Table 1.

Primary Care Preparedness and Response to a Pandemic

CDC-Defined Intervals	CDC Indicators2	Primary Care Experience	Primary Care Actions to Care for Patients and Communities
Investigation (Interval 1)	Investigation of infection	Business as usual for primary care; be ready for a potential pandemic	Continue usual acute, chronic, wellness, mental health, and social care Participate in public health surveillance programs Maintain readiness to address local or global spreads of infections
Recognition (Interval 2)	Recognition of increased potential for ongoing transmission	Patients in sentinel communities begin to get infected; clinicians hear about pandemic possibility	Rigorous hand washing Separate patients with infectious symptoms and those who are well Implement physical distancing measures for all Minimize patients in waiting room Have patients and staff wear masks Disinfect rooms after every patient encounter Switch to virtual visits and telephone-based care Testing and contact tracing
Initiation (Interval 3)	Confirmation of human cases globally with human-to-human transmission	Infections rapidly spread in and across communities; patients worry about their risk of infection	Convert to complete virtual care for first contact Only see patients in person after triaged as necessary Implement proactive population care to identify and reach out to at-risk patients for infection and worsening chronic conditions, mental health, or social needs Implement policies to protect patients, staff, and clinicians Keep patients away from emergency departments and hospitals unless necessary
Acceleration (Interval 4)	Consistently increasing rate of infection, indicating established transmission	Infections spread; patients get infection complications and require hospitalization; patients defer care of non-infectious conditions	Continue virtual care and proactive population care Limit patient contact with emergency and hospital care to necessary care Systematically implement testing protocols Define criteria for hospitalization Create care teams to check in daily/weekly with patients in need Reinforce and support hospital care teams Create home hospital care for sick patients not hospitalized Expand home palliative care for patients who want less aggressive care
Deceleration (Interval 5)	Consistently decreasing rate of infection	Patients get infected—but fewer patients; hospitalized patients improve and need rehabilitation; resume care for non-infectious conditions	Support convalescing patients Support home rehabilitation care services Consider overflow recovery centers or new home care services Develop a strategy to resume “normal” in person care Monitor reopening strategies to ensure patients, clinicians, and staff remain safe
Preparation (Interval 6)	Low infection activity but continued outbreaks possible in some areas	Patients suffer from uncontrolled and missed conditions and risks; there is a high burden of mental and social needs; practices recover from financial and staffing burdens	Attend to pent-up demand as a result of delayed care Address adverse consequences of delayed or deferred care Expand the provision of evidence-based care for unhealthy behaviors, mental health, and social needs Expand the role of social workers and community health workers Leverage the clinician-patient longitudinal relationship to address needs Advocate for essential social and economic policies Rebuild practice

CDC = Centers for Disease Control and Prevention.

Note: many tasks started in early intervals continue throughout subsequent pandemic intervals.