Update 7: ASRM Patient Management and Clinical Recommendations During the Coronavirus (COVID-19) Pandemic
Aug 10, 2020
Origin: ASRM Bulletin
Update No. 7 (August 10, 2020 through September 7, 2020)Read the full document here.
The current update by the ASRM Coronavirus/COVID-19 Task Force (the “Task Force”) affirms 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 issued recommendations for gradually and judiciously resuming the delivery of reproductive care, and which were further elaborated in Updates Nos. 4-6. Given the resurgence of COVID-19 cases in much of the United States, the aforementioned strategies continue to be critical in managing this ongoing pandemic.
In the current revision, updated information is provided concerning: testing, treatments, and vaccines for COVID-19; managing mental health and COVID-19; counseling of patients seeking care during the pandemic; the risk of aerosolization; and updated recommendations for PPE use in the reproductive care setting.
Since the last update, the Task Force has observed the following:
- As of August 9, 2020, COVID-19 cases have exceeded five million in the U.S. with more than 160,000 deaths, an increase of nearly 1.7 million cases since the last ASRM update on July 10th. Because deaths follow case diagnoses, deaths may reach the 175,000 mark by the end of August and are predicted to exceed 295,000 by December 1st if further mitigation measures are not taken.
- In the past four weeks, the virus has spread throughout most of the U.S. and cases have increased 3.4-fold from the levels of disease present in late May. Increases in viral infection within states and locales have followed relaxation of measures to control the contagion, such as wearing of masks, social distancing, isolation and limiting group size. There appears to be no difference in the spread of disease in urban vs. rural environments.
- Now more than ever, it is critical to do everything possible to maximize adherence to scientifically grounded guidelines from the U.S. Centers for Diseases Prevention and Control (CDC) and World Health Organization (WHO). These include proven mitigation strategies, such as social distancing, hand washing and face mask usage, all of which should be strongly emphasized during this watershed moment in the spread of the virus.
- The percentage of tested individuals with a positive result for COVID-19 in the U.S. was lowest in June at 4%, but now is 8%. In some locales, positive testing rates have increased to 12-22%. This high disease prevalence has overwhelmed the capabilities of many local public health resources to effectively test, trace, and isolate, and has strained healthcare resources. Adequate capacity point of care testing and timely result reporting for COVID-19 remain elusive, thus significantly hampering contact tracing and subsequent quarantine. Due to the increased prevalence and these limitations, some states and locales have reversed course regarding reopening measures.
- Phase III trials of COVID-19 vaccines have begun but widespread vaccination remains at least several months away. Notably, pregnant women or women planning pregnancy have not been included in most trials. No curative medication exists, though improved treatments have led to overall better survival rates.
- The prevalence of disease continues to disproportionately affect Latinx and African American individuals and infections continue to increase in younger adults and children.
- Though the use of Personal Protective Equipment (PPE) is highly effective, emerging data demonstrate an increased risk of disease for health care workers, at least in some settings. The reemergence of disease following relaxation of measures to control spread emphasizes that reproductive medicine providers need to practice in a COVID-19 environ for the foreseeable future. Recognition of this challenge is critical to avoid the risk of a renewed shutdown in reproductive services.
The next update from the Task Force will be in four weeks (on or about September 7, 2020), unless conditions warrant earlier release.