COVID-19 Update May 21, 2020

To the Bloom Healthcare community,

Bloom Healthcare intends on being your trusted source of information concerning the coronavirus. We will be circulating this publication weekly and/or as we receive new information from the CDC, AMDA, White House, CO Department of Public Health, international medical journals and other sources. Bloom understands that we are all supporting the same vulnerable population and we appreciate your dedication and a solid team approach. We encourage you to reach out to us at 303.993.1330 or directly to your Bloom provider should you have any questions or require clarification.

The Latest:

From the CDC

The CDC has been steadily updating its guidance regarding testing for COVID-19. Recent updates have stressed the need to test for two key groups: High Priority & Priority.

The high priority group consists of (1) hospitalized patients with symptoms, (2) healthcare facility workers, workers in congregate living settings, and first responders with symptoms, and (3) residents in long-term care facilities or other congregate living settings, including prisons and shelters, with symptoms.

The priority group is comprised of:

1. Persons with symptoms of potential COVID-19 infection, including: fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea, and/or sore throat, and
2. persons without symptoms who are prioritized by health departments or clinicians, for any reason, including but not limited to: public health monitoring, sentinel surveillance, or screening of other asymptomatic individuals according to state and local plans.

This key imperative to test prioritized asymptomatic patients, coupled with guidance from the CDPHE regarding the importance of protecting staff and residents in congregate care settings, underscores the need to increase testing capabilities.

The CDC has also released new recommendations regarding facility testing plans, which we highly recommend reviewing. The full detail is attached. Notably, the CDC suggests all facility residents and staff receive a baseline COVID-19 test, with extensive re-testing recommendations if a single positive case is identified. While this guidance specifically mentions nursing facilities, we expect these recommendations will be applied to assisted living communities in Colorado.  If you need help preparing for widespread testing, please contact Bloom or the CDPHE.

From Johns Hopkins

Some of the latest data regarding Colorado case rates is promising; infection growth slowed during the stay at home order.  However, according to data from Johns Hopkins, Colorado is testing at the 7^th lowest rate in the nation per 100,000 people, just behind South Carolina and ahead of Kansas, both of which have far lower case rates. Tennessee, which has just 65% of the cases per 100k people, is testing at a rate more than twice that of Colorado.

Testing has not been widespread enough to definitively identify cases in our state. This data further highlights the need to remain diligent and consider testing residents in your buildings; the less we know about where COVID is, the less we can do to protect our seniors.

Bloom Community Recommendations

1. Consider contacting skilled nursing facilities for direct admissions – several local skilled nursing providers are designating Covid-positive isolation units.  Rather than sending every positive case to the hospital, considering working with skilled partners to direct admit residents. There is currently a waiver for the 3-day hospital stay requirement for SNF admissions. Patients may be eligible to use Medicare Part A benefit to cover a SNF stay for COVID even if directly admitted.
2. When evaluating new move-ins with unknown COVID status, follow the below guidance:
   1. A resident without known COVID history should have risk assessed for exposures, including:
      1. COVID-19 positive caregiver (family, hospice, home health) within last 14 days
      2. COVID-19 positive person living with patient who has not been cleared formally
      3. Persons with respiratory symptoms visiting or caregiving for the patient
      4. ER visit to a facility with known COVID cases in last 14 days
      5. Hospitalization in last 14 days
      6. SNF or Rehab visit in last 14 days
      7. Multiple caregivers necessary for routine care
   2. Any patient with high risk exposure should be isolated for 14 days prior to move in
      1. Isolation is defined as having no high-risk exposures
      2. Have no visitors except for typical caregivers
      3. All patients, regardless of high risk exposures, should be tested and receive a negative result prior to move in whenever possible.
      4. When patients are unable to isolate for a full 14 days, the accepting community should utilize COVID Transmission Based precautions (Full PPE) for 14 days upon move-in.
3. Continue sourcing extensive PPE.  Plan for the long haul and prioritize respirators and surgical face masks.

CDC Excerpt (full detail attached)

The detailed recommendations can be found here: https://www.cms.gov/files/document/nursing-home-reopening-recommendations-state-and-local-officials.pdf

Our previous COVID-19 communications and recommendations can be found at: bloomhealthcare.com/news/

We appreciate your partnership and continued diligence.

Sincerely,

Thomas Lally, MD