Home Guidelines & Resources COVID-19 (coronavirus)

COVID-19 (coronavirus)

New Content in Brief: March 27, 2020

  • Curtis N. Sessler, MD, FCCP, examines the causes of hypoxemic respiratory failure; reviews the clinical features and diagnosis; and explains management strategies for acute lung injury, including mechanical ventilation. CHEST e-Learning Modules from the Experts
  • The CHEST COVID-19 Task Force curates key emerging research deemed to be helpful to clinicians on the front lines. Articles are listed by category in reverse order of publication date, are freely available, and link to the publication site. This list will be maintained regularly. Suggestions for consideration can be sent to COVID-19@chestnet.org. COVID-19: Research
  • Martha Billings, MD, MSc and Renea Jablonski, MD compare their experiences in managing outpatient pulmonary clinics as they transition to remote telemedicine care (Recorded March 19, 2020). Advice From the Front Lines
  • CHEST Articles
    • Indicators and Triggers for Potential Movement to Crisis
    • Surge Priority Planning COVID-19: Critical Care Staffing and Nursing Considerations
    • Essential Institutional Supply Chain Management in the Setting of COVID-19
  • Recognizing the importance of staying connected with the community, our CHEST front-line clinicians share their experiences and plans for the future as they navigate the COVID-19 pandemic. CHEST Community Experiences
  • Dr. Narasimhan discusses her experience ramping up to manage patients with COVID-19, with Bhakti Patel, MD (Recorded March 16, 2020). Advice From the Front Lines
  • COVID-19 Task Force update from CHEST President Stephanie M. Levine, MD, FCCP. COVID-19 Task Force
  • For more information on the expansion of telehealth services, please review the below guidelines put together by CHEST's Joint Clinical Practice Committee. Practice Management Resources

CHEST GUIDELINE

CHEST Guidelines

CHEST Guideline

Care of the Critically Ill and Injured During Pandemics and Disasters

Natural disasters, industrial accidents, terrorist attacks, and pandemics all have the capacity to result in large numbers of critically ill or injured patients. This CHEST consensus statement series provides suggestions for all of those involved in a disaster or pandemic with multiple critically ill patients, including front-line clinicians, hospital administrators, professional societies, and public health or government officials.

Guideline Summary

Duration: 43 min
Moderator: D. Kyle Hogarth, MD, FCCP, Podcast Editor, CHEST
Participants: Michael D. Christian, MD, FRCPC, FCCP; Niranjan Kissoon, MBBS, FRCPC; Christian E. Sandrock, MD, MPH, FCCP

ADVICE FROM THE FRONT LINES

The following are firsthand short interviews with CHEST-member clinicians who are on the COVID-19 front lines. We will continue to add more interviews as they become available.

NEW

Title: Managing Clinic in the Time of COVID-19
Date: March 19, 2020
Guest Speakers: Dr. Martha Billings and Dr. Renea Jablonski
Staff: Christina Lorenzo

Martha Billings, MD, MSc and Renea Jablonski, MD compare their experiences in managing outpatient pulmonary clinics as they transition to remote telemedicine care (Recorded March 19, 2020).

  • Transitioning from in-person clinic to telemedicine
  • Triaging patients in-clinic with suspected COVID-19 symptoms and reducing staff exposure
  • Treatment management of outpatients with COVID-19
  • Staffing logistics during transition and quarantines
  • Recommendations to peers to help prepare their clinics

Key Takeaway: Be flexible and forward-thinking to prepare your clinic for the remote transition, surges in patient numbers, and staff shortages and safety.

NEW

Title: Managing Patient Ramp-Up in the Time of COVID-19
Date: March 16, 2020
Guest Speaker: Dr. Mangala Narasimhan

Dr. Narasimhan discusses her experience ramping up to manage patients with COVID-19, with Bhakti Patel, MD (Recorded March 16, 2020)

  • Use PPE and isolation precautions for any patient presenting with respiratory symptoms – not doing so risks viral spread.
  • Patients whose condition is deteriorating rapidly pass quickly through the phase when HFNC or NIPPV can be helpful. Consider moving from NRB face mask directly to intubation.
  • Most intubated patients respond well to PEEP; lungs are relatively
  • compliant compared with other causes of ARDS. Recovery is prolonged.
  • Plan now for short supplies, tired and inadvertently exposed and quarantined staff, and what rooms seriously and critically ill patients will occupy.

Key takeaway: however many patients you’re expecting, double it. And, have a plan for protecting personnel during intubations.

CHEST COMMUNITY EXPERIENCES

NEW

Recognizing the importance of staying connected with the community, our CHEST front-line clinicians share their experiences and plans for the future as they navigate the COVID-19 pandemic.

Steven Q. Simpson, MD, FCCP

CHEST President-Elect and COVID-19 Task Force Chair
KU Medical Center

CLINICAL RESOURCES

Personal Protective Equipment for COVID-19

CHEST Articles

  • Management of Patients with COVID-19 Infection
    Ryan C. Maves, MD, FCCP; and Vikram Mukherjee, MD
    This brief article describes known factors related to the transmission of COVID-19, its epidemiologic and clinical factors, and offers guidance on patient management and the protection of healthcare workers. (Written March 11, 2020)
  • Indicators and Triggers for Potential Movement to Crisis Care
    John L. Hick, MD; and Dan Hanfling
    This article provides a refresher on transition to crisis care standards of care, often necessitated in pandemics, and offers strategies to employ in particular situations. (March 19, 2020)
  • Surge Priority Planning COVID-19: Critical Care Staffing and Nursing Considerations
    Anne Marie Martland, MS, ACNP-BC; Meredith Huffines, MS, BA, RN; and Kiersten Henry, DNP, ACNP-BC
    This article addresses nursing leadership and administrative considerations, strategies for optimizing staffing resources, and maintaining staff safety and resilience. (March 19, 2020)
  • Essential Institutional Supply Chain Management in the Setting of COVID-19
    Pritish K. Tosh, MD; and Lisa Burry, PharmD
    As the COVD-19 pandemic evolves, supply chain disruptions for medical supplies and medications are anticipated. As a result, health-care facilities must examine and optimize their supply chain management in order to detect and respond to supply chain disruptions. (March 19, 2020)

COVID-19 Clinical Trial

  • For individuals with high-risk exposure to COVID-19, there is a trial at the University of Minnesota of hydroxychloroquine as post-exposure prophylaxis. It is open to health-care workers from "across the United States" and others with a high-risk exposure. Only asymptomatic individuals with high-risk exposure are eligible, within 3 days of the exposure. If you think you might qualify, you can email covid19@umn.edu.

    For additional info: https://med.umn.edu/news-events/covid-19-clinical-trial-launches-university-minnesota

Additional Resources


World Health Organization (WHO)
For the latest situation updates regarding COVID-19, including data and technical guidance, please visit the World Health Organization.


Centers for Disease Control and Prevention (CDC)
For updated information and guidance on COVID-19 including how to protect yourself and other resources for the community, please visit the CDC.


John Hopkins University of Medicine
For daily updates for the John Hopkins community on health and well-being as it relates to COVID-19, please vist John Hopkins University.


Mayo Clinic

PRACTICE MANAGEMENT RESOURCES

CPT® Code and Description

The resources below provide important information COVID-19 related CPT® codes and descriptions. The new coding guidelines are effective immediately and will be standard across the US health system. ICD-10-CM coding guidelines for encounters related to coronavirus are also available. Check the American Medical Association for updated information related to flexible CMS and regulatory flexibility during COVID 19.

Medicare Telehealth Expanded Coverage

Through the Centers for Medicare & Medicaid Services (CMS), the Trump Administration has announced the expansion of Medicare telehealth coverage, effective March 6, 2020. Included below is an important fact sheet and FAQs regarding this expanded coverage.


NEW

For more information on the expansion of telehealth services, please review the below guidelines put together by CHEST's Joint Clinical Practice Committee.

CHEST Task Force

Stephanie Levine

NEW

CHEST Task Force

COVID-19 Task Force Update from CHEST President Stephanie M. Levine, MD, FCCP

During this difficult time, we want to thank you for being on the front lines of the COVID-19 pandemic. CHEST is dedicated to providing our community with the most accurate, up-to-date information as we work through this health crisis together. To help in the fight, I have asked Steven Q. Simpson, MD, FCCP, to lead a task force made up of CHEST experts across our NetWorks in Chest Infections, Critical Care, and Disaster Response and Global Health. This task force is helping to ensure that we are delivering the educational resources that you need during this unprecedented time. While we recognize that the situation is evolving daily, this group is working to ensure that our online resources are maintained and updated to provide meaningful and complementary guidance to that emerging from the CDC and from your local settings. Please keep us apprised of your needs. We welcome input and ask that you contact us via COVID-19@chestnet.org to tell us how we can best support you.

CHEST E-LEARNING MODULES FROM THE EXPERTS

Acute Respiratory Distress Syndrome (ARDS)

Jason Poston, MD, discusses the definition of ARDS, how to diagnose a patient with ARDS, and treatment paths.

Hypoxemic Respiratory Failure

Curtis N. Sessler, MD, FCCP, examines the causes of hypoxemic respiratory failure; reviews the clinical features and diagnosis; and explains management strategies for acute lung injury, including mechanical ventilation.

Pneumonia

Kathryn A. Hibbert, MD, describes the different types of pneumonia, diagnostic strategies to consider, risk factors for drug resistance, and approaches to treating patients.

Shock

Krysta Wolfe, MD, teaches the different shock evaluation algorithms based on patient’s shock type and management techniques for patients with shock.

Shock, Sepsis, and Hemodynamic Monitoring

Steven Simpson, MD, FCCP, discusses the causes, diagnosis, and treatment of shock and sepsis and evaluates the assessment of the critically ill patient with the use of hemodynamic monitoring.




Media Resources

Searching for a subject matter expert to speak with you for an article or other media on COVID-19? Need vetted, reliable data for your story? Access to the journal CHEST? We can help. Please contact media@chestnet.org to speak with our team of experts.