Practicing during a pandemic – Coronavirus/COVID-19

Published on: March 13, 2020

Since first emerging as a novel virus in December 2019, the SARS-CoV-2 coronavirus outbreak has quickly enveloped the world and, as of March 11, 2020, it was declared by the World Health Organization to be a true pandemic. Currently, there are over 118,000 cases in 114 countries, with 4,291 fatalities. In the U.S., there are 1,215 cases in 43 states, with 36 associated fatalities- and those numbers are growing rapidly.

A few of the issues that challenge the response to the coronavirus outbreak are the variability of symptoms and disease severity of COVID-19 in individuals, a shortage of viral test kits, and a national shortage of hospital beds to treat severely-affected patients.

MIEC is committed to supporting our members during this crisis by helping to identify the best resources for quickly changing information about novel coronavirus and COVID-19, the disease it causes, and the best ways to practice good infection control and maintain continuity of care in their practices during this outbreak.

Government resources for general information and daily updates on coronavirus/COVID-19:

World Health Organization (WHO) Coronavirus website:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

U.S. Centers for Disease Control and Prevention (CDC):

https://www.cdc.gov/coronavirus/2019-ncov/index.html

Departments of Public Health by State:

Alaska:

• Department of Social Services- Division of Public Health
• Alaska DHSS COVID-19 Situation Overview

California:

• California Department of Public Health
• CDPH COVID-19 Updates
• En Español: Novedoso Coronavirus 2019 (COVID-19)

Hawaii:

• State of Hawaii Department of Health
• Hawaii Disease Outbreak Control Division: COVID-19

Idaho:

• Idaho Department of Health and Welfare
• Idaho Official Resources for the Coronavirus

ECRI Institute has launched a COVID-19 Outbreak Preparedness Center, to assist healthcare providers in preparing for and responding to an outbreak in their patient population. This resource is available to non-ECRI members and offers the following information for providers:

• Overview of infection prevention and control
• Preparation and patient handling checklists
• Equipment and alternative supplier lists
• Patient care equipment evaluations, including portable ventilators
• Recommendations for infection control

Infection Control:

Maintaining good infection control practices is always important in the medical practice, but additional measures may be necessary to minimize contamination and virus transmission in the setting of the coronavirus outbreak. At the least, this is a good opportunity to revisit infection control procedures with both clinical and nonclinical staff. Providers should reinforce proper handwashing protocol and frequently disinfect office furniture and equipment, both in treatment rooms and patient waiting areas. If appropriate, staff should wear surgical masks to prevent direct transmission from infected patients, and/or to prevent them from touching their mouth and nose with potentially contaminated hands.

For further information, ECRI Institute and the CDC both offer guidance on general infection control practices.

Additionally, all staff should be strongly advised to stay home if they are experiencing any flu-like symptoms, to avoid the risk of infecting patients or coworkers. If there is the possibility of non-clinical staff to work remotely, this might be considered as well.

Maintaining Continuity of Care:

Providers who are able to treat patients through telehealth should consider whether this would be a viable option for their practices to minimize the risk of viral transmission while still delivering necessary care.

In an effort to support our members during this pandemic crisis, effective March 1, 2020, for services provided on or after, until May 1, 2020, MIEC policyholders will not need prior underwriting approval for telehealth or telemedicine.  All applicable state and federal laws and regulations will still apply and should be followed.  The following guidelines should also be recognized and followed:

1. The healthcare provider should be licensed in the state where they physically reside, AND where the patient physically is present.  Providers should check with state licensing boards to see if any type of reciprocity is being offered for licensing if they are not currently licensed in a particular state.
2. Be aware of your state’s laws and regulations regarding telehealth.  In general, new patients should be appropriately evaluated and/or examined before prescribing medications, either through videoconferencing or in-person visits according to the applicable standard of care.  Avoid prescribing medications to new patients based solely on a telephone conversation or online questionnaire.  With limited exceptions, controlled substances should only be prescribed following a thorough in-person evaluation.  If a face to face visit is required to create a physician/patient relationship, that will continue to be required.  We are unable to change regulatory requirements.  Providers should check with their state to see if any regulations have been relaxed during this pandemic crisis or contact MIEC’s Patient Safety Risk Management team to discuss requirements if there is uncertainty.
3. Providers should continue to create and document medical records for telehealth/telemedicine visits for existing and new patients. Patients should provide documented informed consent for telehealth services.
4. Please remember to take reasonable steps to protect patient privacy and confidentiality during this time, and particularly when using telehealth technology and/or when communicating electronically with patients.  When reasonable, avoid sending Protected Health Information (PHI) via text or unsecured email.

For providers who cannot reduce in-person visits through telehealth technology, consider setting temporary policies to minimize the risk of potential COVID-19 patients infecting other patients. Primary care or other specialty practices that directly manage viral infections might consider quarantine measures within the practice to minimize transmission between patients, while maintaining access to care for COVID-19 patients.

Other practices who do not treat this disease should consider policies that encourage patients to reschedule non-urgent or elective appointments if they are experiencing symptoms indicative of COVID-19.