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. 2020 Nov;17(11):1343-1351.
doi: 10.1513/AnnalsATS.202005-514ST.

Restoring Pulmonary and Sleep Services as the COVID-19 Pandemic Lessens. From an Association of Pulmonary, Critical Care, and Sleep Division Directors and American Thoracic Society-coordinated Task Force

Kevin C Wilson  1 , David A Kaminsky  2 , Gaetane Michaud  3 , Sunil Sharma  4 , Linda Nici  5 , Rodney J Folz  6 , Igor Barjaktarevic  7 , Nirav R Bhakta  8 , George Cheng  9 , Geoffrey L Chupp  10 , Adam Cole  11 , Anne E Dixon  2 , James H Finigan  12 , Brian Graham  13 , Teal S Hallstrand  14 , Jeffrey Haynes  15 , John Hankinson  16 , Neil MacIntyre  17 , Jess Mandel  9 , Kevin McCarthy  18 , Meredith McCormack  19 , Susheel P Patil  19 , Margaret Rosenfeld  20 , Michal Senitko  21 , Sonali Sethi  22 , Erik R Swenson  14   23 , Sanja Stanojevic  24 , Mihaela Teodorescu  25 , Daniel J Weiner  26 , Renda Soylemez Wiener  1   27 , Charles A Powell  28
Affiliations

Restoring Pulmonary and Sleep Services as the COVID-19 Pandemic Lessens. From an Association of Pulmonary, Critical Care, and Sleep Division Directors and American Thoracic Society-coordinated Task Force

Kevin C Wilson et al. Ann Am Thorac Soc. 2020 Nov.

Abstract

Background: In March 2020, many elective medical services were canceled in response to the coronavirus disease 2019 (COVID-19) pandemic. The daily case rate is now declining in many states and there is a need for guidance about the resumption of elective clinical services for patients with lung disease or sleep conditions.Methods: Volunteers were solicited from the Association of Pulmonary, Critical Care, and Sleep Division Directors and American Thoracic Society. Working groups developed plans by discussion and consensus for resuming elective services in pulmonary and sleep-medicine clinics, pulmonary function testing laboratories, bronchoscopy and procedure suites, polysomnography laboratories, and pulmonary rehabilitation facilities.Results: The community new case rate should be consistently low or have a downward trajectory for at least 14 days before resuming elective clinical services. In addition, institutions should have an operational strategy that consists of patient prioritization, screening, diagnostic testing, physical distancing, infection control, and follow-up surveillance. The goals are to protect patients and staff from exposure to the virus, account for limitations in staff, equipment, and space that are essential for the care of patients with COVID-19, and provide access to care for patients with acute and chronic conditions.Conclusions: Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a dynamic process and, therefore, it is likely that the prevalence of COVID-19 in the community will wax and wane. This will impact an institution's mitigation needs. Operating procedures should be frequently reassessed and modified as needed. The suggestions provided are those of the authors and do not represent official positions of the Association of Pulmonary, Critical Care, and Sleep Division Directors or the American Thoracic Society.

Keywords: COVID-19; SARS-CoV-2; bronchoscopy; polysomnography; pulmonary function tests.

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Figures

Figure 1.
Figure 1.
Assessment of the local new case rate. The U.S. Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services recommend a downward trajectory in the new case rate for 14 days before resuming elective medical services. (A) The trajectory of the new case rate can be variable from day-to-day. (B) Using the new coronavirus disease 2019 (COVID-19) hospitalization rate as a surrogate provides less day-to-day variability and is less dependent on testing volume. (C) The mean new case rate over the preceding 7 days (red line) also provides less day-to-day variability.
Figure 2.
Figure 2.
Framework for the prioritization of elective medical services on the basis of acuity. COVID-19 = coronavirus disease 2019.
See this image and copyright information in PMC

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