COVID-19: After the Crisis
Many U.S. hospitals and health systems heeded guidance from the Centers for Medicare & Medicaid Services (CMS) (March 18) and others to pause on any non-emergent/non-urgent surgeries and procedures as a strategy to preserve PPE and other finite resources, including healthcare workforce, early in the pandemic.
On June 8, CMS issued updated recommendations opens in a new tab for re-opening facilities to provide non-emergent, non-COVID-19 healthcare services. The safe resumption of care is of utmost importance. The guidance applies only to Phase II areas, those with no evidence of rebound or surge.
In April, CMS provided guidance opens in a new tab for facilities to begin to resume performing deferred procedures, such as elective surgeries. Elective surgeries are considered those procedures that are preplanned by both the patient and the physician that are advantageous to the patient but are not urgent or emergent. The American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses and American Hospital Association also issued a joint statement opens in a new tab and have shared their roadmap to operationalizing resumption of surgeries.
The following information, resources and tools are provided to support organizations to thoughtfully and practically re-engage and scale up to resume normal, safe, full-service surgery and procedural services.
Three critical operational considerations are:
- Adequate, appropriate PPE opens in a new tab for healthcare workers; patients and visitors should wear cloth face coverings. Such coverings are not PPE, but do serve an important function of “source control” opens in a new tab
- Appropriate staffing, including preserving surge capacity
- Testing capabilities and capacity; CMS recommends viral testing for SARS-CoV-2, the virus that causes COVID-19, for hospitalized patients and those imminently undergoing a procedure or surgery
- Three Foundational Steps to Restart Elective Cases (May 11) opens in a new tab
- Practices to Carry Forward from the Pandemic (April 28) opens in a new tab – Strategies, resources and tools to thrive.
A common, core component of the guidance and roadmap is COVID-19 testing capability and capacity to accommodate the needs of both the healthcare workforce and patients to make sure all feel safe when they come in to seek healthcare services.
CMS cautions any decision to resume procedures is at the discretion of local and state authorities. The guidance recommends routine COVID-19 screening for staff, accompanied by testing and quarantine as appropriate. A facility that decides to reopen procedures should also create areas to reduce the risk and exposure to COVID-19. Any patient who is coming in for a procedure must also be screened for potential symptoms of COVID-19. “When adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory test as well,” according to the guidance.
For COVID-19, there are two types of tests available:
- Diagnostic – are you currently infected with SARS-CoV-2, the virus that causes COVID-19
- Serologic (“antibody test”) – you have had a recent SARS-CoV-2 infection
CDC – Overview of testing for SARS-CoV-2 opens in a new tab (updated June 13) provides comprehensive recommendations on testing for COVID-19.
CDC – Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2 (updated July 2).
CDC – SARS-CoV-2 Testing Strategy: Considerations for Non-Healthcare Workplaces opens in a new tab (updated July 3). These considerations are meant to supplement, not replace, any federal, state, local, territorial or tribal health and safety laws, rules and regulations with which workplaces must comply.
FDA – Emergency Use Authorization (EUA) – COVID-19 resources opens in a new tab. Lists current and terminated EUAs for diagnostic and therapeutic medical devices used to diagnose and respond to the COVID-19 public health emergency, including both PPE and in vitro diagnostics.
Contact tracing is a well-established public health technique used to slow down the spread of infectious outbreaks, such as COVID-19. Specially trained individuals provide support to patients with known or suspected infection to help them recall everyone they have had close contact with during the time they may have been infectious. Contacts are informed they may have been exposed and are armed with education, information and support to understand their level of risk of developing COVID-19 and how to quarantine and self-monitor for symptoms. Timeliness is critical to successful contact tracing.
- Association of State and Territorial Health Officials (ASTHO) – A Coordinated, National Approach to Scaling Public Health Capacity for Contact Tracing and Disease Investigation opens in a new tab
- CDC – Principles of Contact Tracing opens in a new tab
- CDC – COVID-19 Contact Tracing Training Guidance and Resources opens in a new tab
- CDC – Key Information to Collect During a Case Interview (May 21) opens in a new tab
- CDC – Fact Sheet: National Service Resources to Support COVID-19 Contact tracing opens in a new tab
- Public Health Foundation (PHF) – Free contact tracing training opens in a new tab resources.
In the past three most memorable pandemics, 1918’s Spanish flu, 1968’s Hong Kong flu and 2009’s H1N1 flu, the second wave was consistently deadlier than the first. We are now dealing with the first wave of COVID-19, and there is no reason to expect this pandemic will behave differently. Organizations must prepare for surge and wave 2 now, even as you recover from wave 1. CDC’s COVID-19 Surge opens in a new tab tool is invaluable in planning.
For more information and resources to support surge preparedness, click hereopens in a new tab.
- CDC – COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations opens in a new tab (Ver. 1.0 Sept. 16)Immunization with a safe and effective COVID-19 vaccine is a critical component of the U.S. strategy to reduce COVID-19-related illnesses, hospitalizations and deaths, and to help restore societal functioning. This interim playbook for state, territorial, tribal and local public health programs will be updated as new information (e.g., recommendations for pregnant women or pediatric populations) becomes available.
- FDA – COVID-19 Vaccines opens in a new tab (content current as of Oct 6.)FDA has rigorous scientific and regulatory processes in place to facilitate development and ensure the safety, effectiveness and quality of COVID-19 vaccines. Currently, there is no FDA-approved or authorized vaccine for the prevention of COVID-19.
- FDA – Emergency Use Authorization for Vaccines to Prevent COVID-19: Guidance for Industry opens in a new tab (Oct. 6)This guidance provides sponsors of requests for Emergency Use Authorization (EUA) for COVID-19 vaccines non-binding recommendations regarding the data and information needed to support the issuance of an EUA under section 564 of the FD&C Act (21 U.S.C. 360bbb-3) for an investigational vaccine to prevent COVID-19 for the duration of the COVID-19 public health emergency.
- FDA – Development and Licensure of Vaccines to Prevent COVID-19: Guidance for Industry opens in a new tab (June 30)FDA plays a critical role in protecting the U.S. from threats such as emerging infectious diseases, including the Coronavirus Disease 2019 (COVID-19) pandemic. The purpose of this guidance is to assist sponsors in the clinical development and licensure of vaccines for the prevention of COVID-19.
- National Academy of Medicine (NAM) – “Framework for Equitable Allocation of COVID-19 Vaccine opens in a new tab” (Oct. 2)CDC and the National Institutes of Health (NIH) commissioned the nongovernmental NAM to convene experts and develop recommendations to inform national and local guidelines for equitable COVID-19 vaccine allocation, once vaccines become available. Through a transparent, iterative process, with public input throughout, NAM produced this consensus study.For the initial period when vaccine demand exceeds supply, the report recommends a four-phased approach opens in a new tab to allocation built on widely accepted foundational principles and guided by evidence to maximize societal benefit by reducing morbidity and mortality caused by the transmission of SARS-CoV-2.
- Network for Excellence in Health Innovation (NEHI) – Vaccine Summit Series:
- 1st Vaccine Summit (Aug. 27) – “Looming Challenges of COVID-19 Immunization: Communications and Messaging opens in a new tab”
- 2nd Vaccine Summit (Sept. 22) – “Looming Challenges of COVID-19 Immunization: Preparing the Immunization Infrastructure opens in a new tab”
- Premier – “Flu and COVID-19” – information and resources.