key: cord-257312-z6rmd0sg authors: Dörr, Rolf title: Protecting patients and healthcare personnel from COVID-19: considerations for practice and outpatient care in cardiology date: 2020-04-16 journal: Herz DOI: 10.1007/s00059-020-04922-2 sha: doc_id: 257312 cord_uid: z6rmd0sg nan Screen for COVID-19 symptoms by telephone and at the front desk All patients should be screened for COVID-19 symptoms using a coronavirus checklist. The first check should be made during the initial telephone contact by asking about the most common symptoms: fever, cough, and shortness of breath. The second check should be made at the front desk. If there is any suspicion of acute coronavirus infection, the planned cardiology visit should be postponed, and the patient should be immediately referred to an outpatient coronavirus center for SARS-CoV-2 laboratory testing. Consider non-contact body temperature checks at the entrance Infrared non-contact temperature measurement may be used to check patients' body temperature at the entrance, although this method is controversial and not very reliable. A normal body temperature should never be the only parameter used to rule out COVID-19 with certainty. However, an elevated body temperature is a reason for further SARS-CoV-2 testing. All previously scheduled visits and examinations should be reviewed to determine their urgency level. Non-essential appointments may have been made long before the COVID-19 pandemic emerged in Europe at the end of January 2020. All elective check-up visits and examinations without relevant impact on subsequent patient management should be postponed. Exceptions may only be made for patients with new onset of symptoms, especially in patients with suspected acute coronary syndrome. Elective invasive and interventional procedures in patients with chronic ischemic heart disease should also be postponed. This recommendation is further justified by the scientific evidence from the IS-CHEMIA trial [5] . Among 5179 patients with stable coronary disease and moderate or severe ischemia, there was no evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. Transesophagealechocardiography(TEE) should be avoided and only performed on patients with indications in which the procedure is absolutely indispensable. Electrocardiography leads should be avoided with transthoracic echocardiography (TTE). Because of increasing evidence that virus transmission may also be caused by respiratory air and aerosoliza- A shortage of PPE for medical personnel has been one of the biggest issues of the COVID-19 pandemic. There should be a sufficient supply of PPE (gloves, N95 masks, gowns, caps, goggles/face shields) for all members of the medical staff. A plexiglass shield should be in place at the front desk to protect against droplet infection. Segregation and social distancing between patients and personnel are of utmost importance. Whenever possible, at least 1.5 m of distance should be maintained between healthcare personnel and patients. Patients should be prevented from congregating at the front desk and in waiting areas. Patient contact times should be minimized, and traffic flow should be organized to go in only one direction in order to prevent patients and personnel from encountering each other unnecessarily. Meticulous hygiene is absolutely mandatory. Medical equipment, ECG leads, tables, chairs, door handles, and rooms should be meticulously disinfected after every patient. If it is absolutely necessary to examine a patient who has tested positive for SARS-CoV-2, that patient should be scheduled as the last patient of the day. Consider a lung CT scan as firstline testing method in patients with acute dyspnea and elevated body temperature In patients with acute dyspnea of unknown origin and elevated body temperature, a lung CT scan may be considered for confirmation of COVID-19. However, in patients with congestive heart failure and pulmonary edema, the differential diagnosis may be very difficult. World Health Organization (WHO) (2020) Coronavirus disease (COVID-19) Pandemic NewCasesofCOVID-19 inWorldCountries COVID-19: protecting healthcare workers COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel Initial Invasive or Conservative Strategy for Stable Coronary Disease