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As Pennsylvania began shutting down huge swaths of the economy to contain the coronavirus, health care is one category that no one can deem nonessential.
But health facilities around the region — from small drug treatment centers to major academic hospitals — are restricting visitors, limiting some services, rescheduling elective procedures, and turning to telemedicine as they prepare for what is expected to be a huge surge in seriously ill patients.
People who need to go to a clinic for health care frequently are facing special challenges.
At Merakey Parkside Recovery, a treatment center that operates a methadone clinic in West Philadelphia, staffers were figuring out how to make sure clients received their daily dose of methadone.
Because of federal restrictions surrounding the medication, which is itself an opioid, most people in methadone programs have to attend in person every day to receive their dose. Monday evening, the federal Substance Abuse and Mental Health Administration said that states that have declared emergencies over the coronavirus outbreak, as Pennsylvania has, can apply to have stable patients take home 28-day supplies. Patients who are less stable can receive a 14-day supply, the administration said.
“Everything’s kind of changing, literally by the hour,” said Laura Murray, Merakey’s behavioral health chief medical officer. The clinic had already canceled group therapy sessions to limit patients’ potential exposure to others, though it was still holding limited individual counseling.
Buprenorphine, the other major opioid-based addiction treatment medication, has fewer federal restrictions surrounding it; patients can more easily take doses home with them. At Clean Slate, a buprenorphine treatment center with several locations around the city, manager Brooke Feldman said the center was remaining open, but some staff were working remotely, and the clinic was counseling some clients over the phone. The center can also send clients home with longer prescriptions than usual.
Prevention Point Philadelphia, the public health organization that serves people in addiction in Kensington, on Saturday closed the drop-in center where people living rough can rest inside during the day. Primary care services, wound care, legal services, meals, and drop-in case management all have been suspended.
The organization will continue to offer its needle exchange, mail services for people without addresses, and treatment programs for people with HIV.
Main Line Health launched a command center about 10 days ago to coordinate all changes to operations at its hospitals and outpatient centers, said Andrew Norton, chief medical officer of the system.
Nurses staff a dedicated call line for medical staff who have questions, such as where to send a patient for a coronavirus test. Norton and other chief medical officers in the region are conferring frequently to share best practices and coordinate response.
Non-medical employees have been asked to work remotely; meetings of 10 or more are held remotely. Visitor access has been restricted, and patients or visitors are screened for respiratory virus symptoms when they arrive at the hospital. Nebulizers, the standard way medication is administered to patients with respiratory illnesses, have been swapped out for inhalers, which release fewer virus particles into the air.
Like many hospitals in the region, Main Line is evaluating all its scheduled elective procedures, canceling or postponing those of lesser urgency, such as cosmetic surgeries or a knee replacement for pain relief.
“Depending on how much community spread we get, we may see patients who feel fine” but are carrying the virus, Norton said. “One fewer person in the building is one fewer person who may theoretically be minimally symptomatic but carrying the virus.”
On Monday, Jefferson Health said its hospitals would prohibit visitors, with some exceptions. The system began to cut back on elective surgeries on Friday. As of Tuesday, only urgent procedures will move forward and elective procedures will be reduced, said Brandon Lausch, Jefferson Health’s senior director of news and media relations.
In addition, Jefferson is asking its providers to contact patients and anyone accompanying them to surgery on the day before the procedure, so they can be screened for COVID-19 symptoms. Surgeries for patients with “exposure concerns," or who are symptomatic, will be canceled.
Penn Medicine posted on its website that it will be also rescheduling some patient appointments and contacting patients directly if the health system has postponed a procedure. The aim is to prioritize patients who need immediate care, representatives from the health system wrote. Penn is also limiting visitors to inpatient facilities with some exceptions; for outpatients, only one person is allowed to accompany a patient.
Wilmington-based ChristianaCare, the largest health system in Delaware, is postponing all elective procedures at hospitals and walk-in practices beginning Tuesday. The system had already restricted visitation.
And the Mazzoni Center, a health-care provider for the LGBTQ community, announced Sunday that it would suspend all services, including HIV testing and sexually transmitted infection screenings, based on recommendations on social distancing from government agencies, until at least Friday.