Tracking Employee Exposures to COVID-19 Marianne Cloeren, MD,

Tracking Employee Exposures to COVID-19 Marianne Cloeren, MD, MPH Division of Occupational & Environmental Medicine [email protected]

Acknowledgement We acknowledge the support of the University of Maryland, Baltimore, Institute for Clinical & Translational Research (ICTR) and the National Center for Advancing Translational Sciences (NCATS) Clinical Translational Science Award (CTSA) grant number 1UL1TR003098.

Secure web application for online surveys and databases Developed by Vanderbilt University and shared with the world Designed to support online or offline data capture for research studies and operations The REDCap Consortium - a vast support network of collaborators Academic institutions and non-profit organizations share management

Employee COVID19 Exposure Tracking in REDCap The UMB COVID-19 Employee Tracking System in REDCap No Symptoms -- Exposure Report Symptom Monitoring If Symptoms -- Illness Report Quarantine Decision Based on Risk COVID-19 Test Negative Return to Work Planning Symptoms -- Illness Report Daily Symptom Monitoring Isolate & Test (If Not Yet Tested) If Symptoms -- Illness Report COVID-19 Test Postive Symptom Monitoring & Return to Work Planning Contact Tracing

Employee COVID19 Exposure Tracking in REDCap The UMB COVID-19 Employee Tracking System in REDCap No Symptoms -- Exposure Report Symptom Monitoring If Symptoms -- Illness Report EmployeeSymptoms enters information about -- Daily Symptom exposure event – colleague atMonitoring work, Illness Report home/ community, patient encounter Employee health reviews information, Quarantine interviews determines Isolate & Test (Ifif necessary, If Symptoms -- Decision Based on Not Yet Tested) written Illness Report with risk, triggers notification Risk symptom monitoring plan and decision about quarantine or return to work COVID-19 Test COVID-19 Test Push notifications twice a day to employee to complete Negative Postive symptom report If symptoms reported, flag to employee health Employee is directed to complete illness report and moves to illness path Symptom and decisions Return to Work Planning Monitoring & Return to Work Planning Contact Tracing

Employee COVID19 Exposure Tracking in REDCap The UMB COVID-19 Employee Tracking System in REDCap If employee is already having symptoms, No Symptoms -- completes information about symptoms, Exposure Report onset, testing completed and results, last time at work Employee health reviews and decides on Quarantine isolation plan, facilitates access to Symptom Decision Based on testing ifMonitoring not already done Risk Pathway branches depending on results of If Symptoms -- Illness Report COVID-19 testing System pushes reminders to employee to monitor and report symptoms twice a day Return to work plan is based on symptom improvement and COVID-19 status COVID-19 Test Negative Symptom Monitoring & Return to Work Planning Symptoms -- Illness Report Daily Symptom Monitoring Isolate & Test (If Not Yet Tested) If Symptoms -- Illness Report COVID-19 Test Postive Symptom Monitoring & Return to Work Planning Contact Tracing

Employee COVID19 Exposure Tracking in REDCap The UMB COVID-19 Employee Tracking System in REDCap No Symptoms -- Exposure Report Symptom Monitoring Quarantine Decision Based on Risk If Symptomspositive, -- If COVID-19 we canCOVID-19 triggerTest a Illness Report Negative self-report on contacts to support contact tracing Isolation period is longer, andSymptom related Monitoring & to days since last fever Return to Work Planning Symptoms -- Illness Report Daily Symptom Monitoring Isolate & Test (If Not Yet Tested) If Symptoms -- Illness Report COVID-19 Test Postive Symptom Monitoring & Return to Work Planning Contact Tracing

Employee COVID19 Exposure Tracking in REDCap The UMB COVID-19 Employee Tracking System in REDCap No Symptoms -- Exposure Report Future Symptom Monitoring If Symptoms -- Illness Report feature in Symptoms -- Illness Report build Daily Symptom Monitoring Tracking daily symptoms of frontline employees reporting Quarantine to work Isolate & Test (If Decision Based on Risk COVID-19 Test Negative Return to Work Planning If Symptoms -- Illness Report Not Yet Tested) COVID-19 Test Postive Symptom Monitoring & Return to Work Planning Contact Tracing

Option 1 EXPOSURE REPORT

Cloeren And additional contact info

Family Medicine

04/15/2020 Exam room B 11:00

Evaluating a patient for possible COVID-19. Coughed on me while getting specimen.

Assessment of Risk and Plan Employee health reviews, interviews employee if needed Determines risk Establishes plan for Symptom monitoring Return to work vs. quarantine (work at home) Timelines Sends communication via REDCap with recommendations

Follow-up SYMPTOM MONITORING

Symptom Monitoring Automated prompts to measure temperature and document symptoms twice a day Email notification Can be sent via phone Logs responses Tracks missed responses Flags abnormal responses for employee health attention

Symptom Monitoring Form Completed by Exposed Employee Twice a Day Employee Health notified by e-mail (“flag”) if any fever or positive symptom during post-exposure monitoring Illness developing during post-exposure symptom monitoring triggers prompt to report illness

Dashboard views to review aggregate employee data Flexible report options customizable

Option 2 ILLNESS REPORT

Additional contact info Cloeren

Working While Sick? Family Medicine 04/06/2020 04/09/2020

Fever History and Known Exposures 102.3 04/12/2020

04/09/2020 UMB Urgent Care

Assessment & Plan Healthcare worker who worked for 3 days while sick Tested positive Common story Plan: Isolate until 10 days fever free Contact tracing

13:00 Marianne Cloeren Marianne Cloeren

04/09/2020 04/11/2020 1 2 Working closely with occupational health nurses to don and doff PPE for training videos

REDCap Exposure Report The UMB COVID-19 Employee Tracking System in REDCap Triggers 14-day post-exposure symptom monitoring Push notifications, positive symptom flags and missed reports; templated guidance Link sent to employees reporting exposures or identified via contact tracing Used to track COVID-19 employs exposures and illnesses on campus REDCap COVID-19 Illness or Diagnosis Report Current features and potential uses Opportunities for collaboration? Employee completes to document COVID-19 consistent illness, test results 14-day recovery symptom monitoring for planning return to work Push notifications and missed reports; templated guidance on self-isolation Contact tracing report to document last time at work and employee contacts REDCap Daily Symptom Monitoring (in build) Surveillance for front-line clinicians and employees returning to campus Push notifications, positive symptom flags, missed report options Templated guidance on other resources next steps if symptoms