March 12 – Updated Interim Guidance for Evaluating and Reporting Persons Under Investigation for Coronavirus Disease 2019 (COVID-19)

Summary Points

  • Consider COVID-19 in patients with acute respiratory illness who have epidemiologic risk factors, are at higher risk of severe disease or reside in congregate settings.
  • Testing is now available at both commercial and public health laboratories.
  • Contact and droplet precautions can be used for patient evaluation that do not require aerosol generating procedures
  • Report all suspected COVID-19 cases to PDPH. Approval is NOT required for testing at commercial laboratories.

The number of COVID-19 cases in the U.S. continues to increase, including three recently diagnosed cases in Southeast Pennsylvania and the first reported case in Philadelphia. Local cases appear to be sporadic but community transmission is anticipated. To increase our ability to identify cases in a timely manner for containment activities and support the ability of healthcare facilities to safely evaluate and manage symptomatic patients, guidance from the Centers for Disease Control and Prevention on infection prevention and control has been updated to loosen requirements for airborne precautions in the absence of aerosol generating procedures. Diagnostic testing capabilities also continue to expand in both public health and commercial laboratories. Clinicians can continue to use their judgement to determine if a patient with compatible symptoms should be tested. This decision should consider epidemiologic risk criteria, including presence of local transmission, travel history, risk factors for severe COVID-19 disease, and residence in a congregate setting. Special consideration should also be given to healthcare workers.

Patient Assessment and Management:

Providers should maintain vigilance and obtain both travel histories and history of exposure to a suspect or confirmed COVID-19 case when evaluating patients with acute respiratory illness. Screening for respiratory symptoms and potential exposures should be implemented upon arrival to a healthcare setting or when an appointment is scheduled so that patients can be promptly isolated. Many respiratory viruses that can cause similar symptoms are also circulating in Philadelphia and the risk of COVID-19 from local community exposure is unknown. As testing capacity continues to expand, providers should prioritize COVID-19 infection in patients who present with fever and / or symptoms of acute respiratory illness who are at highest risk of exposure, who are at higher risk of developing severe disease or who are at high risk of exposing others. As such, considerations for prioritization of testing are as follows:

  • Patient has exposure risk factors including close contact with a confirmed COVID-19 case OR any international travel within 14 days. Exposure should also be considered for domestic travel to highly affected areas, especially for persons who attended a mass gathering (i.e. a conference).
  • Patient is at risk for severe disease (age >50 years, chronic medical conditions)
  • Patient resides in a congregate setting
  • Patient is a healthcare worker
  • Patient requires hospitalization for symptoms
  • Patient is presenting with progressive acute respiratory illness with no apparent cause

For persons who fulfill any of the above criteria, please take the following actions:

  • Place surgical mask on patient and move patient to a private room as soon as possible.
  • All staff working with the patient should use standard, contact and droplet precautions with eye protection for initial evaluation and specimen collection. Airborne precautions are no longer required for interactions with patients in which COVID-19 is suspected. Airborne precautions (N95 mask or respirator) are required for aerosol generating procedures only. Additional details are available at: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html.
  • Collect the following respiratory specimens for testing:
    • Nasopharyngeal (NP) and oropharyngeal (OP) swabs placed in viral transport media. Both swabs may be placed in the same viral transport media tube.
    • For those with productive coughs, collect sputum. Sputum induction is not indicated.
    • Since several respiratory viruses are currently circulating in the community and are also likely to be a cause of acute respiratory illness, order a respiratory virus panel along with COVID-19. Both COVID-19 and respiratory virus testing can be performed from the same specimen. For patients with mild disease or for whom there is a low exposure risk, COVID-19 testing may be deferred until results from influenza and respiratory virus testing are available.
  • Promptly notify infection prevention personnel at your facility and report the suspected case to PDPH (business hours: (215) 685-6742, after hours: (215) 686-4514).
  • Testing for SARS-CoV-2 (virus that causes COVID-19) is available through the state public health laboratory AND commercial laboratories (LabCorp and Quest). PDPH approval is not required for testing at commercial laboratories. PDPH will assist sites with submission of specimens and supporting documentation for SARS-CoV-2 testing at the state public health laboratory. Specimens will need to be refrigerated and transported on ice packs. For further details, visit: https://www.cdc.gov/coronavirus/2019-nCoV/guidelines-clinical-specimens.html.

Patients who have had a known exposure to a suspected or confirmed COVID-19 case or who have a history of recent travel should be advised to seek care with advanced notification to the healthcare facility and take routine steps to limit the transmission of respiratory viruses (i.e., staying home from work and school, hand washing, good respiratory etiquette). Patients with mild symptoms may remain at home to reduce unnecessary emergency room or clinic utilization.

Additional Resources:

Originally released by the Philadelphia Department of Public Health on March 12, 2020

Related Posts

No results found.

Archives

Opioids For Pain