Update: We are over worked — insufficient sleep again. Also, very hard to access this website, on the secure connection.

Guidelines are currently being issues to major academic teaching hospitals, community hospitals, and private practices.

Current guidelines that are being distributed;
- have written plans in place for screening and isolation,
- have an inventory of personal protective equipment (PPE),
- have local health department after-hours on-call number available (distributed),

For suspected cases;
- wear PPE that has a face mask with full shield (at the minimum!)

Treatment updates; baricitinib has been an excellent potential treatment choice for 19ncov/covid; it is one of the most likely candidates.

The full document for the care during pandemics is too long to post. Here are some highlights;

We suggest surge ventilators with flexible electrical power and oxygen requirements should be available to support patients with respiratory failure that can maintain function while either (1) sheltering in place or (2) evacuating to an outside facility. These ventilators should be portable, run on alternating current power with battery backup, and can run on low-flow oxygen without a high-pressure gas source. Surge ventilators may be of limited capability but should be able to ventilate and oxygenate patients with acute lung injury or ARDS as well as airflow obstruction. This requires the capability to deliver high minute ventilation, high flow, and high positive end-expiratory pressure. They should be safe (disconnect alarm) and relatively easy for staff to operate.

We suggest if a physiologic (nondisease-specific) outcome prediction score can be demonstrated to reliably predict mortality in a specified population upon screening for ICU admission, it is reasonable to use this to exclude admission for patients with a predicted mortality rate > 90%. Similarly, if a disease-specific score can be demonstrated to reliably predict mortality when used in the same manner for patients with the disease, we suggest it is reasonable to use this to exclude admissions for patients with a predicted mortality rate of > 90%.

We suggest highest priority critical care supplies and medications needed for routine day-to-day care, and crucial in mass casualty events, for which no substitutions are available be identified (eg, ventilator circuits, N95 masks, insulin, etc). Once identified, dual sourcing should be used for routine purchasing of these key supplies and medications to reduce the impact of a supply chain disruption.

We suggest developing defined disaster/pandemic plans for monitoring and leveraging popular social media (eg, Twitter, Facebook, others) during all actual or potential surge events, or unusual or large scale planned or unplanned events requiring cooperation, as both a means for gathering and transmitting information, as appropriate.

We suggest surge objectives should be consistent with individual hospital surge goals and include the capability to surge to:

• Up to 200% above maximal routine capacity based on the nature and severity of the disaster (contingency to the crisis)
• Up to the limit of the total number of ventilators available to coalition partners.
• Up to projected patient loads in a slow onset, slow evolving disaster.


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