Coronavirus disease 2019 (COVID-19) has been identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China. There are confirmed cases in New Hampshire. Caregivers in home care and hospice are being urged to continue with standard infection control precautions to limit the spread of the virus in the community.
CMS Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak
CMS announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk.
- CMS Fact Sheet
- CMS FAQs document
- Office of Professional Licensure and Certification,Guidance on Telehealth during the COVID-19 State of Emergency.
- New Hampshire Telehealth Emergency Order #8
- Note: Our current analysis is that the expansion of telehealth does not apply to the hospice face to face requirement.
New Hampshire: Temporary expansion of access to Telehealth Services to protect the public and health care providers.
“Ensuring Granite Staters can receive quality health care without having to increase their exposure to COVID-19 is important,” said Governor Chris Sununu. “This order will ensure health care practices can continue.” Emergency Order #8 applies to “all medical providers including, but not limited to those professions licensed, certified or registered by the Office of Allied Health Professions (PTs, OTS), Board of Medicine, Board of Nursing (RNs, LPNs, LNAs)…” Order #8 requires all insurance carriers, NH Medicaid and MCOs to ensure that payments of rates to in-network providers for services delivered via telehealth are not lower than rates established by the Carrier for in person visits.
- Telehealth includes all modes of telehealth:
- audio-only or
- other electronic media
Health care providers across New Hampshire are adjusting to a new reality. They’re also preparing for an even bleaker possible future – one that includes a surge in patients requiring critical care as the virus continues to spread, and supplies of N95 respirators running low. Refer to the existing CDC guidelines which recommend a combination of approach to conserve supplies while safeguarding health care workers in such circumstances.
More on the Disease
Coronavirus Information from Dr. Hilary Babcock Dr. Hilary Babcock, an infectious disease specialist at Washington University School of Medicine and BJC’s director of infection prevention, shares some important information about coronavirus.
Prevention Steps for Caregivers and Household Members
If you live with, or provide care at home for, a person confirmed to have, or being evaluated for, MERS-CoV infection, you should:
- Make sure that you understand and can help the person follow the healthcare provider’s instructions for medication and care. You should help the person with basic needs in the home and provide support for getting groceries, prescriptions, and other personal needs.
- Have only people in the home who are essential for providing care for the person.
- Other household members should stay in another home or place of residence. If this is not possible, they should stay in another room, or be separated from the person as much as possible. Use a separate bathroom, if available.
- Restrict visitors who do not have an essential need to be in the home.
- Keep elderly people and those who have compromised immune systems or certain health conditions away from the person. This includes people with chronic heart, lung or kidney conditions, and diabetes.
- Make sure that shared spaces in the home have good air flow, such as by an air conditioner or an opened window, weather permitting.
- Wash your hands often and thoroughly with soap and water for at least 20 seconds. You can use an alcohol-based hand sanitizer if soap and water are not available and if your hands are not visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.
- Wear a disposable facemask, gown, and gloves when you touch or have contact with the person’s blood, body fluids and/or secretions, such as sweat, saliva, sputum, nasal mucus, vomit, urine, or diarrhea.
- Throw out disposable facemasks, gowns, and gloves after using them. Do not reuse.
- Wash your hands immediately after removing your facemask, gown, and gloves.
- Avoid sharing household items. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with a person who is confirmed to have, or being evaluated for, MERS-CoV infection. After the person uses these items, you should wash them thoroughly (see below “Wash laundry thoroughly”).
- Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day. Also, clean any surfaces that may have blood, body fluids and/or secretions or excretions on them.
- Read label of cleaning products and follow recommendations provided on product labels. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves or aprons and making sure you have good ventilation during use of the product.
- Use a diluted bleach solution or a household disinfectant with a label that says “EPA-approved.” To make a bleach solution at home, add 1 tablespoon of bleach to 1 quart (4 cups) of water. For a larger supply, add ¼ cup of bleach to 1 gallon (16 cups) of water.
- Wash laundry thoroughly.
- Immediately remove and wash clothes or bedding that have blood, body fluids and/or secretions or excretions on them.
- Wear disposable gloves while handling soiled items. Wash your hands immediately after removing your gloves.
- Read and follow directions on labels of laundry or clothing items and detergent. In general, wash and dry with the warmest temperatures recommended on the clothing label.
- Place all used gloves, gowns, facemasks, and other contaminated items in a lined container before disposing them with other household waste. Wash your hands immediately after handling these items.
- Monitor the person’s symptoms. If they are getting sicker, call his or her medical provider and tell him or her that the person has, or is being evaluated for, MERS-CoV infection. This will help the healthcare provider’s office take steps to keep other people from getting infected. Ask the healthcare provider to call the local or state health department.
- Caregivers and household members who do not follow precautions when in close contact2 with a person who is confirmed to have, or being evaluated for, MERS-CoV infection, are considered “close contacts” and should monitor their health. Follow the prevention steps for close contacts below.
If you have had close contact2 with someone who is confirmed to have, or being evaluated for, MERS-CoV infection, you should:
- Monitor your health starting from the day you were first exposed to the person and continue for 14 days after you were last exposed to the person. Watch for these signs and symptoms:
- Fever3. Take your temperature twice a day.
- Shortness of breath.
- Other early symptoms to watch for are chills, body aches, sore throat, headache, diarrhea, nausea/vomiting, and runny nose.
- If you develop symptoms, follow the prevention steps described above, and call your healthcare provider as soon as possible. Before going to your medical appointment, call the healthcare provider and tell him or her about your possible exposure to MERS-CoV. This will help the healthcare provider’s office take steps to keep other people from getting infected. Ask your healthcare provider to call the local or state health department.
- If you do not have any symptoms, you can continue with your daily activities, such as going to work, school, or other public areas.
You are not considered to be at risk for MERS-CoV infection if you have not had close contact2 with someone who is confirmed to have, or being evaluated for, MERS-CoV infection. CDC advises that people follow prevention steps to help reduce their risk of getting infected with respiratory viruses, like MERS-CoV. For more information, see CDC’s MERS Prevention.
This course provides information on what facilities should be doing to be prepared to respond to a case of an emerging respiratory virus such as the novel coronavirus, how to identify a case once it occurs, and how to properly implement IPC measures to ensure there is no further transmission to HCW or to other patients and others in the healthcare facility.
- For this guidance, a person being evaluated for MERS (considered a person under investigation) is someone with the with the following characteristics:
- Fever3 AND pneumonia or acute respiratory distress syndrome (based on clinical or radiologic evidence) AND EITHER:
- history of travel from countries in or near the Arabian Peninsula4 within 14 days before symptom onset, OR
- close contact2 with a symptomatic traveler who developed fever and acute respiratory illness (not necessarily pneumonia) within 14 days after traveling from countries in or near the Arabian Peninsula4, OR
- a member of a cluster of patients with severe acute respiratory illness (e.g., fever3 and pneumonia requiring hospitalization) of unknown etiology in which MERS-CoV is being evaluated, in consultation with state and local health departments,
- Fever3 AND symptoms of respiratory illness (not necessarily pneumonia; e.g., cough, shortness of breath) AND being in a healthcare facility (as a patient, worker, or visitor) within 14 days before symptom onset in a country or territory in or near the Arabian Peninsula4 in which recent healthcare-associated cases of MERS have been identified.OR
- Fever3 OR symptoms of respiratory illness (not necessarily pneumonia; e.g. cough, shortness of breath) AND close contact2 with a confirmed MERS case while the case was ill.
- Fever3 AND pneumonia or acute respiratory distress syndrome (based on clinical or radiologic evidence) AND EITHER:
- Close contact is defined as a) being within approximately 6 feet (2 meters), or within the room or care area, of a confirmed MERS case for a prolonged period of time (such as caring for, living with, visiting, or sharing a healthcare waiting area or room with, a confirmed MERS case) while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); or b) having direct contact with infectious secretions of a confirmed MERS case (e.g., being coughed on) while not wearing recommended personal protective equipment. See CDC’s Interim Infection Prevention and Control Recommendations for Hospitalized Patients with MERS. Data to inform the definition of close contact are limited; considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with MERS (e.g., coughing likely increases exposure risk). Special consideration should be given to those exposed in healthcare settings. For detailed information regarding healthcare personnel (HCP) please review CDC Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Middle East Respiratory Syndrome (MERS-CoV) Exposure. Transient interactions, such as walking by a person with MERS, are not thought to constitute an exposure; however, final determination should be made in consultation with public health authorities.
- Fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain medications. Clinical judgement should be used to guide testing of patients in such situations.
- Countries considered in the Arabian Peninsula and neighboring include: Bahrain; Iraq; Iran; Israel, the West Bank and Gaza; Jordan; Kuwait; Lebanon; Oman; Qatar; Saudi Arabia; Syria; the United Arab Emirates (UAE); and Yemen.