Creating a COVID-19 Action Plan

March 19, 2020   |   Evidence in Integrative Healthcare

First and foremost, is recognition of an instinctual drive to help people that all our network providers share. You have gained the trust of your patients and clients, and they have routinely looked to you for advice. CHP would like to support you in your calling to help others by providing you with a tailored and condensed version of CDC recommendations during the evolving COVID-19 pandemic. We also provide suggestions of what these recommendations may look like in the practices of chiropractic and naturopathic physicians, acupuncturists, and massage therapists.

If a patient reports to you that they have symptoms you feel are consistent with COVID-19 (i.e., fever, cough, shortness of breath), it is appropriate to take immediate action.

• Direct your patient or client to call their primary care provider.
• If they do not have a primary care provider (or look to you as their primary care provider depending on your specialty and scope of practice under your license), the CDC recommends that you should contact your local or state health department immediately for consultation and guidance.
• If appropriate under your scope of practice, when possible, manage mildly ill COVID-19 patients at home.

If you are planning on suspending your practice to mitigate the spread of COVID-19, you may be able to help in a crucial way by donating blood. The cancellation of group events along with the general anxieties caused by the current outbreak have made it difficult for blood banks to maintain adequate supplies. Historically, this deficit has been addressed by emergency medicine professionals donating their own blood.  Please join them if you are healthy, by contacting your local blood bank to schedule a donation. There is no evidence at this time that COVID-19 can be transmitted by blood transfusion.

During a time of crisis, Mr. Roger’s famously said, “look for the helpers.” Our network providers are the helpers, and we know that you will support those around you in a variety of safe ways to come.  Please share with us your stories of helping those in need by e-mailing us at info@chpgroup.com.

Healthcare Facilities

For those of you who continue to provide quality care to your well patients, the following additional set of recommendations considering the COVID-19 pandemic has been adapted from the CDC to add to our previous blog posts on the topic. These are not designed for clinics evaluating or treating individuals with respiratory infection symptoms; if this is the intent of your practice, please visit the CDC’s website for complete information.

Public health guidance will shift as the COVID-19 outbreak evolves. All healthcare facilities should be aware of any updates to local and state public health recommendations.

Key goals for the U.S. healthcare system in response to the COVID-19 outbreak are to:

1. Reduce morbidity and mortality
2. Minimize disease transmission
3. Protect healthcare personnel
4. Preserve healthcare system functioning

Actions to Take Now to Prepare for an Outbreak of COVID-19

• Explore alternatives to face-to-face triage and visits. The following options can reduce unnecessary healthcare visits and prevent transmission of respiratory viruses in your facility:
  • Instruct patients to use available advice lines, patient portals, on-line self-assessment tools, or call and speak to an office/clinic staff if they become ill with symptoms such as fever, cough, or shortness of breath.
    • Possible implementation strategies:
      •  Consider having patients check in from their vehicle in the clinic parking lot by calling the office on their cell phone, especially if you have a high-volume practice. The clinic can then call the patient when it is their turn to be seen.
      • Patient histories and other intake “paperwork” could be performed over the phone while the patient sits in their vehicle. The patient can then be seen in-person for the physical examination and appropriate treatment.
      • Offer patients the ability to download and pre-fill any forms that are necessary for their visit.
  • Identify staff to conduct telephonic and telehealth interactions with patients. Develop protocols so that staff can triage and assess patients quickly.
    • Possible implementation strategy: Have staff ask screening questions by phone about respiratory infection symptoms before a patient enters the clinic.
  • Determine algorithms to identify which patients can be managed by telephone and advised to stay home.
• Plan to optimize your facility’s supply of personal protective equipment in the event of shortages. Identify flexible mechanisms to procure additional supplies when needed.
• Prepare your facility to safely triage and manage patients.
  • Visual alerts (signs, posters) at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette
    • We have found multiple examples of useful form letters and flyers circulating in the community; an example has been modified and posted for download at the end of this blog post.
    • The CDC is also a useful source for visual alerts.
  • Ensure handwashing and hygiene supplies are available (tissues, waste receptacles, alcohol-based hand sanitizer) to patients and staff
  • Facemasks are available at triage for patients with respiratory symptoms
  • Create an area for spatially separating patients with respiratory symptoms. Ideally patients would be greater than 6 feet apart in waiting areas.

 Plan to Take the Following Actions if COVID-19 is spreading in your community

• Work with local and state public health organizations, healthcare coalitions, and other local partners to understand the impact and spread of the outbreak in your area.
• Monitor healthcare workers and ensure maintenance of essential healthcare facility staff and operations:
  • Ensure staff are aware of sick leave policies and are encouraged to stay home if they are ill with respiratory symptoms.
  • Be aware of recommended work restrictions and monitoring based on staff exposure to COVID-19 patients.
  • Advise employees to check for any signs of illness before reporting to work each day and notify their supervisor if they become ill.
  • Do not require a healthcare provider’s note for employees who are sick with respiratory symptoms before returning to work.
  • In settings of widespread transmission, your facility may consider screening staff for fever or respiratory symptoms before entering the facility.
  • Make contingency plans for increased absenteeism caused by employee illness or illness in employees’ family members that would require them to stay home. Planning for absenteeism could include extending hours, cross-training current employees, or hiring temporary employees.

Outpatient Facilities

• Reschedule non-urgent outpatient visits as necessary.
• Consider reaching out to patients who may be a higher risk of COVID-19-related complications (e.g., elderly, those with medical co-morbidities, and potentially other persons who are at higher risk for complications from respiratory diseases, such as pregnant women) to ensure adherence to current medications and therapeutic regimens, confirm they have sufficient medication refills, and provide instructions to notify their provider by phone if they become ill.
• Consider accelerating the timing of high priority screening and intervention needs for the short-term, in anticipation of the possible need to manage an influx of COVID-19 patients in the weeks to come.
• Cancel group healthcare activities (e.g., group therapy, recreational activities).
• Eliminate patient penalties for cancellations and missed appointments related to respiratory illness.

Promoting the increased use of telehealth where available

• Healthcare facilities can increase the use of telephone management and other remote methods of triaging, assessing and caring for all patients to decrease the volume of persons seeking care in facilities.
• If a formal “telehealth” system is not available, healthcare providers can still communicate with patients by telephone (instead of visits), reducing the number of those who seek face-to-face care.
• Health plans, healthcare systems and insurers/payors should message beneficiaries to promote the availability of covered telehealth, telemedicine, or nurse advice line services
  • CHP is exploring telehealth as a component of our business continuity plan.

The Employer’s Perspective

To decrease the spread and lower the impact of COVID-19, the CDC recommends that employers need to consider objectives, which may include one or more of the following:

• Reducing transmission among staff,
• Protecting people who are at higher risk for adverse health complications,
• Maintaining business operations, and
• Minimizing adverse effects on other entities in their supply chains.

Some of the key considerations when making decisions on appropriate responses are:

• Cross-train personnel to perform essential functions so that the workplace is able to operate even if key staff members are absent.
• Assess your essential functions and the reliance that others and the community have on your services or products. Be prepared to change your business practices if needed to maintain critical operations.
• Employers with more than one business location are encouraged to provide local managers with the authority to take appropriate actions outlined in their business infectious disease outbreak response plan based on the condition in each locality.
• Coordination with state and local health officials is strongly encouraged for all businesses so that timely and accurate information can guide appropriate responses in each location where their operations reside. Since the intensity of an outbreak may differ according to geographic location, local health officials will be issuing guidance specific to their communities.

Recommendations for an Infectious Disease Outbreak Response Plan:

• Share best practices with other businesses in your communities (especially those in your supply chain), chambers of commerce, and associations to improve community response efforts.
• Identify possible work-related exposure and health risks to your employees. OSHA has more information on how to protect workers from potential exposures to COVID-19.
• Review human resources policies to make sure that policies and practices are consistent with public health recommendations and are consistent with existing state and federal workplace laws (for more information on employer responsibilities, visit the and the Equal Employment Opportunity Commission’s websites).
• Explore whether you can establish policies and practices, such as flexible worksites (e.g., telecommuting) and flexible work hours (e.g., staggered shifts), to increase the physical distance among employees and between employees and others if state and local health authorities recommend the use of social distancing strategies.
• Set up authorities, triggers, and procedures for activating and terminating the company’s infectious disease outbreak response plan, altering business operations (e.g., possibly changing or closing operations in affected areas), and transferring business knowledge to key employees. Work closely with your local health officials to identify these triggers.
• Plan to minimize exposure between employees and also between employees and the public, if public health officials call for social distancing.
• Establish a process to communicate information to employees and business partners on your infectious disease outbreak response plans and latest COVID-19 information. Anticipate employee fear, anxiety, rumors, and misinformation, and plan communications accordingly.
• In some communities, early childhood programs and K-12 schools may be dismissed, particularly if COVID-19 worsens. Determine how you will operate if absenteeism spikes from increases in sick employees, those who stay home to care for sick family members, and those who must stay home to watch their children if dismissed from school. Businesses and other employers should prepare to institute flexible workplace and leave policies for these employees.
• Local conditions will influence the decisions that public health officials make regarding community-level strategies; employers should take the time now to learn about plans in place in each community where they have a business.
• Consider cancelling large work-related meetings or events.
• Engage state and local health departments to confirm channels of communication and methods for dissemination of local outbreak information. When working with your local health department check their available hours.