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January 22nd, 2021

COVID-19 Physician Town Hall XXVII

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ReflectionDr. Mark Collins, CIN Medical Director

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Praise Song for the Day

Each day we go about our business,

walking past each other, catching each other’s

eyes or not, about to speak or speaking.

All about us is noise. All about us is

noise and bramble, thorn and din, each

one of our ancestors on our tongues.

Someone is stitching up a hem, darning

a hole in a uniform, patching a tire,

repairing the things in need of repair.

Someone is trying to make music somewhere,

with a pair of wooden spoons on an oil drum,

with cello, boom box, harmonica, voice.

A woman and her son wait for the bus.

A farmer considers the changing sky.

A teacher says, Take out your pencils. Begin.

We encounter each other in words, words

spiny or smooth, whispered or declaimed,

words to consider, reconsider.

We cross dirt roads and highways that mark

the will of some one and then others, who said

I need to see what’s on the other side.

I know there’s something better down the road.

We need to find a place where we are safe.

We walk into that which we cannot yet see.

Say it plain: that many have died for this day.

Sing the names of the dead who brought us here,

who laid the train tracks, raised the bridges,

picked the cotton and the lettuce, built

brick by brick the glittering edifices

they would then keep clean and work inside of.

Praise song for struggle, praise song for the day.

Praise song for every hand-lettered sign,

the figuring-it-out at kitchen tables.

Some live by love thy neighbor as thyself,

others by first do no harm or take no more

than you need. What if the mightiest word is love?

Love beyond marital, filial, national,

love that casts a widening pool of light,

love with no need to pre-empt grievance.

In today’s sharp sparkle, this winter air,

any thing can be made, any sentence begun.

On the brink, on the brim, on the cusp,

praise song for walking forward in that light.

Elizabeth Alexander

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Opening RemarksDon Franke, SVP, Population Health and CEO, AMITA Health Care Networks

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These physician town halls are offered for all

AMITA Health physicians —independent, CIN and

Medical Group.

The content for each session is developed in

conjunction with AMITA physician leaders.

Topics are identified based on calls to the AMITA

physician hotline and through contact with AMITA

physician leadership.

Please let us know what topics you would like

covered in future sessions and encourage your

colleagues to join.

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Meeting Agenda

Welcome & ReflectionDr. Mark Collins

CIN Medical Director

Opening RemarksDon Franke

SVP, Population Health and CEO, AMITA Health Care Networks

AMITA Command Center ReportDr. Stuart Marcus

EVP, Chief Clinical Officer

AMITA Vaccine Program UpdateDr. Michael Kelleher

Chief Medical Officer, AMITA Health Mercy Medical Center

So you've been vaccinated, now what?Dr. Janis Atkinson - VP Medical Affairs, Alverno Lab for AMITA Health

Dr. Dana Vais - Infectious Disease, AMITA Health

Q&AModerated by Dr. Reinhold Llerena

President, AMITA Health Medical Group; AMITA Chief Population Health Officer

Closing RemarksDr. Joseph Lagattuta

CIN Board Chair

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Upcoming COVID Physician Townhall & COVID Consortium Meetings

Email Alyssa.Howell@amitahealth.org to be added to the COVID Consortium meeting invites

January

Monday Tuesday Wednesday Thursday Friday

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Physician

Townhall @

7am

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COVID

Consortium

@ 5:30pm

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Townhall @

7am

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CIN / PCP

Quality Meeting

@ 7am

February

Monday Tuesday Wednesday Thursday Friday

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Physician

Townhall @

7am

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COVID

Consortium

@ 5:30pm

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Physician

Townhall @

7am

Next Townhall

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AMITA Physician Resource Hotline224.273.3900

Calls will be routed to voicemail and returned within 2 hours between 8am-4pm Monday through Friday

After hours or weekend calls will be returned the next business day

Physician Hotline EmailAMITA-MB-AMITA.PhysicianResourceHotline@amitahealth.org

Additional Resources & Playbooks OnlineAMITAhealth.org/covid-19-AMITA

AMITA Health COVID-19 Physician Resources

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Submit Questions Via WebEx Q&A BoxUtilize the Q&A functionality through WebEx on your computer or through the mobile app to submit questions

Computer WebEx App Mobile WebEx App

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Recording and SlidesSlides and a video recording from this townhall will be made available on the AMITA COVID-19 resource site.

AMITAhealth.org/covid-19-AMITA

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Command Center ReportDr. Stuart Marcus, EVP, Chief Clinical Officer

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AMITA Health

COVID-19 Daily

Dashboard

Updated January 21st, 2021

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AMITA Vaccine Program UpdateDr. Michael Kelleher, Chief Medical Officer, AMITA Health Mercy Medical Center

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COVID-19 Vaccine Steering Committee Structure 2.0

Workstreams

Thor Thordarson, Elyse Forkosh Cutler, Rance Clouser, Cristal Gary, Dr. Reinhold Llerena, Drew Palumbo, Don Franke, Sun Lee, Syliva Chen, Hetal Desai, Dr. Bonny Chen, Craig

Kuhl, Dana Cilla, Jenna Lambrecht, Olga Solares, Michelle Hereford, Roxanne Barber, Trisha Musich, Monika Tickoo, Theresa Olson

Project Management Co-Chair

Patricia Mencia

Committee LeadershipDr. Mike Kelleher

Executive SponsorDr. Stuart Marcus

Community Outreach, Partnerships, & Equitable Distribution (Cristal Gary & Elyse Forkosh Cutler)

Population Prioritization, REaL Data, Focus on populations not identified as AMITA patients, Post-Vaccine Wellness, Community partnership, Strategic site selection

Data Integrity / IT (Rance Clouser / Jim Murrell)

Scheduling, Ordering, Documentation, EMR Integration, PureOHS Integration, Moni toring/Tracking/Reporting

Legal / Regulatory (Dana Cilla)

Vaccine policy, protocol and standing order, consent forms, observation waivers, other considerations

Marketing & Communicat ions (Olga Solares & Theresa Olson)

Internal and External Communications

Medical Group Patient Outreach

Drew Palumbo

• AMITA MG patient outreach

• Post-Vaccine Wellness

Membership:

• Medical Group

CIN Patient Outreach

Don Franke

• AMITA CIN patient outreach

• Post-Vaccine Wellness

Membership:

• ACO/CIN

Vaccine Administration

Roxann Barber

• Acquisition

• Storage

• Prep (thawing)

• Distribution / Redistribution

• Ancillary Supplies

• Clinic Staffing

• Clinic Workflow / Logistics

• Clinic workflow process improvements

• Vaccine Tracking

• VAERS / V-SAFE reporting

Membership:

• Nursing

• Operations

• Pharmacy

• TRG

• Associate Health

• Medical Staff

Registration / Billing

Jenna Lambrecht

• Vaccine Administration

Membership:

• R1

• Finance

• Medical Group

• IT

Analyt ics (Monika Tickoo & Hetal Desai)

Vaccine Dashboard, Patient Prioritization, Reporting (including REaL data)

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State / City Transitioning to Phase 1b

• 1/15 Gov. J.B. Pritzker Announcement

• State anticipates substantially completing Phase 1A this week

• Moving into Phase 1B on Monday 1/25, (>65y/o & frontline essential workers)

• IDPH partnering with large pharmacies to launch hundreds of new sites in communities across Illinois

• Deploying Illinois National Guard

• Two teams to two sites in Cook County

• Additional teams to regions across the state to stand up new sites and build out additional capacity

at existing sites

• State continues to build out capacity - smaller independent pharmacies, urgent care clinics, doctors'

offices, and workplaces will all be coming online to serve as vaccination sites

• More information on locations and how to make appointments will be available to the public on a

website to be launched prior to the start of Phase 1B

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US Vaccination Phased Group Overlap

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Illinois Statewide Vaccine Phase Groups Sized

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Illinois Phase 1b Defined

• Persons aged 65 years and older

• Frontline essential workers, defined as those workers who are essential for the functioning of society and are at highest

risk of exposure, including the following: ▪

• First responders: Firefighters (including volunteers), Law Enforcement Officers (LEOs), 911 Dispatch (Public Safety Answering Point – PSAP),

Security Personnel, School Officers. (EMS personnel are considered under Phase 1a).

• Corrections Officers/Inmates: Jail Officers, Juvenile Facility Staff, Workers Providing In-Person Support, Inmates.

• Food and Agriculture Workers: Processing, Plants, Veterinary Health, Livestock Services, Animal Care.

• Postal Service Workers

• Manufacturing Workers: Industrial production of goods for distribution to retail, wholesale or other manufacturers.

• Grocery Store Workers: Baggers, Cashiers, Stockers, Pick-Up, Customer Service.

• Public Transit Workers: Flight Crew, Bus Drivers, Train Conductors, Taxi Drivers, Para-Transit Drivers, In-Person Support, Ride Sharing

Services.

• Education (Congregate Child Care, Pre-K through 12th grade): Teachers, Principals, Student Support, Student Aids, Day Care Workers.

• Shelters/Adult Day Care: Homeless Shelter, Women's

The steering committee will need to determine the criteria for AMITA’s transition to Phase 1b.

19As of January 21st, 2021

https://covid.cdc.gov/covid-data-tracker/#vaccinations

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Click here to watch:

http://content.jwplatform.com/players/ccm9mk8S-Mr4aHRYZ.html

Video message from Michael KelleherMD, chairman of the AMITA Health COVID-19 Vaccine Steering Committee

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So you've been vaccinated, now what?Dr. Janis Atkinson, VP Medical Affairs, Alverno Lab for AMITA Health

Dr. Dana Vais - Infectious Disease, AMITA Health

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VACCINE EFFECTS

• HYPERSENSITIVITY

• REACTOGENICITY

• EFFICACY

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HYPERSENSITIVITY - ANAPHYLAXIS

• mRNA vaccines: 29 cases of anaphylaxis reported so far (Jan 6)

• Pfizer-BioNTech: 21 cases of anaphylaxis of 1,893,360 first doses Dec 14-23, 2020 - rate

11.1 per million doses (flu 1.3 per million doses)

• 71% occurred within the first 15 min

• Median time 13 min

• Average age 40 years old

• 90% female

• No clustering in any region

• Multiple lots

• 17/21 w/ h/o severe allergic reactions; 7 had h/o anaphylaxis

• 4 hospitalized (3 in ICU); 20 discharged home

• NO DEATHS

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Characteristic

Immediate allergic

reactions (including

anaphylaxis) Vasovagal reaction

Vaccine side effects

(local and systemic)

Timing after vaccination Most occur within 15-30

minutes of vaccination

Most occur within 15 minutes Median of 1 to 3 days after

vaccination (with most occurring

day after vaccination)

Signs and symptoms

Constitutional Feeling of impending doom Feeling warm or cold Fever, chills, fatigue

Cutaneous Skin symptoms present in

~90% of people with

anaphylaxis, including pruritus,

urticaria, flushing, angioedema

Pallor, diaphoresis, clammy skin, sensation of facial

warmth

Pain, erythema or swelling at

injection site; lymphadenopathy in

same arm as vaccination

Neurologic Confusion, disorientation,

dizziness, lightheadedness,

weakness, loss of

consciousness

Dizziness, lightheadedness, syncope (often after

prodromal symptoms for a few seconds or minutes),

weakness, changes in vision (such as spots of

flickering lights, tunnel vision), changes in hearing

Headache

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Characteristic

Immediate allergic

reactions (including

anaphylaxis) Vasovagal reaction

Vaccine side effects (local

and systemic)

Timing after vaccination Most occur within 15-30 minutes

of vaccination

Most occur within 15 minutes Median of 1 to 3 days after vaccination

(with most occurring day after

vaccination)

Signs and symptoms

Respiratory Shortness of breath, wheezing,

bronchospasm, stridor, hypoxia

Variable; if accompanied by anxiety, may have an elevated

respiratory rate

N/A

Cardiovascular Hypotension, tachycardia Variable; may have hypotension or bradycardia during

syncopal event

N/A

Musculoskeletal N/A N/A Myalgia, arthralgia

Vaccine recommendations

Recommended receiving 2nd

dose of mRNA COVID-19

vaccine?

No Yes Yes

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REACTOGENICITY

• LOCAL: pain, swelling, erythema at the injection site, localized axillary lymphadenopathy on

the same side as the vaccinated arm

• 80–89% of vaccinated persons develop at least one

• SYSTEMIC: fever, fatigue, headache, chills, myalgia, arthralgias, diarrhea

• 55–83% develop at least one

• most are mild to moderate in severity

• most occur within the first three days of vaccination

• most resolve within 1–3 days of onset

• more frequent and severe following the second dose and among younger persons compared to older

persons (i.e., >55 or ≥65 years [for Pfizer-BioNTech or Moderna vaccines, respectively])

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How the Pfizer Vaccine Works

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Effects of Vaccination

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Immediate reactions

Such as anaphylaxis – IgE mediated

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End Result of Vaccination:Antibodies and Memory Cells

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Covid Vaccine and Lab Tests

• Q: How can I tell if my patient is suffering from Covid or from side effects of the vaccine using

lab tests?

• A: A vaccinated person will not convert to a positive Covid PCR or antigen test – so these

direct viral tests can be used to distinguish an infection with actual virus from a vaccination

response.

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How to Distinguish Natural Infection COVID from Vaccination with Serology

Natural Infection:

Exposed to the entire virus

Vaccination:

Exposed to the Spike Moiety only

Qualitative IgG Nucleocapsid

Pos/Neg

POS NEG

Qualitative IgM Spike

Post/Neg

POS POS

Only the Qualitative IgG Nucleocapsid Antibody can distinguish a natural infection exposure from a vaccine exposure.

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The Infection Cycle of the SARS CoV2 Virus

Main points-- Viral detection methods peak early and disappear first (nasal swabs)-- IgM Antibody generally rises first in the blood before IgG, so it is generally a sign of recent infection (blood test)-- IgG Antibody rises later than IgG in most patients and lasts longer so it is a sign of past infection (blood test)

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IgG Quantitative Spike Titers

• A new Antibody test from Abbott in development

• Will provide a quantitative amount of antibody specific to Spike Protein to help determine if a

vaccinated (or infected) person has developed an immune response

• Expected by Feb 2021

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PFIZER-BIONTECH

• protection does NOT start until 12 days

after the first shot

• it reaches 52% effectiveness a few weeks

later

• A week after the second vaccination, the

effectiveness rate hits 95% (ideal, clinical

trial conditions)

MODERNA

• protection rate of 51% two weeks after the

first immunization

• 94% two weeks after the second dose.

EFFICACY

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Pfizer- BioNTech vaccine

BNT162b2 mRNA

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Moderna mRNA-1273

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COVID 19 VACCINE: ONE shot vs TWO, on schedule

• Vaccine efficacy drops to about 50% after a single shot for both mRNA vaccines (exclude the first 14

days, CIs vary by 30% based on trial data); 5-6x higher titers with the second dose

• Neutralizing antibodies present in only 50% of patients after the first dose, but 100% after the second; one

dose inadequate, particularly for elderly people (age diminishes the duration and magnitude of immune

responses)

• Phase 1 trials for SARS-CoV2, MERS- CoV: higher dose of the single shot needed to elicit immune

response (more side effects)

• Delay: no information on immune durability (the length of time that protective immunity endures)

• mRNA: rapidly degrading set of instructions for cells to make the spike protein of Sars-CoV-2; once

degraded, the cell will stop making the spike protein and the immune system will stop responding to it

• Circulating virus exposed to low levels of antibodies: evolutionary selection of variants that may be able

to bypass those antibodies (escape mutants)

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● United Kingdom (UK): 20I/501Y.V1,

VOC 202012/01, or B.1.1.7

● South Africa: 20H/501Y.V2 or

B.1.351 emerged independently of

B.1.1.7

● Brazil: P.1 (17 new mutations)

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VOCs SARS-CoV2: implications

• Ability to spread more quickly in people

• Ability to cause either milder or more severe disease in people

• Ability to evade detection by specific diagnostic tests

• Decreased susceptibility to therapeutic agents such as monoclonal antibodies

• Ability to evade natural or vaccine-induced immunity

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New Strain Covid and Covid Tests

• Q: Will the new strains of COVID from the UK and South Africa be detected with our current

COVID viral detection molecular and antigen tests?

• A:

• YES. All 6 of our platforms will detect the new strains. The new strain represents a modification of the

spike protein only.

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How to detect a new strain

• Gold standard is RNA sequencing which can be done through the IDPH

• One case has already been detected in Chicagoland

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Rt for new variants: >1.8

“The greater transmission rate is not because the virus is suddenly able to seek you out like a heat-seeking missile. It’s

just probability. It’s not an X-Man. It can’t magically melt through a mask if it has eight mutations in the spike

protein, or even if it has 50 mutations in the spike protein. That’s like saying you can paint a smiley face on a baseball

and suddenly it can travel through a wall.”

Angela Rasmussen - virologist, Georgetown Center for Global Health Science and Security

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MITIGATION MEASURES

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1. Protect yourself

2. Protect others - data to answer the question of whether

vaccinated people can still spread the virus are just

now being collected

WHY MAINTAIN MITIGATION MEASURES

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Effects of a vaccine program against pandemic influenza A(H1N1), US 2009-

2010

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Open Q&AModerated by Dr. Reinhold Llerena, President, AMITA Health Medical Group; AMITA Chief Population Health Officer

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Open Q&A

Computer WebEx App Mobile WebEx App

Submit Questions Via WebEx Q&A Box

Presenters

AMITA Command Center ReportDr. Stuart Marcus

EVP, Chief Clinical Officer

AMITA Vaccine Program UpdateDr. Michael Kelleher

Chief Medical Officer, AMITA Health Mercy Medical Center

So you've been vaccinated, now what?Dr. Janis Atkinson - VP Medical Affairs, Alverno Lab for AMITA Health

Dr. Dana Vais - Infectious Disease, AMITA Health

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Q: When a COVID vaccine becomes available for distribution to healthcare workers is AMITA planning to require all clinical staff receive this (like the flu vaccine) or

voluntary?

A: The vaccine will not be mandatory while under EUA, however we strongly encourage associates and affiliated healthcare workers to be vaccinated

Q: Will we be able to get the vaccine through AMITA and how would we schedule?

1. Associates / Credentialed Providers: already available via Radix Scheduling tool

2. Affiliated provider office staff: submit information for your office staff at the links below so we invite to schedule as supply allows.

• COVID-19 Vaccine Form - CIN Office

• COVID-19 Vaccine Form- Affiliated Offices

3. Unaffiliated healthcare workers: next after we complete AMITA affiliated healthcare worker population

4. Patients / Communities: In the coming weeks based on the state’s phased distribution plan, as supply allows, to be scheduled via InQuicker. Link and process

information will be forthcoming.

Q: Can I get vaccinated if I’ve already had COVID-19?

A: Yes. Research shows it’s rare for people who have had COVID-19 to get reinfected within 90 days, so you could wait 90 days after recovering to get vaccinated. But

you don’t have to do this. If you’ve had COVID-19 but were asymptomatic, you can get the vaccine 10 days after a positive PCR test. If you’ve had COVID-19 with

symptoms, you can get the vaccine once you no longer have symptoms.

Q: Spouses and families of physicians and other care givers are at increased risk. Are allowances being made to vaccinate them? Will they be according to age?

Coexisting medical conditions?

A: AMITA is following the CDC, ACIP, state, and local phased schedules for vaccinating, starting with healthcare workers in Phase 1a, and moving to >65 and frontline

essential workers in 1b.

Q: What are the components of the vaccine?

A: Both Pfizer and Moderna are composed of PEG, Lipid nanospheres, and mRNA. There are no preservatives.

Q: Do we have any information about giving a second dose to those who had an adverse reaction after the first vaccine?

A: The CDC does not recommend receiving the second dose following anaphylactic shock from the first dose. The CDC recommends observation for 30 minutes for those

with a history of anaphylactic shock. Clinic should be prepared to administer epinephrine and have a crash cart on hand.

Frequently Asked Questions

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Closing RemarksDr. Joseph Lagattuta, CIN Board Chair

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Virtual Peer Support for Providers and Associates – Q1 Offerings (Jan-Mar)AMITA Health Behavioral Medicine and Spiritual Care teams continue to provide internal virtual peer support groups. These

groups provide psychological and spiritual support, as well as self-care recommendations in a safe, confidential forum.

Therapists facilitate and assist with steering participants to additional resources. Open sharing and interaction is encouraged.

Weekly

Through Q1Topic Time Facilitator Call 331.303.8777

Monday Anxiety Support Group for Associates and Providers 3-4pm Chris McCarthy Passcode: 676329879#

Tuesday Managing Pandemic Exhaustion 9-10am Dr. Cliff Saper Passcode: 188140393#

Wednesday Facing the Pandemic Alone 4:30-5:30pm Christina Lobraco and Lisa Tamez Passcode: 405569902#

Thursday*Anxiety, Grief, Exhaustion, and the Challenges of

work/life balance7:30-8:30am Lisa Tamez Passcode: 997923859#

Friday* Anxiety, Grief and Exhaustion Support 12-1pm Christina Lobraco & Victoria Storm, Music Therapist Passcode: 323723730#

If your work group, program, unit, or department staff wish to have your own virtual peer support group at a time you designate,

contact Clifton.saper@amitahealth for a request form.

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CME Credit for AMITA Health COVID-19 Physician TownhallsThe evaluation survey needs to be completed for each session attended for credit dating back to 3/27. GME

will issue certificates each month, stating the total CME awarded for said month.

Evaluation Link: https://www.surveymonkey.com/r/MedStaffTownHall

AMITA Health Resurrection Medical Center designates this Activity for a

maximum of 1 AMA PRA Category 1 credit(s)TM. Physicians should only claim credit commensurate

with the extent of their participation in the activity

AMITA Health Resurrection Medical Center is accredited by the Illinois State

Medical Society to sponsor continuing medical education for physicians.

None of our speakers today have any sponsorship disclosures to report

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Thank you!

AMITA Physician Resource Hotline224.273.3900

Calls will be routed to voicemail and returned within 2 hours between 8am-4pm Monday through Friday

After hours or weekend calls will be returned the next business day

Physician Hotline EmailAMITA-MB-AMITA.PhysicianResourceHotline@amitahealth.org

Additional Resources & Playbooks OnlineAMITAhealth.org/covid-19-AMITA