Coronavirus Response

DFA Coronavirus Response (COVID-19) Statement of Principles

Executive Summary

During the COVID-19 pandemic, DFA leaders, members, partners, colleagues, and friends have been providing care on the frontlines and taking leadership roles to address health policy issues which affect the well-being of our patients, and our ability to care for them.

Doctors for America knows that protecting patients in the time of the COVID-19 pandemic means considering all of the factors contributing to the ability of our patients and their communities to stay healthy and to access the care they need. This holistic approach is consistent with our principles around any issue affecting health.

Likewise, DFA, an organization driven by members, is committed to comprehensive engagement on health policy issues that will make a difference in the overall health and well-being of our patients, our communities and ourselves.

This document is intended to provide a framework to assess, develop and implement DFA engagement on health and policy topics related to the COVID-19 pandemic.

Guiding principles:

  1. Protect and improve the health of our patients is our paramount responsibility
      • This would include access to care, adequate resources, availability of testing and treatment options, and affordability
  2. Ensure the capability of health workers to provide the best possible care for patients
      • This would include access to resources not only for patients, but also for the protection and well-being of those who care for patients
  3. Identify and act on urgent issues raised during the pandemic
      • This would include measures like social distancing, public health education and communication, access to testing and treatment for everyone
  4. Identify and prioritize issues to be addressed post COVID 19
      • This would include tabulating the lessons learned from the pandemic and its consequences, particularly the implications of the social determinants of health for the spread and the severity of impact of the pandemic
  5. Emphasize solutions rather than dwelling on problems
      • It is important to recognize that the relevance of reviewing past mistakes is to improve future welfare
  6. Support measures that protect and enhance the capability to provide the best possible care during the pandemic
      • This would include affordable access to effective medications, reduced bureaucracy, and streamlined approvals and policies
  7. Utilize the trusted voice of DFA effectively and efficiently
      • This will include consideration of the appropriate use of coalitions, collaborations and grassroot campaigns
  8. Cultivate and strengthen the DFA community to foster our ability to make a difference
      • This would include collection and dissemination of resources and support to protect the wellness of healthcare providers and combat burnout

Recommended DFA policy positions on COVID-19:

  1. Safeguard public health
    1. Shelter-in-place, enforced nationwide until medical and public health experts agree it can be lifted
    2. Expanded assessment, testing, and treatment (free from individual cost-sharing) to fully assess and treat infections; support accompanying COVID contact tracing efforts
    3. Public health mandates that are sensitive to the needs of vulnerable communities and avoid over-policing, particularly in communities of color.
  2. Support for front-line clinicians and health workers to deliver care safely
    1. Communications demonstrating that the physical and psychological health and well-being of health workers is critical for them to effectively protect patients.
    2. Efforts to ensure adequate PPE and other needed supplies are accessible to front-line health workers.
    3. Support and promote recognized protocols that are designed to protect health workers
    4. Ensure that necessary supplies for testing, diagnosis and treatment are universally available.
    5. Ensure health workers are protected from employer retribution for speaking out about unsafe or ineffective policies and conditions
  3. Accessible and equitable health care coverage, financing, and delivery systems:
    1. Advocating for universality, affordability, accessibility, equity, and adaptability in our health care system, through insurance/financing reform, and other efforts to improve access and achieve better health for all
    2. Drug, vaccine, and other treatment affordability, including effective regulations on pharmaceutical corporations, the pharmaceutical company-to-consumer pipeline, intellectual property and trade regulations, drug price regulation
    3. Keeping People Covered. Open national and state ACA/Medicaid enrollment periods during the pandemic, expand Medicaid in states that have not already done so, stabilize funding and provide states’ needed Medicaid flexibility to meet population needs, health coverage for those experiencing unemployment.
    4. COVIDcare for All - full coverage of needed care related to the pandemic
      Ensure that patients do not have to pay surprise medical bills related to the pandemic
  4. Treating concurrent epidemics - mental illness, violence, trauma, and addiction
    1. Combat the effects of social isolation on our medical communities and our society
    2. Maintain and expand resources for those experiencing symptoms of stress and mental illness, including suicide prevention during times of crisis, 
    3. Support changes in policy and care to ensure those with Substance Use Disorder (addiction)have access to effective support, care, and harm reduction strategies.
    4. Focus on implications of the pandemic on social problems of domestic violence, child abuse and firearm safety. In particular, consider the effects of loosening of firearm purchasing restrictions, and defining gun stores as “essential” during social isolation.
  5. Social Determinants of Health
    1. Recognize that the deleterious effects of the many social determinants of health are highlighted or exacerbated by the pandemic and consider possible solutions to address these underlying threats to health.
    2. Policies supporting continued or enhanced resources for those experiencing poverty, homelessness, food insecurity, and similar, including policies for helping homeless populations during infectious pandemic situations, stable temporary housing, food distribution initiatives, full scope of substance use/addiction treatment and services
    3. Advocating for those in Detention
      1. efforts to provide enhanced care for immigrants and protections for those who are incarcerated or in detention
      2. release of detained asylum seekers/refugees/nonviolent immigrants to prevent spread of COVID in ICE detention facilities
      3. Criminal justice reform that promotes health - may include de-prioritizing prosecution of nonviolent offenses, efforts aimed at decarceration (releasing non-violent prisoners to reduce prison populations and prevent spread)
  6. Facilitating the best available care
    1. Minimum standards for health worker shift length, rest, and whistleblower protections, including alternative sleeping quarters for those who may need to isolate themselves (to protect their families) and a health worker safety hotline to report unsafe conditions.
    2. Make paid sick leave available to all health workers regardless of employment status and prioritize health worker access to COVID-19 testing and treatment to keep health care workers providing care to those who need it.
    3. Provide safe childcare options for health workers who may need them so they can care for patients, as well as freely accessible, consequence-free mental health services to health workers.
    4. Ensure that medical licensing and liability regulations are relaxed to allow health workers to provide care for patients wherever those patients might need them during the COVID crisis
    5. Ensure that health workers-in-training — residents, fellows, medical & nursing students, and volunteers — receive protections similar to those of other health workers, especially from exploitative working conditions.
    6. Workforce protection and expansion, including protecting outpatient clinics and teams, compensation for individual/private practices who are struggling to stay open and meet community needs
    7. Resources to make sure telehealth is rolled out in a way that emphasizes accessibility, privacy, and compassionate care. Ensure reimbursement for these services supports clinicians and teams, values clinician cognitive skills and not simply random technologies, while ensuring maximum affordability for patients.
  7. Building for the future
    1. Recognize the opportunities and challenges of increased use of telehealth
    2. Ensure that adequate resources and training are made available to ensure equitable, affordable and compassionate access to telehealth care.
    3. Ensure that the system provides appropriate reimbursement for these services which supports clinicians and teams, values clinician cognitive skills.

How We Can Make a Difference

DFA policies, positions and communications should be governed by these considerations:

    1. Transparency - in guidelines, clinical information, and distribution of resources
    2. Harmonized and clear communication of care recommendations (or calling out the lack thereof) - e.g. who gets tested, action on test results, protocols for treatment and rationing supplies, PPE protocols.
    3. Ethics of resource allocation, ethics of resource allocation, and development of algorithms prioritizing care for some patients over others in times of scarcity
    4. Ensuring that research and trials investigating therapies and vaccines keep equity, ethics, and global impact in mind
    5. Dissemination of scientific and public health information from trusted sources and cultivating trust in our science-based institutions and channels of communication
    6. Considering the global effects of this pandemic and our chosen domestic responses, including needed supplies for low and middle income countries, health worker engagement overseas, ethics and economics of clinical trials and affordability/accessibility of treatments and vaccines, the intersections with national security and global development concerns as well as international pandemic preparedness

April 14, 2020

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