COVID-19

University of Washington – School of Medicine PPE Policy Statements

• PPE Conservation – Respiratory Care Supplies
• Guidance for Limited Reuse of N95 Respirators and PAPR Hoods
• PPE conservation policy-UWM (3/12/20)

Wyoming Medical Center Protocols and Guidance

• COVID-19 Respiratory Protection Plan Summary

Consolidated Sterilizer Systems (CSS): COVID-19 Face mask Disinfection and Sterilization for Viruses (updated regularly) 

CDC: Decontamination and Reuse of Filtering Facepiece Respirators
CDC: Strategies to Optomize the Supply of PPE and Equipment
CDC: Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)
CDC: Coronavirus Disease 2019 (COVID-19) PPE Situation Summary Updated (3/21/20)
CDC: Healthcare Supply of Personal Protective Equipment (3/12/20)
CDC: Checklist for Healthcare Facilities: Strategies for Optomizing the Supply of N95 Respirators during the COVID-19 Response

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CMS: COVID-19 Response News Alert: CMS Issues Key Protective Mask Guidance for Healthcare Workers (3/10/20)

U.S. Food and Drug Administration (FDA) Coronavirus Disease 2019 (COVID-19) Guidance

JAMA: Conserving Supply of Personal Protective Equipment – A Call for Ideas (3/20/20)

Emory University School of Medicine: Conservation – COVID-19 ACE/DICE Printiable PDFs

The New Yorker: Keeping the Coronavirus From Infecting Healthcare Workers (3/21/20)

Federal Action Toward PPE and Testing Supply

American Hospital Association, American Medical Association, and American Nursing Association Defense Letter (3/21/20)

AMA Advocacy toward emergency steps needed to boost production of PPE for COVID-19

Joint letter to request swift actions be taken to tackle PPE supply issues (3/18/20)

WDH – Public Health Laboratory Coronavirus Disease 2019 (COVID-19) Information

• COVID-19: Information for Healthcare Providers Regarding Laboratory Testing from the WY Department of Health (3/27/20)
  • WDH – WYDOT Pick-Up Locations (3/28/20)
• Updated State Guidance: COVID-19 Testing Recommendations
• WY COVID-19 Map and Statistics
• Important WPHL links for Wyoming Healthcare Providers
• WDH COVID-19 Monitoring Policy (2/10/20)
• State Health Advisory – Assessment of Patients with COVID-19 (HAN) (3/18/20)
• State Health Advisory – Assessment of Patients with COVID-19 (HAN) (3/28/20)

CDC: Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19)

Standard Operating Procedure for public health labs to create their own viral transport media in accordance with CDC’s protocol

CDC: Guidelines for Submitting Specimens to CDC for Laboratory Testing for SARS-CoV-2

CDC: Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19)

Serology Testing

FDA: Coronavirus (COVID-19) Update: Serological Tests (4/7/20)
Univ. of MN – Center for Infectious Disease Research and Policy Antibody tests may hold clues to COVID-19 exposure, immunity – but it’s complicated (4/15/20)

MEDIA

Kaiser Health News: CDC Coronavirus Testing Decision Likely To Haunt Nation For Months To Come (3/23/20)

PPE Information

CDC: PPE Burn Rate Calculator

Modeling and Projections

COVID Act Now: Coronavirus Act Now

Institute for Health Metrics and Evaluation: COVID-19 projections assuming full social distancing

Global Counts

Center for Systems Science and Engineering – Johns Hopkins University

World Health Organization (WHO)

Daily Situation Reports

Wyoming Department of Health

State Testing Numbers and Data by County

Wyoming COVID-19 Map and Statistics

Telehealth will continue to play a key role in helping Wyoming care for patients in response to COVID-19. Use the links below to learn more.

General Guidance and Tools

American Medical Association (AMA) quick guide to telemedicine practice

Wyoming Telehealth Network (WyTN) 

• WyTN Provider Toolkit
• WyTN Provider Network
• WyTN Telehealth Resources

Advisory Booard: 3 ways to ramp up telehealth to deal with COVID-19 (3/20/20)

Advisory Board: Tips to make telework work – for your team.

Billing and Reimbursement

MDedge: Emergency Rule – Docs can bill for telehealth and COVID-19 tests. Here’s how a commentary (3/20/20)

COVID-19 – Telemedicine Information published by WMS (3/18/20)

Blue Cross Blue Shield of Wyoming Telemedicine Operations Update (3/17/20)

Blue Cross Blue Shield of Wyoming Telemedicine Matrix (4/3/20)

UnitedHealthcare Provider Telehealth Policy Update (3/19/20)

CIGNA COVID-19 Interim Billing Guidance for COVID-19 (3/17/20)

TriWest Healthcare Alliance Telehealth Guidance (3/19/20)

Health and Human Services

Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency (3/17/20)

• OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency

Medicare

CMS.gov: Press Release: President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 (3/17/20)

• Physicians can now provide common office visits, mental health counseling, and preventative health screening to beneficiaries via telemedicine regardless of geographic location
  • CMS.gov: MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET(3/17/20)

CMS.gov: Coverage and Payment Related to COVID-19 – Medicare

CMS.gov: Frequently Asked Questions to Assist Medicare Providers – COVID-19 FAQs

CMS.gov: COVID-19: New ICD-10-CM Code and Interim Coding Guidance

Foley: Telehealth: 5 Key Takeaways from the Coronavirus Spending Bill

Medicaid

Medicaid.gov: Coronavirus Disease 2019 (COVID-19)

During these unprecedented times we are all acutely aware of the far reaching and varied impacts of COVID-19. Stresses are heightened on a wide range of fronts: uncertainty, financial, loss of loved ones, fear, changed patterns, dynamic shifts at home, scarcity, and isolation. We know that stressors combined with limited or finite coping skills can lead to a perfect storm that ultimately can result in elevated levels of child abuse. In addition to the heightened stress that families are likely to be experiencing during this time, we also know that children are more isolated than usual, with very few if any outside outlets or safety nets (i.e. public health nurses, schools, church, coaches, etc). The AAP has recommended, when possible, to continue to bring children 2 and under in for their well child checks. The highest risk age for mortality from physical child abuse is infants under the age of 1. This vulnerable population of infants, is also the age of infants that the AAP and CDC are still recommending, when possible, to come in for their well child checks to keep up to date on their immunizations. So, let’s use that as an opportunity to discuss prevention (crying issues, safety plans to put infants down if getting frustrated, screening Mom’s for postpartum depression (Edinburgh postnatal depression scale), and trying to get Mom’s who screen high on the EPDS in for telehealth mental health appointments). Seeing the 2 year olds, gives us an opportunity to review normal toddler behavior (temper tantrums, boundary testing, potty training) that can be triggers/stressors under regular circumstances for families and opens the door to discuss appropriate discipline techniques and reiterate that spanking is not recommended by the AAP.  We can also ask about other children in the home and how families are coping with them.  Toddlers/pre-school aged children can pose frustrations and have trying behaviors for families. We can emphasize to families the importance of “time outs” for parents as well as for children, the importance of remaining as calm as possible, distraction and redirection.  

Additionally, during our well child checks, let’s commit ourselves to good, thorough naked exams on our patients (open hands, look at ears [not just TMs], check frenulums) and stay particularly attuned to TEN4 bruising or bruising in patterns.   Remember TEN 4 – bruising to torso, ears, neck 4 years and under and ANY bruising 4 months or younger is highly specific for concerns for physical abuse. If you see these findings consult a child abuse expert and get the appropriate evaluation by age for the infant (which depending on age of the child will include a minimum of blood work, head CT, and  a skeletal survey).  If possible, take pictures of your findings. Remember that we are all mandated reporters, so if you have a concern report it to your local DFS office.

*** Also remember the important caveat in Wyoming that DFS does NOT take protective custody.  That task lies with Law Enforcement and Medical personnel.***

 If your office is unable to do well child checks at this time, consider compiling a list of previously identified high risk families (including socially at risk, our medically complex kids or kids that are in foster care or kinship care placements) and have your staff reach out and touch base on how they are doing and offer resource assistance as needed. Let families know about telehealth options. ~ Bird Gilmartin, MD, FAAP, AAP Executive Committee Council on Child Abuse and Neglect

Full Text of the WY-AAP Chapter Statement, by Bird Gilmartin, MD, FAAP (4/14/20)

Child Abuse & Neglect – Resources for Providers

American Academy of Pediatrics (AAP): Abusive Head Trauma in Infants and Children (April 2020)
AAP: Child Abuse Review Materials – now free of charge
The Chronicle of Social Change: Coronavirus and What Child Welfare Systems Need to Think About (3/11/20)
AAP: Trauma Toolbox for Primary Care

Child Abuse & Neglect – Resources for Parents and Families

Healthychildren.org

• How Do Infants Learn
• Playing is How Toddlers Learn
• What’s the Best Way to Discipline My Child?
• When Things Aren’t Perfect: Caring for Yourself and Your Children
• Feeling Overwhelmed with Parenting Demands?
• AAP VIDEO: Effective discipline for parents
• AAP VIDEO: Calming Fussy Babies

Governor Gordon Executive Orders

Executive Order to expedite delivery of COVID-19 related supplies

Wyoming Public Health Orders

Statewide Public Health Order on Gatherings (3/20/20)

Statewide Public Health Order on Public Spaces (3/19/20)

COVID-19 Guidance for Wyoming Child Care Providers

Wyoming Department of Health

Guidance for WY Hospitals and Physicians – Resuming Elective Procedures

WDH State Health Alert Notice Addendum (HAN) (4/22/20)

WDH State Health Alert Notice Addendum (HAN) (4/2/20)

WDH State Health Alert Notice (HAN) (3/28/20)

State Testing Numbers and Data by County

State COVID-19 Monitoring Policy (2/10/20)

Wyoming COVID-19 Status Report (4/24/20)

State Licensure Boards

Wyoming Board of Medicine

• State Medical Licensure FAQ

Wyoming Board of Pharmacy

• COVID-19 Guidance – State Board of Pharmacy (3/20/20)

Wyoming State Board of Nursing

• Emergency nursing staffing memo (3/17/20)
• New Guidelines for Telehealth Nursing (3/20/20)

WMS Support Letters

WMS Letter of Support for Gov. Gordon & Dr. Harrist (3/20/20) 

WMS Letter Encouraging Shelter In Place Orders (3/27/20)

AMA Letter: Urging State Governors to Order Shelter In Place (4/3/20)

Presidential Orders & Resources

White House 15 Days To Slow the Spread Guidance (3/16/20)

New joint website from the CDC, White House and HHS www.coronavirus.gov

COVID-19 Advocacy Efforts

AMA COVID-19 Federal Advocacy Progress Report

• Request that the Defense Production Act (DPA) be used to increase the domestic production of medical supplies and equipment
• Encouraged Congress to include in the final “stimulus” legislation specific provisions to help physicians sustain their practices
• Petitioned CMS Administrator Seema Verma for CPT code clarification
• Urged Health and Human Services (HHS) to provide further clarity around testing criteria and priorities (3/13/20)

Financial Relief and Economic Stimulus Packages

AMA ACP AAFP ACS MGMA Adovcacy Letter (3/20/20)

Requested $100 billion for front line health care workers to preserve practices (3/16/20)

Bennet, Barrasso Release Rural Hospital and Provider Plan to Bring Relief to Health Care System Amid Coronavirus Pandemic

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Centers for Disease Control and Prevention (CDC) Guidance

CDC: Travel recommendations

CDC: Information for schools and childcare facilities

CDC: Guidance for higher education

CDC: Guidance information for businesses and employers

Centers for Medicare and Medicaid Services (CMS)

CMS: Annnounces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs (3/22/20)

Physician Board Certification

American Board of Medical Specialties (ABMS): Board Certification Guidance and Information Related to COVID-19

Other General Information and Resources:

CDC: Coronavirus (COVID-19)

• CDC: About Coronavirus Disease 2019 (COVID-19)
• Communication Resources
• FAQs
• Practice Preparedness Guidelines

CMS.gov: CMS Guidance to Providers about COVID-19

Medicaid.gov: Coronavirus Disease 2019 (COVID-19)

Wyoming Tribune Eagle

• Wyoming peak still unknown for COVID-19 pandemic (3/31/20)

Casper Star Tribune

• Gordon still resistant to shutdown order as physicians urge move ‘before it’s too late’ (3/30/20)

Wyoming Physicians Take the Lead

• 307Health – M. Tracy, MD. COVID-19 Testing: Positive Test Numbers Do Not Reflect Active Infections (3/21/20)
• D. Bartholomew, MD. The coronavirus: Pandemic? Overreaction? Government inside job? (3/17/20)

WMS Speaks up in support of Governor Gordon and State Public Health Officer Alexia Harrist, MD, (3/20/20)

AAFP – U.S. Family Physician Shares COVID-19 Insights From Practice in China (3/18/20)

Advisory Board: Anatomy of an Outbreak: COVID-19 and the U.S. Health Care Delivery System

AMA COVID-19 Resource Center

The Doctors Company (TDC): COVID-19 Malpractice Coverage FAQs

New York State Task Force on Life and the Law: Ventilator Guidance

Hennepin Healthcare and University of Minnesota: Duty to Plan – Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2

CHEST: Too Many Patients…A Framework to Guide Statewide Allocation of Scarce Mechanical Ventilation During Disasters

New England Journal of Medicine: Facing COVID-19 in Italy – Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line

Ethics Subcommittee of the Advisory Committee to the DIrector, CDC: Ethical Guidelines in Pandemic Influenza