HOW DO I?
Published on January 27, 2020. Last modified on July 07, 2020
Guidelines for Discontinuation of Isolation for Suspected and Confirmed COVID-19 Patients (April 27)
Fact Sheet for Healthcare Providers CDC 2019-nCoV Real- Time RT_PCR Diagnostic Panel Updated 3/15/2020
Guidance as of April 27, 2020:
1. Post signage at facility points of entry requesting individuals who have respiratory symptoms to alert medical staff and to don a mask.
- Download signage in multiple languages from the California Department of Public Health's website.
- Educate front-line reception staff about screening and infection control procedures.
2. Obtain a detailed travel and social history on all individuals presenting with respiratory symptoms.
- Because the list of countries with community transmission is changing rapidly, please visit the CDC's Travel Health Notice website for the most current list of international areas with sustained transmission.
- Ascertain where patients have traveled during the 14 days prior to symptom onset.
- Ask if the person has been in contact with someone with respiratory symptoms or who has been diagnosed with COVID-19 in the last 14 days.
3. Use clinical judgement to determine if a patient has signs and symptoms compatible with COVID-19.
- Many patients with confirmed COVID-19 have developed fever (subjective or measured) and/or symptoms of acute respiratory illness such as cough or difficulty breathing.
- Clinicians are strongly encouraged to test for other common causes of respiratory infections such as influenza.
4. Isolate individuals with suspected COVID-19
- Place a surgical mask on the patient.
- Move the patient to an airborne infection isolation room (AIIR), if available. If no AIIR is available, place the patient in a single-patient room and close the door.
- Staff entering the room should use standard, contact, and airborne precautions with the addition of eye protection (e.g., gloves, gown, N95 respirator, and a face shield or goggles).
- In accordance with CalOSHA guidelines, PAPRs should be used for any aerosol-generating procedures.
- Staff without access to PPE should stay at least 6 feed back from a suspected case.
5. The following patients and individuals with strong epidemiologic risk factors will be prioritized for testing at the Monterey County Health Department's (MCHD's) Public Health Laboratory (PHL):
- Hospitalized patients
- Symptomatic health care workers and first responders
- Individuals identified for testing by public health contact investigations and disease control activities in high risk settings (e.g., congregate living facilities).
- Individuals identified for testing by public health contact investigation and disease control activities who are not in high risk settings
- Symptomatic individuals >65 years of age and/or with chronic medical conditions
- Symptomatic individuals who are essential service workers
Priority 3 (tests conducted as local testing supplies allow):
- Community-based testing of all low-risk symptomatic individuals
- Clearance testing of confirmed COVID-19 patients
- Screening of asymptomatic residents of congregate living facilities prior to admission or re-admission
- Surveillance testing of asymptomatic individuals
6. Immediately contact the Monterey County Health Department if the symptomatic person meets one of these three criteria to request testing at the MCHD PHL.
- Call 831-755-4521 during normal business hours and 831-755-5100 after normal business hours. When calling the after-hours line, ask for the Hazardous Materials Team, who will transfer you to the on-call Health Officer.
- Health Department staff will provide additional guidance and authorization to send specimens to the MCHD PHL.
7. Under the guidance of Monterey County Health Department staff, collect appropriate specimens.
- Obtain a nasopharyngeal swab (NP) swab using synthetic fiber swabs with plastic shafts placed in separate vials of 2-3 mL viral transport media (VTM).
- Public Health may request additional specimens such as sputum if the patient has a productive cough..
- Specimens should be refrigerated at 2-8° C until they can be transferred to the Monterey County Public Health Laboratory.
- Specimens received at the MCHD PHL by 10:00am will be resulted the same business day afternoon. Specimens received between 10:0am and 1:00pm will be resulted by 9:00am the next business day. Specimens received after 1:00pm will be resulted the next business afternoon.
8. Clinicians with patients who do not meet Priority 1 and 2 criteria for testing at the MCHD PHL can opt to collect specimens according to Lab Corp, BioReference, and/or Quest directions and submit them to commercial laboratories for COVID-19 testing.
- For information about how to submit a specimen to Lab Corp, Lab Corp's customer service line is 800-845-6167 or visit the Lab Corp website.
- For information about how to submit a specimen to Quest, Quest's customer service line is 866-697-8378 or visit Quest's website.
Health care providers should also take the following steps to prepare for local community transmission:
- Monitor stocks of personal protective equipment (PPE) and implement measures to assure appropriate PPE usage. Check with your PPE suppliers about potential wait lists and delivery delays for PPE. Ensure staff are trained on proper donning and doffing procedures, as well as fit tested for N95 use.
- Discuss how your facility would process a suspected COVID-19 patient. Inpatient facilities should plan for isolating special populations like pregnant women and pediatric patients.
- Review your facility's emergency operations, surge, and continuity of operations plans. Have preliminary planning discussions for operations with reduced staffing and higher patient volumes.
- Review CDC guidance regularly on evaluating PUIs, infection control strategies, PPE conservation strategies, and clinical management.
For more information about testing, diagnosing, and reporting COVID-19, please contact the Monterey County Health Department's Communicable Disease Unit at 831-755-4521 during business hours and 831-755-5100 after normal business hours.
Health Advisories/Interim Guidance
Monterey County Health Department
- Monterey County Health Advisory - March 9, 2020
- Monterey County Health Advisory - February 28, 2020
- Monterey County Health Advisory - January 31, 2020
- Monterey County Health Advisory - January 23, 2020
- Long Term Care Facilities:
California Department of Public Health
- Testing for COVID-19: PCR, Serology, and Antigen - May 15, 2020
- All Facilities Letter (AFL) 20-11: Updated 2019 Novel Coronavirus Information - January 31, 2020
- CDC HAN 434: Serious Adverse Health Events Associated with Methanol-based Hand Sanitizers
- CDC HAN 432 – Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19) CDC HAN 427: Updated and Interim Guidance on Outbreak of 2019-nCoV
- CDC Flow Chart to Identify and Assess 2019-nCoV
- CDC Interim Guidance Clinicians Caring for Patients
- CDC Interim Guidance for Evaluation and Testing PUIs
- CDC Interim Guidance for Infection Control
- CDC Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus
- CDC Interim Guidance for EMS Systems and 911 Public Safety Answering Points