President Donald Trump announced new guidelines today to blunt the spread of the novel coronavirus that has infected over 3,800 and killed 69 people in the United States.
All children should receive schooling from home, Trump said. All Americans should avoid gathering in groups of more than 10 people.
The Centers for Disease Control and Prevention on Sunday had recommended that Americans cancel or postpone gatherings of 50 or more people for the next eight weeks.
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Trump also recommended that Americans avoid eating at bars, restaurants and food courts for the next 15 days and avoid discretionary travel.
A vaccine is in Phase I of a clinical trial, but there is no set date when it could become available. When asked, Trump said the coronavirus pandemic could last through July or August.
Dr. Deborah Birx, White House Coronavirus Response Coordinator, said if one person is sick in a household, all should stay home.
Trump has reportedly tested negative for the virus.
In the rapidly evolving response to the coronavirus pandemic, providers are asking Congress for direct funding to meet the challenge of caring for those infected and getting the personal protection equipment that has been in short supply.
In a letter to Senate Majority Leader Mitch McConnell and House Speaker Nancy Pelosi, the American Hospital Association, the American Medical Association and the American Nurses Association are asking Congress to provide additional supplemental emergency funding of at least $1 billion.
They want financial support in order to quickly update, train staff and implement pandemic preparedness plans; to obtain scarce supplies, including personal protective equipment; to rapidly ramp up infection control and triage training, especially in light of growing supply chain shortages; and to provide housing, care and monitoring of patients who do not require hospitalization but must remain isolated.
Persons to be isolated include persons with suspected or confirmed COVID-19 infections who experience mild to moderate symptoms and who are not able to care for themselves at home, the AHA, AMA and ANA said. Separate isolation facilities may need to be constructed or retrofitted in areas in or around hospital emergency departments.
In addition, there are the financial impacts of the cancellations of elective surgeries and procedures.
"Such cancellations could have devastating financial implications for hospitals, physicians and nurses already at financial risk and may limit access to care," they said.
Money is also needed to implement expanded telemedicine and telehealth capabilities; to increase the number of patient care beds using temporary structures, such as temporary hospitals; to cover the increased cost associated with higher staffing levels; and for special infectious disease units needed to care for patients with suspected or confirmed COVID-19 infection.
As schools and childcare facilities shut down during the community spread of coronavirus, hospitals may need to provide alternatives so that physicians, nurses and other staff with young children can come to work, said AHA CEO and president Richard J. Pollack, AMA CEO and executive vice president James L. Madara, and Loressa Cole, enterprise CEO of the ANA.
INPATIENT TO OUTPATIENT SETTINGS
The Centers for Disease Control and Prevention have recommended that some inpatient surgeries be shifted to outpatient settings, when feasible.
The Ambulatory Surgery Center Association has responded, saying there has been a conflicting message about elective surgeries that indicates additional guidance is warranted. The consensus position is that ambulatory surgery centers can continue to provide safe surgical care for patients whose condition cannot wait until hospitals return to normal operations, the ASCA said.
The ASCA recommends keeping facilities open for elective urgent surgeries; assessing and optimizing patients' medical and social risk factors for planned surgeries; and postponing cases where indicated, among other guidelines.
NURSING HOME GUIDANCE
CMS is directing nursing homes to temporarily restrict all visitors and nonessential personnel with a few exceptions such as end-of-life situations.
In those cases, visitors will be equipped with personal protective equipment like masks, and their visit will be limited to a specific room only.
Other measures restrict all volunteers and nonessential healthcare personnel and other personnel such as barbers; cancelling all group activities and communal dining; and implementing active screening of residents and healthcare personnel for fever and respiratory symptoms.
There have already been reports of large numbers of cases of COVID-19 spreading quickly through nursing homes, such as the Life Care Center in Kirkland, Washington.
According to the Centers for Disease Control and Prevention, visitors and healthcare personnel who are ill are the most likely sources of introduction of COVID-19 into nursing homes.
In lieu of visits, CMS is encouraging nursing homes to facilitate increased virtual communication between residents and families, and perhaps to assign a staff member as a primary contact for families to facilitate communications.
The CDC has recommended nursing homes place alcohol-based hand sanitizer with 60% to 95% alcohol inside and outside every resident room, if possible, and in every common area.
Additionally, nursing homes should ensure sinks are well-stocked with soap and paper towels for handwashing. They should make tissues and face masks available for people who are coughing, and make necessary PPE available in areas where resident care is provided.
Finally, they should ensure hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident equipment.
However, the healthcare company Premier said that 87% of healthcare personnel who have responded to a survey said they are not receiving full quantities of the personal protective equipment items they order.
N95 face masks are the most urgently needed supply, with nearly a third (30%) who responded reporting no inventory on hand.
The problem is particularly dire in New York State, where the government has ordered senior living employees to wear masks every shift.
Two-thirds of senior living facilities in the United States cannot obtain the necessary N95 masks, face shields and other personal protective equipment, Premier said.
Healthcare distributors have placed more than 700 unique PPE stock-keeping units on allocation due to COVID-19. Allocation is a process that restricts ordering when demand for a particular product spikes to avoid hoarding. The downside of allocation is that it may limit healthcare providers in the amounts they can buy, even if they have legitimate reasons for larger orders.
THE LARGER TREND
On Friday, President Trump declared the rapidly evolving COVID-19 pandemic a national emergency.
The President's declaration empowers the Secretary of Health and Human Services to authorize the Centers for Medicare and Medicaid Services to take proactive steps through 1135 waivers to federal requirements in Medicare, Medicaid and CHIP.
Because of the declaration, hospitals will be able to discharge patients to skilled nursing facilities more quickly, thus freeing up beds for the most severely ill patients. It removes restrictions for critical-access hospitals that serve rural areas, and also for healthcare professionals so that they may more easily provide care across state lines.
Also, CMS is allowing for the expansion of telehealth, allowing people to communicate with their providers from home.
CMS said it would introduce more flexibility on telehealth in the coming days.
In addition, CMS will temporarily suspend certain Medicare enrollment screening requirements, including site visits and finger-printing for non-certified Part B suppliers, physicians and non-physician practitioners; and it is temporarily suspending non-emergency survey inspections.
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