Community Health Advisory Coronavirus (COVID-19)
weekly message from the director...
This week some of our regional programs have slowly opened some of their services in community settings under the guidance of state and local officials. While at the same time our communities are seeing continuous increases in COVID-19 exposures, almost all our counties dropped down a tier, and we saw 5 more positive cases, which brings us up to 210 cases and 15 deaths, making VMRC the fifth worst impacted regional center in the state. This is clearly no time let our guard down. Families are clearly upset about the protections in place, and consumers are consistently pushing back to return to service sites in the day. As we navigate these issues we’ve found it has become even more important for VMRC to get real clear on how we are ensuring that consumers with vulnerable health conditions remain safe, and the rationale and logic driving these decisions. Below you will find the local policy we’ve established to comply with the August 10th Directive from the Director of the Department of Developmental Services:
The purpose of this notice is to inform our staff, consumers, families, and providers of how we will follow the DDS Directive, “02-081020: DAY SERVICES FOR CONSUMERS AT HIGH RISK FOR SERIOUS ILLNESS DUE TO COVID-19”. This Directive does two things. First it directs VMRC to ensure consumers who have compromised immune systems or who are more susceptible to respiratory illness to remain home rather than attend day service. The second thing it does is to direct VMRC to ensure that people who live in the following settings will not attend day services:
- Adult Residential Facilities for Persons with Special Health Care Needs
- Intermediate Care Facilities/Developmentally Disabled-Nursing
- Intermediate Care Facilities/Developmentally Disabled-Continuous Nursing
While the second prohibition is very simple without any doubt, the first direction requires a better understanding of what is meant by “compromised immune systems” or “susceptible to respiratory illness”, and what is meant by the phrase "day services outside the home."
Under the direction of our clinical professionals at VMRC, and with consultation from DDS and other clinical directors of regional centers, we have determined that the guidance from the governor’s "California for All COVID-19" webpage and Center for Disease Control (CDC) webpage would be the most protective state or local COVID-19 safety guidelines in effect at the time the service is to be delivered.
Some people are at higher risk to get very sick from COVID-19, including:
- People with certain medical conditions:
- Chronic kidney disease
- Weakened immune system from organ transplant
- Serious heart conditions
- Sickle cell disease
- Type 2 diabetes
The state goes on to further explain by citing the CDC guidance that states, “Based on what we know at this time, adults of any age with the following conditions might be at an increased risk for severe illness from the virus that causes COVID-19”:
- Asthma (moderate-to-severe)
- Cerebrovascular disease (affects blood vessels and blood supply to the brain)
- Cystic fibrosis
- Hypertension or high blood pressure
- Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
- Neurologic conditions, such as dementia
- Liver disease
Overweight (BMI > 25 kg/m2, but < 30 kg/m2)
- Pulmonary fibrosis (having damaged or scarred lung tissues)
- Thalassemia (a type of blood disorder)
- Type 1 diabetes mellitus
How We Have Interpreted “Day Services Outside the Home”
The directive references “day services outside the home” and it reiterated at the time that absence payments and other policies would help those providers impacted. Assuming this inclusion of the list of services was meant as a mitigation of provider impact related to this policy, we therefore we are interpreting that the phase “day services outside the home” to refer to the services listed below, given the service is provided outside the home:
Service Code Description (the following bold services are relevant to this policy of possible group services considered not appropriate for high risk individuals)
055 Community Integration Training Program
063 Community Activities Support Service
094 Creative Arts Program
505 Activity Center
510 Adult Development Center
525 Social Recreation Program
Regardless of the above services the regional center may determine that the health risks of an individual remain a deep concern and the service coordinator may wish to call for an IDT meeting to ensure the consumer understands their health risks.
Valley Mountain Regional Center Implementation
Before any consumer returns safely to a day service site there should be a current affirmative statement in the consumer’s record, preferably from the consumer’s interdisciplinary team (IDT), that the individual does not have an identified “Compromised Immune System” and/or is not “Susceptible to Respiratory Illness”.
If a consumer has an identified compromised immune system and or a condition leading to being susceptible to a respiratory illness, as illustrated by the list of 10 higher risk conditions, VMRC will ensure they do not return to the day service site, and we will inform the consumer making the request (including providing them with a “Notice of Action” citing this directive and our policy) and will work with the team to make sure a substitute or alternate service is received.
However, regarding the second list referenced by the CDC, that “might be at an increased risk” the consumer may appeal the regional center recommendation. Because this determination is a health related decision and the IDT will make the decision based on the most recent health information in the record, the consumer may override this decision if they receive a note from their Primary Care Physician (PCP) or other qualified health professional clearing them to participate in the day service on site during the COVID-19 pandemic.
Valley Mountain Regional Center may still recommend the consumer not attend the on-site service, in spite of the doctor’s direction. If VMRC representatives are still concerned after receiving the PCP note, we will ensure all available information is provided and that the consumer fully understands our concerns and the available COVID-19 health information related to their health condition. We may also require an affirmation that the consumer, or their representative, understand the information we’re providing and why VMRC is objecting to the decision to disregard the safety recommendation.
If the consumers are in a work program, we will hold the IDT with clinical input and provide the consumer with the risk information. If the consumer falls within either of the risk categories, we will most likely advice against working, however it is ultimately the consumer’s decision in those situations. If they still want to work after being given the risk information, we will have them sign a form indicating that they have been advised of the risks, but have decided to work despite our advice and will follow quarantine guidelines if living in a congregate setting.
Competitive Employment and Independent Placement
If the consumer is competitively employed or in an Individual Placement, VMRC is not involved in the decision.
Valley Mountain Regional Center
Case Management Update
If You Are Up for the Task, Wear Your Mask!
The health of everyone served through the regional center system continues to be the top priority of the California Department of Developmental Services during the COVID-19 pandemic. “If You Are Up to the Task, Wear Your Mask” is their latest campaign to encourage mask wearing through the sharing of photos. They are seeking photos of consumers, families, regional center and service provider staff while wearing their masks.
If you would like to be a part of this campaign visit the DDS website for full details and instructions. Click on the “Mask Campaign” tab. Photos will be shared on the DDS website and through their social media platforms with the hashtag #WearYourMaskDDS.
Wearing a mask every time you leave your home will help slow the spread of the virus and the flu. It is one way to help ensure the safety of our community and to protect those around you.
Car Seat Check-Up Event
Nationally certified technicians will be available to inspect and help you properly install your child’s car seat or booster seat at an event being held on Saturday, November 14, 9am to 12pm at 1400 Florida Ave in Modesto. An appointment is necessary, so please email: Rena Bryant, RN at email@example.com to book an appointment or obtain more information.
Please bring the following to your appointment:
- Child who rides in the seat
- Child Seat instruction manual (if possible)
- Vehicle owner’s manual (if possible)
Six months or more expectant mothers are welcome as well, and you should plan on spending approximately 45 minutes per car seat. COVID-19 precautions will be in place: Masks, social distancing, and health screenings.
Person-Centered Practices Virtual Training Offered
The Department of Developmental Services is offering a virtual training series on Person-Centered Practices during the month of November. The information was first made available in last week’s Health Advisory, however we have updated information for you to access. Please see the flyer with registration information for the trainings that will occur on Tuesday, November 17, 10am to 12noon and Thursday, November 19, 1pm to 3pm. The sessions are offered at no cost.
HCBS Compliance Preparation is in Progress
VMRC is preparing for compliance implementation of the Home and Community-Based Services (HCBS) Final Rule requirements along with all of California, as well as the nation. Each state has until March 2022 to help providers comply with the requirements.
The goal of the Final Rule is to provide additional protections to individuals while enhancing the services they receive. Promoting community integration for people with disabilities remains a high priority as does the use of a Person-Centered approach to offer meaningful choices to consumers concerning where they live and how they receive services.
VMRC has a Program Evaluator specifically assigned to assist providers during this process—Tumboura Hill in our Community Services Department. Trainings will be offered, so stay tuned. He can be reached at firstname.lastname@example.org.
Director of Consumer Services
· Individuals with developmental disorders, intellectual disabilities and related conditions are 3 times more likely to die of COVID-19., This rate is higher than patients with cancer, heart disease, chronic kidney disease, liver disease and nervous system anomalies.
· SARS-CoV-2 can survive on human skin for 9.2 hours and up to 28 days on glass, polymer currency, stainless steel, vinyl, and paper currency. The good news is that 15 seconds of ethanol exposure can completely inactivate the virus. Hence the continuous need for hand hygiene and disinfecting surfaces.
· When compared to influenza, hospitalized COVID-19 patients had 5 times higher risk of dying in the hospital, and increased risk for 17 respiratory and non-respiratory complications. Some of these COVID-19 complications were higher among non-Hispanic Black or African American and Hispanic patients than non-Hispanic White patients.
· There is 1 in 11 patients hospitalized for COVID-19 being readmitted to the same hospital within 2 months, based on 125,000 unique patients at 865 U.S. hospitals. Risk factors included age 65 years or older, presence of COPD, Heart failure, diabetes and chronic kidney disease, hospitalization within 3 months prior to first COVID-19 admission, and discharge to a skilled nursing facility or to home with health care assistance.
· The U.S. Food and Drug Administration (FDA) authorizes first emergency use of Monoclonal Antibody Treatment of COVID-19., Bamlanivimab is for treatment of mild to moderate COVID-19 in adults and children 12 years and older who are equal to or more than 40 kg, and at risk of progressing to severe COVID-19 and/or hospitalization. Possible side effects are anaphylaxis, and infusion-related reactions, nausea, diarrhea, dizziness, headache, itching, and vomiting.
· The FDA authorizes an emergency use authorization (EUA) to the first test that detects neutralizing antibodies from recent or prior SARS-CoV-2 infection. This is the cPass SARS-CoV-2 Neutralization Antibody Detection Kit. It detects neutralizing antibody, those that bind to a specific part of a pathogen in the lab setting to decrease infection of human cell, though the effect of which in humans is still being researched. The FDA cautions that using this test is not an indication that infection control measures such as wearing mask and physical distancing can be stopped.
· Pfizer’s initial data showed the mRNA vaccine candidate appears to be at least 90% effective in preventing COVID-19, and they are expecting to request an emergency use authorization (EUA) from the FDA in late November. Pfizer will not use the U.S. government distribution partner McKesson in disseminating the vaccine. The distribution will be centered at its Michigan and Belgium sites and has added additional location in Wisconsin and Germany for storage.
· Novavax will begin its late stage trial of the COVID-19 vaccine NVX-CoV2373 in the US later this month. The phase II trials of the vaccine in South Africa has reached 50% enrollment, while the U.K. trial has 60% participants.
· Health care workers are expected to receive the first COVID-19 vaccine doses once approved by FDA. This is based on the CDC’s Advisory Committee on Immunization Practices (ACIP) who will meet 24-48 hours after FDA approves a vaccine to create priority group guidelines.
· American Academy of Developmental Medicine and Dentistry (AADMD) is advocating that individuals with intellectual and developmental disability should be included in the high risk diagnoses that will be considered for early receipt of COVID-19 vaccine.
Please continue to stay safe and healthy.
Claire B. Lazaro, MSN, RN, NP, PHN, FNP-C
Director of Clinical Services
A Message from the President
Dear Members of the VMRC Community,
Last week, Tony shared the passing of Wilma Murray, one of VMRC’s long time staff members. Wilma positively impacted all who knew her. During her career at VMRC she repeatedly showed her dedication to our consumers, staff and community.
Personally, I never saw her without a smile. In remembrance, I suggest we do as her family suggested, “please extend love and kindness to the people in your lives.” My thoughts and prayers are with her family. You can see her obituary here.
November Personal Protective Equipment Distribution
We have 2 PPE Distribution Days Left in November
Friday (TODAY) – November 13, 1pm – 3pm, ARC of Amador, 75 Academy Drive, Sutter Creek, CA 95685
Friday – November 20, 1pm – 3pm, UCP, 959 E. Monte Vista Avenue, Turlock, CA, 95382
Thank you to Valley CAPS Manteca, ARC of Amador, and UCP Stanislaus County for hosting us. We wanted to reach some areas that we serve outside of Stockton, Modesto and San Andreas. Also, a very big thank you to SAC6 and SCDD North Valley Hills for being a HUGE help. We couldn’t do this without them!
Please spread the word to families and service providers. Like always, if a family or vendor can not make the event and would like delivery, we will do the best we can to fulfill that delivery request.
Please have families notify their Service Coordinators, and vendors notify their Community Services Liaisons.
Self-Advocacy Council 6
Lisa Utsey - Self Advocacy Council 6 chairperson invites you to join the SAC6 Friday CHATS!
With so much happening because of the virus SAC6 wants to hear how you are doing and share information so we can all get through this together!
Health and Wellness
Join us on a SAC6 ZOOM CHAT!!
Let’s Check In with each other!
WHEN: Friday November 13, 2020
WHERE: ZOOM - computer, tablet, cell phone
The next SAC6 CHAT:
· Friday, November 13, 2020 - What's New with Special Olympics? By SAC6 Members and Special Olympics Participants
Join Zoom Meeting on your computer, tablet or phone
Meeting ID: 962 5777 9463
You must enter the Password or you can call in:
TOLL FREE NUMBER TO CALL IN:
· 1-877-853-5257 US Toll-free
Five County Data Update
as of November 12, 2020
San Joaquin County
- 23,224 total positive cases and 500 deaths
8.3 new cases per 100,000 people and 4.3% positivity rate (Substantial/Red....2nd Most Restrictive)
- 18,852 total positive cases and 410 deaths
9.0 new cases per 100,000 people and 4.4% positivity rate (Substantial/Red....2nd Most Restrictive)
- 443 total positive cases and 8 deaths
6.8 new cases per 100,000 people and 2.8% positivity rate (Moderate/Orange....2nd Least Restrictive)
- 373 total positive cases and 21 deaths
3.9 new cases per 100,000 people and 3.9% positivity rate (Minimal/Yellow.... Least Restrictive)
- 361 total positive cases and 15 deaths
8.9 new cases per 100,000 people and 2.5% positivity rate (Substantial/Red....2nd Most Restrictive)
State of California
- 1,003,110 total positive cases and 18,129 deaths
- 8.4 new cases per 100,000 people and 3.4% positivity rate
Valley Mountain Regional Center
- 210 positive consumer cases and 15 deaths
- 12 positive VMRC staff cases
- 1 positive volunteer case
- 76 positive provider cases and 1 death
Local County, State and National Public Health Resources