Without aggressive disease mitigation strategies such as stay-at-home orders, surges in COVID-19 could overwhelm health care capacity. These strategies paired with radical changes to social and economic activity can also have consequences on a community’s ability to meet the basic needs of citizens, according to a recent article by Kaiser Permanente leaders. This signals the need for a new phase: disease suppression.
Published in the New England Journal of Medicine, “Kaiser Permanente’s System Capabilities to Suppress Covid-19,” looks at eight capabilities aimed at suppressing the novel coronavirus. The article is written by physicians and leaders at Kaiser Permanente including Stephen Parodi, MD, Bechara Choucair, MD, Scott Young, MD, Jim Bellows, PhD, David Grossman, MD, and Vincent X. Liu, MD, MSc.
“We know that the nonpharmaceutical interventions have been effective, but from an economic standpoint—from a basic societal standpoint—we need to be able to increase the level of functioning that we have in our society,” said Dr. Parodi, associate executive director of The Permanente Medical Group and national infectious disease leader for Kaiser Permanente, an AMA Health System Program Partner.
“We're at a point where until we have a vaccine that's safe, effective and in the bodies of billions of people, our best tools to help us suppress this pandemic will be looking at these very concrete strategies that we can put in place as a community, society, country and world,” said Dr. Choucair, senior vice president and chief health officer at Kaiser Permanente.
Robust testing programs
It is key to perform aggressive testing for symptomatic, exposed and asymptomatic patients to identify and address COVID-19 reemergence.
“For us to get to the point where we're really effective in suppressing the pandemic, we need to be able to be testing very broadly,” said Dr. Choucair.
Contact tracing, case finding and isolation
“We have to do contact tracing for those who are testing positive and those who have been exposed to people who are positive, we have to be able to warn them,” said Dr. Choucair. “Those fundamental public health approaches are key to this roadmap that we've put together.”
Kaiser Permanente maintains close partnerships with local public health agencies to detect early signs of resurgent infections. Together they also trigger responses for case finding, contact tracing and home isolation.
Community health care
“It's going to take a village to help us get over this pandemic,” said Dr. Choucair, adding that early on Kaiser Permanente partnered with the National Health Care for the Homeless Council with specific targeted services and support to people experiencing homelessness.
“We've developed a social health playbook that offers our front-line workers very concrete steps and protocols to help with our members who are dealing with things like food insecurity, stable housing, financial strain, social isolation, and other social factors that have been exacerbated as a result of the pandemic,” said Dr. Choucair.
Care of patients in the home, whenever possible
Patients’ fears of becoming infected in hospital or clinic environments have led to advancements in delivering care at home through home monitoring, telehealth and acute medical care. Read more about how Permanente uses telehealth during the COVID-19 pandemic.
“We anticipate that a significant percentage ongoing will be telehealth,” said Dr. Parodi. “We’ve asked every single specialty within Kaiser Permanente to assess which types of cases can be seen with video or by telephone and then which ones are going to be the ones that actually require in-office attention.”
Learn more from the AMA about how to establish telehealth and deliver patient care while practicing physical distancing.
Maintaining community-level surge capacity
Physicians and other health professionals must remain vigilant to preserve excess care capacity for the foreseeable future. This includes community and regional coordination for acute care.
For example, Kaiser Permanente developed detailed operational playbooks for COVID-19 mitigation and hospital surge. Additionally, the system’s purchasing and inventory program worked to ensure a secure supply chain for medical supplies moving forward, including personal protective equipment.
Targeted and safe health care reopening
Kaiser Permanente is taking a careful approach to reinstituting elective surgeries and other care. This ensures risks are minimized while addressing ongoing clinical needs. Real-time risk modeling will also be helpful to identify optimal approaches to health care reopening.
“We are in this for the long haul,” said Dr. Parodi. “The way that we conduct health care in this nation and actually the nature of the way our communities are going to function with the reality that COVID-19 is with us, has fundamentally changed.”
Ongoing research to combat COVID-19
COVID-19 has presented in unusual patterns of clinical disease and has vexing properties that do not fit neatly with other respiratory viral infections, says the article. More robust epidemiologic data is needed to properly plan for future COVID-19 cases in the U.S.
Research should look at understanding the pathophysiology of the virus, evaluating effective therapies, and developing and testing vaccine candidates.
Patients need appropriate education about COVID-19 such as how to protect themselves by recognizing symptoms, practicing hand hygiene and covering coughs. But it also includes communication between physicians, other health professionals and organizations in the community.
“This entire response requires a team. Physicians being paired with their clinical teams and increasing their telemonitoring capabilities has been really key to the initial part of this response,” said Dr. Parodi. “The physician partnership with public health and policy makers has made a huge difference in being able to influence the right policies that need to be in place from a global public health perspective.”
The AMA has developed a COVID-19 resource center as well as a physician’s guide to COVID-19 to give doctors a comprehensive place to find the latest resources and updates from the Centers for Disease Control and Prevention and the World Health Organization.