COVID-19 Prep
Joey Sweeney, PharmD, BCPS
At the time of this writing (mid-May), most of the United States has seen the crest of the first surge of COVID-19. The curve has flattened in much of the country, and for a number of reasons, many states are beginning to reopen their economies. However, many of the states reopening have not experienced the magnitude of decline in cases that other parts of the world saw prior to reopening. Community testing is still inadequate, contact tracing efforts are understaffed, and personal protective equipment (PPE) for nonmedical workers continues to be scarce. Two months of staying at home, along with massive unemployment not seen since the Great Depression, are pressuring many Americans to discontinue social distancing and re-engage in routine economic activities. Widespread resumption of these activities likely means we will begin to see additional COVID-19 surges throughout America over the coming months.
If you work in a pharmacy located in an area not heavily hit during the first wave, consider yourself fortunate. Do not consider yourself immune. We have witnessed the devastation of human life in New York, Italy, Spain, and other areas throughout the world when health systems were unprepared for a surge. And we will likely continue seeing a lack of a well-coordinated federal response to this pandemic. Take this gift of time to prepare your pharmacy for the devastation that will ravage your community as additional waves tear across America.
An expert opinion by Kuy and colleagues published in the New England Journal of Medicine outlines a systematic approach for health systems to ensure they are adequately preparing for surges of patients. The authors provided this opinion based on firsthand experience preparing other health systems for the first COVID-19 surge.
They focus on four primary areas that health systems should address prior to facing a surge. It is absolutely crucial that a system doesn’t wait—moving fast and early is the best chance we have to avoid being overwhelmed when a surge does occur.
Mitigating local transmission
Hospitals and clinics should employ three tactics to reduce exposure and transmission of COVID-19: Limit the number of people entering the facility, reduce on-site staff to essential workers only, and screen everyone who enters the facility. Using telemedicine to treat patients at home and limiting visitors and vendors are the primary ways to limit people entering the facility.
Reducing staff to only essential workers has two benefits: It reduces the number of potential disease vectors and also creates a pool of workers who can be called upon if the essential workers become sick (presuming this pool of workers have adequate skills).
Limiting visitors can be difficult in certain situations (obstetrics, hospice, etc.), so the health system must be sensitive to the unique visitor scenarios that surround these cases. Severely limiting vendors will also reduce disease transmission vector load within the facility.
Screening everyone who enters the facility will limit or control individuals who are actively contagious. This screening will not stop asymptomatic carriers, but this is not a valid reason to avoid doing the screening. Health systems that willfully avoid screening at entrances do so at severe peril to the patients they are supposed to help and the personnel they are entrusted to protect.
Conserving, protecting, and supporting staff
The most valuable resources to a health system are its staff who are putting their own health on the line to save lives. Health systems are ethically and morally obligated to do everything within reason to protect the safety of their staff. Risk can never be reduced to zero, but an effort to keep staff as safe as reasonably possible must be made. Staff will become sick, either from community spread or contracting the virus at work. Health systems need to develop strategic workforce planning strategies.
Pharmacists should be thoughtful about how they participate in patient rounds. The authors propose that only a skeleton crew should visit confirmed or suspected COVID-19 patients. Reducing staff exposure to these patients is a key way to reduce staff risk. By reducing the number of face-to-face interactions with patients, the supply of PPE will also be stretched further.
Eliminating nonurgent strains on the system
CMS has recommended canceling elective procedures. Unfortunately, the term elective does not have a universal definition, so each health system is tasked with developing their own plan. Many professional groups and state boards have provided guidance, however.
Postponing elective procedures accomplishes many objectives, one of which is conserving staff by limiting unnecessary exposure to COVID-19. These staff can be kept “in reserve” to fill in once nonelective staff become ill, are in quarantine, or are in need of respite. Postponing elective procedures also conserves PPE. While financial risk to the health system is profound, there have been, and will likely continue to be, federal laws that alleviate some of these financial pressures.
Coordinating communication
As new information rapidly becomes available, frontline staff need to be kept “in the know.” Health systems should establish a central team to disseminate daily communications to all staff. The authors also recommend systems host recorded virtual town halls. Recording the sessions gives clinical staff the option to asynchronously view these presentations if they are performing clinical duties during this time. A single shared intranet site should be created to minimize the chance of frontline staff using out-of-date information.
Frontline staff should also be allowed to report issues to leadership, with the ability to do so anonymously if they desire. This was a great practice prior to the pandemic but is absolutely critical to implement now if your system has not already done so.
Despite the fact that areas of the country are opening back up, COVID-19 is still just as much a threat now as it was months ago. We still don’t have a silver bullet therapy, a vaccine, or adequate community testing and contact tracing.
Powder kegs of COVID-19 cases are about to ignite in many parts of the country. Ensure that your health system is ready for additional waves of patients.
The best time to prepare is before the surge arrives. Reduce transmission risk, take care of your staff, eliminate the nonessentials, and create a rock-solid communication strategy. Your staff and your patients will be grateful you did!