The COVID-19 Pandemic
The COVID-19 pandemic is spreading rapidly in the United States and around the world. In the U.S., there are more than 330,000 cases; although that number is likely higher. The New York metro area has reached capacity and is experiencing significant strain. This past week, our ENVOY team began supporting other hospitals in need, standing shoulder-to-shoulder in the fight against the coronavirus, providing relief to our colleagues at Mount Sinai hospital in New York City.
Hospitals in Detroit, New Orleans and Chicago are emerging as new hot spots in the fight against COVID-19.
Treatment recommendations continue to be limited to supportive care measures. Some claim therapies such as hydroxychloroquine and azithromycin could be used as potential preventive and treatment options; however, those recommendations are controversial and there are no evidence-based studies indicating efficacy or safety in treating the coronavirus. As the virus spreads, healthcare workers and hospital systems will need to frequently monitor their hospital’s infection control bulletins, the CDC’s website, Envision communications and local health department recommendations.
The Envision National COVID-19 Task Force will continue to release resources, guidance and communications as available.
Identification, Testing, Treatment, Quarantine Protocols and Reporting
Below are general guidelines and recommendations. Continue to follow local guidance from your hospital or local health officials, if available.
Quarantine Considerations for Healthcare Providers with low staffing
The CDC has recommended that “facilities could consider allowing asymptomatic HCP who have had an exposure to a COVID-19 patient to continue to work after options to improve staffing have been exhausted and in consultation with their occupational health program…Facilities could have exposed HCP wear a facemask while at work for 14 days after the exposure event.”
Quarantine of an Envision Clinician
Site clinical leaders (or site medical directors or chiefs) should complete the Quarantine Intake Form or contact the Envision COVID-19 Hotline at 1.844.607.5824 if a physician or APP has mandated or self-directed quarantine.
Envision recommends the following PPE guidance:
- Wear a surgical/procedure face mask and eye protection (face shield or goggles) for all routine (non-aerosol generating) patient encounters, if available
- Wear a mask for the entire shift unless it becomes wet, torn or soiled
- Wear a higher level of PPE (e.g., an N95 mask or PAPR) for aerosol-generating procedures such as intubation, extubation, suctioning, etc. for undifferentiated respiratory failure patient
- Clean plastic face shields and eye protection periodically and reuse after cleaning
- Discard disposable face masks if a patient coughs or sneezes on the provider or if the clinician comes in contact with a high-risk COVID-19 patient
Hospitals should plan immediately for significant increases in patient volume in the emergency department and medical inpatient units. https://annals.org/aim/fullarticle/2763037/how-should-u-s-hospitals-prepare-coronavirus-disease-2019-covid
- Develop a strategy for patient volume and complexity
- Identify alternative locations for staffing and triage of respiratory illness patients
- Develop surge staffing plans for the entire institution
- Protect and support our healthcare workers on the frontlines
- Define a strategy for limited healthcare resources
- Develop clear chains of command and open communication policies
Triage and alternative care areas
Hospitals and clinicians should ensure rapid triage and isolation for patients who screen positive as a PUI. Facilities should consider alternative treatment areas and modify emergency department intake/triage protocols. Telehealth solutions for patient triage should be employed where available to protect healthcare workers from exposure and mitigate volume surges.
EMS workers or outpatient clinic providers should use personal protective equipment as described above and immediately inform the healthcare facility to prepare. Facilities should maintain a well-ventilated space, separated by six or more feet from other patients for incoming patients who screen positive as PUIs. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html
CMS has clarified its statement regarding EMTALA regulations for COVID-19. Qualified RNs can perform a medical screen exam; however, check your hospital bylaws to determine if RNs are considered qualified to perform a medical screening examination at your facility. https://www.cms.gov/files/document/qso-20-15-hospitalcahemtala.pdf
The CDC’s guidance for treatment and evaluation is rapidly evolving. Continue to follow the CDC guidelines at https://www.cdc.gov/coronavirus/2019-ncov/index.html
Wellness Resources and Daily COVID-19 Support Meetings
to access wellness resources for clinicians and corporate employees, as well as to add the daily COVID-19 support meetings to your calendar.