How will covid-19 school closures affect healthcare workers ability to work?
In a preprint publication in medRxiv, researchers performed a simulation to determine how covid-19 school closures could cause absenteeism amongst healthcare workers with dependent children. Using a software to analyze data from various databases, the authors estimate that 7.5 to 8.6 percent of healthcare workers nationally would miss at least some work as a result of the school closures. At the county level, school closures would result in a 2.0 to 18.6 percent shortage of healthcare workers, depending on the county. The model also found that nearly all counties in the United States have the financial resources necessary to provide childcare for all healthcare workers who need it. Despite up-front costs, such plans could end up being less expensive in the long run by helping to prevent avoidable healthcare slowdowns. The study still requires peer-review.
How much PPE is too much PPE?
A point of contention among frontline health care workers has emerged: how much personal protective equipment is truly needed to safely take care of patient? It seems that most agree on the requirement of an N95 respirator for aerosol-generating procedures such as intubation and suctioning of the mouth and throat. But there is disagreement over whether the masks are also required for close contact with patients with suspected or confirmed covid-19. The Centers for Disease Control, the Occupational Safety and Health Administration, and the American College of Emergency Physicians all recommend use of an N95 for close contact with these patient groups. The World Health Organization, on the other hand states, that a surgical mask alone is sufficient in these contexts. Understandably, many hospitals have adopted the more lenient standards endorsed by the WHO. Also unanswered it whether healthcare team members should be permitted to bring their own N95s for close contact outside of aerosol-generating procedures, even if their hospital does not provide the masks for such purposes. This week, the American Academy of Emergency Medicine came out in support of use of N95s for close contact with patients with suspected or confirmed covid-19. They AAEM has even offered to assist to members wishing to file an OSHA complaint against employers that stand in the way of emergency physicians using their own personal N95s, and to help with litigation if physicians are wrongfully terminated over this issue.
New York bolsters its workforce at any cost
New York Governor Andrew Cuomo announced sweeping deregulations governing the practice of medicine as part of an executive order aimed at bolstering New York's healthcare workforce. The executive order included provisions that remove supervision requirements of nurse practitioners and physician assistants, allow international medical graduates to practice without a license (provided they meet other requirements), allow retired physicians to resume practice, and most controversially, remove work hour restrictions from resident physicians and post-residency fellows in specialty training. New York had been the only state codifying work hour restrictions of residents and fellows. If residency programs loosen work hour restrictions, however, they may be at risk of losing accreditation by falling out of compliance with the requirements of the Accreditation Council for Graduate Medical Education. The ACGME has confirmed that despite the current pandemic, work hour restrictions remain in effect.
On the brink of wartime powers
For several days, the Trump administration has been taunting industry with the use of its Defense Production Act powers that would allow it to direct private sector manufacturing. Yesterday the administration announced that the Federal Emergency Management Agency would use the powers to direct production of covid-19 tests. Part of the rationale was that the directive would allow the administration to require that manufacturers only distribute tests within the United States. However, at the eleventh hour, the administration announced that it had been able to procure the tests without use of DPA powers, and so the DPA powers have still not been officially employed during this pandemic. USA Today.
Tele-MSE, coming to an emergency department near you?
Under the Emergency Medicine Treatment and Labor Act (EMTALA), emergency departments are required to provide a medical screening exam (MSE) to any patient who seeks care. Two weeks ago, the Center for Medicare and Medicaid Services issued a memorandum stating that EMTALA still required an in-person MSE to anyone seeking care, and that the requirements were not affected by other CMS changes to telemedicine in light of the SARS-nCoV-2 pandemic. During a call yesterday, CMS Administrator Verma indicated to frontline physicians that CMS was considering allowing MSEs done by telemedicine to be considered compliant, such as by iPad. This move could reduce demands for PPE by eliminating one more interaction between patients and the health care team.\ Ventilator allocation plans run risk of discrimination. Washington has been one of the hardest hit states during the covid-19 pandemic. In anticipation of an impending shortage of life saving supplies such as ventilators, discussions on how to allocate these resources as they become scarce are already underway. Among many characteristics suggested for consideration is "general health." However, a coalition of disability advocates have filed suit against the state arguing that such a framework is inherently discriminatory against individuals with disabilities, and runs afoul of the Americans With Disabilities Act.