Health Advisory: Update #7 & Interim Guidance on Outbreak of COVID-19

| March 27, 2020
stethoscope sitting on empty desk with a white coat hanging on the back of a chair

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

Contact: Melissa Sixberry, Director of Disease Control  509-249-6509

Requested Action:

Background:

COVID-19 disease should be considered in patients with lower respiratory infection symptoms such as fever, cough, or shortness of breath, without other explanation. It may also manifest with milder symptoms such as sore throat, coryza, body aches and fatigue.

As the COVID-19 outbreak continues to rapidly evolve, it is important to ensure local health jurisdictions and clinical partners are aware of current operational guidance on: testing, personal protective equipment, isolation, and quarantine. A summary of current recommendations is provided below. In addition, links are provided to documents for more detailed guidance on each topic. For the most up-todate reports of cases in Yakima County, visit the Yakima Health District COVID-19 website.

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

  1. Reporting confirmed cases, hospitalizations and deaths related to COVID-19
    • Fax lab and demographics to 509-249-6628
  2. Requesting testing at the WA DOH PHL
    • If testing at a commercial lab, YHD does not need to be notified. Follow guidelines outlined in “Testing”
    • During business hours call 509-249-6541. After hours 509-575-4040 Option 2

1. Limit Risk of Exposure at Healthcare Facilities

Healthcare facilities must be implementing measures to minimize the possibility of exposure in lobbies, potential exposure to the healthcare workforce as well as to free up room space.

  • Healthcare facilities are encouraged to implement telehealth options as available.
  • Healthcare facilities are encouraged to cancel and/or reschedule all non-emergent procedures.
  • Hospitals must implement visitor restrictions and it is recommended that permitted visitors are screened for symptoms and fever. For Patients with COVID-19, the Yakima Health District recommends allowing one asymptomatic close contact visitor with PPE and that the visitor is restricted to the unit.
  • To further reduce the volume of patients coming into its facilities, healthcare facilities should reschedule non-essential visits unless clinically necessary for the next 4-6 weeks.

2. PPE

Patients with known or suspected COVID-19 who are critically ill as well as those requiring aerosol generating procedures are recommended to be placed in standard/airborne/contact precautions with eye protection. For other patients with known or suspected COVID-19, the Department of Health recommends using standard/droplet/contact precautions with eye protection.

Follow recommendations for extended use and limited reuse of N95 filtering facemask respirators in healthcare settings.

Guidance document for PPE: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/ppeCOVID-19confirmed.pdf

3. Isolation – Health Care Workers and First Responders

Health Care Workers (HCW) and First Responders (FR) with confirmed COVID-19 should not return to work until at least 3 days (72 hours) have passed since recovery. Recovery is defined as:

  1. Resolution of fever without the use of fever-reducing medications AND improvement in respiratory symptoms (e.g., cough, shortness of breath) AND 
  2. At least 7 days have passed since symptoms first appeared

Healthcare workers and first responders can return to work provided they:

  • Adhere to respiratory hygiene, hand hygiene, and cough etiquette
  • Wear a facemask at all times while in the healthcare facility until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer.

Employers should consider reassigning HCWs with recent COVID infection who work with severely immunocompromised patients, such as bone marrow transplant, solid organ transplant, and oncology patients, to work in other areas as is possible until 21 days after initial symptom onset. Guidance document for health care workers and first responders: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/HealthCareworkerReturn2Work.pdf

4. Quarantine – Healthcare workers and First Responders

Asymptomatic HCWs and FRs with High or Medium Risk Exposures to a known case of COVID-19 in an occupational setting should actively monitor for symptoms consistent with COVID-19 infection but can return to work provided they:

If the HCW or FR has a close household contact (such as family member or roommate) with COVID-19 they are required to:

  • Quarantine at home until 14 days after most recent close contact with the ill individual and attempt to limit ongoing exposure as is possible.
  • If the HCW or FR becomes symptomatic, immediately isolate and notify their PCP for testing at the WA DOH Public Health Lab.

5. Isolation – General Public

Consistent with CDC guidelines, WA DOH recommends persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions:

6. Quarantine – General Public

Individuals who have been in close contact with someone with COVID-19 should monitor their health for fever, cough and shortness of breath during the 14 days after the last day they were in close contact with the sick person with COVID-19. They should not go to work or school, and should avoid public places for 14 days.

Guidance document: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDexposed.pdf

7. Testing

There are currently no restrictions on who can be tested for COVID-19 and commercial testing is becoming more available. Healthcare providers are encouraged to test any patient with symptoms consistent with COVID-19 (e.g., fever, cough, shortness of breath). We will continue to closely monitor available testing supplies and lab capacity and will notify you of any changes to these recommendations.

If testing capacity is at any time limited, we will request that providers resume prioritization of testing for COVID-19 as follows:

The following patients with COVID-19 symptoms should be tested for COVID-19:

  • Patients hospitalized with severe lower respiratory illness
  • Patients who work in any setting where healthcare services are delivered (including hospital, department of corrections, juvenile detention centers, mental/behavioral health clinics, longterm care facilities, and similar)
  • Patients working in other public safety occupations (e.g., law enforcement, fire fighter, EMS)
  • Patients who live or work in an institutional or congregate setting (e.g., corrections, long term care facility, homeless/shelters)
  • Patients working in critical infrastructure occupations (e.g., grocery stores, pharmacist, restaurants, gas stations, public utilities, etc.)
  • Patients with close household contacts who work in healthcare (including long term care and other congregate care settings) and public safety occupations.
  • Patients older than 60 years
  • Patients with underlying medical conditions
  • Pregnant women

The following individuals experiencing symptoms of COVID-19 (e.g. fever or cough or shortness of breath) can be tested at the WA DOH Public Health Lab:

  • Patients who work in any setting where healthcare services are delivered (including: hospital, department of corrections, juvenile detention centers, mental/behavioral health clinics, longterm care facilities, and similar)
  • Patients working in other public safety occupations (e.g., law enforcement, fire fighter, EMS)
  • Patients who live or work in an institutional or congregate setting (e.g., corrections, long term care facility, homeless/shelters)
  • Patients hospitalized with severe lower respiratory illness
  • Patients with close household contacts who work in healthcare (including long term care and other congregate care settings) and public safety occupations.

Testing is not recommended in members of the general public who are asymptomatic. A negative test result does not rule out an infection.

To conserve swabs needed for COVID-19, discontinue outpatient influenza testing unless you wish to perform both tests and your lab can run both from the same swab.

8. Recommendations for Airborne Contaminant Removal for Room Turnover

  1. Two hours is a necessary, and conservative estimate when a facility does not know what the air exchange rate is for a facility.
  2. If a facility can guarantee 6 or more exchanges per hour, that facility can move to a one hour turnover.

Guidance document for testing: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/Interim2019NovelCoronavirusQuicksheetProviders.pdf

9. Patient Education

Providers should review documents below with patients and provide a copy to take home. Providers should immediately notify patients of positive results and direct them to the patient education below. Positive cases should also be advised to notify close contacts and provider them with education below for “exposed to a confirmed”.

  • For symptoms—What to do if you have symptoms of COVID-19 and have not been around a person diagnosed with COVID-19.

  • For exposed—What to do if you may have been exposed to a person with COVID-19.
  • For confirmed or suspected—What to do if you have confirmed or suspected COVID-19.

Other patient resources available on WA DOH Coronavirus website

10. Resources: