Department 01110 of Health Mike DeWine, Governor Amy Acton, M.D.. MPH, Director Jon Hustecl. Lt. Governor RE: Director?s Order for the Management of Non-essential Surgeries and Procedures throughout Ohio I, Amy Acton, MD, MPH, Director of the Ohio Department of Health (ODH), pursuant to the authority granted to me in RC. 3701.13 to ?make special orders. . .for preventing the spread of contagious or infectious diseases? and for the purposes of preserving personal protective equipment (PPE) and critical hospital capacity and resources Within Ohio, ORDER the following: 1. Effective 5:00 pm. Wednesday March 18, 2020, all non-essential or elective surgeries and procedures that utilized PPE should not be conducted. A non-essential surgery is a procedure that can be delayed without undue risk to the current or ?Jture health of a patient. Examples of criteria to consider include: a. Threat to the patient?s life if surgery or procedure is not performed; b. Threat of permanent dysfunction of an extremity or organ system; 0. Risk of metastasis or progression of staging; or (1. Risk of rapidly worsening to severe (time sensitive) Eliminate non-essential individuals from surgery/procedure rooms and patient care areas to preserve PPE. Only individuals essential to conducting the surgery or procedure shall be in the surgery or procedure suite or other patient care areas where PPE is required. Each hospital and outpatient surgery or procedure provider, whether public, private, or nonpro?t, shall establish an internal governance structure to ensure the principles outlined above are followed. This action is taken to protect our healthcare workforce during this unprecedented event. This Order shall remain in full force and effect until the State of Emergency declared by the Governor no longer exists, or the Director of the Ohio Department of Health rescinds or modi?es this Order. This Order takes into consideration and is consistent with the Ohio Hospital Association?s Implementing Guidelines for the Management of Non-Essential Surgeries and Procedures Throughout Ohio dated March 16, 2020. COVID-19 is a respiratory disease that can result in serious illness or death, is caused by the 2 virus, which is a new strain of coronavirus that had not been previously identi?ed in humans and can easily Spread from person to person. The virus is Spread between individuals who are in close contact with each other (within about six feet) through respiratory droplets produced when an infected person 246 North High Street 614 466?3543 Columbus, Ohio 43215 U.S.A. The State of Ohio is an Equal Opportunity Employer and Provider of ADA Services. coughs or sneezes. It may be possible that individuals can get 9 by touching a surface or object that has the virus on it and then touching their own mouth, nose or eyes. On January 23, 2020, the Ohio Department of Health issued a Director?s Journal Entry making COVID- 19 a Class A reportable disease in Ohio. On January 28, 2020, the Ohio Department of Health hosted the ?rst statewide call with local health departments and healthcare providers regarding COVID-19. On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization declared the outbreak of COVID-19 a public health emergency of international concern. On January 31, 2020, Health and Human Services Secretary, Alex M. Azar II, declared a public health emergency for the United States to aid the nation?s healthcare community in responding to On February 1, 2020, the Ohio Department of Health issued a statewide Health Alert Network to provide local health departments and healthcare providers with updated guidance for and revised Person Under Investigation (PUI) criteria. On February 3, 2020, the Ohio Department of Health trained over 140 personnel to staff a call center for COVID-19, in the event it was needed. On February 5, 2020, the Ohio Department of Health began updating and notifying the media of the number of PUIs in Ohio every Tuesday and Thursday. On February 6, 2020, the Ohio Department of Health updated all agency assistant directors and chiefs of staff on COVE-19 preparedness and status during the Governor?s cabinet meeting. On February 7, 2020, the Ohio Department of Health and the Ohio Emergency Management Agency met to conduct advance planning for On February 13, 2020, the Ohio Department of Health conducted a Pandemic Tabletop Exercise with State agencies to review responsive actions should there be a pandemic in Ohio. On February 14, 2020, the Ohio Department of Health held a conference call with health professionals across the state. The purpose of the call was to inform and engage the healthcare community in Ohio. Presentations were provided by the Department of Health, Hamilton County Public Health, and the Ohio State University. On February 27, 2020, the Ohio Department of Health and the Ohio Emergency Management Agency briefed the directors of State agencies during the Govemor?s cabinet meeting regarding preparedness and the potential activation of the Emergency Operations Center. On February 28, 2020, the "Governor DeWine, Health Director Update COVID-19 Prevention and Preparedness Plan" was sent to a broad range of associations representing healthcare, dental, long?term care, schools, colleges and universities, business, public transit, faith-based organizations, non-pro?t organizations, and local governments. On March 2, 2020, the Ohio Department of Health activated a Joint Information Center to coordinate COVID-19 communications. On March 5, 2020, the Ohio Department of Health hosted the Governor?s Summit on Preparedness, a meeting with the Governor, cabinet agency directors, local health department commissioners, and their staff. On March 6, 2020, the Ohio Department of Health opened a call center to answer questions ?'om the public regarding COVID-19. On March 9, 2020, testing by the Department of Health con?rmed that three (3) patients were positive for COVID-19 in the State of Ohio. This con?rms the presence of a potentially dangerous condition which may affect the health, safety and welfare of citizens of Ohio. On March 9, 2020, the Ohio Emergency Management Agency activated the Emergency Operations Center. On March 9, 2020, the Governor Declared a State of Emergency in Executive Order On March 11, 2020, the head of the World Health Organization declared a pandemic. On March 11, 2020, testing by the Ohio Department of Health con?rmed that one (1) more patient was positive for in the State of Ohio. On March 1 1, 2020, the Ohio Departments of Health and Veterans Services issued a Joint Directors? Order to limit access to Ohio nursing homes and similar facilities. On March 15, 2020, the Ohio Department of Health issued a Director?s Order to limit access to Ohio?s jails and detention facilities. On March 15, 2020, the Ohio Department of Health issued a Director?s Order to limit the sale of food and beverages, liquor, beer and wine to carry-out and delivery only. On March 15, 2020, the CDC issued Interim Guidance for mass gatherings or large community events, stating that such events that consist of 50 or more people should be cancelled or postponed. On March 15, 2020, the Ohio Department of Health issued a Director?s Order closing polling stations. Multiple areas of the United States are experiencing ?community spread? of the virus that causes COVID- 19. Community spread, de?ned as the transmission of an illness for which the source is unknown, means that isolation of known areas of infection is no longer enough to control spread. The CDC reports that people are most contagious when they are most (the sickest) however some spread might be possible before people show although that is not the main way the virus spreads. Mass gatherings (50 or more persons) increase the risk of community transmission of the virus 9. Accordingly, upon guidance from the U.S. Surgeon General, American College of Surgeons and numerous other public health experts, I hereby ORDER, beginning at 5:00 pm. Wednesday, March 18, 2020 all non-essential surgeries and procedures are cancelled. A non-essential surgery is a procedure that can be delayed without undue risk to the current or ?iture health of a patient. Examples of criteria to consider include: threat to the patient?s life if surgery or procedure is not performed; Threat of permanent dysfunction of an extremity or organ system; risk of metastasis or progression of staging; or risk of rapidly worsening to severe (time sensitive). Eliminate non-essential individuals from surgery/procedure rooms and patient care areas to preserve PPE. Only individuals essential to conducting the surgery or procedure shall be in the surgery or procedure suite or other patient care areas where PPE is required. Each hospital and outpatient surgery or procedure provider shall establish an internal governance structure to ensure the principles outlined above are followed. The Order is issued for the purposes of preserving personal protective equipment (PPE) and critical hospital capacity and resources Within Ohio. This action is taken to protect our healthcare workforce during this unprecedented event. This der shall remain in ?ill force and effect until the State of Emergency declared by the Governor no 10rger is the Director of the Ohio Department of Health rescinds or modi?es this Order. 9. March 17, 2020 Amy-{Act MD, MPH Director Health