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Impact of coronavirus in the U.S.

The Trump Administration announced on 3/13/20  aggressive actions and regulatory flexibilities to help healthcare providers and states respond to and contain the spread of 2019 Novel Coronavirus Disease (COVID-19). Public-health officials warned Americans that a U.S. outbreak of the new coronavirus (COVID-19) was not a matter of if, but when it would happen and how many people would have severe illness. On January 31 2020, Health and Human Services Secretary Alex M. Azar II declared COVID-19 a public health emergency (PHE) for the United States. The number of cases is being actively monitored by the Centers for Disease Control and Prevention (CDC)

Current scenario

The CDC recommends that for the next 8 weeks, organizers cancel or postpone in-person events that consist of 50 people or more throughout the U.S. to curb the spread of COVID-19. At this time, there is no vaccine to protect against COVID-19 and no medications approved to treat it. Non-pharmaceutical interventions would be the most important response strategy". 

As currently there is no vaccine to prevent coronavirus disease 2019 (COVID-19), the best way to prevent illness is to avoid being exposed to this virus, according to the CDC.

How can wound care and hyperbaric medicine clinicians leverage telemedicine to curb spread of COVID-19? 

1. Videoconferencing can help with early diagnosis of new COVID-19 cases

With the help of a telehealth system, providers at the West China Hospital of Sichuan University conducted the first remote diagnosis of coronavirus. The initiative will be expanded to other hospitals as well. 

Initial clinical manifestations of COVID-19 largely overlap those of the common cold or flu. When in doubt, wound and hyperbaric oxygen therapy (HBOT) patients presenting symptoms of cold or flu can connect with their clinician via telemedicine, prior to their in-person visit. With remote televisits, clinicians can screen these patients by gathering history and checking for signs of contagious illness without close contact with the patient. See CDC's criteria to guide evaluation of suspected cases of COVID-19. If COVID-19 is suspected, healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department (CDC’s Emergency Operations Center (EOC) at 770-488-7100). In addition, CDC provides instructions to direct patients for testing and quarantine.

2. Televisits allow patients in home care and isolation to continue to receive care 

Israel’s Sheba Medical Center in Tel Aviv unveiled the first known coronavirus telemedicine program to monitor people under investigation for COVID-19 and to treat those with the disease, according to The Jerusalem Post. According to the head of telemedicine services at Sheba, “By minimizing direct contact between the patients and medical personnel, we reduce the percentage risk of healthcare staff contacting the virus.” They plan on communicating with patients in home care and isolation at least twice a day. A telehealth-driven model could be expanded in the U.S. if coronavirus cases grow, as reported by HealthTech.

For patients with wounds in home care and isolation, clinicians can continue to provide weekly check-ins through televisits, and ensure their caregivers feel supported and patients are engaging in self-care to the extent they are able to. See CDC Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus (2019-nCoV)

3. Telemedicine allows wound and HBOT clinicians to protect themselves and ensure patients continue to receive care

We are used to hearing on every flight: "In the event of emergency, put your oxygen mask on first." The reason behind this is that we need to be alive and well in order to help others. With COVID-19, the same principle applies. Healthcare personnel are on the front lines of caring for patients with confirmed or possible infection with coronavirus disease 2019 (COVID-19) and therefore have an increased risk of exposure to this virus. CDC provides guidance on how clinicians can protect themselves. In addition, the ability to connect, evaluate and treat patients remotely whenever possible helps clinicians reduce risk of getting sick themselves, and ultimately allows clinicians to help more patients. 

Wound care and HBOT clinicians can take advantage of telemedicine to remotely see patients and to provide remote consultations to colleagues treating patients with wounds. In the U.S., the Centers for Medicare and Medicaid (CMS) and various private insurers provide reimbursement for several telemedicine modalities. See "What is new in 2019 for Telehealth and Telemedicine?" and "Interprofessional Internet Consultations with the WoundReference TeleVisit Tool"

Resources 

About the Authors

Elaine Horibe Song, MD, PhD, MBA
Dr. Song is a Co-Founder and Chief Executive Officer of WoundReference, Inc., a clinical and reimbursement decision support & telemedicine platform for wound care and hyperbaric clinicians. With a medical, science and business background, Dr. Song previously served as medical director for a regenerative medicine-focused biotech company in California, and for a Joint Commission International-accredited hospital network. Dr. Song also served as a management consultant for Kaiser Permanente, practiced as a plastic surgeon in private practice and academia, and conducted bench and clinical research in wound healing, microsurgery and transplant immunology. Dr. Song holds a position as Affiliate Professor, Division of Plastic Surgery, Federal University of Sao Paulo, and is a volunteer, Committee Chair of the Association for the Advancement of Wound Care. She has authored more than 100 scientific publications, book chapters, software registrations and patents.
Jeff Mize, RRT, CHT, UHMSADS
Jeff is a Principal Partner with Midwest Hyperbaric LLC and is the Co-founder and Chief Clinical Officer for Wound Reference. Jeff is a Registered Respiratory Therapist, a Certified Hyperbaric Technologist (CHT) by the National Board of Diving and Hyperbaric Medical Technology, a Certified Wound Care Associate (CWCA) by the American Academy of Wound Management. After receiving primary hyperbaric training from National Baromedical Services he trained as a UHMS Safety Director and is a UHMS Facility Accreditation Surveyor. He is the 2010 recipient of the Gurnee Award and the 2013 recipient of the Paul C. Baker Award for Hyperbaric Oxygen Safety Excellence. He has also served on the UHMS Board of Directors (2010-2015) In 2020, Jeff received "The Associates Distinguished Service award (UHMSADS). "This award is presented to individual Associate member of the Society whose professional activities and standing are deemed to be exceptional and deserving of the highest recognition we can bestow upon them . . . who have demonstrated devotion and significant time and effort to the administrative, clinical, mechanical, physiological, safety, technical practice, and/or advancement of the hyperbaric community while achieving the highest level of expertise in their respective field. . . demonstrating the professionalism and ethical standards embodied in this recognition and in the UHMS mission.”
Tiffany Hamm, BSN, RN, CWS, ACHRN, UHMSADS
An Advanced Certified Hyperbaric Registered Nurse and Certified Wound Specialist with expertise in billing, coding and reimbursement specific to hyperbaric medicine and wound care services. UHMS Accreditation Surveyor and Safety Director. Principal partner of Midwest Hyperbaric LLC, a hyperbaric and wound consultative service. Tiffany received her primary and advanced hyperbaric training through National Baromedical Services in Columbia South Carolina. In 2021, Tiffany received the UHMS Associate Distinguished Service Award
Cathy Milne, APRN, MSN, CWOCN-AP
Advanced Practice Wound, Ostomy Continence Nurse at Connecticut Clinical Nursing Associates Connecticut Clinical Nursing Associates American University
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