Managing The New Normal, COVID-19 & Continuity of Service

In the last article, I said that I believed we needed to look at the current conditions as the new normal, and in doing so it required a strategy to deal with it. I am by no means any more expert in virology than you are, however, I think we can explore together what we know and what we may be able to do in the new normal.

What Do We Know

We know that COVID-19 is a respiratory virus that is highly infectious. We know that at least up to now, it has been far deadlier by mortality rate than the common Flu. We know very clearly how it is spread and we know very clearly, how we might prevent that spread. That is a powerful start point, we have both information and understanding that can help mitigate risk. The question is how do use it and what strategies do we implement?

Pre-Screening

Before any appointment is to be undertaken, the patient needs to be pre-screened by phone. The questions to be used are freely available but I will document them here:

• Have they travelled to any of the affected countries in the last 2 weeks?
• Have they any flu-like symptoms or have they been exposed to anyone who is showing flu-like symptoms?
• Have they got a raised temperature?
• Do they have a new continuous cough?

The answers to these questions will allow you to ensure that no one with active symptoms or who has been exposed to someone with active symptoms will make an appointment. However, we know that people can be asymptomatic with this disease. It also appears that people with COVID-19 are infectious before they are symptomatic. So pre-screening questions are helpful, but not enough.

Protecting Your Staff & Patients

In order that we can protect both Patients and Staff from the virus we need to take some stringent steps in the clinic. We must try to limit physical attendance in the clinic. To do that, we must change what we do and how we do it. Clean and care, minor repairs like receiver changes and even fine-tuning of hearing aids don’t necessarily need to be done with the Patient in the clinic.

We need to offer a curbside drop off or pick up service for any need that can be met in that way. Tell Patients to arrive at a particular time, meet them outside and either take their aid for repair, fine-tuning or give them their consumables.

You need to initiate a full remote care strategy where possible. That means turning on the remote care features on every single hearing aid you have provided that is capable. Then discussing how it works with your Patients. Don’t have the discussion fifty times, record a video explaining it and doing a step by step set up at their end and put it on youtube. Get your Patients to watch it.

What about services that can’t be offered in this manner? What about impressions, fitting hearing aids, providing hearing tests, removing earwax? All of those things need in-person appointments and closer physical contact.

In-Person Appointments

If we are to offer in-person appointments we need to be very careful about how we do it, we also need to ensure all staff are clear on the process that you design. Firstly, you need to build buffer time between Patients attending. This is imperative in order that we can ensure proper social distancing. Patients need to be informed that you are keeping buffer periods in order that risks of exposure are minimised.

They also need to be told that if they do not turn up at their time of appointment, they will not be seen. Because to do so, will limit the time needed to disinfect the clinic area. You need to be very clear on this and stringent. To be laissez-faire will mean that you could be putting people at risk. So that’s:

• 15 minute buffer times between Patients for cleaning purposes
• Patients advised to turn up exactly on time for appointment
• Patients advised that late attendance will mean re-appointment

PPE in the Clinic

At this stage of the response to this virus, it is quite difficult to source personal protective equipment such as surgical masks, eye protection and nitrile gloves. That will change as manufacturers around the world ramp up their production. Of course, that is dependent on the infection rate and death rate slowing down through the measures being taken.

This equipment will be available and plentiful probably within one to two months depending on what happens. The question is how and even if we should use it. Firstly, I believe that if we are going to be in close contact with Patients before a vaccine or reliable treatment is available, it is incumbent upon us as health professionals to protect them and ourselves.

Three To Six Feet

At present, Governments are advising that people try to keep a three to six feet distance between themselves and others. In most clinic rooms I have ever seen that would mean them seating out in the hallway. More than that, some of the things we do involve close contact, in particular otoscopy. That means that distancing is an issue for us, where distancing is an issue, we need to consider the use of PPE.

The use of PPE in the clinic will reduce the risk of infection to both staff and Patient. Therefore, it makes sense for us to use it whenever possible. The question is, how? Do we wear masks and gloves during the consultation? Do we ask the Patient to wear masks and gloves as well? If we decide that is indeed the way to do things, do we meet them at the door with said mask and gloves?

If we are wearing masks, and they are wearing masks, what is that going to do to our ability to communicate and their ability to understand? If we wear a face shield instead, will it give us the protection we need while allowing the Patient to see our mouth. These are all questions we need to consider, we don’t just need to consider them, we need to get them right.

If we are wearing masks, or visors, we need to follow stringent health authority guidelines in relation to them. One use per Patient, then discard in a clinical waste bag for the gloves and mask, and disinfect for the visor if wearing one.

Disinfection Protocols

The room and clinic surroundings need to be disinfected, including the chair, the table, any door handles, any equipment that was in contact with their body, any equipment or furnishings they could have possibly touched. In order for it to be effective, you need an in-depth checklist in your clinics to be followed everytime in order that something does not slip by you.

With this type of regime in place, perhaps we can continue to offer more of the services we provide. It won’t be normal, it won’t even be close, but it may be the way for us to continue to do what we do.

Moral Arguments & Realism

As an addendum here, I am not interested in getting into the moral arguments with anyone. Yes I agree, we need to be encouraging our Patients at this time to self isolate. However, sometimes they need urgent care, even if that is just changing their damn wax guard for the fifty first time while listening to I don’t remember you telling me about that.

In the short term, we can easily handle such instances initailly over the phone and if all else fails, at a road-side drop off. However, this virus is not going away, even if our Governments manage to arrest the spread in the community as China has done. We will still need to take stringent measures to ensure our Patients are safe and mitigate the risk of them being infected or infecting others in our care.

If our Governments fail in arresting the spread of this vile little particle, we need to find a way to do what we do in the safest manner possible. I hope that I have at least given you some ideas about how you can do it. And for the sake of baby Jebus, turn on the remote care system on your Patient’s hearing aids and talk them through how to use it.