Coronavirus (COVID-19) Info for Physicians
- Not everyone needs a test. Testing is appropriate for those who have at least one symptom of COVID-19 disease.
- Currently, COVID-19 testing is widely available in Utah.
- Mildly ill patients should be encouraged to stay home and contact their healthcare provider by phone for guidance about clinical management.
The following resources are to assist physicians during the spread of the virus in Utah. If you are currently evaluating any patient suspected of having been infected with Coronavirus, contact the Utah Dept. of Health immediately at 888-EPI-UTAH (374-8824).
Crush the Curve Website and Assessment Tool - Helps answer patient questions on whether to be tested.
What to Tell Patients
The CDC has created a handout for medical practice to make available for concerned patients. Click here to download the pdf, or visit the CDC’s web page of printable handouts and posters.
Practice Protocols & Preparedness
Pre-Screening: When scheduling appointments, instruct patients and persons who accompany them to call ahead or inform staff upon arrival if they have symptoms of any respiratory infection (e.g., cough, runny nose, fever) and to take appropriate preventive actions (e.g., wear a facemask upon entry to contain cough, follow triage procedures).
Promote Respiratory Hygiene: Take steps to ensure all persons with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit. Consider posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and health care personnel with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use facemasks or tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.
Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% alcohol-based hand sanitizer (ABHS), tissues, no touch receptacles for disposal, and (if available) facemasks at healthcare facility entrances, waiting rooms, patient check-ins, etc.
Limit Exposure: Ensure that patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) are not allowed to wait among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies. In some settings, medically-stable patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.
Rapid Triage: Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough):
- Identify patients at risk for having COVID-19 infection before or immediately upon arrival to the healthcare facility.
- Implement respiratory hygiene and cough etiquette (i.e., placing a facemask over the patient’s nose and mouth if that has not already been done) and isolate the PUI for COVID-19 in an Airborne Infection Isolation Room (AIIR), if available. See recommendations for “Patient Placement” below. Additional guidance for evaluating patients in U.S. for COVID-19 infection can be found on the CDC COVID-19 website.
- Inform infection prevention and control services, local and state public health authorities, and other healthcare facility staff as appropriate about the presence of a person under investigation for COVID-19.
The above is summary guidance for practices. Please visit the CDC’s protocol for full details; it is being updated on a rolling basis. MCMS encourages practices to utilize the CDC’s preparedness checklist for COVID-19 and the CDC’s interim guidance for community transmission preparation in various facility and practice modalities.
What to Look For
The CDC’s clinical criteria as of May 3, 2020 says:
Clinicians considering diagnostic testing of people with possible COVID-19 should continue to work with their local and state health departments to coordinate testing through
public health laboratories, or work with commercial or clinical laboratories using diagnostic tests authorized for emergency use by the U.S. Food and Drug Administration.
Clinicians should use their judgment to determine if a patient has signs and
symptoms compatible with COVID-19 and whether the patient should be tested. Asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19, has been reported. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing) but some people may present with
other symptoms as well. Other considerations that may guide testing are epidemiologic factors such as the occurrence of local community transmission of COVID-19 in a jurisdiction. Clinicians are encouraged to test for other causes of respiratory illness.
Other considerations that may guide testing are epidemiologic factors such as known exposure to an individual who has tested positive for SARS-CoV-2, and the occurrence of local community transmission or transmission within a specific setting/facility (e.g., nursing homes) of COVID-19. Clinicians are strongly encouraged to test for other causes of respiratory illness, for example influenza, in addition to testing for SARS-CoV-2. Another population in which to prioritize testing of minimally symptomatic and even asymptomatic persons are long-term care facility residents, especially in facilities where one or more other residents have been diagnosed with symptomatic or asymptomatic COVID-19.
SARS-CoV-2 can cause asymptomatic, pre-symptomatic, and minimally symptomatic infections, leading to viral shedding that may result in transmission to others who are particularly vulnerable to severe disease and death. Even mild signs and symptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed healthcare personnel, due to their extensive and close contact with vulnerable patients in healthcare settings.
UDOH has updated guidance on testing criteria as of March 23.
They are now allowing testing of ALL symptomatic individuals who desire to be tested.
For healthcare personnel, testing may be considered if there has been exposure to a person with suspected COVID-19 without laboratory confirmation. Because of their often extensive and close contact with vulnerable patients in healthcare settings, even mild signs and symptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed healthcare personnel. Additional information is available in CDC’s Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19).
When & How to Report
If you have a patient under investigation for COVID-19, immediately let your facility’s infection control department know and report it to the state public health department. If you are currently evaluating any patient suspected of having been infected with Coronavirus, contact the Utah Dept. of Health immediately at 888-EPI-UTAH (374-8824).
How to Test
The agency’s interim guidelines say to collect multiple clinical specimens and all three specimen types—upper respiratory (nasopharyngeal AND oropharyngeal swabs), and lower respiratory (sputum, if possible) for those patients with productive coughs. Induction of sputum is not recommended. Specimens should be collected as soon as possible once a PUI is identified, regardless of the time of symptom onset. Maintain proper infection control when collecting specimens.
It’s important to test for other respiratory pathogens at the time of the initial evaluation. Don’t let such testing delay your shipping the specimen for testing.
Here is new guidance (3/20/2020) on alternatives to viral transport media/universal transport media and flocked nasopharyngeal swabs.
Also, the CDC recommends—for biosafety reasons—against performing virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens that come from patients under investigation for 2019-nCoV.
Testing resources are being ramped up, but are still inadequate for testing everyone who may want to be tested, therefore judicious use is recommended based on the physicians’ best judgement and should be limited currently to those who meet the guidelines for testing and are at the greatest threat for sustaining harm from the virus (elderly, those with existing respiratory challenges or chronic conditions, etc.).
In addition to the Utah Department of Health, LabCorp , Quest Diagnostics and ARUP are also providing testing. They have each posted web pages (1, 2, 3) that they are updating on a rolling basis.
State/Local Government Directives
Utah Governor's Recovery Plan
Apr 22nd - Elective Procedures Resumed
Mar 27th - Utah Governor's Stay at Home Directive
Mar 25th - Telehealth Requirements Relaxed
Mar 25th - Summit County Residents Ordered to Shelter-In-Place
Mar 24th - State Restricts Non-urgent Surgeries
Mar 24th - Businesses Urged to Donate Personal Protective Equipment
Mar 23rd - Public Schools, Technical Colleges Dismissed Until May 1
Mar 21st - State Clarifies Mass Gathering Instructions
Utah Phased Guidelines for the General Public and Businesses to Maximize Public Health and Economic Reactivation
- Healthcare Phased Guidelines
The Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 document provides guidance on when healthcare workers with confirmed or suspected COVID-19 can return to work, and includes options for basing this decision on test-based criteria and non-test-based criteria. There is additional guidance on what precautions these healthcare workers need to take when they return to work.
The Discontinuation of Home Isolation for Persons with COVID-19 document provides options for basing discontinuation decisions on test-based criteria and non-test-based criteria.