COVID19
COVID-19 Resources & Guidelines for NDs

IMPORTANT INFORMATION ON THE NOVEL CORONAVIRUS (COVID-19)

As concerns about the spread of coronavirus mount and efforts to contain it escalate, Naturopathic Doctors should be aware of the latest advisories from public health agencies and credible organizations, and be prepared to report and/or advise patients accordingly.

The AANP advises healthcare practitioners to follow public health guidelines, and standard preventive medicine protocols, including basic naturopathic and lifestyle protocols that can support the immune system and mitigate the risk of exposure to infectious diseases.

We will continue to update this page as we receive more information and as things change.



ND Researchers Launch Registry for Your Covid-19 Case Studies

A team of Naturopathic research programs has created a registry to collect information on naturopathic approaches to providing supportive care during the pandemic. This registry can be completely anonymous without required reference to you or your practice, and does not collect any protected health information (PHI) regarding patients/clients. If you have provided care, please consider submitting information to the registry! Read FAQ here.

Resources
The AANP Urges Physicians and Hospitals to Utilize IV Vitamin C to Combat the COVID-19 Pandemic

The American Association of Naturopathic Physicians urges our medical colleagues to incorporate this treatment from the naturopathic medicine toolkit immediately in an effort to save lives and reduce long-term morbidity. While we applaud the use of IVC by a small number of hospitals in the U.S., it unfortunately remains a rarely utilized intervention, despite the potential to save lives and reduce the ventilation needs on critically ill patients.


The AANP Calls On Authorities to Engage Naturopathic Physicians

The American Association of Naturopathic Physicians calls on Federal, State and Local authorities to engage naturopathic doctors in emergency measures to supplement the healthcare workforce during this the Coronavirus Pandemic.

Our best methods to contain the spread of this disease is prevention: social distancing and basic public health prevention protocols, including:

  • Instruct patients on proper handwashing technique
  • Use hand sanitizer with at least 60% alcohol
  • Sneeze and cough into your elbow rather than hands
  • Avoid touching your face unless hands are washed
  • Avoid touching eyes, nose, mouth
  • Avoid shaking hands or elbow bumps - consider the vulcan hand “shake” :-)
  • Avoid large gatherings
  • Practice Social Distancing (maintain at least 3 ft between you and someone coughing/ sneezing)
  • Reschedule any non-urgent travel
  • Stay home if sick and contact your health care provider

(Excerpted from the Oregon Health Authority and Oregon Multnomah County Health Department’s Guidance for Small Clinics):

Treating Patients

There are simple steps a clinic can take to help prevent the spread of viral infections, including having a plan to ensure that a person ill with any respiratory illness follows good cough etiquette and hand hygiene.

For patients who might be ill with a respiratory viral infection, clinics should also have a plan in place that addresses how to care for a patient before they arrive, during intake, and while the patient is being seen. As much as possible, clinics should focus on prescreening questions at the time of scheduling the appointment and telemedicine consults.

Click below for guidance for reaopening clinics, shared courtesy of Oregon Association of Naturopathic Physicians.

OANP Guidance for Reopening Clinics

Click below for guidance for reaopening clinics, shared courtesy of Connecticut Association of Naturopathic Physicians.

Reopening Guidance for Connecticut Licensed Naturopathic Physicians


Click below for a sample ND clinic COVID-19 Office Protocol shared courtesy of Dr. Mona Fahoum, Meridian Medicine, which includes the following:

  • Front desk screening protocol
  • Front desk script
  • Cleaning schedules (Front desk and clinic room)
  • Staff Self-monitoring/self-reporting guidelines
  • Provider Triage of Patient Under Investigation (PUI)
  • In-office Triage of PUI
  • Management Guidelines of PUI
  • Criteria to Guide Evaluation and Testing of PUI
  • Guidelines on who should be Quarantined and who should be in Isolation
  • COVID-19 Testing Procedure
  • Drive-up Testing Protocol
  • Sample Collection Protocol

Sample ND Clinic COVID-19 Office Protocol


Office procedures/plans might include:

  • A STOP before entering door sign. Here's a template
  • Instruct patients to call ahead — or inform the health care provider upon arrival — if they have symptoms including a cough, shortness of breath and fever. Ask the patient to wear a facemask to contain their cough, and place the patient in an exam room as quickly as possible. Here are guidelines on when masks are appropriate and how to properly use them.
  • Consider screening patients for other germs that cause respiratory illness.
  • If a person with possible COVID-19 arrives unexpectedly, ask the patient to wear a mask and take them immediately to an exam room. Keep the exam room door closed.
  • If possible, schedule a person who may have COVID-19 as the last patient of the day.
  • If possible, suspected COVID-19 patients should be escorted into the building through an entrance that allows them to access an exam room without exposing others.
  • Minimize the number of healthcare workers interacting with the patient. Caregivers should follow Oregon Health Authority's guidance, which includes eye protection and a surgical or procedure mask.
  • Collect all specimens and perform clinical interventions in the exam room if possible.
  • The exam room should be left empty for as long as possible after the patient has left; the room should be thoroughly cleaned and disinfected.
  • Patients who are under evaluation for COVID-19 may stay at home if they are not sick enough to be admitted, but will need a plan for who to contact if clinical symptoms worsen. See CDC guidance for home care.
  • If a patient does not have a clinical need to be sent to the emergency department or a hospital, do not send them there. You do not need to routinely notify the state authority when evaluating patients with respiratory illness. Discuss a plan with the patient to seek appropriate medical care should symptoms worsen.

Protecting yourself and employees

Clinics play a vital role to keep their communities healthy. To do that, they need to take care of their providers. There are basic steps every employer should take to plan for the unexpected.

Those steps should include:

  • Ensure that your leave policies support employees who need to stay home when they are ill.
  • Instruct anyone who becomes sick with a fever and cough illness at work to go home immediately, and return only after they are free of symptoms for at least 24 hours (without the use of fever-reducing medicines or cough suppressants).
  • If your organization works with companies that provide contract or temporary employees, talk to those agencies about the importance of sick employees staying home, and encourage partners to develop flexible sick leave policies.
  • For employees who are sick with acute respiratory illness, do not require they provide a healthcare provider’s note to validate their illness or to return to work.
  • Create or update policies to allow employees to stay home to care for a sick family member or child who cannot go to school.
  • Plan for absenteeism by identifying essential functions and creating plans for continuity of operations.
  • Cross-train personnel to perform essential functions so the workplace can operate even if key staff are absent.
  • Consider what your business would require to maintain critical operations (identify alternative suppliers, prioritize customers, temporarily suspend some operations if needed).

The American Academy of Family Physicians has prepared a Checklist for Physician Offices for COVID-19.

Checklist for Physician Offices COVID-19 (AAFP)

It's imperative for all of the ND Community to communicate Facts, Not Fear, but also urgency to follow public health guidelines.

  • Please communicate only evidence-based, accurate information.
  • Reassure patients and the public regarding fears and discourage biases.
  • Reinforce the importance of social distancing.
  • Reinforce their role in supporting the global and local community efforts of containment.
  • Use social media to inform the public of what steps your clinic is taking to reduce the spread and accommodate patients.
  • Whenever possible, include citations for public education materials.
  • Refrain from posting medically inaccurate or unsubstantiated claims regarding any potential therapies with relation to COVID-19.
  • If you see misinformation from other providers, assume best of intentions and reach out to the individual privately or contact the AANP.

Sample ND Clinic COVID-19 Office Protocol


How to Message Prevention and Symptom Treatment Options to the General Population:

The AANP has teamed with professionals in the integrative medicine, dietary supplement, and legal fields to analyze the sudden increase in regulatory activity around natural approaches to improving immune resiliency, and treating viral infections and/or COVID-19. This resource provides information on the various laws at play, offers suggestions for providers to mitigate risk, and highlights where regulatory actions may cross the line into scope of practice - with the unintended effect of limiting the ability of licensed providers to discuss important and appropriate non-pharmacological methods to mitigate COVID-19 and its symptoms.

Please read the Fact Sheet on Regulatory Agency Warning Letters (released June 5, 2020) for guidance on how to communicate your services to the public.

Fact Sheet on Regulatory Agency Warnings


All healthcare providers should refrain from making health claims or proclamations about a "cure" or product that can "prevent" or successfully treat COVID-19. There are currently no nutrients, botanicals, vaccines, pills, lozenges or other prescription or over the counter products available to prevent, treat or cure COVID-19 specifically. Web-based/email marketing that promote potentially false and misleading statements about prevention and cures of COVID-19 hamper efforts to safeguard public health and may create liability for healthcare providers making such claims. Click here to view a sample of an FDA warning.

Naturopathic clinics should decide whether to test patients for COVID-19 in your clinic, or refer to other clinics in your community. IF you decide to offer this service, it is absolutely imperative that you follow all safety precaution guidelines extremely carefully!

Due to limited testing capacity at this time, COVID-19 testing is not routinely available for patients presenting for care in the outpatient setting.


The following patients with COVID-19 symptoms are considered at highest priority for testing:

  • Healthcare workers
  • Employed in public safety occupation (e.g., law enforcement, fire fighter, EMS)
  • Part of an illness cluster in a facility or institution (e.g., healthcare, school, corrections, shelters)
  • With severe lower respiratory illness (hospitalized or fatal)
  • With worsening symptoms
  • Older than 60 years
  • With underlying medical conditions
  • Pregnant women
  • Had contact with a suspect or lab-confirmed COVID-19 patient or had travel from an affected geographic area, within 14 days of their symptom onset

Testing Labs

FCC Opens COVID-19 Telehealth Program Application

This provides $200 million in funding as part of the CARES Act, to help health care providers furnish connected care services to patients at their homes or mobile locations in response to the COVID-19 pandemic.

The COVID-19 Telehealth Program is open to eligible health care provider sites that treat patients, whether located in rural or non-rural areas or U.S. territories. The COVID-19 Telehealth Program is limited to nonprofit and public eligible health care providers that fall within the categories of health care providers in section 254(h)(7)(B) of the 1996 Act: (1) post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools; (2) community health centers or health centers providing health care to migrants; (3) local health departments or agencies; (4) community mental health centers; (5) not-for-profit hospitals; (6) rural health clinics; (7) skilled nursing facilities; or (8) consortia of health care providers consisting of one or more entities falling into the first seven categories. See guidelines to apply for the FCC COVID-19 Telehealth Program.


Federal TeleHealth Guidelines and Resources

The CDC recommends using telemedicine technologies to not only protect your patients and clinic staff, but also to be able to continue providing healthcare services to your community. Here are some FREE resources.

While federal guidelines require the use of both audio and visual in order to bill for telemedicine, some states have issued emergency orders further relaxing these standards to allow audio only. Please check with your state health department!

Also remember to ensure your patient’s privacy by reminding them to use headphones, meet in a private area, and to not share their login credentials.


TeleHealth Platforms

HIPAA TeleHealth guidelines usually require the use of a HIPAA-compliant platfor for conducting TeleHealth, these requirements have currently been relaxed ONLY DURING THIS PUBLIC HEALTH EMERGENCY. Temporarily, HHS has indicated it is acceptable to use non-HIPAA compliant forms of communication as long as they are person to person, not person to group (i.e., not FaceBook Live). While there are many paid platforms available, following are some free services:

  • Doxy.Me (HIPAA-compliant)
  • FaceTime (for Apple Products) (Free)
  • Skype (Free)
  • Zoom (Free)
  • VSee
  • SimplePractice
  • Optimantra (provides a HIPAA compliant video chat option on its EMR platform for its members at no additional cost)

General TeleHealth Resources

This section is NOT specific to COVID-19; these are general telemedicine resources/guidelines.


State TeleHealth Guidelines and Resources (Note: The AANP cannot guarantee that all of the telehealth/telemedicine resources cited apply to NDs, or that they are up to date. If you have a more up to date resource than you see listed, please send it to advocacy@naturopathic.org.)

Telehealth Template Forms (please send more if you have one to share!)

Malpractice Coverage for Telehealth

The legality of practicing Telemed is up to the states as the laws and emergency actions vary from state to state.

  • NCMIC's Telemedicine Policy. Assuming an ND is legal with the states in which the practice and the states where patients are located, the NCMIC policy covers for Telemed.

  • Sprague Israel Giles/Arch Insurance Company provides coverage for telemedicine/telehealth services, and offers the following guidelines:
    • Services are considered rendered in the State where the patient/client resides, not where you are based.
    • If the State where services are rendered issues ND licenses, coverage will apply if you have an ND license in that State.
    • If the State where services are rendered does not issue ND Licenses, coverage will apply per the allowable scope of practice for that State for an unlicensed health practitioner.

    Arch Insurance Company is waiving any and all additional costs associated with increasing telemedicine coverage on your policy to show telemedicine as a majority part of your operations. SIG needs to know what % of services you plan to render via telemedicine for the foreseeable future, but it will NOT cost you anything more.

    The carrier applies coverage according to updated legislation, and an emergency order granting out-of-state NDs access to telemedicine services for residents would count. If they get legal approval to provide services in a state without first having to obtain an ND License in that State, SIG should be able to cover their services, per that State’s allowable scope. If it is a State that does NOT issue ND licenses, coverage as usual would apply per the legal scope for an unlicensed provider in that State.

  • Aegis/MedPro: See Question 9 in MedPro's Covid-19 resource site, which states: “Will my coverage remain in force if I am temporarily practicing in a new state (whether care is provided in-person or remotely) in which I AM NOT authorized or licensed to practice? Yes, if your practice in that new state is being conducted under an applicable federal or state waiver.”
  • *Note that the billing Q&A section in MedPro's sige is not applicable to ND’s. Aegis has negotiated a 12 pay plan for ND through AFCO and all customer service representatives have been advised to work with any borrowers calling asking for accommodations. This includes waiving late fees and or extending cancellations when appropriate.

Prescription Refills

The CDC is urging people to have a 3 month supply of any prescriptions, and many insurers are waiving restrictions that prevent patients from refilling early. Providers should work with patients to have prescriptions refilled now in the event of shortages and/or additional social distancing mandates.


Supplement Inventory

The global impact of the pandemic and extremely high demand for some products is definitely interrupting the supply of certain ingredients, especially for immune support products. In the face of supply challenges across the entire supplement industry, AANP’s corporate partner Fullscript encourages providers to use their similar products tool to find brands or products that you may not have tried before in case your trusted product may be unavailable.

Visit AANP Corporate Partner Fullscript


PPE Supplies

Sources of Personal Protective Equipment (as supplied to us as valid sources by NDs who have used them):

  • Source with available KN95 masks as of May 10, 2020 www.opacs.com or call Lilly 480-634-4214.
  • The World Health Organization (WHO) provides detailed information and daily updates.

    The Centers for Disease Control has comprehensive information for providers and the public.

    For Health Professionals (THERE ARE MANY SECTIONS FOR HEALTH PROFESSIONALS, you should read at a minimum:)

    We will add printed materials and resources from public health organizations and as provided to us by our community contributors. Contact communications@naturopathic.org if you would like us to add a resource.

    World Health Organization

    Centers for Disease Control and Prevention

    Community Contributors

    Tracking the PPP

    This spreadsheet to track expenses for the Paycheck Protection Program has been generously shared by Eva Sofia, ND, RD, LAc. Click here to access the spreadsheet.


    FCC Reimbursement for Telehealth Expenses for Schools, Community Clinics and Rural Clinics

    The FCC has a pool of money to reimburse ALL TELEHEALTH expenses for eligible healthcare providers to help provide telehealth services to patients at their homes or mobile locations in response to the COVID-19 pandemic. This can reimburse your costs for equipment or services like Doxy.me, etc.

    An eligible healthcare provider is defined as:

  • Post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools
  • Community health centers or health centers providing health care to migrants
  • Local health departments or agencies
  • Community mental health centers
  • Not-for-profit hospitals
  • Rural health clinics

  • New Financial Relief Resources (as of April 16, 2020)
  • Community Development Financial Institutions finance community businesses. You might be able to use locator to identify grants or loans to access for your practices. The organization that houses this locator, the Opportunity Finance Network, is getting $125 million in capital from Google Fund for the CDFI's that are members of the Opportunity Finance Network to focus on businesses owned by women and people of color. Check to see if a CDFI near you has access to these resources. Click here to access CDFI near you.
  • In the Bay Area in California, the "Opportunity Fund" has $50 million to help small businesses affected by COVID 19.
  • US Chamber of Commerce has The Save Small Business Fund which will provide $5,000 supplemental cash grants to help as many businesses as possible meet their most pressing needs—from rent and making payroll, to overall business operations. To qualify, applicants must employ between three and 20 people, be located in an economically vulnerable community, and have been harmed financially by the COVID-19 pandemic.

    Grant applications will open on April 20, 2020. Grants will be awarded weekly on a rapid and rolling basis until all funds have been dispersed. To learn more about the Save Small Business Fund or apply for a grant, visit www.savesmallbusiness.com.


  • Congress Passes Historic COVID Aid, Relief and Economic Security Act (CARES)

    On Wednesday, March 25, 2020, the U.S. Senate unanimously adopted a $2 trillion bipartisan agreement to address the needs of the American people and health care providers confronting the coronavirus pandemic. The House is expected to pass it on Friday. It is the biggest economic rescue package in U.S. history. This comprehensive package provides new resources to address all aspects of the COVID-19 pandemic. Two provisions in particular will assist naturopathic physicians impacted by the crisis.


    On April 23rd, Congress passes additional COVID-19 stimulus funding to supplement the original CARES Act. Click here to see the comparison of congressional response measures.


    Direct Assistance to Physicians

    $100 billion in direct assistance to physicians, hospitals and other health care workers for unreimbursed expenses and lost revenues due to reductions in other services as a result of the COVID-19 outbreak. Detailed guidance for eligibility and submitting requests is forthcoming from the Department of Health and Human Services (HHS). AANP lobbyists are seeking clarification on how/if this will apply to NDs. Stay tuned for more info!


    Small Business Stimulus

    $360 billion in Small Business Administration grants and loans for small businesses, including physician practices. All naturopathic clinics would qualify for a variety of relief packages available to small businesses. Some of the provisions include:

    • As of April 15, the PPP has exhausted current funds and stopped processing applications.

      Paycheck Protection Program: $350 billion of 100% government-guaranteed Small Business Admininstration Loans
      • Can be used for employee salaries, paid sick or medical leave, insurance premiums, and mortgage, rent and utility payments.
      • Interest rate cannot exceed 4%
      • Up to 8 weeks of average payroll and other costs will be forgiven if the business retains its employes and their salary levels.
      • Principal and interest is deferred for up to a year and all borrower fees waived.
      • Click here to view slide deck for The Paycheck Protection Program video below.
    • Emergency Economic Injury Disaster Grants and Loans (EIDL): $10 billion in grants and loans to businesses that have been adversely impacted and need financial support.
      • Provides an advance grant of $10,000 (within 3 days of application) to small business and non-profits that apply.
      • The advance grant does not need to be repaid even if the application is subsequently denied by EIDL.
      • The grant may be used to provide paid sick leave to employees, maintain payroll, or pay business obligations and debts, including rent and mortgage.
      • Maximum EIDL loans are up to $2 million with interest rates up to 3.75%, as well as principal and interest deferment for up to 4 years.
    • Employer Payroll Tax Credits for employers whose (1) operations were fully or partially suspended due to a COVID-19 related shut-down order, or (2) gross receipts are down by more than 50%.
      • For 50% of wages paid by employers to employees during the crisis.
      • Credit is provided for the first $10,000 in compensation per employee from March 13, 2020 to December 31, 2020.

      Click here to read a section by section explanation of the Small Business Stimulus Package. A simple application process is supposed to be released by the end of next week that would allow business to apply and receive funds in the same day. The standards for eligibility will be proof of payroll costs and will be relaxed compared with 7(a) loans issued during more typical times. While the SBA guarantees the loans, borrowers will apply through banks, credit unions and other lenders. Currently, 1800 private lenders are already approved to issue these loans. Inquiries at this time should be directed to your bank or the Small Business Administration


      What Stimulus Loan Should I Apply For and How? An excellent side by side comparison to help guide you on what assistance you should apply for from the CARES stimulus for small business programs. Paycheck Protection Program Application.


      Student Loan Support

      Allows all student loan payments, principal, and interest to be deferred for six months through September 30, 2020, without penalty for all federally owned loans. Includes medical school student loans.

      • Navient has suspended payments and interest accrual on all U.S. Department of Education (ED) owned loans until September 30, 2020. You do NOT need to call Navient to opt in to this, only call if you want to opt out and continue making payments.
      • For FFELP loans (prior to 2010) owned by Navient (but not owned by the Dept of Ed), Navient is offering up to three months of administrative forbearance to qualified FFELP borrowers who request it. This program brings your eligible loans current and postpones payments for up to three months. During this time, you will not be responsible for making payments but please know interest will continue to accrue. At the end of this forbearance, unpaid interest will not be capitalized (added to your outstanding principal balance). Please be aware that if this accrued interest is not paid and you postpone your payments in the future with a different forbearance or deferment then interest could be capitalized (added to the outstanding principal balance) increasing your overall loan balance. You have to call and ask for this.

      Other Financial Resources

      CPA's Specializing in COVID Stimulus Package

      Banks Participating in the U.S. Small Business Administration Paycheck Protection Program
      • View a list of banks participating in the U.S. Small Business Administration Paycheck Protection Program. The list includes which banks will work with non-customers. View the list.

    AANP webinars related to the COVID-19 and Business and Telemedicine Resources during this national emergency continue to be available to AANP members and non-members free of charge, but are now behind a login portal. You do not have to be a member of the AANP to create a free guest profile, but these resources are only available to students and doctors in the naturopathic community.

    Click here to access webinars

    Clinical Resources related to the COVID-19 during this national emergency continue to be available to AANP members and non-members free of charge, but are now behind a login portal. You do not have to be a member of the AANP to create a free guest profile, but these resources are only available to students and doctors in the naturopathic community.

    Click here to access Clinical Resources