COVID-19 Efforts Q4 2020

The Task Force began meeting immediately and included leaders from almost every division in the health system. The team worked with a fervor fueled by the hope of an end to this pandemic that has taken so many lives and caused so much suffering. Members of the Task Force scoured every document issued by the Federal Government’s Operation Warp Speed (COVID-19 Response) and the New Jersey Department of Health’s COVID-19 Plan. Plans included a wide range of information and it was clear that individuals working in healthcare would be very early in the prioritization of scarce vaccine resources. The team also knew that any COVID vaccine would be granted emergency use authorization (EUA) and require a significant amount of patient demographic collection, education and consents. All employees were surveyed regarding their interest in receiving a vaccine under the EUA so the task force could understand the volume of individuals within our organization that would want to be vaccinated when the system may have access to a vaccine.

The Task Force assessed potential vaccination clinic locations, availability of individuals to perform vaccination, and equipment needed to vaccinate tens of thousands of employees safely as case numbers were beginning to rise again. The Informatics group on the Task Force designed a web-based scheduling program that took into account all of the various patient qualifications and demographic information that would be needed to administer the vaccine to our System's employees. We worked with physicians in our medical group to create videos for employees to understand risks and benefits of the vaccine. Physicians also staffed call centers to address vaccine recipient questions and concerns.

Amidst the flurry of vaccine readiness planning the teams also coordinated several changes to COVID-19 treatment options. Remdesivir received full FDA approval in mid-October and in early November, the first COVID-19 monoclonal antibody, Bamlanivimab, received emergency use authorization from the FDA. This medication, and the one on its heels, would pose a unique challenge because it was approved for use in patients with COVID-19 that were not sick enough to be hospitalized. The corporate pharmacy team worked with physician and nursing leaders to evaluate the best way to identify, refer and treat patients with COVID-19 that meet criteria for this therapy. Concise yet thorough treatment algorithms were developed and disseminated to align with the EUA requirements and prescribers were able to utilize Bamlanivimab within days of its arrival at the medical centers. When Casirivimab-Imdevimab was granted EUA two weeks later, the system was able to use its agility to easily create an infrastructure for safe administration of this new COVID treatment for outpatients in addition to Bamlanivimab. These two products have played a large part in preserving inpatient beds by providing treatment for outpatients before they need hospitalization. The Corporate Pharmacy team assertively advocated for the sites at the state level to send more of these critical monoclonal antibodies. Our site’s preparation, planning and execution of a clear administration for these products allowed for rapid integration and treatment of a significant number of patients treated each week. Each site within our system worked together to share products to ensure that each patient that qualified for the treatment would be able to receive it in one of our facilities. No other health system in New Jersey had such aggressive adoption of these products granted EUA by the FDA. At the time of this writing, RWJBarnabas Health is one of the earliest adopters and largest users of the COVID-19 monoclonal antibodies, Bamlanivimab and Casirivimab-Imdevimab. Members of the enterprise have shared their knowledge and process for handling these products with other health systems across the country with the hope that we can help others fight this disease from every angle through increased administration.

In late November, Pfizer was the first pharmaceutical company to submit an application for review of their COVID-19 Vaccine candidate with the FDA. With the FDA review of Pfizer’s vaccine candidate days away, Indu Lew was featured on a COVID-19 Vaccine Episode of Dateline NBC. Indu was able to expertly convey the tremendous efforts being made by health systems across the country to plan for mass vaccination without much information, resources or time. Her analogy of planning for a dinner party where you were unsure of how many were coming, who was coming, where the dinner would be held and when it was happening was such an eloquent and relatable vision for the viewers across the world. Despite not knowing when we would get vaccine and how many we would receive, the Vaccine Task Force started scheduling clinics to begin in the third week of December. Sites were checking and rechecking temperature logs for their ultra cold freezers. The Corporate team developed a vaccine handling policy that addressed vaccine receipt, storage, transfer and administration. Clinical Engineering worked closely with pharmacy leaders to ensure calibrated, remote, continuous, alarmed digital data loggers were available and configured for all vaccine storage equipment. Our System Scarce Resource Committee developed prioritization criteria, classifying employees as high, medium and low risk. Invitations to register would be sent to members of each group based on their risk of exposure to COVID-19 in the workplace.

On December 10, 2020 the FDA reviewed the evidence submitted by Pfizer as support for emergency approval of their COVID-19 vaccine. Several members of the corporate pharmacy team attended the meeting to ensure that the infrastructure built to educate recipients and document pertinent information was as correct as possible – everyone knew that vaccine delivery would occur shortly after approval of an EUA. Pfizer’s vaccine was approved for individuals over the age of 16. Reports had come from England with warnings about anaphylaxis to the vaccine. Our system prepared for this by coordinating with the medical alert and rapid response teams at our acute care sites that would be administering vaccine and providing each clinic with an emergency supply kit with medications.

Even though Thanksgiving celebrations were kept small, case numbers in New Jersey and hospitalizations were beginning to rise exponentially. The reserve of critical medications for the sickest patients requiring mechanical ventilation were being taxed as shortages were starting to impact supply chain. The strategic preparation in planning for inventory and utilization changes for this second surge with the sites and the central warehouse were coming to fruition. At this point Moderna’s vaccine candidate’s data was submitted to the FDA for EUA and the team compiled the information needed to prepare for the eventuality that our system would be managing both the Pfizer and Moderna vaccines.

The system learned that RWJ University Hospital in New Brunswick was selected by the state to be a pre-positioned vaccine site – one of a small number of medical centers that would receive vaccine first to test the delivery process. The Corporate Pharmacy team worked with various NJ Department of Health members to ensure each site was registered and set up correctly to receive and document vaccine shipments. Clinical Information system teams ensured that all vaccines administered would be transmitted to the state’s vaccine registry system NJIIS. The team at New Brunswick created videos to assist other pharmacy departments in our enterprise to successfully receive, store and administer the Pfizer vaccine. The soft-launch in New Brunswick was a success and served as an exceptional way to test the clinic throughput and design – feedback was provided to all the sites daily at the system clinic huddles. During this same week, the FDA approved Moderna’s COVID-19 vaccine and would be shipping to the sites within days. Invitations for employees to register were now being sent each day.

Vaccination at all acute care sites began on December 21, 2020. A schedule was created to ensure that clinics and recipients would be available at an interval to accommodate the second dose of the vaccine. Clinics were running on most days of the week vaccinating employees. The Corporate Pharmacy team worked with the sites to move product around the system in the NJIIS program to ensure that enough product was available for scheduled appointments and to minimize waste. As our acute care sites were working diligently to vaccinate the tens of thousands of employees, the vaccine task force and Corporate Pharmacy team began working with the NJ Department of Health to start a mass vaccination clinic in Edison. While the work done to get these clinics up and running felt insurmountable, the joy and appreciation expressed by everyone that was able to receive a vaccine was truly rewarding. While we will be managing COVID-19 for a long time to come, the relentless dedication of all of our colleagues that worked tirelessly to handle each unique challenge posed was nothing less than heroic. Our clinics were neither perfect or smooth at all times but the were effective because of the incredible leaders and front line individuals that continue to do their part to control this pandemic. As we look to 2021 and beyond, our organization has never been more able to adapt, pivot and work together to help our entire organization be RESILIENT and provide the highest level of care for the patients we serve.

trends in confirmed cases in hospital by region