both BARDA and the community of care providers. For BARDA this data metric reflects a substantial return on investment, strengthening preparedness for a MCI and improving the standard patient care every day.
Dr. Kahn has indicated that the patient’s rapid recovery would not have been possible without the non-surgical enzymatic debridement approach combined with RECELL. By using these two cutting-edge products together and taking an end-to-end approach to burn care, Dr. Kahn was able to provide next-generation burn care to his patient.
While products that address each of these treatment targets can independently improve burn care, use of multiple products could have an even greater impact on patient health when they are used together in tandem. At BARDA, we envision such synergy further increasing the efficiency of burn care when all these new products would ultimately get integrated into routine burn care.
The overall quality of the national burn care system would consequently improve as well leading to speed recovery times, reduced pain and scarring, and improve patient outcomes. In an MCI, technologies that alleviate bottlenecks and enable doctors to treat patients more effectively and efficiently could, in turn, help doctors treat more patients and save more lives.
The successful patient outcome that resulted from the synergistic use of these two products that BARDA has funded demonstrates how we are fulfilling our mission to protect health and save lives through partnership with the private industry. This example helps validate the underlying strategy of integrating overlapping MCMs across the care continuum into routine clinical practice which builds synergy, value, and improves national preparedness over the long term.
Check out the
MUSC Catalyst News to learn more about the treatment this patient received from the team at the Medical University of South Carolina.
From 2009 to 2019, there have been an average of 64,100 wildfires annually, burning an average of 6.8 million acres each year, according to data from the
National Interagency Fire Center. This year, wildfires present a tougher challenge to emergency managers and shelter operators, because shelters need to protect people from both wildfires and the spread of COVID-19.
Communities can – and often do – face multiple, complex disasters and emergencies at the same time. Experienced emergency responders, especially those in the western and southwestern parts of the US, have faced wildfires in the past, and many emergency managers have worked to help their communities combat COVID-19. Today’s emergency managers and shelter providers must be ready to provide a safe and healthy environment for evacuees that protects them from both threats.
Cleaner air shelters are an important resource during wildfire season. They create a safe space for individuals who do not have
adequately clean air in their homes. Facilities used for cleaner air shelters often include school gymnasiums and civic auditoriums. However, putting individuals and groups together in cleaner air shelters can create an environment for the transmission of COVID-19 among evacuees, staff, and volunteers using the facilities.
Facility planners and emergency responders can take several steps to prevent the transmission of COVID-19 in cleaner air shelters. CDC’s
COVID-19 Considerations for Cleaner Air Shelters and Cleaner Air Spaces to Protect the Public from Wildfire Smoke can help prepare shelter operators to do this. Here are six things you can do at your emergency shelter to help protect evacuees, staff, and volunteers:
To learn more about operating a safe emergency shelter in the event that your community faces a wildfire this year, check out these resources from
National Center for Environmental Health plans, directs, and coordinates a program to protect the American people from environmental hazards, including wildfire smoke. To learn more about wildfire smoke and its potential health effects, including the intersection of wildfire smoke and COVID-19, visit
Protect Yourself from Wildfire Smoke.
Division of Critical Infrastructure Protection (CIP) is actively tracking wildfires and other emerging issues at the intersection of disaster health and critical infrastructure protection. To receive information on the latest resources and tools to optimize your organization’s ability to respond, recover, and prepare for threats and incidents impacting the nation’s health critical infrastructure, subscribe to the ASPR CIP mailing list.
When disaster strikes, state, tribal, or territorial authorities can call on responders from the National Disaster Medical System (NDMS) to help handle some of the nation’s toughest emergency-related health challenges. NDMS responders are elite medical professionals who work as doctors, nurses, pharmacists, and other civilian health professionals in communities across the country. Following a disaster or emergency event, NDMS responders deploy at the request of states to provide medical support and increase capacity. Since the beginning of the pandemic, NDMS responders have been serving across the country, assisting states and territories as well as tribes and local communities.
In the initial days of the Novel Coronavirus 2019 (COVID-19) outbreak, NDMS responders provided medical support during the first quarantine operations in more than 50 years. Since then, NDMS responders helped save lives at alternate care sites, including the Javits Center in Manhattan, provided mortuary assistance, helped decompress ICUs, worked to help prevent the spread of COVID-19 in hard hit areas like the Northern Navajo Nation, and more. The response to COVID-19 is continuing at a relentless, unprecedented pace, and our NDMS responders are answering the call to service by providing the best of care during one of the greatest public health crises in a century.
The work that NDMS responders do is vital to public health – and it is hard. NDMS responders are working with determination, dedication, and perseverance to protect health and save lives; and ASPR is committed to ensuring our responders remain healthy, both mentally and physically.
Although some responders experience challenging stress reactions while they are deployed, some of them have distressing symptoms that only start to manifest after they return home. After NDMS responders return home, they are contacted by behavioral health professionals who have experience working in disasters and are themselves on NDMS teams. Building on similar programs that have been implemented by the U.S. Public Health Service and the Centers for Disease Control and Prevention, responders are contacted after they have been home 10 to 14 days. The goal is to follow up at the 30-day mark with those responders who could benefit from additional contact.
Talking to a behavioral health specialist is completely voluntary, but many of our responders have told us that it helps. For some responders, this is one of the few times that they pause to really reflect on their deployment and how it has impacted them personally. Many comment on just appreciating the gesture on the part of the U.S. Department of Health and Human Services and NDMS.
The signs and symptoms of stress can be identified by a behavioral health specialist over the phone, and they encourage returning responders to take such signs seriously so their symptoms do not evolve into disorders. For some responders, these symptoms can manifest as a memory that they keep reliving over and over again. Others may have trouble sleeping or suffer from guilt or worry over potentially exposing others to COVID-19. Some people just find that they are irritable and less tolerant around family and friends. Many responders think about the patients they were not able to help and the ones who passed away despite their best efforts. Others suffer from compassion fatigue, the emotional exhaustion that comes from facing so much death and so many hard cases.
First, behavioral health professionals help responders recognize when they have a problem and need to take care of themselves. From there, the behavioral health specialists talk to the responders about strategies they can use to cope with the stress of their deployment. Just as the response to COVID-19 is very different from many previous responses, so are the strategies for coping in the aftermath of this challenging disaster response. In the past, behavioral health professionals encouraged responders to get together with people in their communities, their friends, and their families when they returned from deployment. Now, responders have to balance the need for connection with the need to keep the people around them safe by practicing social distancing, so many of the practices we once encouraged are not viable or must be approached with extreme caution. Today, our behavioral health responders help the NDMS medical responders identify the source of their concerns; learn about simple, practical strategies like practicing mindfulness and gratitude or meditation; and connect to resources that can help responders cope. The NDMS behavioral health professionals also help responders recognize when they need more than just a phone call. Although a few calls can help a lot of our responders, some people need more assistance. In those cases, we help connect them with the professionals who can provide longer term medical or psychological care.
Although responding to a disaster is hard, most responders we have talked to say that they are glad that they deployed. Even though they face a complex set of stressors, many NDMS responders also find satisfaction in the service and a sense of connection with their NDMS teammates. For many responders, being a part of the team that helped respond to COVID-19 at healthcare facilities in hotspots across the country makes them proud.
The challenges that NDMS responders face are, of course, not unique. Medical professionals across the country are also suffering from stress disorders and other behavioral health issues, including compassion fatigue, moral injury, and more. If you are in a leadership role and manage part of the healthcare workforce, check out these practical tips to help promote behavioral health. If you are a healthcare worker, try to take some time for self care.
I need to talk about this patriot for a minute. You can't see, but under this mask is my dad. He just returned home after being deployed by the U.S. Department of Health and Human Services’ (HHS) National Disaster Medical System (NDMS) to fight in one of our nation's COVID-19 hotspots, South Texas.
There is power in first-hand accounts. Many of you are probably like I was a few weeks ago, personally untouched by the virus. You've seen all the horrid stories of death on the news. You probably know a few people that have tested positive for the virus, but they haven't died. A coworker's friend's grandfather may have passed away, but still you haven't had to bury any of your own.
The most personal casualty for you up to this point has been your mental health and summer plans, which is no small thing, mind you. But the death is just far enough removed that the initial lock down adrenaline has worn thin and a numbness to it all has set in.
When my dad called me last week, my heart began to pound. I knew that he had deployed with NDMS. He been running off to disasters for more than 15 years now, ever since seeing the devastation caused from Hurricane Katrina. As a member of the NDMS Disaster Medical Assistance Team in Tennessee he sets up medical tents and triages and treats patients who have survived hurricanes, floods, and earthquakes... he was even in Haiti after the earthquake that killed 220,000 people in 2010. He's seen some of the worst natural disasters recorded in our lifetime. But he's never called me on a deployment before. He's never had the time. So when the phone rang, I leapt out of my seat and answered the call. I quickly realized he still didn't have the time, he had TO MAKE the time. For his own well-being, he needed to tell me his story.
"I lost count of all the code blues today," he said. I had never heard him so tired, fearful, or overwhelmed. The hospital he was deployed to normally has one intensive care unit (ICU) with 50 beds. He was operating out of the hospital’s fourth make-shift ICU in the basement. The hospital was overrun with COVID. What was one floor of ICU patients had turned into four floors scattered between three different buildings within a matter of days caring for approximately 270 patients. Added to this, was a waiting list from surrounding hospitals desperate to send patients to a hospital where more resources existed.
"We only hydrate before and after our shifts," he said. They were too afraid to lift their masks while they were in the hospital. Death was all around them. Every time the intercom crackled, a room number was announced and the battalion of scrubs scrambled. Another patient, dead. When they changed shifts, the incoming doctors asked for the list of rooms that would not make it through the night...the list was endless.
"I looked over at my colleagues in the elevator and I wondered, is it me or you today?" he said. While he was deployed four of the staff fell ill to COVID-19, including the director of the ICU. The more one works, the more tired one gets, the more susceptible one becomes to the virus. NDMS has deployed thousands of health care professionals throughout the U.S. but there still wasn't enough help. During a round, he would call for nurses or respiratory therapists. An hour later they would run in, apologize, and call out the room number that had coded and kept them preoccupied.
"They're all dying alone," he said. He had to call the wife or the son/daughter of the patient and tell them their loved one was not going to make it through the night. The nurses held up iPads as the family wailed on the screen saying their goodbyes. When the call ended, the nurse dialed another number and ran to the next room.
"This is a pandemic," he said.
My dad is home now after serving 14-days of 12 hour shifts. This is what he is trained to do. It’s his personal call to help others when others are at their most vulnerable.
“I’ve already gotten called up for my next mission,” he said to me a few days after his return. As a federal intermittent employee with NDMS my dad can turn down a deployment, and some providers do because of their regular full-time health care jobs in their own communities. I know my dad won’t turn them down. If there is a way he can go, if he can make sure his shifts are covered, he will always go. He always does.
I share this story because I am proud of my father. I hope that his experience can enlighten your decision to practice good protective measures. We all have a role to play. Stay home as much as possible and otherwise practice social distancing, and wear a face mask. I have seen and heard bold displays of willful ignorance in the name of "patriotism." But this is not patriotic. It's traitorous to the medical workers risking their lives to save our countrymen. Just like a bullet can kill a soldier in battle, so can your cough on a vulnerable citizen.
Real patriots wear masks. You can save a life. You can save my dad's life.
For more information on how to help stop the spread of COVID-19, visit the Centers for Disease Control and Preventions webpage “How to Protect Yourself & Others.” For more information about NDMS, and other deployable resources made available by HHS and its Office of the Assistant Secretary for Preparedness and Response, visit
Are you interested in taking on new challenges to protect health and save lives during disasters and public health emergencies? If so, join our NDMS teams. We are currently hiring physicians, nurse practitioners, nurses, respiratory therapists, paramedics, and physician assistants.
On September 19, 2019, President Trump issued an executive order calling on public and private partners to modernize influenza vaccines to strengthen national security and public health. Today, I am proud to announce that the National Influenza Vaccine Modernization Strategy 2020-2030 has been released. This strategy is aimed at building domestic capacity and capability through the use of new technologies to speed up the overall process of influenza vaccine manufacturing as well as other complementary medical countermeasures (MCM).
First, we must find end-to-end solutions by strengthening and diversifying influenza vaccine development and manufacturing, and address issues that threaten the supply chain.
We must strengthen our domestic manufacturing capacity to protect the American people from the threat of pandemic influenza viruses. By supporting a stronger vaccine enterprise, we not only enhance our ability to manufacture influenza vaccines, but we also can strengthen domestic capabilities that may be used to address other new and emerging threats.
Alternative manufacturing techniques – including cell-based, recombinant, and other synthetic technologies – have the potential to speed vaccine development and enable us to save more lives during an influenza pandemic. Innovations in adjuvants - ingredients used in some vaccines to help create a stronger immune response in people receiving the vaccine – are already being used to make effective vaccines that use less antigen.
These modern approaches are used to manufacture and optimize many different kinds of vaccines. By diversifying and strengthening U.S. manufacturing capacity and enhancing manufacturing techniques, we can help ensure the timely development of safe and effective vaccines to combat influenza and other emerging infectious diseases as well.
Next, the National Influenza Vaccine Modernization Strategy calls on public and private partners to push the boundaries of science and find new, innovative ways to detect, prevent, and respond to this old and persistent threat. Influenza viruses are constantly evolving and changing and we must use targeted investments and strong partnerships – including non-traditional partnerships - to help ensure that our response to this threat is one step ahead of the virus.
Today, there are many potentially transformative approaches and technologies on the horizon - from platform technologies to innovative partnerships to the development of a universal flu vaccine that could provide robust, long-lasting protection against multiple strains of influenza. Moving these and other potentially groundbreaking technologies off the drawing board and into the clinic will require dedication, planning, and targeted investments.
In just a few months, the Trump Administration has spurred the development of a broad portfolio of innovative MCMs to address COVID-19, many of which rely on platform technologies. In fact, all five of the vaccine technologies currently supported as part of BARDA’s COVID-19 vaccine portfolio leverage platforms. By continuing to invest in platform technologies, we may be building our nation’s overall capacity to face persistent health security threats like influenza and new pathogens.
Finally, the National Influenza Vaccine Modernization Strategy focuses on finding new ways to increase influenza vaccination in America. Although vaccination is the best way to protect against influenza, a shocking number of people – about 55 percent of adults and 48 percent of children during the 2017-2018 flu season – did not get vaccinated to protect themselves and the people around them from influenza.
We must also work to help ensure that new technologies are being developed to enable everyone to get vaccinated. Influenza vaccines must continue to be developed and refined to better protect special populations, including the elderly, young children, and people with special underlying medical conditions – the people who are often most vulnerable to influenza outbreaks and pandemics.
Partners across government and industry must work together to expand access to influenza vaccines, help people better understand the risks they face from influenza vaccination, make it easier to administer the vaccine, and enhance influenza vaccination tracking.
Effectively protecting the American people from influenza disease, particularly an influenza pandemic, is a daunting challenge. We must take on that immediate challenge. Both federal and non-federal investment in influenza pandemic response is vital to help us prepare for the next influenza pandemic. Investing in enhanced platforms and domestic manufacturing capacity to support MCM, as well as promoting MCM access and uptake, will enhance our nation’s ability to address a variety of pandemic threats beyond influenza.
Now is the time for federal, state, local, tribal and territorial governments, private partners, non-governmental organizations, academia, professional associations, and international stakeholders to come together to embrace, coordinate, and develop next-generation technologies and solutions to combat seasonal influenza outbreaks and future pandemics. Many of the efforts described in the strategy can boost readiness to other emerging infectious disease like COVID-19. To learn more, check out the National Influenza Vaccine Modernization Strategy.
In the current pandemic, ICUs worldwide are caring for COVID-19 patients with life-threatening multiple organ dysfunction, in other words, sepsis. This trend provides a stark reminder that sepsis is likely to arise as a secondary confounder of any health security threat, whether in the current coronavirus pandemic or a future public health emergency.
BARDA focuses on developing safe, effective medical countermeasures, such as vaccines, treatments, and diagnostics, against all potential health security threats the United States faces – chemical, biological, radiological, nuclear, pandemic, and emerging infectious diseases. Being fully prepared for those threats requires real solutions for sepsis.
In 2018, BARDA launched the DRIVe Solving Sepsis program to expand the range of tools to reduce the incidence, morbidity, mortality, and cost of sepsis, and to prepare for health security threats. Sepsis, a term still unfamiliar to many Americans, is a dysregulated response to infection leading to organ dysfunction.
Any infection can lead to sepsis – a bacterial infection, seasonal influenza, or SARS-CoV-2. Sepsis is far reaching, affecting individuals of any age from neonates to the elderly, and can be life threatening. The CDC reports more than 270,000 lives are lost to sepsis each year in the U.S., among more than 1.7 million cases. In years with major public health events, like COVID-19 that can lead to viral sepsis, those numbers can climb much higher.
Diagnostics for SARS-CoV-2 infection are critical to the response, but they don’t tell the whole story. Roughly 20 percent of those infected become severely ill and require hospitalization. There’s a need to identify COVID-19 patients who are on the path to sepsis. BARDA is exploring whether technologies that may predict sepsis can aid healthcare providers and COVID-19 patients in early identification of health deterioration before patients fall victim to sepsis. If providers could identify those patients sooner, both in hospitals and remotely in other care settings, those professionals could make informed, strategic decisions about the critical resources needed and better target early interventions to improve patient outcomes.
Pilot studies launched through the Rapidly Deployable Capabilities team, as part of the BARDA-COVID-19 medical countermeasure response, will evaluate utility of these technologies for COVID-19 patients and potentially against any future public health threat to our nation. Since the sepsis technologies are agnostic to the source of infection, validating their use builds real solutions to any emerging infectious disease outbreak.
BARDA partnered with Cytovale and Immunexpress; both are developing diagnostic devices for rapid assessment of blood biomarkers that identify or predict the onset of sepsis. These host-blood-based technologies are being evaluated for their ability to detect sepsis earlier in COVID-19 patients. The rapid turnaround and minimal blood volume needed could provide results indicating sepsis in COVID-19 patients in tandem or faster than molecular SARS-CoV-2 confirmation results.
BARDA also extended our partnership with Beckman Coulter for the COVID-19 response. Beckman Coulter is working with Dascena to develop a machine learning algorithm to predict using their Early Sepsis Indicator results combined with clinical and vital sign data from the Electronic Health Record to determine the likelihood of sepsis prior to the onset of clinical symptoms. These sepsis diagnostic tools identify the risk of severe patient outcomes, providing critical information for clinical management and allocation of precious hospital resources.
In parallel, we are working with the Sepsis Alliance to broaden training and education for healthcare providers to draw the connection between emerging infectious disease, like COVID-19, and sepsis and the need to monitor the long-term health of COVID-19 sepsis survivors.
Saving someone’s life can be pretty simple. As a volunteer EMT and firefighter in my community, I have gone through a lot of training so I can provide life-saving care when seconds count. I am proud to serve on the frontlines of the response to COVID-19, both in my volunteer role and as a responder from the U.S. Department of Health and Human Services.
Yet you don’t necessarily have to do all of that to help people in your community. Sometimes, all you need to do is dedicate a little time - and be willing to give up about a half a liter of your blood. A single donation can save up to three lives, and it’s a safe way to help others in need, especially as we continue to fight COVID-19.
Much of modern healthcare relies on the steady, regular flow of blood donations. Patients who are getting cancer treatments, organ transplants, treatment for traumatic injuries, and are undergoing many other medical procedures all rely on blood donations.
Right now, the American Red Cross reports an urgent need for blood and platelet donations. As America opens up again, many people are getting medical procedures that were put on hold due to the COVID-19 pandemic. In addition, people who have recovered from COVID-19 can donate their plasma, which can be used as a treatment for hospitalized patients. Volunteer blood and plasma donations are needed to support these procedures as well as other medical needs.
To help meet this critical need, my friends and I agreed we would get out there and donate – and I am proud to say that I was the first one!
Right now, you have to make an appointment to donate – walk-ins are generally discouraged due to social distancing requirements across the country. I went online and at first it looked like all of the donation slots were full, but I called my local blood donation center, and it turned out they did have times available! They were just having problems with their website. So, I scheduled my appointment and went to my local blood donation center.
Although some people are concerned that they could contract COVID-19 while donating blood, the risk is low and blood donation centers are taking precautions to protect their patients. When I donated blood, I was really impressed by all of the precautions the administrative and healthcare professionals at my area donation center were taking to help keep everyone safe. They only allowed four people in to donate blood at a time, social distancing measures were in place, and they were sure to keep everything spotlessly clean and sanitize surfaces frequently.
When I arrived, I got a temperature screening, an interview, and a blood pressure test. Next, I sat back while the nurse pricked my arm and just waited until the donation was complete. For most people, the blood donation process is pretty quick. On average, it just takes an hour and 15 minutes to donate blood.
One of the great things about donating blood these days is that you know your donation really helps someone; in fact, I got a notification on my phone when someone received my donation! I turned to my wife and told her that I might have just saved someone’s life. It was pretty cool!
Today is World Blood Donor Day, and it is a great time to consider donating whole blood or plasma to help people in your community. Almost anyone who is in good health and over the age of 16 or 17, depending on the type of donation and the state where you live, can donate.
If you have recently recovered from COVID-19, you also may be able to donate plasma to help fight the pandemic. Donating convalescent plasma, a possible treatment for the virus, allows you to share your potentially life-saving antibodies with people who are currently hospitalized with severe COVID-19 infections. Donating plasma does take a little more time – about three hours. In order to donate, you must have a prior, verified diagnosis of COVID-19, but be symptom free and fully recovered at the time of your donation. You also need to be at least 17 years old, weigh more than 110 pounds, and feel well. If you think you may be able to donate convalescent plasma, check out The Fight Is In Us, which offers a free analytic tool to help you assess your eligibility. If you are able to donate, you can schedule an appointment at one of the many accredited donation centers across the country.
Donating whole blood or plasma only takes a little time – and a prick on your arm – but your donation can be used to help save someone’s life and make your community a little bit healthier.