COVID-19 Update

Physicians & Medical Providers

  Please Note: Be Cautious of Fake Information - A malicious website pretending to be the live map for Coronavirus COVID-19 Global Cases by Johns Hopkins University is circulating on the internet waiting for unwitting internet users to visit the website (corona-virus-map.com). Visiting the website infects the user with the AZORult trojan, an information stealing program which can exfiltrate a variety of sensitive data. It is likely being spread via infected email attachments, malicious online advertisements, and social engineering. Furthermore, anyone searching the internet for a Coronavirus map could unwittingly navigate to this malicious website.

Ohio COVID 19 Vaccination Program Enrollment Checklist
Job Aid Access the Vaccination Provider Program

Revised Reporting Requirements for COVID-19 Cases

Both COVID-19 laboratory Confirmed Cases and clinical Probable Cases are now reportable as Category A Diseases.

New cases require reporting within 24 hours of diagnosis to local Public Health Departments (call 937-225-4508 in Dayton & Montgomery County)

Criteria for Confirmed and Probable cases are available in the linked document below.



pdf COVID 19 Public Health Required Reporting (114 KB)

COVID-19 Resources For Healthcare Providers

As you care for others, don’t neglect your self-care.

The Ohio Physicians Health Program (OPHP) is offering free drop-in COVID-19 Physician Peer Support Sessions via Zoom.

Learn more at Ohio Physicians Health Program Resources








Priority 1 Ohioans with symptoms who are:
  • Hospitalized.
  • Healthcare workers. This includes behavioral health providers, home health workers, nursing facility and assisted living employees, emergency medical technicians (EMTs), housekeepers and others who work in healthcare and congregate living settings.*
Priority 2 Ohioans with symptoms who are:
  • Residents of long-term care/congregate living settings.
  • First responders/public health workers/critical infrastructure workers.
  • 65 and older.
  • Living with underlying conditions.
    • Consideration should be given for testing racial and ethnic minorities with underlying illness, as they are at increased risk for COVID-19 and more severe illness.

Ohioans without symptoms who are:
  • Residents or staff directly exposed during an outbreak in long-term care/congregate living settings.

Other Ohioans who are:
  • Designated by public health officials to evaluate/manage community outbreaks (such as in workplaces, other large gatherings).
Priority 3 Ohioans with and without symptoms who are:
  • Receiving essential surgeries/procedures, including those that were reassessed after a delay.
  • Receiving other medically necessary procedures not requiring an overnight stay/inpatient hospital admission, as defined by their providers’ process for COVID-19 testing.
Priority 4 Individuals in the community to decrease community spread, including individuals with symptoms who do not meet any of the above categories.
Priority 5 Asymptomatic individuals not mentioned above.
*Congregate living settings are those where more than six people live and where there is a propensity for rapid person-to-person spread of infectious disease. (Some examples are assisted living/nursing centers; Ohio Veterans Homes; residential facilities for mental health/substance use treatment; psychiatric hospitals/group homes; centers/facilities/group homes for people with intellectual disabilities; homeless and domestic violence shelters; youth detention centers; prisons; and jails.)
pdf COVID-19 Testing in Ohio (301 KB)
New Personal Protective Equipment Guidance (1 April 2020)

ODH has issued revised guidance for personal protective strategies, use, and reuse. Details are in the three documents linked below.

Among the new recommendations:

  • All staff in long-term care facilities should wear a surgical/medical facemask while working to avoid asymptomatic transmission of COVID-19 to residents and other staff. This includes facilities not known to be affected by COVID-19.
  • In settings where facemasks are not available, healthcare personnel (HCP) might use homemade masks (e.g., bandana, scarf) as a last resort. However, homemade masks are not considered PPE. Caution should be exercised when considering this option.

pdf PPE Use and Reuse (375 KB)
pdf PPE Strategies (361 KB)

When can my patients resume work or other activities after COVID-19 disease?

  Changes as of July 17, 2020

  • Except for rare situations, a test-based strategy is no longer recommended to determine when to allow HCP to return to work.
  • For HCP with severe to critical illness or who are severely immunocompromised, the recommended duration for work exclusion was extended to 20 days after symptom onset (or, for asymptomatic severely immunocompromised HCP, 20 days after their initial positive SARS-CoV-2 diagnostic test).
  • Other symptom-based criteria were modified as follows:
    • Changed from “at least 72 hours” to “at least 24 hours” have passed since last fever without the use of fever-reducing medications
    • Changed from “improvement in respiratory symptoms” to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19
  • A summary of current evidence and rationale for these changes is described in a Decision Memo.
Symptom-based strategy for determining when HCP can return to work.

HCP with mild to moderate illness who are not severely immunocompromised:

  • At least 10 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved

Note:  HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.

HCP with severe to critical illness or who are severely immunocompromised

    • At least 20 days have passed since symptoms first appeared
    • At least 24 hours have passed since last fever without the use of fever-reducing medications and
    • Symptoms (e.g., cough, shortness of breath) have improved

Note:  HCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 20 days have passed since the date of their first positive viral diagnostic test.

As described in the Decision Memo, an estimated 95% of severely or critically ill patients, including some with severe immunocompromise, no longer had replication-competent virus 15 days after onset of symptoms; no patient had replication-competent virus more than 20 days after onset of symptoms.  Because of their often extensive and close contact with vulnerable individuals in healthcare settings, the more conservative period of 20 days was applied in this guidance.  However, because the majority of severely or critically ill patients no longer appear to be infectious 10 to 15 days after onset of symptoms, facilities operating under critical staffing shortages might choose to allow HCP to return to work after 10 to 15 days, instead of 20 days.

Test-Based Strategy for Determining when HCP Can Return to Work.

In some instances, a test-based strategy could be considered to allow HCP to return to work earlier  than if the symptom-based strategy were used. However, as described in the Decision Memo, many individuals will have prolonged viral shedding, limiting the utility of this approach. A test-based strategy could also be considered for some HCP (e.g., those who are severely immunocompromised1) in consultation with local infectious diseases experts  if concerns exist for the HCP being infectious for more than 20 days.

The criteria for the test-based strategy are:

HCP who are symptomatic:

HCP who are not symptomatic:

Return to Work Practices and Work Restrictions

After returning to work, HCP should:

  • Wear a facemask for source control at all times while in the healthcare facility until all symptoms are completely resolved or at baseline. A facemask instead of a cloth face covering should be used by these HCP for source control during this time period while in the facility. After this time period, these HCP should revert to their facility policy regarding universal source control during the pandemic.
    • A facemask for source control does not replace the need to wear an N95 or equivalent or higher-level respirator (or other recommended PPE) when indicated, including when caring for patients with suspected or confirmed SARS-CoV-2 infection.
  • Self-monitor for symptoms, and seek re-evaluation from occupational health if symptoms recur or worsen

Myth Buster: The young do not get COVID-19

Figure 2 below is from an Early Release article from Morbidity & Mortality Weekly Report (18 March 2020). It clearly illustrates that young adults contract severe disease requiring hospitalization in numbers roughly equal to other age groups. Young people do have lower mortality numbers. The notion that young people are somehow “immune” or unaffected by COVID-19 disease is untrue. The full article is available below.

FIGURE 2. COVID-19 hospitalizations,* intensive care unit (ICU) admissions,† and deaths,§ by age group — United States, February 12– March 16, 2020

* Hospitalization status missing or unknown for 1,514 cases.
† ICU status missing or unknown for 2,253 cases.
§ Illness outcome or death missing or unknown for 2,001 cases.

Ethics in the Time of Coronavirus

Large-scale catastrophes and emergencies can overwhelm health care systems leading to scarce resources and insufficient availability of curative and life-saving treatment. Physicians may need to conduct triage and make unilateral decisions regarding who receives treatment, who is denied treatment, and from whom treatment might be withdrawn when the demand for services exceeds the supply.

Ethical principles shift from autonomy and beneficence to utility, fairness, and stewardship.

Guidance developed jointly by physicians and government organizations on the just and ethical allocation and delivery of health care during catastrophes and emergencies is available (see the linked discussion and references).


pdf Ethics in the Time of Coronavirus (191 KB)

Talking Points about novel Coronavirus

Novel Coronavirus (named SARS-CoV-2) causes COVID-19 disease.

COVID-19 disease is a respiratory infection.

  • Common symptoms include: Cough. Shortness of breath. Muscle aches.
  • Cases can range from mild to severe.
  • The vast majority of people (more than 80%) have mild disease and recover with symptomatic care.

Novel coronavirus is more infectious that influenza.

Novel coronavirus is more likely than influenza to cause severe disease, especially in people over 60 years old and those who have chronic medical conditions (heart and lung disease, diabetes, and immunosuppression, among others).

Novel Coronavirus is new, but it is not entirely different than other illnesses.

  • The same approach we use with any viral respiratory illness will work with Coronavirus.

People who are mildly ill, should stay home and take care of themselves until recovered.

  • Try not to pass the infection to anyone else in the household, regardless of whether it might be influenza, a common cold, or Coronavirus.
  • Try to keep six feet between the ill person and other people in the household.
  • Having a bathroom just for the ill person is recommended if possible.
  • Wash hands frequently with soap and water.
  • Do not use the same personal items, such as drinking glasses and utensils, as the ill person.
  • Clean and sanitize “touch points” such as light switches and doorknobs frequently.
  • Smother coughs with a tissue or elbow.

If patients are asked to come into the office, telling them what to expect may be helpful to them.

  • Tests may be done for influenza or for whatever your office routinely tests.
  • Many (or most) people will not meet criteria for COVID-19 testing.
  • Be prepared to send people home to self-isolate as described above.

pdf Talking Points about novel Coronavirus (179 KB)

State Medical Board of Ohio

https://med.ohio.gov/COVID-19

The State Medical Board maintains a list of the Medical Board Updates for Licensees. The site lists orders and statements from the Medical Board as well as Orders and Health Alerts from the Ohio Department of Health and the Ohio Board of Pharmacy.





Ohio State Medical Association

https://www.osma.org/aws/OSMA/pt/sp/home-page

The Ohio State Medical Association (OSMA) is the first and largest physician-led organization in Ohio. We proactively and persistently advocate for effective healthcare policy outcomes, provide professional development opportunities for physicians, and promote useful resources that advance patient care and the medical profession. Established in 1846, the OSMA is the leading voice of physicians, residents and medical students in Ohio.

The Latest State Orders & Clinical Regulatory Changes... What Do They Mean for You?
March 23, 2020
The COVID-19 pandemic continues to evolve rapidly in Ohio and across the country. Thank you to all the physicians and staff that are either on the front line or trying to see patients to provide needed care and working to keep practices open. The OSMA is here to help you in whatever way we can. Here is a quick overview of the latest information for Ohio physicians and upcoming issues
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Centers for Medicare & Medicaid Services Announce Relief for Quality Reporting Burdens
March 22, 2020
Medicare quality reporting programs including the 1.2 million clinicians in the Quality Payment Program and on the front lines of America’s fight against the 2019 Novel Coronavirus (COVID-19).
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6 Top Insights from 2 AMA Presidents
March 20, 2020
AMA President Patrice Harris, MD and former president Steve Stack, MD, current Commissioner of the Kentucky Department for Public Health, shared insight on the COVID-19 pandemic in the U.S. and discussed the importance of all communities coming together to free up hospital capacity and minimize the burden of the virus.
Watch the Video
CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response
March 18, 2020
As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators.
Read More
All Non-Essential Surgeries Must Be Postponed
March 17, 2020
Ohio Department of Health Director Amy Acton, MD, has ordered hospitals and outpatient surgical centers to postpone all elective, non-essential surgeries and procedures indefinitely.
Read More
Information for Physicians Related to Coronavirus’ Impact on Your Practice
March 16, 2020
As you are aware, the healthcare system in Ohio and across the country and world is in a state of flux due to issues related to COVID-19. After speaking to numerous practices over the last several days we recognize physicians and practices are looking for information and guidance related not only to testing/treating patients for COVID-19 but also simply how you can keep your practice open, safe and viable over the next several weeks.
Read More
Ohio releases new COVID-19 Guidance for Primary Care & Outpatient Providers.
March 15, 2020
The coronavirus situation warrants a unified, consistent approach and requires primary care providers and other outpatient services providers to comply with the following course of action regarding screening and treatment of potential COVID-19 patients.
Read More
New ODH Health Alert Released:
March 14, 2020
Updated Guidance for Resource Management
Read More
ODH Releases Letter to Primary Care, Pediatrician, OB-GYN partners
March 11, 2020
Addressing the topic of COVID-19 in relation to pregnant women and children:
Read More


Substance Abuse and Mental Health Services Administration (SAMHSA)

https://www.samhsa.gov/coronavirus

COVID-19 Public Health Emergency Response and 42 CFR Part 2 Guidance (PDF | 168 KB)

TAP 34: Disaster Planning Handbook for Behavioral Health Treatment Programs

NEW: Considerations for the Care and Treatment of Mental and Substance Use Disorders in the COVID-19 Epidemic: March 20, 2020 (PDF | 81 KB)

NEW: Considerations for Crisis Centers and Clinicians in Managing the Treatment of Alcohol or Benzodiazepine Withdrawal during the COVID-19 Epidemic: March 19, 2020 (PDF | 213 KB)

NEW: Considerations for Outpatient Mental and Substance Use Disorder Treatment Settings (PDF | 104 KB)

NEW: Covid19: Interim Considerations for State Psychiatric Hospitals (PDF | 132 KB)

NEW: Virtual Recovery Resources (PDF | 369 KB)

Tips For Social Distancing, Quarantine, And Isolation During An Infectious Disease Outbreak (PDF | 544 KB)

Guidance for OTPs

Opioid Treatment Program (OTP) Guidance (March 16, 2020) (PDF | 216 KB)

OTP Guidance for Patients Quarantined at Home with the Coronavirus (PDF | 154 KB)

FAQs: Provision of Methadone and Buprenorphine for the Treatment of Opioid Use Disorder in the COVID-19 Emergency (PDF | 137 KB)

Sample OTP COVID-19 FAQs (PDF | 341 KB)

Use of Telemedicine While Providing Medication-Assisted Treatment (PDF | 146 KB)

Additional Federal Guidance

The Notification of Enforcement Discretion on Telehealth Remote Communications

DEA Information on Telemedicine (PDF | 75 KB)

DEA Diversion Control Division COVID-19 Information

Stay up to Date

Coronavirus.gov

Coronavirus Disease 2019 (COVID-19)

What the U.S. Government is Doing



The Joint Commission

COVID-19

The Joint Commission is working to distill and post up-to-date resources to support health care professionals and organizations during the pandemic. The Joint Commission is trying to provide only the information that best meets the needs of health care workers and leaders.

Please Note: Be Cautious of Fake Information

A malicious website pretending to be the live map for Coronavirus COVID-19 Global Cases by Johns Hopkins University is circulating on the internet waiting for unwitting internet users to visit the website (corona-virus-map.com). Visiting the website infects the user with the AZORult trojan, an information stealing program which can exfiltrate a variety of sensitive data. It is likely being spread via infected email attachments, malicious online advertisements, and social engineering. Furthermore, anyone searching the internet for a Coronavirus map could unwittingly navigate to this malicious website.

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