Situation Overview
The purpose of this notification is to provide assessments and resources for the diverse events that could impact global and domestic healthcare and public health. 

Healthcare Ready is sharing the following summary assessments of three (3) distinct threats and associated resources to assist in threat mitigation and potential response. 

Novel Coronavirus (COVID-19) Pandemic
As of August 6, the World Health Organization (WHO) reports a total of 18,614,177 confirmed cases (including 259,344 new cases in the last 24 hours) and 702,642 deaths (including 6,488 deaths in the last 24 hours) globally. 

As of August 6, the Centers for Disease Control and Prevention (CDC) officially reports 4,802,491 confirmed cases (including 53,685 new cases in the last 24 hours) in the US, across all 50 states, the District of Columbia, Puerto Rico, Guam, and the US Virgin Islands, and 157,631 deaths (including 1,320 in the last 24 hours). 

As parts of the nation continue to reopen, others are reimposing restrictions as case numbers continue to surge. According to the New York Times Coronavirus in the US dashboard, 11 US states and territories have reported an increase in daily cases per capita in the last 14 days, 26 states and territories report relatively stable case numbers in the last 14 days, and 17 states and territories report a decrease in daily cases per capita in the last 14 days. 

Healthcare Ready COVID-19 Resources

• For all resources created by Healthcare Ready, including tip sheets and infographics, please visit our newly updated resource center: https://healthcareready.org/resources/
• For COVID-19 specific resources, please visit: https://healthcareready.org/covid19/

• The US Food and Drug Administration (FDA) issued Emergency Use Authorizations (EUAs) for the first two tests that estimate the quantity of antibodies in patients who already had COVID-19. Rather than simply identifying the presence of antibodies, these tests seek to determine the relative level of antibodies present in the blood.
• On July 24, FDA reissued an EUA for the LabCorp COVID-19 RT-PCR Test. This EUA marked the first diagnostic test authorized to screen individuals who have no reason to suspect that they have been diagnosed with COVID-19, and also allows for pooled testing.
• CDC updated its guidance on the decontamination and reuse of N95 Filtering Facepiece Respirators. The guidance covers appropriate contingency and crisis strategies and discusses when and how to implement those strategies.
• The American Hospital Association (AHA), American Medical Association (AMA), American Society of Health-System Pharmacists (ASHP), and United States Pharmacopeia held a summit in July to discuss the resiliency of the pharmaceutical supply chain in the United States, within the current context of the global pharmaceutical manufacturing system.
• On July 28, the US International Development Finance Corporation announced that it signed a letter of interest with Eastman Kodak Company to provide a $765 million loan to allow it to expand its facilities and begin producing active pharmaceutical ingredients (APIs). The facilities are supposed to produce APIs found in non-biologic, non-antibacterial generic pharmaceuticals, specifically those in short supply.

• Pooling procedures, also known as pool testing or batch testing, are a method of analyzing a group of COVID-19 diagnostic testing samples and conducting only one test for the entire batch. CDC has released guidelines on pooling testing methods and procedures, including how to perform them, and how to report the results.
• FDA recently released an update on its efforts to bolster advanced manufacturing capabilities in the United States. The document described how advanced manufacturing techniques like 3-D printing are being encouraged by the FDA in order to support public health preparedness.
• On July 29, FDA posted a template to help COVID-19 diagnostic test designers more easily apply for an EUA for tests designed for non-lab settings. The template provides guidance on the recommended benchmarks and performance metrics that tests should take, with an emphasis on tests that can be used in non-lab settings, such as entirely at home.
• The National Institutes of Health (NIH) announced the launch of the Medical Imaging and Data Resource Center on August 5. This collaborative network will seek to utilize AI and medical imaging to fight COVID-19 through early detection and personalized therapies.

• In early August, CDC updated its interim guidelines on antibody testing in healthcare settings. The guidelines cover the uses that antibody testing can have in helping monitor and respond to the pandemic, as well as the best ways to implement the use of serologic tests.
• HHS Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) released issue 10 of its publication The Exchange. Issue 10 covers how communities, public health providers, and healthcare facilities should be preparing for and responding to wildfires and planned outages amid COVID-19 and the upcoming annual influenza season.
• CDC continues to update its resources for tribes and their local communities. The resources include specific COVID-19 resources for understanding how to respond to the pandemic, and appropriate use information for Personal Protective Equipment.
• On August 5, CDC updated its considerations for community-based organizations as they adapt to new levels of activity during the COVID-19 pandemic. The considerations include recommendations for mitigating the spread of COVID-19 by maintaining as healthy of an environment as possible.
• The National Governors Association (NGA) issued a new publication on August 3 on considerations for states and governors as they prepare for a potential COVID-19 vaccine and its mass distribution. The considerations cover different stages in distribution from industry all the way to the public, deciding which populations are highest priority to receive the vaccine, and how to combat misinformation around the vaccine.

• General
  • HHS released a report showing that in April, 44% of primary care visits for Medicare beneficiaries in April were conducted through telehealth. This is up from .1% in February, and the number of visits increased from approximately 14,000 per week to approximately 1.3 million per week.
  • ASPR TRACIE continues to update its topic collection on evacuation and sheltering considerations for healthcare facilities. The topic collection contains a number of resources on those topics for a number of evacuation and sheltering causes and how healthcare facilities should be planning for them.
    • Other topic collections include natural disasters, utility failures, and COVID-19 health equity.
  • The Rural Health Information Hub has stood up and continues to update a page on rural healthcare surge readiness. The hub has resources for a variety of fields, from hospital care to long-term care, on how to respond to COVID-19.
• Pharmacies:
  • On July 31, the National Association of Chain Drug Stores (NACDS) released a statement on the eventual deployment of a COVID-19 vaccine. The statement suggested that pharmacies, due to their ubiquity, accessibility, and existing vaccination infrastructure, including pharmacies in any vaccine distribution plan would be important in ensuring the smoothest, fastest, vaccination regime possible.
  • ASHP released an article discussing how pharmacists are utilizing telehealth during the COVID-19 pandemic. The article includes discussions with several pharmacists who use telehealth to perform services such as teaching patients how to use medical devices, remote check-ins with patients, and coordinating appointments with the patient’s medical team.
• Hospitals:
  • On July 28, the National Academies of Sciences, Engineering, and Medicine published a consultation paper on staffing considerations hospitals should take for crisis staffing during the COVID-19 pandemic. The paper offers a number of paths for consideration, including that critical care providers supervise beside care rather than provide it themselves.
  • ASPR TRACIE continues to update its COVID-10 hospital resource compilation. The compilation includes guidance and resources for hospitals covering areas such as equipment supply surge, hospital operations, and telemedicine.
• Dialysis Centers
  • HHS published a report on the end stage renal disease networks’ responsibilities during COVID-19. The report looks at the specific actions the networks are taking to support individual clinics and patients.
• Long-term Care Facilities
  • On August 5, the Centers for Medicare & Medicaid Services (CMS) posted a new FAQ page on COVID-19 testing in nursing homes and skilled nursing facilities. The FAQs include information on distribution of kits, training, and reporting of results.
  • ASPR TRACIE recently released a new technical assistance resource that contained information on lessons that skilled nursing facilities have learned during the COVID-19 pandemic.

• On August 6, the NIH announced it was beginning a clinical trial for a treatment that combines remdesivir with interferon beta-1a. Interferon beta-1A is an immunomodulator traditionally prescribed for the treatment of multiple sclerosis and has antiviral and anti-inflammatory properties.
• HHS and the Department of Defense (DoD) announced that they formed an agreement with Janssen Pharmaceuticals Companies of Johnson & Johnson for production of a COVID-19 vaccine candidate. The agreement involves the government providing approximately $1 billion in funding to make a manufacturing demonstration project possible, in return for owning the first 100 million doses of the vaccine.
  • The two departments also announced a similar agreement with Sanofi and GlaxoSmithKline, to provide $2 billion in support of late-stage development, clinical trials, and also a manufacturing demonstration project, in return for the first 100 million doses of the vaccine candidate.
• On July 30, FDA updated its FAQs on its EUA for remdesivir being used to treat certain patients hospitalized with COVID-19. The updates include information on revisions made to Gilead’s fact sheets that are given to providers and patients.
• The Biotechnology Innovation Organization (BIO) is maintaining a COVID-19 therapeutic development tracker to display updated information on therapies in development across the industry and around the world. The data is updated weekly on Monday mornings. 
• ASHP continues to update its table on emerging COVID-19 related treatments. The database, which includes antiviral agents, supporting agents, and other related treatments, assesses the evidence that is continually being produced for a variety of responses to COVID-19. 

• Healthcare Ready is maintaining a list of state-level actions related to prescription refills. Visit the Map Your Meds: State-by-state guide to getting Rx refills during an emergency page for an updated list.

• On August 4, CDC updated its resource for workplaces outside of the healthcare sector on how to coordinate with local health departments on contact tracing. The guidance covers how the employer should be involved in the process, the ways that they can assist local health departments, and what they should know about how contact tracing works.
• Recent considerations for how employees should prepare to return to work during the COVID-19 pandemic were updated on the CDC’s website. The considerations include basic principles such as wearing a mask, considering the length of time you are interacting with others, and avoiding sharing equipment when possible.

• Initial impacts to Puerto Rico included flash flooding caused by heavy rain, as well as mudslides and river flooding. 
• From North Carolina to Maine, more than 3 million homes and businesses lost power as a result of the storm. Additionally, many communities along the East Coast saw significant surge flooding as the storm made landfall. 
• The storm caused a tornado outbreak, with over 20 tornadoes reported in North Carolina, Virginia, Maryland, Virginia, Delaware, and Pennsylvania.

• The Federal Emergency Management Agency (FEMA) announced that an emergency disaster declaration was approved for Florida and North Carolina. These declarations, which were implemented in response to Hurricane Isaias, provide federal disaster assistance funding to those states in order to bolster the response of state and tribal entities.

• The governors of Connecticut, Delaware, New Jersey, and Virginia all declared a State of Emergency for their respective states. The declarations ensured that the appropriate resources could be deployed to affected sections of their state.

• In response to damages caused by Hurricane Isaias, FEMA has approved over $16 million in additional funding being provided for recovery from Hurricane Marìa. The funding is for 88 projects including repairs to parks, debris removal, and utility repairs.

• Apple Fire, in Riverside County, was started on July 31, and as of August 6 had burned 28,085 acres and was 30% contained.
  • The fire has caused evacuations for residents in certain affected areas. While Evacuation Orders have been lifted for Riverside County, certain areas in the county are still under an Evacuation Warning.
  • Certain sections of San Bernardino County are under Evacuation Orders and Evacuation Warnings. San Bernardino County residents affected by Evacuation Orders are encouraged to contact the American Red Cross. 
• Stagecoach Fire, in Kern County, was started on August 3, and as of August 6 had burned 4,250 acres and was 10% contained.
  • Kern County Fire Department announced recommended and precautionary evacuations for certain residents.
  • A temporary evacuation center has been set up in the parking lot of a former K-Mart in Tehachapi.
• Pond Fire, in San Luis Obispo County, was started on August 1, and as of August 6 had burned 1,962 acres and was 95% contained. 
  • All evacuation warnings have been lifted.