New Guidance on Restoring Elective Pulmonary and Sleep Services Is Released

An international task force has developed guidance1 for the safe resumption of elective in-person pulmonary and sleep services that had been put on hold due to the COVID-19 pandemic.

The American Thoracic Society (ATS) led the task force, which comprised clinicians who are members of the Association of Pulmonary, Critical Care, and Sleep Division Directors and/or ATS who are actively engaged in treating patients with COVID-19.

“To facilitate implementation of the guidance, we aimed to account for limitations in staff, equipment, and space that are essential for the care of COVID-19 patients and provide access to care for patients with acute and chronic conditions,” Kevin C. Wilson, MD, chief of Guidelines and Documents at ATS and professor of Medicine at Boston University School of Medicine, said in a press release.2

Guidance on restoring specific elective services in pulmonary and sleep medicine clinics, as well as in pulmonary function testing laboratories, bronchoscopy and procedure suites, polysomnography laboratories, and pulmonary rehabilitation facilities, is highlighted. 

Included as part of the guidance are the following:

  • So that staff has time to acclimate to a new workflow, polysomnography services should reopen in a phased manner. Consider home sleep apnea testing as the first step.
  • To determine procedure scheduling, consider using a priority scoring system at bronchoscopy and procedure suites.
  • Compare the diagnostic importance of pulmonary function testing vs the risk of exposing staff and cross-contaminating equipment.


For elective clinical services to resume, the document states that the community new case rate should be consistently low or have a downward trajectory for at least 14 days. In addition to this, an institution should be able to implement the following operational strategies: patient prioritization, screening, diagnostic testing, physical distancing, infection control, and follow-up surveillance. 

According to Dr Wilson, the document also provides guidance on strategies to mitigate the risk of viral transmission as services resume.

“Transmission of SARS-CoV-2 is a dynamic process and, therefore, it is likely that the prevalence of COVID-19 in the community will wax and wane. This will impact an institution's mitigation needs,” the authors wrote. “Operating procedures should be frequently reassessed and modified as needed.”

—Colleen Murphy


  1. Wilson KC, Kaminsky DA, Michaud G, et al. Restoring pulmonary and sleep services as the COVID-19 pandemic lessens: from an Association of Pulmonary, Critical Care, and Sleep Division Directors and American Thoracic Society-coordinated task force. Ann Am Thorac Soc. Published online July 14, 2020. doi:10.1513/AnnalsATS.202005-514ST   
  2. ATS Publishes New Guidance on Safely Restoring Elective Pulmonary and Sleep Services. News release. American Thoracic Society. July 16, 2020. Accessed July 17, 2020.