Corona Virus Disease 2019 (COVID-19) April 2020 Update

Corona Virus Disease 2019 (COVID-19)
April 2020 Update
Written by:  Carolyn St.Charles, RN, BSN, MBA
Chief Clinical Officer, HealthTechS3
April 27, 2020

The Numbers

The CDC COVID-19 statistics as of April 22 include 828,441 cases and 46,379 deaths in the United States and U.S. territories.  Three states Alaska (335), Montana (442), and Wyoming (447) have less than 500 reported cases.  Five other states have between 500 and 1,000 reported cases including Hawaii (537),  North Dakota (679), Vermont (823), Maine (907), and West Virginia (963). 

However, the CDC states that this may not be an exact number due to a variety of reasons including “delays in reporting and testing, not everyone who is infected gets tested or seeks medical care, and there may be differences in how states and territories confirm numbers in their jurisdictions.”1)https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html


Masks for Everyone
Many healthcare organizations are now implementing a policy requiring all on-site staff, including those not involved in direct patient care, to wear face masks.  This is in alignment with the CDC recommendations to wear cloth face coverings in public settings where social distancing measures are difficult to maintain, especially in areas of significant community-based transmission.2)https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html


Implementing a “masks for everyone” policy may give staff who do not work in a patient-care area a higher sense of security against infection.  However, it is critical that staff are educated on the appropriate use of face masks including how to put the mask on and take the mask off properly.

If the use of home-made face masks are allowed in non-patient care areas, following the CDC guidelines for the type of masks is also critical.3)https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

Recommendations to Consider

  1. Determine in consultation with providers,  infection control, and ideally public health,  if you will implement a “masks for everyone” policy
  2. Determine when masks must be worn and in what locations
  3. Determine if you will allow homemade cloth masks – and if so in what locations
  4. Determine how masks will be laundered (if cloth)
  5. Train staff who have not been trained on the appropriate use of masks including how to safely put a mask on and take the mask off

Easing Restrictions

Although the COVID-19 pandemic is far from over, states are beginning to ease restrictions including opening more businesses and easing stay-at-home restrictions.  The federal government issued “Guidelines for Opening Up America Again”4)https://www.whitehouse.gov/openingamerica/ on April 16 that includes “gating” criteria recommended for states to satisfy before proceeding to a phased comeback, as well as recommendations related to each of three phases.  A summary of the “Guidelines for Opening Up America Again” related to Gating Criteria, Core State Preparedness, and the Phased Approachfor healthcare organizations and employers are  included at the end of this document as a reference.

Many healthcare providers are concerned, and appropriately so, that easing the current restrictions before appropriate safeguards and mitigation strategies have been put in place, such as wide-spread testing and contact tracing, may result in a second wave of infections and mortality. 

As we have already seen in the news, some states have decided not to adhere to the federal government guidelines and are moving forward before gating criteria has been met and safeguards are in place.  The news also reports that some governors are not checking with public health or medical personnel before lifting restrictions.

Recommendations to Consider

  1. Continue to follow CDC recommendations
  2. Stay in close contact with local and state public health departments
  3. Continue to educate staff
  4. Ensure you have a sufficient supply of masks, especially if you implement a “masks for everyone” policy
  5. Ensure you have sufficient PPE before you start elective surgery
  6. If you haven’t already — complete the CMS Focused Infection Control Survey for Acute and Continuing care5)https://qsep.cms.gov/data/275/COVID-19FocusedSurvey-InfectionControlSurveyToolforNon-LTC.pdf or the COVID-19 Focused Survey for Nursing Homes.6)https://www.ahcancal.org/facility_operations/disaster_planning/Documents/self-assessment.pdf
  7. Communicate with your community about what you are doing and what restrictions are still in place, such as restrictions on visitors, etc.

Misinformation

As in any crisis, misinformation abounds.  The most recent implies that ingesting disinfectant might kill the virus.  As healthcare professionals you know this is very very dangerous —  but some people without healthcare background may see this as a viable option. 

Recommendations to Consider

  1. Add information to your web site and other public information sources about the danger of ingesting disinfectants or other non-proven cures or prevention of COVID-19
  2. Provide links to CDC and/or Public Health on your web site
  3. Encourage your community to call public health, their provider or clinic if they have any questions about potential prevention strategies or cures

Continue to Support Your Staff

A report by NPR, “Trauma On The Pandemic’s Front Line Leaves Health Workers Reeling” states that a recent study published in JAMA found that half of Chinese health care workers who treated COVID-19 patients earlier this year now suffer from depression, 44.6% have anxiety and 33% have insomnia.7)https://jamanetwork.com/journals/jamanetworkopen/article-abstract/27632298)https://www.npr.org/sections/health-shots/2020/04/23/840986735/trauma-on-the-pandemics-front-line-leaves-health-workers-reeling

Certainly, the number of COVID-19 patients cared for may vary widely between hospitals.  However, even for those with no or low incidence of patients, the stress of preparing and the unknown, including if they or their family will become infected, is a very real ongoing stressor.

The National Center for PTSD has excellent resources on their web site to help healthcare workers and responders, including an article on Managing Healthcare Workers’ Stress Associated with the COVID-19 Virus Outbreak. 9)https://www.ptsd.va.gov/covid/COVID19ManagingStressHCW032020.pdf

It’s also important to remember that every member of your staff, even those that are not direct-caregivers, may be experiencing stress related to COVID-19.

Recommendations to Consider

  1. Continue to communicate regularly and often to all staff
  2. Make counseling services available if at all possible

Thank You

In sincere and heartfelt appreciation to all the helpers, who are making sacrifices every day to provide the highest quality care for your community.

See the source image

SUMMARY
Guidelines for Opening Up America Again
10)https://www.whitehouse.gov/openingamerica/

GATING CRITERIA
SYMPTOMS
Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period
and
Downward trajectory of covid-like syndromic cases reported within a 14-day period
CASES
Downward trajectory of documented cases within a 14-day period
or
Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)
HOSPITALS
Treat all patients without crisis care
and
Robust testing program in place for at-risk healthcare workers, including emerging antibody testing

CORE STATE PREPAREDNESS

Testing & Contact Tracing

    • Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results
    • Ability to test Syndromic/ILI-indicated persons for COVID and trace contacts of COVID+ results
    • Ensure sentinel surveillance sites are screening for asymptomatic cases and contacts for COVID+ results are traced (sites operate at locations that serve older individuals, lower-income Americans, racial minorities, and Native Americans)

Healthcare System Capacity

    • Ability to quickly and independently supply sufficient Personal Protective Equipment and critical medical equipment to handle dramatic surge in need
    • Ability to surge ICU capacity

Plans

    • Protect the health and safety of workers in critical industries
    • Protect the health and safety of those living and working in high-risk facilities (e.g., senior care facilities)
    • Protect employees and users of mass transit
    • Advise citizens regarding protocols for social distancing and face coverings
    • Monitor conditions and immediately take steps to limit and mitigate any rebounds or outbreaks by restarting a phase or returning to an earlier phase, depending on severity

EMPLOYER GUIDELINES

The “Guidelines for Opening Up America Again” include employer guidelines for all phases Since healthcare organizations are employers, they would be included in these recommendations.

    • Develop and implement appropriate policies, in accordance with Federal, State and local regulations and guidance, and informed by industry best practices, regarding:
      • Social distancing and protective equipment
      • Temperature checks
      • Sanitation
      • Use and disinfection of common and high-traffic areas
      • Business travel
    • Monitor workforce for indicative symptoms.  Do not allow symptomatic people to physically return to work until cleared by a medical provider
    • Develop and implement policies and procedures for workforce contact tracing following employee COVID positive test.

In addition, there are recommendations for employers to follow for each of the three phases that are included below.

PHASED APPROACH

 The “Guidelines for Opening Up America Again”, includes recommendations for healthcare organizations and employers as part of each of three phases.

    • Phase 1 – For States and Regions that satisfy the gating criteria
      • Healthcare
        • Resume elective surgeries as clinically appropriate, on an outpatient basis at facilities that adhere to CMS guidelines

    • EmployersContinue to encourage telework, whenever possible and feasible with business operationsIf possible, return to work in phasesClose common areas where personnel are likely to congregate and interact, or enforce strict social distancing protocolsMinimize non-essential travel and adhere to CDC guidelines regarding isolation following travelStrongly consider special accommodations for personnel who are members of a vulnerable population

    • Phase 2 – For States and Regions with no evidence of a rebound and that satisfy the gating criteria a second time
      • Healthcare 
        • Resume elective surgery, as clinically appropriate, on an outpatient and in-patient basis at facilities that adhere to CMS guidelines
        • Visits to Senior Care Facilities and Hospitals remain prohibited.  Those who do interact with residents and patients must adhere to strict protocols regarding hygiene.

    • Employers
      • Continue to encourage telework, whenever possible and feasible with business operations
      • Close common areas where personnel are likely to congregate and interact, or enforce strict social distancing protocols
      • Strongly consider special accommodations for personnel who are members of a vulnerable population

    • Phase 3 – For States and Regions with no evidence of a rebound and that satisfy the gating criteria a third time
      • Healthcare
        • Resume visits to Senior care facilities and hospitals.  Those who interact with residents and patients must be diligent regarding hygiene.

    • Employers

HealthTechS3 hopes that the information contained herein will be informative and helpful on industry topics. However, please note that this  information is not intended to be definitive. HealthTechS3 and its affiliates expressly disclaim any and all liability, whatsoever, for any such  information and for any use made thereof. HealthTechS3 does not and shall not have any authority to develop substantive billing or coding  policies for any hospital, clinic or their respective personnel, and any such final responsibility remains exclusively with the hospital, clinic or  their respective personnel. HealthTechS3 recommends that hospitals, clinics, their respective personnel, and all other third party recipients of  this information consult original source materials and qualified healthcare regulatory counsel for specific guidance in healthcare  reimbursement and regulatory matters.

Resume unrestricted staffing at worksites

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