Here are key takeaways from KET’s April 24 program on the spread of coronavirus-19 disease, called COVID-19, in Kentucky. The show examined steps health care providers are taking to re-open businesses and care for patients while taking precautions for the coronavirus, and also provided an update on testing in Kentucky.
Guidelines for Re-Opening Hospitals, Clinics, and Dentist Offices
Starting the week of April 27, Kentucky’s health care sector launched Phase One of its plan to re-open hospitals and clinics to non-emergency/non-urgent outpatient services. Services covered in Phase One include diagnostic radiology, laboratory services, physical therapy, chiropractic, dentistry, oral surgery, and optometry.
On May 6, Phase Two of the re-opening begins, allowing services including cataract removal, biopsy, laparoscopy, and endoscopy. All patients getting these procedures will be tested for COVID-19 beforehand.
Phase Three begins on May 13 and allows medical providers to resume non-emergency/non-urgent inpatient surgery and procedures at 50% of their pre-COVID-19 volume. Services covered include joint replacement, hysterectomy, and tonsillectomy.
Lastly, Phase Four starts on May 27 and increases inpatient surgeries and procedures to a volume determined by each facility.
According to Dr. Brent Wright, MD, president of the Kentucky Medical Association, and Dr. Mark Moats, DMD, president of the Kentucky Dental Association, Kentucky’s health care providers are prepared to meet the challenges of performing operations and other procedures while meeting heightened safety protocols. Key takeaways:
- Telemedicine will be relied upon for patient-physician interaction
During the past several weeks while most in-person appointments were halted, the use of telemedicine increased and proved to be a valuable substitute for Kentuckians with medical needs that required immediate attention.
“Telemedicine has been a technology available for years, but it really hasn’t had the focus of use as it’s seen in this pandemic,” Dr. Wright says. He believes that telemedicine will continue to be used over the coming months for scheduling patient-physician appointments whenever possible since social distancing is still recommended.
- Acquiring personal protective equipment (PPE) will require cooperation and assistance within the state medical community
Dr. Moats says within Kentucky, dentists have committed to share PPE whenever possible and to acquire PPE from businesses who have changed their production to help medical providers. These measures help dentists and staff continue to provide care using highly sanitary methods that are required in a close, in-person setting.
“Dentistry – this is the world we live in,” Dr. Moats says. “We begin our training in that foundation, and as we move forward we’ve instituted some of the best practices that we’ve learned during this recent crisis to begin establishing a safe foundation to welcome our patients and our dental teams back to our practice.”
- Physicians will rely on their knowledge and expertise to re-open and adapt to a new normal
“Physicians have been trained in infectious disease and in infection control,” Dr. Wright says. “COVID-19, because of the way this virus transmits, forces us to re-do some of the ways we deliver care. You have to be very careful about where the patient moves, you have to practice social distancing in the waiting room. That may sound easy, but you really have to control the process.”
Since patients aren’t allowed to sit side by side in waiting rooms anymore, Dr. Wright says that text messaging has been used by clinic staff to contact patients while they wait in their cars, letting them know when a room is available and then providing PPE and taking their temperature once they enter the building.
“Offices have had time to look at the research, to look at the best evidence and put those in their workflows so we can welcome patients back into our practices during this week and in the weeks ahead,” he says.
Ramping Up COVID-19 Testing in Kentucky
Dr. Steven Stack, Kentucky’s commissioner of public health, says that state and local health departments, along with medical care providers, are increasing testing for the coronavirus. More robust testing will help officials determine the right steps to take in order to re-open Kentucky businesses and public offices. Key takeaways from his discussion:
- How does drive-through testing work?
Drive-through testing for COVID-19 is offered by several different providers, the most prominent being through Kroger Health in agreement with Kentucky’s public health department. “You register for the location,” Dr. Stack says, “and you’re given a time and a place to be. As I’m told, it’s a pretty efficient process – you drive through, you get your specimen. It’s self-collected, they supervise you and tell you what to do.”
After a person drops off their specimen, they receive an email notification one to two days later with results, Dr. Stack says. If a person tests positive for COVID-19, Kroger submits that result to the local public health department, and the patient will soon be contacted by an epidemiologist who conducts contact tracing. Tests administered through other providers – such as a person’s own physician or clinic – go through a similar process.
- As testing increases, how will officials make decisions about easing restrictions on business and social activity?
“We’re having to make decisions based on limited data where the type of people tested and the number of people tested continues to change – it’s generally getting bigger,” Dr. Stack says. “What happens then is that the more people we test, the fewer as a percent will be positive.”
Dr. Stack and his staff will examine the data from several perspectives, looking at total number of positives, and also at what he calls “positivity rates.” Those measure the percentage of positive results within the overall testing sample.
“It’s not a concrete, defined situation yet, and I think all of the states are struggling with the same thing,” he says.
- Does the state have a plan to conduct random testing in various communities to produce more data about the infection level?
As testing capacity continues to expand over the next several weeks, Dr. Stack says that public health department will study whether the overall positive cases and the percentage of positive cases are rising or falling.
“And then we’re going to have to be focused, and hire a lot of contact tracers, so we can drill down and interview all of the positives and try to do contract tracing and then isolation around them so we don’t spread the disease,” he says.
Over time, Dr. Stack says that antibody testing, which if conducted accurately can determine whether a person has already had COVID-19, will become valuable in conducting random population samples in a community in order to assess how far the disease has progressed.