Communicable Disease

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Communicable Disease

Director: Jennifer Johnson

 

FOR HEALTHCARE PROVIDERS

Updated 3/30/2020

For childcare questions, please contact ChildCare Aware at 1-800-446-1114 or visit: https://childcareawarewa.org/families/#whotocall. School-based childcare information can be found on the Skagit County Coronavirus page.

Hospitals, long-term care facilities, healthcare providers, and EMS are the first responders to COVID-19. Skagit County Public Health is working closely with state and local partners to ensure that all providers in Skagit County have updated information and guidance for the novel coronavirus.

Receive Skagit Health Alerts via email: Healthcare providers in Skagit County should receive regular health alerts by email. If you are NOT receiving health alerts, please email communicabledisease@co.skagit.wa.us with your name, healthcare credentials, and the healthcare facility you serve.

Critical Updates [Updated 3-27-2020]

Note that these updates and guidelines include the latest information from the Washington Department of Health Epidemiology and Local Health Jurisdictions Health Officers. Not all links have been updated at this time but will be in short order.

  • EVALUATION: Health care providers with limited testing can consider the DOH prioritization to determine who to test. All patients with symptoms consistent with COVID-19 (fever ≥100.4⁰F and cough) should be given the same isolation guidance REGARDLESS of test results: stay home away from others for at least 7 days following the start of symptoms OR for an additional 72 hours after symptoms resolve, whichever is longer. Use these helpful discharge sheets:
  • TESTING: Testing through the Public Health Lab NO LONGER needs approval from local public health and health care providers can submit to PHL directly. Many commercial labs are coming online with testing. All positive results must be immediately called into Public Health. Skagit County Public Health does not have clinical services and does not test for COVID-19.
  • PPE: Clinics must first try to get PPE through their normal supply chain first. If clinics cannot obtain PPE through retailers, fill out and email this form to dem@co.skagit.wa.us. Be specific in your order request (quantity and item). Clinics and facilities must document that they have exhausted all supplies at facility and at local level. Include this documentation in your request: (1) documentation that entity has an active order into their normal supply chain, (2) documentation that there is an approved conservation plan is in place and implemented, and (3) reduction/elimination of all non-urgent medical procedures.
    • DOH Guidance on PPE updated 3/15/2020
    • Obtaining PPE:  Clinics must first try to get PPE through their normal supply chain first. If clinics cannot obtain PPE through retailers, fill out and email this form to dem@co.skagit.wa.us. Be specific in your order request (quantity and item). Clinics and facilities must document that they have exhausted all supplies at facility and at local level. Include this documentation in your request: (1) documentation that entity has an active order into their normal supply chain, (2) documentation that there is an approved conservation plan is in place and implemented, and (3) reduction/elimination of all non-urgent medical procedures.
  • GUIDANCE ON EXPOSURE OF HEALTHCARE WORKERS: New return-to-work guidance for health care workers and first responders infected or exposed to COVID-19.

Webinars

Archived Webinars
CDC Clinical Outreach and Communication Activity (COCA) Call archive: https://emergency.cdc.gov/coca/calls/2020/index.asp

March 5, 2020 DOH & Skilled Nursing/Long-Term Care/Adult Family Home Webinar recording: https://attendee.gotowebinar.com/recording/219677331034520839

General Updates

Current case counts of Skagit residents lab-positive for COVID-19 are available on our website.
See the current status of COVID-19 cases in Washington at the Department of Health website.

Isolation versus Quarantine

We have been asked for clarification regarding isolation and quarantine. Please review the definitions below.

Isolation: Patients WITH symptoms, which a healthcare provider suspects to have (or is lab-confirmed to have) COVID-19. Patients should be advised that they should expect to be on home isolation for a minimum of 7 days following symptom onset. These patients should remain under home isolation precautions for 7 days OR until 72 hours after fever is gone and symptoms get better, whichever is longer. If a symptomatic patient then tests negative for COVID-19, they should follow normal provider advice for infections (i.e. stay home while they’re sick). [Handout for patients suspected for COVID-19]

Quarantine: Patients WITHOUT symptoms but exposed to confirmed case of COVID-19. These patients are advised to stay home, avoid public places, and to monitor their health for 14 days following the last day they were exposed to the ill person. If patients do develop symptoms, most will develop mild symptoms in which case patients should stay home and away from other people. If the patient develops symptoms that cannot be managed at home or has high-risk for complications (age 60 years or over, are pregnant or have other medical conditions), they should contact their healthcare provider and tell them they have been exposed. [Handout for patients exposed to COVID but not yet symptomatic]

NOTE that isolation and quarantine are operationally similar for the patient: patients should stay home and avoid public places. If symptoms worsen and cannot be managed at home, patients should call their healthcare provider ahead of coming into the clinic or hospital.

Personal Protective Equipment (PPE)

Requesting PPE
If clinics have critical PPE needs to evaluate and test for COVID-19, and are unable to obtain PPE through commercial suppliers or affiliated clinics, they can request PPE through Skagit County Department of Emergency Management. If clinics cannot obtain PPE through retailers, fill out and email this form to dem@co.skagit.wa.us. Be specific in your order request (quantity and item). Clinics and facilities must document that they have exhausted all supplies at facility and at local level. DOH is implementing a prioritization system and requires this information. Include this documentation in your request:

  • Documentation that entity has an active order into their normal supply chain.
  • Documentation that there is an approved conservation plan is in place and implemented.
  • Reduction/elimination of all non-urgent medical procedures

PPE Recommendations for COVID-19

DOH Guidance on PPE updated 3/15/2020

For evaluating a patient suspected for COVID-19 prior to initiating any aerosol-generating procedures*, use droplet/standard/contact precautions.
* Aerosol-generating procedures include but are not limited to: endotracheal intubation, open respiratory and airway suctioning, tracheostomy care, cardiopulmonary resuscitation, sputum induction, bronchoscopy, aerosolized administration of pentamidine or other medications, pulmonary function testing, any procedures that use bone saws/centrifuges/blenders/aspiration equipment.

For Aerosol-Generating Procedures plus Nasopharyngeal (NP) Swabs*
Ideal PPE: if available, CDC and DOH recommend using airborne precautions (N95/CAPRs/PAPRs) in addition to droplet/standard/contact precautions. Patients do NOT need to be in a negative air pressure room. Rooms with patients suspected of COVID-19 should be cleaned prior to the next use but do not have to remain vacant for an extended period of time. This is the only PPE recommended for aerosol-generating procedures.

  • Ideal PPE list: N95/CAPR/PAPR, face shield/goggles/glasses with side protection, gown, gloves

Acceptable PPE, for NP swabs only: Department of Health and CDC have approved that health care providers without N95/CAPRs/PAPRs can use a surgical mask with a face shield, maintaining droplet/standard/contact precautions.

  • Acceptable PPE list: surgical mask, face shield, gown, gloves

It is very important to doff PPE correctly to avoid exposure.

Why the Change in Recommendations?
The World Health Organization has always endorsed droplet/contact/standard precautions for evaluating patients with COVID-19 and taking NP or OP swabs. [See here.] WHO reports that there is no currently available evidence that cough generated via NP/OP specimen collection leads to increased risk of COVID-19 transmission via aerosols.

PPE Conservation
It is important for our first responders, and healthcare system partners to know that even with our continuous efforts to supply the needed PPE to providers in our state, we will not meet the full need in our state. Implementing PPE conservation strategies is critical.

Personal Protective Equipment (PPE) Resources

First Responders

Emergency medical services (EMS) play a vital role in responding to requests for assistance, triaging patients, and providing emergency medical treatment and transport for ill persons. EMS workers have unique challenges as they are in enclosed spaces during transport and need to make quick decisions.

As part of the public health investigation into any notifiable condition, health care providers that are exposed to confirmed cases of illness will be notified of their exposure. Exposure risk is determined by the illness and how it is transmitted. EMS and Fire personnel that transport a patient positive for COVID-19 will be notified and will be given guidance on next steps. Healthcare providers, including first responders, are only considered exposed if they did NOT don the acceptable PPE outlined above when caring for the patient.

The following guidance and resources are for first responders and emergency medical service providers who anticipate having close contact with persons with confirmed or possible COVID-19 in their work.



Evaluation

There are currently no restrictions on who can be tested for COVID-19 and commercial testing is becoming more available. Healthcare providers may test any patient with symptoms consistent with COVID-19 (e.g., fever, cough, shortness of breath) but until testing supplies and laboratory capacity are widely available, public health is asking providers to follow the below recommendations.

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

  • Patients hospitalized with severe lower respiratory illness
  • Staff that work in any setting where healthcare services are delivered (e.g., clinics, hospitals, behavioral health care clinics).
  • Patients in other public safety occupations (e.g., law enforcement, fire fighter, EMS)
  • Patients who live or work in in an institutional setting (e.g., corrections, long term care facility, homeless/shelters)

The following patients with COVID-19 symptoms should contact their healthcare provider and be tested for COVID-19 if their symptoms worsen or their healthcare provider recommends testing:

  • Patients older than 60 years
  • Patients with underlying medical conditions
  • Pregnant women

Younger, healthy individuals with mild illness do not need to be tested and testing is not recommended in persons who are asymptomatic. A negative test result does not rule out an infection. Anyone with symptoms consistent with COVID-19 (e.g. cough, fever) should follow the same isolation guidance: sick people should stay home, away from other people in their household, for a minimum of 7 days following symptom onset OR as long as they have symptoms plus 72 hours symptom-free without medications, whichever is longer.

Provide patients with the following guidance documents so that they know how to best prevent the spread of infection to other people:


Report patients being tested who are hospitalized to Public Health. Report to the Skagit County Public Health urgent health care provider line at 360-770-8468 (health care providers only).

Testing

There are currently no restrictions on who can be tested for COVID-19 and commercial testing is becoming more available. Healthcare providers may test any patient in whom they suspect COVID-19. While testing is becoming more available, there are limitations in health care providers’ capacity to obtain samples and lab capacity to process specimens rapidly.

Skagit County Public Health does not have clinical services and does not test for COVID-19.

Regardless of which lab you use, report any positive results to the accountable local health department (determined by where the patient resides). If possible, call between 8am-4:30pm. Skagit County Public Health’s urgent health care provider line is 360-770-8468 (health care providers only). See page 2 of the notifiable conditions poster for phone numbers for other county health departments.

Nasopharyngeal swabs, oropharyngeal swabs, sputum and/or bronchiolar lavage specimens can be tested for COVID-19. Each lab specifies which specimen they will accept.

Commercial Labs Testing for COVID-19 [Updated 3/9/2020]

*Note that testing through commercial labs does not require pre-approval from Public Health. Please report hospitalized patients that are being tested to Public Health. Report ALL positive results to Public Health.

Testing via Washington State Public Health Lab (PHL)

  • Health care providers can order testing through PHL for the following groups:
    • 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 group (e.g., healthcare, school, corrections, business)
    • Patients with no health insurance.
  • Collect the following specimens. Follow PPE guidelines above. See here for additional specimen collection and submission instructions.
    • Nasopharyngeal (NP) swab [NEW: NP only]
    • Sputum or bronchiolar lavage (BAL), if available
  • Complete 1 2019-nCov Sample Submission Form for each sample
  • Label each sample tube with 2 patient identifiers and the type of sample (i.e., NP&OP or sputum).
  • Keep specimens cold after collection and during transport. Regular ice packs are okay. 72 hours after collection, specimens need to be frozen to ≤ -70°C and shipped on dry ice. If you do not have a courier, call Public Health at 360-416-1500.
  • Report any positive results to the accountable local health department (determined by where the patient resides). If possible, call between 8am-4:30pm. Skagit County Public Health’s urgent health care provider line is 360-770-8468 (health care providers only). See page 2 of the notifiable conditions poster for phone numbers for other county health departments.

Long-Term Care Facilities

Skagit County Public Health is following WA State Department of Health and Centers for Disease Control & Prevention guidance for managing the COVID-19 outbreak. Below is a list of some resources that we hope will be helpful, in addition to other information on this page for health care providers.

WA State Department of Health

Centers for Disease Control & Prevention (CDC)

Centers for Medicaid & Medicare Services (CMS)

Department of Social & Health Services (DSHS)

Public Health – Seattle & King County

Home Health and Hospice Agencies

Skagit County Public Health is following WA State Department of Health and Centers for Disease Control & Prevention guidance for managing the COVID-19 outbreak. Below is a list of some resources that we hope will be helpful, in addition to other information on this page for health care providers.

Centers for Medicaid & Medicare Services (CMS)

Mental Crisis

Resources to help support your mental health or that of a loved one:

Care for Your Coronavirus Anxiety Toolkit
How to Help Someone with Anxiety or Depression during COVID-19
Resources to Support Mental Health and Coping with the Coronavirus
The VOA Crisis Line links to an in person crisis responder, if necessary. The people on the other end of the call are licensed MHPs and know our local resources. 1-800-584-3578 is the BEST number to use locally. Local chat line www.imhurting.org

Temporary Worker Housing COVID-19 Guidance

The Department of Health (DOH) is working to keep licensed facilities informed about continuing developments surrounding COVID-19 as well as provide guidance and resources. Many facilities have contacted DOH this past week requesting guidance on how their organizations should respond to COVID-19. The provided response is based upon guidance from the Governor, local health officials, the Center for Disease Control (CDC), all of which are available on the DOH COVID-19 website. Check the sites below often, as resources are updated to respond to the evolving situation. 

DOH recommends posting the following information for employees and occupants, so that they may protect themselves and others at the facility. Consider posting signs at entrances, bathrooms, and other common areas. 

Additional information and resources:
Centers for Disease Control and Prevention For guidance on reducing transmission and cleaning/sanitizing methods.
Department of Labor & Industries (L&I) information on sick leave and worker’s compensation
Local county health departments
https://wa211.org/ 
The Washington 211 (WA211) network has been designated and contracted by the Washington State Department of Health (DOH) to serve as the principal call center to provide information and referrals about the Coronavirus (COVID-19).
Communities and Community Organizations
Stigma Reduction
Article from California on Guidance for Farmworkers
Cornell Agriculture Workforce Development (Novel Coronavirus Prevention & Control for Farms)

Resources: