HOW DO I?
Published on January 27, 2020. Last modified on April 06, 2020
Fact Sheet for Healthcare Providers CDC 2019-nCoV Real- Time RT_PCR Diagnostic Panel Updated 3/15/2020
Guidance as of March 19, 2020:
1. Post signage at facility points of entry requesting individuals who have respiratory symptoms and recently traveled to internationally to alert medical staff and to don a mask.
- Download signage in English, Spanish, and Chinese 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 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.
3. Use clinical judgement to determine if a patient has signs and symptoms compatible with COVID-19.
- Most 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
- 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. Severely ill (e.g., hospitalized) 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):
- Fever or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath) AND a history of close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset, or
- Fever and signs/symptoms of a lower respiratory illness (e.g., cough or shortness of breath) requiring hospitalization AND a history of travel from an area with community transmission of COVID-19 within 14 days of symptom onset, or
- Fever with severe acute lower respiratory illness (e.g., chest x-ray confirmed pneumonia, ARDS) requiring hospitalization AND without alternative explanatory diagnosis (e.g., influenza) AND no source of exposure has been identified (no history of travel to affected geographic regions listed above and no known contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset).
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) AND oropharyngeal (OP) swab using synthetic fiber swabs with plastic shafts placed in separate vials of 2-3 mL viral transport media (VTM).
- There should only be 1 swab in each VTM-containing tube.
- Specimens should be place in separate bio-hazard bags (one specimen per bag) to avoid contamination if leaking occurs.
- 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 the above critieria for testing at the MCHD PHL can opt to collect specimens according to Lab Corp and/or Quest directions and submit them to commercial laboratories for COVID-19 testing.
- Clinicians should not send healthy or mildly symptomatic patients to the hospital ERs and MCHD for the sole purpose of collecting specimens 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
California Department of Public Health
- 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