COVID-19: Updates and Resources

New Content in Brief: May 20, 2020

  • Now Available! COVID-19 Journal Club Advice From the Front Lines
  • CHEST offers critical care procedures for non-intensivists being tasked to take care of ICU patients during the COVID-19 pandemic. Clinical Resources
  • Cardiovascular Disease, Drug Therapy, and Mortality in COVID-19. Research
  • S M Abdullah Al Mamun, MD, MBBS, FCCP, discusses how they treated a patient from the start as a suspected COVID-19 case, taking full precautions during treatment. Voices from the Community

VOICES FROM THE COMMUNITY

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.

To submit a video, please visit our Voices from the Community submission form.

Gretchen R. Winter, MD

University of Alabama at Birmingham

Salman Ali, MBBS

Pakistan

S M Abdullah Al Mamun, MD, MBBS, FCCP

Evercare Hospitals , Dhaka, Bangladesh

Sabiha Raoof, MBBS, FCCP

Medisys Health Network

Vincent Gould, APRN-BC

UT Health San Antonio, Pulmonary/Critical Care Division

Nneka O. Sederstrom, PhD, MPH, MA, FCCP

Children's Minnesota

Ihtzaz Bashir Chaudary, III, MBBS

Aziz Bhatti Teaching Hospital, Gujrat, Pakistan

Candace A Huebert, MD, FCCP

University of Nebraska Medical Center
Omaha, Nebraska
 

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


Updated Recommendations for COVID-19 PPE

  • This handy infographic displays updated PPE recommendations for usage with patients who test positive or are suspected positive for COVID-19. Download now!
    Updated Recommendations for COVID-19 PPE

Code Blue Steps During Pandemic

  • CHEST offers a code blue protocol developed from institutional practices that have evolved in the time of COVID, designed to ensure delivery of the best possible care for patients, while protecting providers.
    Code Blue Steps During COVID-19 Pandemic

Ultrasound Cleaning Protocol

  • View general procedures for the cleaning and disinfection of ultrasound equipment.
    Code Blue Steps During COVID-19 Pandemic

What is Acute Respiratory Distress Syndrome (ARDS)?

  • CHEST offers a clinical overview of Acute Respiratory Distress Syndrome (ARDS) including diagnostic criteria.
    What is ARDS?

Multisystem Inflammatory Syndrome in Children

  • COVID-19 had been thought to spare children, but a recently identified Multisystem Inflammatory Syndrome is causing critical illness in children up to 2-4 weeks following a SARS-CoV-2 infection.
    Pediatric Multisystem Inflammatory Syndrome infographic

Airway Management

All three documents provide consensus expert opinion from the CHEST Difficult Airway Management faculty members for teams conducting emergency airway management (endotracheal intubation) for suspected or confirmed COVID-19 patients. These documents are adapted from the Difficult Airway Management course materials, highlighting considerations in balancing effectiveness and safety of the procedure for patients and the health-care team.

CHEST Emergent Airway Management for Suspected or Confirmed COVID-19 Patients: Provides equipment, personnel, and planning considerations for ICU and airway team leaders who are planning for or engaged in airway management of COVID-19 patients.

CHEST APPROACH to Airway Management- COVID-19 Highlights: Adapts the CHEST APPROACH framework for difficult airway management with key considerations for procedural safety in the COVID-19 setting. Airway teams can use the APPROACH framework to create a shared mental model of the procedure.

CHEST Airway Checklist with APPROACH with COVID-19 Highlights: A companion checklist for the CHEST APPROACH framework for difficult airway management. A team member positioned outside of the room can manage the checklist to support the team's ability to be prepared and maintain situational awareness.

Focused Lung and Cardiac Ultrasound Exams in COVID-19 Patients

A daily lung and cardiac ultrasound exam is performed on COVID-19 patients. Four lung zones that roughly correspond with the upper, middle (or lingula), and lower lobes are examined on the anterior, lateral, and posterior chest walls, respectively. The lung findings are coded with the highest number in each zone as normal (0), discrete B-lines (1), fused B-lines (2), subpleural consolidations (3), or lobar consolidation (4). At least one cardiac view, usually the parasternal long-axis view, is obtained daily to assess left ventricular systolic function. Any suspected abnormal findings warrant obtaining additional cardiac views for further investigation. The summary of findings sheet (page 2) can be laminated, placed in the patient’s room, and updated daily. The daily exam tracking sheet (page 3) is for clinicians to keep track of their patients’ findings while rounding.


COVID-19 Clinical Summary


COVID-19: ICU for the Non-Intensivist


COVID-19 Precautions During Airway Management


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

CHEST Articles

  • Currently Available and Emerging Therapies for COVID-19
    Kelly M. Pennington, MD; and  Eva M. Carmona, MD
    This article covers therapies and medications currently in use or under trial for the treatment of patients with COVID-19. (March 30, 2020)
  • 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. (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)

Additional Resources


World Health Organization (WHO)
WHO offers international guidance on the COVID-19 pandemic, including situation reports, research updates, and strategic preparedness information.


Centers for Disease Control and Prevention (CDC)
The CDC’s COVID-19 webpage for health-care professionals features information on clinical care, infection control, staff training, and more.


Johns Hopkins University COVID-19 Case Tracker
This dashboard from the Johns Hopkins University Center for Systems Science and Engineering provides a regularly updated map of confirmed COVID-19 cases and deaths around the world.

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.

CARES ACT Provider Relief Fund

Congress appropriated $100 billion to reimburse providers for lost revenues/increased expenses due to COVID-19. Funds are being distributed by the Health Resources Service Administration (HRSA).

The initial $30 billion total has been distributed to health-care providers over the last several weeks. Payments were sent directly, and providers were not required to engage in any activity/application.

The next phase of the Provider Relief Fund ($50 billion) is now available via the Provider Relief Application Portal in the general distribution phase. This distribution will have requirements, including submission of year-over-year revenue data to demonstrate the impact of COVID-19 on practice revenue. In the event certain conditions are met, these funds do not need to be repaid, but it will be essential to separately account for expenses for which received funds will be used. The 2019/2020 revenue loss must equal or exceed the amount of Provider Relief Funds received. Learn more and apply.


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.


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


CMS Issues Interim Final Rule

On Thursday, April 30, 2020, CMS released a new Interim Final Rule . During the COVID-19 Public Health Emergency, the Interim Final Rule makes several new, important temporary changes to Medicare regulations and payments. One important change retroactively (to March 1, 2020) increased payments for telephone-only visits to established patients:

These telephone codes may be used when addressing a new or old problem for established patients, and the time accrued includes the billing provider total time throughout a 7-day period, including review of chart, records, images; and communicating with the patient. There should not be another patient encounter for 7 calendar days before or after the telephone visit.

In addition, the new Interim Final Rule now allows attending physicians at teaching institutions providing supervision to report for telephone (using 99441-99443) or video (using 99212-99215) telemedicine encounters by residents, when the supervision is provided immediately after the resident encounter, rather than during the telephone or video visit.

A CMS press release about the rule is available at https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid.

CHEST Task Force

In early March 2020, CHEST President Stephanie Levine, MD, FCCP, 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 to ensure CHEST properly supports our community in this time of need. Through the development of educational resources and advice, this group aims 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.

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Steven Simpson, MD, FCCP

COVID-19 Task Force, Chair
Board of Regents, President-Elect

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Christopher Carroll, MD, FCCP

Critical Care NetWork, Chair
Social Media Work Group, Co-Chair

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James Geiling, MD, MPH, FCCP

Disaster Response and Global Health, Chair

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Holly Keyt, MD, FCCP

Chest Infections NetWork, Vice-Chair

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Stephanie Levine, MD, FCCP

Board of Regents, President

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Ryan Maves, MD, FCCP

Disaster Response and Global Health, Vice-Chair

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Septimiu Murgu, MD, FCCP

Education Committee, Chair

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Marcos Restrepo, MD, PhD, FCCP

Chest Infections, Chair




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.






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