Summit’s Coronavirus (COVID-19) Management Policy

Summit Medicine and Pediatrics is informed and prepared for the COVID-19 pandemic. We are in contact with the Center for Disease Control (CDC) and the Arizona Department of Health (AZDH) and have developed an action plan to manage the unique requirements of this disease. From time to time, based upon the developing course of this pandemic and the evolving opportunities and tools for medical management of patients infected with COVID-19, we will update our Coronavirus (COVID-19) Management Policy. Herein we provide our:

Coronavirus (COVID-19) Management Policy
Coronavirus (COVID-19) Testing Authorization
Coronavirus (COVID-19) Testing FAQs
Coronavirus Fact Sheet

Coronavirus (COVID-19) Management Policy

Summit Medicine and Pediatrics (SMP) is dedicated to providing at all times within our office a safe and healthy environment for our patients and our staff. While efforts to define and to contain the COVID-19 pandemic continue to evolve, SMP is taking proactive, thorough and voluntary steps to prevent the spread of the disease in our office and in our community. This policy shall remain in effect from 16 March 2020 through 31 May 2020, with a possibility of further extension should risk from the pandemic remain significant.

What is Summit Medicine and Pediatrics Doing for You in Planning for and Addressing the COVID-19 Pandemic?

Daily Thorough and Repetitive Cleaning

According to the Center for Disease Control and Prevention (CDC) and the World Health Organization (WHO), the disinfection of flat surfaces is a key component in a comprehensive strategy to minimize the spread of both viral and bacterial illness. Using bactericidal and viricidal products approved by the Environmental Protection Agency (EPA) and Occupational Safety and Health Administration (OSHA), SMP is working constantly to ensure a healthy and reassuring experience:

Facilities – Our facility adheres to strict infection control and public health safety policies and recommendations in accordance with both CDC and OSHA guidelines. SMP has augmented its regular infection control cleaning program, including cleaning for high traffic areas, door handles, chair arms, computer keyboards, telephones, toilets, and other frequently touched surfaces.
Reception – SMP does not have a crowded ‘Waiting Room’. Rather, our patients sit comfortably in a reception area that allows ‘Social Distancing’ and they are escorted promptly to be seen by our medical staff in a timely and efficient manner. Upon arrival at our facility, patients who express concerns for, or exhibit signs of, infectious disease are brought back immediately to our treatment areas.
Treatment Areas – SMP has augmented the cleaning schedule of all treatment areas, including the cleaning of certain, high-traffic, frequent-touch surfaces in between patient visits. We make disinfectant supplies readily available to our staff for spot cleaning at every level of care.
Isolation – For patients who arrive with complaints consistent with COVID-19 or Influenza, SMP has a dedicated ‘Isolation Room’ into which such patients are invited immediately for evaluation and treatment upon arrival at our facility. Our Isolation Room is cleaned thoroughly and promptly after each use.

Access to Hand Sanitizer, Hand Soap, Disinfectant Spray, Disposable Drinking Cups, and Disposable Facial Tissues; Mobile Phone Use Restriction; Automatic Payment Authorization

The principles of personal hand hygiene, including avoidance of touching one’s eyes, nose and mouth, is an essential component to minimizing the spread of COVID-19 and other viri. Our staff is required to apply such principles throughout the day, and we remind our patients constantly to do so while visiting us at our facility. While we know many patients are following these principles, here are some other ways SMP assists patients with methods to reduce the transmission of illness:

Hand Sanitizers – SMP has hand sanitizer dispensers at reception and treatment areas for use by both staff and patients.
Hand Soap – At every turn, between patient appointments, and as often as twice and hour, our staff washes their hands thoroughly with warm, soapy water for a minimum of 20 seconds.
Disinfectant Spray – Many viri are aerosolized for minutes prior to landing and remaining viable for days upon flat surfaces. SMP staff applies disinfectant spray frequently to reduce such risk for viral transmission, both through aerosolized inhalation and by surface contact.
Disposable Drinking Cups – We have retired (temporarily) our glass and ceramic coffee cups, and now offer complimentary water and other hot and cold beverages to our patients in disposable drinking cups.
Disposable Facial Tissues – ‘Sneezes and Coughs’ are a major cause for the transmission of viri. We provide, throughout our facility, boxes of disposable facial tissues. We adhere to the ‘one cough, one tissue’ principle, and throw away used tissues immediately.
Mobile Telephone Use Restriction – Mobile telephone carry many viri and bacteria. We encourage our staff and patients alike to avoid handling and using their mobile telephones at all times within our facility.
Automatic Payment Authorization – Currency and credit cards carry many viri and bacteria. Payment for services at SMP is authorized and processed without our patients having to access or handle their cash and credit cards.

Specialized Testing for COVID-19

Effective 16 March 2020, SMP is partnering with Sonora Quest Laboratories to provide testing for COVID-19 infection. We will begin offering COVID-19 testing to those who meet the Center for Disease Control (CDC) clinical and/or epidemiological criteria for COVID-19 testing: CDC Information for Healthcare Professionals

COVID-19 testing will be restricted to the following persons:

Established patients exclusively
Established patients who are symptomatic with fever, cough or shortness of breath
Established patients who have been exposed to others with fever, cough or shortness of breath (possible COVID-19 infection)
Established patients who have been exposed to others confirmed to have been infected with COVID-19

Established patients who would like to be tested for COVID-19 are invited to contact our office at 480-981-9000 to schedule an appointment. At all times at Summit Medicine and Pediatrics, we are cognizant of the importance of reducing the risk of the spread of infectious disease among our patients. Therefore, it is important to note that WALK-IN TESTING AT OUR OFFICE IS NOT PERMISSIBLE; in the interest of maintaining strict control and reduced risk of infectious outbreak, we plan to cluster our patients into specific time slots for COVID-19 testing, and encourage all patients who are symptomatic with fever and cough to arrive at our office wearing their own protective N-95 mask upon arrival, and apply the following procedure:

PARK AND REMAIN IN YOUR VEHICLE upon arrival at our office at the time of your appointment
Call our office at 480-981-9000 and notify our staff of your arrival and location within the parking lot
Dr. Mike will approach your vehicle in full, droplet isolation attire and obtain the testing specimen as you remain in your vehicle
You will receive and review instructional and educational material regarding the testing process and Dr. Mike will answer any questions you may have
You may be required to acknowledge and sign certain documents related to the processing and billing for the testing process

Testing for COVID-19 is performed by obtaining a nasopharyngeal viral swab specimen. A thin, sterile swab is inserted deeply and briefly into the naris and removed. The specimen is then sent to the lab for real-time reverse transcriptase polymerase chain reaction (RT RT-PCR). The results are typically available for review by Dr. Mike within 3-5 days, depending upon the overall test demand within the community, and results and Dr. Mike’s recommended course of action, if necessary, will then be communicated directly to the patient.

Testing for COVID-19 will be billed to our established patients’ insurance company on file, and patients are responsible for payment to Sonora Quest Laboratories for any costs attributable to copays, deductibles, restrictions in coverage, and denials of coverage. For established patients who are uninsured or under-insured, Summit Medicine and Pediatrics has negotiated with Sonora Quest Laboratories to establish a client bill fee of $110.00 for COVID-19 testing, payable at the time of service.

Empowering Our Staff with Facts and Supplies

SMP staff are the foundation of our success, and therefore, their health, safety, skill and knowledge are paramount. Here are some ways we’re supporting our staff so they can better support our patients:

Supplies – SMP stocks and provides hand sanitizer, hand soap, disinfectant spray, gloves, gowns, splash guards, respiratory masks, and other personal protection equipment. We also provide disposable protective facial masks for use by patients who exhibit signs of infectious disease.
Information – SMP is continuously communicating with staff about evolving CDC and WHO guidelines and recommendations. We update our Infection Control Policies and Procedures as necessary to incorporate and apply the latest, most effective principles of infection control.
Clothing Change – We encourage both patients and staff to change and launder clothing immediately upon returning home from our facility.

We are Available to You 24-Hours-a-Day, 7-Days-a-Week to respond to your Questions and ConcernsDr. Mike is available 24/7 by dedicated mobile telephone to every one of our patients, and is ready to answer your questions and concerns. He remains in close contact with the CDC and the Arizona Department of Health for updates and information on the COVID-19 pandemic, and is more than happy and prepared to receive your calls to answer your questions, provide professional advice for staying healthy, and alleviate concern.

6. Temporary Telemedicine Services

In the near future, SMP will offer the option to patients of visiting, in person, our office for appointments, or visiting, remotely and virtually through video connection, with Dr. Mike. It is important to note that the use of telemedicine services requires the purchase and implementation of sophisticated and HIPAA-compliant software, and due to the high demand for such services in the current healthcare crisis, it may be months before we are able to implement telemedicine services at our office. The staff at SMP will now offer to every patient the option of a standard, in person office visit, or a telemedicine, virtual office visit (when available):

Standard Office Visit – In the office, we are able to assess vital signs, perform an examination, perform many tests (e.g. ECG), and draw blood for laboratory analysis. These aspects of an evaluation cannot be performed during a telemedicine, virtual office visit.
Telemedicine Office Visit – Outside of the office, we are unable to assess vital signs, perform an examination, perform many tests (e.g. ECG), and draw blood for laboratory analysis. These aspects of an evaluation may limit Dr. Mike’s ability to diagnose and treat underlying medical conditions.

What can You Do for Summit Medicine and Pediatrics in Planning for and Addressing the COVID-19 Pandemic?

We request that you help us keep the Summit Medicine and Pediatrics facility a healthy environment by following the CDC’s infection control recommendations for management of patients suspected of having COVID-19 infection:

Know the Symptoms – Symptoms of COVID-19 infection may appear 2-14 days after exposure, and may include:
- Fever
- Cough
- Shortness of breath
Know the Alternatives – Symptoms of COVID-19 infection are similar to those of Influenza; if you’ve not yet received (and do not have a contraindication for) the annual flu shot, please consider getting one from your local pharmacy
Call Ahead – Please call us at 480-981-9000 well-ahead of your appointment when you are sick or exhibiting early symptoms of COVID-19 illness, so that we may prepare appropriately for your visit and protect other patients from potential exposure.
Be Prepared – Upon your entry into our facility, you will be welcomed, and:
- We will request to take your temperature immediately
- We will request that guests who accompany you into our facility and are not scheduled to be seen by our medical staff wait outside our facility or in your vehicle for the duration of your visit with us
- We will offer you the option to wait outside our facility or in your vehicle as well as we prepare for your visit with us; we will call your cell phone when we are ready for you
Take Precautions – Consider adhering to the following principles:
- Apply ‘Social Distancing’ by avoiding close contact with others in your household and community; always keep a distance of 5 feet from others
- Avoid hugs, kisses, handshakes, ‘high-fives’, and other skin-to-skin contact when greeting others
- Cover your coughs or sneezes with a facial tissue, then dispose of the used facial tissue immediately in the trash
- Clean and disinfect frequently objects and surfaces that are touched frequently, such as doorknobs, door handles, chair arms, computer keyboards, telephones and toilets
- Use hand sanitizer when entering and exiting supermarkets, department stores, convenience stores, and offices, including Summit Medicine and Pediatrics
- Wash your hands frequently with warm, soapy water for at least 20 seconds before eating, after using the bathroom, and after blowing your nose, coughing or sneezing
- Be prepared and informed on updates for the COVID-19 pandemic by visiting the CDC website at www.cdc.gov/
Delay Routine Office Visits – Consider scheduling and rescheduling routine office visits for management of chronic, stable conditions and wellness evaluations for a later time in June or July 2020. Doing so will help avoid the potential for unanticipated exposure to COVID-19.

Let’s Remember at All Times What We’ve Learned from Other Global Pandemics.

COVID-19 isn’t the first pandemic we’ve faced. We have learned a great deal from pandemics associated with SARS, MERS, H1N1 and Ebola, and such experience has helped prepare us to take care of COVID-19 patients today. While every major health event in our communities has unique elements of concern and unknowns to discover, we are uniquely positioned to provide exceptional care to our COVID-19 patients. We will get through this… together.

Here are some helpful sources for information on the COVID-19 pandemic:

https://www.cdc.gov/coronavirus/2019-ncov/index.html

https://www.cdc.gov/media/dpk/diseases-and-conditions/coronavirus/coronavirus-2020.html

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/index.php#novel-coronavirus-home

https://www.hopkinsmedicine.org/coronavirus

https://coronavirus.jhu.edu/

Coronavirus (COVID-19) Testing Authorization

PATIENT NAME: DATE OF BIRTH:

CONTACT EMAIL: CONTACT TEL:

I acknowledge that:

I am being tested for COVID-19 infection.
The test specimen is being sent to Sonora Quest Laboratories for processing and analysis.
The test process and reporting of results will take 3-5 business days to complete.
I am responsible for any charges and balance billing costs not covered by my health insurance company.
My test results may be forwarded and shared with public health agencies for the purpose of data collection and infection control.
I give permission to Dr. Lucherini and to Sonora Quest Laboratories to contact me by email and/or telephone, and to leave a voicemail message, if necessary, with the results of my test.

I elect to process payment for this COVID-19 test as follows:

[ ] Billing through my health insurance company (provide updated insurance information)

[ ] Immediate payment through our Summit Medicine and Pediatrics Client Service: $ 110.00

Patient or Legal Guardian Signature Date

Legal Guardian Printed Name (if necessary)

Coronavirus (COVID-19) Testing FAQs

What steps should I take to prevent illness?

Wash your hands:
- Wash your hands often with soap and warm water for at least 20 seconds especially after you have been in a public place or after blowing your nose, coughing, or sneezing.
- If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands with the sanitizer and rub them together until they feel dry.
Avoid touching your eyes, nose, and mouth with unwashed hands at all times.
Avoid close contact with people who are sick
Cover coughs and sneezes with a disposable tissue or with the inside of your elbow

What precautions should I take if I have had “close contact” with a person confirmed to have been infected with COVID-19?

The CDC defines “close contact” as:
- Being within approximately 6 feet of a COVID-19 case for more than a few minutes; close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a COVID-19 case; OR
- Having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on, shaking hands with, hugging, etc.).
Any patient who has had “close contact” with a person confirmed to have, or being evaluated for, COVID-19 infection, should immediately seek care from a healthcare professional and/or notify the Arizona Department of Health.

What does it mean if I have a “detected” (positive) COVID-19 test result?

If you have a “detected” (positive) test result, it is interpreted as a presumptive positive test result. It is very likely that you have COVID-19, and your sample will be sent to the Arizona Department of Health for confirmation.
There is a very small chance that this test can give a positive result that is wrong (a false-positive result).
It is imperative that you place yourself in strict quarantine (complete avoidance of ‘direct contact’ with others with concurrent airborne particle isolation) to avoid spreading the virus to others for a minimum of 14 days.
Mike will work with you to determine how best to care for you based on the test results along with other factors of your medical history, such as symptoms, possible exposures, and geographic location of places you have recently traveled.

What does it mean if I have a “not detected” (negative) COVID-19 test result?

If you have a “not detected” (negative) test result, it is interpreted that the virus that causes COVID-19 was not found in your sample. It is very likely that you do not have COVID-19, and your sample will not be sent to the Arizona Department of Health for confirmation.
For COVID19, a negative test result for a sample collected while a person has symptoms usually means that COVID-19 did not cause your recent illness, and that your illness is caused by a different pathogen.
It is possible, though very unlikely, for this test to give a negative result that is incorrect (false negative) in some people with COVID-19, meaning you could possibly still have COVID-19 even though the test is negative. Therefore, while a negative test most likely means you do not have COVID-19, Dr. Mike will consider the test result together with all other aspects of your medical history (such as symptoms, possible exposures, and geographical location of places you have recently traveled) in deciding how to care for you.
It is important that you work with Dr. Mike in the days and weeks following this test to help you understand the next steps you should take in managing your illness.

When Should I Go to the Emergency Room?

For the vast majority of patients suffering from respiratory illness, even illness due to COVID-19, it is unnecessary to go to an emergency room for diagnosis and treatment.
However, for certain individuals with respiratory illness who have difficulty breathing, it is often necessary to seek emergency care. If you are suffering with shortness of breath, Dr. Mike will assist you in making the decision whether or not to be seen in an emergency room, and you should contact him right away.
If it is necessary to seek evaluation and medical care in an emergency room, it is imperative that you inform the triage staff immediately upon arrival of your complaint of shortness of breath and concern for COVID-19 infection so that they may place you promptly into isolation to prevent potential further transmission of illness.

Should I Travel?

Patients planning personal travel should heed the travel restrictions, advisories, and warnings from our government and avoid all non-essential travel to the CDC Level 2 and Level 3 countries.
Check the CDC’s Traveler’s Health Notices for the latest guidance and recommendations on travel.

Is There a Vaccine for COVID-19?

At this time, there is no vaccine to prevent Coronavirus disease.
With the support of our federal government and agencies, several pharmaceutical companies are working feverishly to develop, test for safety and efficacy, produce and distribute a vaccine against COVID-19. It is estimated that this process will take 12-18 months to complete.
The best way to prevent illness from COVID-19 is to avoid being exposed to the virus.

Coronavirus Fact Sheet

What is a Coronavirus?

Coronaviri are a large family of viri that usually can infect animals, but can also infect humans. Sometimes an animal C oronavirus can change so that it can infect people and become a human Coronavirus. There are seven known types of human Coronaviri.

Four types (229E, NL63, OC43, and KHU1) are common and cause mild to moderate respiratory infections, like the common cold.
Two types, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV), can cause severe respiratory infections.
One type (2019-nCoV) is a new, or novel, Coronavirus discovered in China in 2019 (COVID-19). It is this strain of Coronavirus that is responsible for the current pandemic.

In this 5-minute presentation, Dr. Peter Lin, Family Practice, Toronto, Canada, provides an excellent summary of Coronavirus:

What is a Novel Coronavirus?

A novel Coronavirus is a new Coronavirus strain that has not been previously isolated and identified in humans.

Who Gets Coronavirus Infections?

Most people become infected with Coronaviri that cause the common cold at some point during their lives. These infections often occur in the fall or winter. Severe Acute Respiratory Syndrome (SARS) is a type of Coronavirus infection discovered in China in 2002. The SARS-CoV virus that causes SARS quickly spread to more than two dozen countries in North America, South America, Europe and Asia before it was controlled. During the 2002-2003 outbreak, nearly 8,100 people became infected. In the United States, eight people with laboratory-confirmed SARS infection were identified, and it was determined they had traveled to areas where the virus was spreading. Since 2004, no cases of SARS have been reported in the world.

Another type of Coronavirus infection is Middle East respiratory syndrome (MERS). Since it was discovered in 2012, nearly 2,500 people with MERS have been identified. All these cases have been linked to travel to or residence in and near the Arabian Peninsula. Countries in or near the Arabian Peninsula include Bahrain, Iraq, Iran, Israel, the West Bank and Gaza, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, the United Arab Emirates, and Yemen. Two people in the United States have had MERS and both traveled to Saudi Arabia where they likely became infected.

How Do Coronaviri Spread?

Human Coronaviri most commonly spread from one infected person to others through respiratory droplets produced when an infected person coughs or sneezes, has close personal contact (such as caring for or living with an infected person), or by touching an object or surface with the virus on it followed by touching their mouth or eyes before washing their hands. Three human Coronaviri (SARS-CoV, MERS-CoV, and COVID-19) are also thought to spread from infected animals to people through direct contact or ingestion of contaminated meat.

What Are the Symptoms of Coronavirus Infection?

Coronaviri typically cause respiratory symptoms, such as runny nose, headache, cough, sore throat, and fever. Sometimes, Coronaviri can cause more severe infections, such as pneumonia (infection of the lungs), kidney failure, or even death. It is clear that people older than 60-years-of-age are at greater risk for developing more serious sequelae of COVID-19 infection, especially those who have chronic and compromising medical conditions.

Are Children at Risk for Coronavirus Infection?

Coronaviri can cause a mild respiratory illness in children, and they can spread the illness to others as well. However, it is important to note that COVID-19 does not appear to cause serious or significant illness in children at this time. It is believed that children, whose immune system is exposed to a wide variety of viral pathogens as they engage in social activity among other children, and whose pulmonary clearing mechanism with healthy and active bronchial cilia that can clear pathogens from their lungs much more efficiently than do adults, have inherent and effective protection against the more severe consequences of the disease.

How Soon after Exposure Do Symptoms Occur?

It depends on the type of Coronavirus. In general, symptoms usually appear 2–14 days after exposure, however, more research is necessary to determine with precision the periods of incubation and communicability for COVID-19.

How Are Coronavirus Infections Diagnosed?

Special laboratory tests for respiratory or blood samples are needed to diagnose Coronavirus infection. This testing is more likely to be used if you have severe symptoms or if your infection might be caused by an uncommon strain of Coronavirus like SARS-CoV, MERS-CoV, or COVID-19. It is important to note that specialized testing must be developed separately for each novel Coronavirus found to infect humans, and for COVID-19, such testing has been created and is now being distributed to laboratories across the United States for use selectively in patients who exhibit signs of COVID-19 infection.

What Is the Treatment for Coronavirus Infection?

There is currently no specific treatment or cure for Coronavirus infection. Treatment consists of supportive care and relief of symptoms. For most people suffering illness from Coronavirus infection, hospitalization is not necessary, and supportive care for illness can be coordinated with your community physician or medical clinic.

How Can Coronavirus Infection Be Prevented?

A vaccine to prevent Coronavirus infection is not currently available. The following tips will help prevent respiratory illnesses of any kind:

Wash your hands often with soap and warm water for at least 20 seconds, and help young children do the same.
If soap and warm water are not available, use an 60% alcohol-based hand sanitizer.
Wash your hands especially after coughing and sneezing, before and after caring for an ill person, and before preparing and eating foods.
Cover your nose and mouth with a disposable tissue when you cough or sneeze and then throw the tissue immediately in the trash.
Avoid touching your eyes, nose, or mouth with unwashed hands.
Avoid close contact (such as kissing, sharing cups, or sharing eating utensils) with people.
Clean and disinfect frequently touched surfaces and objects, such as toys, computer keyboards, telephones, doorknobs, etc., especially if someone is sick within the home and is also touching these surfaces and objects.
Stay home, isolated from others, when you are sick, except when it is absolutely necessary for you to get medical care outside the home.
Wash your hands after animal contact and after visiting farms, markets, barns, petting zoos, and agricultural fairs.
Avoid contact with animals who are sick.

How Can I Learn More about Coronaviri?

If you have concerns or questions about Coronaviri, contact Dr. Mike. The following resources may also be of assistance:

https://www.cdc.gov/coronavirus/2019-ncov/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2Findex.html

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

https://www.nhs.uk/conditions/coronavirus-covid-19/

https://www.rivm.nl/en/novel-coronavirus-covid-19

https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert?utm_source=health.gov.au&utm_medium=redirect&utm_campaign=digital_transformation&utm_content=health-topics/novel-coronavirus-2019-ncov

http://dhss.alaska.gov/dph/Epi/id/Pages/Human-Coronavirus.aspx