ALCOAST 137/20 - APR 2020 COVID-19: HEALTH, SAFETY, AND WORK-LIFE (HSWL) UPDATE 1

R 161417 APR 20
FM COMDT COGARD WASHINGTON DC//CG-11//
TO ALCOAST
UNCLAS //N06000//
ALCOAST 137/20
COMDTNOTE 6000
SUBJ: COVID-19: HEALTH, SAFETY, AND WORK-LIFE (HSWL) UPDATE 1
A. COMDT COGARD WASHINGTON DC 202055 MAR 20/ALCOAST 098/20
B. COMDT COGARD WASHINGTON DC 241740 MAR 20/ALCOAST 104/20
C. COMDT COGARD WASHINGTON DC 201727 MAR 20/ALCOAST 096/20
D. Military Civil and Dependent Affairs, COMDTINST M1700.1 (series)
E. Administration of United States Public Health Service (USPHS) Officers
Detailed to the Coast Guard, COMDTINST 6010.5 (series)
F. Coast Guard Standards of Ethical Conduct, COMDTINST M5370.8 (series)
G. COMDT COGARD WASHINGTON DC 202131 MAR 20/ALCOAST 100/20
1. This ALCOAST updates medical policy promulgated in REFs (A) and (B), as
well as promulgates policy regarding outside activities and the clinical
duties of HSWL personnel who are high risk for complications arising from
COVID-19 or who have high-risk household members.
2. Clinic Core Functions. Unless local requirements dictate otherwise, CG
clinics and sickbays are still open with limited service availability.
Routine appointments will continue to be managed via telehealth appointments.
    a. Extended Periodic Assessments/Requirements. Effective 24 Mar 2020, the
term of validity for the following periodic medical assessments is extended
120 days:
        (1) Periodic Health Assessments
        (2) Annual Dental Examinations
        (3) Occupational Medicine Surveillance Examinations
        (4) Dive Physicals that do not require waivers
        (5) Annual Aviation Physicals that do not require waivers
        (6) Landing Signal Officer Physicals
        (7) Laboratory tests required for Individual Medical Readiness (IMR)
        (8) Vaccinations required for IMR
        (9) Commissioning Physicals that expired after 24 March 2020, providing
that the commissioning candidate contacts the pertinent physical exams department
and/or examining health care provider and verifies that there has been no
significant change in the candidate’s health since the physical in question was
signed. The verification will be documented in the candidate’s medical record via
an administrative encounter note filed adjacent to the corresponding physical exam.
    b. Periodic and Military-Specific Examinations that must proceed. For examinations
below that require a new dental examination, the new dental examination requirement
is deferred until further notice. Where possible, however, personnel who require
such examinations should attempt to provide a DD Form 2813, Department of Defense
Active Duty/Reserve/Guard/Civilian Forces Dental Examination, that is less than
12 months old. If no dental examination is performed, document on the DD 2808:
“Dental exam not completed.” In addition, for separation and retirement examinations,
this should also be noted on the DD 214. Routine annual dental examinations that
are being deferred should be noted in the CG Service Treatment Record, Section VIII,
on the most recent SF 603 or SF 603A, whichever is more recent.
        (1) Dive Physicals that require new waivers or waiver renewals, to include
temporary waivers.
        (2) Annual Aviation Physicals that require new waivers or waiver renewals,
to include temporary waivers.
        (3) Retirement and Separation Physicals. The Veteran’s Administration is
continuing to perform Compensation and Pension Examinations.
        (4) Accession Physicals.
        (5) Commissioning Physicals that are more than 120 days expired or have not
yet been conducted.
    c. Core Services. CG Clinics and sickbays are still open and able to see CG
members for face-to-face appointments. Availability of face-to-face services are
resource dependent and may be impacted by local quarantines/isolations.
The following services are considered core functions:
        (1) Non-COVID-19 related urgent or acute medical care
        (2) Periodic and Military-Specific Examinations as described in 2.b above
(any examinations not specifically addressed as deferred will continue as needed
and determined by each regional Senior Medical Executive.
        (3) X-ray services as needed for diagnostic purposes or for the exams
described in 2.b above
        (4) Laboratory services as needed for diagnostic purposes, if needed for
medication changes/renewal/monitoring, or if needed for the exams described in
2.b above.
        (5) Pharmacy Services
        (6) Overseas Screenings
        (7) Certain aviation up-chits (some can be completed via telephone or
telehealth consultation IAW REF (B), as determined by the cognizant aviation
medicine provider).
    d. Surge services.
        (1) Rapid strep testing as long as medical supplies are available.
        (2) Rapid influenza testing as long as medical supplies are available.
        (3) COVID-19 testing.
    e. Patients needing testing should call ahead to their servicing clinic to
receive specific guidance for their situation. Patients shall not present to a
CG clinic or sickbay with signs and symptoms of COVID-19 without having contacted
the clinic ahead of time.
    f. The preferred option for specimen collection and testing is community
testing if the Turn Around Time (TAT, or time from collection to results) is less
than 48 hours.
    g. If no rapid TAT community testing is available, CG clinics and sickbays may
now collect lab specimens from suspected COVID-19 patients and may treat and
evaluate such patients, provided proper Personal Protective Equipment (PPE) is used
as per Centers for Disease Control and Prevention (CDC) recommendations and provided
such patients are isolated from other patients. HSWL Service Center has developed
guidance via a Time Compliance Technical Order for HSWL COVID-19 specimen
collection procedures.
    h. Personnel who do not live within 50 miles of a CG clinic or sickbay should
use the following link to find a testing site near them:
https://my.castlighthealth.com/corona-virus-testing-sites/.
    i. Specimens will not be collected from asymptomatic persons for the purpose of
shortening a quarantine period, as current tests lack the sensitivity for a
negative result to be meaningful to guide clinical or operational decision making.
3. The performance of activities outside the normal duties of HSWL personnel are
governed by REFs (D), (E), and (F) for CG personnel and USPHS Officers detailed to
the CG, respectively. Outside activities (such as medical volunteer work or
off-duty civilian employment) that have been previously approved may be continued
provided that the appropriate PPE is worn and supplied by the outside activity; no
CG PPE will be used for outside activities. For CG personnel, Commanding Officers
and Officers-In-Charge retain the authority to continue or restrict outside
activities. There is no change in the approval process for new outside activity
requests at this time.
4. HSWL personnel who provide direct clinical care and are high risk for severe
COVID-19 disease.
    a. As currently defined by the CDC, persons meeting the following criteria
are considered high risk for severe COVID-19 disease: Age 65 or older, pregnant,
have chronic lung disease or moderate to severe asthma, have a serious heart
condition, are immunocompromised (cancer treatment, smoking, bone marrow or organ
transplantation, immune deficiencies, poorly controlled HIV or AIDS, and
prolonged use of corticosteroids and other immune weakening medications), have
a BMI >40, have diabetes, have chronic kidney disease and who are undergoing
dialysis, or have liver disease.
    b. HSWL personnel meeting one or more of these criteria may be excused from
providing face-to-face patient care as long as operational needs (to include
potential deployments), as defined by the HSWL SC Chief of Operational Medicine,
can be met. Such personnel may provide face-to-face patient care provided
appropriate PPE is available and is worn with each patient encounter.
    c. Additional Return To Work (RTW) guidance is being developed for the
entire CG.
5. CG Auxiliary Health Care Providers. Per REF (G), Auxiliary operations may
continue at the discretion of the District Commander. CG Auxiliarists must apply
proper risk management principles prior to requesting, planning, or undertaking
any assignment to duty where risk of exposure to COVID-19 is possible. All
requests for CG Auxiliary Health Care Providers must coordinate with the Chief
Medical Officer of the CG Auxiliary, and the HSWL Service Center Operational
Medicine Division.
6. POC: CAPT Shane Steiner, Chief, Operational Medicine, COMDT (CG-1121),
at: 202-475-5256, Shane.C.Steiner@uscg.mil.
7. RADM Dana L. Thomas, Director, Health, Safety, and Work-Life, sends.
8. Internet release is authorized.