CDC: Hospitals must screen all ED patients for new coronavirus

• The CDC says it now is an EMTALA requirement to screen all patients for the new coronavirus.
• Hospitals must provide initial care for suspected coronavirus cases even if they lack advanced treatment capacity.
• CMS issued additional visitor and staff guidance for preventing and responding to coronavirus infections at nursing homes and hospices .

Emergency care regulations for hospitals now will require them to screen for the new coronavirus, according to a memo from federal healthcare officials.

The Centers for Disease Control and Prevention (CDC) issued a March 9 memo to state survey agencies that outlined how potential coronavirus cases apply to hospital requirements under the Emergency Medical Treatment and Labor Act (EMTALA).

“Every hospital or CAH [critical access hospital] with a dedicated emergency department (ED) is required to conduct an appropriate medical screening examination of all individuals who come to the ED, including individuals who are suspected of having COVID-19, and regardless of whether they arrive by ambulance or are walk-ins,” the memo states.

Minimum coronavirus requirements for hospitals with a dedicated ED include providing:

• A medical screening exam
• Necessary stabilizing treatment
• Transfers of patients with emergency medical conditions “when appropriate”

Hospitals with capacity and the specialized capabilities needed to provide stabilizing treatment for COVID-19, the disease caused by the new coronavirus, “are required to accept appropriate transfers from hospitals without the necessary capabilities,” such as small and rural hospitals.

The memo noted that hospitals may not use signage to steer suspected COVID-19 cases away from the ED, but they may take other steps to reduce potential exposure of staff or other patients to patients who could have the virus, including by:

• Setting up alternative screening sites on the hospital campus
• Setting up screening at off-campus, hospital-controlled sites
• Setting up screening clinics operated by local communities at sites not under the control of a hospital

If hospital staff conclude that an ED patient may be a possible COVID-19 case, the guidance says the hospital should isolate them immediately, initiate “stabilizing treatment” and coordinate with state or local public health officials, who in turn will coordinate with the CDC.

The CDC created a landing page for the most up-to-date guidance on screening, testing, treatment, isolation and other COVID-19 topics.

Nursing home guidance describes visitor restrictions

The Centers for Medicare & Medicaid Services (CMS) issued expanded guidance this week for nursing homes. The guidance was seen as critical since CDC data indicate that older adults and those with underlying chronic or life-limiting medical conditions are at greater risk of poor outcomes when infected with the new coronavirus.

For instance, nursing homes were directed to bar access to some visitors, including those who:

• Show signs or symptoms of a respiratory infection, such as fever, cough, shortness of breath or sore throat
• Had contact in the last 14 days with someone with a confirmed diagnosis of COVID19 or who is under investigation for having the disease or is ill with a respiratory condition
• Traveled internationally within the last 14 days to countries with sustained community transmission of COVID-19
• Live in a community where community-based spread of COVID-19 is occurring

Expanded restrictions for nursing homes in counties — or adjacent counties — with a COVID-19 case included limiting visitation, such as by having visitors limit contact with patients and meet in the patient’s room or a dedicated visitation location. For nursing homes not in affected counties, the CDC recommended discouraging visitation.

Other new steps for nursing homes include:

• Increasing visible signage about the coronavirus at entrances and exits
• Offering temperature checks
• Increasing the availability of hand sanitizer
• Offering personal protective equipment (PPE) for visitors (if supply allows)
• Providing instruction to visitors on hand hygiene, limiting surfaces touched and use of PPE
• Restricting access by those with fevers or other symptoms of COVID-19 or who are unable to demonstrate proper use of infection control techniques
• Using signage that discourages visits until “another time”

The CDC urged nursing homes to ask visitors whether they took any trips within the last 14 days on cruise ships or were in other settings where crowds are confined to a common location, and if so, to defer their visit.

Hospice guidance

Similarly, CMS issued new guidance for hospices on ways to prevent, monitor and respond to cases of COVID-19.

Those facilities were directed to ask volunteers, visitors and patients questions to determine their risk of having a coronavirus infection, including whether they:

• Traveled internationally within the last 14 days to countries with sustained community transmission
• Have signs or symptoms of a respiratory infection, such as a fever, cough or sore throat
• Have had contact in the last 14 days with someone who has, or is under investigation for having, COVID19 or who has a respiratory illness
• Reside in a community where community-based spread of COVID-19 is occurring

The agency wrote that any hospice staff members who develop signs and symptoms of a respiratory infection while on the job, should:

• Immediately stop work, put on a facemask and self-isolate at home
• Alert the hospice’s infection control manager or team to include information on individuals, equipment and locations the person came in contact with
• Contact and follow local health department recommendations for next steps (e.g., testing, locations for treatment)