Kevin C. Wilson , 1 , David A. Kaminsky 2 , Gaetane Michaud 3 , Sunil Sharma 4 , Linda Nici 5 , Rodney J. Folz 6 , Igor Barjaktarevic 7 , Nirav R. Bhakta 8 , George Cheng 9 , Geoffrey L. Chupp 10 , Adam Cole 11 , Anne E. Dixon 2 , James H. Finigan 12 , Brian Graham 13 , Teal S. Hallstrand 14 , Jeffrey Haynes 15 , John Hankinson 16 , Neil MacIntyre 17 , Jess Mandel 9 , Kevin McCarthy 18 , Meredith McCormack 19 , Susheel P. Patil 19 , Margaret Rosenfeld 20 , Michal Senitko 21 , Sonali Sethi 22 , Erik R. Swenson 14 , 23 , Sanja Stanojevic 24 , Mihaela Teodorescu 25 , Daniel J. Weiner 26 , Renda Soylemez Wiener 1 , 27 , Charles A. Powell 28
Background: In March 2020, many elective medical services were canceled in response to the coronavirus disease 2019 (COVID-19) pandemic. The daily case rate is now declining in many states and there is a need for guidance about the resumption of elective clinical services for patients with lung disease or sleep conditions.
Methods: Volunteers were solicited from the Association of Pulmonary, Critical Care, and Sleep Division Directors and American Thoracic Society. Working groups developed plans by discussion and consensus for resuming elective services in pulmonary and sleep-medicine clinics, pulmonary function testing laboratories, bronchoscopy and procedure suites, polysomnography laboratories, and pulmonary rehabilitation facilities.
Results: The community new case rate should be consistently low or have a downward trajectory for at least 14 days before resuming elective clinical services. In addition, institutions should have an operational strategy that consists of patient prioritization, screening, diagnostic testing, physical distancing, infection control, and follow-up surveillance. The goals are to protect patients and staff from exposure to the virus, account for limitations in staff, equipment, and space that are essential for the care of patients with COVID-19, and provide access to care for patients with acute and chronic conditions.
Conclusions: Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a dynamic process and, therefore, it is likely that the prevalence of COVID-19 in the community will wax and wane. This will impact an institution’s mitigation needs. Operating procedures should be frequently reassessed and modified as needed. The suggestions provided are those of the authors and do not represent official positions of the Association of Pulmonary, Critical Care, and Sleep Division Directors or the American Thoracic Society.