COVID-19: Guidance for AANEM Members
AANEM has received numerous emails and calls from its physician members asking for guidance on how to best handle caring for their neuromuscular patients, many of whom may be immunocompromised, in light of the COVID-19 pandemic. Unfortunately, there is little evidence-based guidance on COVID-19 or how to handle these vulnerable patients. AANEM has reviewed the currently available resources and guidance published by the most reputable sources of healthcare information to put together some guidance for physicians. AANEM urges its members to adhere to information from public health officials, other government entities as listed below, and on the CDC website. This webpage provides information regarding common questions we are receiving.
Rescheduling Patient Visits
One of the major questions facing our members is whether or not elective tests or visits or other procedures should be canceled at this time. According to the CDC:
“Patients should receive any interventions they would normally receive as standard of care. Patients with suspected or confirmed COVID-19 should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed. Healthcare personnel entering the room should use Standard and Transmission-based Precautions
However, the Centers for Medicare & Medicaid Services recently announced that all elective and non-essential surgeries and procedures be postponed “until further notice.”
We are seeing major institutions, including the Mayo Clinic, making the decision to postpone ALL elective or nonurgent tests/visits/procedures for at least 8 weeks (https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-deferring-elective-care/
). Cleveland Clinic has decided to cancel all elective surgeries scheduled from March 19-27 (https://my.clevelandclinic.org/landing/preparing-for-coronavirus
). Physicians are encouraged to discuss issues related to patient care with their hospitals and provide their recommendations regarding which patients need to be seen versus those that can be delayed without impact on patient care or outcomes. Physicians should carefully consider when to cancel nonurgent procedures or prioritize their more urgent patients in order to reduce potential exposure and to ensure judicious use of potentially limited supplies of personal protective equipment (PPE). Physicians should check the CDC website for updates to this recommendation given the evolving nature of this situation.
Please be aware that the Centers for Medicare & Medicaid Services have expanded their coverage of telehealth services so this may also be an option for some patient visits. If you do not currently have telehealth capabilities set up in your practice, the AMA has a Quick Start Guide
. AANEM is currently working on additional resources about this coverage option and will have more information prepared and available in the next few days.
Special Precautions While Performing EDX Testing
AANEM members have asked whether or not any special precautions should be taken when performing an EMG, such as wearing a mask or gloves. Given the current shortage of PPE and the diversion of available supplies to ICUs and ERs, AANEM cannot state that all physicians performing an EMG should wear protective gear. Each institution and/or practice will have to determine the allocation of PPE internally. As this situation continues to unfold, hopefully the supply chain can catch up to the current demands. AANEM will work with its physician leaders to update our recommendations as the availability of PPE changes.
For patients with known COVID-19 infection, suspected COVID-19 infection, or a patient who has had close contact with an infected individual, as with other systemic infections, non-urgent EMGs and NCSs should be postponed until the patient is no longer infectious or it is determined that they do not have COVID-19. (See CDC materials https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html). If a patient needs an EMG or NCS in this circumstance, then PPE is recommended for the physician and the patient.