Editor's Note: This story was updated on June 19, 2020.
The next phase in fighting America's new coronavirus epidemic is suppression, ensuring infection rates are low enough that hospitals aren't overwhelmed, according to Stephen Parodi and five other leaders at Kaiser Permanente. Parodi and colleagues in a recent NEJM Catalyst piece outline eight strategies Kaiser is implementing to suppress new coronavirus infection rates and combat Covid-19 long-term.
A focus on suppression
The authors acknowledged that, as the United States begins to reopen nonessential businesses and ease social distancing measurers, cases of Covid-19, the disease caused by the new coronavirus will still occur. As such, it will be important to implement new strategies aimed at reducing future waves of Covid-19 cases—which can help to avoid overwhelming hospitals, the Kaiser leaders wrote.
"Society as a whole, and the health care and public health systems in particular, are embarking on an unprecedented task—to demonstrably reduce the effects of a pandemic without an immediately available vaccine," they wrote. "But if successful, we will save lives and preserve our communities for the future."
To do so, Parodi, EVP of the Permanente Federation and the national infectious disease leader at Kaiser, told FierceHealthcare that health systems in the United States "need a complete and comprehensive approach to suppress the virus."
8 strategies for suppressing Covid-19
Here are Kaiser's eight strategies for successful suppression of Covid-19 cases, according to the leaders.
1. Widespread testing programs
The authors wrote that widespread testing for symptomatic and asymptomatic patients infected with the new coronavirus, as well as individuals who've been exposed to the virus, is the "bedrock" of Kaiser's suppression strategy. While Kaiser ramps up its PCR testing capabilities it is using other indicators to identify potential cases of Covid-19, including patients contacting the health system through the call center and secure email messages with signs of cold, cough, and flu symptom; EHR data; patient symptom surveys; and other data that could "flag disease activity in a given locale."
2. Contact tracing
Contact tracing is "a foundational element of successful Covid-19 disease suppression," because it can help "to identify and reduce the risks of community transmission," the authors wrote.
According to the leaders, the key to developing a robust contact tracing program is maintaining "close partnerships with local public health agencies to detect early signs of resurgent infections and trigger responses for case finding, contact tracing, and home isolation."
Disrupting transmission in the home will also be key, the authors wrote. They noted that Kaiser is working "to ensure that infection-prevention practices, early identification of contacts, and testing of additional patients are carried out, whether the setting is a skilled nursing facility, a residential care facility, or a personal home."
3. Addressing the social determinants of health
America's Covid-19 epidemic "has starkly highlighted disparities in income, food security, and technologist access within communities," the authors wrote, adding that those gaps can make "[v]ulnerable populations … more susceptible to poor health care outcomes under the best of circumstances."
In response, health systems need "[p]roactive, cross-sector support" to address both the "clinical and social determinants of health," the leaders wrote. They noted that health systems should partner with advocacy groups to help the most vulnerable populations in their communities. Kaiser, for example, is collaborating with the National Health Care for the Homeless Council to increase Covid-19 prevention and treatment efforts among the homeless population.
4. Caring for patients in the home, if possible
The Covid-19 epidemic has led many people to be apprehensive about seeking care at hospital facilities because they fear potentially contracting the new coronavirus. As a result, innovation in virtual medicine has accelerated, including at-home patient monitoring, home care, and telehealth, the authors wrote.
Kaiser transitioned to a "virtual first" strategy in March, with telehealth visits accounting for 95% of all adult and family medical visits at Kaiser sites in Northern California. Using these virtual visits, providers can check on suspected or confirmed Covid-19 patients using biometric devices like thermometers and pulse oximeters to monitor the progression of their symptoms.
5. Preparing for a Covid-19 surge
Given that outbreaks of Covid-19 are still likely to occur, providers need to "remain vigilant to preserve excess care capacity for the foreseeable future," the leaders wrote.
They noted that Kaiser has developed detailed operational playbooks for both the mitigation of Covid-19 and potential surges, and has shared them online with other health systems. Kaiser also has developed a purchasing and inventory program to ensure a stable medical supply chain, the authors wrote, though they added that government intervention to ensure the nation's medical supply chain is stable will be essential.
6. Targeted and safe reopening of health care facilities
As areas in the United States begin to reopen, hospitals will need to decide when to resume scheduled surgeries and other non-Covid treatments that had been postponed because of the epidemic. This needs to be done with a "careful and graded approach … to ensure that we minimize the risks of potential Covid-19 infection as we address ongoing clinical needs," the authors wrote.
To make decisions about restarting non-Covid care, health systems should develop evidence-based guidelines and targeted risk stratification, the leaders wrote. They noted that Kaiser has deployed risk stratification tools that prioritize surgical and procedural care, and the health system is assessing whether tools it already uses—such as inpatient warning scores, which are used to identify patients at risk of deterioration at the hospital—can be repurposed to help providers care for Covid-19 patients.
7. Continuing research on the new coronavirus
More epidemiologic data is required for health systems to accurately plan for potential Covid-19 surges, the authors wrote. Specifically, predictive and surveillance models will be needed to identify outbreaks within local communities, according to the leaders.
More research on the pathophysiology of the new coronavirus will also be necessary, as will evaluations of therapies that could be effective at treating Covid-19 and the development and testing of potential vaccines against the new coronavirus, they wrote.
8. Communicating effectively
Patients need to be educated about Covid-19, especially if they're part of a contact investigation, the leaders wrote. Patients should be able to recognize symptoms of the disease and should be aware of ways they can protect themselves against contracting the new coronavirus, such as washing their hands, covering their coughs, and avoiding school and work while they're sick.
According to the leaders, Kaiser has utilized a variety of strategies to educate patients about Covid-19, including websites, handouts, text messages, call center scripts, and emails (Parodi et. al., NEJM Catalyst, 6/8; Minemyer, FierceHealthcare, 6/9).