COVID-19: Precautions and Testing Update

Posted March 15, 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 across the state; however, most cases and deaths are occurring in King, Pierce and Snohomish Counties. As of March 12, 457 cases have been reported in the state with 31 deaths.  There are at least nine long term care facilities affected in the state.  

UPDATES

NEW Updated guidance from the Centers for Disease Control & Prevention is available: Interim Infection Prevention and Control Recommendations for Patients with Suspected of Confirmed COVID-19 in Health Care Settings. Airborne transmission from person-to-person over long distances is unlikely. Summary of changes to the guidance:

  • Updated PPE recommendations for the care of patients with known or suspected COVID-19:
    • Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demandDuring this time, available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk to healthcare providers (HCP).
      • Facemasks protect the wearer from splashes and sprays.
      • Respirators, which filter inspired air, offer respiratory protection.
    • When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Facilities that do not currently have a respiratory protection program, but care for patients infected with pathogens for which a respirator is recommended, should implement a respiratory protection program.
    • Eye protection, gown, and gloves continue to be recommended.
      • If there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP.
  • Included are considerations for designating entire units within the facility, with dedicated HCP, to care for known or suspected COVID-19 patients and options for extended use of respirators, facemasks, and eye protection on such units.  Updated recommendations regarding need for an airborne infection isolation room (AIIR).
    • Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed. AIIRs should be reserved for patients undergoing aerosol-generating procedures.
  • Increased emphasis on early identification and implementation of source control (i.e., putting a face mask on patients presenting with symptoms of respiratory infection). 

Please do not advise patients with no known exposure to call the Spokane Regional Health District (SRHD) for consultation. SRHD does not provide testing nor do we have nurses on staff to assess a patient’s clinical condition. Please advise patients according to the documents below:

Several academic and commercial labs are testing for COVID-19, including the University of Washington Medicine Laboratory, LabCorp, NEW Quest, and NEW ARUP. 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. No public health notification or approval is required. NEW The Washington State Insurance Commissioner has ordered all Washington insurers to waive deductibles and copays for testing.  

NEW SRHD encourages healthcare providers to test for COVID-19 in patients with compatible symptoms and negative influenza tests to better understand the presence of the disease in our community. However, patients with only mild symptoms not requiring medical care should not be directed to come into the office to avoid exposing others unless the person works or volunteers at a long term care center, senior center, or other setting where they have frequent contact with seniors or other medically fragile persons.  

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.  

UPDATED WHEN TO USE WA PHL (SRHD notification required)

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

  • Healthcare workers
  • Employed in public safety occupation (e.g., law enforcement, firefighter, EMS, etc.)
  • Part of an illness cluster in a facility or institution (e.g., healthcare, school, corrections, shelters, long term care, etc.)
  • Patients with no health insurance 

Patients who meet the criteria above and you choose to use the WA PHL, approval is no longer required by SRHD but please continue to notify SRHD Epidemiology of high risk situations for which you are ordering testing by calling 509-324-1442 during business hours or 509-869-3133 after hours. Please consider conducting a respiratory pathogen panel to rule out other etiologies.

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. NEW NP and OP swabs can be placed in the same viral transport medium container and is preferred to minimize the number of samples needed to be run.

WHEN TO USE ACADEMIC OR COMMERICAL LABS (SRHD approval not required)

There are no restrictions or inclusive criteria to use academic or commercial labs 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 testing through one of the labs below as they would any other commercial testing at their discretion. 

Due to resource constraints, there is no need to notify SRHD Epidemiology in advance about tests sent to academic or commercial labs, 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 509-869-3133. 

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 (DOH is no longer recommending airborne precautions).
  • 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. Otherwise, standard, contact, and droplet precautions can be used.
  • 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.
  • Patients should be asked to isolate at home pending test results. 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/NovelCoronavirusOutbreak2020/HealthcareProviders

Additional Resources