COVID-19: Guidance for Healthcare Professionals

Updated Guidance for Optimizing the Supply of PPE (Updated March 17, 2020)

April 16, 2020

UPDATED Interim Guidance for Clinicians Evaluating, Reporting, and Requesting Diagnostic Testing for Possible COVID-19 Cases

GUIDANCE SUBJECT TO CHANGE. Please read this guidance in its entirety.

Summary

  • The expanding global outbreak of respiratory infections due to a novel coronavirus (COVID-19) has been declared a pandemic and is being closely monitored by the WHO, CDC, and state public health officials. For the most up-to-date information about the outbreak, visit https://www.cdc.gov/coronavirus/2019-ncov/index.htmland https://dph.georgia.gov.
  • COVID-19 clinical presentation varies in severity from asymptomatic infection or mild illness to severe or fatal illness. Symptoms include fever, cough, shortness of breath, chills, repeated shaking with chills, headache, sore throat, new loss of taste or smell, or muscle pain.; case-patients can also develop pneumonia and some reports suggest the potential for clinical deterioration during the second week of illness, although the full spectrum of clinical illness remains unknown.
  • All novel respiratory virus infections (including COVID-19) have now been added to the list of diseases that are immediatelynotifiable by law in Georgia.

 

Recommendations for clinicians evaluating patients at your facility

  1. Obtain a detailed history for ALL patients being evaluated with fever and acute respiratory illness. Persons with exposure to known COVID-19 cases, congregate settings, or travel may be more likely to have COVID-19 infection.
  2. If COVID-19 is suspected, appropriate PPE should immediately be utilized by the patient and healthcare professional. Patients should be asked to wear a surgical mask upon arrival and be evaluated in a private room with the door closed, ideally an airborne infection isolation room, if available. Ideally, healthcare personnel entering the room should use standard precautions, contact precautions, airborne precautions, and use eye protection (e.g., goggles or a face shield).
    1. CDC has recently made updates to its infection prevention guidance in healthcare facilities, and has changed the level of PPE required:https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html. Cloth facemasks are not considered to be PPE, but may be appropriate for visitors and patients. Facemasks, if available, should be reserved for healthcare providers and are an acceptable alternative when the supply chain of N95 masks or respirators cannot meet the demand. During this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to the healthcare provider. Eye protection, gloves, and gowns remain in the recommendations, although if gowns are in limited supply, they may be reserved for aerosol-generating procedures or other situations described at the above link.
  3. Clinicians who suspect COVID-19 infection in a patient, and who can take a specimen, may contact the Georgia Department of Public Health (DPH) at 1-866-PUB-HLTH (1-866-782-4584) to request testing at the Georgia Public Health Laboratory (GPHL). The testing request system is also available online athttps://dph.georgia.gov/covid-19-online-testing-request. The clinician will be asked to complete an online form containing demographic, exposure, and clinical information, and a medical epidemiologist will review the request within 24 hours, between the hours of 8 am and 8 pm, 7 days per week. At this time, laboratory testing for COVID-19 performed at the GPHL MUST be approved and coordinated by DPH following triage.  If testing is approved, laboratory submission forms and instructions will be emailed. Only requests initiated by a provider can be considered. Patients should not be directed to contact the Georgia Department of Public Health about COVID-19 testing.
    1. If you evaluate a patient who meets the criteria below and you are able to collect a sample as outlined below at your facility, please submit an online request for testing:
      • Hospitalized patients
      • Any person with symptoms
      • The following people without symptoms may be tested as capacity allows:
        • Healthcare workers, first responders, and other critical infrastructure workers that have been exposed to COVID-19
        • Residents of a long-term care facility or other group residential setting experiencing an outbreak of COVID-19
    2. A nasopharyngeal (NP) swab is the preferred sample type and should be used for all asymptomatic persons. However, if you are unable to collect a NP, a nasal (NS) swab OR oropharyngeal (OP) swab is also acceptable for symptomatic patients. A NS is only appropriate for symptomatic patients and both nares should be swabbed with a single swab. Use only synthetic fiber swabs with plastic shafts. Do not use calcium alginate swabs or swabs with wooden shafts, as these may cause testing errors. Place swab immediately into a sterile tube containing 2-3 ml of viral transport media (preferred). Amies transport medium or sterile saline may be used if VTM is unavailable. Store swab promptly after collection at 2-8° Celsius for no more than 72 hours prior to transporting. Guidance for safe sample collection of both NP or NS: https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-speci… 
    3. If you cannot collect a sample yourself, but your patient falls into one of the groups above, you may refer them to one of the Specimen Point of Collection sites (SPOCs). Your patient will need to travel to one of these sites to have a sample taken, and results may be received much faster for patients tested through GPHL compared to those tested through SPOCs. The form for SPOC referral can be found at https://dhpexternal.dph.ga.gov/spoc.html
  4. Patients with who do not fall into one of the groups above will not meet criteria to be tested at GPHL but can be tested at commercial labs—see below:
    1. If you want to test these patients for COVID-19, commercial laboratory testing is the best option. Commercial laboratories are expected to conduct a substantial number of COVID-19 tests going forward. Currently, commercial labs will not collect specimens at their facilities. Providers should contact the commercial lab they are contracted with regarding supplies needed for testing. CVS has also recently opened a rapid testing site at the Georgia Tech campus which patients can self-refer to.
  5. Any patient who is exhibiting fever and respiratory symptoms should remain home regardless of testing until:
    1. He/she has had no fever for at least 72 hours without the use of fever-reducing medications

         AND

              b. Other symptoms have improved (for example, when cough or shortness of breath have improved)

         AND

               c. At least 7 days have passed since symptoms first appeared

More information about what to do if you are sick can be found at:

https://dph.georgia.gov/document/document/home-isolation-and-monitoring-procedures/download

  1. CDC has updated the risk assessment and recommendations for HCP exposed to a COVID-19 patient to allow for additional flexibility as described below:  https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html.  Facilities could consider allowing asymptomatic HCP who have had an exposure to a COVID-19 patient to continue to work after options to improve staffing have been exhausted and in consultation with their occupational health program. These HCP should still report temperature and absence of symptoms each day prior to starting work. Facilities should have exposed HCP wear a facemask while at work for the 14 days after the exposure event if there is a sufficient supply of facemasks. If HCP develop even mild symptoms consistent with COVID-19, they must cease patient care activities, don a facemask (if not already wearing), and notify their supervisor or occupational health services prior to leaving work. To determine when a sick or exposed healthcare provider can return to work, please see our detailed guidance: https://dph.georgia.gov/document/document/dph-return-work-guidance-03-26-2020/download.

For more information

Clinicians who have other questions unrelated to testing triage, may call 1-866-PUB-HLTH (1-866-782-4584) and ask for a Medical Epidemiologist.