Coronavirus: vial with pipette in laboratory

Information for Providers and Clinical Staff

Columbia University Irving Medical Center offers the following guidance and resources to help our clinical staff respond to COVID-19.  Our top priority is to provide the best possible care for our patients while ensuring the safety of our clinical staff who are on the front lines.

If you have questions about the screening or management of a patient, please contact Shunichi (Nick) Homma, MD, CMO ColumbiaDoctors, at sh23@cumc.columbia.edu. For all other questions, please email covid19questions@cumc.columbia.edu.

Screening Patients

Please see the attached Interim NYP Laboratory COVID-19 (SARS-CoV-2) Testing Document for testing in NYP labs. The COVID-19 Ambulatory Testing and Management Guidelines outline general management strategies and appropriate testing strategies (and supplements the ambulatory protocol) for outpatients at any Columbia, NYP or WCM practice using labs outside of NYP.

Patient screening prior to an appointment

When scheduling an appointment, staff should ask all patients if they have been in contact with anyone with a confirmed COVID-19 infection and about any other factors that relate to COVID risk such as age, COPD, cardiac disease, cancer, or immunocompromising condition. Please note that we expect this screening criteria may change over time.

If the patient answers yes to exposure, the call should be referred to a clinician who can obtain more details on symptoms and other existing risk factors. If the patient answers yes to exposure and other risk factors and is also experiencing mild symptoms (fever, cough, or shortness of breath), the clinician should contact IP&C for further instructions

If the clinical illness (described) warrants an in-person evaluation, the clinician should refer to the closest Emergency Department (ED) and instruct the patient to wear a surgical mask if possible and avoid public transit. The clinician should also alert the ED.

If the patient does not have symptoms, visits should be scheduled for more than 14 days after last exposure. Patients should be instructed to call back if they develop symptoms (fever, cough, shortness of breath).

Patient screening after arriving for an appointment

All patients should be screened for fever, cough, or rash.  If the patient has none of these symptoms, proceed with routine registration.

  • If the patient acknowledges fever, cough, and/or rash, provide the patient and anyone accompanying the patient with a surgical mask and instruct them to wash their hands. The patient should be relocated to a single room with the door closed as soon as possible. Note: fever and rash without respiratory symptoms is not suggestive of COVID-19; screening for rash in addition to these symptoms identifies and helps prevent transmission of measles, chickenpox and other infectious diseases.
  • If the patient acknowledges fever or cough or shortness of breath, the patient should be asked about exposure to someone with confirmed or suspected COVID-19. If no exposure occured, it is recommended to keep the patient separated from other patients or in a closed door room.
  • If the patient reports exposure to a known or suspected case, relocate the patient and anyone accompanying the patient to an exam room with a closed door and notify clinical staff. If a negative pressure room is available, it should be used.

Clinicians should follow the Revised Guidelines for Patient Placement and Use of Personal Protective Equipment for Patients with Confirmed or Suspected COVID-19. Please also see Recommendations for Conservation of N95 Respirators.

The clinician(s) should then follow the testing criteria in the Interim NYP Laboratory COVID-19 Testing document and in the COVID-19 Ambulatory Testing and Management Protocol.

Upon discharge of a patient with suspected COVID-19, the exam room must remain closed to other patients for one hour (30 minutes if the patient was in a negative pressure room) and surface cleaning/disinfection must be performed with an EPA-approved emerging viral pathogens claim or claim against human coronaviruses.

Patients with severe respiratory illnesses

Patients who did not have contact with COVID-19 patients but require hospitalization for severe respiratory illnesses such as pneumonia or acute respiratory distress should also be tested for COVID-19.

Patients who are pregnant or nursing

For additional guidance regarding suspected or confirmed COVID-19 patients who are pregnant or nursing, please see Interim Guidelines for Suspect and Confirmed COVID-19 for Obstetrics (Antepartum, Labor & Delivery, Post-partum, and Ambulatory Care), Neonatal ICUs, and Well-Baby Nurseries

Testing Patients for COVID-19

Testing

Please see the attached Interim NYP Laboratory COVID-19 (SARS-CoV-2) Testing Document and the COVID-19 Ambulatory Testing and Management Protocol.

The COVID-19 Exposure and Quarantine FAQ provides commonly asked questions about caring for suspected or confirmed COVID-19 patients.

Airway Management

The NYP Guidelines for Airway Management of Suspected or Confirmed COVID-19 Patients outlines the directions and inventory for the PPE kit as well as provides guidance for airway management including personnel, pre-intubation, intubation, post-intubation, extubation, transportation and CPR. 

For additional guidance on airway management, please see NYP Guidelines for Respiratory Support of Suspected or Confirmed COVID-19 Patient: Non-invasive Ventilation, High Flow Nasal Cannula Oxygen, Invasive Ventilation and Patients with Tracheostomies and NYP Process for Using Intubation Bags for Suspected or Confirmed COVID-19 Patients.

Additional Guidance

For additional guidance regarding suspected or confirmed COVID-19 patients who are pregnant or nursing, please see Interim Guidelines for Suspect and Confirmed COVID-19 for Obstetrics (Antepartum, Labor & Delivery, Post-partum, and Ambulatory Care), Neonatal ICUs, and Well-Baby Nurseries

If a patient comes in with suspected COVID-19 or a positive case, please enter the event in SafetyZone.

Providing Care for Patients

Fever and Cough Clinic

As of March 23rd, our provider community can refer patients who are experiencing symptoms of COVID-19 (fever, nasal congestion, sore throat, and cough) to a new Fever and Cough Clinic, located at the ColumbiaDoctors Primary Care Nurse Practitioner Group office in Washington Heights.

Providers at the clinic will follow current COVID-19 testing guidelines and have the capacity to test for COVID-19.  Current guidelines limit COVID-19 testing to patients whom clinic providers determine are in need of hospitalization, however, the guidelines may change in the days ahead allowing for broader testing. Testing will be ordered in Epic, and specimens will be tested at CUIMC labs.

Please see the attached letter for more information, including how to refer a patient.

Protecting Health Care Personnel

Providers and other members of the health care team can take several measures to minimize exposure to the virus that causes COVID-19, including setting up triage mechanisms to identify patients at risk for the illness. 

Masks and PPE

All providers who are collecting specimens for SARS-CoV-2 testing should wear fit-tested N95 respirators, along with gloves, gowns, and goggles or face shields. Please see these Recommendations for Conservation of N95 Respirators. Until further notice, all members of our workforce who are patient-facing will receive a surgical mask that they must wear continuously throughout their entire shift, at all times while around others, in order to protect themselves, their coworkers, and our patients. As of March 30, we will provide one N95 respirator for all patient-facing faculty and staff. For more information, see CUIMC’s Updated Mask Policy for Patient-Facing Staff (March 30).

Clinicians should follow the Revised Guidelines for Patient Placement and Use of Personal Protective Equipment for Patients with Confirmed or Suspected COVID-19 and the NYP Guidelines for Airway Management of Suspected or Confirmed COVID-19 Patients.

Transport and Patient Care

Recommendations regarding transport of patients are available in the Interim Guidance for Transport of COVID-19-positive or COVID-19-suspected Patients between Units or to Necessary Procedures.

The COVID-19 Exposure and Quarantine FAQ provides commonly asked questions about caring for suspected or confirmed COVID-19 patients.

Get information on cleaning and down-time in exam rooms following a confirmed case of COVID-19.

Free Virtual Urgent Care for CUIMC Employees

All CUIMC employees are now eligible for free virtual urgent care visits with CUIMC and Weill Cornell emergency department physicians via NYPOnDemand. The NYPOnDemand app can be downloaded by visiting the NewYork-Presbyterian website.   

What to do if You Have Symptoms

If you have symptoms (cough, fever, shortness of breath, sore throat), stay home. For up-to-date guidance, see Health care Personnel (HCP) with COVID-19 Exposures or COVID-19–Like Illness

  • If your symptoms are mild, you do not need to seek medical care.
  • If you are a member of a higher risk group or your symptoms are severe, such as difficulty breathing, contact your primary care provider (PCP). 
  • If you are not a member of a higher risk group and your symptoms worsen after three or four days, contact your PCP. In about 80% of cases, symptoms resolve by themselves with supportive care (including rest, fluids, and taking fever reducing medications such as Tylenol or ibuprofen). Stay at home for at least seven days after your symptoms first start and at least three days after you no longer have a fever (without the need to use fever-reducing medications), whichever is longer. 

Contacting Workforce Health and Safety

All health care workers who were exposed to a patient or staff member under investigation or positive for COVID-19 in an NYP facility and who develop a fever, cough, or shortness of breath must call the Workforce Health and Safety (WHS) hotline: 7 days a week, 6:00 a.m.- 11:00 p.m., Phone: 646-697-9470.   

All health care workers who were contacted by DOH because of a confirmed community exposure or believe they may have exposed to someone outside of NYP with COVID-19 must call the Workforce Health and Safety hotline: 7 days a week, 6:00 a.m.- 11:00 p.m., Phone: 646-697-9470.   

A Workforce Health & Safety provider will contact the Department of Health as required on behalf of staff members and staff will be provided with instructions and guided through the process by WHS.

If you need immediate medical attention, please call your local ED, identify that you have had contact with a COVID-19 positive patient and they will ensure that you and all staff have proper personal protective equipment to prevent potential transmission.

If you test positive for COVID-19 at an outside provider or testing facility or you have been in close contact with a symptomatic and laboratory confirmed individual:

  • Immediately contact either of the following:
    • Workforce Health & Safety (212.305.7590)
    • The Department of Infection Prevention & Control (212.305.7025).
  • And notify your chair, division chief, or department administrator, who must contact either of the following:
    • Rudi Odeh-Ramadan, PharmD
      Interim Vice Dean of Administration, VP&S
      212.882.1519
    • Roe Long
      Chief Operating Officer, Columbia Doctors
      212.305.3155

If you have had exposure to COVID-19 in the community, workplace, or have traveled to a Level 3 country but are symptom free, notify your supervisor and WH&S. You can continue to work but will be required to wear a mask and closely monitor your symptoms including taking your temperature twice per day. If you become symptomatic, again notify your supervisor and stay home.

An employee who tests positive for COVID-19 or is placed off duty because of a confirmed exposure to COVID -19 must obtain clearance from the Workforce Health and Safety hotline: 7 days a week, 6:00 a.m.- 11:00 p.m., Phone: 646-697-9470.  Staff will be screened by phone for symptoms and if no symptoms are present, staff will be directed to go in person to their local WHS to be cleared for work.

Temporary Living Accommodations for Medical Personnel

In an effort to provide NYPH Medical Personnel a comfortable and local accommodation near the hospital, Bard Hall at CUIMC will have rooms available for you to reserve during your clinical rotations.  

Accommodations at Bard Hall include:  single room occupancy with a twin bed, desk, chair, and dresser drawers. Each floor shares a community use restroom and shower facility.  In addition, a community laundry room is available in the building for your use (which is operated by utilizing a laundry card with funds added to the account). 

If you are interested in reserving a room in Bard Hall, please complete this form. You will be notified of your accommodation and check-in details via your email.   

Travel Guidelines for Providers and Clinical Staff

For up-to-date information regarding travel restrictions, please see Travel Restrictions by Affiliate Type.

During the current outbreak of COVID-19, it is important that we do everything to help our patients, including protecting the health and optimizing the availability of our critically needed clinicians and staff who must stand ready for our patients. Columbia University Irving Medical Center has instituted the above travel restrictions, with special consideration for all clinical faculty and clinical staff. That includes all personnel who are essential to our ability to provide patient care, including nurses and technicians, pharmacists, radiology staff, clinical lab personnel, IT personnel involved in Epic; front desk staff, cleaning staff, and others. If you are not sure whether your position is included in this category, please check with your supervisor.

All non-clinical faculty and staff must follow Columbia University policies regarding travel.

Wellness Resources

The Department of Psychiatry has worked with ColumbiaDoctors and NYP to provide support services and guidance for stress management, psychological support, and emotional fatigue arising from the COVID-19 pandemic. Resources include virtual group support and debriefing sessions, individual debriefing and counseling sessions, and informational guidance for faculty, trainees, and staff and to share with their families. Please see Emotional Wellbeing and Other Resources

Starting this week, CUIMC faculty can call 646-774-5366 for one-on-one debriefing or support sessions. Faculty who call in during designated times will be connected within a few minutes to a member of the psychiatry faculty through Zoom or WebEx. The schedule:

  • Monday: 10 a.m.-1 p.m.
  • Tuesday: 3-6 p.m.
  • Wednesday: 10 a.m.-1 p.m.
  • Thursday: 3-6 p.m.
  • Friday: 10 a.m.-1 p.m.

Also starting this week, Columbia Psychiatry will offer departments an opportunity to have their faculty and house staff debrief with peers in a virtual group format to engage in practical exercises and obtain practical suggestions on managing some of the challenges all health professionals are facing. These groups will be facilitated by skilled members of the psychiatry faculty.

The schedule for department- and division-specific debriefing groups: 

  • Medicine: Monday, noon
  • Pediatrics Emergency: Tuesday, 11 a.m.
  • Emergency Medicine: Tuesday, noon
  • Critical Care: Wednesday, noon
  • Pediatric Critical Care: Wednesday, 5 p.m.
  • Anesthesiology: Wednesday, 7 p.m.
  • Surgery: Wednesday, 7 p.m.
  • Obstetrics & Gynecology: Thursday, noon
  • Pediatrics: Friday, noon 

“I am proud to say that a large number of our full time and voluntary faculty have volunteered their time and skills for this effort,” says Jeffrey A. Lieberman, MD, the Lawrence C. Kolb Professor and Chairman of Psychiatry and director of the New York State Psychiatric Institute. “Over the ensuing weeks and possibly months we will endeavor to sustain these activities and offer additional services as warranted.”
The program is led by Columbia psychiatry faculty members Lou Baptista, MD, Claude Mellins, PhD, and Laurel Mayer, MD.

Columbia Narrative Medicine Resources

Human Resources Policies

This Human Resources Policy Guidance builds on pertinent Columbia University Human Resources policies and will generally pertain to all full-time and part-time employees (Faculty and Staff – Officers and Support Staff). Other employee groups will be reviewed on a case-by-case basis. For unionized employees, please contact Labor Relations for additional guidance. The Guidelines for CUIMC Faculty who Support the Clinical Mission contains information on underlying medical conditions and procedures clinical staff should take if exposed to COVID-19. Please see the COVID-19 Temporary Leave Policy for up-to-date guidance on pay continuity, paid emergency absence, and childcare resources for University employees. 

Updates will be provided as needed.

Essential Personnel

During an emergency, Essential Personnel provide services that relate directly to the health, safety, and welfare of the University, ensure continuity of key operations, and maintain and protect University properties.

  1. Each School and Department is responsible for final determinations as to which of its personnel are Essential. Essential Personnel are generally defined as the Faculty and Staff who are required to report to their designated work location, to ensure the operation of essential functions or departments during an emergency or when the University has suspended operations.
  2. There are some individuals who may be required to perform essential services remotely and those individuals will be identified in advance and notified by their managers.
  3. If unable to report to work, appropriate leave time—Vacation or Personal Days—must be taken. If leave time is not available, pay is not provided. Exceptions to this guidance must be approved by the Senior Business Officer (SBO) of the School or Department.
  4. Essential Personnel are expected to work in emergency situations unless they are specifically excused by their departments.  Failure to report to work as directed may result in disciplinary action up to and including termination.

Telecommuting and Alternate Work Schedules

CUIMC is committed to maintaining its mission of patient care, research and education during this time of uncertainty. As with all health care and research institutions, much of our work must be performed on-site by our dedicated faculty and staff.

For the most up-to-date information regarding telecommuting accommodations for clinical, non-clinical, and research faculty and staff, please see CUIMC’s Remote Work Guidelines and Tips.

Self-Isolation Guidance

If you’re unsure whether you need to self-isolate, see this resource. If you have confirmed the need to self-isolate, see How to Self-Isolate. If an employee has been advised by the Department of Health, their personal physician or the University to self-isolate, the following steps should be taken: 

  • Employee should stay home (not go to work, events, or other social gatherings).
  • Employee should immediately contact their manager and local Human Resources officer. The local HR officer should immediately notify CUHR Leave Management. 
  • Employee should contact their primary care provider to let them know that they are self-isolating.
  • Employee should monitor their temperature twice a day.
  • If Employee experiences fever, cough and difficulty breathing, they should contact their primary care provider immediately. 
  • If Employee lives with others, they should not spend time in shared living spaces and should limit contact. The sharing of household items (drinking glasses, towels, eating utensils, bedding, etc.) should be avoided.
  • Employee should arrange for food to be delivered via friends, grocery delivery services, etc.
  • High touch surfaces (e.g. doorknobs, telephones, remote controls, and bathroom surfaces) should be cleaned often with a standard household disinfectant such as Clorox® wipes.
  • Employee is expected to work remotely, if able, and asked to stay in daily contact with their manager and local HR. 
  • Information regarding their self-isolation is confidential and should only be shared on a need-to-know basis.
  • Local HR should provide EAP benefit information to remind employee about the availability of this resource.

Please visit Columbia University's webpage for coronavirus information and up-to-date guidelines.

NOTE: THIS GUIDANCE MAY BE MODIFIED AS CIRCUMSTANCES RELATING TO COVID-19 CHANGE

Reference

Campus Status

Rapidly changing circumstances related to the ongoing COVID-19 pandemic require additional measures to slow the spread of the virus while maintaining basic operations to support the medical center.

Facilities management has increased cleaning and disinfecting efforts in academic and residential buildings, but many facilities—including libraries, athletic centers, campus eateries, and student housing—have been temporarily closed. Per CUIMC policy, non-essential gatherings of over 25 people will be canceled through at least April 30. For personnel who are still commuting to campus to support essential operations, temporary parking is available at reduced rates.

For the most up-to-date information regarding campus status, including closures, parking information, and campus operations, visit Facilities Management and Campus Services. Information is updated frequently as the impact of the virus changes locally and nationally.

Recent updates, campus resources, and additional information are also available through the University’s COVID-19 Guidance for the Columbia Community.

Changes to GME Requirements

Certain graduate medical education activities are being suspended to allow the GME community to focus on patient care and institutional issues during the COVID-19 crisis. Read the March 18, 2020 letter from ACGME president Thomas Nasca, MD.

Additional Resources