Health Advisory: Update #4 & Interim Guidance on Outbreak of COVID-19

woman in lab coat looking through microscope

This is an evolving situation. The guidance is subject to change frequently. Please ensure you are reviewing the information as it comes out.

Washington state is responding to an outbreak of COVID-19. As of this morning there are 102 confirmed cases in Washington State. Currently, there are no confirmed cases in Yakima County. This alert will review current testing guidelines, testing at commercial labs, testing at WA DOH PHL, changes in PPE procedures and additional resources.

Testing guidelines have been changing rapidly to be able to provide COVID-19 testing to the public. To scale up testing capacity, commercial lab testing is available in addition to the Washington State Department of Health (DOH) Public Health Lab (PHL). Specimens that are processed in commercial labs that have positive results are considered “presumptive positive” until confirmed by the WA DOH PHL.

At this point in time, providers must contact YHD when:

  1. Reporting confirmed cases of COVID-19
  2. Requesting testing at the WA DOH PHL
    • If testing at a commercial lab, YHD does not need to be notified. Follow guidelines outlined below in “Provider Assessment Flow for testing at Commercial Laboratories

YHD Contact Procedures:

  1. During business hours (8:30AM-4:30PM Monday-Friday) call YHD Communicable Disease Line at 509-575-4040, option 2.
  2. Outside of business hours leave a message at 509-249-6541. YHD staff will triage the next business day.

Testing Guidelines as of 3/7/20 at 5PM

There are currently no restrictions on who can be tested for COVID-19. Healthcare providers may test any patient with symptoms consistent with COVID-19 (e.g. fever, cough, shortness of breath).

If COVID-19 is being considered in symptomatic patients, patients must be instructed to self-quarantine for 7 days after the onset of symptoms, and/or 72 hours after resolution of symptoms- whichever is longer.

The following patients with COVID-19 symptoms are considered highest priority for testing:

  • Healthcare workers
  • Patients in other public safety occupations (e.g. law enforcement, fire fighter, EMS)
  •  Patients involved in an illness cluster in a facility or institution (e.g. healthcare, school, corrections, shelters)
  • Patients with severe lower respiratory illness (hospitalized or fatal)
  • Patients with worsening symptoms
  • Patients older than 60 years
  • Patients with underlying medical conditions
  • Pregnant women
  • Any other patient can be tested per healthcare provider judgement

In general, we do not recommend testing asymptomatic persons. However, providers may consider testing asymptomatic persons if they have been in close contact with a confirmed case. A negative test result does not rule out an infection.

If COVID-19 is being considered, providers must instruct patients to self-quarantine. Quarantine must be in place until test result comes back negative and/or seven days after symptom onset or 72 hours after resolution of symptoms – whichever is longer.

Providers should review documents below with patients and provide a copy to take home:

Provider Assessment Flow for testing at Commercial Laboratories:

In general, healthcare providers should send specimens for COVID-19 testing to commercial laboratories. Please see each laboratory’s test menu for specimen collection instructions, submission forms, and shipping requirements. Please be sure to include the patient’s name, date of birth, address and phone number. The Washington State Insurance Commissioner has ordered all Washington health insurers to waive deductibles and copays for COVID-19 testing.

COVID-19 testing at the University of Washington

COVID-19 testing at LabCorp

Provider Assessment Flow for testing at WA DOH Public Health Lab:

Specimens from the following patients can be sent to the WA State Public Health Labs with YHD approval:

  • Healthcare workers
  • Patients in other safety occupations (e.g. law enforcement, fire fighter, EMS)
  • Patients involved in an illness cluster in a facility or group (e.g. healthcare, school, corrections, business)
  • Patients with no health insurance

If seeking testing at the Public Health Labs:

  1. Immediately notify Public Health (509-575-4040 option 2)
    • a. If outside of business hours (8:30AM-4:30PM Monday-Friday), leave a message at 509-249-6541 and YHD staff will triage reports the next business day.
  2.  Providers should collect two specimens and send with 2019 nCoV form including submitter name, address, phone number and fax number. If the patient can produce sputum, collect nasopharyngeal (NP) and sputum specimens. If the patient cannot produce sputum, collect NP and oropharyngeal (OP) swabs. When collecting NP and OP specimens, use a synthetic swab and place the specimen in 2-3 ml viral transport media, put two identifiers (e.g., name, birthdate) on tubes and form, and store at 2-8oC.
  3.  WA DOH Public Health Lab will fax its results to the submitter and the Yakima Health District.
  4. If specimen is not approved for WA DOH Public Health Lab testing, provider can follow guidance for Commercial Lab Testing.

Changes in PPE Procedures:

Washington state is implementing new guidelines for PPE specific to COVID-19. COVID-19 PPE Procedures are now “Special Droplet/Contact Precautions”.

These differ from CDC guidelines but are recommended by both WA DOH and Yakima County Health Officer Dr. Teresa Everson.