Patient Management and Clinical Recommendations During The Coronavirus (COVID-19) Pandemic

Update #9: The current update by the ASRM Coronavirus/COVID-19 Task Force (the “Task Force”) continues to affirm the recommendations presented in Update No. 3 (American Society for Reproductive Medicine Patient Management and Clinical Recommendations during the Coronavirus (COVID-19) Pandemic - Update No. 3, April 24, 2020), which were further elaborated upon in Update Nos. 4-8. Collectively, these updates recommend the judicious resumption of the delivery of reproductive care, with the use of careful preventive measures, such as the use of Personal Protective Equipment (PPE), including masks, frequent hand washing, and social distancing measures. Given the continued presence of COVID-19 cases in much of the United States (U.S.), these strategies continue to be critical in managing this ongoing pandemic. Read the full document here.

Since the last update, the Task Force has observed the following:

  • As of October 4, 2020, the U.S. continues to lead the world in COVID-19 deaths and cases. COVID-19 cases now exceed 7.4 million in the U.S. with more than 209,400 deaths. At present, COVID-19 represents the third leading cause of daily deaths following cardiovascular disease and cancer.

  • Daily cases in the U.S. exceeded 54,000 last week and are concerning for a possible second wave of contagion in the U.S. As we enter the flu season, the Task Force strongly advises all reproductive health practices to require flu immunization for all their healthcare providers and strongly recommends that all patients receive the flu vaccine as well.

  • Statewide viral spread and population positivity rates now differ widely across the U.S. Specifically, some states that instituted restrictions have flattened the curve (NY, MA, NJ, CT, DC, FL, RI) but in other states viral spread has increased (SD, ND, IA, MO, NE, OK, ID, MO, AK). In the past two weeks, more than 20 states have observed an increase in COVID-19 cases, while only eight have recorded a decrease (AZ, CA, FL, LA, NV, RI, TX, WY). Percentages of positive testing are now at 0.9% in MA, but other states have positivity rates above 10% (AL, NV, MO, FL, IA, KA, UT), and in some the positivity rate exceeds 20% (ID, WI, SD, MS). These statewide differences may lead to re-imposing restrictions on the delivery of reproductive services for certain locales in crisis. Additionally, disease prevalence may demand increased frequency of testing for patients and providers.
  • Nevertheless, the Task Force emphasizes that surveillance testing (i.e. the ongoing, systematic collection, analysis, and interpretation of health-related data essential to planning, implementation, and evaluation of public health practice) does not constitute prevention and, at present, scrupulous attention to the use of PPE, including masks, hand washing, and social distancing measures should continue to be required. Recently, the virus has spread to leaders in the U.S., including the President and First Lady, emphasizing that surveillance testing alone cannot prevent viral spread and that all are vulnerable to COVID-19.
In the current revision, the Task Force continues to support the judicious delivery of fertility care with strict adherence to recommended measures for disease prevention, including implementation of travel restrictions and quarantines when appropriate. This update provides: new information on testing including consideration of point-of-care antigen testing for patients undergoing fertility care; surveillance recommendations; updates on vaccine types and therapeutics; and mental health recommendations for the specialty.

The next update from the Task Force will be in four weeks (on or about November 9, 2020), unless conditions warrant earlier release.

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