Ongoing coronavirus (COVID-19) updates and resources for integrative healthcare professionals

Katherine Shagoury

October 7, 2021
Yuri_B/Pixabay
Last Updated: OCtober 7, 2021

Latest Updates Include:

  • Studies suggest vegan diet boosts vaccine efficacy; Two doses of Pfizer-BioNTech vaccine highly effective for at least six months; Nasal microbiota could point to who develops COVID-19 symptoms; New research finds COVID-19 may trigger Guillain-Barré syndrome; and more news updates and statistics (pg. 2)

  • Latest signs and symptoms, testing, treatment, and prevention (pg. 3)

  • Managing a healthcare practice amid a pandemic (pg. 4) 

  • Vaccine and treatment status tracking (pg. 5) 

  • New articles, tips, resources for practitioners and practice managers available (pg. 6) 

The novel coronavirus (COVID-19) continues to impact our daily lives, and healthcare practitioners remain on the frontlines working tirelessly to combat this global pandemic.

A pneumonia of unknown cause was detected in Wuhan, China and first reported to the World Health Organization (WHO) on December 31, 2019. The outbreak was declared a public health emergency of international concern by the WHO on January 30.

As the situation continues to evolve, and the world adapts to a new normal with guidelines, restrictions, and continued concerns about variants, spread, and containment, integrative practitioners should be aware of the latest advisories from public health agencies and credible organizations and be prepared to advise patients or pivot their practices.

We at Integrative Practitioner are here to support all healthcare providers who are caring for patients and keeping medical facilities up and running. To that end, this page will serve as an ongoing source of: 

We will be providing regular updates on this page as they are available. Check back regularly for new information. 

Latest news updates and statistics on next page

Latest News Updates and Statistics 

The latest news updates from Integrative Practitioner include:

  • Studies suggest vegan diet boosts vaccine efficacy, reduces COVID-related morbidity and mortality. Click here to learn more. 
  • Two doses of Pfizer-BioNTech vaccine highly effective for at least six months, study finds. Click here to learn more. 
  • Nasal microbiota could point to who develops COVID-19 symptoms. Click here to learn more. 
  • New research finds COVID-19 may trigger Guillain-Barré syndrome. Click here to learn more. 
  • Pregnant women who receive COVID-19 vaccine pass antibodies to newborns, study finds. Click here to learn more. 
  • Researchers identify new way to encourage vaccinations and masking. Click here to learn more. 
  • FDA authorizes boosters for some patients. Click here to learn more. 
  • Delirium common consequence of severe COVID-19, study finds. Click here to learn more.
  • Distinct immune response identified in early phase of COVID-19 infection. Click here to learn more.
  • Researcher finds menstrual changes plausible after COVID-19 vaccination. Click here to learn more.

The total number confirmed cases as press time, according to the John’s Hopkins University Coronavirus Resource Center, is 236,735,143 with 44,085,931 cases in the U.S. 

There are currently 727,895 deaths linked to COVID-19 in the U.S. and 34,395,882 have recovered. Additionally, 6,388,963,634 vaccination doses have been administered worldwide. Click here for the latest statistics provided by Johns Hopkins University.

Official guidelines and recommendations on next page

Official Guidelines and Recommendations

Integrative healthcare professionals may or may not care for patients with confirmed or suspected COVID-19. The U.S. Centers for Disease Control and Prevention (CDC) offers comprehensive guidance for practitioners and their patients and staff to keep healthcare settings safe.  

Clinical Presentation

The incubation period for COVID-19 is thought to extend to 14 days, with an average of four to five days from exposure to symptoms onset. One study reported that 97.5 percent of persons with COVID-19 who develop symptoms will do so within 11.5 days of infection.

The severity of COVID-19 illness ranges from mild to moderate, severe, and critical, with 81 percent of cases classified as mild to moderate, 14 percent as severe, and 5 percent as critical. Among patients who developed severe disease, the median time to dyspnea from the onset of illness or symptoms ranged from five to eight days, the median time to acute respiratory distress syndrome from the onset of illness or symptoms ranged from eight to 12 days, and the median time to intensive care unit admission from the onset of illness or symptoms ranged from 10 to 12 days.

While presentation may vary among individuals and over the course of the disease, the latest signs and symptoms list, per the CDC, include:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

The CDC notes some patients are asymptomatic and never develop symptoms, while others may be pre-symptomatic and will exhibit symptoms later on. Transmission is possible in both cases. Therefore, healthcare providers should take the proper precautions to ensure safety.

Age is the strongest risk factor for severe COVID-19, complications, and death. Based on currently available information and clinical expertise, older adults and people who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19. Some research points to obesity and vitamin D deficiency and prominent modifiable risk factors. Practitioners should understand patients who may be at increased risk and other people who need to take extra precautions.

There are limited data about reinfection with SARS-CoV-2 after recovery from COVID-19. ​While viral shedding declines with resolution of symptoms, it may continue for days to weeks, the CDC says.

Testing

Integrative healthcare clinics should decide whether to test patients for COVID-19 or refer to other clinics in the community. Clinics who do offer testing should follow all safety precaution guidelines, including testing and specimen collection, handling, and storage.

Due to limited testing capacity, COVID-19 testing is not routinely available for patients presenting for care in the outpatient setting. Patients with COVID-19 symptoms considered highest priority for testing include:

  • Healthcare workers
  • Employed in public safety occupation
  • Part of an illness cluster in a facility or institution
  • With severe lower respiratory illness
  • With worsening symptoms
  • Older than 60 years old
  • With underlying medical conditions
  • Pregnant women
  • Had contact with a suspect or lab-confirmed COVID-19 patient or had travel from an affected geographic area within 14 days of symptom onset

Testing resources include:

Treatment

The National Institutes of Health published guidelines on prophylaxis use, testing, and management of patients with COVID-19. The recommendations are based on scientific evidence and expert opinion and are updated as new data become available. The current statement includes sections on critical care, antiviral therapy, immune-based therapy, and adjunctive therapy. Click here for more information.

There U.S. Food and Drug Administration (FDA) has approved one drug for the treatment of COVID-19 in certain situations, Veklury, commonly known as remdesivir. Current clinical management includes infection prevention and control measures and supportive care, including supplemental oxygen and mechanical ventilatory support when indicated.

However, several drugs approved for other indications, as well as multiple investigational agents, are being studied for the treatment of COVID-19 in clinical trials around the globe. These trials can be accessed at ClinicalTrials.gov.

In addition, providers can access and prescribe investigational drugs or agents approved or licensed for other indications through Emergency Use Authorizations (EUAs), Emergency Investigational New Drug (EIND) applications, compassionate use or expanded access programs with manufacturers, or off-label use.

The guidelines should not be considered mandates. The choice of what to do or not to do for an individual patient is ultimately decided by the patient with their provider.

Social Distancing, Quarantine, and Isolation

Limiting close face-to-face contact with others remains the best way to reduce the spread of COVID-19. Social distancing means keeping a safe space between yourself and other people who are not from your household. To practice social distancing, stay at least six feet from other people who are not from your household in both indoor and outdoor spaces.

Social distancing should be practiced in combination with other everyday preventive actions to reduce the spread of COVID-19, including wearing masks, avoiding touching your face with unwashed hands, and frequently washing your hands with soap and water for at least 20 seconds.

COVID-19 spreads mainly among people who are in close contact for a prolonged period. Spread happens when an infected person coughs, sneezes, or talks, and droplets from their mouth or nose are launched into the air and land in the mouths or noses of people nearby. The droplets can also be inhaled into the lungs. Recent studies indicate that people who are infected but do not have symptoms likely also play a role in the spread of COVID-19.

If you are sick with COVID-19, have symptoms consistent with COVID-19, or have been in close contact with someone who has COVID-19, it is important to stay home and away from other people until it is safe to be around others.

Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:

  • At least 10 days have passed since symptom onset
  • At least 24 hours have passed since fever resolved without the use of fever-reducing medications
  • Other symptoms have improved

Additionally, persons exposed to COVID-19 may discontinue isolation after 10 days if no symptoms have been reported during daily monitoring, or after seven days if no symptoms have been reported and the patient receives a negative test result. Continued monitoring and masking are recommended through day 14. 

A small fraction of persons with severe illness may produce replication-competent virus beyond 10 days that may warrant extending duration of isolation and precautions for up to 20 days after symptom onset. Consider consultation with infection control experts.

Persons infected with SARS-CoV-2 who never develop COVID-19 symptoms may discontinue isolation after at least 10 days following the date of their positive test.

The best method for containing the virus is prevention. Practitioners should communicate social distancing and public health measures to their patients.

Practice management considerations continued on next page

Practice Management Considerations

As healthcare facilities begin to relax restrictions on services provided to patients in accordance with guidance from local and state officials, there are precautions that should remain in place as a part of the ongoing response to the COVID-19 pandemic. Integrative practitioners should develop a thorough clinic protocol considering official guidelines and recommendations.

The CDC recommends additional infection prevention and control practices in addition to standard practices that are already a part of routine healthcare. These include:

  • Continued use of telehealth strategies
  • Instruct patients to reschedule appointments if they have symptoms
  • Advise patients to put on a face covering before entering the facility
  • Develop a triage protocol for patients with possible COVID-19 requesting evaluation and manage such patients from home when possible
  • Screen and triage everyone entering the facility for COVID-19 signs and symptoms
  • Take steps to ensure that everyone adheres to source control measures and hand hygiene practices while in the facility
  • Limit and monitor points of entry to the facility
  • Consider establishing screening stations outside the facility
  • Properly manage anyone with symptoms of COVID-19 or who has been advised to self-quarantine
  • Implement universal source control measures
  • Encourage physical distancing
  • Implement universal use of personal protective equipment
  • Develop targeted testing protocols
  • Consider if elective procedures or non-urgent visits could be postponed
  • Implement physical barriers and dedicated patient flow pathways
  • Explore options to improve indoor air quality in shared spaces
  • Create process to respond to COVID-19 exposures
  • Establish reporting within and between healthcare facilities and public health organizations 

Telemedicine

The use of telehealth technologies is widely recommended to protect both practitioners and patients. General telemedicine resources include:

The Centers for Medicare & Medicaid Services (CMS) issued multiple waivers, providing flexibility during the pandemic, and granting payment parity between telehealth and in-person clinical care for Medicare. Check with your state health department to confirm whether your services are covered under the state Medicaid program.

Additionally, the COVID-19 Telehealth Program provides $200 million in funding, appropriated by Congress as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to help healthcare practitioners provide connected care services to patients at their homes or mobile locations in response to the COVID-19 pandemic. The program provides immediate support to eligible healthcare providers responding to the COVID-19 pandemic by fully funding their telecommunications services, information services, and devices necessary to provide critical connected care services. Click here for more information.

Many electronic medical records (EMRs) offer integration with HIPAA-compliant telehealth platforms. For practices with an established EMR, this may be a viable option. However, there are several compliant platforms, including:

  • Doxy.me
  • AMC Health
  • swyMed
  • Teladoc
  • Mend

Note, a HIPAA-compliant platform may be required for insurance reimbursement.

Triage

When scheduling appointments for routine medical care, instruct patients to call ahead and discuss the need to reschedule their appointment if they have symptoms of COVID-19 on the day they are scheduled to be seen. If they don’t have symptoms of COVID-19, advise them that they should still put on their own cloth face covering before entering the facility.

When scheduling appointments for patients requesting evaluation for possible COVID-19, use nurse-directed triage protocols to determine if an appointment is necessary or if the patient can be managed from home.

If the patient must come in for an appointment, instruct them to call beforehand to inform triage personnel that they have symptoms of COVID-19 and to take appropriate preventive actions.

Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with COVID-19, symptom screening remains an important strategy to identify those who could have COVID-19 so appropriate precautions can be implemented.

Source Control Measures

Take steps to ensure that everyone adheres to source control measures and hand hygiene practices while in a healthcare facility. Post visual alerts, such as signs or posters, at the entrance and in strategic places like waiting areas and elevators to provide instructions in appropriate languages about wearing a cloth face covering or facemask for source control and how and when to perform hand hygiene.

Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer with 60-95 percent alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.

Healthcare professionals should always wear a facemask while they are in the healthcare facility, including in breakrooms or other spaces where they might encounter co-workers. They should also wear eye protection in addition to their facemask to ensure the eyes, nose, and mouth are all protected from exposure to respiratory secretions during patient care encounters, and wear an N95 or equivalent or higher-level respirator, instead of a facemask, for aerosol-generating procedures and surgical procedures.

Healthcare delivery requires close physical contact between patients and the healthcare professional. However, when possible, physical distancing of at least six feet between people) is an important strategy to prevent COVID-19 transmission. Practitioners should consider:

  • Limiting visitors to the facility to those essential to the patient’s care
  • Scheduling appointments strategically to limit the number of patients in waiting rooms
  • Modifying in-person group healthcare activities to virtual methods or scheduling smaller sessions while having patients sit at least six feet apart

Office Considerations

To reduce or eliminate disease exposure, practice managers should consider implementing physical barriers and dedicated pathways to guide symptomatic patients through triage areas, remote triage facilities for patient intake areas, and outdoor assessment and triage stations for patients with respiratory symptoms, if possible.

Additionally, explore options to improve indoor air quality in all shared spaces, such as optimizing air-handling systems, ensuring appropriate directionality, filtration, exchange rate, proper installation, and up-to-date maintenance. Portable solutions, like HEPA filtration units, are reasonable alternatives to augment air quality in areas when permanent air-handling systems are not a feasible option.

Proper cleaning and disinfecting protocols should be followed.

Practitioner Exposure Risk

The potential for exposure to COVID-19 is not limited to direct patient care interactions. Transmission can also occur through unprotected exposures to asymptomatic or pre-symptomatic co-workers in breakrooms or co-workers or visitors in other common areas. Therefore, practitioners should:

  • Emphasize the importance of source control and physical distancing in non-patient care areas.
  • Provide family meeting areas where all individuals can remain at least six feet apart from each other.
  • Designate areas for healthcare professionals to take breaks, eat, and drink that allow them to remain at least six feet apart from each other, especially when they must be unmasked.

Staffing Considerations

For integrative healthcare professionals who manage clinics and other providers, there are steps practice managers should take, including updating leave policies to support employees who need to stay home if they or a household member are sick. Practice managers should instruct providers who become sick with a fever or other symptoms to stay home and return only after they are free of symptoms for at least 24 hours.

Practice managers should also consider creating or updating policies for employees who must stay home to care for sick family members or children who cannot go to school.

Additionally, practice managers should plan for employee absences due to illness by identifying essential functions, creating plans for community operations, and cross-training employees to perform essential functions.

Click here for more information on supporting your clinic staff. 

Communicating with Patients

Integrative healthcare professionals should communicate facts, not fear, and encourage following public health guidelines. The American Association of Naturopathic Physicians suggests the following:

  • Communicate only evidence-based, accurate information.
  • Reassure patients and the public regarding fears and discourage biases.
  • Reinforce the importance of social distancing.
  • Reinforce their role in supporting the global and local community efforts of containment.
  • Use social media to inform the public of what steps your clinic is taking to reduce the spread and accommodate patients.
  • Whenever possible, include citations for public education materials.
  • Refrain from posting medically inaccurate or unsubstantiated claims regarding any potential therapies with relation to COVID-19.
  • If you see misinformation from other providers, assume best of intentions and reach out to the individual privately.

Practitioner Self-Care 

Vaccination and treatment tracking continued on next page

Vaccination and Treatment Tracking

Scientist around the world are racing to produce a safe an effective COVID-19 vaccine. There are currently over 100 vaccine programs underway, with 54 vaccines in clinical trials on humans and 87 preclinical vaccines being tested in animals.

Vaccines typically require years of research and testing, including preclinical testing and multiple safety and efficacy trials before approval. The preclinical phase includes testing a new vaccine on cells and animals such as mice to see if it produces an immune response. Phase 1 assesses its safety in healthy people, phase 2 observes its effect on different cohorts of healthy people, and phase 3 monitors safety and efficacy on a larger scale. The final stage is approval, in which federal regulatory agencies review trial results and determine it is approved or not.

Some of the latest vaccine-related updates include: 

  • FDA authorizes vaccine boosters people age 65 and older, and patients at high risk.
  • Clover Biopharmaceuticals announces vaccine efficacy results against Delta variant.
  • Pfizer says a smaller dose of the vaccine is safe and effective for children ages 5 to 11 years old.
  • Pfizer-BioNTech vaccine granted full FDA approval.

Leading Vaccines 

  • BioNTech, Pfizer, and Fosun Pharma mRNA vaccine (combined phase 2 and 3): emergency use authorization
  • Moderna and National Institutes of Health messenger RNA (mRNA) vaccine (phase 3): emergency use authorization
  • Gamaleya Research Institute Gam-Covid-Vac vaccine (phase 3): approved for early use in Russia
  • AstraZeneca and the University of Oxford (combined phases 2 and 3)
  • CanSino Biologics and Academy of Military Medical Sciences adenovirus (Ad5) vaccine (phase 3): approved in China
  • Beth Israel Deaconess Medical Center and Johnson & Johnson Adenovirus 26 vaccine (phase 3): emergency use authorization
  • Vector Institute vaccine (phase 3): approved for early use in Russia
  • Novavax protein-based vaccine (phase 3)
  • Sinopharm and Beijing Institute of Biological Products inactivated virus vaccine (phase 3): approved in China, UAE, Bahrain.
  • Sinovac Biotech inactivated vaccine (phase 3): approved in China
  • Wuhan Institute of Biological Products and Sinopharm inactivated virus vaccine (phase 3): approved for limited use in China and UAE. 
  • Bharat Biotech inactivated virus vaccine (phase 3): approved for emergency use in India.  

Click here to track COVID-19 vaccine development in real time.

Guidelines for Vaccinated Individuals 

A person is considered fully vaccinated two weeks after receiving the last required dose of vaccine. Individuals who have been fully vaccinated can:

  • Visit with other fully vaccinated people indoors without wearing masks or staying six feet apart.
  • Visit with unvaccinated people from one other household indoors without wearing masks or staying six feet apart if everyone in the other household is at low risk for severe disease.
  • Refrain from quarantine and testing if they do not have symptoms of COVID-19 after contact with someone who has COVID-19.

The CDC recommends that fully vaccinated people continue to take these COVID-19 precautions when in public, when visiting with unvaccinated people from multiple other households, and when around unvaccinated people who are at high risk of getting severely ill from COVID-19:

  • Wear a well-fitted mask.
  • Stay at least six feet from people you do not live with.
  • Avoid medium- and large-sized in-person gatherings.
  • Get tested if experiencing COVID-19 symptoms.
  • Follow guidance issued by individual employers.
  • Follow CDC and health department travel requirements and recommendations.

Treatments

There is no known cure yet for COVID-19. The FDA has approved remdesivir for treatment of COVID-19 in certain situations. Additionally, the FDA has granted emergency use authorization for some treatments. However, further trials are needed to demonstrate widespread safety and effectiveness.

The following is a list of treatments and interventions currently under clinical investigation in order from most promising to least promising:

  • Dexamethasone and corticosteroids
  • Favipiravir
  • MK-4482
  • Recombinant ACE-2
  • Ivermectin
  • Oleandrin
  • Convalescent plasma
  • Monoclonal antibodies
  • Interferons
  • Cytokine inhibitors
  • Blood filtration systems
  • Stem cells
  • Anticoagulants
  • Vitamin and mineral supplements, including vitamin C, vitamin D, and zinc

Other supportive treatments to help patients with COVID-19 include prone positioning and ventilators and other respiratory support devices.

Resources continued on next page

Resources for Integrative Practitioners 

This list is updated weekly. Check back regularly for new resources. 

Guidelines and Recommendations

Vaccines, Treatments, and Other Clinical Trials

Telemedicine

Practice Management

News and Education

Self-Care

References continued on next page

References

John’s Hopkins University (2020) Coronavirus COVID-19 Global Cases by Center for Systems Science and Engineering at Johns Hopkins University School of Medicine. Retrieved from: https://coronavirus.jhu.edu/map.html

U.S. Centers for Disease Control and Prevention (2020) Coronavirus (COVID-19). Retrieved from: https://www.cdc.gov/coronavirus/2019-nCoV/index.html

World Health Organization (2020) Rolling updates on coronavirus disease (COVID-19). Retrieved from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen

 

Editor’s note: This article will be updated. Contact [email protected] to contribute.

About the Author:

Katherine Shagoury

Katherine Shagoury

Katherine Shagoury is the editor of Integrative Practitioner. She brings a decade of experience creating and managing content for national healthcare audiences as a digital editor and professional journalist, including serving as managing editor for a popular medical billing and coding association and as a reporter for the Boston Globe, Boston.com, and USA Today. A certified personal trainer and nutrition coach with the National Academy of Sports Medicine, a certified group fitness instructor with the Athletics and Fitness Association of America, a certified barre instructor, and a TRX qualified trainer, her passion for and commitment to healthy living fuels her enthusiasm for supporting the integrative healthcare community.

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