Psychiatry Town Hall John Krystal M D The

Psychiatry Town Hall John Krystal, M. D.

The bad news: Discarded disposable gloves on the street BBC

The good news: Gloves with decorative fingernails on the outside

Outline • Covid Trends • Support Services

New Haven Hotspots: Familiar neighborhoods with familiar challenges WTNH May 6, 2020 Edgewood West River The Hill Fair Haven

Covid-19 YNHH – Past Peak April 21 Ventilators

Greenwich: decreasing! April 13

Northeast CT is behind: Lawrence and Memorial May 4 ICU

What can one make of the timecourse of cases vs ventilated patients across sites? • Peak of ventilated=Peak of cases (L and M): homogeneous community presenting relatively symptomatic for treatment • Peak of ventilated is earlier (Greenwich): homogeneous community presenting and treated early (less progression to ventilators) • Peak of ventilated is later (YNHH): heterogeneous community (hotspots) either hotspots of severe presentation, a subgroup with greater acuity or complexity, or both

Reopening • Yale began limited surgeries on May 11 and more extensive opening: May 18 • Backlog of >3500 surgical procedures • Target 100% of usual activity in June • 120% in July • Department of Medicine to open “Covid Clinic” P. Taheri, May 7, 2020

Vacation Policy (Yale Medicine) • All departments are expected to maintain a full complement of clinical services throughout the summer of 2020. • Departments are asked to manage faculty absences and attendance so patients will not encounter any unnecessary delays in access. • Considerable uncertainty still exists in the clinical space and it is possible faculty could be called back to support a second surge of COVID

Reopening: Patient screening • Outpatients and accompanying caregivers • Screened for symptoms 2 days before and on visit • Procedural visit: tested no more than 2 days before visit • Testing before immunosuppressive treatments • Testing all patients from nursing homes, jails, etc. • Inpatients: tested prior to admission P. Taheri, May 7, 2020

Preparing PPE supplies for ambulatory opening • Overall ability to provide basic PPE is adequate for short-term • Target 100% of usual activity in June; 120% in July • Many modification to the “model” needed (YSM, start July 6; housestaff) • Shortages are more for OR and ICUs • Transitioning to reusable gowns

What will reopening look like in psychiatry • Censuses rising in ED and on inpatient units (YNHH, VA) • First step likely to be nearly full return to on-site inpatient work • Patients already tested in ED before going to Units • Asymptomatic faculty/staff/trainees to be tested periodically • End platooning arrangements • “At risk” groups will not be required to come in initially, but will not be prohibited from returning to work • PPE supplies will support. • General principles consistent across institutions, but implementation times may differ for many reasons (PPE supplies, etc. )

Toward universal testing of staff • ~50% of patients offered appointments are declining due to covid exposure concerns, primarily • Understandable: initial estimates of infection rates among asymptomatic individual were ~7% (UK) • However past peak, rates in asymptomatic healthcare workers are <1% • Stanford justified re-opening clinics as “safe” • Ramping up testing capacity • Big increases in 6 hr test capacity • No increases in 2 hr test capacity (Cepheid) through September

Toward universal testing of staff

Replication-competent virus not grown beyond 10 days Antibodies

An data-informed return-to-work policy • 14 days after onset of symptoms and 3 days post “recovery” • Not use virus testing: non-replicating virus detected after 10 days • Not use antibody testing: do not know if antibodies are protective • May use antibody testing: to support ≥ 11 days post-infection

Ramping up test capacity • Big increases in 6 hr test capacity • No increases in 2 hr test capacity (Cepheid) through September • Near implementing nasal turbinate tests (short swab, plentiful) to compensate nasopharyngeal tests (long swab, short supply) • Saliva tests available “soon”

VA-Psychiatry • Planning for reopening

CMHC • Securing PPE supplies • So far no covid+ inpatients

YNHH • 6 -bed Covid Unit in Psychiatry set up on LV 2 • 6 covid positive patients • Full PPE

Outline • Covid Trends • Support Services

Childcare Stress

A few childcare resources through Yale • Bodel Center remains open. Emergency Care benefit is available through Yale, as is the Yale Babysitting Service. • Back-up care benefit is through Bright Horizons Care Advantage information is available here. For more information, contact Susan Abramson. • Additional resources collated by Kristine Olson, M. D. , Chief Wellness Officer, YNNH: https: //medicine. yale. edu/caregivers/

A few additional childcare resources (closed Facebook Groups, you can request to join) • New Haven Moms & Tots Group (more resources and support than finding child care) https: //www. facebook. com/groups/757255421056489/ • Great Babysitters in the Hamden Area (no screening process) https: //www. facebook. com/groups/963319697118259/ • Yale Faculty and Staff Parents (support and resources, discussions) https: //www. facebook. com/groups/2733498336703333/

Well-being – proactive plan endorsed • Town Hall Huddles for Every Department and Major Section • Screening questionnaire rolls out today to YM and YNHH • Short (~20 items, most yes/no) • Gives option to seek 1: 2: 1 care and links to 1: 2: 1 site

Three levels of support for healthcare workers • Community Level: • • • Stress and Resilience Town Halls (General, Specialized) Mindfulness Sessions, Yale Stress Center Support/Education Materials, Yale Covid Web Page, etc. • Unit Level • • • Unit/Department Level Town Halls Buddy System, Peer Support Palliative Care Huddles Psychological Medicine Consultation (bottom-up) Leadership Initiative (top-down) Me Team Community • Individual • • 1: 2: 1 Program (Sam Ball) with referrals to Community Volunteers and LTCC YNHH and Yale Health EAPs

Town Halls (Jack Tebes, Ph. D. ) • 68 Town Halls, 2, 231 attendees • TOWN HALL TEAM • Town hall facilitators: Shelley Amen, Bonnie Becker, Hilary Blumberg, Erin Carrubba, Elizabeth Connors, Christine Desmond, Flavia De. Souza, Sarah Fineberg, Deborah ried, Derrick Gordon, Zach Harvanek, Ayana Jordan, Dick Kravitz, Bernadette Lecza, Larry Levenson, Luming Li, Allison Ponce, Maya Prabhu, Susan Rubman, Anjali Sankar, Lynelle Schneeberg, Michelle Silva, Sheryl Silverstein, Raina Sotsky, Matt Steinfeld, Dave Tate, Jack Tebes, Ke Xu, and Noka Zador. • The current program support team includes: Keisha April, Michael Awad, Brittany Miller-Roenigk, Corianna Sichel. • Administrative and technical support team: Susan Florio and Chris Gardner.

• Daily Stress and Resilience Town Halls: • Monday, May 18, 5: 00 pm Making Sense of Your Feelings During the Pandemic and What to Do with Them. Led By: Drs. Bonnie Becker and Richard Kravitz • Tuesday, May 19, 12: 00 pm Practicing Wellness to Promote Resilience • Led By: Drs. Ayana Jordan and David Tate • Wednesday, May 20, 4: 00 pm Parenting and Family Matters • Led By: Drs. Elizabeth Connors and Zach Harvanek • Thursday, May 21, 3: 30 pm Dreams and Nightmares in the Time of COVID: What Do They Mean and What Do We Do? Led By: Drs. Susan Rubman and Allison Ponce • Friday, May 22, 4: 00 pm Why Am I Feeling Guilty and What Can I Do About It? Led By: Drs. Shelley Amen and Jack Tebes

1: 2: 1 https: //medicine. yale. edu/caregivers/resilience/ • Active today on covid website • Web-based request for contact • Follow-up contact within 24 hours • Assess, Debrief, Refer (hierarchy of interventions) • Referral sources: • Yale EAP • YNHH EAP • Individual treatment for people who can pay (volunteers) • Short-term individual treatment for faculty/staff who cannot: LTCC

Additional Department Town Halls • Diversity Town Hall (Cindy Crusto, John Krystal) Wednesday May 27, 2020 at 2 PM