The coronavirus disease 2019 (COVID-19) pandemic has already exerted an enormous impact on the entire world. Everything is overwhelmed in the face of a rapid escalation of cases. The countries that have already reported the peak of transmission are easing their preventive measures yet fearing a second wave of infection. A second wave refers to the resurgence of COVID-19 cases in a population that has already witnessed the peak of the pandemic.
For example, China worries about the revival of the virus, as the country is reporting new asymptomatic and “imported” cases after “prematurely” relaxing its preventive measures, which were in place for around 3 months.
In the USA, after months of hunkering down for shelter-in-place orders from March 2020 on, all 50 states began to reopen in the spring and summer with varying timelines, guidelines, and regulations. With suddenly crowded parks, pools, restaurants, and bars across the nation, it may have been tempting for some of us to believe (or at least hope) that we were returning to some semblance of normalcy. But despite widespread quarantine fatigue, SARS-CoV-2, the virus that causes COVID-19, never went away.
Unfortunately, new cases of COVID-19 have begun to surge across the country. On July 17, the U.S. reported more than 70,000 new coronavirus cases, breaking its record for the 11th time in the past month, according to a New York Times database. As of press time, case numbers are increasing in 44 U.S. states and territories, and the West and Southeast are covered in hot spots from California and Nevada to Louisiana, Mississippi, Alabama, Georgia, Florida, South Carolina, and Tennessee. While new cases have gone flat in a few areas like hard-hit New York and New Jersey, we’re only seeing a downtick in cases in three states: Arizona, Delaware, and Maine, per reporting by The New York Times.
When is a second wave of COVID-19 expected to hit?
Because the United States is a patchwork of differing rates of cases and a second wave can only hit after a first wave has tapered down significantly, it’s hard to say when the next wave might hit and the timing could vary vastly from place to place.
For example, New York—once the epicenter of the pandemic—has gotten cases down to a very low level, which now puts it at risk of a second wave, says Davidson Hamer, M.D., a board-certified infectious disease specialist and professor of global health and medicine at the Boston University School of Public Health and Medicine.
All in all, though, “it’s highly likely we will experience a second wave and possibly more waves starting this fall and winter, with a potential peak around October or November,” says Dr. Varkey. Nevertheless, past pandemics also give us an idea of what we might expect from COVID-19, too: The H1N1 influenza pandemic, for example, hit the U.S. in the spring of 2009 and returned for a second wave in the fall and winter.
Therefore, it’s high time healthcare providers buckle up and restrategize how to combat the second wave of COVID-19. Now is the time to prepare for the challenges of the months ahead.
Covid-19: How to prepare for a second wave?
Healthcare organizations must implement new strategies to rapidly recognize infectious individuals, screen employees, communicate shortages, assist stressed and/or infected healthcare workers, adapt to disease surges, implement telemedicine more broadly, and assure active and effective employee and public communication, explore new technologies and solutions, such as clinical surveillance, cleaning solutions. Most importantly, the science must continue to be actively monitored. As healthcare organizations monitor the scientific findings that are helping improve COVID outcomes, vigilance around the next new concerns—whether they be infectious, economic, supply chain, environmental, or worker related—must be ongoing. Clinical surveillance tools that quietly monitor while supporting the science, and that alert healthcare providers when action is indicated, will be invaluable as we move into the new norms around the pandemic and challenges to healthcare in general.
Hospitals should debrief on what has gone well and what hasn’t. They should consider not only implementing their best ideas permanently, but also sharing them more broadly with their peers. For areas where they were challenged, they should analyze and, if possible, test and implement new approaches.
They should also assess their surge plans to ensure they have adequate PPE and other supplies and evaluate their overflow plans.
Do an after-action report
Once providers that have had an outbreak have no positives in the building e.g a nursing home, they should conduct an after-action report- It should be counted as one of emergency preparedness trainings, and an after-action report should be done where everything that went well and what didn’t are listed to make necessary changes to prepare for a fall/winter surge. This after-action report should include input from residents and families.
Continue to monitor environmental cleaning
Environmental cleaning and disinfection is a core infection prevention strategy to reduce disease. The infection preventionist also should be routinely monitoring whether staff are cleaning the environment properly.
Modified hospital designs have become necessary as the first wave of the pandemic tears through U.S. communities
Modern hospitals often lack the flexibility to accommodate a sudden surge of patients. In particular, many hospitals have been running out of space and resources to treat COVID-19 patients with severe symptoms, while at the same time handling those with mild symptoms and the asymptomatic who may infect health care workers and other patients. The temporary hospital spaces are more likely to support isolation and medical care for milder COVID-19 cases but such modified hospital designs — similar to the temporary hospital wards and field hospitals of past outbreaks — have become necessary as the first wave of the pandemic tears through U.S. communities, and they will likely be needed again for a second wave of outbreaks. Waiting rooms and emergency areas also need to be redesigned to stop potential spread from a COVID patient. A report discussed possible changes in emergency department structure to optimize infection prevention and control (Figure 1) and potential spaces adjacent to the emergency department that would allow providers to isolate patients with respiratory illness from nonrespiratory cases in a rural hospital in Carbonear, NL, Canada as a potential model for others to follow:
Additionally, a new telehealth solution is an excellent way to plan ahead. Having telehealth provides hospitals the ability to expand their service offerings in multiple ways, according to a report. For example, telehealth services have the potential to improve outcomes for high-risk obstetric patients in rural communities, while telehealth facilitated the use of anti-microbials in rural areas where infectious disease physicians were not available. The research also found that telehealth capabilities are predictably available in larger hospitals as well as teaching hospitals, and the professors say policymakers would be wise to provide support to smaller facilities before the second wave hits.
As we saw during the first wave of the coronavirus, even health systems that had invested in telehealth found they needed to dramatically ramp up their capabilities. Therefore, strengthening the infrastructure for telehealth or good telehealth service is required. HiLiteMD is HIPAA compliant, connects providers, staff and patients within its specific workflows to care for patients remotely. Send a document, message survey, offer telemedicine services easily with one click for telehealth video conferencing.
Using telehealth to leverage clinicians from areas that are affected by the coronavirus can replenish vital healthcare services in areas that are overwhelmed. This puts trained resources where they are most needed, saving lives while shielding those who have not been infected. It’s an approach that also helps to prevent harm, such as when local workers become overtaxed in keeping up with demands for care.
The use of telehealth to replace in-person, routine care ensures continuity in care without exposing individuals to other illnesses—including the coronavirus—in the waiting areas of physician practices or EDs. Leading health plans are already offering telehealth to their members, but with caveats, and the offerings are disproportionately in states with reimbursement mandates. In the federal space, reimbursement for telehealth is still spotty—permissible in Medicare Advantage (MA) but hamstrung in fee-for-service (FFS) Medicare by the site restriction.
- Screen patients who may have symptoms of COVID-19 and refer as appropriate
- Provide low-risk urgent care for non-COVID-19 conditions, identify those persons who may need additional medical consultation or assessment, and refer as appropriate
- Access primary care providers and specialists, including mental and behavioral health, for chronic health conditions and medication management
- Provide coaching and support for patients managing chronic health conditions, including weight management and nutrition counseling
- Participate in physical therapy, occupational therapy, and other modalities as a hybrid approach to in-person care for optimal health
- Monitor clinical signs of certain chronic medical conditions (e.g., blood pressure, blood glucose, other remote assessments)
- Engage in case management for patients who have difficulty accessing care (e.g., those who live in very rural settings, older adults, those with limited mobility)
- Follow up with patients after hospitalization
- Deliver advance care planning and counseling to patients and caregivers to document preferences if a life-threatening event or medical crisis occurs
- Provide non-emergent care to residents in long-term care facilities
- Provide education and training for HCP through peer-to-peer professional medical consultations (inpatient or outpatient) that are not locally available, particularly in rural areas
Today we are looking for the best practices and implemented solutions from around the globe and opting for telehealth is an effective approach. Join us today. Contact us at Info@HiLiteHealth.com or visit our website https://www.hilitemd.com for more information.
CEO | HiLite Health