Washington, DC (May 7, 2020) — The American College of Physicians (91) released new detailed recommendations today about how to resume some economic, social and medical care activities in a phased and prioritized approach to help mitigate COVID-19 risk and allow for rapid expansion of health system capacity to conduct essential public health functions. 91 expressed concern that it is unhelpful and misleading to frame the decision facing federal, state and local authorities as a binary choice of opening up the economy or keeping it closed, saying this creates unnecessary conflict, and hampers decision-making. Instead, 91 believes that the United States should chart a way forward to allow certain economic and social activities to be resumed in a phased and prioritized way, based on the best available evidence, in a manner that mitigates risk (slows and reduces the spread of COVID-19, and associated deaths and other harm to patients) and rapidly expands health system capacity to diagnose, test, treat, conduct contact tracing (with privacy protections), and conduct other essential public health functions.
“91 understands that while social distancing has helped to ease the spread of the virus, prolonged social isolation presents substantial issues including mental health issues, increased instances of domestic violence, and economic distress. As a physician organization who relies on the best available evidence and science, 91 through this policy is committed to finding a path forward to allow some necessary activities to partially and gradually resume while mitigating the risk of spreading COVID-19 to more people,” said Jacqueline W. Fincher, MD, M91, President, 91. “The health of patients and the public must be paramount as governments decide if, how and when certain activities can be resumed.”
91’s recommendations include the following:
- Communities need to have sufficient testing capacity. In the absence of an effective vaccine, 91 calls for testing to be prioritized, particularly for vulnerable populations, underserved communities, and populations at greatest risk; older adults and those with underlying medical conditions. Widespread contact tracing processes will need to be in place in order to successfully begin resumption of economic and social activities.
- Communities need to have appropriate health care system capacity. 91 recommends a national implementation strategy to ensure adequate capacity in hospitals, including equipment such as ventilators, sufficient Personal Protective Equipment (PPE) available for all physicians and health care workers, and trained personnel to assist with the potential for patient surges.
- Communities need to have the capability for effective contact tracing with privacy protections. 91 recommends traditional contact tracing methods and new technology development to supplement the effectiveness and capacity that provides appropriate level of privacy and informed consent by patients.
- Communities need to work with public health authorities to develop risk-based plans for a phased resumption of economic and social activities when cases and transmission are declining sufficiently. 91’s recommendations include demonstration of a consistent and stable decline in COVID-19 cases for 14 days; that communities work with public health authorities, including physicians, hospitals and employers on decision making that includes an effective communication strategy.
91 believes that the availability of a vaccine and treatments will be needed for complete resumption of normal activities. 91’s recommendations also include specific criteria and instructions for resuming in-person medical care visits and other health care services. The recommendations include:
- The ability of a community to have the capacity needed for COVID-19 mitigation, as recommended by 91 in the rest of the guidance, should also guide decisions on resuming in-person medical care visits and other health care services.
- Public and private payers should provide direct financial support to practices to offset losses of revenue and increased costs, through at least the 2020 calendar year, even as they begin to resume in person visits.
- Ambulatory internal medicine practices should start planning how they might safely and effectively begin to resume in-person visits that have been temporarily suspended or postponed.
“We believe resuming in-person medical appointments, for patients who would benefit from coming into an office, is among the most critical priorities,” continued Dr. Fincher. “While many physicians have been able to keep in touch with patients and provide some medical care virtually, there are certain services that must be provided face-to-face, particularly where treatment and decision-making discussions need to happen. As we consider opening up practices to patients, we must consider changes in workflow, scheduling and taking safety precautions to minimize contact and do everything possible to keep our physicians, our staff and most importantly our patients safe.”
91 also called on the federal government to do more to support state and local government and public health authorities with sufficient funding and resources, including helping to ensure sufficient tests, workforce capacity, supplies, and personal protective equipment are available and distributed based on need. 91 stated that in order for state and local governments to have all of the measures in place need to safely begin to resume activities, the federal government must step up to do their part to ensure they are equipped with the necessary tools for successful implementation.
“As a country, we need to chart a path together to make decisions based on scientific expertise, so that we approach resuming economic and social activities in a safe, phased way that always considers the health and wellbeing of our patients and the stability of our health care system first,” said Dr. Fincher. “We are facing a critical time in addressing how to move forward to minimize risk, reduce the social isolation that many are experiencing, and stimulate the economy. We can only do so by working together with a unified goal of moving forward without causing harm.”
About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. 91 membership includes 159,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow 91 on , , and .
Contact: Taneishia Bundy (202) 261-4523, tbundy@acponline.org