3/25/2020 Clinical Availability Update:
OccMedCIC will continue to support our clients as needed and adhere to the following guidelines:
- OccMedCIC does not evaluate or treat ill workers
- Our reduced clinical schedule will be staffed by a skeleton crew
- Strict adherance to social distancing by limiting patient volume in waiting room and using N95 masks
- When seeing a patient face-to-face the staff and provider will be wearing N95 respirator with the windows open.
Regarding new work injuries, client companies must call ahead to schedule an evaluation. If an essential service worker who is not ill but injured, e.g., laceration, requires hands-on face-to-face care, then OccMedCIC should be a safer option (less potential Covid 19 exposure) compared to other health care venues such as the Emergency Department. Depending on Public Health Directives, providers and staff may be on-call, i.e., pulled into office as necessary.
OccHealth Services like PreEmployment and FAA exams for essential service providers may be available in person or remotely. Please call to inquire.
Please note: We did explore performing Covid 19 test sample collection ourselves but learned we cannot at this time due to lack of available sample collection material. Again, we will not be evaluating or treating workers with suspected Covid 19 face-to-face. Rather, we remotely evaluate employee's symptoms, exposure level and/or ability to work.
Please stay safe, practice social distancing, wash your hands and call us if you have questions about keeping your workplace safe,
John W. Burress, MD, MPH, FACOEM
Telehealth during COVID-19 Pandemic
OccMedCIC has utilized telehealth successfully for years. Telehealth (remote audiovisual input) when clinically appropriate can facilitate the delivery of care conveniently for the worker (consider return to full duty scenario).
Throughout the evolving COVID-19 pandemic, all follow-ups that can be seen via telehealth will be rescheduled as such. Although not ideal, some new injuries that do not require rule out xrays may be treated via telehealth.
For our clients who are strategically minimizing the spread of COVID-19, please consider the following ideas:
- No one should work while ill. Rationale includes that respiratory symptoms from Covid19 are non-specific (meaning one cannot tell mild Covid19 from another viral upper respiratory illness) and vary considerably (e.g., some have malaise, sore throat, headache, or runny nose). Further, GI symptoms (diarrhea, vomiting) occur prior to fever and respiratory symptoms in small percentage of those coming down with Covid19. Follow CDC Link Here.
- Change work schedules to three days a week thus cutting workforce on site by at least half each day, e.g., half M,W,F and half T, TR, Saturday. Hours per work day could be extended as desired. Follow OSHA Link Here. Page 15/35: "Establishing alternating days or extra shifts that reduce the total number of employees in a facility at a given time, allowing them to maintain distance from one another while maintaining a full onsite work week."
- Give option, without adverse consequence on group health benefit, to those over 55 years old (could pick another number here) and/or those with any chronic medical conditions to not work. Rationale includes their known increased risk of morbidity/mortality from Covid19. Follow CDC Link Here.
The country seems to be following Washington State’s lead. Here are practical handouts from Washington State that reference CDC:
3/19/2020 OccMedCIC COVID-19 Update
OccMedCIC, LLC learned the following updates by attending a call hosted by the Massachusetts Medical Society on Tuesday, March 17, at 4 p.m. with Dr. Monica Bharel, DPH Commissioner; Dr. Lawrence Madoff, Medical Director of the DPH Bureau of Infectious Disease and Laboratory Sciences; and Dr. Catherine Brown, State Epidemiologist.
- 218 positives to date…20 over last 24 hours (as of 3/17/2020 4pm)
- Moved from containment to Mitigate phase
- 7 counties with community spread
- Goal of social distancing “flatten curve” so healthcare won’t be overwhelmed
- State labs can now test 400 patients a day
- Test all healthcare workers with symptoms as priority to reserve manpower
- Those hospitalized
- Suspect living in congregate
- Commercial lab/hospital approved
- Covid19 is a mandatory reporting disease (labs send to DPH)
- Touched on limitations in supply of PPE; Mass trying to access national supply…shortage lead to halting elective cases and emphasis on telehealth
- Emphasis on diverting 80% of mild case away from ED in favor of telehealth, self-care.
- Drive through testing via Labcor kits per one hospital after telehealth visit…limited now by supply of N95. Regional coalition
- CDC liberalized to allow mask (most spread from droplet nuclei) except high risk. Eye gear and gloves. “real driver” is droplet nuclei. Infection from Surfaces is feasible (two day survival on plastic; frequent hand sanitizer or wash). Droplet Particles do not hang in air for long (example elevator previously used); aerosol not thought to be a factor
- 617-983-6800 mass.gov/covid19 Epi number
- Period of isolation if not tested? Per State Epidemiologist (Catherine Brown “aligning with those with positive Covid19 test”. States: 72 hours fever free, improvement in respiratory symptoms, and at least 7 days since onset symptoms. [not blanket 14 days; this is new and I have not seen this in written form yet]
- Question about telehealth, e.g., Baker’s statements is for “any condition” not just Covid19 related specifically. Some disparity noted, i.e., Medicare not covering telephone only visits
- Question regarding RTW: “Yes, 72 hours after fever, cough doesn’t have to go away but there should be an improvement”.
- What if, Med Assistant becomes positive, what about other staff? If she was not symptomatic while working, then no need for other staff to quarantine.
- Question testing asymptomatic spouse of individual with positive Covid 19 test? Test designed to assess those with symptoms.
- Contact tracing…within 6 feet for 10-15 minutes when someone symptomatic.
- UMass setting up testing facility, others going up around state
- Mild to moderate illness? presume Covid19, isolate 7 days or until 3 days after fever + symptoms improved.
3/13/2020 OccMedCIC COVID-19 Update
- The DPH issued guidance to all health care providers regarding the prioritization of testing of Persons with Suspect COVID-19 through the Massachusetts State Public Health Laboratory. Priorities for testing are to identify areas where public health action can slow the transmission of disease and both individuals at risk for increased severity of illness, as well as the health care and critical infrastructure workforces.
- The guidance lays out 6 criteria, categorizing by epidemiologic or occupational risk and clinical features. If a patient meets the criteria in categories 1-6, DPH approval is not necessary prior to the submission of the sample for testing; provided that testing should occur through the Massachusetts State Public Health Laboratory.
- The guidance lays out 2 additional criteria (7 + 8); patients who meet the criteria in categories 7 or 8 should be tested through commercial laboratories and specimens should not be sent to the Massachusetts State Public Health Laboratory.
*CATEGORY 8 Other symptomatic individuals for whom knowledge of COVID-19 infection is medically indicated including older individuals and those with co-morbidities Fever OR mild to moderate respiratory illness 1 Close contact is defined as: a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case – or – b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on) while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection).