How to prepare and respond to Coronavirus (COVID – 19)

VeeOne Health is actively working on innovative solutions to fight coronavirus outbreak. Our team of engineers and physicians have developed unique work flows and technology to support the health care systems to tackle COVID-19 pandemic.
VeeOne Health has developed an easy to implement telehealth solution for the coronavirus outbreak, our technology platform provides rapid access to the provider, improves patient satisfaction and reduces the cost to the health care system. Our telehealth carts can be used in urgent care centers to limit the COVID-19 exposure to health care workers, but also health care providers able to scale their practices with our telehealth platform. Providers can also use our web-based technology platform to see the patients form home. Our platform has built in messaging capability so there is no need of separate HIPAP compliant messaging application. Telehealth visits have shown to be sufficient to do the initial assessment and it also allows the provider to triage the patients. Patients can be seen 24/7 from home and because at this point there is no treatment for coronavirus patients can be evaluated, managed at home with telemedicine technology.

Dr. Shaji Skaria, MD

Intensivist and Pulmonologist

Over the past decade, the appearances of novel airborne viruses have posed major public health threats. Covid-19 or Corona virus is the latest of such virus’ and has taken the world by storm. It has been over 50 years since we have last seen a pandemic. Preparedness is key and local hospital leaders are taking the necessary steps to help treat and screen appropriately. The most appropriate means of protection, for health care workers (HCW) against such threats, is not well defined A major concern for health care providers remains exposing vulnerable or non-infected patients to those patients who do have the virus and arrive to seek care in clinics, waiting rooms, hospitals and other such areas. To date, most patients experience mild to moderate illness while treating viral symptoms and recover within a week from the onset of symptoms. These patients either come to the emergency room or go about their day and don’t realize that they are increasing the risk to health care workers and others.
Virtual care is the key. I had the opportunity to take care of such a patient virtually in the intensive care unit. By leveraging telehealth, I was not only able to actively manage, treat and stabilize this critically ill patient with Covid-19 but also protect myself.
When patients come into ER with mild/moderate symptoms and are not sick enough to be admitted they put others including the HCW and those around them at risk. As we know respiratory droplets can live on surfaces or in the air for more than 3 hours and travel as far as 6 feet. These patients can be triaged through virtual care, receive lab orders and scheduled appointments to report to the site and complete specimen collection without having to leave their vehicles and possibly exposing others to the virus. Now is the time to think about, ways we disrupt the current to traditional health care. Model and think about how best to protect others as well as our HCW’s.

Dr. Amir Amiri MD

ICU, Acute Care Surgery & Trauma

General concerns for PUI and COVID-19-positive patients

Healthcare Worker safety concerns:

Droplet precautions for all general contact.

Airborne precautions for any aerosolized procedures (nasal swab, nebulized treatment, bipap, bronchoscopy, intubation). Recognize the high risk of infection in any of these procedures.

All patients with respiratory symptoms and/or fever will be masked upon arrival to ED and should remain masked when healthcare providers are in the room with the patient. Hospital will limit, if not eliminate, any non-essential visitors to the hospital.

As the number of admitted COVID patients rises in Sacramento, we will ultimately run low PPE supplies for the hospital and region.

Close respiratory monitoring of PUI and COVID-19-positive patients.

The MICU team should be notified EARLY if there is a COVID or PUI patient with worsening respiratory status and will keep a list of all COVID patients in the hospital for monitoring purposes. Avoiding crash intubations is essential. When the intubation of a COVID-19 patient or PUI is needed (outside of the ED), intubation will be conducted by a designated COVID/PUI airway team consisting of a specified attending and fellow.

Respiratory Concerns:

Notify intensivist EARLY if there is a COVID or PUI patient with worsening respiratory status. Avoiding crash intubations is essential. Intubation (outside of the ED) will be conducted by the intensivist, who will be caring for the patient (or anesthesiologist, if intensivist is unavailable).

The intensivist should be aware of PUI within this hospital and kept aware of any PUI/COVID-19 patient whose status is worsening.

Patient safety concerns:

COVID-19 patients may deteriorate rapidly.

Success in reducing mortality has been achieved through early intubation for respiratory failure.

What to do:

Maintain a list of all PUI/COVID-19 patients available to the intensivists on duty.

Have discussions early with the patient/family about patient’s wishes regarding intubation and code status.

Notify the intensivist and RT early if the patient is worsening or if you think intubation will be required.

Avoid all aerosolizing procedures on PUI/COVID-19 positive patients, when possible.


PUI or COVID-19-positive patients requiring oxygen should receive, in order:

1. Nasal cannula, then

2. Non-rebreather (NRB) mask if > 6 LPM of oxygen is required, then

3. Intubation

Need for supplemental oxygen in PUI or COVID-19-positive patients

PUI or COVID-19-positive patients receiving oxygen via nasal prongs should have a surgical mask that covers their nose placed over their face.

Switch to a non-rebreather (NRB) mask if > 6 LPM of oxygen is required.

Note: A non-rebreather mask is the ONLY option for escalation prior to intubation.

AVOID any HFO2, BIPAP, bag-mask ventilation.

Intubation of PUI and COVID-19-positive patients

Intubation should be conducted by the intensivist caring for the patient if available.

Protective Gear

Intubating location proposal

Intubation personnel (limit number of people in the room during procedure) should include only

Intubation personnel

Intubation criteria guidelines

Other considerations

Limitations for participation in the care of critically ill PUI and COVID-19 patients

Extubation of PUI and COVID-19-positive patients

Extubation is also an aerosolizing procedure and RT should don appropriate PPE and perform in a closed room. To avoid airway emergencies of PUI and COVID-19 patients who are being extubated, extubation should only proceed when attending physicians are present but need not be in the room at the time.

Equipment Considerations

ICU Procedures and Interventions

Try to consolidate procedures into one trip with minimal personnel.

For Central line access in those with acute renal failure, consider early placement of a trialysis catheter to avoid additional future procedures.

Run a thorough checklist prior to entering room and anticipate need for all supplies.

Limit lab draws to those necessary for clinical decision making and try to consolidate/batch timing of blood drawn.



Code status

All patients should have early and documented code status discussion focused on goals of care around intubation and resuscitation. Admitting physician or ED physician should place palliative care consult upon admission. Goal is Palliative Care consult with family and patient within 24hr of admission with prognosis and goals of care discussed specific to COVID experience.