NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Dear Colleagues,

We are in a challenging time as the COVID-19 pandemic rapidly accelerates in New York City. Healthcare providers will need to make critical decisions that are far different than the normal practice of medicine and will likely require applying different standards of care during the next several weeks to months. Learning from the experience of our colleagues in other countries hardest hit by COVID-19, and watching the pandemic unfold in NYC, impacts on our healthcare system will continue to worsen. As the number of persons requesting testing for COVID-19 increases, the supply of personal protective equipment (PPE) diminishes. Many healthcare facilities are experiencing high patient volumes that will likely increase in the coming days and weeks. There are few options available to find N95 respirators and surgical masks along with other PPE. Healthcare resources must be saved to treat the sickest patients who require inpatient and critical care.

Mild and moderately ill persons with COVID-19 who seek testing are exposing others in healthcare settings including other patients and healthcare staff. At this point in the pandemic, demand for unnecessary testing is contributing to the rapidly diminishing supply of PPE and leading to a decreasing supply of swabs and viral transport media used to collect diagnostic specimens for COVID-19 testing. Additionally, some healthcare facilities in parts of the city, especially emergency departments (EDs), have seen a surge of visits due to influenza-like illness attributed to COVID-19. Emergency medical care should be reserved for persons who are severely ill, and persons with milder illness need to be strongly encouraged to stay home.

COVID-19 like illness includes any new onset (in last 7 days) of subjective or measured (≥100.4oF or 38.0oC) fever OR cough OR shortness of breath OR sore throat that cannot be attributed to an underlying or previously recognized condition. In children, fever with sore throat may be attributable to conditions other than COVID-19 (e.g., strep throat) and parent/guardian should consult a healthcare provider to determine if medical evaluation is needed.

To preserve PPE for HCW providing medically necessary care for hospitalized patients, the NYC Health Department is directing healthcare facilities to IMMEDIATELY STOP TESTING NON-HOSPITALIZED PATIENTS FOR COVID-19 unless test results will impact the clinical management of the patient. In addition, do not test asymptomatic people, including HCWs or first responders. COVID-19 testing is only indicated for HOSPITALIZED PATIENTS.

Implement measures to prevent unnecessary in-person healthcare visits by people with mild or moderate illness. EDs should only receive severely ill patients or those who require immediate emergency care. Individual hospital systems may create alternate testing venues to offload their emergency departments. Outpatient testing must not be promoted or advertised outside of these strategies. People with mild or moderate illness should be discouraged from leaving their home for testing.

MANAGING PPE NEEDS

This health alert is geared toward healthcare workers including EMS. Guidance for other first responders is a priority and will be provided by their respective agencies.

STOCKPILE

Currently, PPE in the NYC stockpile that is available to healthcare facilities and providers in NYC includes N95 respirators, N95 respirators that are labelled expired, face masks, eye protection (goggles and face shields), gloves, and isolation gowns. Due to the overwhelming demand for supplies, severe shortages in the supply chain, and limited stockpiled resources, requests for PPE will be prioritized based on the facility type and stratified by the type of patient care provided. At this time, only requests from hospitals, emergency medical services (EMS), nursing homes, and dialysis centers will be considered. Supplies are prioritized for healthcare providers and facilities that are providing direct patient care in inpatient settings or in specific settings whose staff cannot maintain 6 feet of separation from a patient.

If you are:

A hospital, you may request N95s, face masks, eye protection, isolation gowns, and gloves.

A nursing home, you may request facemasks; if you have ventilator patients, you may request N95s, goggles, face shields, gloves and isolation gowns.

An EMS provider, you may request N95s, face masks, eye protection, isolation gowns, and gloves.

A dialysis center, you may request face masks.

Facilities should contact their respective associations to make a request from the stockpile.