CDC has released a new HAN Health Alert Advisory on Severe Illness Associated with Using Non-Pharmaceutical Chloroquine Phosphate to Prevent and Treat COVID-19. The Summary includes “Chloroquine phosphate, when used without a prescription and supervision of a healthcare provider, can cause serious health consequences, including death. Clinicians and public health officials should discourage the public from misusing non-pharmaceutical chloroquine phosphate (a chemical used in home aquariums). Clinicians should advise patients and the public that chloroquine, and the related compound hydroxychloroquine, should be used only under the supervision of a healthcare provider as prescribed medications.” Find the CDC HAN at https://emergency.cdc.gov/han/2020/han00431.asp?deliveryName=USCDC_511-DM24285.
CDC has released a number of new Guidance protocols today on:
- Return to Work Criteria for Health Care Personnel with Confirmed or Suspected COVID-19, at https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html, including sections on Return to Work Practices and Work Restrictions, and Crisis Strategies to Mitigate Staffing Shortages.
- Strategies to Optimize Personal Protective Equipment Supply, at https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html, including sections on eye protection, isolation gowns, facemasks, and N95 respirators.
- Disposition of Non-Hospitalized Patients with COVID-19, at https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html, which provides various protocols for allowing patients to discontinue home isolation.
The National Consortium of Telehealth Resource Centers will present a March 19, 2020 webinar on Telehealth and COVID-19. For details and registration see https://www.telehealthresourcecenter.org/event/nctrc-webinar-telehealth-and-covid-19/.
CMS has announced expansion of payment for Medicare and Medicaid Telehealth services to help deal with the COVID-19 pandemic. For more information see:
- Medicare Telehealth Health Care Provider Fact Sheet: Medicare coverage and payment of virtual services, March 17, 2020 – https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.
- Medicare Telehealth Frequently Asked Questions (FAQs), March 17, 2020 – https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf.
- Medicaid State Plan Fee-for-Service Payments for Services Delivered Via Telehealth, March 17, 2020 – https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-telehealth-services.pdf.
- General Medicaid Telehealth Guidance, undated – https://www.medicaid.gov/medicaid/benefits/telemedicine/index.html.
NBC News has published an article on Coronavirus testing: Information on COVID-19 tests according to state health departments. The article includes:
- Alaska: “For information about coronavirus in Alaska, check the Alaska Department of Health and Social Services’ coronavirus website [at http://dhss.alaska.gov/dph/Epi/id/Pages/COVID-19/general.aspx].”
- California: “Call your health care provider or local public health department [see https://www.cdph.ca.gov/Pages/LocalHealthServicesAndOffices.aspx] to be evaluated for testing if you are symptomatic, may have had contact with a person with coronavirus, or recently traveled to countries that have community spread. As of March 13, [2020,] California had 18 public health labs [see https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19_CA_Map_03.11.20.png] testing for coronavirus, with three more expected to be offering tests by next week. There are some private labs testing as well, though the state is not tracking their testing data. For a patient to be tested by a public health lab, their provider must contact the local public health department for approval and instructions. Most test results are available within 48 to 72 hours. The state has requested all labs notify the Department of Public Health about positive results. For more coronavirus information, visit the California Department of Public Health’s webpage [at https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx].”
- Idaho: “Call your health care provider if you believe you need to be tested. Any provider can request a test from the state, as long as they meet CDC infection control requirements for collection. However, not all providers in the state are set up to meet those requirements, according to the Department of Health. Test results are usually available 24 hours after they are sent to the state lab. There are four private labs conducting tests in the state that may have different response times. For more information, call 2-1-1 or your local public health district [see https://coronavirus.idaho.gov/contact/], or visit Idaho’s coronavirus website [at https://coronavirus.idaho.gov/].”
- Montana: “Call your health care provider to discuss whether you are a candidate for testing before appearing in person. If you do not have a primary care provider, you can call a community health center or urgent care clinic about getting tested. Providers are testing according to CDC guidance [see https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html], with a focus on people exhibiting symptoms that could indicate COVID-19. Providers do not need department approval to administer a test, but the department consults on cases as necessary. Test results from the state public health lab are typically returned daily. For more coronavirus information, visit the Montana Department of Public Health and Human Services website [at https://dphhs.mt.gov/publichealth/cdepi/diseases/coronavirusmt] or contact your county or tribal health department [see https://dphhs.mt.gov/publichealth/FCSS/countytribalhealthdepts].”
- Oregon: “For information about coronavirus in Oregon, check the Oregon Health Authority’s website [at https://www.oregon.gov/oha/PH/DISEASESCONDITIONS/DISEASESAZ/Pages/emerging-respiratory-infections.aspx].”
- Washington: “Call your health care provider to discuss whether you should be evaluated in person and considered for testing. Currently, there are no restrictions on who can be tested, however, it’s up to the provider to decide. Sample collection is done at the provider’s office. Samples are then sent to facilities such as the Washington State Public Health Lab or the University of Washington Virology Lab for analysis. Results are generally available within 24 to 48 hours. Turnaround time can be affected by demand. For more information, read the Washington State Department of Health’s medium article on testing [at https://medium.com/wadepthealth/covid-19-testing-process-what-you-need-to-know-ad741ed1a806] or visit the department’s coronavirus website [at https://www.doh.wa.gov/Emergencies/Coronavirus].”
CDC has issued a New HAN Health Alert titled Information and Guidance about Global Travel on Cruise Ships, Including River Cruises, Due to COVID-19, dated March 15, 2020. Among other things it recommends that clinicians “ask all patients about their planned or recent cruise ship travel, including river cruises.” See https://emergency.cdc.gov/han/2020/han00430.asp.
On March 12 CMS published a FAQ sheet about Essential Health Benefits Coverage to ensure individuals, issuers, and states have clear information on coverage benefits for COVID-19. Find it at https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/EHB-Benchmark-Coverage-of-COVID-19.pdf.
CMS Emergency Preparedness & Response Operations has a Current Emergencies web page that lists emergency-related documents, and which could be an ongoing reference for what’s new. It includes links to the press release and Fact Sheet about the National Emergency declared on March 13, but neither document includes information specific to dialysis facilities or transplant centers. Find the web page at https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page.
If you bookmarked our web page on Network Guidance on COVID-19 Stress for Staff, or forwarded the blog post about it, on March 13 or 14, please make sure you’re linking to https://www.esrdnetwork18.org/wp-content/uploads/20200313-Coping-with-ID-Outbreaks.pdf and advise the people to whom you forwarded the post. The following day we corrected the link in the blog post, but the original included a typo.
Networks 16 and 18 have assembled a web page on Healthcare Workers – Coping with Infectious Disease Outbreaks in the Dialysis Setting. In addition to guidance for maintaining your own health in situations of extreme stress, it includes links to the SAMHSA Disaster Distress Helpline (in English, Spanish, and 14 other languages) and their document on Taking Care of Your Behavioral Health: Tips for Social Distancing, Quarantine, and Isolation during an Infectious Disease Outbreak. Find the Network web page at http://www.esrdnetwork18.org/wp-content/uploads/20200313-Coping-with-ID-Outbreaks.pdf. While it’s aimed at facility staff, patients will also find it useful for managing their own stress.