COVID-19 Provider Toolkit

Minimize communication barriers associated with personal protective equipment, including opaque masks that cover face and muffled voice, particularly for those who are hearing impaired or at-risk for delirium; tele-communication - for example with pads device or smart phone, from outside the room, can be helpful so that patient can directly see the provider’s full face. For direct in-person encounters (when masks are required), ensure that empathy for the patient’s situation is conveyed using other verbal and non-verbal cues.  

           https://pubmed.ncbi.nlm.nih.gov/34807257/ 

           https://pubmed.ncbi.nlm.nih.gov/34802856/ 

As appropriate for a patient's unique values and HIPAA restrictions, engage patient’s identified care partners (e.g., home care provider and/or family member) when conveying diagnostic, prognostic, or therapeutic medical options.

https://pubmed.ncbi.nlm.nih.gov/34801232/

Understand the patient's health literacy and health numeracy, while adapting communication strategy and resources using techniques like “Teach Back” to ensure knowledge comprehension. Use infographics and be aware of basic shared decision making principles.

https://pubmed.ncbi.nlm.nih.gov/24673669/ 

https://pubmed.ncbi.nlm.nih.gov/26617669/ 

https://pubmed.ncbi.nlm.nih.gov/34600777/ 

https://pubmed.ncbi.nlm.nih.gov/26112797/ 

https://pubmed.ncbi.nlm.nih.gov/28559034/

Access and use the large number of one-page, patient-oriented handouts that can be resourced during an episode of emergency department (ED) care to overcome health literacy barriers.

https://jamanetwork.com/journals/jama/fullarticle/2783248 

https://jamanetwork.com/journals/jama/fullarticle/2776307 

https://jamanetwork.com/journals/jama/fullarticle/2771435 

https://jamanetwork.com/journals/jama/fullarticle/2770415 

https://jamanetwork.com/journals/jama/fullarticle/2768390 

https://jamanetwork.com/journals/jama/fullarticle/2767351 

https://jamanetwork.com/journals/jama/fullarticle/2767634 

https://jamanetwork.com/journals/jama/fullarticle/2764955

https://jamanetwork.com/journals/jama/fullarticle/2764238

https://jamanetwork.com/journals/jama/fullarticle/2764560

https://jamanetwork.com/journals/jama/fullarticle/2762694

https://jamanetwork.com/journals/jama/fullarticle/2763533

Provide alternative communication stream options for follow-up questions, including real time communication - email, secure messaging, and telemedicine.

https://pubmed.ncbi.nlm.nih.gov/34779570/ 

https://pubmed.ncbi.nlm.nih.gov/34767741/ 

https://pubmed.ncbi.nlm.nih.gov/34736774/

Recognize non-English language and other health care disparities such as access to Telemedicine or follow-up.

https://pubmed.ncbi.nlm.nih.gov/34735015/

Avoid isolating cognitively frail patients from care partners when visitor restriction rules apply. When hospital policies cannot accommodate in-person care partners, ensure uniform access to alternative video communication options (every care partner has a smart-phone or pad device and every person living with dementia has assistance to use those devices in the room).

https://pubmed.ncbi.nlm.nih.gov/34659653/

https://pubmed.ncbi.nlm.nih.gov/33211114/ 

Understand that patients and care partners value empathetic communication from the most senior physician on the team. A direct brief conversation is highly valued and helps improve patient outcomes.

https://pubmed.ncbi.nlm.nih.gov/34625320/

https://pubmed.ncbi.nlm.nih.gov/34551877/ 

https://healthcity.bmc.org/policy-and-industry/how-talk-patients-about-covid-19-vaccine

Display patient-friendly vaccine flyers throughout your ED and provide to each patient as an informational handout upon ED arrival including regional/local resource links.

https://www.acep.org/corona/COVID-19-alert/covid-19-articles/reach-vaccine-hesitant-populations-with-new-acep-tools/

Without judgment or expectations, provide basic vaccine information during the initial stages of non-critical ED evaluations for the patient/family to contemplate throughout the visit. Sharing that information can have important impacts for the patient, their community and future ED visits.

https://pubmed.ncbi.nlm.nih.gov/24673669/

Access and use the large number of one-page, patient-oriented vaccine FAQ handouts that can be resourced during an episode of ED care to overcome health literacy barriers.

https://jamanetwork.com/journals/jama/fullarticle/2777172 

https://jamanetwork.com/journals/jama/fullarticle/2776229

https://jamanetwork.com/journals/jama/fullarticle/2772168 

Understanding that most patients value a physician’s judgment, and opinion and time, be prepared to answer patients' questions about vaccine safety or efficacy and refer them to easy to digest reliable local information resources.

https://pubmed.ncbi.nlm.nih.gov/34565643/ 

https://pubmed.ncbi.nlm.nih.gov/34591105/

1. COVID-19 patients who require mechanical ventilation benefit the most from daily dexamethasone treatment (8.7% absolute risk reduction, number needed to treat to prevent one death is 12). Hospitalized patients with a new supplemental oxygen requirement who receive dexamethasone also experience a mortality benefit (2.9% absolute risk reduction in the RECOVERY trial, number needed to treat to prevent one death is 35).
   
   
2. Strongly consider 6 mg of dexamethasone daily for all patients who require supplemental oxygen - including those being discharged on home oxygen therapy.
   
   
3. Do NOT start dexamethasone on patients who do not require supplemental oxygen. There is no benefit in these patients and there was a non-significant signal of potential increased mortality for these patients in the RECOVERY trial.
   
   
4. Consider the potential risks of steroid treatment in treated patients so that these risks can be mitigated.

*For patient’s born or recently living in certain regions of Africa, Asia or Latin American where Strongyloides stercoralis is endemic, consider getting an infectious disease consultation prior to starting treatment with immunosuppressive agents.

Sequence variation in circulating viruses can impact the effectiveness of each of the individual monoclonal antibody treatments.

These medications may be INEFFECTIVE if a variant of concern contains mutations that allow the virus to escape the specific monoclonal antibody or antibodies in each different medication. Therefore, the choice of monoclonal antibody medication is typically made at a regional or local level for the treatment that best covers locally circulating variants. Know your healthcare system and consult with local health authorities in your area to know what treatments will work in your community.

1. The highest level of evidence exists to treat patients with 7 or fewer days of symptoms - so we recommend starting these medications in appropriate patients as early as possible after the onset of symptoms.
   
   
2. Advanced age (>55) is the strongest risk factor for disease progression. Chronic medical conditions such as diabetes, heart disease and obesity - among others - are also risk factors for COVID-19 disease progression. Immunosuppression is another key risk factor for COVID-19 disease progression.
   
   
3. A limited meta-analysis of the small number of studies performed with these medications show that they reduce the risk of hospitalization by about 70%.
   1. Risk of hospitalization in placebo group 6%, risk in the treatment group 1.8%; absolute risk reduction 4.2%, number needed to treat to prevent one hospitalization is 24.
      
      

4. The process providers must use to access monoclonal antibody treatment for their patients is variable.  It is important to know how to get your patients these and other acute treatments in the specific environment you are working in.  The US Department of Health and Human Services has a website to help you/your patients locate local treatment centers. Therapeutics Distribution | HHS Protect Public Data Hub