We thank Dr. Vinciguerra for her letter. She correctly points out that a pandemic is an evolving situation, rather than a static one, and recommendations may not apply to all time points during the pandemic. She describes an earlier pandemic scenario, which she terms the “contingency standard of care,” in which there are still sufficient resources to perform electrodiagnostic studies (EDX). It is in this situation that the coronavirus disease (COVID) guidance document applies most readily.1 She also points to a second pandemic scenario, which she terms the “crisis standard of care,” where medical resources, including staffing, are not available to carry out EDX studies.

Dr. Vinciguerra stratifies the availability of resources and their effect on EDX testing in her letter. We did not address resource availability in our guidance document, although it is clearly a driver of the ability to perform EDX or other testing.1 Our intention was to provide recommendations regarding patient selection for EDX testing to clinicians during the time of the pandemic. However, in such a scenario where resources are unavailable or must be directed toward critical care, most, if not all, EDX studies may have to be postponed. Clinicians will have to rely on the clinical features and other diagnostic testing that may be available, accepting more diagnostic uncertainty before deciding on empiric treatment in acute situations, such as suspected Guillain Barre syndrome or myasthenic crisis. The “possibly urgent” category in our guidance document may also have to be handled similarly.1 Resumption of EDX will depend on the subsequent availability of resources and will vary by location.

我们感谢 Vinciguerra 博士的来信。她正确地指出，大流行是一种不断变化的情况，而不是静态的，建议可能不适用于大流行期间的所有时间点。她描述了一个早期的大流行场景，她称之为“应急护理标准”，其中仍有足够的资源来进行电诊断研究 (EDX)。正是在这种情况下，冠状病毒病 (COVID) 指导文件最容易应用。1她还指出了第二种大流行情景，她称之为“危机护理标准”，其中包括人员配备在内的医疗资源无法用于开展 EDX 研究。

Vinciguerra 博士在她的信中对资源的可用性及其对 EDX 测试的影响进行了分层。我们没有在我们的指导文件中解决资源可用性问题，尽管它显然是执行 EDX 或其他测试能力的驱动因素。1我们的目的是在大流行期间向临床医生提供有关 EDX 检测患者选择的建议。然而，在资源不可用或必须用于重症监护的这种情况下，大多数（如果不是全部）EDX 研究可能不得不推迟。临床医生将不得不依赖临床特征和其他可能可用的诊断测试，接受更多的诊断不确定性，然后再决定在急性情况下进行经验性治疗，例如疑似格林巴利综合征或肌无力危象。我们指导文件中的“可能紧急”类别也可能需要进行类似处理。1 EDX 的恢复将取决于随后的资源可用性，并因地点而异。