Table 1

Primary Care Preparedness and Response to a Pandemic

CDC-Defined IntervalsCDC Indicators2Primary Care ExperiencePrimary Care Actions to Care for Patients and Communities
Investigation (Interval 1)Investigation of infectionBusiness as usual for primary care; be ready for a potential pandemicContinue 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 transmissionPatients in sentinel communities begin to get infected; clinicians hear about pandemic possibilityRigorous 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 transmissionInfections rapidly spread in and across communities; patients worry about their risk of infectionConvert 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 transmissionInfections spread; patients get infection complications and require hospitalization; patients defer care of non-infectious conditionsContinue 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 infectionPatients get infected—but fewer patients; hospitalized patients improve and need rehabilitation; resume care for non-infectious conditionsSupport 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 areasPatients suffer from uncontrolled and missed conditions and risks; there is a high burden of mental and social needs; practices recover from financial and staffing burdensAttend 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.