In the US we have a patchwork of what it means to transition from “stay at home” orders to “safer at home.” These guidelines are implemented differently in each state, which means we all have questions about routine care needs. Preventative care appointments like dental cleanings, mammograms, or colonoscopies are often on people’s calendars months in advance. How do you make sense of what’s safe? What’s necessary? And what you should reschedule?
Guidance from government
Professional organizations are basing their practice recommendations on Federal government guidelines. In this time of transition, and with so much still unknown about how the virus is progressing, as well as the differences between states, caution is a wise approach.
The Centers for Medicare and Medicaid Services have issued recommendations for communities in Phase 1 of the Opening Up America Again guidelines. They are based on the community having a low incidence of COVID-19 and maintaining low or steady infection rates.
Use these resources to think through your decisions about routine appointments and other activities that take you out of the house:
- Regularly visit you state health department’s website and review the current number of infections and death and compare these with the previous 2 weeks. Typically, this information is made clear with graph or county specific updates.
- When the appointment in question is related to a health concern or follow up due to a specific diagnosis, arrange a telemedicine (call or video) appointment to discuss the best approach.
- Whether you are scheduled for an appointment or a procedure, information about infection control practices should be clearly spelled out on the website or in materials sent to you. You should understand how equipment is cleaned, if the staff is tested for the virus, the number of infections among staff, and how you will be protected during the procedure.
- In some cases, you may be asked to be tested before your appointment.
- Ask questions that are not answered on the website and any others that concern you. Information is critical for your safety.
Recommendations from professional organizations
The American College of Radiology published recommendations on May 6th for beginning non-urgent radiology practice such as mammograms, image guided diagnostic procedures, and more. They describe the conundrum faced by clinical practice because the usual means of analyzing risk versus benefit for any non-urgent radiology procedure is not possible, given the unknowns.
A collaborative statement was published in late March by the American College of Radiology and the American Society of Breast Surgeons recommending postponing screening exams. For women with specific concerns or symptoms, a conversation with her primary care clinician is suggested first, followed by an in-office exam.
The American Gastroenterology Association also notes that re-opening practices for non-urgent care must only happen after a recorded downward trajectory of 2 weeks/14 days. The Association undertook a meta-analysis of multiple studies to provide clinicians with a summary to guide their patients, primarily because a common problem seen in GI practice is irritable bowel, symptoms consistent with COVID. Currently, a clear pattern has not yet been established.
The CDC issued guidance for dental practices on April 27th. They noted that dental emergencies do happen and because COVID is spread via the respiratory tract, screening is critical for a dental practice. Screening questions about symptoms and a temperature check are suggested, along with asking patients to wear a mask upon entering the practice area. Individual state dental boards are also providing guidance.
The New Normal: Not Urgent
If it’s not urgent then likely you will find that appointments, exams, and tests will be available based on state direction. As states or cities open keep in mind the 14-day measure. Generally, people who become symptomatic will do so in about 5 days, but the full impact of opening may not be apparent for 14 days or even longer.
As informed consumers of care, the data on COVID spread, as well as deaths, will provide a picture for your specific area. Without testing and tracing we are limited to reports of people who are infected. The number of people who are carriers but never symptomatic remains the unknown.