Track COVID-19 rates to signal when to resume non-emergent care

While some hospitals are just approaching their peak of treating COVID-19 patients, others are already looking toward the time facilities can start taking in patients—and revenues—for non-emergent patients.

Resuming more normal activities, however, will be contingent on massive testing availability in a community and working together to find COVID-19-positive patients and isolate them and those with whom they have been in contact, said Rochelle Walensky, MD, MPH, chief of the Division of Infectious Diseases at Massachusetts General Hospital in Boston.

Walensky was the featured guest at question-and-answer session hosted by the Journal of the American Medical Association (JAMA) Monday.

She noted that Mass General has had 1,700 COVID-19-related cases, with a current average of about 150-170 such deaths a day. Even though the hospital has been caring for COVID-19 patients for several weeks, the severity of the disease has seemed to increase, with more patients requiring intubation than in the earlier days, she said.

In an editorial for JAMA published online April 17, she and co-author Carlos del Rio, MD, wrote, “Important in answering the ‘when’ of returning to normalcy is to acknowledge that the U.S. has not had a uniform COVID-19 experience or response.”

Noting that the cornerstone of the next phase will require “massive testing,” she also warned that public cooperation with continued social distancing and hand hygiene will also remain necessary, perhaps for months to come.

CMS published guidelines Sunday for hospitals who want to expand their operations again, but as with the White House and CDC criteria on “Opening Up America Again” issued April 16, moving toward normal depends on the number of COVID-19 cases in a region and whether those numbers are going down.

Cases should have a “downward trajectory of documented cases within a 14-day period,” and there should be robust testing available in the area, according to the White House criteria.

CMS also said hospitals and other facilities should be in close coordination with state and local public health officials and that “every effort should be made to conserve personal protective equipment.”

The CMS guidelines outlined considerations about the physical ability of facilities to have both COVID-19 and non-emergent care, sanitation protocols, adequate supplies, and testing capacity.

In addition, the American College of Surgeons also issued guidelines for resuming elective surgeries, beginning with a focus on communicating with local health officials. “Know your rates,” the ACS wrote in the guidance. “Knowing your community’s COVID-19 numbers, including prevalence and incidence rates, as well as local isolation mandates, will help dictate timing of ramp up.”