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Posted on: April 7, 2020

COVID-19 Update for Clinicians April 7, 2020

In this update:

  • COVID-19 Data Update
  • Snohomish County Isolation & Quarantine Facility
  • HIPAA & Telehealth during COVID-19 Emergency
  • Cloth Face Coverings

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Summary

Taken together, these data provisionally suggest that COVID-19 transmission is decreasing in response to social distancing and containment efforts. Hospitalizations have not yet decreased and are likely to lag by 1-2 weeks. Although we are currently lacking in serologic studies to determine the prevalence of past infection and presumed (or at least transient) immunity, it seems unlikely that herd immunity is contributing to the decline. Therefore, any retreat on social distancing and containment efforts at this time would likely lead to a resurgence in cases and hospitalizations. While social distancing measure have imposed significant economic and psychosocial hardship on the community, sustaining their use remains necessary for the foreseeable future until conditions for their downgrading and contingency plans for any possible resurgence are in place. The Health District is engaged in discussions with the Washington State Department of Health and other local health jurisdictions about the maturation of control measures as the pandemic evolves. For additional information on pandemic projections from modeling, visit https://covid19.healthdata.org/.

In the meantime, the Health District urges your support in maintaining the community’s voluntary adherence to social distancing requirements and principles.  In accord with Health Officer’s Order 20-62, we also ask you to advise patients as follows:

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Snohomish County COVID-19 Isolation & Quarantine Facility

Requested actions:

  • Be aware the correct method of entry to the isolation and quarantine (I&Q) facility is via issuance of a Snohomish Health District Health Officer’s Order.
  • Share this information with your colleagues and co-workers who are likely to encounter patients meeting criteria for entering the facility (e.g., ED, urgent care, hospitalists, discharge planning, social workers).
  • Advise them to follow the steps set forth below to access I&Q

Background

  • The I&Q site is designated as short-term shelter for primarily for individuals who do not have a domicile. It may also rarely be considered for others who have a domicile, but not one which is suitable for I&Q as determined by SHD (e.g., severely immunosuppressed housemate and inadequate separate rooming to accommodate co-habitation while still infectious).
  • Facility mission:
  • Isolation of confirmed cases who are still contagious.
  • Isolation of suspected cases with specimens collected and results pending.
  • Quarantine of contacts to confirmed cases.
  • Entry is gained via service of a written health officer’s order. Individuals may not self-refer, nor may health care or human services providers directly refer to the site. All entry is vetted and gated by the Snohomish Health District pursuant to the process set forth herein.
  • The facility is operated by the Snohomish County Department of Emergency Management in consultation with the Health District and other partner agencies where applicable.
  • The I&Q site provides basic shelter, sanitation-and-hygiene, food, and triage of urgent medical and mental health issues that cannot be deferred for the short duration that individuals will be ordered there (generally <14 days). The health care available on site is limited in scope and patients with urgent medical problems will largely be transported to urgent care or emergency departments for issues that cannot be appropriately handled on-site or deferred. Limited chemical dependency services will be provided, but withdrawal needs to be addressed by the referring provider/facility prior to transfer to the facility. Other “wrap-around” services may be provided at the discretion of the facility and collaborating community partners.
  • This will be a secured facility, but use of incentives, enablers, and de-escalation techniques will be the modus operandi for facility staff, security staff and law enforcement—all of whom will be on-site 24 hours per day. Subjects who make an unauthorized departure from the facility may be subject to misdemeanor charges and consideration for pursuit of court action if deemed relevant on a disease control basis by the Health District.
  • Upon release from isolation or quarantine, orders to remain at the facility are terminated and the individuals must leave the facility.

Key Criteria for Eligibility

  • Confirmed or suspected COVID-19 case who is still considered infectious by the Health District OR close contact with a verified COVID-19 case in the prior 14 days
  • Medical evaluation for COVID-19 completed and specimen collected-and-submitted for SARS-2CoV testing
  • No need for acute inpatient or long-term care
  • The individual is able to care for themselves without nursing support.
  • The individual does not have an acceptable domicile to isolate or quarantine.
  • The individual is not in alcohol or opioid withdrawal (such individuals should be medically managed by the referring facility or partnering acute care setting prior to candidacy for entry into the I&Q facility).

Referring provider or referring agency responsibilities:

  • Call 425-339-5278. After hours calls should be limited to true emergencies where holding the individual of concern in their current bed/space until the next day is not advisable. In general, orders will be issued between 8AM-5PM with rare exceptions made for disease control emergencies.
  • Provide: name, date of birth, and contact information
  • Describe clinical and social scenario and basis of referral for I&Q
  • Hold individual until decision is made regarding the need for isolation/quarantine.  If in the interim the individual leaves against medical advice or against a verbal directive from the Health District, do NOT use force to stop them.
  • If the Health District determines an order for I&Q is not warranted, the individual can be released per routine procedures of the referring facility when appropriate.
  • If the Health District does issue an order for I&Q, the referring provider will:
    • Read and provide the order to the individual, sign the service-of-notice section on the order, and give a copy to the individual.
    • Keep a copy in the patient record/chart, if applicable.
    • Send a copy of the order with staff-signed notice-of-service back to the Health District.
    • Complete the intake form requested by the I&Q facility and fax to the I&Q facility along with a copy of the health officer’s order and any other information the facility/clinician feels appropriate for continuity. That fax number is 425-322-2762.
    • Dispense a 14-day supply of any medications needed and schedule any required follow-up or make any necessary referrals.
    • Arrange for transportation to Isolation-and-Quarantine site. Call Northwest Ambulance (425-328-7651) to arrange transport.

HIPAA & Telehealth during COVID-19 Emergency

A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients. OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

Cloth Face Coverings 

CDC is recommending use of cloth face coverings in community-based settings, especially when social distancing may be difficult to maintain or ensure.

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