February 11, 2020

How CMS wants providers to prepare for the coronavirus

Daily Briefing

    The global death toll from the new coronavirus this weekend exceeded that of the SARS outbreak—and CMS has issued a new memo to U.S. providers outlining the clinical safety standards and requirements providers must follow to prevent the new virus' spread.  

    Our analysis: The 'recurring themes' of disease outbreaks

    About the outbreak

    Reports of the new coronavirus first surfaced in early December 2019 in Wuhan, China. According to the World Health Organization (WHO), the main symptoms of the virus, called 2019-nCoV, are fever and lesions in both lungs. Some patients also have reported difficulty breathing, WHO said.

    As of Tuesday, health officials reported more than 42,638 cases of the virus globally, with the vast majority of those cases reported in China. Officials have reported more than 300 cases of the new coronavirus outside of mainland China, including 13 confirmed cases in the United States.

    Officials in China said there were more than 1,000 reported deaths linked to the virus as of Tuesday, including one U.S. citizen who was in Wuhan. A vast majority of the deaths occurred in mainland China, but Hong Kong and the Philippines each have reported one death linked to the virus. According to WHO, the latest death toll means the new coronavirus outbreak has exceeded the 813 people who died during the eight-month SARS outbreak that began in 2002.

    CMS urges providers to follow current safety standard to prevent coronavirus' spread

    In the memo CMS sent to providers, the agency advised providers to adhere to Standard, Contact, and Airborne Precautions, such as using eye protection when treating patients.

    CDC also recommended clinicians use alcohol-based hand rub/hand sanitizer for hand hygiene, and to wash hands thoroughly with soap and water for at least 20 seconds in instances in which hands are noticeably dirty.

    According to the memo, providers also should review CDC's recommendations for how to self-assess emergency preparedness and infection control strategies. Additionally, the memo offers training and self-assessment tools for providers to reference as they review and update their procedures.

    The memo comes as U.S. hospitals are facing an intense flu season, which is straining resources and forcing public health officials to closely monitor medical supplies and treatments. The increased demand has left hospitals scrambling to prepare for the coronavirus' potential spread, the New York Times reports. For example, Northwell Health earlier this month activated its emergency operations center and other hospitals have started to build their inventories of medical face masks.

    Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security, said hospitals could easily deplete their inventories of masks, gowns, and gloves if there's an influx in patients. He said hospitals will "burn through their supplies very quickly."

    Bonnie Castillo, the executive director of National Nurses United, said, "Our concern is that there is inadequate planning and training [,] … basic staffing," and limited availability of supplies to protect nurses and patients from infections.

    However, many providers believe they are better prepared for an epidemic now than they were a few years ago. Barbara Rosen, an official with Health Professionals and Allied Employees, a New Jersey union, said, "We all went through the Ebola virus a couple of years ago. For this round, everything seems very prepared."

    New reports shed light on how the coronavirus spreads

    But there might be cause for concern, as new research published in JAMA on Friday sheds light on how the coronavirus progresses and spread.

    One study focused on 13 patients who received care at three hospitals in Beijing from Jan. 16 to Jan. 29. The cases mostly involved healthy young adults. The patients' median age was 34. While none of the patients died or experienced severe symptoms, the researchers warned that the findings should put an end to the notion that only older people can become infected with the virus.

    Meanwhile, another study shows just how quickly the virus can spread among patients and providers. For that study, researchers analyzed 138 patients who were admitted to Zhongnan Hospital of Wuhan University from Jan. 1 to Jan 28. The patients' ages ranged from 22 to 92—with 56 years being the median age.

    The researchers believe that 41% of the patients contracted the virus in the hospital, including 17 patients admitted for other conditions and 40 health care workers.

    One patient in particular infected at least 10 health care workers and four other patients with the new coronavirus. The researchers noted that the patient was admitted to the hospital for abdominal symptoms and the providers, not suspecting the individual had the coronavirus, placed the patient in a surgical ward with other patients.

    The researchers believe one reason the virus was able to spread so quickly was because patients who did ultimately have the virus at the time they were admitted did not present with the usual symptoms. The researchers estimated 10% of the patients did not initially report the usual signs of the coronavirus. Instead, the patients reported experiencing diarrhea and nausea.

    The researchers also noted that patients' symptoms of the virus progressed quickly from mild to severe. The researchers found the median time from when patients showed their symptoms and when they began to experience shortness of breath was five days. It took an additional two days to warrant hospitalization, and severe breathing trouble occurred on average within eight days, the researchers said.

    Overall, the researchers found about 26% of the 138 patients needed intensive care and the death rate among the patients was 4.3%.

    Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in an interview  with JAMA said the findings are a "heads up" to providers to carefully monitor their patients' symptoms (Morse, Healthcare Finance News, 2/7; Falconer, Axios, 2/9; Grady, New York Times, 2/7; Wang et al., JAMA, 2/7; Thielking, STAT News, 2/7; Abelson/Thomas, New York Times, 2/7; New York Times, 2/11; Hay, Reuters, 2/10).

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