COVID-19: Guidance for Healthcare Professionals

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

July 22, 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

Recommendations for clinicians evaluating patients at your facility

  1. Obtain a detailed history for ALL patients being evaluated with fever and acute respiratory illness.
  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 collect 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 at https://dph.georgia.gov/covid-19-online-testing-request. The clinician will be asked to complete an online form containing a short list of questions about demographic, exposure, and clinical information, and an 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.  Once approved, laboratory submission forms and instructions will be emailed. Only requests initiated by a provider can be considered through this link, all requests made by providers who can submit the sample to GPHL themselves will be approved.
    1. A nasopharyngeal (NP) swab is the preferred sample type. However, if you are unable to collect a NP, a nasal (NS) swab OR oropharyngeal (OP) swab is also acceptable. If a NS is used, 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… 
    2. If you cannot collect a sample yourself you may refer them to one of the Specimen Point of Collection sites (SPOCs). You patient will need to travel to one of these sites to have a sample taken. Patients can self-refer by finding a site and phone number at https://dph.georgia.gov/covidtesting
  4. If preferred, testing for patients can be done at commercial labs—see below:
    1. 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.
    2. Patients can also self-refer to some pharmacy locations like CVS and Walgreens
  5. Patients may also self-refer to DPH run Specimen Point of Collection Sites (SPOCS)
    1. Information on finding a location and scheduling an appointment can be found at https://dph.georgia.gov/covidtesting
  6. Any patient who is exhibiting fever and respiratory symptoms and
    1. Who has mild or moderate illness and are not severely immunocompromised should remain in isolation until:
      1. At least 10 days have passed since symptoms first appeared and
      2. At least 24 hours have passed since last fever without the use of fever-reducing medications and
      3. Symptoms (e.g., cough, shortness of breath) have improved
    2. Who has severe to critical illness (if they were hospitalized for shortness of breath, pneumonia, low oxygen levels, respiratory failure, septic shock, and/or multiple organ failure) or who are severely immunocompromised should remain in isolation until:
      1.  At least 20 days have passed since symptoms first appeared
      2. At least 24 hours have passed since last fever without the use of fever-reducing medications and
      3. Symptoms (e.g., cough, shortness of breath) have improved
    3. More information about what to do if you are sick can be found at: https://dph.georgia.gov/isolation-contact
  7. For information on how to manage patients who have tested positive for COVID-19 and for detailed guidance on illness severity categories and immunocompromising conditions, please see DPH resources:
    1. Return to Work for Healthcare Personnel https://dph.georgia.gov/document/document/dph-return-work-guidance/download
    2. Return to Work for Non-healthcare Personnel https://dph.georgia.gov/document/document/dph-covid-19-return-work-guidance-after-covid-19-illness-or-exposure-persons-not/download
    3. Return to School https://dph.georgia.gov/document/document/return-school-guidance/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.