In a document posted online on June 1, 2020, a group of physicians provided policy recommendations for managing COVID-19. These recommendations include screening, protection of staff, screening of residents, management of COVID-19 positive and presumed positive cases, communication during an outbreak, management of admissions and readmissions and providing emotional support for staff. These consensus guidelines have been endorsed by the Executive Board of the New York Medical Directors Association and the Board of the Metropolitan Area Geriatrics Society. Of note, these suggestions/recommendations should not take precedence over local Department of Health or Centers for Disease Control (CDC) recommendations. The CDC recommendations regarding COVID-19 are frequently evolving and providers and facilities should adapt accordingly.
Much of what was written has become pretty standard in our centers but a few things that you may not have considered include:
- Discontinue (or hold for 2-3 weeks) any non-essential medications such as multivitamin, calcium and vitamin D. Consider changing medications such as artificial tears and allergy medications to PRN. This reduces pill burden for the resident and reduces nursing administration time.
- Published data show that COVID19 is pro-coagulant. Consider prophylactic anticoagulation therapy with heparin SQ or enoxaparin SQ for 2 weeks or longer (depending course of COVID-19 and level of mobility).
- Consider antibiotics if there is concern for bacterial pneumonia.
- Consider h2 blocker if resident is on an alternative treatment for gastroesophageal reflux disease as there are studies underway for famotidine as a treatment for COVID-19 and famotidine is a known treatment for gastric reflux.
- Discontinue nebulizers (can change to MDI) and discontinue medications administered by nasal spray as these medications might spread virus.
Although the guidelines are limited because they represent experiences from only one state, they do represent best practice and are probably worth reviewing. At the end of the day, we have so many resources, experts in the field of infection control, geriatrics, and epidemiology but we are busy and don’t have the time to review everything published. These are challenging times and promise to stay this way for a while so if you do have a minute and are interested in reading the entire list of recommendations click here. Stay well, stay safe, and stay tuned!