The Centers for Disease Control and Prevention (CDC) is promising more information to help clinicians treat and care for patients with coronavirus.
“It’s very important clinicians have the information they need to make the best decisions possible for their patients,” Nancy Messonnier, M.D., director of the CDC’s National Center for Immunization and Respiratory Diseases, said during a media call Tuesday to provide an update on the response to the virus known as COVID-19.
The Clinician Outreach and Communication Activity call is expected to attract thousands of listeners as healthcare professionals try to stay current with the ever-changing coronavirus situation. The last call, held in late January at the start of the coronavirus outbreak, had more than 10,000 listeners, Messonnier said.
Clinicians can sign into the call where the CDC promises information on what they can do to prepare for COVID-19, including how to identify patients suspected of having the virus, apply infection prevention and control measures, assess risks for exposures, optimize the use of personal protective equipment supplies and manage and care for patients who are hospitalized or who remain at home.
In the U.S., nine people have died in the Seattle area, as two earlier deaths in the state were tied to the virus. There have now been more than 115 cases of coronavirus in more than a dozen states.
Vice President Mike Pence announced Tuesday that the CDC was lifting all restrictions on testing for coronavirus and would be releasing new guidelines for testing people. Under the new guidance, any American can be tested if a doctor suspects the virus, according to news reports.
The CDC previously advised doctors to only test patients if they had known exposure to someone with the virus, travel history to an affected region or symptoms of a serious respiratory illness.
“The situation today is evolving and dynamic,” Anne Schuchat, principal deputy director at the CDC, said Tuesday as she testified before the Senate Committee on Health, Education Labor and Pensions on the coronavirus outbreak. In two months, COVID-19 has gone from a cluster of pneumonia cases in one city in China to affect over 70 countries and territories with an estimated 90,000 cases worldwide and about 3,000 deaths.
The U.S. is now seeing community-transmitted spread of the disease in a few areas of the country, meaning an infected patient has not traveled to an area of the world where they might have been exposed to the virus or had contact with someone known to have the virus. Health officials, therefore, don’t know the original source of the virus.
The latest survey of U.S. physicians found confidence in coronavirus preparedness had dropped over a four-week period. In a Feb. 26-27 survey by InCrowd, only 16% of doctors stated they thought the U.S. government was taking strong precautions to prevent the spread of the virus, a decline from 35% in late January and early February. Only 14% said they felt prepared to treat a patient who potentially had COVID-19, down from 25%. Concerns by physicians over the virus tripled in a month, with 29% expressing concerns, up from 9%
“We’re definitely observing growing frustration from our physicians as we monitor this important issue,” said Daniel S. Fitzgerald, InCrowd CEO and president. “Respondent confidence around preparedness of the physicians themselves has declined since our first wave, as well as preparedness related to their facilities, and their views of the general preparedness of the country.”
Doctors have mixed opinions about whether they have adequate information about coronavirus.
"I'd like to see fewer politicians talking about coronavirus and more CDC and WHO (World Health Organization) experts talking about it," said Ed Hellman, M.D., an orthopedic surgeon in Indianapolis. As a surgeon, he won't be on the front lines of treating patients, but his impression from other doctors is there is not a lot of good information available about how physicians should care for patients with the virus.
Aaron Hattaway, M.D., a Florida radiologist, worries the healthcare system will be overwhelmed if the coronavirus continues to spread. “All we can do is gear up,” he said. Because a CT scan can also be used to diagnose coronavirus, Hattaway said he has advised other radiologists in his practice what to look for if a test is ordered by an emergency room physician.
Stephanie Page, M.D., a hospitalist at Mount Auburn Hospital in Cambridge, Massachusetts, said she expects the coronavirus outbreak will get worse but that the Beth Israel Lahey Health system that owns the hospital has worked hard to provide regular updates to clinicians there.
It is good news that the CDC has relaxed restrictions on who can be tested for the virus, she said. “I’m nervous. I think it’s coming. I don’t know how bad it’s going to be on the East Coast or in the entire U.S.,” she said.
Some healthcare organizations have expressed concern about the global supply chain for supplies including personal protective equipment (PPE) such as masks, gowns and gloves to protect clinicians treating patients with the virus.
“Our priority is making sure that the highest risk health exposure healthcare workers have the appropriate PPE and looking at ways other folks might be protected,” said the CDC’s Messonnier.
At Mount Auburn, a clinician who suspects a patient might have the virus is advised to call an infection prevention team, which is available 24 hours, to do a risk assessment and decide whether there is a need for testing, Page said. “There is stewardship going on in Massachusetts hospitals,” said Page, as institutions try to conserve supplies of PPE. Clinicians now have to ask for certain types of masks at the nurses’ station whereas before they were readily available.
Hattaway says he is optimistic there will be enough protective equipment. “I like to think the hospitals are going to get the resources to protect people,” he said.
In an effort to do that, the Food and Drug Administration and the CDC announced they will allow a wider range of respiratory protective devices to be used in healthcare settings.