Hit first in U.S. by COVID-19, Washington doctors eye safe reopening

Sara Berg, MS , News Editor

In the U.S., the first case of COVID-19 was reported in Washington after a man returned home from a trip to Wuhan, China, in January. Washington quickly became an early hot spot for COVID-19 as the rest of the country watched. Recently, most areas of the state have seen a flattening of cases, but long-term care facilities still grapple with an increase.

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As the state balances reopening and managing another surge, the Washington State Medical Association (WSMA) continues to focus their efforts on helping physician practices remain afloat.  

“While our state is moving to reopen in phases, there is a community in the central part of our state, Yakima, that is currently having an aggressive outbreak,” said Jennifer Hanscom, executive director and CEO of WSMA. “They are experiencing an outbreak in both the long-term care community as well as in the migrant workers community.”

“We are learning that every community is impacted differently and we have to be on alert for that,” said Hanscom.

With the COVID-19 landscape changing daily, here is some of the work WSMA has been doing on behalf of physicians and their practices across the state.

“Our governor is looking at how best to reopen our state and he’s looking to do that in phases,” said Hanscom. “He’s asked the health care community to develop a framework how best to phase back in non-urgent procedures, elective surgeries and dental care, which have been delayed or completely stopped since early March.”

The goal is to reopen in a way that continues to protect patients and health care workers. But, as WSMA works to build a framework, one of the challenges is how? Should it be a phased approach for the entire state even though every community has different experiences, or should it rely on local health jurisdictions, and state, community and capacity data? With the latter, individual communities would decide what measures to take on their own.

Following the WSMA’s framework for reopening, the governor enacted a new proclamation recognizing that “patients’ health relies on a health care delivery system that can meet a range of needs in a timely manner, including acute care, surgical services, chronic illness management and behavioral health care, as well as the treatment of COVID-19 patients in both acute and chronic settings,” said Hanscom.

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“While we appear to be slowly conquering the initial wave of COVID-19 in our patients, the hidden harm being imparted to other patients from continuing to delay ‘elective-but-time-sensitive’ care has the potential to result in broad, deep and long-lasting health, social and economic impact,” she said. “We appreciate the governor putting elective care decisions back into the hands of physicians who are anxious to get back to caring for their patients and we want to continue to assure patients that our clinics and hospitals are safe.”

As states revise their COVID-19 stay-at-home orders, the AMA offers a checklist that provides guidance for physicians to safely manage reopening their practices.

The Governor’s new proclamation provides guidance on good safety measures that need to be in place as with any other infectious disease, physical distancing, universal mask use, being aware of any limitations on access to personal protective equipment, adopting conservation strategies provided by the department of health and continuing with telemedicine options.

This will also help ensure the state is prepared should there be another wave of cases that hits Washington later in the year. Learn more about a Harvard epidemiologist’s warning about COVID-19’s second wave this fall.

Washington Gov. Jay Inslee has placed trust in the physician and scientific community to flatten the curve, but WSMA is “extremely anxious about moving forward” because the economic challenges not only affect large hospitals and physicians employed by those systems, but private practices too, said Hanscom.

“We have deep concerns about people being able to bridge to the other side of this outbreak,” she said. “We are mindful that the economic impacts are severe, and at the same time we need to assure the patient community that they will be safe seeking care in the clinic or hospital setting.”

WSMA is working to ensure patients know they are safe if they come into a physician’s clinic and helping them navigate telehealth or phone consults, said Hanscom, adding that “we’re doing our best to educate patients that if they have a health concern, they need to reach out to their physician and get the care they need.”

“We are trying to educate policy makers in our state right now to do all that we can to support physician practices economically so that should the surge come back in the fall, we do have physician practices that are ready to treat those patients,” said Hanscom.

Responding to the COVID-19 crisis has taken a toll on physicians and the health care team. For example, when Washington had their first surge, an emergency physician contracted COVID-19 at the hospital that had the most cases.

“We saw a need in our physician member community to make sure that they got the emotional and wellness support they needed during this intense time where they were being overrun by patients, while also seeing their colleagues fall ill,” said Hanscom. “We offered our wellness work as a resource to our members and to provide them with support.”

WSMA physicians have access to a support line staffed by psychiatrists, an online therapy platform and a private COVID-19 discussion forum, among other resources.

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“Most important to us in terms of recovery is making sure that the physician community and the patient community are well prepared to operate at a time of COVID-19,” said Hanscom. “We know that it’s not going away anytime soon, yet we still need to be able to continue to deliver routine, preventive or chronic care. We all must adapt to living in this new dynamic.”

The AMA has two free surveys to help health care organizations monitor the impact COVID-19 has on their workforce during this pandemic. The surveys can be used to track trends in stress levels, identify specific drivers of stress, and develop supportive infrastructures based on these drivers. Organizations that use the surveys will receive support free-of-charge from the AMA in launching the surveys and access to data through an easy-to-use reporting dashboard.

Additionally, the AMA offers resources to help physicians manage their own mental health and well-being during the COVID-19 pandemic and provides practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.