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Posted on: March 1, 2020

March 1, 2020 COVID-19 Updated Guidance for Clinicians

  • The February 28 update contained an error of omission in the definition of a person under investigation (PUI) eligible for testing.  The phrase “…requiring hospitalization” was missing from the second row addressing clinical features for patient with a history of travel from affected areas within the past 14 days. That update has been corrected and re-issued and the corrected table is also shown here. No other changes to the guidance in the February update have been made.

chart for health revised alert 03012020

  • A second Snohomish County case has been confirmed in a Jackson High School student. That individual is doing well clinically and is isolated at home after having sought health care on February 24 and February 26 and being confirmed on February 28. A public health investigation is already underway to identify and initiate activity restrictions and monitoring for close contacts. These include a small handful of close contacts with whom the individual had brief contact after clinical recovery but while still infectious and prior to being made aware of the diagnosis. These students are on home quarantine. The last date of class attendance by the individual preceded onset of illness by two days and no other school community members are considered close contacts at this time. 
    • If a Jackson High community member presents for care, please follow the CDC guidance above with respect to screening for COVID-19 testing eligibility. Involved health care facilities have already addressed notification of their health care contacts. If you have questions or concerns about possible exposure, contact your facility’s infection prevention team.  
  • Public Health – Seattle & King County reported three presumptive positive cases of novel coronavirus (COVID-19), including one person who died and two associated with a long-term care facility where a possible healthcare-associated outbreak is under investigation. For more information on that situation, see https://www.kingcounty.gov/depts/health/news/2020/February/29-covid19.aspx.  
  • These recent cases may be the first detected episodes of locally transmitted infection, but given that the vast majority (80%) of COVID-19 infections are mild-to-moderate and many are even asymptomatic, it is highly likely that many undetected COVID-19 cases have also occurred and continue to occur. This is a clear signal that local transmission of COVID-19 has likely been established in the community, just as federal and state public health officials have been advising us would likely occur.  
  • As you can imagine and have likely witnessed, this news of local transmission of COVID-19 in the region is already placing high stress on health care systems, state and local public health agencies, and the community at large. 
    • We are aware of many people presenting to health care settings requesting COVID-19 testing who lack clinical and/or epidemiologic features necessary to meet testing criteria. 
    • Less frequently but still occasionally do we encounter health care providers seeking testing for patients that fail to meet criteria. As our public health approach to COVID-19 transitions from containment to mitigation, confirming the diagnosis in each individual case will fade. COVID-19 testing, now available locally through the Washington State Public Health Laboratories to reduce turnaround time, still requires Health District endorsement and remains finite in capacity. This will likely remain so until a test becomes available for commercial laboratory or point-of-care testing. Until that time, triage of this resource will be focused on those situations where it will provide the greatest benefit: hospitalized patients with severe febrile respiratory disease of undetermined etiology, health care workers with meeting clinical and epidemiologic criteria, and other cases of high public health value.  
  • Recall that the primary intent of our public health containment efforts to-date have been to delay (not stop) the establishment of local transmission in order to afford facilities, schools, businesses and the community at-large time to prepare. We urge you to assist public health in helping your patient population and colleagues accommodate the current situation, plan appropriately, triage health concerns by telephone whenever feasible, and promote standard prevention messages (e.g., hand hygiene, avoid touching face, avoid ill people, social distancing, and self-isolation when ill). 
  • Staff and patient population engagement should include addressing issues of stress, anxiety, and stigma. Visit https://www.doh.wa.gov/Emergencies/Coronavirus/Resources and scroll down to Resources on Mental Health and Personal Impact.
  • The Health District has established a call center for clinicians to triage questions related to evaluation and management of possible COVID-19 patients: 425-339-5278. This line is intended exclusively for health care providers. Calls submitted by non-clinicians will be re-routed to the general information line for community members: 1-800-525-0127 and press #.  Neither line provides tele-health services; non-clinicians calling with health complaints or concerns will be re-directed to contact their personal health care provider. 
    • If you have not done so already, please anticipate increased patient call loads in the weeks and months to come and utilize telephone triage to minimize unnecessary facility visits.

Resources

Information for Health Care Professionals
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/

https://www.doh.wa.gov/Emergencies/Coronavirus/Resources

Healthcare System Preparedness and Response
https://www.cdc.gov/flu/pandemic-resources/planning-preparedness/healthcare-preparedness-response.html

Strategies for Optimizing the Supply of N-95 Respirators
https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-supply-strategies.html

Non-Pharmaceutical Interventions
https://www.cdc.gov/nonpharmaceutical-interventions/index.html

Pandemic Preparedness Resources
https://www.cdc.gov/coronavirus/2019-ncov/php/pandemic-preparedness-resources.html

Washington State Department of Health Resources
https://www.doh.wa.gov/Emergencies/Coronavirus/Resources

Snohomish Health District
https://www.snohd.org/ncov2019 

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