ACP, other groups address shortages of PPE, medications, tests during COVID-19 pandemic

Researchers, government agencies, and organizations, including ACP, have been focusing attention on resource shortages related to COVID-19.

The College praised the recently passed CARES Act for providing funding to increase manufacturing, supply, and distribution capacity for personal protective equipment (PPE) but also stressed in a news release that all possible means must be used to ensure that there is sufficient PPE immediately available to every physician, nurse, and health worker on the front lines. The news release and a letter to Congress addressed all of ACP's legislative priorities related to the CARES Act.

ACP also called for assessment of the need for nonurgent, in-person medical appointments. The “Statement on Nonurgent In-Person Medical Care” recommends transitioning patients who do not need to be seen in person to virtual visits or delaying their visits during the national emergency created by COVID-19. The new policy addresses how physicians should assess the need for in-office visits. The statement also asks government and all other payers to immediately expand their coverage and payment policies to include both video-enabled and audio-only phone calls and make that coverage retroactive to the date of the president's declaration of national emergency, allowing physicians to quickly convert routine or preventive visits to telephone or telehealth visits for as many patients as possible.

The College also issued a statement on a policy on allocation of scarce resources. “When, as in times of health system catastrophe, routine ‘first come, first served’ or ‘sickest first’ approaches are no longer appropriate, resource allocation decisions should be made based on patient need, prognosis (determined by objective scientific measures and informed clinical judgment) and effectiveness (i.e., the likelihood that the therapy will help the patient recover). Allocation of treatments must maximize the number of patients who will recover, not the number of ‘life-years,’ which is inherently biased against the elderly and the disabled,” the statement said.

ACP is also advocating on immigration issues, highlighting the potential for clinician shortages during the pandemic. In a letter to the U.S. State Department, the College expressed concern that current suspensions of visa processing could prevent the arrival of international medical graduates for residency as well as affect the ability of foreign physicians already in the U.S. to practice. On March 26, the U.S. State Department issued a statement encouraging medical professionals with an approved U.S. nonimmigrant or immigrant visa petition or certificate of eligibility in an approved exchange visitor program, especially those treating or working to mitigate COVID-19, to review the websites of their nearest embassy or consulate for information on requesting a visa appointment. Medical residents on J-1 visas “may consult with their program sponsor, [the Educational Commission for Foreign Medical Graduates], to extend their programs in the United States. Generally, a J-1 program for a foreign medical resident can be extended one year at a time for up to seven years,” the State Department said.

The College recently reinforced its recommendations in support of social distancing and maintains a COVID-19 Resource Hub, which includes its continually updated physician's guide, and Annals of Internal Medicine's collection of coronavirus content is freely available online.

A group of medical organizations addressed reports that clinicians and hospitals have stockpiled medications thought to potentially treat COVID-19, including chloroquine, hydroxychloroquine, and azithromycin, for themselves. “We strongly oppose these actions,” said the March 26 statement from the American Medical Association, American Pharmacists Association, and American Society of Health-System Pharmacists. They noted the lack of evidence for off-label use of these treatments and potential consequences for patients with appropriate prescriptions. “Stockpiling these medications—or depleting supplies with excessive, anticipatory orders—can have grave consequences for patients with conditions such as lupus or rheumatoid arthritis if the drugs are not available in the community.”

The FDA has issued an emergency use authorization for chloroquine phosphate and hydroxychloroquine sulfate. The U.S. Department of Health and Human Services said in a press release on March 29 that the drugs will “be distributed and prescribed by doctors to hospitalized teen and adult patients with COVID-19, as appropriate, when a clinical trial is not available or feasible.” An Ideas and Opinions article published by Annals of Internal Medicine on March 30 highlighted limitations of the research on hydroxychloroquine in COVID-19 and discouraged the drug's off-label use until more evidence is available and the supply is bolstered.

Given the shortage of tests for COVID-19, the FDA also updated its policy specimen collection guidelines for COVID-19 testing. “Based on available data, FDA believes that, for symptomatic patients, nasal swabs could be used that access just the front of the nose rather than the depth of the nasal cavity,” said a March 23 statement.

On March 30, Annals of Internal Medicine published a retrospective study finding that 22 of 133 COVID-19 patients in Beijing had positive real-time fluorescence polymerase chain reaction results for SARS-CoV-2 in the sputum or feces after pharyngeal swabs became negative. The authors cautioned that it's not known whether these positive sputum or fecal results indicated that patients could still be infectious and said more study in this area is needed.