Requested actions
- Be aware CDC updated its COVID-19 isolation duration guidance.
- Test all patients with new onset of COVID-19 symptoms as well as close contacts to confirmed cases, regardless of age or health status. Testing should be completed within 24 hours of symptom onset.
- Ensure your facility is able to provide COVID-19 testing to your patients and consider expanding internal testing capacity (higher volume, extended hours) to support our community-wide COVID-19 response.
- Inform all patients who test positive for COVID-19 that the Washington State Department of Health will call them for information about their close contacts.
- Call or have the patient call the COVID-19 Care Coordination Team at 1 (833) 453–0336 if you have a medically stable patient who needs support with quarantine or isolation for COVID-19.
- Continue to routinely screen individuals for behavioral health and substance use disorder issues
Background
CDC updated its guidance on the discontinuation of transmission-based precautions and disposition of patients with COVID-19 in healthcare settings. DOH updated its patient education to reflect this guidance. The updates include:
- Except in rare situations, CDC no longer recommends using a test-based strategy to determine when to discontinue transmission-based precautions.
- For patients with severe to critical illness or who are severely immunocompromised, CDC extended the recommended duration for transmission-based precautions to 20 days after symptom onset (or, for asymptomatic severely immunocompromised patients, 20 days after initial positive SARS-CoV-2 diagnostic test).
- Symptom-based criteria were modified:
- Changed from “at least 72 hours” to“at least 24 hours” have passed since last fever without using fever-reducing medication.
- Changed from“improvement in respiratory symptoms” to “improvement in symptoms” to address the expanding list of COVID-19 symptoms.
Test-based strategies are no longer recommended.
Research shows the test-based strategy prolongs isolation of patients who continue to shed detectable SARS-COV-2 RNA but are no longer infectious. Additionally, SARS-COV-2 diagnostic testing reagent is in short supply and this change will reduce reliance on supplies.
Use symptom-based discontinuation of isolation criteria.
Discontinue isolation of patients with mild to moderate illness who are not severely immunocompromised once:
- At least 10 days have passed since symptom onset, and
- At least 24 hours have passed since last fever without using fever-reducing medication, and
- Symptoms have improved.
Discontinue isolation of patients with severe to critical illness or who are severely immunocompromised once:
- At least 20 days have passed since symptoms first appeared, and
- At least 24 hours have passed since last fever without the using fever-reducing medication, and
- Symptoms have improved.
Discontinue isolation of patients who are not severely immunocompromised and who were asymptomatic throughout infection once:
- At least 10 days have passed since the first positive viral diagnostic test.
PCR testing is not recommended after discontinuation of isolation or precautions.
For people previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within 3 months after the date of symptom onset for the initial COVID-19 infection. Additionally, quarantine is not recommended in the event of close contact with an infected person until 3 months have past since date of symptom onset.
Test all patients with new onset of COVID-19 symptoms.
Continue to test all patients with new onset of COVID-19 symptoms, regardless of age or health status. Test patients as soon as possible after seeking care, ideally within 24 hours. If unable to test within this timeframe, refer patients to a community-based testing site. We strongly encourage broad testing.
Limit testing of asymptomatic people to the following priority populations.
- Close contact of a case.
- Exposed to COVID-19 during an outbreak in a congregate setting.
- From a racial or ethnic group disproportionately affected by COVID-19—African American, Alaska Native, American Indian, Latinx, Native Hawaiian, Pacific Islander.
- Pregnant and in labor.
- Infants born to parents with suspected or confirmed COVID-19.
- Undergoing a procedure that increases the risk of aerosolized particle spread.
- Undergoing an invasive surgical procedure (if possible, test within 48 hours of procedure).
Immediately report COVID-19
- Cases in the following people—call (509) 249-6541
- Healthcare workers (e.g., EMS, medical, nursing, any healthcare facility employee).
- Public safety workers (e.g., law enforcement, firefighter).
- Staff or resident of long-term care facilities, senior living centers, permanent supportive housing or similar congregate settings (e.g., shelter, temporary worker housing, correctional facility).
- Anyone who dies with COVID-19.
- Anyone with suspected MIS-C.
Educate all patients that you test
If COVID-19 is being considered, whether testing is performed or not, provide the following guidance documents to patients, and emphasize isolation for ill persons and self-quarantine for exposed contacts.
- Patients with confirmed or suspected COVID-19
- Patients who were exposed to a confirmed COVID-19 case
- Unexposed patients with COVID-19 symptoms
Resource Requests for COVID-19 Test Kits and PPE
In order to reach our goal of testing 1,000 individuals per day, we need all providers to ensure their facilities are providing testing and are responding to patients’ needs with respect to volume of testing and available hours for testing. Community-based testing sites are a resource that is meant to supplement testing through health care providers’ offices, and also to provide testing to those who may not have access to health care.
Providers that are in need of PPE or COVID-19 test kits should contact the Emergency Operations Center Resource Section Chief at (509)-574-1919.
Additional resources
WA State Risk Assessment Dashboard
Yakima Provider Resources Website