>> Hello, everyone.
Welcome today to our webinar on what you
need to know bout COVID-19 and the role
of community health workers
in the Latino community.
This webinar is a collaboration
between NACHW and CDC.
My name is Colleen Barbaro.
I'm a health scientist on the applied research
and translation team in CDC's Division
for Heart Disease and Stroke Prevention.
And I'm here today with Denise Smith
and I will let her introduce herself.
>> Good afternoon, everyone.
Thank you so much, Colleen and the whole
team at the Centers for Disease Control.
My name is Denise Octavia Smith,
and I'm the executive director
of the National Association
of Community Health Workers.
Great to be joining you.
>> Great. So just a few housekeeping
items before we get started.
I first wanted to mention
that the slides and recording
from this webinar will be posted afterwards.
So you will have access to these things later.
We'll also be taking questions
at the end through the Q
and A button at the bottom of your screen.
And you do have access to the
Q and A box during the webinar.
So feel free to type in questions for
myself and/or Denise at any point.
And we'll do our best to answer your
questions after the presentation.
Next slide.
So today's objectives for the presentation
will first provide an overview of COVID-19
that community health workers can
apply when guiding COVID-19 prevention
in the communities that they serve.
We'll discuss the evidence-based
COVID-19 prevention recommendations
on how individuals can help themselves,
their families and communities in preventing
or slowing the spread of COVID-19.
We'll share messages, tools and other resources
in Spanish that health promotors may use
to inform at-risk groups including older
adults and people with underlying conditions.
And we'll discuss the experiences of
community health workers and the changing roles
that they face in the COVID-19 pandemic.
Next slide.
Let's start with the coronavirus background.
So the coronavirus refers to a large family
of viruses that cause respiratory illness.
It was first isolated in the 1960's.
It's named for the crown-like
spikes on the surface.
There are four subgroupings,
alpha, beta, gamma and delta.
And some of the coronaviruses can
spread between animals and humans
or what is known as zoonotic disease.
Next slide.
Okay, next slide.
There are seven human coronaviruses
listed on this slide.
The common human coronaviruses
are provided at the top,
and then other human coronaviruses
include SARS and MERS.
Next slide.
So the common human coronaviruses --
let's talk now about the clinical
presentation and diagnosis.
They usually cause mild to moderate
upper respiratory tract illnesses
like the common cold.
They may cause more severe disease
like pneumonia or bronchitis.
They're more common in infants,
older adults and people
with underlying conditions
that weaken the immune system.
The symptoms of coronaviruses may include
runny nose, headache, cough, sore throat,
fever and general unwell feeling.
Diagnosis involves lab tests that can be used
to test respiratory specimens in serum or blood
for coronavirus infection in
patients with more severe disease.
Next slide.
So common human coronaviruses --
let's talk now about how they spread.
They're most commonly spread from an infected
person to others through respiratory droplets
by coughing, sneezing or talking.
Close personal contact such as touching
or shaking hands, and touching an object
or surface that has the virus on it.
These viruses commonly occur in fall and
winter, but they can occur year-round.
Young children are most likely to get
infected with the common human coronaviruses.
And most people will get infected
at least once in their lifetime.
Next slide.
So let's talk briefly now about
some other human coronaviruses
that you may have heard of called SARS and MERS.
Next slide.
SARS and MERS were recognized in the early
and mid-2000's -- I'm sorry -- after 2010.
The SARS virus was first
recognized in 2002 in China.
The MERS virus was recognized
in 2012 in Saudi Arabia.
And the scope of the outbreaks included
SARS having 8,000-plus probable cases
and 774 deaths from 2002-2003.
There's been no known human
cases of SARS since 2004.
For MERS, there were 2,400-plus
lab-confirmed cases
and 850-plus deaths as of October 3rd, 2019.
And two US cases in 2014 were
among healthcare professionals.
Next slide.
Looking at the clinical picture
for SARS and MERS, it involves --
these viruses involve transmission between
people through close person-to-person contact.
The most common symptoms include fever and
chills, body aches, cough, shortness of breath.
Complications can include pneumonia
in SARS and MERS particularly,
as well as kidney failure in MERS.
As far as treatment, there's no specific
antiviral treatment licensed for SARS or MERS.
And individuals seek medical
care to relieve their symptoms.
Looking at prevention, no vaccine is
available and everyday preventive actions
to prevent the spread of respiratory viruses
including hand hygiene are important.
Next slide.
Let's move on now to discuss coronavirus
disease 2019, or what is known as COVID-19.
Next slide.
COVID-19 was first identified in
Wuhan, China in December of 2019.
It's caused by the virus SARS-COV-2.
Early on, many patients were reported to have a
link to a large seafood and live animal market.
Later patients did not have
exposure to animal markets,
and this indicated person-to-person spread.
Travel-related exportation
of cases has been reported.
The first US case was reported
on January 21st, 2020.
And CDC is reporting confirmed
COVID-19 cases in the US online
at our website, and the link is provided here.
Feel free to keep updated on
the cases here using that link.
Next slide.
COVID-19, we know a little
bit about how it spreads based
on what is known from other coronaviruses.
But investigations are ongoing to better
understand the spread of this particular virus.
It is presumed to occur primarily
through close person-to-person contact
through respiratory droplets produced when
the infected person coughs, sneezes or talks.
And it is possibly spread by touching a
surface or object that has the virus on it
and then touching the mouth, nose or eyes.
Next slide.
So symptoms of COVID-19, the main symptoms
include fever, cough and shortness of breath.
There have been a wide range of illness
severity that has been reported.
Some have mild to severe illness
and it can result in death.
Estimated incubation period is 2-14 days,
and complications may include pneumonia,
respiratory failure and multi-system
organ failure.
Next slide.
We'll talk now about how
you can prevent COVID-19.
There are some everyday actions that you
can take to prevent respiratory illnesses.
You want to avoid exposure to the virus.
You can wear cloth face covering
if you're leaving the house.
You don't want to touch your
eyes, nose or mouth.
You want to cover your mouth
when you're coughing or sneezing
with a tissue and then discard it after use.
You'll also want to avoid
contact with people who are sick.
And you'll want to stay home if you are sick,
recognizing the fact it will be easier for some
to stay -- easier for some
to stay home than others,
makes practicing these everyday
actions at work all the more important.
Next slide.
So everyday actions to prevent respiratory
illnesses include covering your cough or sneeze
with a tissue and throwing
it away, as I mentioned.
Washing your hands often with soap or water
for at least 20 seconds is also important.
And you wat to use a alcohol-based hand
sanitizer with at least 60% alcohol if soap
and water are not readily available.
You also want to clean and disinfect
frequently-touched objects and surfaces.
And we do acknowledge that many poor families
are without soap and sanitizer at this time.
And some individuals are homeless.
And we see a role for community
health workers in coordinating
with community-based organizations
including the police departments,
fire departments to help access
these essential products.
Next slide.
So let's talk a minute now about
washing your hands the right way.
First, you'll want to wet your hands with
clean tap water and close the key in soap.
Then you should rub your hands
together with the soap to create a foam.
You want to be sure to wash
the backs of your hands,
between your fingers and under your fingernails.
And the whole process should last 20 seconds.
If you don't have a watch handy, you can
keep rubbing your hands until you're done
as you're washing them, and sing
the Happy Birthday song twice.
You can rinse your hands thoroughly with clean
tap water and dry your hands with a clean towel,
electric hand dryer or air dryer.
Soap and friction are what help to
lift the dirt, grease and microbes.
And that's why it's so important to wash
your hands by following these steps.
Wet, lather, scrub, rinse and dry.
So you can stay healthy and
keep those around you healthy.
Next slide.
Cleaning and disinfecting, as
I've said, is very important.
You'll want to wear disposable
gloves to clean and disinfect.
You'll want to routinely clean
and disinfect high-touch surfaces
and high-touch surfaces include tables,
doorknobs, light switches, countertops, handles,
desks, phones, keyboards,
toilets, faucets, sinks, et cetera.
You'll want to clean the visible
dirty surfaces using soap and water,
and when you're disinfecting you'll want to
use EPA-registered household disinfectants.
And we've provided a link here on
this slide to those disinfectants.
You can visit that website and find the list.
You will want to make sure you follow the
instructions on the label to ensure safe
and effective use of the product.
So just a moment here, we'll discuss using
household bleach to disinfect surfaces.
To do this you mix five tablespoons or
one-third cup of bleach per gallon of water.
Or you can mix four teaspoons
of bleach per quart of water.
Let me say that again because I tripped
over my words and I want to get it correct.
Four teaspoons of bleach per quart of water.
You'll want to follow the
manufacturer's instructions
for proper application and ventilation.
And you'll want to check to make sure the
product hasn't passed its expiration date.
You never want to mix household bleach
with ammonia or any other cleaner.
Unexpired domestic bleach will be effective
against coronaviruses when properly diluted.
Next slide.
So we can talk a minute now
about social distancing.
This is keeping space between yourself
and other people outside of your home.
And this is essential to preventing
the spread of the coronavirus.
To practice social distancing, you'll want
to stay at least six feet or two meters away
from other people when outside of the home.
You do not want to gather in groups.
You want to avoid crowded
places and mass gatherings.
And do not hug, kiss or shake hands.
Another thing is to avoid close
contact with people who have symptoms.
And this public health measure
is just very important
and something you've probably
been hearing a lot about.
And we do know that social
distancing is a challenge
for many families who are sharing one space.
It's even more crucial that these
households follow safety guidance when trying
to prevent the spread of coronavirus.
And that includes handwashing,
cleaning surfaces, et cetera.
There is a webpage on the CDC coronavirus
or COVID-19 website that discusses guidance
for those living in close quarters.
Next slide.
CDC recommends wearing cloth face
coverings outside of the home
to help prevent the spread of COVID-19.
I'm sure you've been hearing about
the use of cloth face coverings.
You do not place the cloth face coverings
on children under the age of two or anyone
who has trouble breathing or is
unconscious, incapacitated or otherwise unable
to remove the mask without assistance.
A washing machine can be used to
wash a face covering routinely.
And you'll want to continue to
take other preventive actions,
even when you're wearing a cloth face covering.
You'll want to remain at least six
feet apart from other individuals.
You'll want to wash your hands often.
You'll want to clean high-touch
surfaces in your home often.
And you do still want to
stay home when you're sick.
The cloth face coverings recommended are
not surgical mask or N-95 respirators.
Those are critical supplies that must
continue to be reserved for healthcare workers
and other medical first responders.
Next slide.
We know now that some are potentially
at a higher risk for COVID-19.
And these individuals include those 65
years or older, people who are living
in a nursing home or long-term care facility.
People of all ages with underlying
medical conditions,
particularly if they're not well-controlled.
And this includes people with chronic
lung disease or moderate to severe asthma.
And people with serious heart conditions.
Next slide.
Another group that are highly at risk
are those who are immunocompromised.
Cancer treatments, smoking, bone marrow or
organ transplantation, immune deficiencies
and poorly controlled HIV or
AIDS put individuals at risk.
Prolonged use of corticosteroids
and other immune weakening medications are
also putting some individuals at a higher risk.
People with severe obesity, which is defined as
a body mass index or BMI of 40 or higher as well
as people with diabetes, people with
chronic kidney disease undergoing dialysis,
and people with liver disease
are also all at risk.
At this present time, we
have no specific information
about the risk of COVID-19 in people with HIV.
The risk from immune suppression is not known,
but with other viral respiratory
infections the risk for people
with HIV getting very sick is greatest in
people with a low CD-4 cell count and people not
on HIV treatment, anti-retroviral
therapy or ART.
People with HIV can also be at an increased
risk of getting very sick with COVID-19 based
on their age and other medical conditions.
Next slide.
We are now talking about COVID-19 treatment.
There's no specific antiviral
treatment license for COVID-19.
There is supportive care to relieve symptoms
and manage pneumonia and respiratory failure.
Next slide.
You do want to seek medical care
if you feel sick with a fever,
cough or difficulty breathing, and if you have
been in close contact known to have COVID-19
or if you live in or have recently been in
an area with ongoing spread of COVID-19.
There are additional symptoms that
indicate it's a medical emergency
and immediate care is needed.
This includes troubled breathing, persistent
pain or pressure in the chest, new confusion
or inability to arouse, and bluish lips or face.
And there's more about that on the
CDC website, so please visit it.
Next slide.
So lastly, there's a few links on this slide.
You do want to stay informed about
COVID-19 and the most recent information --
all the information I've been discussing
is found online at www.cdc.gov/covid-19.
There's also the CDC travel advisories
that you'll want to check and find areas
with ongoing spread and with level
two or three travel health notices.
And there's also pages on stress and
coping that you might find helpful.
All right, so I'd like to turn the presentation
over now to Denise to talk about the role
of community health workers and COVID-19.
>> Well good afternoon again, everyone.
My name is Denise Octavia Smith and
I'm the founding executive director
of the National Association
of Community Health Workers.
I just want to thank Colleen and Betsy and
the team at the Centers for Disease Control
for taking time to develop this presentation
specifically for community health workers.
Next slide please.
Who is a community health worker?
If you are looking at the slides
now, I'm referring to the definition
by the American Public Health Association.
I know there are some that are
connecting to us only by phone.
We've put here this definition of CHW's as
trusted members of who have unusually close
or unique understanding of the
community that they're serving.
Those who are serving as a liaison between
health and social services in the community.
Those who facilitate access to a
variety of services from health systems.
Behavioral health and community-based services.
Those who improve the quality and
cultural competence of service delivery.
Those who increase individual and community
capacity by increasing health awareness.
And I'm going to use the term today
community health worker as an umbrella term.
This includes [Spanish term] or
community health representative.
And more than 50 titles that are
used for roles around the country
that describe the work of
community health workers.
Next slide please.
Like all health or medical professionals,
we want community health workers
to build their capacity, their knowledge
and their readiness to understand COVID-19
and to be able to transmit
accurate and factual information
in their communities and through their services.
We want community health workers to
receive training by health personnel.
We want community health workers to be
authorized and recognized by their health teams
to deliver medical information about COVID-19.
We want community health workers to be prepared
to inform, to guide and educate your peers
to conduct appropriate health
promotion and disease prevention.
Next slide, please.
So I'm giving here a snapshot of the
roles of community health workers.
Many of these descriptions may resonate
with you in your work in community,
in a health or social service system.
Some of you may be promoting let's say
preventative actions, increasing the ability
of individuals to manage their chronic
disease or promote healthy behavior.
Many of you are providing information
right now to break down the myths
and rumors that are present about COVID-19.
Many of you are busy trying to identify
populations who are most at risk,
and earlier Colleen presented
that comprehensive list to you.
And a number of you are right
now actively referring clients
to services beyond medical services
to help meet their psychosocial needs.
Next slide, please.
Community health workers can be an
ear right now for so many millions
of people whose lives have been
disrupted by this pandemic.
They may be experiencing loneliness
or a time of social estrangement.
CHW's, many of you right now are
helping to organize food delivery,
helping people to enroll in utility assistance.
You're advocating with landlords to make sure
that people are able to maintain their homes
or negotiate their rents due to unemployment.
A lot of you, I know, are busy explaining
the changing role and facilitating enrollment
for social benefits and resources
that are now available
in your community and perhaps in your state.
You're promoting preventive health
behaviors to curve contagion.
Social distancing, appropriate handwashing,
the appropriate way to wear a cloth mask.
All of these are ways that you can
promote to prevent the contagion.
And many of you are busy reinforcing
public health messages about COVID-19.
We want to thank you for the critical role
that you are playing and all of the ways
that you're stepping up in this time.
Next slide, please.
Community health workers as experts during
this COVID-19 emergency response time.
Next slide.
I want to say and list up this
important and critical workforce.
Each of you who are on the call and
you are community health workers,
you are a frontline public health workforce
that is critical for localities and states
to provide immediate response
to the COVID-19 pandemic.
Next slide, please.
Some of the factors that are going to promote
your effectiveness in service delivery
in your community -- community health workers
are someone who comes from within the community.
Someone who shares the experience, the language,
perhaps the same chronic disease state.
You speak the language and
you share the experiences
of that community where you're
providing services.
You know the customs and the
issues that your communities face,
those barriers and how to overcome them.
You share the same social or
cultural background of the community
and that can include the same local
language, the same dress, the same face.
You also understand the myths and beliefs
that are moving through community,
and how best to communicate actual and
factual information to dispel those myths.
Next slide, please.
I'd like to shift gears now and speak
to the important role that a number
of community health workers may be serving in.
And that is in going into the
community and conducting home visits
or providing community services
at a shelter, at a food pantry.
You may be shopping and delivery
food to a person's home.
This provides greater opportunity and a greater
need for you to have the right information
and accurate kind of protocols
and methods to protect yourself
when you're conducting a home visit.
So let's talk about what a
home visit is and the ways
that you can prepare yourself
with your employer.
A home visit is a set of social and
health activities that are provided
at a person's home or in their apartment.
This is care that allows the
CHW to detect, to support
and control health problems
that the individual may face.
And also to help them move
toward their health goals.
It can enhance the autonomy of the
individual that you're serving.
And the overall goal is to improve the
quality of that person or that family's life.
Home visiting can be a set of specific
tasks, making it a means of your liaisoning
between the family and the health system
and the services that people are providing.
Next slide, please.
During the COVID-19 pandemic,
CHW's must establish priority
criteria for making home visits.
We know that social distancing is a critical
way to reduce the spread of COVID-19.
And so making a decision to conduct
home visits is a important decision
that should be prioritized.
We're looking at families who have adults living
in their home who are over 60 years or over.
People who live alone or who are
without family networks and support.
People who are unable to travel easily to their
health center or clinic or medical provider.
Families with ill or handicapped
family members or patients.
People who've been recently
discharged from the hospital
that you're conducting follow-up services for.
And people taking vital medications.
These may all be reasons and different
categories of community members
that you might prioritize in
conducting your home visits.
Next slide, please.
Set goals for your home visiting services.
Are you going to coordinate care for
people who cannot leave their homes
and access services at a
health center or clinic.
How much information, education or
support are you going to provide
to the patient, individual or to the family?
Will you facilitate primary, secondary
or tertiary prevention services?
Will you suggest and do you have the protocols
to suggest when to go to an emergency room?
Is this home visit necessary?
Or can this safely and effectively
be provided through other means?
Will you help the continuation and coordination
of these services between the provision
of health and social service systems?
Next slide, please.
There are a number of safety
practices that we'll list up now
for the community health worker
workforce when conducting a home visit
and providing community services.
We want to develop and sustain a culture of
safety, even during these times when we know
that there are many needs at the
individual or community level.
If you're conducting a home visit or providing
community services, ask if the individual
or family members have experienced
coughing, fever or shortness of breath.
Ask if the family members have traveled
recently to certain international destinations
or those geographies in the US that are known
hotspots like California, New York, Louisiana,
Washington state or other states that currently
have high numbers of people with COVID-19.
Always follow universal precautions.
Seek training if you do not have
training on universal precautions.
Those of course include handwashing before and
after your visit, or if you're able to carry
and use hand sanitizer with you,
that hand sanitizer should have
60% or more alcohol content.
Do not eat or drink during the visit.
Avoid touching surfaces and
carry with you disposable tissue.
Wear your gloves and your cloth
face covering as instructed.
Keep your distance from others,
although that may be new for you.
About six feet or two meters when
you're conducting home visits
or your community services.
And don't take unnecessary risks.
Go back to your priorities and seek
guidance before you conduct that home visit.
Next slide, please.
There are myths and legends about
the novel coronavirus or COVID-19.
We're going to list up just a few here.
Rinsing your nose prevents contagion.
This is not true.
The virus is spread, as Colleen talked
about, in a number of different ways.
And we want to promote and practice reduction of
that infection and spread by washing our hands
or using hand sanitizer, covering
our mouth and nose with a face cloth,
and applying our universal precautions.
But rinsing your nose will
not prevent the contagion.
Nor will eating garlic.
While that may be a cultural norm and
it may have positive benefits that you
and your doctor have discussed, eating
garlic is not going to protect you
against COVID-19 or the novel coronavirus.
Nor will sesame oil kill COVID-19.
Spraying your body with alcohol or chlorine is
not effective and it is not recommended for you
to address the COVID-19 novel coronavirus.
These are myths and legends.
And if you hear them in community or among
your peers, refer back to these slides and back
to the factual information that was
provided earlier so that people know how
to effectively protect themselves.
Next slide, please.
Now I would like to turn the
presentation back over to Colleen.
She's going to explore some of the bilingual
resources that are available through the CDC.
>> Great. Next slide.
So CDC offers a variety of graphics that
you can use to educate others about COVID-19
and the precautions that need to
be taken to stop the spread of it.
There are graphics that you can use
on social media shown on this slide.
Next slide.
And some more graphics here, and
showcasing that we have bilingual resources,
and go on the website to see the
variety of languages covered.
Next slide.
There are tip sheets as well that
can be helpful in communicating
with your clients and with
those in the community.
So this slide shows the symptoms
of coronavirus disease.
There's a tip sheet there.
And then also how to stop when you're
feeling sick and identify potential symptoms.
Next slide.
So more tip sheets here, just a lot that you can
look through and decide what's helpful for you.
Next slide.
A few other examples here as well
showing our bilingual resources.
Next slide.
We have infographics as well,
similar to the graphics.
These are helpful in getting across
a good amount of information,
really focusing on the factual information
and messaging that's so important for you
to disseminate in your communities
and educate others.
So these are useful as well.
Next slide.
And there are posters as well.
And if you want to put these up
in your community or in places
where you can help spread awareness.
These are helpful resources as well.
Next slide.
And lastly, there are videos and those
are in English as well as Spanish.
And handwashing -- it explains some of the
steps of handwashing, but there are these videos
that provide the visual and show you kind of the
amount of time and could be very helpful for you
in helping to spread awareness about one of the
most essential practices of proper handwashing.
Next slide.
Right, so this is the end
of our presentation today.
And we hope that it was helpful for you.
Denise and my contact information
is on this slide.
And so you can feel free to follow
up with any additional questions.
As we mentioned at the beginning of the
presentation, the slides and a recording
of this webinar will be posted
on the CDC website.
So you'll be able to access it.
We'll now move on to the Q and A section, and
we've seen that you've ben entering questions
and using the question and answer
button during the presentation.
You can type any more questions you have now
into the chat box or the
question and answer box.
And know that we're documenting
all of these questions and concerns
and we'll be using them to
inform future efforts.
And we'll move now to trying to answer
some of the questions that we can today.
>> We have a few questions.
One of them is, can this still be transmitted
through kissing or community smoking?
>> So that is a good question.
I think that there was a slide on this.
Yes, it can be transmitted through kissing.
And there is probably the potential
or anything that your mouth touches
to spread those respiratory droplets.
Just following the best precautions you can
about social distancing is really important,
and hygiene and not spreading
respiratory droplets is important.
>> There is a question for --
I think this one is for Denise.
Denise, they're asking if you see
a role for community health workers
in any state doing contact tracing efforts.
And what role could that be?
>> Sure. That's a great question.
We have heard a lot I'm sure in the media and
on the news in your state and around the country
about the need to continue to scale
up testing and contact tracing
so that we can really understand the
infection rates across the country
so that we can continue to protect our citizens.
Community health workers historically
have had specific roles in contact tracing
for community health workers working with STD's.
They would have received this type of training,
and many CHW's have done
this work over many decades.
Right now there are states or cities in
specific parts of our nation who are exploring
and developing initiatives
to stand up contact tracing.
And often they are centering and prioritizing
the community health worker workforce,
not only to perform the specific act of contact
tracing, but when they are engaging individuals
and community members to link them to care
coordination and navigation of services
and other supported systems which are the
role and where the skill and competencies
of community health workers really shine.
If you are interested in contact
tracing within your state,
I would look to your department
of public health.
I would carefully track the activity and those
initiatives as they will usually be presented
by your governor, your state health
department or other source for you
to get more information about
those opportunities.
>> I have a question.
It's a general question that I have here.
But it's on three levels.
One person is asking if sop and water
are sufficient for disinfecting,
while another person is commenting on
whether the cloth fabric masks are sufficient
for avoiding the virus to come through.
And if the answer is no, would
that be in the best interest
of the patients when we're visiting?
>> So those are both two great questions
regarding disinfecting your hands.
Hand washing with soap and water
for the recommended 20 seconds
is what is being recommended.
And so that's really important for your hands,
or you use the alcohol-based
hand sanitizer with 60% alcohol.
As far as disinfecting surfaces,
that's where the recommendations
to dilute some solution of
bleach are recommended.
And so that is how you clean the surfaces.
But I advise you to go to the CDC COVID webpages
to look at more on disinfection, hand hygiene.
There's a lot of good information there.
And so whatever your specific purpose,
there's just a lot there that you can look up
and make sure you're doing the practice
that is recommended for what you're doing.
And I'm sorry, the second part of the
question was about cloth face coverings.
So we don't know everything yet
about how things are spreading.
The CDC recommendation right now is
wearing cloth face coverings in public.
And I've advised you to go to the
website and look at that as well.
And really there's a lot of
guidance on the webpages.
There's an FAQ section and you might
find some references to pages there
about preventing infection and protecting
both yourself as a health professional
and also working in communities and
you know, working with households.
So I would look at those and make some
decisions, you know, based on that information
and continue to look at it as we're updating
it with new guidance and information.
We don't know everything yet, and so webinars
like today are really important for us
to take your questions and
take that back and continue
to develop that information to help you.
>> Okay.
There are conditions such as HIV and many people
on the chat box were discussing
all these conditions
that are -- that do affect the body greatly.
But in the case of HIV, once
it's treated and controlled,
are these immune compromising diseases
a risk of infection or complication --
at any higher risk of infection
or complication of COVID?
>> Can you repeat the question?
>> Yes. Specifically in the case of the HIV
where you know it's an immunocompromising
disease but it can be treated and controlled.
Once treated and controlled,
are they still at a higher risk
of contracting the virus or
developing complications?
>> I don't think we can --
>> Well, just briefly I'll refer to the
earlier slides that Colleen presented.
There are many different categories
that can put someone at increased risk.
So if the person is asking -- if that
person is able to manage their HIV,
if they're taking their medications or if that
is not an issue, there may still be other issues
that make that person at greater risk.
And so maybe we'll have Colleen just
go over those increased risk factors
and those categories again for people to
understand that there can be intersection.
There can be many factors that can
increase your risk for infection.
>> That's right, Denise.
And it's important to remember that we
can't speak to your risk as an individual,
but we have these categories of individuals
where we know that the risk is higher.
And the notes that we have are that there's
not all the information we want right now
about the risk of COVID-19 in people with HIV.
We know that those that don't have
a control are probably more at risk,
but we can't say that those with control,
you know, are not going to be at risk.
So I think it's safe to really
look at these categories
and take the precautions needed
if those risk factors are there.
And in your patients and yourself, it's just
very important to protect these populations.
So I'm referring now to slide 23
with those who are immunocompromised.
I'm just going to read the list one more time.
This includes those undergoing cancer treatment,
smoking, bone marrow or organ transplantation.
Immune deficiencies, and
poorly controlled HIV and AIDS.
And then the use of any immune
weakening medications.
So it really could be a lot of individuals,
so just really important to focus
on those people and not underestimate the risk.
>> There is a question here
that is making reference
if we have other languages available
for resources besides Spanish.
>> Yes. And I'm not sure the exact number
of languages represented on our website.
But we have a number of different resources.
So please visit our communications and those
resources and see if you can find what you need.
And if you can't, please contact us and let us
know what you need and we'll communicate that.
>> Another question I have has to
do with community health workers.
Are they factored in the workforce development
planning for coronavirus contact tracing teams?
>> Sure. So as mentioned before, there are
a number of national initiatives as well
as initiatives happening at the state or city
level that are all considering the critical role
that community health workers can play right now
to enhance public health capacity
specific to contact tracing.
Contact tracing is an important aspect
of the role of community health workers.
One, because we have an ability to really
build trust and to provide respectful services
in a language and in a context that many
communities that may be not difficult to reach
but may experience barriers to accessing the
health system or information about infection.
And CHW's are able to reach them.
So yes, there are many initiatives that
include a role for community health workers.
The National Association of Community Health
Workers, what we are doing is offering
to people clarity on the role of community
health workers, that we are effective
to support contact tracing efforts.
And that we are also effective to continue
to provide all of the other services
within our roles and our qualities and
skills in this time of emergency response.
>> Thank you for that.
>> There is another question related, and
this is I guess for you again, Denise.
If you have any pearls of wisdom
to share with them about how
to best spread the preventative
measures and messages in Indian country.
Especially in rural areas.
>> Yeah. Our rural communities
have unique challenges.
There are many community health workers
who had their initial face-to-face
or community-based services disrupted
and a lot of them transferred
or transitioned those services to
phone-based services, onto Zoom,
onto different web platforms or even telehealth.
But for our rural communities there are
real barriers and there are real challenges
for community health representatives or
CHW's to connect with their communities.
If you are still conducting home visits, one,
I hope that you have support
in your transportation.
So if people are reimbursing you for
the services that you're providing.
I know many of you have to drive several
miles to reach and connect with your clients.
Please refer back to all of the safety
precautions to conduct your home visits.
Oftentimes if people are coming into town
or coming into clinics to get tested,
that may be an opportunity for you
to share or distribute information
so that you don't always have to travel to
communities to conduct those home visits.
This is really going to take a networking
and a collaborative effort for all of us,
but particularly for folks in rural communities.
So for instance if you are attempting
to service elders and you know
that perhaps there is a separate
service, one that you do not provide,
that brings food to the home, maybe you
want to try and coordinate your education
and you services with those services.
So that you're better able to get the
services to the elders who need them.
And folks don't have to make as many
visits to the home, increasing the risk
of infection for that vulnerable individual.
At NACHW, we have representatives
from the CHR community
who we would love to make connections with you.
They work across the country.
So that you can get specific
answers on ways to innovate
and coordinate services in your tribal nation.
>> Colleen, I believe that someone is
asking regarding the probable cases.
Can you expand on that a little bit more,
specifically on the perspective
of testing being available?
>> So the testing, probable cases and kind of
suspected cases of COVID and kind of erring
on the side of caution, when those are sick,
that's kind of how we've been going about this.
But testing is you know, picking up and
we will be able to confirm cases of COVID
when testing is widely available in communities.
But kind of in the meantime, as testing's been
stood up and tried to get it widely implemented
in communities, we do need to
take the necessary precautions
around probable cases and
around suspected cases.
And really the guidance and the recommendations
by CDC right now is erring on the side
of caution with regard to symptoms
and following these safety practices.
And that's what you're seeing with
our social distancing measures
and all of the messaging and
recommendations right now.
>> Is it also a myth that people who
suffer the flu are at a high risk
of testing false positive to the virus?
>> I have not heard that to be true.
And I'll see if any others
on the call have heard that.
I don't think I've heard that.
I'll look on the website.
>> I haven't seen that in
the Q and A anywhere there.
>> No.
>> Thank you.
>> There is another question here for Denise.
And that question is --
Are CHW's being given additional
resources and training to learn how
to conduct some visits through telehealth?
These might help reach more
clients in rural areas.
>> Yes. So I have certainly heard from community
health workers and employers across the country
that they are offering -- for those who
offer telehealth services and for those
who can reach their clients that way,
they are offering free trainings.
There are also a number of
different online platforms
that are offering free software
and free trainings as well.
If you worked with a employer,
I'd reach out to that employer
and see what is the approved platform
for you to conduct telehealth services.
But certainly there are a number --
all of the kind of popular platforms
including the Google Hangouts and Zoom,
a number of them -- Microsoft teams, a number
of them are offering free services and supports.
So that if you want to transition
your telehealth services,
you can better understand the benefits
and kind of the functions of those tools.
>> On that very same thought, what are
the thoughts about virtual home visits
and maintaining patient privacy,
patient/client privacy?
>> Yeah, well if you've already been providing
services to those clients, that individual
or family member, hopefully you already
have the appropriate waivers or approvals
or signatures to provide service.
So let's assume that that person has
been working with that client before.
There are some security issues
with using telehealth.
We know that -- I've even had one
of my Zoom meetings to be hacked.
I don't know what the official term is.
But someone just kind of jumped onto the meeting
and fortunately we were not addressing HIPAA
protected or a confidential issue at the time.
This is why you really want to understand the
platform that you're using and why you want
to receive proper training about that.
You need to get the approval from the patient,
from the individual or family to be able
to communicate with them in that way.
I know when I was providing services
for people living with HIV/AIDS,
we needed to get that individual's
consent before we could make a phone call,
before you can leave a voicemail, before you
can leave a note or notice in the mailbox.
So please consider all of those privacy
and protection protocols before you
are rushing to implement telehealth.
Even in your desire to want to reach
clients, we have to protect their privacy.
>> There's another question
here for you, Denise?
Should community health workers continue
with routine home visitation activities?
Or should home visit only be reserved
for those patients more at risk
or with serious conditions or needs?
>> Yeah. So if you are -- if you have an
employer and your employer is recommending
or asking you to continue to conduct home
visits, I would hope and would advocate
for that employer to provide you with the
appropriate personal protective equipment.
As well as some of the safety precautions
and protocols that Colleen mentioned before.
So if you don't have training in universal
precautions, if you do not have access
to gloves, hand sanitizer and appropriate
cloth masks, if you are not able to conduct
that home visit and maintain a social distance
of six feet or more while you're conducting
that visit -- and if this
is not a priority visit,
if there is a way to conduct the same
service in a no-touch or a low-touch fashion,
I am advocating for your safety and for
the safety of your peers, your coworkers,
your family members that you do all that you
can to protect yourself and your clients.
So work with your employer.
Make sure that you understand and that you
receive training as we mentioned earlier
from a medical professional so that you really
understand how this novel coronavirus is
transmitted or how it can infect you.
Understand the risks of the
clients that you may be serving.
And if they're at high risk, do what you
can to reduce that risk by practicing
and applying all of those safety precautions.
>> We're reaching the time to
almost conclude our webinar today.
But I want to leave you,
Colleen, the last question.
And this one is, why is an N95 not
recommended to wear during a home visit?
>> So these masks are being reserved
for healthcare professionals right now.
And so I'm not sure that we've provided at
CDC any recommendations for home visits yet.
But that is the guidance we have right now,
is the N95 masks are recommended
for healthcare professionals.
But I think it's important
to talk to your employer.
And I would advise you to go to the
CDC website and look at those pages
for healthcare professionals and what's
being recommended to protect yourself
and protect others and be knowledgeable
of that and talk with your employer.
>> So we have reached five-oh-one PM.
We should be concluding the webinar.
Ladies, please go ahead and
conclude the webinar for today.
Thank you very much for being with us.
Please conclude the webinar.
>> Thank you.
It's been great and these questions have
all been helpful, helpful discussion.
And it's been great to hear Denise as well.
>> Thank you, everyone.
Thank you, Betsy and Colleen
and all the team at CDC.
And for everyone on the call, my
prayers are with you and your family
and your community during this time.
>> Slides and webinar are going
to be available pretty soon.
Stay tuned.
Some of the questions that have
been raised will not be forgotten.
So stay tuned.
We're going to be coming back to you.
Thank you very much.
>> Thank you, bye.
