The first COVID-19 case was reported in China in November 2019. Only four months after the outbreak, the COVID-19 was declared a pandemic. A pandemic is a global outbreak of a new disease - meaning the disease is spread worldwide. In essence, and not to instil fear, everyone is at risk, primarily if the number of patients that are sick exceeds the current healthcare system resource available.
Unless the population at large practice social distancing, the number of COVID-19 cases will be on the rise. Amongst other countries, the South African government declared a state of disaster, and the United States of America have declared a state of emergency in an attempt to decrease the spread of the virus.
This article was written in an attempt to provide clinical recommendations during the COVID-19 pandemic, to ensure the safety of the patients, clinicians and staff members. Although this paper was written in the context of audiology and hearing related assessment and management, other professionals may be able to modify, contextualize and use these recommendations in their practices.
This one page summary of practices to follow during the pandemic highly references the Centers for Disease Control and Prevention recommendations. It is important for clinicians to keep up to date with the CDC, NICD and other communicable disease control centre recommendations as the situation changes and may have changed by the time you read this article.
Social distancing: minimizing contact
Social distancing is a central aspect of attempts to limit the spread of the virus across the globe. In public health, social distancing is an infection prevention and control behaviour in an attempt to slow down or stop the spread of an infectious disease. This normally includes reducing social contacts, working from home, and spending more time at home as much as possible.
But how can clinicians provide services while minimizing contact?
Many audiological systems today offer the capability to assess and treat patients remotely*. This is especially true with hearing aid fitting softwares, you can virtually adjust and program patients' hearing amplification devices remotely. If you are not already taking advantage of this technology, this might be the right time to do it.
*Rehabilitation services can still continue through tele-audiology (i.e. using Skype or WhatsApp). Check your local health authority for the scope of practice and reimbursement of tele-health services.
In your practice, reducing the amount of surfaces that needs to be touched will assist in decreasing the likelihood of infections. For example, keeping your practice’s door open at all times will allow individuals to have one less surface to worry about. It is also a good idea to have multiple pens for patients to use when signing in. An alternative would be to disinfect the pens after each patient’s contact with it to minimize infections.
It is recommended that you disinfect your entire practice daily; this includes chairs, keypads, your audiology equipment (especially the headsets!), counters etc.
Though the goal is to limit human contact as much as possible, we know that this is not always possible! Especially in countries where patients have limited or no internet connectivity to allow for remote audiological management.
Audiology at your door-step
Try as much as possible to focus on essential appointments, all appointments that may be non-essential should be postponed. With that being said, we know the importance of hearing and/or communication! Especially at this time, our patients should still have access to our services in order for them to be able to receive communications about what is happening around them.
If you are in an area, it might be worth seeing your patients from their homes (and in their garden) or a common area (a car maybe? because a car blocks outside noise fairly well). Before meeting your patients it is worth doing a telephone screening, this is infact important for patients coming to your practice as well. This telephone screening should include questions regarding their symptoms (i.e. do you have a fever?) and whether they have travelled to any high risk countries recently (or if they’ve been in physical contact with someone who has travelled to a high risk region). If ‘yes’ to any of those questions, patients should self-isolate for a minimal of 14 days and monitor how they feel. There are country-specific guidelines regarding what a patient should do if they suspect being infected and those will not be covered here. If patients walk into the office it is wise to let them fill in a form asking them if they were in contact with a coronavirus positive individual, if they have symptoms and more to determine the risk and get them to sign to this "declaration".
Mobile, battery operated diagnostic audiology systems will be of good use in this time. To ensure that you can take your services anywhere and can test a patient in the least cluttered environment. The more clutter or contact surface area the more likely one can be infected - if disinfection is not carried out. These systems may help you carry out your services where it may be less risky or is more convenient. BUT REMEMBER, disinfect your device after every patient!!
Audiology drive-through service
The American Academy of Audiology has recommended great advice regarding hearing aid device support. This is especially helpful in countries like South Africa where our patients may not have high-end hearing aids and internet connectivity to facilitate remote hearing aid programming. The American Academy of Audiology recommends patients to deposit their hearing aids in staff member’s cars (a staff member will have to be in the patient’s living area/ environment). The hearing aid can then be cleaned and restored or programmed in the practice then sent back to the patient in a similar manner. This will dramatically reduce the infection rate as patients wouldn’t have to come to the practice, wait in the waiting room, and be in contact with everyone in the practice.
A mere cough can produce about 3000 droplets and these can be deposited on people, clothes and surface areas. In addition, some of these droplets (smaller particles) can remain in the air. Some studies on other coronaviruses (including SARS) suggest that the viruses can survive outside the human body on surfaces such as metal, glass and plastic for as long as nine days. Because of this, in some cities, well-meaning volunteers venture out at night to clean the keypads of cash machines/ATMs.
We do not know how long the virus can remain on money, and we know we cannot disinfect paper money with any alcoholic liquids. Clinicians should attempt to set up cardless payment services in their practices to minimize cross-contaminations. This can be done through tapping your credit card without touching the tap area, e-wallet, EFTs and many similar cashless payment methods.
The ability of the virus to linger for long periods of time only underlines the crucial importance of hand hygiene and disinfecting surfaces. With that being said, we should still follow the general World Health Organizations and CDC recommendations on how to best minimize both our risk and the population’s at large.
Lastly, this is the time when we need to stand together as a people. We ALL have a big role to play to ensure the prevention and control of this disease.
Your decision in relation to the COVID-19 does not only harm you, but may have greater implications for others. If you have some of the symptoms of COVID-19, self isolate. If you have been quarantined, comply! We all have a responsibility not to infect others.