KEEPING PHYSICIANS IN MIND AND INFORMED.

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COVID -19

The Arkansas Medical Society has worked closely with the Arkansas Department of Health and other healthcare community leaders to serve physicians since the beginning of the COVID-19 pandemic that hit Arkansas in March 2020. Our top priority has been and will always be the safety and well-being of the healthcare community that we serve, including our 4,200 member physicians, residents, and medical students. 

Latest Posts on COVID-19

Latest Email Updates from AMS

Click here to read older emails and to search all of our information we have sent out. 

• 8-26-21_Email Update – Off-label Use of COVID Vaccines, Toxicity Use of Animal Forumuals of Ivermectin, Third Dose Guidance, Expanded payments for at-home vaccinations for Medicare patients
• 8-10-21_Email Update – Temporary Increase in Arkansas Medicaid COVID-19 Vaccination Administration Rate
• 7-29-21_Email_Update – Governor issues public health emergency for next 60 days.
• 5-26-21 Email Update – Prior Authorization Suspensions to End May 31; Update on Vaccine Recommendations for 12-15 year olds
• 4-27-21_Email Update – Updated Recommendations for Johnson & Johnson Vaccine
• 4-13-21 Email Update – ADH, CDC Call for Pause of Johnson & Johnson Vaccine; Vaccine Hesitancy Declines but Concerns Remain
• 3-9-21_Email Update – Vaccine group 1B Opens Up
• 2-22-21_Email Update – ADH New Policy on Quarantine After Full Vaccination
• 2-3-21_Email Update – Free Webinar: Monoclonal Antibodies – Response to the COVID-19 Outbreak
• 1-28-21_Email Update – ACHI – Can Employers Require Staff to Get Vaccinated for COVID-19?
• 1-22-21_Email Update – AMA Update on Biden Administration National Strategy on COVID-19 and Pandemic Preparedness

Arkansas Department of Health

View the ADH COVID-19 dashboard here.
It will be updated four times a day.

ADH has activated a call center to answer questions from health care providers and the public about the novel coronavirus. Call 1-800-803-7847 and identify yourself as a physician needing assistance, and they will quickly assist you. 

• ADH Updates, Stats, Resources, and Health Directives.

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Vaccine Information

Map of Community Pharmacies That are Offering the COVID-19 Vaccine

Arkansas Department of Health Vaccine Plan – January 2021

Personal Protective Equipment (PPE) Update

Visit www.arkmed.org/ppe for all of our PPE information.

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Telemedicine

View the latest information from insurance carriers, HIPAA, and other sources on telemedicine during the COVID-19 crisis.

ARKMED.org/telemedicine

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Treatment Guidance

5\12 -Remdesivir, an anti-viral drug with in vitro effectiveness against COVID-19, has been released from the manufacturer Gilead Sciences under emergency use authorization for hospitalized patients with COVID-19 infection. It is being distributed through federal offices directly to state health departments.

Arkansas will receive approximately 50 courses of Remdesivir today (5\12). The drug will be distributed to hospitals in the state that are currently treating COVID-19 patients and to some other geographically strategic hospitals.

Guidelines for use have been released at https://www.gilead.com/remdesivir and pharmacy and therapeutics committees and infection control committees at individual facilities will be encouraged to follow those guidelines for use in their institutions.

3\28 – Chloroquine phosphate, when used without a prescription and supervision of a healthcare provider, can cause serious health consequences, including death. Clinicians and public health officials should discourage the public from misusing non-pharmaceutical chloroquine phosphate (a chemical used in home aquariums). Clinicians should advise patients and the public that chloroquine, and the related compound hydroxychloroquine, should be used only under the supervision of a healthcare provider as prescribed medications. Click here to read the entire ADH Health Alert.

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Practice Management Assistance

If you have specific questions related to COVID-19 and your practice, send us an email here.

Caring for Patients with COVID-19

How COVID-19 Spreads

Based on what is currently known, COVID-19 spreads mostly from person-to-person via respiratory droplets among close contacts.

How to Protect Yourself

Adhere to CDC recommendations for infection prevention and control (IPC):

• Assess and triage patients with acute respiratory symptoms and risk factors for COVID-19, including placing a facemask on the patient and using an Airborne Infection Isolation Room (AIIR), if available.
• Use standard precautions, contact precautions, and airborne precautions and eye protection.
• Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE. Use soap and water if hands are visibly soiled.
• Learn more about proper use of PPE to prevent self-contamination.
  • PPE Prioritization
  • Guidance for Healthcare Workers using their own PPE
• Perform aerosol-generating procedures, including collection of diagnostic respiratory specimens, in an AIIR, while following appropriate IPC practices, including use of appropriate PPE.

Return to Work for Infected/Exposed Healthcare Personnel

3/23 – The following guidance has been issued regarding when healthcare personnel who have potential exposure to patients with COVID-19 in the healthcare setting may return to work. These recommendations are from the CDC based on the known information about COVID-19. Click here to read all ADH/CDC recommendations.

Home Quarantine Information from ADH

3/27 – The Arkansas Department of Health said on Thursday (3\26) that they are no longer actively monitoring most people who were placed under voluntary quarantine.

However, ADH does want exposed people identified by local physicians to be given instructions about how to do self-quarantine and what to do if they develop symptoms. The department has a form that can be used to convey this information to patients.

You can download an AMS version of the ADH information guide here. We suggest you have the patient sign the form and retain a copy in the medical chart.

Forced Quarantine

Occasionally, it has been necessary for ADH to place someone under enforced quarantine by issuing an order of quarantine, which is a legal order signed by the Secretary of Health, Dr. Nate Smith. This is only done in cases where people clearly put the public health at risk by not complying with voluntary quarantine and is not something that a community physician can do. If an order of quarantine becomes necessary due to non-compliance, a local physician should contact ADH at the Physicians Hotline (1-844-930-3023) and ask to speak to the Medical Director for Immunization and Outbreak Response or the ADH physician on call to discuss.

You can read the entire ADH statement here.

Clinic Signs

Below are signs that you can post at your clinic to alert your patients on what to do before entering your clinic.  We have also translated these signs to help communicate with your Spanish and Marshallese patients. To download, click on the links below.

Clinic Sign_English

Clinic Sign_Spanish

Clinic Sign_Marshallese

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Testing Guidance, Collection, and Reimbursements

5/4 – Vendors Available to Assist with Testing

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Elective Procedure Guidelines

7\31 -Effective August 1, 2020, based on data showing very low positivity rates in pre-procedure testing to date, the requirement for a negative COVID-19 test prior to elective procedures is rescinded. However, due to the level of spread within many Arkansas communities and to limit introduction of COVID-19 into hospitals and surgery centers, ADH still strongly encourages pre-procedure testing for COVID-19. Nothing in this revision is to be construed as restricting a facility from requiring a negative pre-procedure test for COVID-19. These requirements pertain to all elective procedures. This directive does not apply to small rural hospitals under 60 beds and critical access hospitals, although they are strongly advised to follow this directive to maximize resources and minimize risk.

Directive on Resuming Elective Procedures, Phase IV

6\10 – We encourage physicians to be extra cautious when performing elective procedures. For those patients who have had a COVID-19 test within the 72 hour window, the physician might want to ensure that a system is in place to proactively note the test results prior to performing the procedure.

Contact with a COVID-19 positive patient for more than 15 minutes will trigger a series of events including a 14 day quarantine. During the quarantine some may return to work depending on whether or not they are deemed critical for healthcare delivery.

5\25 – Directive on Resuming Elective Procedures, Phase III

5\11 – Directive on Resuming Elective Procedures, Phase II

5\8 – Updated Guidance on Elective Procedures

The Arkansas Department of Health issued new guidance today that provides greater flexibility while specifying the conditions that must be met as part of Phase II of the resumption of elective procedures.

Read the updated guidance here.

5\6 – ADH Public Health Laboratory to Perform Preoperative Testing

The Arkansas Department of Health (ADH) Public Health Laboratory (PHL) is offering to perform preoperative SARS-CoV-2 testing when no other laboratory (reference or hospital) resource can be identified. The information below is provided to inform users of this option:

1. Physicians and institutions are strongly encouraged to use reference or
   local hospital laboratories for pre-operative testing SARS-CoV-2 on
   weekdays.
2. The ADH PHL will perform SARS-CoV-2 testing on weekends and
   weekdays.
3. Referring physicians and institutions are responsible for arranging
   delivery of specimens to be tested to the ADH PHL. The ADH has
   courier service from local health units (LHU) to the PHL. If needed, this
   should be arranged by contacting the LHU in advance of the day(s) of
   need.
4. Specimens should arrive in the PHL by midday Saturday or Sunday.
   Specimens arriving after that time will be processed the following day.
5. While every attempt will be made to provide a 24-hour turn-around-time
   for the results of pre-operative testing SARS-CoV-2, testing of
   specimens obtained from an outbreak investigation or congregate living
   setting may supersede the latter.’Questions regarding the above can be directed to Dr. James Bledsoe at 479-685-5393.

4\28 – Antibody Testing Primer – With multiple versions of serum antibody test kits being promoted around the state, the Arkansas Department of Health want to remind physicians that they do not support these test kits. This primer helps explain why.

4\26 – Updated Guidance on Acceptable Specimen Collection

Nasopharyngeal specimen is the preferred choice for swab-based COVID-19 testing. When
collection of a nasopharyngeal swab (NPS) is not possible, there are other acceptable alternatives.  Click on link above to read the entire guidance.

4\23 –Updated Guidance from ADH on COVID-19 Testing

Testing capacity and technology for COVID-19 are rapidly changing. PCR tests can now be done using traditional technology or rapid result point of care instruments. These are tests for components of the virus. Serological tests are also available but not appropriate for diagnosis.

Over the past week, capacity for COVID-19 testing at commercial labs has increased significantly, resulting in shortened turnaround times. Therefore, the Arkansas Department of Health (ADH) now recommends that clinicians consider testing patients for COVID-19 based solely on their symptoms.
This means patients can be tested even if they do not have known risk factors of contact with a person confirmed to have COVID-19 or travel to an area with widespread community transmission of COVID-19. In addition, we also now recommend testing all those with history of potential exposure to COVID-19, even if asymptomatic.

Providers should use their best clinical judgment to determine if a patient’s presentation is consistent with COVID-19 and needs testing. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing, sore throat). However, some patients have had atypical presentations with diarrhea and without fever. Other groups worthy of screening include those admitted to hospital ICUs, those with sudden onset severe illnesses, and pregnant women.

This relaxation of testing criteria will allow for more accurate estimates of COVID-19 prevalence in Arkansas. Testing capacity at ADH’s Public Health Laboratory has also increased. Due to our public health mandate, we continue to prioritize the testing of patients who:

1. Require a rapid diagnosis because they are hospitalized with significant
   symptoms or
2. In the intensive care unit, or those who reside in an institutional facility
   (i.e., longterm care, correctional facility, etc.), or are part of the cohort of
   known contacts of positive cases that we are actively following.

If you have a patient who you think meets criteria for testing at ADH, please call the Physician Hotline at 1-844-930-3023 to discuss the case with an ADH clinician. Otherwise, continue to send specimens to your preferred commercial lab.

CDC recommends providers have a supply of face masks and tissues for patients with symptoms of respiratory infection. These should be provided to patients with symptoms of respiratory infection at check-in. Source control (putting a face mask over the mouth and nose of a symptomatic patient) can help to prevent transmission to others.

4\17 – ADH Directive Regarding the Use of Nucleic Acid Amplification Test:  The Arkansas Department of Health (ADH) recognizes the importance of having diagnostic NAATs for the detection of SARS-CoV-2 at POC settings such as those listed above during the current public health emergency. In the interest of patient safety, the ADH requires that all POC NAAT devices and assays used outside of CLIA approved laboratories have written approval from the Arkansas Secretary of Health.
Click here to read the entire directive.

3/20 – Price Gouging: We have received a few calls about price gouging from medical supply vendors and out-of-state labs. The Arkansas Attorney General’s office intends to vigorously pursue prosecution of these bad actors. Generally a 10% or more increase in price over the pre-emergency price is considered price gouging. See the information from the AG’s office.

3/20 – DHS Laboratory COVID-19 Testing Reimbursements for Medicaid

3/17 – Specimen Collection Procedure:  Commercial labs, such as LabCorp, Quest, and Roche, now provide COVID-19 testing. Health care providers intending to test their patients for COVID-19 should obtain the requirements for specimen collection, storage, and shipping from the commercial lab that they plan to use. Click here to read the rest of the Specimen Collection Guide (3/13/20).

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Centers for Disease Control and Prevention

COVID-19 Information for Healthcare Professionals

Find current interim guidance and healthcare professional preparedness checklists.

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American Medical Association Guide for Physicians

This quick-start COVID-19 physician guide, curated from comprehensive CDC, JAMA and WHO resources, will help prepare your practice, address patient concerns and answer your most pressing questions.

https://www.ama-assn.org/delivering-care/public-health/physicians-guide-covid-19

Updated as of March 6, 2020.

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