ACR Issues Advice on Reopening Clinics During the COVID-19 Pandemic

When the coronavirus disease 2019 (COVID-19) first started spreading in the United States, rheumatologists and rheumatology health professionals reduced the number of face-to-face visits and other services to various degrees. Now, they are looking at phased reopenings, which may vary significantly depending on local conditions, according to the American College of Rheumatology (ACR).

As stay-at-home orders are revised and businesses in the United States begin to reopen, rheumatology practices are also returning to normal business, which has prompted ACR to release advice on strategies for reopening practices during the COVID-19 pandemic.

“The ACR holds that the individuals best suited to evaluate local conditions and coordinate reopening efforts are providers who, in shared decision making with their patients, staff and local authorities, can devise and follow plans to maximize patient safety and deliver high quality care,” the document said.

The document is split into 3 sections based on the main questions patients and staff might have:

• Is it safe to go back to the workplace?
• How will the clinic be reopened?
• When is it safe for staff and patients to return to the clinic after a confirmed case of COVID-19?

Returning to the Workplace
ACR recommends advising patients to continue working from home if possible, avoid group interactions, wear a mask, and practice careful hand hygiene. The document notes that over time, factors influencing whether or not a patient can return to the workplace may evolve, depending on future therapeutic advances and the availability of a COVID-19 vaccine.

Individual circumstances should also be taken into account when advising patients whether or not they should return to the workplace. This may include:

• The patient’s ability to tolerate ongoing and future quarantine and isolation
• Conditions in the workplace
• The patient’s underlying health
• Local incidence and prevalence of COVID-19 and local testing rates

Similar considerations should be taken when advising patients about returning to public spaces beyond work, including family visits. ACR recommends advising that patients also take into account the risk to those around them and if they could expose the elderly and those with comorbid conditions if they are infected.

Reopening the Clinic
The ACR document provides a long list of suggestions to be taken into account when reopening a medical facility. Among the suggestions are:

• Reopen in phases and continue using telehealth when it is appropriate
• Screen employees daily and patients prior to clinic visits
• Require all patients to wear masks and provide masks to patients who do not have one
• Arrange exam rooms and waiting rooms to allow for physical distancing. If possible, allow patients to check in by phone and remain in their cars until an exam room is ready.

ACR is also recommending offices have a plan if a patient tests positive after visiting the clinic in case they were asymptomatic during the visit.

Returning After a Confirmed Case
In addition to when patients can return to the clinic after COVID-19 infection, there is also the question of when patients can safely resume disease-modifying antirheumatic drugs and/or biologic therapy after infection.

Data around when patients can resume treatment are lacking, ACR notes, but the organization has recommended previously that patients who had uncomplicated infections may restart treatments within 7 to 14 days after symptoms resolve. Patients who have a positive test but are asymptomatic may consider restarting treatments 10 to 17 days after the positive test. Patients who are recovering from more severe infections may need to be evaluated on a case-by-case basis.

Data about when people can return to the clinic after an infection are emerging. For now, ACR recommends that people can return when they have been without a fever for at least 24 hours, symptoms have improved, and at least 10 days have passed since the onset of their symptoms. Patients with severe or critical COVID-19 or who are severely immune compromised should wait 20 days from the onset of their symptoms. Asymptomatic patients who test positive may return 10 days after the positive test if they do not develop symptoms.