California Pacific Medical Center

Antibody Testing of Healthcare Workers May Show Spread of COVID-19

Posted on Jun 1, 2020 in California Pacific Medical Center, Innovation, Quality, Research, Safety, Scroll Images

antibody tests

A new study launching at Sutter’s California Pacific Medical Center (CPMC) will use antibody tests to identify front-line doctors who have developed antibodies against the virus. Antibody tests (also called “serology tests” because they use blood samples) are used to determine if someone is producing antibodies to defend against the virus.

“A powerful way to help limit the spread of COVID-19 is to facilitate early and accurate diagnoses of viral infections and appropriate quarantine for those infected,” says Greg Tranah, Ph.D., scientific director of CPMC’s Research Institute, director of Sutter’s Center for Precision Medicine Research, and lead researcher of the new physician serology study at CPMC.

Current methods diagnose COVID-19 are valid, but can have limitations when it comes to tracking disease patterns. Serology tests show some promise in this area, for use in certain circumstances.

“Serology tests may help identify people who have been exposed to the virus even weeks after an initial infection, including people who did not show symptoms. Other studies of COVID-19 ‘seropositivity’ can reveal the extent of viral exposure, as well as the timing of first exposure and increasing rates of exposure,” says Dr. Tranah.

The new serology study aims to enroll intensivists, emergency department doctors, infectious disease specialists, anesthesiologists, hospitalists, surgeons and internal medicine residents at CPMC.

Beginning May 18, blood samples will be collected from study participants every eight weeks through 2020. The samples will be tested for the presence of antibodies produced in response to prior COVID-19 exposure. Study participants will be asked to answer a brief questionnaire to determine if they have experienced symptoms of COVID-19.

“We’re using a two-step serology test that can process multiple samples concurrently with high reliability, sensitivity and specificity,”(1) says Jose Montoya, M.D., an infectious disease specialist working at Sutter’s Palo Alto Medical Foundation who is collaborating with Dr. Tranah on the study.

Serology tests with high sensitivity and specificity are less likely to have false-positive or false-negative results and a more meaningful predictive value.

Results of the blood tests will be stored in a database, and rates of seropositivity will be compared across medical specialties bi-monthly. “Longitudinal serology testing will allow us to track rates of seropositivity among different physician specialty groups and study the duration and intensity of immune response to COVID-19,” says Dr. Tranah.

There is no current evidence that people who have detectable antibodies are immune to re-infection from COVID-19 or what the timeframe of immunity is, if any. Until more evidence is available, antibody tests should not be used to make decisions related to social distancing or the use of personal protective equipment.

“Understanding the surge of infection rate and spread is an important part of preparedness. Epidemiological studies of emerging COVID-19 infections can help determine the burden of disease, develop better estimates of morbidity and mortality, and help complement the results of PCR tests,” says Dr. Tranah.

Learn more about COVID-19 tests by following our Educational Series on this topic.

Reference:

  1. Nirmidas Biotech Rapid Test for COVID-19 IgM/IgG.

Nurses Give Blood—Encourage Others To Do The Same

Posted on May 15, 2020 in California Pacific Medical Center, Scroll Images, Wellness, Year of the Nurse

SAN FRANCISCO – During 2020’s Year of the Nurse and the Midwife, front-line workers at Sutter’s California Pacific Medical Center (CPMC) continue to give back.

At the hospital’s Van Ness campus in San Francisco, healthcare workers, including doctors, nurses and staff, took part in a blood drive hosted by Vitalant.

The drive was open to all Sutter employees and held in a large conference room to allow for social distancing.

Interventional radiology technologist Lauren Hamilton said while donating, “I always try to give blood as often as I can. You can save multiple people’s lives in one donation.”

Nearly 60,000 units of red blood cells are transfused in patients across Sutter Health each year. Donated red blood cells do not last forever; they have a shelf-life of up to 42 days.

There is currently a national blood shortage due to COVID-19, which is why CPMC continues to host blood drives at least once a quarter.

“It’s incredibly important and a very easy way to give back to society,” beamed Hamilton, who has the universal Type O blood.

According to The American Red Cross, O negative is the most common blood type used for transfusions when the blood type is unknown. For this reason, it’s used most often in cases of trauma, emergency, surgery and any situation where blood type is unknown.

California Pacific Medical Center, part of Sutter’s not-for-profit integrated network of care, has three campuses in San Francisco: Davies, Mission Bernal and Van Ness. CPMC’s state-of-the-art Van Ness campus hospital opened in March 2019.

Data Detectives Track the Pandemic

Posted on May 13, 2020 in California Pacific Medical Center, Expanding Access, Innovation, Palo Alto Medical Foundation, Quality, Research, Scroll Images, Transformation

Like a shadow lengthening at sunset or a dark cloud slowly obscuring the sun, the novel coronavirus has the potential to spread silently before positive tests confirm diagnoses in people infected with the virus.

To help get ahead of the curve and prepare Sutter’s integrated healthcare system to manage a potential surge in infections or a re-emergence of novel coronavirus later this year, Sutter leaders are collaborating with researchers and statistical analysts to track infection rates in the Sutter patient population and predict the course of viral spread.

Sutter researchers are experts in data analysis who leverage current and new methods aligned with Sutter privacy safeguards. Their work helps strengthen Sutter’s response to the pandemic. Here’s how:

1. TRACK THE VIRUS: Sutter Health Biobank
Sutter researchers are exploring ways to detect the novel coronavirus before it spreads further, by assessing exposure rates in Sutter’s patient population. This effort is led by Gregory Tranah, Ph.D., Scientific Director of CPMC and Director of Sutter’s Center for Precision Medicine Research.

The COVID-19 Seroprevalence and Surveillance Study will identify blood and serum samples from Sutter Biobank volunteer participants that show antibodies against the novel coronavirus. “Seroprevalence” means the level of a virus or other pathogen in a population, as measured in blood.

“Understanding the surge of infection rate and spread is an important part of preparedness. Epidemiological studies of emerging COVID-19 infections can help determine the burden of disease, develop better estimates of morbidity and mortality, and guide return-to-work and personal-safety decisions based on exposure history,” says Dr. Tranah.

The Sutter Biobank has been enrolling patient volunteers to give blood samples when a blood draw is ordered for clinical reasons. From early December 2019 through March 21, 2020 over 700 Biobank participants had blood samples drawn and archived.

“These samples provide Sutter with a unique opportunity to perform population-based surveillance of COVID-19 exposure when the virus began to spread in Northern California. They represent highly diverse patient data from Sutter’s integrated network. This is meaningful information that will allow us to determine the rate and timing of peak exposure and leveling of exposure rate,” says Dr. Tranah.

“Further, we can use the Biobank samples to find potential evidence of a resurgence of COVID-19 infection this fall. Earlier detection means we can plan for early containment of the virus.”

2. MONITOR VIRAL SPREAD: COVID-19 Surveillance
Researchers and statistical analysts at Sutter’s Center for Health Systems Research (CHSR) are collaborating with Sutter’s Enterprise Data Management, Informatics, Information Services and other operational departments to perform much-needed surveillance on the COVID-19 pandemic and provide insights to Sutter leaders.

Each morning, the CHSR team prepares reports for all Sutter hospitals on the number of patients who have tested positive or are suspected of being positive for COVID-19. They also track total hospital capacity and intensive care unit bed occupancy to help front-line staff with surge-capacity planning.

“Surveillance helps us understand how COVID-19 may be spreading amongst the patients we care for and our healthcare workers, and how we can prepare for potential surges in viral infection rates in the coming months,” says Alice Pressman, Ph.D., MS, Co-Director of CHSR.

Dr. Pressman and her colleagues at CHSR are developing the COVID-19 Universal Registry for Vital Evaluations (CURVE)—a centralized resource for research and quality improvement activities for COVID-19 disease surveillance and modeling, as well as health services and epidemiologic analyses.

“The registry will allow us to conduct research to assess the impact of COVID-19 on the healthcare system, Sutter patients, and our community of employees and healthcare workers,” says Dr. Pressman.

This registry develops the structure for the minimum necessary data to be used for each project, securely within the Sutter network. In turn, the knowledge gained can help to inform patient care and operations as Sutter continues to face COVID-19.

In support of Sutter’s Advancing Health Equity initiative, the CHSR team studied the demographics and clinical characteristics of COVID-19-infected individuals and their outcomes, which helped identify patient subgroups that may be more vulnerable to the disease. Early results indicate there may be inequities by sex, race, ethnicity and socioeconomic status.

“Research during a pandemic is vital to determine which parts of our communities and sub-groups of patients are most affected, so that we can allocate resources and care for our most vulnerable patients,” says Dr. Pressman.

3. A MATHEMATICAL CRYSTAL BALL: Statistical modelling to help predict the future of viral spread
One of the challenges of the COVID-19 pandemic is that scientists don’t fully understand the impact of the virus or its prevalence in our communities.

“One way to help answer these questions is through statistical modeling,” says Dr. Pressman. “We can use infectious-disease models as tools to help us predict the future of the novel coronavirus spread and the potential impact of social distancing and containment efforts on flattening the curve.”

Dr. Pressman and her team are collaborating with researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to understand the models IHME has published for California state COVID-19 data. “We hope to apply these models to our system to help us allocate healthcare resources and make decisions about future containment efforts.”

Data crunching to help halt a pandemic:
Surveillance is the systematic collection, analysis and interpretation of health-related data. For surveillance of the novel coronavirus and COVID-19, Sutter is using surveillance systems to monitor COVID-19 disease across the system. Surveillance and biobanking can help:
• Monitor the spread and intensity of COVID-19 disease
• Understand disease severity and the spectrum of illness
• Understand risk factors for severe disease and transmission
• Monitor for changes in the virus that causes COVID-19
• Estimate disease burden
• Produce data for forecasting COVID-19 spread and impact
• Improve patient care and help improve Sutter’s response to the pandemic

Solutions for Sleeplessness: A New Study Tests Behavioral Therapy and Medications

Posted on May 6, 2020 in California Pacific Medical Center, Expanding Access, Innovation, Quality, Research

More than 20 million Americans suffer from chronic insomnia. This sleep disorder can cause emotional distress, impaired functioning and reduced quality of life. It can even contribute to an increased risk for other health problems such as depression and high blood pressure.

Researchers at Sutter Health’s San Francisco Coordinating Center (SFCC) are collaborating with investigators at the University of Pittsburgh and other leading institutions nationwide to help improve insomnia treatment. Their collective focus begins with attempts to better support people suffering from the disorder in remote communities since access to sleep clinics may be limited.

The newly launched COZI (Comparative Effectiveness of Zolpidem and Cognitive Behavioral Therapy for Insomnia in Rural Adults) study will assess the effectiveness of web-based cognitive behavioral therapy for insomnia (CBT-I) compared with a common prescription sleep medication (zolpidem) or the combination. COZI is the largest, multicenter, randomized clinical trial of its kind to be conducted in rural primary care practices.

The study uses a self-guided online approach to CBT for insomnia developed by collaborators at the University of Virginia. COZI will enroll 1,200 people ages 18 to 80 with chronic insomnia in rural primary care practices affiliated with eight U.S. academic medical centers. Treatment effects will be evaluated at nine weeks, and at six and 12 months.

Katie Stone, Ph.D.
Katie Stone, Ph.D.

“Both zolpidem and CBT-I have been proven effective in treating chronic insomnia. However, COZI is the first randomized trial to comprehensively explore how these therapies compare in providing sustained sleep improvements, as well as their potential side effects and impact on other health outcomes,” says Katie Stone, Ph.D., senior scientist at SFCC and lead investigator of COZI for Sutter.

“People in rural areas with insomnia may have difficultly traveling to sleep clinics for care. Our goal is to test an approach that delivers insomnia treatment in their homes, making it easier for them to use an innovative, convenient approach to manage their sleep disorder,” said Daniel Buysse, M.D., Professor of Psychiatry and Clinical and Translational Science at the University of Pittsburgh School of Medicine, and co-lead investigator of COZI.

“We anticipate this new approach to delivering insomnia treatment will help lead to sustained improvements in how providers care for adults in rural communities with this common sleep disorder,” said Dr. Stone.

“This project was selected for PCORI funding for its scientific merit and commitment to engaging patients and healthcare providers in a major study conducted in real-world settings. COZI may help answer an important question about chronic insomnia and fill a crucial evidence gap,” said PCORI Executive Director Nakela Cook, M.D., MPH.”

The four-year, $5.7 million study is sponsored by the Patient-Centered Outcomes Research Institute (PCORI).1

Contact Katie Stone, Ph.D. for more information about the COZI study.

A Dose of Technology to Aid Sleep Therapy:

Many clinical studies test whether a treatment works under ideal conditions in specialized research centers, but health care is rarely delivered in such idealized situations and settings. Pragmatic clinical studies such as COZI test a treatment’s effectiveness in “real-world” practice situations such as outpatient settings, and also can include a wider range of study participants—making their findings more applicable to a broader patient population.

While CBT-I is well-established as an effective strategy for treating insomnia,2,3 it is usually delivered in person by behavioral health specialists. CBT-I broadens access to insomnia treatment and provides sleep disorder education, monitoring and individualized behavioral recommendations to improve sleep. In rural communities, use of CBT-I may be even more important because these types of sleep therapies can be limited in remote areas.

Citations:

  1. PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit www.pcori.org.
  2. Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late‐life insomnia: a randomized controlled trial. JAMA. 1999;281(11):991‐9. PubMed PMID: 10086433.
  3. Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder‐Frederick L, Frederick C, Quigg MS, Cohn WF, Morin CM. Effect of a Web‐Based Cognitive Behavior Therapy for Insomnia Intervention With 1‐Year Follow‐up: A Randomized Clinical Trial. JAMA Psychiatry. 2017;74(1):68‐75. Epub 2016/12/03.

Collaboration Connects Asian American COVID-19 Patients with Healthcare

Posted on May 1, 2020 in Affiliates, California Pacific Medical Center, Community Benefit, Scroll Images, Uncategorized

SAN FRANCISCO — California Governor Gavin Newsom has made it clear in recent weeks that the State must greatly increase COVID-19 testing in order to re-open. Testing provides critical information to public health and government officials to help slow the spread of COVID-19.

In order to achieve the governor’s goal of 60,000 tests performed per day, providers like North East Medical Services (NEMS), one of the largest community health centers in the Bay Area, are offering drive-through testing. Drive-through testing greatly increases the number of people who can be tested.

NEMS currently serves 70,000 patients in San Francisco, many of whom are low-income, best-served in a language other than English, and are from immigrant families.

Partnership Connects COVID-19-Positive Patients to Care

Thanks to a decades-long relationship between NEMS and California Pacific Medical Center (CPMC), part of Sutter Health’s integrated network of care, San Francisco-based NEMS patients who test positive—and who need immediate medical care—receive a referral to CPMC. Together, these organizations provide care for 32,000 Medi-Cal patients; NEMS provides primary and specialty care, while CPMC serves as the in-network hospital for NEMS’ patients.

According to NEMS President & CEO, Eddie Chan, “NEMS is very fortunate to have CPMC as our partner in providing world-class medical care to the majority of our patients in San Francisco.”

Eighty percent of NEMS’ patients prefer to be served in a language other than English, and NEMS offers linguistically-competent and culturally-sensitive health care services in many languages and dialects. NEMS drive-through testing is limited to current patients, but anyone who wishes to get tested can call NEMS to register as a patient without coming into the clinic.

CPMC is one of the largest not-for-profit medical centers in California with three hospital campuses in San Francisco, including Davies, Mission Bernal and Van Ness. The medical center supports a system of care for patients across the City when they need emergency and hospital services.

In San Francisco, Sutter affiliates take patients in partnership with many providers and clinic groups. By partnering with NEMS, Sutter Pacific Medical Foundation and Brown & Toland Physicians, CPMC is helping ensure that shared patients have access to COVID-19 testing and a comprehensive set of services should they become symptomatic.

Paying it Forward: Sutter Teams with Vitalant to Offer COVID-19 Survivor-Donated Blood Plasma to Patients

Posted on Apr 27, 2020 in Alta Bates Summit Medical Center, California Pacific Medical Center, Community Benefit, Expanding Access, Innovation, Quality, Research, Scroll Images, Transformation

Convalescent plasma, rich in protective antibodies, is the liquid component of blood.

With experts predicting that a vaccine for COVID-19 is at least a year away, Sutter and Vitalant are collaborating to offer investigational treatment with convalescent plasma—blood plasma collected from people who have recovered from COVID-19—to hospitalized patients with severe cases of the disease under requirements recently outlined by the U.S. Food and Drug Administration (FDA).

Convalescent plasma, rich in protective antibodies, is the liquid component of blood. Not-for-profit Sutter Health is the first non-academic hospital system in California to participate in this research, launching expanded access program testing the use of convalescent plasma at its affiliates California Pacific Medical Center (CPMC), Sutter Medical Center Sacramento and Alta Bates Summit Medical Center, with other Sutter sites beginning the clinical trial in the coming weeks.

“By collaborating with community partners like Vitalant, we’re bringing an opportunity for the latest cutting-edge research to our patients,” says Sean Townsend, M.D., an intensive care medicine specialist in CPMC’s Division of Pulmonary and Critical Care. “Convalescent plasma is a potentially promising treatment for COVID-19 that we will test in clinical trials across the Sutter integrated network of care. We hope to build a supply of convalescent plasma that will add to our arsenal of emerging treatments to fight the virus.”

Vitalant physician colleague, Chris Gresens, M.D., adds, “We hope this therapy will serve as a type of ‘stop-gap vaccine substitute’ by providing severely affected patients just enough of an ‘immune boost’ to help them to recover more fully and quickly.”

The plasma donor must test negative for COVID-19 and be otherwise healthy. Convalescent plasma from one donor may be used to treat as many as four hospitalized patients with the illness who consent to participate in a clinical trial of the treatment.

Convalescent plasma has been studied for the treatment of numerous illnesses, most recently for infectious diseases such as Ebola, SARS, MERS and H1N1.

How you can help:

  • Under the new U.S. FDA guidelines, eligible blood donors who have had a documented diagnosis of COVID-19, and remain asymptomatic for at least 14 days post-recovery, may donate their plasma.
  • Sutter patients and health care workers who previously tested positive for COVID-19 can book an appointment for free donor screening at Sutter walk-in clinics: make a video appointment through My Health Online or call Sutter’s COVID-19 Advice Line (866) 961-2889 for more information.
  • Vitalant will only accept donors who meet all FDA-required general donor eligibility criteria in addition to the COVID-19 convalescent plasma qualifications.
  • Non-Sutter affiliated potential donors may apply to donate plasma at a Vitalant site by completing the form at Vitalant.org/covidfree. Donors cannot walk in for this procedure; they will be contacted by Vitalant to schedule an appointment.