Another Message from SART
This message is intended to assist SART members in getting through the COVID-19 pandemic.
The ASRM COVID-19 Task Force guidance was updated on 3/30/20. View these documents at the link below.
SART continues to strongly encourage adherence to these recommendations and emphasizes that members should check and comply with local and state ordinances.
This message is intended to assist SART members in getting through this pandemic. We all must adjust and make personal sacrifices to lessen the impact of SARS CoV-2 and COVID-19 in our local communities. SART encourages member feedback and exchange of ideas. Comments and ideas may be sent directly to Kelley Jefferson, SART administrator at ASRM, so that we can consolidate that information for future communications. (firstname.lastname@example.org, 205-978-5000).
1. What are some basic things we need to be doing to keep patient and staff as safe as possible?
It is important to understand that infected individuals can transmit the virus through respiratory droplets in the absence of fever or other symptoms. The best way to minimize risk is to avoid non-urgent testing and procedures and perform telemedicine.
2. If I need to see urgent patients, what else can I do specifically?
a. Have only the minimal number of essential staff present on-site to assist in urgent care visits.
b. Identify symptomatic patients early. Preferably do this by pre-screening outside of your clinic or via phone call prior to their visit. Unless absolutely necessary, do not let any symptomatic patient come to the office. Temperature screenings at the entrance to each facility for all individuals, including all patients, physicians, and staff, should be considered. A history of fever (100.0 F. or greater), cough, runny nose, sore throat, new onset of shortness of breath, or exposure within the last 14 days to anyone who was diagnosed with COVID-19, tested positive for SARS CoV-2, or has experienced the above symptoms, should be proactively sought. If a symptomatic person comes into the office, isolate them immediately to prevent further exposure.
c. Make sure symptomatic healthcare providers do not come to work until carefully evaluated. If they are exposed to coronavirus outside of work, they must self-quarantine for 14 days.
d. Hand sanitization stations should be located throughout the facility, including multiple hand sanitization stations in each patient-facing area and in all shared office areas. Wash hands frequently and in front of patients to visibly reassure them. Ask patients to wash their hands prior to exiting the examination room.
e. The CDC recommends all patients wear a face mask as an additional measure to social distancing, particularly when that distance (six feet) is likely to be breached. Cloth face coverings are an acceptable method for minimizing the risk of coming into contact with droplets that may contain the virus. Surgical masks and N-95 respirators are critical supplies that should be reserved, to the extent possible, for healthcare workers and first responders on the front line of caring for COVID-19 patients.
f. Implementation of social distancing in all shared spaces, especially patient waiting rooms, to ensure a six-foot radius around individuals whenever possible. This may include, but is not limited to:
(i) reorganizing waiting room seating by placing chairs six feet apart.
(ii) scheduling onsite patient visits throughout business hours to minimize individuals in shared spaces.
(iii) requesting that patients remain in their personal vehicles outside the facility until a staff member communicates via text or phone call it is safe to enter the facility.
(iv) utilizing a “patient only” or “single guest policy” to minimize patient guests onsite.
g. Continuation of all routine and regular sanitary procedures, sterile protocols, and quality assurance processes that form the standard of care in the fertility industry, including but not limited to: sanitization of waiting rooms, reception areas, consultation rooms, and shared patient areas multiple times daily; sanitization and sterilization of procedure, recovery, examination, phlebotomy, and ultrasound spaces after each patient visit; sanitization of all surfaces that experience frequent public use, including doorknobs, elevator buttons and touchscreen pads, railings, counter tops and especially telephones, computer keyboards and computer accessories.
h. Designation of quarantine area for any individual (patient or staff member) who begins to demonstrate symptoms consistent with COVID-19 while onsite or must be seen when symptomatic. A rapid quarantine protocol should be initiated for affected individuals. The rapid quarantine protocol must include masking the affected individual, isolating the individual in the quarantine area until the individual can be escorted safely from the facility to seek care, and sanitization of any potentially contaminated surfaces as identified by the individual and/or staff members who cared for the individual while onsite. As soon as it is possible, the practice staff treating the patient must be tested for SARS-CoV-2. All staff and patients who came in proximity with patient will need to be informed and tested for SARS-CoV-2 as well. While results are pending, affected individuals will need to be quarantined.
i. Staggering of clinic staff when possible, keeping some staff isolated at home such that their simultaneous onsite presence is minimized.
j. Institution of coordinated sanitization of any shared work spaces or equipment to minimize the risk of inter-group exposure.
3. This is stressful. How can I help my staff and patients cope with the impact of coronavirus and the uncertainty in their care?
Acknowledge to all that this is a difficult and overwhelming situation. Let them know you recognize the additional hours they may have worked, their fears about being exposed to the virus while doing their job, and the impact of treating patients who are highly distressed by treatment suspension and the pandemic in general. Let them know your current plans regarding their role and pay over the next couple of months (i.e., if you are planning layoffs, furloughs, salary cuts, etc.). If these changes are coming, staff need to prepare. If not, they can be reassured about their professional and financial security.
Encourage them to suspend unproductive efforts to predict when this situation will be over and when work as normal will resume. In the meantime, we should focus on what is immediately in front of us (the next day or two, for example). Remind staff to be intentional about their self-care. Critical tools for coping include moderate to high intensity physical exercise, time spent outdoors, a relaxation or meditation practice, and limiting news consumption to twice per day, and not near bedtime. Headspace (now free for healthcare workers), Buddhify, and Insight Timer are three meditation apps that could be used.
Let staff know that if they are feeling panicked, unable to sleep, experiencing uncontrollable crying spells, drinking more than they would like, or otherwise having difficulty functioning or coping, reaching out to a mental health professional is important. Contact the mental health provider associated with your clinic and inquire about his or her willingness to provide support to your staff and patients alike. Keep in mind that many staff and patients may be more comfortable talking confidentially about their anxiety with a third party such as a counselor not associated with the clinic. One can find a counselor on the Mental Health Professional Group website: https://connect.asrm.org/mhpg/sectiondirectory
Strive to communicate with each of them frequently and directly via phone or preferably video-call. Start each conversation by acknowledging the shared experience of this pandemic and how it has affected our lives. Questions like, “How are you doing? How is your family? Are you working from home?” will help to find common ground. You want to try and connect to your patient by understanding how your patient’s life is being affected. Then, have staff and providers discuss the patient’s treatment plan and timeline. Even though timelines may be uncertain, hearing from their provider, even for a few minutes, and acknowledging the situation is extremely helpful for your patients.
Patients also will benefit from the same support you recommend to your staff. (Suspend efforts to pin down firm treatment timelines until more data is available, practice self-care, seek counseling if symptoms are more severe.). If communicating these strategies to each patient individually is not feasible, consider adding this information to your website and encouraging patients to look there. Please refer to recent ASRM/MHPG communications released on April 3rd and April 6th for more detail on patient resources.
4. What kinds of messages should physician leaders and mental health providers share with their staff and patients?
These are uncertain times and at present no one knows when this crisis will end. Acknowledge that uncertainty can be anxiety provoking. Emphasize that everyone has the same goal in mind: for the patient to take home the baby they desire. Emphasize that your program is doing everything it can to help them achieve that goal in the safest and most medically responsible way. SART, alongside ASRM, continues to emphasize the need for all reproductive medicine teams to ensure that they are fully prepared and proactive in providing emotional and psychological support to patients and staff.
- “Our staff and the providers are here to support you through the process: in that way, this is no different than in the past and no different than in the future.”
- “Although we have paused temporarily, ultimately, we will move forward with your family building plans as soon as possible.”
- “Remain confident that we will do everything we can so you can have the family you want to have.”
- “I know how you feel,” to patients who’ve been forced to change their family building plans due to precautions instituted by providers or recommended by government. You don’t know how they feel; only they do. If you want to commiserate with them say something like, “This must be awful for you,” or “This is so frustrating.”
In order for all reproductive medicine teams to ensure that they are prepared and proactive in providing emotional and psychological support for patients and staff, it is essential that they understand the impact of the threat, how it manifests in patients, healthcare providers, and staff, and how mental health professionals are vitally important in addressing these needs in patients and staff alike.
The COVID-19 pandemic presents an unprecedented threat of unimaginable proportions to the psychological and emotional well-being of fertility patients and staff.
- Patient and staff concerns may include the invisibility and uncertainty of the pandemic and may result in feelings of panic, worry, difficulty with concentration and decision-making, terror, helplessness, hopelessness, and loss of control.
- Patient concerns also include cancellation of treatment cycles and/or the inability to initiate a treatment cycle, fear of running out of time and never achieving pregnancy, the potential impact of the coronavirus and COVID-19 on pregnancy and the fetus, and the risk of exposure and infection in the medical office.
- Staff concerns also include managing patient anxiety and questions, exposure or exposing others to COVID-19, childcare concerns with school cancellations, increased workload due to limited staffing, and financial uncertainty.
Familiarize yourself with the COVID-19 stress management guidelines of the major professional organizations (e.g., ACOG, ASRM, ESHRE, SMFM, CFAS, CDC, WHO).
Be transparent with your patients that we do not really know when “business as usual” will resume, but remind them that it will.
Emphasize that this is a situation that peaks, then ebbs, then ends. Give them permission to just wait and take a break, or to press on with alternate family-building efforts and support them in whatever decision they make.
5. How does the recently approved two-trillion-dollar CARES Act help me and what can I do to access that relief?
For small business owners (<500 employees), the Coronavirus Aid, Relief and Economic Security (CARES) Act, enacted March 27, 2020 by Congress, provides financial assistance in the form of low interest loans, some of which may be forgivable, to help small businesses, like fertility practices, stay afloat amid the pandemic and economic downturn.
- Contact your bank immediately and inquire whether it qualifies to administer Paycheck Protection Loans (PPL). If so, apply ASAP. These loans cover your practice expenses, including payroll, but you will have to provide appropriate documentation. If your bank does not qualify, contact a bank that does to administer such loans. PPL is obtained directly from your bank.
- Go to www.sba.gov and apply immediately for an Economic Injury Disaster Loan (EIDL). These are loans administrated by the Small Business Administration (SBA).
- Contact your bank about available mortgage deferral programs. Some offer three-month deferrals of payments which will then be tacked on to the loan balance at maturity (i.e., you do not have to have a balloon payment at the end of three months!)
Both PPL and EIDL are low-interest loans, and some of them may be forgivable. If you have already reduced your work force, you might be able to re-hire some or all of your employees before June 30, 2020 once you receive PPL or EIDL. In fact, you may be qualified for loan forgiveness if you have not reduced your work force by more than 25%.
Bottom line: the federal government has implemented a generous assistance program which you should apply for. Note the deadline for applying is June 30, 2020, although it is unclear whether funds allocated will be exhausted before then. So start now! And expect a huge log jam as other small businesses and the banking industry figure out the extent of relief available.
You may also want to listen to the ASRM webinar, "The CARES Act and Related Relief Measures: A Primer for ASRM's Members," held April 3, 2020. For more on this topic visit: