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Preparing for a second wave of COVID-19

Medical Economics JournalMedical Economics August 2020
Volume 97
Issue 12

Practices must take these steps to ensure they are ready.

Even though the first wave of COVID-19 cases is still happening,health experts warn that once the weather gets cooler in the fall, a second wave of cases is likely to arrive.

And if the wave coincides with the start of flu season, it would put an enormous strain on doctors and their practices. That’s why practices should start preparing now.

With an increase in the number of patients with cough and fever symptoms, the problem lies in how to differentiate illnesses. Doctors will need to correctly and quickly distinguish COVID-19 from the flu, strep throat or other viral illnesses.

Alicia Wright, M.D., a pediatrician for Holston Medical Group in Kingsport, Tennessee, says it’s important to keep patients who have symptoms of COVID-19 separate from those who do not.

“We are continuing to perfect our social distancing and virtual visit protocols so that it becomes second nature for our staff and providers,” Wright says. “This includes masking, temperature screening, call triage, making sure our lobbies are social distanced enough, as well as improving our survey questionnaires at the beginning of every visit. Perfecting these protocols practiced each day puts us and our patients in a safer position so whenever the illness does return, we are really prepared.”

Jeff Bullard, M.D., family medicine specialist at MaxHealth in Colleyville, Texas, notes his practice’s greatest challenge with the initial wave of COVID-19 was lack of preparedness.

“We have had to develop infection-control policies, navigate PPE [personal protective equipment] procurement and learn new way to communicate with patients,” he says. “The most glaring challenge was how to deliver care. [COVID-19] required a rapid shift from brick and mortar to virtual care delivery, which for most of us was a new skill.”

Stock up on PPE

Coordinating PPE procurement was a big obstacle when the coronavirus first started spreading. It’s expected to continue to be a concern, as everyone needs the same equipment at the same time.

“Maintaining relationships with suppliers as well as leaning on the local community are two important factors in making sure practices maintain the appropriate amount of PPE,” Wright says.

For example, she suggests reaching out to the community to ask for donations of homemade face masks, face shields and goggles. Some local manufacturers have shifted their production lines to make hand sanitizer.

Most practices don’t routinely maintain a stockpile of PPE to manage pandemic-level events. Bullard says the lack of PPE greatly affected his ability to see patients in the office early on and also hindered the practice’s ability to be a testing resource for patients.

“To prepare for a second wave, clinics must begin ordering PPE now,” he says. “Most distributors are allocating monthly supplies of PPE to outpatient clinics but only a limited amount with each order. By ordering frequently throughout the summer, you should be able to build a decent stockpile before flu season and what many believe will be the return of [COVID-19].”

For many practices, finding vendors that can sanitize N95 masks has been challenging, and this is where partnerships with state resources and national associations may be helpful in finding solutions.

Providing care

It’s also vital that physicians prepare for the next wave of COVID-19 by maintaining competencies gained during the first wave.

As the pandemic began and many facilities started closing, proactive physicians were finding alternative ways to care for and communicate with patients. If a second wave comes in the fall, physicians will find themselves once again experiencing closures and shelter-in-place orders. Physicians will need to let patients know what options are available to contact them and spell out circumstances in which they may need an in-person visit versus a virtual encounter.

Telehealth and virtual visits help ensure the continued delivery of health care during times of high COVID-19 activity, which is particularly critical for individuals in high-risk groups.

During the upcoming flu season, doctors will need to leverage telehealth to virtually assess symptomatic patients and conduct drive-through flu and COVID-19 testing.

Practices should be building these protocols now, Bullard says.

“Most doctors are now well down that path of optimizing and integrating this new delivery model,” he says. “At the same time, factors like the fear of a reversal of insurance parity and the need to rightsize the financial strain COVID-19 has placed on practices are tempting doctors to move back to what was comfortable and abandon televisits in favor of in-office visits.”

Communication matters

Excluding appointment reminders and lab follow-up, practice communication historically focused on managing incoming patient requests. The is not a winning strategy in the COVID-19 era.

In recent months, fear of infection and lack of information have left patients uncertain about how to address their health care needs, as shown by the reported 30% to 70% decrease in physician visits around the country, including a survey from the Commonwealth Fund.

Physicians must stay highly engaged with their patients as COVID-19 continues to disrupt health care delivery and traditional access. What may have once felt like overcommunicating should be the goal moving forward.

Now is the time to update social media channels to keep patients informed about safety protocols in place and what to expect during a visit.

“At my clinic, during [COVID-19], we utilized text, email, portal, website and social media messages to educate patients about limiting exposure and staying home safely while simultaneously informing them about available virtual visit, in-person visits, parking lot check-ins and drive-through testing,” Bullard says. “Our patients reported feeling appreciative, connected and supported during a stressful time.”

Placing prominent signage at the practice, especially on doors and in waiting areas, is a great way to keep patients informed about what to expect.

“I think the most important thing is for our staff and patients to know that their safety is our highest priority,” Wright says. “We aim to take measures to ensure that patients and staff are confident that their well-being is being protected.”

Staff issues

Stuart A. Meyers, M.D., an internist in Woodbridge, Va., says that COVID-19 causes a very stressful scenario for those who work on the front line.

“They can be helped by assuring all PPEs are available, even the ones not used for [COVID-19], monitoring their quality so that they can feel as safe as possible,” he says. “Front-line personnel shoulddevelop proper management strategies, including rigid time off and [standard procedures] developed during the first wave.”

A practice’s staff must feel prepared and have the appropriate resources to do their jobs each day, especially when dealing with COVID-19 situations.

“Look for every opportunity to communicate with your staff,” Bullard says. “Along with the ongoing worry about employment sustainability, workers are also concerned about their health and the health of their families. Keep your employees informed about the financial stability of the practice and all you are doing to assure their continued employment.”

Additionally, he says to develop a robust clinic safety plan. It should include work site cleaning, contamination prevention and patient triage protocols, along with infection control policies that will be followed if patients who test positive for COVID-19 receive care at the practice.

“Review the plan details, and the logic behind it, with all your employees,” Bullard says. “Take every opportunity to engage your employees as participants or even as monitors who are responsible for assuring plan adoption and success. This gives everyone an opportunity to hold some control over their environment. Even more, it lets them know that their safety is an important matter that you care about.”

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health