4 Coronavirus Prescriptions for U.S. Healthcare Community

Public health officials, healthcare settings, and diagnostic manufacturers face multiple coronavirus challenges.

U.S. healthcare organizations should be taking urgent preparation and response actions to address the possibility of a coronavirus pandemic, a new journal article says.

After reaching epidemic proportions in Wuhan, China, in December, corona virus disease 2019 (COVID-19) has spread to 77 countries, with more than 90,000 confirmed cases and more than 3,000 deaths, according to the World Health Organization. As of March 5, there had been 162 confirmed cased in the United States, with 11 deaths, worldometer reported.

Although Americans are not at high risk of COVID-19 infection now, the situation in the United States and other countries is likely to worsen, the CDC says. "This virus is NOT currently spreading widely in the United States. However, it is important to note that current global circumstances suggest it is likely that this virus will cause a pandemic."

The new journal article, which was published this week in the Journal of the American Medical Association, features four steps that U.S. healthcare organizations should be taking to address the COVID-19 crisis.

1. Preparedness planning

Healthcare organizations should base preparedness planning on plans for earlier pandemics such as the 2009 H1N1 influenza outbreak, the journal article's co-authors wrote.

"In many ways, the current coronavirus epidemic is reminiscent of the beginning of the 2009 influenza pandemic. Many healthcare institutions did substantial work on those plans at that time, and to the extent they still exist, institutions should use those plans as the foundation for needed planning efforts now," they wrote.

Planning efforts for the 2009 influenza pandemic included protection of healthcare workers, staffing shortage contingencies, coping with patient surges, triage topics, and addressing scarce resources.

There are several actions that hospitals can take to accommodate patient surges, the lead author of the journal article told HealthLeaders.

"Hospitals will have to become efficient at managing bed capacity—converting non-patient care space into bed space and creating intensive care unit beds out of stepdown units and post-anesthesia care units. They will have to become more efficient at handling their ordinary admissions and optimize staffing," said Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore, Maryland.

2. Hospital and clinic response

Hospitals and clinics should be prepared to rise to several challenges if the COVID-19 virus spreads widely in the United States, the journal co-authors wrote.

• For patients who may be infected, protocols should be created for triage and isolation of the patients in emergency rooms, urgent care centers, and outpatient clinics so they do not spread the illness. Similar measures should be taken in settings with vulnerable populations such as skilled nursing facilities, assisted living sites, and long-term care facilities.
   
• Hospitals and clinics should be prepared to protect healthcare workers and prevent the spread of COVID-19 to uninfected patients. Measures include engineering efforts, staff training, and acquisition of personal protective equipment.
   
• With some COVID-19 patients experiencing respiratory distress, hospitals should assess ICU capacity, including bed space and mechanical ventilator resources.
   
• Hospitals with the expertise and resources should be prepared to provide extracorporeal membrane oxygenation for patients with severe acute respiratory distress syndrome (ARDS).
   
• As knowledge of COVID-19 advances, clinicians will have to stay updated on care guidance. For now, clinicians should follow existing guidance for ARDS, pneumonia, and sepsis.

3. Expansion of diagnostic testing

Compared to countries such as South Korea, Italy, and the United Kingdom, the United States has lagged in testing for COVID-19 infections. U.S. testing must increase, the journal article co-authors wrote.

"Medical and public health experts need to expand testing to all patients who have unexplained ARDS or severe pneumonia, and ultimately to patients who have mild symptoms consistent with COVID-19. … To reach a high-level testing capacity will require the major clinical diagnostic companies to develop and manufacture testing kits at large scale."

The CDC and state-operated labs have insufficient testing capacity, Adalja told HealthLeaders.

"To speed up diagnostic testing, it will be necessary to move beyond the government labs that are doing the current testing and have commercial labs engage. It is also important that hospitals should have the capacity to develop their own tests. Eventually, we will hopefully have commercial test kits that can be used at point of care," he said.

4. Public health responses

Public health officials can take several actions to slow the spread of COVID-19 in the United States, including rapid diagnosis and isolation of infected people, tracking people who have come into contact with infected individuals and urging them to stay home during the two-week incubation period, and communicating with the public about ways to avoid infection such as handwashing techniques.

"Social distancing" such as cancelling large gatherings and closing schools should also be considered, the co-authors wrote.

Adalja said public health officials should weigh school closures carefully. "If community spread is already commenced, school closures may not have an impact. It is also important to remember that most school closure data comes from influenza, which has a different epidemiological dynamic and is much more dependent on children transmission than coronavirus."

The length of school closures is another key factor, he said. "Will children congregate outside of school and defeat the purpose? Will parents have to take off work? And what about children who get their meals at school?"