April 9, 2020

What the latest Covid-19 guidelines mean for health care workers

Daily Briefing

    As the number of U.S. cases from Covid-19, the disease caused by the new coronavirus, surpassed 400,000, CMS and CDC released new guidance intended to help providers prevent the virus' spread and ensure critical health care workers who are exposed to the virus can return to work more quickly.

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    US Covid-19 cases surpass 400K, deaths top 14K

    As of Thursday morning, U.S. officials had reported 429,264 cases of Covid-19 in the country—up from 397,754 cases as of Wednesday morning.

    Officials as of Thursday morning also had reported 14,820 U.S. deaths linked to the new coronavirus—up from 12,956 deaths reported as of Wednesday morning. On Wednesday, New Jersey and New York again reported their largest one-day increases in Covid-19 deaths that the states have seen thus far, at 275 and 799, respectively. In total, New Jersey has reported more than 1,500 Covid-19 deaths and New York has reported more than 6,000 deaths related to the new coronavirus thus far.

    CMS updates infection control guidance for providers

    On Wednesday, CMS released updated infection control guidance documents intended to help inpatient and outpatient facilities prevent the new coronavirus' spread and help hospitals quickly expand their capacity to isolate and treat Covid-19 patients. The guidance documents cover a range of topics, including alternate testing and treatment sites, cleaning and disinfection, drive-thru screenings, visitation limits, patient triage, screening and treatment, staffing, and telehealth.

    The documents also apply to a range of health care facilities, including critical access hospitals (CAHs), rural health clinics, federally qualified health centers (FQHCs), and more. For example, the updated guidance provides dialysis facilities with new instructions on how to protect immunocompromised patients with end-stage renal disease against the new coronavirus by allowing facilities to provide home dialysis training and support services. The guidance also allows facilities to establish Special Purpose Renal Dialysis Facilities (SPRDFs), or facilities that can be used to isolate vulnerable or infected patients.

    In addition, the updated guidance outlines how hospitals and CAHs can perform appropriate medical screening examinations at alternate, offsite screening locations to help prevent the spread of the new coronavirus. CMS in the updated guidance also recommends that ambulatory surgical centers, FQHCs, and other outpatient clinical facilities partner with hospitals to conserve and share critical resources.

    The guidance also revises some of CMS' earlier recommendations for hospitals, CAHs, and psychiatric hospitals on discharging Covid-19 patients to other care locations, screening and visitation restrictions for health care facilities, staff screening and testing, and return-to-work policies.

    CDC relaxes guidance to allow essential workers to return to work sooner

    Separately, CDC on Wednesday issued new guidance intended to allow essential workers, including health care workers, who have been exposed to the new coronavirus to return to work sooner.

    CDC's previous guidelines recommended that workers who had been exposed to the virus stay at home for 14 days before returning to work. However, under the new guidance, CDC says critical workers who have been exposed to the virus can return to work if they do not present any symptoms of Covid-19 and take additional protective measures such as wearing a mask, practicing social distancing, and cleaning and disinfecting their workspaces. CDC said such workers also should self-monitor for symptoms and undergo screenings by their employers. The new guidelines also recommend that employers increase air exchange in workplace rooms, increase the frequency of cleaning, and immediately send workers home if they begin feeling sick.

    CDC Director Robert Redfield said the agency issued the new guidelines because "[o]ne of the most important things we can do is keep our critical workforce working" (Axelrod, The Hill, 4/8; Millman, NBC New York, 4/9; King, FierceHealthcare, 4/8; Bean, Becker's Hospital Review, 9/8; CMS release, 4/8; Miller et al., Associated Press, 4/9; Sullivan, The Hill, 4/8; CDC interim guidance, accessed 4/9; New York Times, 4/9).

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