Ongoing coronavirus (COVID-19) updates and resources for integrative healthcare professionals

Official Guidelines and Recommendations

Integrative healthcare professionals may or may not care for patients with confirmed or suspected COVID-19. The U.S. Centers for Disease Control and Prevention (CDC) offers comprehensive guidance for practitioners and their patients and staff to keep healthcare settings safe.  

Clinical Presentation

The incubation period for COVID-19 is thought to extend to 14 days, with an average of four to five days from exposure to symptoms onset. One study reported that 97.5 percent of persons with COVID-19 who develop symptoms will do so within 11.5 days of infection.

The severity of COVID-19 illness ranges from mild to moderate, severe, and critical, with 81 percent of cases classified as mild to moderate, 14 percent as severe, and 5 percent as critical. Among patients who developed severe disease, the median time to dyspnea from the onset of illness or symptoms ranged from five to eight days, the median time to acute respiratory distress syndrome from the onset of illness or symptoms ranged from eight to 12 days, and the median time to intensive care unit admission from the onset of illness or symptoms ranged from 10 to 12 days.

While presentation may vary among individuals and over the course of the disease, the latest signs and symptoms list, per the CDC, include:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

The CDC notes some patients are asymptomatic and never develop symptoms, while others may be pre-symptomatic and will exhibit symptoms later on. Transmission is possible in both cases. Therefore, healthcare providers should take the proper precautions to ensure safety.

Age is the strongest risk factor for severe COVID-19, complications, and death. Based on currently available information and clinical expertise, older adults and people who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. Some research points to obesity and vitamin D deficiency and prominent modifiable risk factors. Practitioners should understand patients who may be at increased risk and other people who need to take extra precautions.

There are limited data about reinfection with SARS-CoV-2 after recovery from COVID-19. ​While viral shedding declines with resolution of symptoms, it may continue for days to weeks, the CDC says.

Testing

Integrative healthcare clinics should decide whether to test patients for COVID-19 or refer to other clinics in the community. Clinics who do offer testing should follow all safety precaution guidelines, including testing and specimen collection, handling, and storage.

Due to limited testing capacity, COVID-19 testing is not routinely available for patients presenting for care in the outpatient setting. Patients with COVID-19 symptoms considered highest priority for testing include:

• Healthcare workers
• Employed in public safety occupation
• Part of an illness cluster in a facility or institution
• With severe lower respiratory illness
• With worsening symptoms
• Older than 60 years old
• With underlying medical conditions
• Pregnant women
• Had contact with a suspect or lab-confirmed COVID-19 patient or had travel from an affected geographic area within 14 days of symptom onset

Testing resources include:

• Abbott Labs
• Boston Heart SARS-CoV-2
• CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel (CDC)
• cobas SARS-CoV-2 (Roche Molecular Systems, Inc.)
• COVID-19 RT-PCR Test (Laboratory Corporation of America)
• CPT Medical
• CTK Biotech
• ePlex SARS-CoV-2 Test (GenMark Diagnostics, Inc.)
• KBMO Diagnostics
• Lyra SARS-CoV-2 Assay (Quidel Corp.)
• New York SARS-CoV-2 Real-time Reverse Transcriptase (RT)-PCR Diagnostic Panel (Wadsworth Center, NYSDOH)
• Panther Fusion SARS-CoV-2 (Hologic, Inc.)
• Professional Co-Op or call 866-999-4041
• Quest SARS-CoV-2 rRT-PCR (Quest Diagnostics Infectious Disease, Inc.)
• RealTime Labs
• Simplexa COVID-19 Direct (DiaSorin Molecular LLC)
• TaqPath COVID-19 Combo Kit (Thermo Fisher Scientific, Inc.)

Treatment

The National Institutes of Health published guidelines on prophylaxis use, testing, and management of patients with COVID-19. The recommendations are based on scientific evidence and expert opinion and are updated as new data become available. The current statement includes sections on critical care, antiviral therapy, immune-based therapy, and adjunctive therapy. Click here for more information.

There U.S. Food and Drug Administration (FDA) has approved one drug for the treatment of COVID-19 in certain situations, Veklury, commonly known as remdesivir. Current clinical management includes infection prevention and control measures and supportive care, including supplemental oxygen and mechanical ventilatory support when indicated.

However, several drugs approved for other indications, as well as multiple investigational agents, are being studied for the treatment of COVID-19 in clinical trials around the globe. These trials can be accessed at ClinicalTrials.gov.

In addition, providers can access and prescribe investigational drugs or agents approved or licensed for other indications through Emergency Use Authorizations (EUAs), Emergency Investigational New Drug (EIND) applications, compassionate use or expanded access programs with manufacturers, or off-label use.

The guidelines should not be considered mandates. The choice of what to do or not to do for an individual patient is ultimately decided by the patient with their provider.

Social Distancing, Quarantine, and Isolation

Limiting close face-to-face contact with others remains the best way to reduce the spread of COVID-19. Social distancing means keeping a safe space between yourself and other people who are not from your household. To practice social distancing, stay at least six feet from other people who are not from your household in both indoor and outdoor spaces.

Social distancing should be practiced in combination with other everyday preventive actions to reduce the spread of COVID-19, including wearing masks, avoiding touching your face with unwashed hands, and frequently washing your hands with soap and water for at least 20 seconds.

COVID-19 spreads mainly among people who are in close contact for a prolonged period. Spread happens when an infected person coughs, sneezes, or talks, and droplets from their mouth or nose are launched into the air and land in the mouths or noses of people nearby. The droplets can also be inhaled into the lungs. Recent studies indicate that people who are infected but do not have symptoms likely also play a role in the spread of COVID-19.

If you are sick with COVID-19, have symptoms consistent with COVID-19, or have been in close contact with someone who has COVID-19, it is important to stay home and away from other people until it is safe to be around others.

Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:

• At least 10 days have passed since symptom onset
• At least 24 hours have passed since fever resolved without the use of fever-reducing medications
• Other symptoms have improved

Additionally, persons exposed to COVID-19 may discontinue isolation after 10 days if no symptoms have been reported during daily monitoring, or after seven days if no symptoms have been reported and the patient receives a negative test result. Continued monitoring and masking are recommended through day 14. 

A small fraction of persons with severe illness may produce replication-competent virus beyond 10 days that may warrant extending duration of isolation and precautions for up to 20 days after symptom onset. Consider consultation with infection control experts.

Persons infected with SARS-CoV-2 who never develop COVID-19 symptoms may discontinue isolation after at least 10 days following the date of their positive test.

The best method for containing the virus is prevention. Practitioners should communicate social distancing and public health measures to their patients.

Practice management considerations continued on next page