Health Advisory: Update #5 & Interim Guidance on Outbreak of COVID-19 

| March 12, 2020
two women in white lab coats and goggles insert fluid into testing vials in a lab

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

For immediate release: March 11, 2020 Contact: Melissa Sixberry, Director of Disease Control 509-249-6509

Washington state is responding to an outbreak of COVID-19. As of this morning there are 366 confirmed cases in Washington State. While there are no confirmed cases in Yakima County, that will likely change in the next few weeks. This alert will review (1) current testing guidelines (2) WA DOH PHL Testing Procedures (3) Quarantine and Isolation Guidelines (4) PPE Procedures (5) Visitor Restrictions (6) Messaging to Low-Risk Patients (7) Additional Resources.

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

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 3/11/20 at 12PM

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

The following patients with COVID-19 symptoms are considered highest priority for testing at the WA State DOH PHL:

  • Healthcare workers who have symptoms of COVID-19 (fever, cough, shortness of breath), and especially healthcare workers who have had exposure to a known or suspected case
    • As we are not yet seeing community spread of COVID-19 in Yakima County and risk to healthcare workers and the general population is low, healthcare workers are encouraged to contact their personal physician for COVID-19 testing.
      • Any suspected occupational exposure to COVID-19 by a healthcare worker with or without symptoms should be reported to their indicated Occupational Health Office, and testing coordinated through YHD
    • Patients in other public safety occupations (e.g. law enforcement, fire fighter, EMS) who have symptoms of COVID-19 (fever, cough, shortness of breath).
      • As we are not yet seeing community spread of COVID-19 in Yakima County and risk to public safety occupations and the general population is low, public safety workers are encouraged to contact their personal physician for COVID-19 testing.
      • Any suspected occupational exposure to COVID-19 by a public safety worker with or without symptoms should be reported to their indicated Occupational Health Office, and testing coordinated through YHD
    • Patients involved in an illness cluster in a facility or institution (e.g. healthcare, school, corrections, shelters)
    • Patients who have symptoms of COVID-19 (fever, cough, shortness of breath) that do not have health insurance

The following patients are not a priority for testing at the WA State DOH PHL but should be a priority for commercial lab testing:

  • Patients with severe and/or worsening symptoms
  • Patients older than 60 years, underlying medical conditions, pregnant womenIn 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

WA DOH PHL Testing Procedures
If seeking testing at the Public Health Labs:

  1. Immediately notify Public Health (509-575-4040 option 2)
    • 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 outlined in Update #4: Interim Guidance on Outbreak of COVID-19.

Quarantine and Isolation Guidelines

  • If COVID-19 is being considered in symptomatic patients that do not require hospitalization, patients must be instructed to self-quarantine until test result comes back negative and/or for 7 days after the onset of symptoms and/or 72 hours after resolution of symptoms- whichever is longer.
  • Providers should review documents below with patients and provide a copy to take home.

Changes in PPE Procedures The CDC recently changed their guidance for PPE. These are now consistent with what was outlined in Update #4: Interim Guidance on Outbreak of COVID-19.

Facemasks are considered acceptable. Eye protection, gown and gloves continue to be recommended. PPE is  “Special Droplet/Contact Precautions”.

Visitor Restrictions

It is highly recommended that hospitals and long-term care facilities put visitor restrictions policies in place.

  • Screen visitors, staff and patients for acute respiratory illness symptoms before entering the facility. Visitors with fever or acute respiratory infection symptoms should not be allowed.
  • All visitors should limit movement around the hospital to wards/areas pertinent to their visit
  • Children under age 16 should not be allowed except under extraordinary circumstances
  • Obstetric patients may have one partner and one birth support person accompany them
  • Neonates and medically fragile children may have one parent plus one support person who must remain in the room for the duration of the visit
  • Patients at end-of-life may have no more than two visitors
  • Minors under 18 years old may have one parent, visitor or guardian
  • Patients with developmental delay, altered mental status, or disruptive behavior that would benefit from the presence of a family member may have one visitor
  • Patients undergoing surgery/procedures may have 1 visitor who should leave the facility as soon as possible after the surgery/procedure is completed

Messaging to Low-Risk Patients

  • Patients who present to healthcare facilities that are not one of the priority populations as outlined in “Testing Guidelines as of 3/11/20 at 12PM” should be asked to contact their primary care provider for testing and/or self-manage symptoms at home, if able.
  • Patients should be advised to contact primary care provider with worsening symptoms.

Resources