ASNC’s efforts during the COVID-19 pandemic

Sharmila Dorbala, MD, MPH, FASNC President, ASNC

These are extraordinary times for the human race. Though the world has suffered a handful of pandemics during the past century,1 there’s no standardized response; the individualized nature of each contagion presents its threat before the best course of action can be determined. I’m writing this on April 7th, as frontline medical professionals are working around the clock, risking their lives to make great strides. Most of the rest of the population—some physicians included—are now doing our best to work from home, as the world around us has shut down.

We at ASNC fully understand the risks and challenges inherent in this crisis: nuclear cardiology professionals attending to their most vulnerable patients must also minimize their own risk of COVID exposure; our field’s trainees also need to safely manage critical patient care duties, while seeking out new educational paradigms to advance their educational goals. This COVID pandemic has—with very short notice—dramatically changed both our clinical practice and education.

The hopeful news is that, in just two weeks, ASNC developed reliable, up-to-date resources to meet these risks and challenges. Our new ASNC COVID-19 resources page now hosts: (1) a webinar on COVID-19; (2) an information statement on COVID-19; (3) a webinar on telemedicine and advocacy during COVID-19; (4) advocacy efforts for regulatory relief; and (5) an ASNC 2-week virtual nuclear cardiology elective.

Here’s a brief overview of what you’ll find when you visit our new ASNC COVID-19 Resource Center at https://www.asnc.org/news:

1. ASNC’s webinar, in collaboration with the Chinese Society of Nuclear Medicine (CSNM) and the Singapore Society of Nuclear Medicine: “COVID-19 Preparedness for Nuclear Cardiology Labs: Insights from the US, China and Singapore.” Key highlights include:

   • Learning from nuclear medicine physicians from Wuhan and Singapore on how they curtailed the spread of COVID-19 in their laboratories.
   • Reasons why following local and hospital recommendations is critical.
   • The importance of pre-screening of patients, temperature checks, separation of COVID from non-COVID patients, hand hygiene, laboratory, and ventilation system disinfection procedures—and more—to protect patients and staff.

   This recorded webinar is available for viewing on the ASNC website.

2. ASNC’s and SNMMI’s joint information statement, “Guidance and Best Practices for Nuclear Cardiology Laboratories during the Coronavirus Disease 2019 (COVID-19) Pandemic: An Information Statement from ASNC and SNMMI.” A preprint version of this paper2 is available for download from the ASNC website. Key recommendations include:

   • Pre-screen all patients
   • Postpone all elective and non-urgent procedures (>95% scheduled procedures are being postponed at most centers)
   • Perform urgent procedures to facilitate short-term patient management including discharge for patients in the emergency room and in the hospital (A tiered approach to indications is provided in the document.)
   • Avoid exercise stress, preferentially perform vasodilator stress imaging
   • Perform protocols that allow for rapid lab throughput: stress first, PET, novel software/novel scanner protocols for short scan duration

3. A recorded webinar on telemedicine and advocacy that discusses key information effecting your practice and billing, including telemedicine, billing requirements for telemedicine, the latest private payer telehealth policies, and Medicare’s newly expanded Accelerated and Advance Payment Program.

4. This has been a challenging time for the practice of nuclear cardiology with postponement of elective testing and redistribution of workforce. ASNC has been working tirelessly advocating on behalf of our members with congress. ASNC joined the American Medical Association (AMA) in a letter to the congress urging all payers to provide coverage for telehealth patient visits, financial support for practices on the frontlines of COVID-19 testing as well as financial support for practices negatively impacted by cancelation of elective visits and procedures. See https://www.asnc.org/news#Private%20Payer%20Coverage%20for%20COVID-19 for this and more advocacy information.

5. ASNC’s new virtual nuclear cardiology elective, held April 6th-17th, 2020 via Zoom conference. This offering was created to support both training program directors—suddenly dropped in a flurry of unexpected responsibilities—and their trainees—who remain responsible for completing their educational goals—ensures that radiology, nuclear medicine, and cardiology trainees gain fundamental knowledge from ASNC leaders across the country. The highlights of this novel and extensive 10-day course via Zoom video conferencing include:

   • A daily didactic for 30 minutes
   • “Live” case reviews for 90 minutes
   • Teaching by expert nuclear cardiologists and fellows from 5 major medical institutions in the USA, and
   • A comprehensive virtual curriculum with:

     1. pre-recorded talks
     2. guideline documents
     3. key nuclear cardiology papers as pdf files
     4. prerecorded webinars

Fellows in training are the future of ASNC. This complimentary virtual nuclear cardiology elective has connected ASNC with fellows from several institutions worldwide. The success of the course is already clear from the first few days of full registration and attendance by fellows in training.

While critical times like these call us to share our very best, they also, inevitably, put us in touch with the tragic loss of human lives. Among the many losses known and yet-to-come, we mourn the passing of two Italian physician colleagues and imagers to COVID: Dr. Eugenio Inglese, MD, a co-founder of the Italian Nuclear Cardiology Group passed away in March, as did, Dr. Maurizio Galderisi, MD, FESC, Vice President of EACVI and chair of the echo section.

We hope that ASNC members and their families are all practicing social distancing and are able to remain safe and well. ASNC staffs have been working from home since March 16th, remaining productive while also staying healthy. Be sure to check the ASNC COVID-19 Resource Center (https://www.asnc.org/news) for regular updates.