ABC | Volume 115, Nº2, August 2020

Statement Grossman et al. Position Statement of the Brazilian Society of Cardiology Department of Exercise Testing, Sports Exercise, Nuclear Cardiology, and Cardiovascular Rehabilitation (DERC/SBC) on Activities Within its Scope of Practice During the COVID-19 Pandemic Arq Bras Cardiol. 2020; 115(2):284-291 It bears stressing that, given the nationwide heterogeneity of the epidemiological curve of COVID-19 and regional differences in the incidence of new cases, hospitalization rates, and infrastructure (such as the occupancy rate of public and private hospitals), different recommendations may be relevant to different locations. Therefore, these should always follow the guidance of health organizations and authorities. 22 Once there is clear evidence that the pandemic is being brought under control and social isolation measures are lifted by health authorities, conventional CPMR services (i.e., including face-to-face activities) will be able to resume their activities, gradually and with strict observance of the relevant precautions for the protection of patients and providers alike. As activities are gradually resumed, the following recommendations will apply: • Patients, their chaperones, and staff members with flu- like symptoms or a history of contact with confirmed or suspected cases in the preceding 14 days are to self-isolate for however long is recommended by health organizations and local health authorities. 23 • Noncontact (infrared) temperature screening of patients upon arrival is advised. • Face coverings, hand sanitizer, and frequent handwashing with soap and water are mandatory for patients and all others who attend exercise facilities. Staff members are to follow the recommendations of health regulatory agencies, trade unions, and relevant professional boards/trade associations regarding the use of PPE. • Spray bottles containing 70% alcohol and disposable paper towels are to be made available for disinfection of exercise equipment before and after individual use. Shared use of equipment (weight machines, weight benches, free weights, etc.) should be avoided. • To promote increased air circulation, keep doors and windows open whenever possible. • Reduce the number of patients allowed in the facility simultaneously, so as to allowgreater distancing between them. • Implement predefined working hours, with a strictly controlled duration of and intervals between sessions, to overlap between groups and allow disinfection of the environment and equipment. Note: to provide a measure of legal protection to facilities that offer CPMR, it is recommended that a letter of referral for rehabilitation be obtained from the patient’s attending physician, as well as written informed consent from patients themselves. 4. Nuclear Cardiology During the pandemic, nuclear cardiology services are advised to limit their activities to urgent studies in symptomatic patients, in which the test result has the potential to change immediate management or affect the patient’s short-term prognosis. It is also essential that scans be performed on inpatients and emergency department patients requiring urgent assessment, as this can guide management, shorten hospital stay, and thus free up hospital capacity. 3,24 4.1. Adaptation of Nuclear Cardiology Practices During the COVID-19 Pandemic 4.1.1. General Considerations When Scheduling a Nuclear Cardiology Scan 24,25 • Increase the interval between scans to avoid crowding. • When scheduling, ask if the patient has any signs or symptoms suggestive of possible COVID-19 infection (fever, cough, dyspnea, unusual fatigue, myalgia, diarrhea, anosmia, hyposmia, dysgeusia, or ageusia). If so, the appointment should preferably be postponed. • Ask if the patient has been exposed to a confirmed or suspected case in the preceding 2 weeks. If so, the scan should preferably be postponed. • Patients should be contacted the day before the scan to ensure they are not experiencing any suspicious signs or symptoms. If so, the scan should be rescheduled if possible. • Patients should be instructed to come in for the scan alone. Patients who absolutely require a companion or chaperone should come with only one person, ideally someone with no relevant risk factors (such as diabetes, unstable heart disease, arrhythmias, age >65 years, etc.). • Ask that patients and their chaperones come in already wearing PPE (face coverings at the very least). Alternatively, the facility should consider providing PPE to be worn for the entire time patients are at the nuclear medicine department. 4.1.2. Considerations Upon Patient Arrival at the Facility 24-26 • Upon arrival at the nuclear cardiology lab, reassess the patient for the presence of signs, symptoms, or potential exposure to COVID-19, by interview or completion of a specific epidemiological questionnaire. • Given the risk of transmission by asymptomatic carriers, patient care staff in the waiting room and all other non- medical staff in the laboratory are to wear a mask at all times. • Instruct patients and their chaperones to wear face coverings while in the nuclear medicine department. • Facilities must ensure that waiting rooms have easy access to hand washing stations and/or hand sanitizer. • Enforce a distance of at least 2 meters between individuals, so as to avoid crowding in waiting rooms and other facilities. Instruct all those who attend to follow distancing rules, respiratory etiquette, and frequent hand washing and/or application of hand sanitizer. • In facilities offering modalities other than just nuclear cardiology, interactions between inpatients and outpatients should be avoided, as should any contact between outpatients and patients with cancer or other immunocompromised patients. 4.1.3. Considerations During the Scan 24-26 A) Regarding staff and the environment • General principles of PPE use apply throughout the scan. 288