Gov. Tony Evers today directed Wisconsin Department of Health Services (DHS) Secretary-designee Andrea Palm to extend the Safer at Home order from April 24, 2020 to 8 a.m. Tuesday, May 26, 2020, or until a superseding order is issued. The order implements some new measures to ensure safety and support the progress we've made in containing COVID-19, but also allows certain activities to start up again. The order is available here. 

“A few weeks ago, we had a pretty grim outlook for what COVID-19 could mean for our state, but because of the efforts of all of you, Safer at Home is working. That said, we aren't out of the woods just yet,” said Gov. Evers. “As I've said all along, we are going to rely on the science and public health experts to guide us through this challenge. So, as we extend Safer at Home, I need all of you to continue doing the good work you've been doing so we can keep our families, our neighbors, and our communities safe, and get through this storm together.”

“Before we lift Safer at Home, the steps of testing and more robust public health measures must be in place,” explained Secretary-designee Palm. “These steps will help us reduce the risk of a second wave of the virus. If we open up too soon, we risk overwhelming our hospitals and requiring more drastic physical distancing measures again.”

The extension of the Safer at Home order includes a few changes. Some changes allow more businesses and activities to open back up, while other changes help make businesses safer for employees and customers. The changes in this order include: 

Businesses and activities ramping up service and operations:

• Public libraries: Public libraries may now provide curb-side pick-up of books and other library materials. 
• Golf Courses: Golf courses may open again, with restrictions including scheduling and paying for tee times online or by phone only. Clubhouses and pro shops must remain closed.
• Non-essential Businesses: Non-essential businesses will now be able to do more things as Minimum Basic Operations, including deliveries, mailings, and curb-side pick-up. Non-essential businesses must notify workers of whether they are necessary for the Minimum Basic Operations.
• Arts and Crafts Stores: Arts and craft stores may offer expanded curb-side pick-up of materials necessary to make face masks or other personal protective equipment (PPE). 
• Aesthetic or Optional Exterior Work: Aesthetic or optional exterior law care or construction is now allowed under the extended order, so long as it can be done by one person.

Safe Business Practices:

• Safe Business Practices for Essential Businesses and Operations: Essential Businesses and Operations must increase cleaning and disinfection practices, ensure that only necessary workers are present, and adopt policies to prevent workers exposed to COVID-19 or symptomatic workers from coming to work.
• Safe Business Practices for Retailers that Essential Businesses and Operations: Retail stores that remain open to the public as Essential Businesses and Operations must limit the number of people in the store at one time, must provide proper spacing for people waiting to enter, and large stores must offer at least two hours per week of dedicated shopping time for vulnerable populations.
• Supply Chain: Essential Businesses and Operations that are essential because they supply, manufacture, or distribute goods and services to other Essential Businesses and Operations can only continue operations that are necessary to those businesses they supply. All other operations must continue as Minimum Basic Operations.

 Other changes include:

• Schools: Public and private K-12 schools will remain closed for the remainder of the 2019-2020 school year.
• Local parks and open space: Local health officials may close public parks and open spaces if it becomes too difficult to ensure social distancing or the areas are being mistreated. 
• Travel: People are strongly encourage to stay close to home, not travel to second homes or cabins, and not to travel out-of-state if it is not necessary. 
• Tribal Nations: Tribal Nations are sovereign over their territory and can impose their own restrictions. Non-tribal members should be respectful of and avoid non-essential travel to Tribal territory. Local government must coordinate, collaborate, and share information with Tribal Nations. 
• Duration: The changes in this order go into effect on April 24, 2020. The order will remain in effect until 8 a.m. on May 26, 2020. 

If you have questions, a Frequently Asked Questions (FAQ) document is available here for your review.

The public should continue to follow simple steps to avoid exposure to the virus and prevent illness including:

• Avoiding social gatherings with people of all ages (including playdates and sleepovers, parties, large family dinners, visitors in your home, non-essential workers in your house);
• Frequent and thorough hand washing with soap and water; 
• Covering coughs and sneezes;
• Avoiding touching one's face; and 
• Staying home.

This is a rapidly evolving situation, and we encourage you and the public to frequently monitor the DHS website. We encourage you to follow @DHSWI on Facebook, Twitter, or dhs.wi on Instagram. Additional information can be found on the CDC website.

The State Legislature passed, and the Governor has signed, the state's COVID-19 response package, which includes liability immunity provisions. A late amendment broadens the measure and ensures there is no ambiguity about protections applying to COVID and non-COVID patients alike.  

The legislation also includes provisions that will help the state draw down additional federal dollars for Medicaid as well as a provision related to out of network billing.  

Below is the liability immunity language as adopted.

SECTION 98. 895.4801 of the statutes is created to read:

895.4801 Immunity for health care providers during COVID-19 emergency.

(1) DEFINITIONS. In this section:

(a) “Health care professional” means an individual licensed, registered, or certified by the medical examining board under subch. II of ch. 448 or the board of nursing under ch. 441.

(b) “Health care provider” has the meaning given in s. 146.38 (1) (b) and includes an adult family home, as defined in s. 50.01 (1).

(2) IMMUNITY. Subject to sub. (3), any health care professional, health care provider, or employee, agent, or contractor of a health care professional or health care provider is immune from civil liability for the death of or injury to any individual or any damages caused by actions or omissions that satisfy all of the following:

(a) The action or omission is committed while the professional, provider, employee, agent, or contractor is providing services during the state of emergency declared under s. 323.10 on March 12, 2020, by executive order 72, or the 60 days following the date that the state of emergency terminates.

(b) The actions or omissions relate to health services provided or not provided in good faith or are substantially consistent with any of the following:

1. Any direction, guidance, recommendation, or other statement made by a federal, state, or local official to address or in response to the emergency or disaster declared as described under par. (a). 
2. Any guidance published by the department of health services, the federal department of health and human services, or any divisions or agencies of the federal department of health and human services relied upon in good faith.

(c) The actions or omissions do not involve reckless or wanton conduct or intentional misconduct.

(3) APPLICABILITY. This section does not apply if s. 257.03, 257.04, 323.41, or 323.44 applies. 

Brad Burmeister, MD, an emergency physician and President-Elect of Wisconsin ACEP, continues his COVID-19 discussion with Fox 11-Green Bay "Good Day Wisconsin" morning show.  View interview here. 

The Emergency Medicine Foundation is awarding funding of up to $100,000 in new research grants on emergency medicine areas related to COVID-19. 

Topics may include, but are not limited to, the following:

• Personal Protective Equipment (PPE), including Design, Cleaning, Re-use
• Ventilator Scarcity
• Telemedicine
• Laboratory Testing
• Rapid Screening, Triage and Testing
• Clinical Diagnosis
• Epidemiology of Disease
• Therapeutics
• Diagnostic Radiology, including Point of Care Ultrasound
• Emergency Medicine Workforce, including Safety
• Emergency Physician Wellness
• Special Populations, such as High Risk, Homeless, Non-English Speaking, Transplantation Patients

Proposals are due June 5, 2020.  Learn more and read the RFP.

Governor Evers announced that the state is seeking volunteers to support Wisconsin's healthcare system during the COVID-19 pandemic. Active and retired healthcare professionals and those who wish to help in non-clinical support positions are encouraged to sign up to volunteer through the Wisconsin Emergency Assistance Volunteer Registry (WEAVR). 

The number of patients in Wisconsin who need to be treated for COVID-19 is expected to surge in the coming weeks. Building a network of available volunteers now will greatly reduce the hardships on hospitals and clinics that would not normally have the capacity to care for the increase in patients. 

Both active and retired healthcare professionals can volunteer for critical clinical roles by entering their information into the WEAVR, a secure, password-protected, web-based volunteer registration system for healthcare and behavioral health professionals. Individuals who are not licensed professionals are also encouraged to sign up to volunteer for non-clinical support positions.

Volunteers will be assigned to locations across Wisconsin to support ongoing efforts related to the COVID-19 national emergency. Those who are willing to travel should note that when they sign up. All volunteers should also be aware that they will be required to complete a background check.

The full copy of the Governor’s press release is available online (link).

The American College of Emergency Physicians has launched the Field Guide to COVID-19 Care in the ED to assist emergency physicians on the front lines in the current crisis. The guide is a compilation of current knowledge on the evaluation and treatment of COVID-19.

It is a living document; ACEP will continue to update it as new information, guidance, and best practices evolve. Some sections are listed as "Coming" - that is because ACEP is working with NIH to develop the national guidelines for COVID-19. 

Brad Burmeister, MD, an emergency physician and President-Elect of Wisconsin ACEP, discussed COVID-19 during three segments on the April 7th Fox 11-Green Bay "Good Day Wisconsin" morning show.  View interview here. 

 

As the COVID-19 crisis continues, there are wide-ranging resources available for physicians and health care professionals. However, identifying which resources would benefit your health care practice is difficult.

The Wisconsin Medical Society (WisMed), gener8tor and WisMed Assure hosted a free webinar about the government resources available to independent physicians and health care practices, as it relates to the stimulus package. Topics covered include:

• Which federal grant/loan programs is my business eligible for?
• SBA Disaster Loan (e.g. Economic Injury Disaster Loan or EIDL)
• CARES Act and the Paycheck Protection Program (PPP)

View webinar, and visit the COVID-19 resource pages for  other important updates and information on the Wisconsin Medical Society's website.

The Wisconsin Chapter of the American College of Emergency Physicians (WACEP), whose member physicians are on the frontlines in the battle against the COVID-19 pandemic, strongly urge all Wisconsinites to stay home and avoid gatherings of any type.  

WACEP favors postponement of the April 7th Spring Election in Wisconsin. In lieu of such action, voters who have already received an absentee ballot are strongly encouraged to vote absentee and have their ballot postmarked by the deadline of April 7th, election day, and received by April 13th at 4:00 pm.

To stop the spread of COVID-19 and flatten the curve, Wisconsin must adhere to current emergency orders, recommended social distancing and make all efforts to stay at home when possible.  In our state, the worst days of this crisis are still ahead of us but will be more manageable if we all act responsibly.   

Governor Evers announced that Wisconsin has been granted a major disaster declaration for the entire state of Wisconsin, as a result of the COVID-19 pandemic. The declaration provides access to Public Assistance programs for all 72 Wisconsin counties and the state’s federally recognized tribes.

Gov. Evers earlier this week requested that the federal government provide the following programs to support the state’s response: Public Assistance, Direct Assistance, Hazard Mitigation (statewide), and certain Individual Assistance programs; Crisis Counseling, Community Disaster Loans and the Disaster Supplemental Nutrition Program.

The Federal Emergency Management Agency (FEMA) notified the state today that it is granting the request for Public Assistance to help provide reimbursement for emergency protective measures taken by state and local governments in their response to the COVID-19 outbreak. The declaration also authorizes direct Federal Assistance which means when the State and local governments lack the capability to perform or to contract for eligible emergency work and/or debris removal, the State may request that the work be accomplished by a federal agency. The governor’s additional requests for assistance remain under review.

The major disaster declaration covers assistance to public entities, and will cover eligible projects submitted by counties, cities, townships, tribes, and certain private, not-for-profit organizations. Local governments in the declared counties are now eligible for federal assistance and should contact county emergency management directors for further information. Under the program, FEMA provides 75 percent of eligible costs, while the remaining 25 percent is the responsibility of state and local agencies.

The Governor’s full press release is available online (link).