FOR HEALTHCARE PROVIDERS
Updated 4/8/2020
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 4/8/2020]
- Be aware that, while several drugs are under investigation for managing COVID-19, non-pharmaceutical interventions (NPIs) remain the most important tool in controlling this pandemic. This includes clear guidance on isolation and quarantine as soon as COVID-19 is clinically suspected. The materials below should be provided to patients suspected of COVID-19 and are available in multiple languages here.
- Familiarize yourself with the guidance on implementing home care for people who do not require hospitalization.
- If an NP swab is not possible, the following specimens are acceptable alternatives:
- An oropharyngeal (OP) specimen collected by a healthcare professional, or
- A nasal mid-turbinate (NMT) swab collected by a healthcare professional or by onsite self-collection (using a flocked tapered swab), or
- An anterior nares specimen collected by a healthcare professional or by onsite self-collection (using a round foam swab).
- Be aware that the Washington State Public Health Lab is no longer testing inconclusive results from commercial labs. Patients should be retested and the specimen resubmitted to the commercial lab if possible. While the patient has symptoms and has not been ruled out for COVID-19, they must be instructed to isolate as if they did have a positive result.
- Please put patient home residence and phone number on all lab requisition forms so that the lab is able to report positive results to the correct LHJ.
- Understand the guidelines for discontinuing isolation and droplet precautions for COVID-19 patients in healthcare facilities and at home (see below).
- Make sure healthcare workers with confirmed or suspected COVID-19 are safe to return to work before they do so.
- Review strategies for optimizing personal protective equipment (PPE) supplies during ongoing shortages.
- Phone in reports to the Health Department COVID-19 cases in specified people (see below). Fax reports on all COVID-19 positive Skagit County residents to 360-416-1515.
- Encourage patients and colleagues to practice social distancing and to comply with Gov. Inslee’s Stay Home, Stay Healthy proclamation.
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.
The WA DOH dashboard reports data from Washington Disease Reporting System, which is experiencing technical difficulties and lags behind the true number of cases in Skagit County.
The following situation update resources are also available, with the same delay caveat above:
- Statewide and county-specific dashboard including maps, epi-curves, cumulative case and death counts, testing, demographics, and hospitalizations
- Statewide and county-specific epi-curves (note that the dates used are symptom onset date for lab-confirmed cases)
- Statewide and county-specific trends
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
CDC Guidance on PPE when caring for persons suspected for COVID-19 updated 3/30/2020
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 at their discretion, taking into account their own testing capacity and respective PPE availability.
The following patients with COVID-19 symptoms are considered highest priority for testing:
- 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, long-term care facilities, and similar) Patients in other public safety occupations (e.g., law enforcement, fire fighter, EMS)
- Patients who live or work in 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.)
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
Please note that 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 or have died to Public Health as soon as possible to the Skagit County Public Health urgent health care provider line at 360-770-8468 (health care providers only). Report positive test results in non-hospitalized patients via phone to 360-416-1500 or confidential fax 360-416-1515.
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.
See guidance for obtaining nasal and mid-turbinate swabs here.
Commercial Labs Testing for COVID-19 [Updated 3/9/2020]
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.
- If seeking testing at the Public Health Laboratories, call your local health jurisdiction (LHJ) with the above information to discuss the case. If possible, please call 8 AM – 4:30 PM. PHL will fax its results to the submitter and LHJ. For PHL testing, collect specimens and send with the below nCoV form including submitter name, address, phone number, and fax number.
- Collect the following specimens. Follow PPE guidelines above. See here for additional specimen collection and submission instructions.
- Collect a single nasopharyngeal (NP), Mid-turbinate or Nasal specimen using a synthetic swabs and place in 2-3 ml viral transport media Collection of sputum should only be done for those patients with productive coughs. Induction of sputum is not recommended. If a lower respiratory tract specimen (sputum, BAL, or tracheal aspirate) is available, collect lower respiratory sample in sterile container and nasopharyngeal (NP) synthetic swab in 2-3 ml viral transport media.
- Complete 1 2019-nCov Sample Submission Form for each sample
- For all samples, put specimen type and two identifiers (e.g., name, birthdate) on tubes and form, and store at -28°C. . 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 Skagit County Public Health at 360-416-1500.
Report positive test results in non-hospitalized patients to Skagit County Public Health via phone to 360-416-1500 or confidential fax 360-416-1515. Report patients being tested who are hospitalized or have died to Public Health as soon as possible to the Skagit County Public Health urgent health care provider line at 360-770-8468 (health care providers only).
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:
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