Guidance will aid clinicians in various healthcare settings to prevent and mitigate the spread

Under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) has issued a series of updated guidance documents focused on infection control to prevent the spread of the 2019 Novel Coronavirus (COVID-19) in a variety of inpatient and outpatient care settings. The guidance, based on Centers for Disease Control and Prevention (CDC) guidelines, will help ensure infection control in the context of patient triage, screening and treatment, the use of alternate testing and treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning and disinfection guidelines, staffing, and more.

The guidance is designed to empower local hospitals and healthcare systems, helping them to rapidly expand their capacity to isolate and treat patients infected with COVID-19 from those who are not. Critically, the guidance released today includes new instructions for dialysis facilities as they work to protect patients with End-Stage Renal Disease (ESRD), who, because of their immunocompromised state and frequent trips to health care settings, are some of the most vulnerable Americans to complications arising from COVID-19. The guidance is part of the unprecedented array of temporary regulatory waivers and new policies CMS issued on March 30, 2020 that gives the nation’s healthcare system maximum flexibility to respond to the COVID-19 pandemic.

“CMS is helping the healthcare system fight back and keep patients safe by equipping providers and clinicians with clear guidance based on CDC recommendations that reemphasizes and reinforces longstanding infection control requirements,” said CMS Administrator Seema Verma.

The guidance is particularly timely for dialysis facilities. Dialysis facilities care for immunocompromised Americans who require regular dialysis treatments and are therefore particularly susceptible to complications from the virus. Today’s updated guidance has multiple facets, including the option of providing Home Dialysis Training and Support services – to help some dialysis patients stay home during this challenging time – and establishment of Special Purpose Renal Dialysis Facilities (SPRDFs), which can allow dialysis facilities to isolate vulnerable or infected patients. These temporary changes allow for the establishment of facilities to treat those patients who tested positive for COVID-19 to be treated in separate locations.

In addition to dialysis facilities, the infection control guidance affects a broad range of settings including hospitals, Critical Access Hospitals (CAHs), psychiatric hospitals, Ambulatory Surgical Centers (ASCs), Community Mental Health Centers (CMHCs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Outpatient Physical Therapy or Speech Pathology Services (OPTs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs).

For hospitals, psychiatric hospitals and CAHs, the revised guidance, for example, provides expanded recommendations on screening and visitation restrictions, discharge to subsequent care locations for patients with COVID-19, recommendations related to staff screening and testing, and return-to-work policies.

Similarly, for hospitals and CAHs, the revised guidance on the Emergency Medical Labor and Treatment Act (EMTALA) includes a detailed discussion of: patient triage, appropriate medical screening and treatment; the use of alternate testing sites; telehealth; and appropriate medical screening examinations performed at alternate screening locations, which are not subject to EMTALA, as long as the national emergency remains in force. This step will allow hospitals and CAHs to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19.

For outpatient clinical settings, such as ASCs, FQHCs, and others, guidance discusses recommendations to mitigate transmission including screening, restricting visitors, cleaning and disinfection, and closures, and addresses issues related to supply scarcity, and Federal Drug Administration (FDA) recommendations. In addition, CMS encourages ASCs and other outpatient settings to partner with others in their community to conserve and share critical resources during this national emergency.

Updated guidance for ICF/IIDs, and PRTFs include practices related to screening of visitors and outside health care service providers, community activities, staffing, and more.

CMS will continue to monitor and review the impact of the COVID-19 pandemic on the clinicians, providers, facilities and programs, and will update regulations and guidance as needed.

To view the latest updates to these CMS guidance documents on infection control, go to: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page

For information on the COVID-19 waivers and guidance, and the Interim Final Rule, released on March 30, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.

These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov.  For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

WASHINGTON, April 8, 2020 – USDA Rural Development has taken a number of immediate actions to help rural residents, businesses and communities affected by the COVID-19 outbreak. Rural Development will keep our customers, partners, and stakeholders continuously updated as more actions are taken to better serve rural America.

Read the full announcement to learn more about the opportunities USDA Rural Development is implementing to provide immediate relief to our customers, partners, and stakeholders.

The COVID-19 pandemic has underscored now more than ever how incarceration and health are inextricably linked. The Robert Wood Johnson Foundation (RWJF) has included incarceration among 35 illustrative measures being used to track progress toward building a Culture of Health in America. To further explore incarceration as a key measure of health in the United States, on April 2, the Culture of Health blog published a timely post by RWJF’s Carolyn Miller and Doug Yeung of RAND. The post looks at the important effects of incarceration on health and health equity for prisoners, families and communities.

The post also includes a reference and link to a recent issue of the American Journal of Public Health, supported by RWJF, that sheds light on new research that broadens our understanding of how incarceration negatively influences possibilities of hope, happiness, sense of security, and other critical components of well-being.

Support & Referral Helpline

The Pennsylvania Department of Human Services (DHS) has launched the statewide Support & Referral Helpline staffed by skilled and compassionate caseworkers who will be available 24/7 to counsel Pennsylvanians struggling with anxiety and other challenging emotions due to the COVID-19 emergency and refer them to community-based resources that can further help to meet individual needs.

“Pennsylvanians will overcome this crisis together by following the guidance of public health professionals who advise social distancing to slow the spread of the COVID-19 virus, but physical isolation does not mean social isolation,” said DHS Secretary Teresa Miller. “We must support people where they are during this time of crisis.”

The toll-free, round-the-clock support line is available at
1-855-284-2494. For TTY, dial 724-631-5600.

To create and staff the support line, DHS has partnered with the Center for Community Resources (CCR), an experienced regional crisis and call center provider based in Butler County, licensed to provide crisis services.

CCR staff are trained to be accessible, culturally competent and skilled at assisting individuals with mental illness, intellectual disabilities, co-occurring disorders and other special needs. Staff use the principles of trauma-informed care to listen, assess needs, triage calls, and provide appropriate referral to community resources to children, teens, adults and special populations.

CCR will collaborate with individuals, families, police, emergency medical teams, hospitals, schools, and human service providers on the local level to provide quality care to their community members.

“We recognize the significant strain this crisis is putting on families across Pennsylvania, and we want you to know that you do not have to struggle alone. If you need help, reach out,” said Secretary Miller. “The compassionate caseworkers staffing the Support & Referral Helpline will be there to answer your call and be a line of support during this difficult time.”

Many other resources also remain available to Pennsylvanians in need of support, including:

• National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
• Nacional de Prevención del Suicidio: 1-888-628-9454
• Crisis Text Line: Text “PA” to 741-741
• Veteran Crisis Line: 1-800-273-TALK (8255)
• Disaster Distress Helpline: 1-800-985-5990
• Get Help Now Hotline (for substance use disorders): 1-800-662-4357
• United Way of Pennsylvania: Text your zip code to 898-211 for resources and information in your community.

For the latest information on COVID-19 in Pennsylvania, visit the Pennsylvania Department of Health website.

USDA Rural Development Deputy Under Secretary Bette Brand today announced that USDA is expanding servicing options for guaranteed lenders due to the COVID-19 pandemic. Apparently, USDA is expanding upon the deferral flexibility it announced March 31, 2020. More details on the Community Facility Loan Guarantee Program.

From the AgriSafe Network

This webinar took place on March 23, 2020 and highlights evidence-based information about COVID19 to help agricultural producers identify strategies for responding on their farm. The intended audience is ag producers, ranchers, farmers, farmworkers, veterinarians, Extension personnel, rural health care providers, and others who work in agriculture. The webinar is available OnDemand!

At the end of the webinar, participants will be able to:

• Be aware of common signs and symptoms of COVID-19
• Understand the transmission risk to yourself, employees, and potentially your animals
• Describe infection control principles and appropriate strategies for limiting disease transmission
• Locate resources and training for ag producers related to infection prevention.

The Pennsylvania Department of Health (Department) has received questions and requests for guidance from hospitals, health systems, and their representatives on their responses to Coronavirus Disease-2019 (COVID-19) and whether measures being implemented or contemplated are compliant with the statutory and regulatory requirements under the jurisdiction of the Department.  The Department is providing the guidance as an update to the guidance issued on March 21, 2020.

UPDATED Guidance on Hospital Responses to COVID-19

Daily Yonder

Every part of the country will feel the economic fallout from the coronavirus crisis. But the small and isolated rural areas that lagged during the economic boom may fare better, relatively speaking, in the aftermath of the pandemic.

Those places tend to be less tied to global and financial markets. With little population density, they are less conducive to virus transmission. So far, states such as Wyoming, the Dakotas, Nebraska and Iowa have reported far fewer COVID-19 cases than New York and other states with large cities.

“If you are a somewhat more isolated economy that does not attract as much visitation from either outside the U.S. or even domestically, you are less vulnerable,” said Adam Kamins, an economist and director at Moody’s Analytics, in a webinar last month.

The states least affected by the huge spike in unemployment claims are largely rural. They include West Virginia, Arkansas and Georgia. In part, that’s because those states have taken less dramatic steps to slow the spread of the virus. Among them, only West Virginia issued a stay-at-home order before the end of March.

Nevertheless, “the industries that have been hard hit are just not as prevalent in rural areas,” said Ernie Goss, an economics professor at Creighton University in Omaha, Nebraska. He cited the relative lack of retail and hospitality businesses in Corn Belt states.

Economists rank regions as economically vulnerable to coronavirus fallout based on demographic and economic factors, including their number of COVID-19 cases, connection to international travelers, reliance on tourism, population density and reliance on global trade, according to a Moody’s Analytics analysis.

Read more.

Daily Yonder

Coronavirus Infection Rate, April 5

The novel coronavirus continued its march across rural America over the weekend. By Sunday night, April 5, two-thirds of rural counties had at least one case. Just over 200 rural counties have reported a death attributable to COVID-19.

The map above shows the spread of the virus and deaths as of Sunday night, April 5. Click on individual counties for more information, or explore a larger version of the map here.

• Green: Rural counties with no cases (665 counties)
• Orange: Rural counties with cases of COVID-19 (1,109 counties)
• Red: Rural counties with deaths (203 counties)
• Pink: Urban with no cases (61 counties)
• Gray: Urban with cases (575 counties)
• Black: Urban with deaths (528 counties)

These figures likely under-report the presence of the disease, according to a study by researchers at the University of Texas. They estimate that even in counties that report no COVID-19 cases, there is a 9 percent chance that the virus is present in that community.

If a county has one case, the Texas researchers predict that there is a 51 percent chance that the virus is spreading through the community.

From April 1 to 5, an additional 172 rural counties reported a case of coronavirus infection. Only 665—or about a third—of rural counties have yet to report a case of COVID-19. Only 61 urban counties—5 percent of all metro counties—say they have yet to find a COVID-19 case.

The number of reported COVID-19 cases continues to increase slightly faster in rural counties than in urban areas. Over the weekend (Friday through Sunday, April 3-5), cases in rural counties increased by 26 percent. Nationally, COVID-19 cases increased by 22 percent in the same time period.

In rural counties, there were 80 deaths reported over the weekend attributed to COVID-19.

Parts of rural America aren’t seeing the booms like in New York, D.C., and other urban areas, but cases in those parts of the country are now speeding up. Yet, more remote areas also tend to be the places that are already struggling in terms of what their health systems can bear.

Click here to see maps from the New York Times on the spread of COVID-19 in rural America.