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CommentaryCovid-19 EpidemicPreventive MedicinePrimary Care

Opening OHC Office, Carefully; New Procedures; Office Covid-19 Tests

We have been working diligently to prepare our office and staff to resume limited patient care in the Orchard Health Care office consistent with Massachusetts Department of Public Health (DPH) guidance. On Friday we saw our first members with urgent problems.

Under Phase II DPH guidelines, we will still perform most visits by video links. However, we also will soon add some in-office visits for important clinical situations (in addition to clearly urgent problems) where direct physician-patient contact clearly means better care. Timing for allowing routine visits in office is uncertain as of now but will increase in subsequent phases. We describe new office procedures below.

Testing now for active SARS-CoV-2 virus in our office

We are immensely excited that we just received our supplies to do in-office testing for live Covid-19 virus. You may have read the announcement about two weeks ago in the NY Times that a new antigen immunoassay for live SARS-CoV-2 virusĀ  developed by the Quidel company was conditionally approved by the FDA. We have been using their device for two years for similar testing for influenza virus and strep infections. The test takes 15 minutes from a nasal swab (front of nose, not all the way back) and is highly accurate. (The PCR test requires a nasopharygeal swab and also tests for live virus, but by a different chemical technique.) We tentatively plan to test everyone who comes for in-office visits for active virus. Quidel told us they expect as well to distribute an accurate antibody test (fingerprick blood) for SARS-CoV-2 exposure and past infection sometime in July. We will integrate that test into our procedures when it is available.

Procedures for remote video visits

Nurses and assistants will contact each of you in advance of your scheduled video link with Dr. Sobel or Dr. Kanner to confirm issues of concern, do medication reconciliation, and inquire about medical interactions with other providers. You may be asked to check your weight, blood pressure or blood sugar at home if applicable. Staff will also help arrange urgent lab tests that may be requested for those visits. We expect monitoring blood tests to be allowed before long.

These visits have largely gone smoothly so far and have been quite productive for all of us. Feedback has been strongly positive.

Procedures for visits in the office

The goal of these procedures is to make your urgent office visit in this time of Covid-19 smooth, thorough and effective yet brief so as to minimize everyone’s close physical exposure in the office. This is safest for you and for us. To accomplish this goal we plan to gather administrative data and clinical screening data by telephone a day or two before you arrive.

  1. Staff will prescreen each scheduled patient by telephone or video link within 48 hours in advance of the appointment. This screening questions will include those for video visits mentioned above. In addition, there will be questions to elicit exposure risk or symptoms related to Covid-19 infections, since at this time we will continue to refer likely infected patients to the respiratory clinic. If co-pays become necessary, we may try to deal with them as well in advance.
  2. You will be asked to call the office from your car on your arrival at our building and to remain in your car until we call you to come up. The goal again is to minimize overlap of patients in the office itself.
  3. You must wear a face mask when you come up to the office. If you do not have one, let us know and we will provide you one before you enter the office suite.
  4. When our SARS-CoV-2 viral testing is fully set up, we will take you into an adjacent office for a nasal swab to be tested for active virus. The test result is ready in 15 minutes. Then you will be ready to enter our main office suite.
  5. We may ask you to come to the main door for entry, or possibly to the rear door. In either event there will be minimal delay and you will be escorted directly to an exam room.
  6. Following the visit, we will escort you out of the suite. Arrangements for consultations and imaging and such will be done by staff after you leave, taking account of your scheduling preferences. Confirmation of arrangements will be done by phone or email.

Our protection for you

We will look different. To protect you (and us), all staff will dress in scrubs (just like on TV) that are replaced daily. I believe we chose maroon. Clinical staff will wear N95 masks and most likely face shields when we see you. We are all washing hands assiduously. The exam room used will be vacant for at least 30 minutes and most likely an hour, with all surfaces sanitized, in between patients. In effect, we are being one level more cautious because we all will be in close proximity, not really socially distanced, in a closed space for more than a few minutes. And we are acutely conscious of the concern for asymptomatic carriers or presymptomatic infections that could readily be transmitted in such high-risk setting. Hence the precautions.

SARS-CoV-2 virus testing on arrival

Now that the Quidel active Covid-19 virus antigen test kits have arrived, we are getting them set up and pretested. Within a few days we most likely will begin to test all patients arriving for an urgent office visit for the presence of active virus. In this case we will do the test in an adjacent office space before you enter our office suite (that is current plan). You will get the result as we bring you into our office itself.

In addition, we plan to test all our staff with the SARS-CoV-2 antigen test twice weekly to assure ourselves (and you) that the Orchard Health Care environment and staff remain safe and free of Covid-19. This new antigen test gives us that capability, which is shared by only a limited number of regional clinical practices.

Knowing with good confidence that you are free of the Covid-19 is reassuring to everyone concerned. (We understand the SARS-CoV-2 antigen test to be insurance covered. It will cost between $50 and $60. In the event insurance does not cover, the charge will be put on the patient’s clinical account.) When we get the additional blood test kit for SARS-CoV-2 antibody in July, we most likely will also do that on everyone coming by.

In summary

We are now beginning to see members with urgent medical problems in our office. We have reconfigured our space and procedures to be as biologically safe as we can be, to protect you and us. In addition, we now have capability to accurately test onsite for SARS-CoV-2 active virus, which we plan to do for everyone visiting. We hope you like maroon scrubs.



One Comment

  • Corinne Reppucci says:

    Very impressive & cutting edge. As your patient, I really appreciate
    the care you have taken to protect not only me but also your staff,
    though you have always done that.

    A question I have is; if you don’t have an urgent medical issue,
    should you be tested anyway?

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