The Role of POCUS for Care Facilities in the Age of Covid-19

Point-of-care services such as portable ultrasound diagnostics are an excellent way for care facilities to continue to address broader health care needs during what may be a prolonged impact from the Covid-19 outbreak. By limiting access to select, point-of-care providers, care facilities can complement their infectious disease protocols, limiting exposure to potentially deadly diseases while ensuring continued care for other conditions.

The recent media coverage of the Covid-19 virus runs the gamut from hysteria to hubris, but infectious diseases are a constant concern for care facilities that serve seniors and others with compromised immune or respiratory systems.

While the majority of cases of Covid-19 infection are projected to be mild, the virus has a number of factors that make it particularly dangerous to the population served by care facilities. In cases where the patient is over 70 and has a current pulmonary condition, the projected fatality rate of Covid-19 jumps to an estimated 13.2%, according to the WHO[1]. In the case of the senior care facility in Kirkland, Washington, 35 of the 36 residents tested positive for Covid-19, and there have been 22 deaths at the facility, to date.

Regardless of the nature of the media coverage, incidents like this give us an opportunity to take a new look at the protocols facilities put in place to address virus containment for patients.

When reviewing methods to control the spread of a virus, it’s important to note that there are three main factors that contribute to risk for seniors[2]:

  1. Impaired Immune Function
  2. Anatomic and Functional Changes
  3. Degree of Exposure to Infections

Of those three factors, the primary factor care facility staff can control is the degree to which patients are exposed to the virus. The challenge is that patients in care facilities have other conditions that still need to be diagnosed and treated, often requiring services that are not typically available within the facility or requiring a specialist.

If the only choice for service is a hospital or specialty clinic like a radiology center, the chances of exposing patients to a virus rise exponentially with each person, vehicle, and surface encountered. In the case of Covid-19, limiting exposure to the virus is especially critical due to the ease of transmission – the virus can be airborne, individuals with the virus could be contagious for up to five days before showing the first signs of illness, and the virus has been estimated to remain active on surfaces for up to 48 hours.

Point-of-care services, such as portable ultrasound diagnostic services, provide a way for care facilities to exercise control over exposure to the virus. By bringing tools and specialists into the care facility, rather than taking patients out into an uncontrolled environment, facility staff can limit the environment around the patient to clean surfaces and knowledgeable healthcare personnel using proper infection control.

Care facilities should expect that safety protocols put into place by point-of-care providers ensure that staff and equipment complement the facility’s infectious disease protocols.

For example, New Frontier’s Clinical Standards require that all ultrasound machines be cleaned, inspected, and disinfected daily, transducers and the environment be cleaned thoroughly between each patient, personnel utilize proper PPE based on the conditions, and that personnel monitor the condition of their health before visiting customers. If personnel have an elevated temperature (above low-grade fever), they will be asked to remain at home and monitor their condition, they will be paid for the day, and a substitute technologist will be engaged to perform scheduled procedures. No one should feel they need to risk their health or the health of others for a paycheck.

Covid-19 has highlighted the challenges faced by care facilities trying to protect a vulnerable population. Select point-of-care services can be a way for care facilities to maintain access to necessary health care services, while minimizing the risk of viral exposure for senior and immune-compromised patients.  

[1] “Mortality increases with age, with the highest mortality among people over 80 years of age (CFR 21.9%). The CFR is higher among males compared to females (4.7% vs. 2.8%). By occupation, patients who reported being retirees had the highest CFR at 8.9%. While patients who reported no comorbid conditions had a CFR of 1.4%, patients with comorbid conditions had much higher rates: 13.2% for those with cardiovascular disease, 9.2% for diabetes, 8.4% for hypertension, 8.0% for chronic respiratory disease, and 7.6% for cancer.” – Excerpt from “Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)”, (LINK), World Health Organization, February 24, 2020

[2] “The Second Fifty Years: Promoting Health and Preventing Disability,” (LINK), Institute of Medicine; Berg, RL and Cassells, JS, editors. 1992