Table 7.

Plans for contingency management

Risk detection area	Description of contingency	Actions to minimize risks
Reception	Detection of close contact or suspected case [6] upon customer admission (triage, questionnaire, temperature check)	-Interrupt patient admission and refer to the corresponding healthcare service to continue with care until COVID-19 is confirmed or not. -Record the contingency -Ventilate the area, perform additional cleaning and disinfection of everything that has been in contact with the patient
Doctor or diagnostic office	A patient under care in the center has symptoms or a positive COVID-19 test result during the diagnostic stage	-Activate the protocol to isolate every contact the patient had in the center for over 15 min in the last 72 h and the health authority should perform the monitoring until medical discharge
Physician’s office	A patient has symptoms or a positive COVID-19 test result during ovarian stimulation	-Cancel the cycle -Isolate any healthcare worker or staff who has been in close contact with the patient in the last 14 days to continue with their care in accordance with the protocol for suspected case
Laboratory	Symptomatic or COVID-19-positive patients upon reception of biological material in the lab, which cannot be cancelled due to medical criteria	-Process sample with protocol for high-risk sample management, as in the case of HIV -Activate protocol for contingency cleaning
Patient care	The couple present symptoms or a positive COVID-19 test result during patient ovarian stimulation	-Cancel sperm sample reception at the lab and keep oocytes frozen
Patient care/laboratory	Symptomatic or COVID-19-positive patients detected after embryo transfer	-Activate protocol for cleaning* if the detection took place within 12 to 24 h of transfer -Evaluate with physicians any close contact and what to do if there are any extra frozen embryos -Provide patients with any information available for advice
Patient care/laboratory	Asymptomatic patient or during the window period after treatment	-Inform the lab for material handling -Isolate and test all staff who have been in close contact -Activate protocol for contingency cleaning
Medical director/HR	A staff member has symptoms or positive COVID-19 test result	-Evaluate the close contacts with the rest of the staff and patients in the last 72 h for isolation -If the center has an alternative team to carry out the services, after cleaning and disinfection of all facilities, can continue with medical attention*
Medical director	A staff member has symptoms or positive COVID-19 test result, and for some reason all staff must be totally isolated	-Establish a referral agreement with another center for patients under treatment which could not be postponed nor cancelled until reopening -Reopen when the quarantine time of contacts is over, and the staff test results are negative (at least 14 days) -Clean and disinfect all facilities -Activate the protocols for maintenance of equipment with biological material to ensure its preservation under controlled conditions for storage

*Protocol for contingency cleaning:

• Close all areas used by the infected person.

• Wait 24 h before cleaning and disinfecting. If you cannot wait 24 h, wait as much as possible.

• Clean and disinfect all areas used by the infected person.

• If 7 days have gone by since the infection was informed, it is not necessary to perform additional cleaning or disinfection.