The next speaker is Dr. Ed Gallade. His talk will be on managing 5,000-plus employee health during the pandemic. Dr. Gallade is a specialist in occupational medicine and internal medicine. He oversees the occupational medicine services provided to community employers and is responsible for the occupational health needs of the 5,700 employees of Roper St. Francis Healthcare. He received his BA from Clark University, his MD degree from the State University of New York Downstate Medical Center, and his master's in public health degree from Columbia University specializing in infectious disease epidemiology. He is board certified in internal medicine and occupational medicine. He is vice chair of the American College of Occupational and Environmental Medicine, Public Safety Medicine Section, and a special expert on the NFPA Fire Service Occupational Safety and Health Committee. He is medical consultant for the Charleston Symphony Orchestra, Charleston Stage, and for emergency medical response for the Patriots Point Naval and Maritime Museum, USS Yorktown, Charleston Harbor, South Carolina. Dr. Gallade is formerly an epidemic intelligence service officer at the Centers for Disease Control and Prevention and an epidemiologist with the New York City Department of Health. Please welcome Dr. Gallade. Okay, so we've got a clicker. Yes, we do, but I'm going to make sure it turns green. We've got another one, because this one's battery's bad. Yeah, you could use your. I'll just. Right here. I was a member of the AV club in junior high school, so just relax. We've got the situation well in hand. Yeah, we need an overhead projector. I hope everybody can hear me out there and here. It's a real pleasure to be here and to see everybody from the nose down. I think that we've pretty much had it up from up to here, seeing people two-dimensionally over the last two years, and enough with the Zoom and the Webex. So when I talk with Rhonda and everybody and Al back in the beginning of the year, it was not going to be a realistic expectation for me to be in person because it's two weeks before my daughter's wedding, but that's another story, and this was back in March. So I'm so pleased that things have calmed down and to actually see my colleagues in front of me rather than doing this remotely. The title that Al gave, Dr. Al gave, was kind of like the running title, and this is the real title here that you can see on your screen. It wouldn't fit on the program here, but what I wanted to tell you about— So what I wanted to—when I thought about the talk, the success of the talk has everything to do with, you know, what's the makeup of your audience. I really didn't know, and I'm so glad that there's, you know, 60 people out there. In addition to the group here, this is what we've come to expect with the meetings. But I figured that most of you had some contact with COVID-19 during the pandemic. So, you know, what could I talk about that would be something that you didn't know already? So one thing I thought about was, you know, what surprised me about what happened over the last two, two and a half years at this point? And then the other thing was, as we progressed, taking care of the medical center population is— it really was reflecting on what was going on in the community. We could really predict what was going on. So that was the basis of the talk, is perhaps give you something just a little bit different than stuff you already know, that you've already had ad nauseum trying to figure out what's going on. So my note of bene is that things are very fluid and they continue to be very fluid. So the agenda is that I'd like to take a group survey from the group here and then just give you a little bit of a brief intro and a personal vignette, a look back. We'll talk about, in the context of Medical Center Occupational Health, how our incident command structure worked, and then talk a little bit more about how the population that we took care of at Robert St. Francis reflected what was going on in the community. And then finally, talk a little bit about the benefits of practicing out in the pandemic. Not to worry. We're fine. We are fine. So before we go on, and again, for those who are out in the field, you know, if you yell hard enough, we might be able to hear you. But just a show of hands, how many of you take care of health care providers in an employee health department, in a hospital setting? Okay, great. And how many of you actually personally took care of COVID-19 patients and did fitness for duty evaluations before returning to work? The employer's asking. Okay, so good. So we've got a point of reference here. So in terms of what I get to do and where I work, so Robert St. Francis, we've got four hospitals. We've got about 6,000 employees now. We've got a bunch of express care locations, freestanding emergency departments, and a couple hundred outpatient sites. We provided most of the care in the Lowcountry, which is a three-county area around Charleston. HCA's got a system. There's the VA and the Medical University, but we provided most of the inpatient care. We also provided a large mass vaccination initiative, which we're really proud of. And in terms of what my job involves, there are two components. One is taking care of the employees of Robert St. Francis, and we're known as teammates. I drank the Kool-Aid, and I work with him as teammates now. And the other is our Outward-Facing Occupational Medicine program to industry. So I've got the 6,000 employees of Robert St. Francis, and then I have six on-site clinics, including Boeing, Bosch, Molly Bear, Eva Utility, and then we have a very vibrant freestanding occupational medicine clinic. And I've got an extremely sharp nurse practitioner who's minding the store, but I'm still constantly in touch with her, helping out. So that's pretty much what's going on. On a day-to-day basis, although a lot of what I'm doing at this point continues to be putting out fires, literally and sometimes figuratively, and I see patients typically one-and-a-half to two days a week. And when I'm on administrative time, I'm in my office at the practice, so I may jump in and out to help Mallory, my nurse practitioner, and she's getting greened, and she's got a patient to run by me. So it's a very, very rich professional environment that I get to practice in with some really, really smart people that I've been able to surround myself with. So I still see a lot of patients, plus doing all of the administrative things. So here's the story I want to set up for our conversation here today. So in January 2021, my daughter and my future son-in-law at the time told us that we wanted to have a big Charleston wedding for 175 of their closest friends in Charleston in March of 2022. And as you can imagine, who do you think the first person was who I called once they told me the news? Who do you think it was? But I won't bore you with the options. But I called my ID guy, because are we going to be able to pull this thing off? That was concerning, because for the father of the bride, the optics of my daughter's wedding turning into a super spreader event, you know, was not so hot. And so as the pandemic progressed in the first part of 2021, the prospects of having people come in with their vaccine cards and a negative PCR two days before the wedding was looming large. And so I posted a letter on the kids' not, if you've gone to weddings. So now everybody's got a K-N-O-T not site where they put the details of the wedding and where they can send gifts and things like that. So I posted this letter after they reviewed it. And nevertheless, the kids, my future daughter's in-laws and the wedding planner were concerned about what I might be expecting. But meanwhile, you know, through the year and into January, Omicron burned out, okay, by the end of January or so. And so I posted an update on February 7th, which is about, you know, six weeks before the wedding. Tell everybody to relax. We're not going to be checking cards. We're not going to be. But if you're sick, you know, I make house calls. I will swab you. I will get a turnaround time and a PCR, and we'll take care of you. And so it was all very, very reassuring. And so on March 19th, we had an epic wedding. I mean, a pandemic cooperated, the weather cooperated, and yes, and it was unoffendful. And there's the beautiful daughter. Okay. When I saw it, I said, yeah, yeah, thank you. I said to Beth when I showed her the slides, because I got to run everything by her, I said, Beth, this is the awe moment. And I nailed it. I knew it was going to be the awe moment. Yeah, she's gorgeous. And I got a great son-in-law, great fam. It was a great vibe. And everything fell into place. But it was obviously unfair. Well, yeah, absolutely. So a quick look back. So this is March 2nd, 2020. So Nancy Messonnier, who was the person who got up there while Trump was in Europe to say that people may get sick. People may get infected. This is March of 2020. And, of course, you know, she was ghosted from the administration. She's got a great gig now. She's running a foundation out in California. But, you know, Nancy just told the truth. And on March 6th of 2020, we had our first cases in South Carolina. And our incident command activated about 10 days later. So as you can imagine, when you're running a hospital system, it's got a lot of moving parts. And basically on the first day up on the white board, we stated what our mission was going to be for incident command. And that was to prevent the spread of the disease in our facilities, to get everybody the best care that they can for both our teammates and for our patients. We had all these logistics issues of masks and materials and make sure that we had anything and everything that we needed. And also to provide consistent messaging and to make sure that the rumor mill and everything that was going on in the community and with the press did not, you know, inflame things. So early on, this is like in April of 2020, the incident command, we were meeting daily twice a day to try to figure out what was going on. And over time, we were able to decrease the frequency. But the cadence of the meeting was always the same. We started out with my team giving what the case count was among our employees, what was going on in terms of how many nurses were out, how many respiratory therapists were out, you know, what did we need to staff properly. And we looked at the epidemic curve of both our workforce as well as what was going on in the community. Then we moved on to how many beds were filled, how many unit beds, how many negative pressure beds did we have, how many people we had on hold down in the emergency room, and what the overall positivity rates were. We went through staffing and what was going on in terms of the hospitals and the outpatient world. We had a whole component of infection control and security involving screening and dealing with whether or not we're going to let visitors into the building and what the criteria were to let them in. And then our logistics people, we looked at our inventories. And we came very, very close. Actually, early on, we ran out of supplies to do tests. And it was very, very tight. Maybe we were without a test for like 12 to 24 hours in the health care system. So things were pretty dicey early on. And then finally, the last person to talk during the meetings was our corporate communications guy, who was just terrific in terms of keeping everybody on point and getting the messaging out there, dealing with the press and dealing with the TV stations and making sure that the teammates were getting the best information that we could. So in terms of the role of Teammate Health, our employee health service, incident command, I realized, I just sat down, I started listing, what do they need from us? First of all, someone's got to be the source of truth in terms of what the case counts are. So we realized that we were going to be the authority on that. Early on, there was a challenge in terms of getting tested. So we worked very hard to make sure that if somebody needed a test, they got a test. Make sure that if they needed medical care, we got them in the proper level. And then we also tracked their recovery to see how many folks were going to be able to go back to work in a couple of weeks. How many folks, long haul, were we talking about? And so we were able to keep HR and the benefits people and all the rest of the managers informed in terms of what they should expect their needs to be in terms of bringing travelers in to cover for folks who are still out. And then on the flip side, was working with IP, with infection prevention, to assess the exposures that might be going on in the workplace. Doing some, we had three or four clusters that I'll tell you about, infection prevention piece. And then, you know, we had nurses tracking all of our active cases. And so, you know, as an internist, as well as an op doc, you know, we were concerned about getting people the functional restoration that they needed, depending upon the severity of the illness that they had experienced. And including tracking those who required hospitalization. Unfortunately, we got very few hospitalizations. And then there was this minor thing about, you know, is this case work-related or not? And so that was, that's where the occupational medicine physician, you know, earns our pay in terms of making the call. So what our wins were, and what the lessons were, were that we were able to maintain the transparency in our communication. We were able to support the infrastructure of the organization, as well as working with the individual teammates and their family. We had to be very light on our feet, as all of us were, as the technology changed, you know, as I was reflecting early on before we had our own technology, you know, to send a swab out to the state lab or to LabCorp, it'd be seven or nine days before we got the results back. And I see nodding heads there. So the results were historical and totally irrelevant by the time we got the results back. We sensitized the teammate population that things were fluid. And as we learn, and as the technology improves, and as our resources change, that we will be changing our policies and how we operate. And so early on, you know, we were waiting like five, six, nine days for a lab test that might be costing us 75 to $90. So at this point, you know, we've got, you know, point of care PCR, and we also have a real fire breathing of a machine that can crank out a thousand PCRs a day at six bucks a piece in our laboratory. So we've got that kind of capacity to support both the teammates of my organization, as well as help out what the needs are of my outward facing clients are. And then we developed this thing called the exposure advisor. And the exposure advisor, I had developed at the time of Ebola, back in 2015, to make sure that exposures, if they occurred in offices, like my office is about 10 minutes from the airport, from the emergency departments that made sure that everybody had the resources in place. And so basically we expanded the mission of the exposure advisor from dealing with emerging infections, needle sticks, respiratory, to serve as the coordinator for everything that went on with the Roper workplace. And we had some brilliant in-house IT programmers, and we were able to pull from the HR database, from the lab database, and from our email system to be able to facilitate the communication. So here's the, so this was the poster that was plastered all over the hospital. And this is the one that actually predated COVID. And basically we modified this so that people would get it to us online, as well as calling us 24 seven. So we made the exposure advisor the place to go for information 24 seven. So the teammates could go online, or they could call us to get advice on what to do if they had symptoms. And the exposure advisor was supported with phones and online by a number of really talented clinicians. We had a lot of APPs who were previously, like they were with the orthopedist and the neurosurgeons, and when all of the elective cases shut down, we had all this great talent that was sitting around looking for something to do. So that we had these really smart APPs answering the phones and helping manage. And then we had these really spectacular people in the laboratory. I just can't say enough great things about how talented our laboratory director and our medical director were. And so we're able to take all of this complex, large volume of information and analyze it for surveillance, for decision-making. We were able to collect information just to make that call in terms of whether or not it was work-related. And in terms of clearing people to return to work after their period of activity had passed, at first it was 14 days, and then of course the healthcare people said, there's no way, who's gonna see the patient? So we cut it back to 10 days. I think this is all, it's a little bit of a historical curiosity at this point in terms of how things were then as well as now. And we were at the very end, our latest state is that if you are through your period of communicability and you are feeling better, you can go online and attest. And so our entire return to work program is automated. So we don't have to have individuals calling nurses to get the blessing before they can be medically cleared to return to work. And then we had an expanded role. We use the exposure advisor to manage our vaccination program and our medical exemptions. We were able to do a lot of quantitative analysis, a lot of in-house analytics, tracking our epi curve, our vaccine effectiveness, what was going on with the workforce. And we were able to give the HR, we've got 50 nurses out, we've got 20 respiratory therapists out, we've got X number of people in the laboratory out. So we were able to give them real time what the staffing needed to be. And among the other things that we were able to do, we were able to identify what our concerns were with the antigen test during the Omicron surge. So this is the first time that, the first time that I looked at these two graphs together, I realized that what's going on in the community was consistent with what was going on at Roper St. Francis. So the upper curve, each one of the blocks is a case and the upper curve is Roper St. Francis and the lower curve is what was going on in Charleston County. So you can see that they just really followed one another and it really reassured us in terms of, we could help track what was going on in the community. And so we were able to collect information on our teammates, regardless of where they got diagnosed. At first, they were coming to us to get their swabs done, but as time went on, and certainly now with people doing home tests and such, we were able to collect information on our teammates and really make it representative of what was going on, give us a flavor of what was going on in the community. We used the antigen test early on, but then as we all know, it's got limited usefulness, especially when the incidence in the community is less than 5%, depending upon which variant is out there. And we were able to assess just how well the vaccine was going on. And then finally, based upon the way that we were collecting information, we could make the call is, what was community acquired versus workplace acquired disease? So this epicurve goes from the very beginning of April, 2020 and through September of 2021. And so the red cases are community acquired cases. The greenish ones we call work-related, and I'll tell you a little bit more about those. And at the very end, the blue ones, those represent the breakthrough cases of folks who have been vaccinated. And so that's when that whole thing started. We were having challenges with the breakthrough. And because we had just really excellent data from our timekeeping software, we were able to do some fairly substantial rate calculations. So on this slide here on the Y-axis is cases per 100,000 person hours. And on the X-axis is time from February to September of 2021. And so if we go back and we looked at this, I'm walking over here, but it's online and I'm pointing. When we started looking at this number here, it appeared to be about 50% of all cases that were breakthrough cases. When we did the calculation, and we actually were able to calculate rates because of the terrific data we were able to get from our HR software, we can see that incident rate ratio between vaccinated and not vaccinated range from 1.8 to 3.2 to 2.1 at the very end, even as cases were increasing during Delta. And this was very reassuring to us that the vaccine worked, it kept people out of the hospital, off the vent and dying. And this really speaks to the robusticity of the data that our computer analytics people had in-house. So we were able to structure the information we needed to make the call in terms of cases being work-related or not. So early on in the pandemic in 2020, the first cluster we had was five respiratory therapists who were sitting around the break room without their masks on eating lunch and doing the documentation. So find the mistakes in this picture and the irony of respiratory therapists being the ones causing the first cluster of cases was not lost on anybody. We had a cluster of teachers from our daycare center who were not wearing their masks because they were concerned that it was gonna freak out the kids. So we had to close down the daycare center for two weeks because of that. We had a cluster of cases in the intensive care unit at one of our major hospitals. And it was probably in part due to just the number of cases they were sending upstairs before. We truly had all of our PPE and our negative pressure rooms in place. And in fact, we can even go back and I can show you. So this is where our cluster was of our respiratory therapists and this group here, this was everything that was going on in the intensive care unit. When I talked to the chief nursing officer about this, she shared with me that the nurses were blowing off steam and parting their asses off outside of work. And there's probably some confounding factor, but nevertheless, we called that work related. And so you can see just as time had gone, we had very few cases of workplace associated disease and it was all because of masking. I think the vaccine definitely, plus masking absolutely mitigated what the risk was. So as part of that exposure advisor, this is the way that the data was collected. Half of it was provided by the teammate. And then this section here was the interview that one of our exposure advisor nurses who pulled down the documentation. And we were looking here for alternative explanations in terms of risky procedures or exposure prone, high risk procedures. And then once we had that information, we were able to determine, for example, that this individual was just wearing a surgical mask without any eye protection. And then basically I come down here and I looked at all the information and then I make the call, this specific case here, incubation period and limited PPE consisted of work related disease. And so I gave the big yes. So that was a very, very structured kind of way that we were able to determine what was work related and what wasn't. And this, you talk about comp and you talk about the way that the federal government had mandated coverage for wage replacement people. Where, oh, this was a really, it was an important piece of information for two things, certainly for all of the HR issues, but certainly for us to be reassured how few of our cases were actually occurring in the workplace. And it's kind of like with influenza, if you want a good safe place to be, hang out in the hospital because there's so little transmission going on on the invasion side. On a Sunday afternoon, I got a call from Vanessa Shamrock, who's our lab director, telling me that she had a couple of nurses who were sick, who had negative Sophia antigen tests. And they were insistent that they had COVID-19. And so they went ahead at the same time, they got PCRs and they were both positive. So they were kind of like the index cases for what were the, and they were the basis for a study that we did early on in Omicron in December, 2021 to January, 2022. We did 84 tests concurrently with antigen and PCR. And when it came right down to with 32 out of 84, were false negative tests. And at the same time, FDA was putting out a notice about concerns about that. So as most of you do at this point, you may use the antigen test if it's negative, if it's positive, except if it's negative and you've got symptoms confirmed with PCR and things are gonna change at the next mutation. We may bring the antigen test back online, but at this point we're using the very limited extent. And certainly when you look at the sensitivity and specificity and the positive value, when the incidence in the population is less than 5%, there's just no role really for the antigen test. The next thing I wanted to tell you about was how we dealt with vaccine exemptions and job accommodations. So we had a medical panel, including me, Jim Fitzpatrick, who is our extensivist, our chief medical officer and one of our ID guys. So the four of us looked at each one of these requests for vaccine exemptions, or for the group that wanted to be excused from working in a clinical environment because of health issues. So basically we reviewed, this panel reviewed all of these. We were typically early on, we're meeting like twice a week for a couple of hours at a time going through these. And we had the whole database managed by my teammate health manager, who's got real underachiever, masters of nursing and medical informatics. So she's the one who ran the database for us. And on the religious panel, we've had our vice president of diversity, inclusion and health equity, who's also a board certified OBGYN, plus our VP of mission, director of pastoral care and a VPHR. So they took care of the religious panel. I'm very happy. It had nothing to do with dealing with the religious requests for exemption from the vaccine. And so in terms of the accommodations that were presented, accommodation requests that were presented to the medical side for people who did not want to work in a clinical environment, there were some medical conditions of concerns, plus those moms who are breastfeeding and reproductive health issues, like they're trying to get pregnant or get early pregnancy. And they were concerned. Our decision-making was basically, based upon if they were to get COVID-19, would they have a serious case that might place them at risk of hospitalization going on event or death. The breastfeeding and the reproductive health issues and the work with the OBs. And as we know, getting vaccine if you're pregnant is a good thing rather than something that they need to be concerned with. But I think that we're all sensitive to dealing with pregnant moms. I mean, there are emotional issues, there are non-scientific issues, there are CYA issues in terms of the obese, in terms of being very sensitive to, there's the science, and then there's the emotion, and everything goes along with it. We were very, very sensitive to that. So we worked with the obese. And so most of the accommodation requests that we made, 252 that were approved, 172 not approved, they came through in the pre-vaccine era. And once we had like 97% of our workforce fully vaccinated, we were prepared to ask them to reapply because we felt that the risk of their getting a serious case of disease was substantially mitigated by having the vaccine on board. And it turns out what happened is that once vaccine was on board, we had very few folks who felt that they needed to be excused from clinical work. And it was very helpful for us because we had all these nurses and medical assistants and others working on the floors or in the outpatient centers who are totally out of the workforce. I'm doing pretty good on time. All right. So this is what we ended up doing in terms of vaccine exemptions on the medical and religious side. As it turns out, we had, after the information about the safety of the vaccine, and we had people who were exempted who were pregnant, who were going through chemotherapy and other things, when it came right down to it, we had very few people who were exempted. In our population of about 6,000 employees, we had 218 religious exemptions that we let the religious committee work on and only a couple of that were rejected. It's actually a fairly entertaining meeting, but I'm not gonna go there. So many of you probably know or probably experienced this with people looking to us for help, or just what a rewarding experience this was for us and how many really terrific relationships among the folks that I work with every single day who know me because I was very, very visible. I would round on the floors on the weekends just checking in just to see how people were doing. If you have an opportunity to work in employee health for a healthcare institution, MCOH is very rewarding, and I would strongly encourage you to reach out to the hospital in your community to see if they need a physician level person to help. Because again, really, I've never worked with a more committed and smart group of people in a workplace than working with my colleagues. And then finally, as all of us know, doing Occ Med, we get to do cool stuff. We get to go cool places and do things that people who are in the exam room or not involved with healthcare don't get to do. So this is day one of our mass vaccination clinic on January 20th of 2021. So this was out in the parking lot behind our big convention center here. So it was a drive up clinic and it was January, and it actually gets cold in Charleston, South Carolina. It was really, really cold. So I was out there. How cold was it? It was so cold that we saw a chicken walking across the street with a cape on. Ah, I'm sorry. Well, I'm here till Thursday night. So here I am with a couple of our really, really four plus smart nurse practitioners and our job was to monitor everybody post vaccine. So they would come through and they would park. Were any of you here or were you online when Bob Oliverio gave the talk last year from Roper St. Francis? So Bob's my boss. He was kind of like, he was known as swab Bob because he ran all of our walkthrough testing and the vaccine. So Bob Oliverio and I worked together. So these two nurse practitioners, just terrific. We had a reunion after we were shutting down the vaccine clinic here and to actually see these two lovely young women, all three of us without our masks on, it was great. So this is where it started. And as it ended up, we moved into the parking garage here. We ended up providing over 70,000 doses of vaccine over four months, very gratifying experience and just hanging out with them. In terms of relationships, early on in June of 2020 with the celebration of Juneteenth, June 19th of is the national holiday for the end of slavery that occurred in Texas. So early on, they wanted to do a concert with the Charleston Symphony. Am I off? Did I turn myself off? Am I back on? Sorry, buddy. Yeah. All right, I'm gonna continue in the interest of time here. And I'm sorry for the people out there. So, can they? Okay. Okay, excellent. Then I'll continue. So basically I got contacted by the Charleston Symphony and they wanted to know if they could put on a concert. And this is June of 2020. This is when things are really, really hot. And we're struggling with testing the musicians, testing the singers. What is the risk of dissemination of virus if you're positive and you play an oboe or a trumpet or is masking enough? So we had like 40 members of the orchestra spread six feet apart all over the stage. And we pulled it off. We pulled it off. And this is way before we had the high volume testing and we really knew what was going on. So on the picture on the right here, the orchestra wanted to thank me for helping them out. And I played tuba and sousaphone in high school and college. So they sat me back here with the tuba players. This is the Wednesday rehearsal for the Saturday. The Saturday night concert. And it's the best seat in the house here. So got the timpani over here. And for any of you playing instruments, I mean, to be totally enveloped by the sound and have the orchestra applaud you. I mean, it was a spectacular experience. Well, the punchline is that the next day I got a call from the personnel manager who is a bass trombonist. They're saying that they had a case in one of the oboists. And of course they're not masked at all. And the question is, what are we supposed to do? And this happened like on Friday and Friday night. We didn't know, you know, were we supposed to cancel the concert or not if we had a whole bunch of cases? Well, as it is, we ended up canceling the concert at the last minute because as it turns out, there was only that one or two cases, that only one case that is, but we just couldn't take a chance on not canceling it in a timely fashion. So on April 16th, this is right before, this is, it was, it was just a spectacular concert. And on April 16th, we had the rescheduled concert that was supposed to be in January. It was the, it was really, you know, it's real fun just to be involved with all of, just be around it. So for those of you who know the term from CDC, they always talk about the late breaker in terms of what's going on. And so there's a late breaker after I sent my slides to Rhonda, is that I got a call. They were putting on Beethoven's Ninth, which is with a big chorus, you know, it's, and I heard, we heard about four cases in kids from the Charleston, College of Charleston choir who were going to be on stage of cases. And we ended up, and we also had our first chair, cellist also turned positive. But meanwhile, everyone's been vaccinated. People continue to mask. And so basically we let things continue and we got everybody tested and everybody was negative. So those four guys were a couple of men, a couple of women from College of Charleston obviously got it on campus. And as you can imagine, singing is a very, very efficient way to disseminate. And, you know, we had that terrible outbreak early on in the pandemic. And so basically we were able to have the concert with no further spread. We also took care of the, our professional stage company. So this is, these are the resident actors from our Charleston stage. And we followed the equity infection prevention protocol that they were using in New York City. We used it in Charleston. So we would do swabbing every week, which made a lot more sense early on before Omicron where it didn't make any sense because we had an incubation period of two days. So because we could do self-administered swabbing, swabbing, but the EUA needed to be observed. So every week they would get the cast in before rehearsal. And so this is a picture of my computer screen from my desk as I am observing them. So the manager, production manager of the theater would say, okay, and we're going to pick our favorite nostril and begin. And they would swab 15 seconds on one side and switch. And it really worked well. Early on, we had 16 cases in one week that wiped out the production for two weeks, but they all came back and we had a very, very successful season. And the last production was Kinky Boots. Have you seen Kinky Boots? Oh, well, you need to see. So this is Cyndi Lauper, so you get it. Okay, so these are all of my people, my actors and actresses. And here, of course, I always have to do the photo op. So this is Lola and these are the angels. And you just go online, look at the video, but I always have the opportunity for a photo op. And so what general internist or family practitioner gets a picture like that? So it was absolutely spectacular, arguably from a professional standpoint, one of the most gratifying things I was involved with. And then one last thing, how could we forget COVID theater? And when we talk about COVID theater, we talk about all of the plastic acrylic sheets to reassure people unnecessarily. A bunch of our practices got these aerosolizers, they were using this botanical spray, and it was just really, really awful. We certainly learned that taking temperatures was totally useless, and again, it was part of COVID theater. And then, and certainly the deep, deep cleaning, and we'll talk a little bit about this tomorrow when we talk about the employee response. So in conclusion, what we did in our healthcare workforce really was able to help us understand what was going on in the community. Certainly masking had a substantial effect on mitigating transmission, and we were able to tell our outward facing clients, this is what we did in healthcare, and this is the reason why you should mask. Our healthcare system gave us pretty much everything that we needed to pull this off with all of this extra staff, with all the laboratory people, and they really allowed us to have a true success in making the best outcome as we could out of a really stressful, very, very fluid situation. So that's the Ravenel Bridge that, I go underneath that in my boats in time as well. So thanks for your interest, and I hope I was able to impart some of the enthusiasm and how much I enjoyed doing the job. There's a question over here. Thank you, outstanding lecture. This was right on a timely topic that I think we're all interested in. I was curious about the exemptions. How many people do you have in your organization and the idea of what those numbers meant as far as percentage-wise? Yeah, so it ended up being a very modest number in terms of the exemptions. Are you talking about vaccine exemptions? Yeah, so it was really, really small. The number was up there, and they're on the slides that we have. So in the grand scheme of things, overall, our vaccination rate for the whole organization was close to 98%. Early on, we exempted folks who had had disease, but then CMS changed the rules of engagement and said that having had natural infection would not be a qualifying exemption. So we got them all back in, and we did get everybody boosted, and it just speaks to the culture. As far as the denied exemptions, what was their fate? Fired, let them leave, or expected? We had about 30 people who left the organization because of this. So- How many people? 30, three-zero. So it was very, very modest. We were able to get everybody properly documented, and that was part of the problem was that they just did not provide the documentation. They weren't making, they weren't helping themselves out, so we're able to work with them. So now we've got Omicron, and we've got, again, very few cases on our inpatient side. And over the last couple of weeks, I didn't show the epidemic curve for Omicron because depending upon which scale I used on the Y-axis, you know, the peak for Omicron, during the first surge, it was like 65 cases a week. That was the peak. During January of 2022, before it burned out, we were at like 200 cases a week. It was a busy time. But the thing, and this is the last thing that I'll tell you is that in contrast to early on when we had to bring in a ton of travelers and we had to shut down elective surgery, which was financially devastating to the organization, even during Omicron, we had 200 people out a week. Elective surgery went on. People went, the amount of virtual visits in our primary care practices was modest. People were going to their appointments, and we didn't need the travelers, and life went on. And so when we reactivated the incident command, Dan Ray, who's my ID guy, we're talking about this. And the first meeting, you know, with that whole orchestration and things, he says, you know, Ed, you know, it's kind of like we're getting the band back together. And we're all in tune, and we all know the songs, and it's just a very well-oiled machine. No one behaved badly. There weren't egos. It's just one mission, and I'm just very fortunate that I work in a really top-shelf organization. Makes me look good, and it's a pleasure to work with when these things happen. I know Dr. Delaney will be around. He's got part of the panel tomorrow, so I want to invite y'all to continue the conversation. Thank you so much. Thank you.

COVID-19

employee health

Roper St. Francis Healthcare

occupational medicine

mass vaccination

exposure advisor

data management

vaccine exemptions

teamwork