Medical Advisory Team (MAT) Resources
PPE conservation for hospitals and healthcare facilities: NM hospitals and healthcare facilities should immediately begin maximal PPE conservation practices (if not already enacted); and, this MAT assessment outlines specific guidance on conservation approaches, practices and protocols.
Antibody testing guidelines for the public: Advertisements and news stories about blood antibody tests to detect past COVID-19 infection are becoming more common. Blood antibody tests for COVID-19 are different than the tests done with nose or throat swabs. Swab tests can help determine who is at risk for developing symptoms of COVID-19 or spreading the disease by detecting the virus in the person’s respiratory system. Blood tests, however, tests for past viral infections by testing not for the virus itself, but for the antibodies a person’s body produced to fight the virus. And, importantly, not all antibody tests are reliable. In this assessment, the MAT highlights some of the differences between these two types of tests.
The MAT presents a framework for resuming medically necessary surgical procedures in hospital and ambulatory surgical centers settings, including principles, timing and phasing, prioritization and scheduling, patient screening and testing, facility considerations, PPE supplies, and reporting requirements.
The MAT presents a framework for resuming non-emergent and medically necessary care and procedures in medical offices, including principles, PPE supplies, facility considerations, patient screening, and reporting requirements.
The MAT has revised its original 4/9 assessment following release of NIH treatment guidelines and additional guidance from the FDA. The NIH guidelines conclude that there is insufficient clinical data to recommend either for against using hydroxychloroquine (HCQ) for treatment of COVID-19. The MAT reccomends individual providers may consider treatment of inpatients using the emergency use access (EUA) approval guidelines provided by the FDA, with the understanding that clinical data regarding HCQ in the treatment of COVID-19 is limited.
Antibody testing overview: Presently, the MAT only recommends serologic COVID-19 antibody testing in the following settings: 1) subset of acutely ill patients; 2) focused epidemiologic surveillance during the ongoing outbreak and post-outbreak in vulnerable populations; 3) general epidemiologic surveillance; and, 4) as a tool in studying long-term outcomes in individuals with symptomatic and asymptomatic COVID-19.
The MAT reccomends the following guidelines for the treatment of COVID-19 associated coagulopathies: 1) Administer standard-dose thromboprophylaxis for all hospitalized patients, unless contraindicated; 2) Intermediate-dose thromboprophylaxis should be administered for all critically ill patients with sequential compression devices, unless contraindicated; 3) Sequential compression devices should be used on all patients with a contraindication to coagulation; and, 4) Standard therapeutic anticoagulation should be administered for strongly suspected VTE episodes that cannot be confirmed with imaging, unless contraindicated.
The MAT recommends the standarized treatment guidelines for COVID-19 patients provided by the Society for Critical Care Medicine and the Infectious Disease Society of America be used at acute care facilities.
Antibody testing guidelines for healthcare providers: Providers should consider COVID-19 antibody testing for patients in certain circumstances, such as for patients with acute respiratory tract disease as a complement to NAAT, especially in patients in whom COVID-19 disease is suspected and NAAT results are negative, and in patients with resolved serious upper respiratory tract infection that occurred during the pandemic. Additionally, antibody should not be used as an indication of resolved infection or protection from future infection. Further, providers should fully inform patients of issues associated with testing (e.g. false negative/positives) and perform tests using assays from reputable companies.
Children, like adults, should also follow social distancing guidelines put in place since they may be more likely asymptomatic and infected with COVID-19; activities such as organized sports, school gatherings should continue to be avoided. It is also important to address the social and emotional needs of children as some recent studies have shown social isolation and economic pressures due to COVID-19 can increase child abuse, teen suicide, and substance use among children.
The MAT recommends no community should stop access to alcohol during the COVID-19 pandemic, as it will result in increased pressures on the healthcare system. An unattended withdrawal from alcohol is potentially life-threatening event, with a prevalence of death resulting from this at the 5 to 8% range (higher than the COVID-19 fatality rate).
Download the New Mexico Statewide Acute Care Medical Surge Plan for COVID‐19 Pandemic Response
The MAT supports clinical trial development for Pre-Exposure Prophylaxis (PrEP) for Healthcare Workers, but does NOT recommend routine PrEP with hydroxychloroquine (HCQ) for healthcare workers and first responders at this time. Also, the MAT does not recommend post-exposure prophylaxis (PEP) with HCQ for community members who may be asymptomatic but may have had significant exposure.
The MAT recommends Convalescent Plasma treatment be restricted to organizations either participating in the Mayo Clinic Expanded Access Program or those organizations in an ongoing clinical trial, given the onerousness of the current available processes to obtain Convalescent Plasma.
The MAT reccomends the State of NM work with Gilead, the manufacturer of Remdesivir to obtain approval for University of NM Hospital and Presbyterian to participate in clinical trials for COVID-19; however, availability of Remdesivir is very limited and therefore should not be considered a valid treatment for COVID-19 patients statewide.
Although the technology behind cloth masks with HEPA filters has potential, the MAT suggests further testing for particle filtration by a scientific lab; until such time, the MAT does not recommend these masks for healthcare workers. Additionally, cloth masks for general public use should be utilized in alignment with CDC guidance and recommendations: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html
The MAT outlines 13 criteria the State of NM should consider when purchasing ventilators; and, any vendor offering to sell ventilators should confirm their product meets these specifications. An operating manual or verbal conversation is not a substitute.
The MAT proposes the following mathematically-derived Personal Protective Equipment (PPE) burn rate of per-patient/24hrs (under maximal conservation measures and recycling efforts):
- Respirators (N-95 level or equivalent): 1.27
- Gowns: 1.75
- Eyewear/googles/face shields: 0.9
- Gloves (all sizes): 8.6
These calculations were estimated for hospitals and do NOT include ambulatory, ambulance services, skilled nursing facilities etc.
To maximize conservation of Personal Protective Equipment (PPE), the MAT reccomends NM hospitals follow exisiting CDC guidance: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
The MAT reccomends NM hospitals develop policies and procedures directing health care professionals to prioritize Personal Protective Equipment (PPE) for those in direct care of COVID-19 positive patients and Patients Under Investigation (PUIs), focusing reusable PPE on high utilizers, and cohorting COVID-19 confirmed patients to the maximum extent possible for conservation of PPE.
To maximize the supply of Personal Protective Equipment (PPE), especially N95-type respirators, the MAT recommends NM acute care and ambulatory facilities implement structures and policies for the recycling of N95-type respirators. The MAT reccomends the use of Ultraviolet (UV) Light, Vaporized Hydrogen Peroxide (VHP), as well as manufacturer’s instructions for reusable PPE (respirators, gowns) for recycling.
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