COVID-19 Alert for Healthcare Providers

Posted March 6, 2020. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

New Washington state cases of COVID-19 continue to be reported primarily in King and Snohomish Counties. As of March 6, 79 cases have been reported in with the state with11 deaths. Most cases have been reported in King and Snohomish Counties; however, one case each have been reported in Jefferson and Grant Counties. Many cases have been linked to Life Care, a skilled nursing facility in Kirkland. As of March 6, there are no confirmed cases in Spokane County residents.

UPDATES

NEW Airborne precautions are no longer strictly recommended by the Washington Department of Health (DOH). Standard, contact, and droplet precautions should be used for suspect COVID-19 cases. However, healthcare workers should wear gloves, gowns, a fit-tested N95 mask, and eye protection for any potentially aerosolizing procedures, including the collection of nasopharyngeal specimens. Rooms should be left vacant for one hour after a patient leaves.

NEW Please do not advise patients with no known exposure to call the Spokane Regional Health District for consultation. Please advise patients according to the documents below:

• What to do if you have confirmed or suspected coronavirus disease (COVID-19)
• What to do if you were potentially exposed to someone with confirmed coronavirus disease (COVID-19)
• What to do if you have symptoms of coronavirus disease 2019 (COVID-19) and have not been around anyone who has been diagnosed with COVID-19

Two new commercial laboratories have started testing for COVID-19, greatly expanding testing options across the country. The University of Washington Medicine Laboratory began testing on Monday March 2 and NEW LabCorp began testing on Thursday March 5. These tests are open to all patients at the clinician’s discretion with no restrictions; no public health notification or approval is required. These options should be used for patients who do not meet the strict criteria for testing at the Washington State Public Health Laboratory (WA PHL) as indicated below, but do meet symptom criteria consistent with a COVID-19 illness while other respiratory pathogens are being simultaneously ruled out. NEW We expect other commercial laboratories, including Quest, ARUP and Mayo Clinic Laboratories, to begin testing as soon as next week.

NEW DOH has expanded criteria for testing at the Washington Public Health Lab (WA PHL) to include persons for which public health action is of upmost importance. See below.

As the outbreak expands, emergency departments are likely to become quickly overwhelmed. Outpatient settings need to have appropriate PPE and plans in place to safely collect appropriate specimens and management of suspect COVID-19 patients. Standard, contact and droplet precautions are recommended (no longer airborne).

WHEN TO USE WA PHL (SRHD approval required)

WA PHL testing is primarily reserved at this time for persons with:

• severe illness and travel to countries with widespread or sustained community transmission (For persons reporting travel, use the COVID-19 Assessment for Evaluating Persons with Fever and Acute Respiratory Illness tool)
• persons with contact to a known COVID-19 case
• NEW persons associated with known local outbreaks and clusters of illness (such as Life Care in Kirkland); or
• NEW other high-risk situations (such as COVID-19 in a healthcare worker; outbreaks in facilities such as long-term care or correctional facilities; or deaths).

Patients who meet the criteria below OR NEW criteria of significant public health importance as described above need to have testing approved by Spokane Regional Health District (SRHD) Epidemiology (if sending specimens to WA PHL) by calling 509-324-1442 during business hours. Please also conduct a respiratory pathogen panel to rule out other etiologies.

• Fever or signs/symptoms of lower respiratory illness (e.g., cough or shortness of breath) AND is a person who has had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset
• Fever and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization AND
  • A history of travel to affected geographic areas with widespread or sustained community transmission OR
  • No source of exposure has been identified and there is no alternative explanatory diagnosis (e.g., influenza)

WA PHL Specimen Submission Form and instructions are here: https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/PublicHealthLaboratories/MicrobiologyLabTestMenu. Nasopharyngeal (NP) swabs and sputum are preferred, but oropharyngeal (OP) swabs can replace sputum if sputum cannot be obtained.

WHEN TO USE UNIVERSITY OF WASHINGTON LAB (UW LAB) or LABCORP (SRHD approval not required)

There are no restrictions or inclusive criteria to use the UW Lab or LabCorp for COVID-19 testing; however, testing of asymptomatic persons is not recommended. If someone does not meet the criteria listed above for testing at the WA PHL, the clinician may order that testing through UW Lab or LabCorp as they would any other commercial testing at their discretion.

• UW Lab – how to submit samples: https://testguide.labmed.uw.edu/public/view/NCVQLT.
  • UW Lab requires a specific virology requisition form and the test code is NCVQLT.
• NEW LabCorp – how to submit samples: https://www.labcorp.com/tests/139900/2019-novel-coronavirus-covid-19-naa
  
  • The test code is 139900.
• Nasopharyngeal (NP) swab is preferred for these labs.
  

Due to resource constraints, there is no need to notify SRHD Epidemiology in advance about tests sent to UW Lab or LabCorp, with the exception of suspect cases who are healthcare workers or suspect cases that may be connected to a facility outbreak. However, if any person tests positive for COVID-19, those results should be immediately reported to 509.324.1442.

If COVID-19 is suspected:

• Ask patients with suspected COVID-19 infection to wear a surgical mask as soon as they are identified and evaluate them in a private room with the door closed using standard, droplet and contact precautions (NEW DOH is no longer recommending airborne precautions).
  • http://www.wsha.org/wp-content/uploads/Droplet_Contact-Precautions_2020.03.04.pdf
• All healthcare personnel entering the room should use standard precautions, contact precautions, droplet precautions, and use eye protection (e.g., gown, gloves, N95 mask or PAPR, and face shield or goggles) if collecting NP specimens or other potentially-aerosolizing procedures.
• Immediately notify infection control personnel at your healthcare facility per your COVID-19 response plan .
• Collect an upper respiratory specimen (NP and/or OP swab, depending on lab) and store in viral transport medium. Specimens should be refrigerated and shipped cold. See above for guidance of using WA PHL, UW Lab, or LabCorp.
  • Concurrent local commercial testing of a second upper respiratory specimen should occur with a respiratory pathogen panel to rule out other infectious causes, including but not limited to influenza. Results for the respiratory pathogen panel are not necessary for submission to UW PHL or LabCorp (all samples can be obtained at the same time and the patient can be sent home to isolate while awaiting test results if further medical care is not needed; consider waiting to send COVID-19 samples to see if respiratory pathogen panel results are negative).
    • If the patient is epidemiologically linked to a confirmed case (e.g., a close contact), test for COVID-19 regardless of respiratory pathogen panel results.
• Patients should be asked to isolate at home pending test results. NEW The guidance for isolation for confirmed and suspected COVID-19 cases is seven days after onset of symptoms or 72 hours after fever has resolved, whichever is longer.

RESOURCES

Washington State Department of Health and CDC have compiled additional guidance for healthcare providers, which is available on their website (this is a rapidly evolving situation and you should continue to check for updates to these documents): https://www.doh.wa.gov/Emergencies/Coronavirus/Resources

• Healthcare Provider Evaluation Tool for Possible Public Health Testing
• Novel Coronavirus Fact Sheet for Patients
• University of Washington COVID-19 Specimen Collection and Submission Instructions
• Healthcare Infection Prevention Guidance for COVID-19
• Healthcare Professional Preparedness Checklist for Transport and Arrival of Patients Potentially Infected with COVID-19
• Hospital Preparedness Checklist for Suspected or Confirmed COVID-19 Patients
• Public Health Lab COVID-19 Specimen Collection and Submission Instructions
• Lab Biosafety Guidelines
• Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19)

Additional Resources

• COVID-19 Global Cases, GIS Mapping, Johns Hopkins Center for Systems Science and Engineering
• Information for Healthcare Professionals: https://www.cdc.gov/coronavirus/COVID-19/guidance-hcp.html
• Interim Guidance for Preventing Transmission in Homes and Communities: https://www.cdc.gov/coronavirus/COVID-19/guidance-prevent-spread.html
• Guidance for Travelers: https://wwwnc.cdc.gov/travel/notices/watch/novel-coronavirus-china