SARS-CoV-2/Novel Coronavirus-19 (COVID-19) is a global pandemic. Transmission can occur in both symptomatic and asymptomatic persons. Viable viral particles can be detected up to 3 hours after aerosolization and up to 3 days on solid surfaces. Gastrointestinal symptoms may occur in up to 48.5% of patients, including anorexia (83.8%), diarrhea (29.3%), and vomiting (0.8%). Coronavirus has been detected in saliva, blood, and feces. All endoscopic procedures should be considered potentially aerosol-generating.

All four national gastroenterology societies (ASGE, ACG, AGA, AASLD) have released a JOINT GI SOCIETY MESSAGE with recommendations to gastroenterologists and gastroenterology care providers during the COVID-19 pandemic. The Commonwealth of Virginia (March 12, 2020) and the Federal Government (March 13, 2020) declared states of emergency because of the COVID-19 outbreak.

A summary of key multi-society recommendations:

1. Strongly consider rescheduling elective non-urgent endoscopic procedures.
2. Pre-screen all eligible patients for high-risk exposure or symptoms. Patients should be asked about history of fever or respiratory symptoms, family members or close contacts with similar symptoms, any contact with a confirmed case of COVID-19, and recent travel to a high-risk area. Avoid bringing patients (or their escorts) into the medical facility who are over age 65 or have one of the CDC-recognized risks listed above.
3. Check body temperature of the patient upon arrival at endoscopy unit or clinic.
4. Wear appropriate personal protective equipment (PPE): gloves, mask, eye shield/goggles, face shields, and gown. (Please note that levels of required PPE may differ based on whether a patient is at low-risk or is suspected or confirmed to have COVID-19, as well as other local and institutional factors including the local prevalence of the virus and available supplies. All staff performing or assisting with endoscopic procedures for suspected or confirmed COVID-19 patients should wear N-95 masks or the equivalent or higher-standard mask.)
5. For COVID-19 positive patients, or those awaiting test results, isolation precautions should be taken with procedures performed in negative-pressure rooms conforming to Level 3 biosafety requirements, whenever possible and available.
6. Centers should strategically assign available personnel. It is important to minimize concomitant exposure of those with similar or unique skill sets. Non-physician practitioners and fellows who might not participate in cases may be helpful screening and triaging patients or performing virtual visits.

Given the evolving and fluid nature of the situation, institutions and private practices have been formulating their own local directives. The VGS urges gastroenterology providers and endoscopists to follow the evolving CDC and federal recommendations, as well as your local and state requirements.

Updated Guidelines (4/1/20): JOINT GASTROENTEROLOGY SOCIETY MESSAGE: COVID-19 Use of Personal Protective Equipment in GI Endoscopy

 

For more information and links to information on coronavirus infection and GI practice, please visit: https://www.asge.org/home/advanced-education-training/covid-19-asge-updates-for-members/

For pertinent details regarding COVID-19, including steps healthcare facilities can take to prepare for COVID-19 in the community and interim guidance for healthcare facilities: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html