Q&A: New York GIs on how to prevent spread of COVID-19
As one of the states hit hardest by the COVID-19 pandemic, New York has had to make many changes to reduce spread of the virus.
In a recent article published in the American Journal of Gastroenterology, Seth A. Gross, MD, FACG, FASGE, AGAF, the Clinical Chief from the division of Gastroenterology and Hepatology and Associate Professor of Medicine, at NYU Langone Health, and colleagues highlighted recommendations for hospitals and institutions to follow to prevent COVID-19.
Healio Gastroenterology and Liver Disease spoke with Gross on what New York City gastroenterologists and endoscopy units are currently doing to combat the pandemic and the increased use of telemedicine. – by Monica Jaramillo
Healio: What recommendations do you offer the health care system to prevent COVID-19?
Gross: We have five key takeaways. One is if you’re in an area that does not see the level of COVID-19 cases like we have seen in New York City, work with your hospital and make sure you have testing available. You want to try to identify patients early. Furthermore, healthcare providers must assume a patient has it, since someone could be asymptomatic and shed the virus before symptoms develop. You need to put up those safeguards and safety measures to protect yourself and the rest of your health care team but also to protect your patients.
Another important point is personal protective equipment (PPE). We need to be very diligent about taking it on taking it off and make sure your hospital and your facility has an adequate supply. Come up with a system in how you are going to dispense PPE. Establish the appropriate PPE needed for various clinical situations. Another key message is to reinforce social distancing and washing your hands. These things are critical because they are going to decrease the spread of this virus. There are many people out there who need medical care including gastrointestinal care who don’t have the virus. Physicians should work with their IT department to develop telemedicine support, get them online as soon as possible. You can take care of patients with common complaints and not have to go to the office. Many clinics are not operating so this is a good way to get patients care as we get through this pandemic.
Healio: Is telemedicine covered by insurance and what is academic distancing?
Gross: Telehealth is a way for physicians to interact with their patients, where they don’t need to come to the office. Telehealth has been of interest for quite some time, but the biggest challenge as always been reimbursement. However, Medicare and private insurers are covering telemedicine visits. We don’t know if after the pandemic is behind us, will that reimbursement continue.
For many physicians whether you are a full-time faculty member at a university, or you are voluntary faculty where you have privileges, there are so many opportunities during the week for educational conferences. You can have grand rounds, case conference, tumor board, Transplant selection conference, and inflammatory bowel disease conference. All of these are normally held in conference rooms, but now they are all virtual meetings. So just like people are practicing social distancing outside of the health system, as universities and hospitals we have to do “academic distancing". Everything is in a virtual format.
Healio: What is New York doing regarding outpatient care and endoscopic procedures?
Gross: Right now, the recommendation on a federal, state and GI tri-society level has been to hold off on elective procedures. The reason why we are doing this is to not expose patients unnecessarily to hospital, not to expose the health care system to asymptomatic patients with the virus and to preserve PPE. We are trying to be strategic. We are
only mainly doing procedures for patients being admitted to the hospital right, but on a case by case basis outpatient procedures are also being done. We are looking at things week to week to see when we can transition back to a regular office and endoscopy schedule.
Healio: What are you doing in terms of inpatient care?
Gross: One thing we are doing is we set up different teams of inpatient gastroenterology services just in case anyone gets ill, we have back up. The general internal medicine services are being overwhelmed with patients either suspicious for or confirmed with COVID-19. What they are doing in many hospitals is they are asking subspecialists to help on the medical wards and ICU. We’ve had some of our fellows get retrained in critical care to work the ICU. We are doing things very differently now, even endoscopy units in the New York City area are being converted into ICUs. Everything is changing from day to day and sometimes even hour to hour in terms of how hospitals are handling the influx of patients.
Gross SA, et al. Preparation in The Big Apple: New York City, A New Epicenter of the COVID-19 Pandemic. 2020
Disclosures: Gross reports no relevant financial disclosures.