Coronavirus (COVID-19) Info for Physicians

IMPORTANT INFORMATION ABOUT COVID-19 TESTING
  • Not everyone needs a test. Testing is appropriate for those who are at highest risk for developing severe COVID-19 disease.
  • Currently, COVID-19 testing is not widely available, but is available to symptomatic persons in priority rank order. (Healthcare personnel providing direct care are among the top priority.)
  • 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).

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., signsposters) 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 March 24, 2020 says: 

Clinicians considering testing of persons with possible COVID-19 should continue to work with their local and state health departments to coordinate testing through public health laboratories, or use COVID-19 diagnostic testing, authorized by the Food and Drug Administration under an Emergency Use Authorization (EUA) through clinical laboratories.  Increasing testing capacity will allow clinicians to consider COVID-19 testing for a wider group of symptomatic patients.
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. Most patients with confirmed COVID-19 have developed fever (subjective or confirmed) and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). 

 

UDOH has updated guidance on testing criteria as of March 23.

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 (12, 3) that they are updating on a rolling basis. 

 

What Precautions to Take

Health care personnel should use standard precaution, contact precautions, airborne precautions and eye protection such as goggles or a face shield before entering the room. Please note that, in situations where fit-tested NIOSH-approved N95 or higher-level respirator for healthcare personnel are in a shortage, surgical masks may be used. Eye protection, gown, and gloves continue to be recommended, but if there are shortages of gowns, they should be prioritized for aerosol-generating procedures, care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP.

Section 2 of this CDC web page emphasizes important PPE compliance. For full precaution guidance, refer to the CDC’s isolation precautions guideline.

CDC Guidance on PPE:  With limited supplies of PPE, conservation may be key. Use PPE judiciously.

Utah State Restricts Non-Urgent Procedures
- Mar. 24, 2020.

Other Resources

CDC Situation Summary

CDC Information for Healthcare Professionals

Evaluating Patients and Reporting COVID-19 
Management of Patients with COVID-19
Protecting Yourself - Infection Control
Preparedness Resources - Checklists
FAQ for Healthcare Professionals

CDC Travel Advisories

Utah Department of Health Resources

Recommendations for Providers
Directory of Local Health Departments
Utah Coronavirus Task Force -Twitter Feed


JAMA Network's Coronavirus Diagnosis and Treatment Info Page

American Medical Assoc. Coronavirus Resource Center

  - A Physician's Guide to COVID-19
  - 
AMA Coding Guidance for COVID-19
  - 
Quick Reference: CPT reporting for COVID-19 Testing 

TELEHEALTH Providers for Remote Patient Visits

For those who have no telehealth capabilities via hospital, health system, etc., here are a couple of options to consider:

  • AZOVA (free to sign up and set up, $50 per provider/mo. subscription or per patient encounter fee options)
  • Doxy.me (free to sign up, $35-$50 per provider monthly subscription, no per patient fee)
  • RelevantMD (offering Free 2-way secure texting service during COVID-19 outbreak - call 801-360-5552 for info.)

NOTE on Telehealth: Effective immediately, physicians may use any audio or video communication technology that is non-public facing to care for patients, and they won’t face penalties if these telehealth technologies do not fully comply with HIPAA regulatory requirements. That’s according to an announcement from the HHS Office of Civil Rights, which has chosen to exercise its HIPAA enforcement discretion due to the COVID-19 public health emergency. Note that this applies to patients being treated for any reason, and is not limited to only those patients being treated for suspected COVID-19.  For more information, including examples of technologies that are considered “non-public facing,” read the HHS OCR announcement in full or explore these other resources:

Coronavirus Scams to Watch Out For
Warning - Malware Trojan Masked as Coronavirus Map

S.L. Chamber of Commerce Employer Information

Utah Bankers Association Statement

SBA disaster relief is available.

The U.S. Small Business Administration (SBA) offers federal disaster loans* for businesses and private nonprofits that have been severely impacted by the coronavirus (COVID-19). The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. Pre-existing disaster loans still in repayment will have their payments deferred automatically through the end of 2020. The SBA accepts applications for Economic Injury Disaster Loans directly. Click here to learn more about SBA Economic Injury Disaster Loans.

The SBA’s Economic Injury Disaster Loans are just one piece of the expanded focus of the federal government’s coordinated response. On Mar 25th, the U.S. Senate unanimously passed a massive $2.2 trillion coronavirus spending bill aimed at alleviating the economic impact of the outbreak. The bill now moves to the U.S. House of Representatives for approval, and then to the president to be signed into law. We are monitoring these developments closely and will brief you on the provisions of the stimulus package and how they may benefit you as soon as the bill has been finalized.

 

Info for Specialty Physicians

Obstetrics

ACOG Practice Advisory: Novel Coronavirus 2019 (COVID-19)

FAQs: Coronavirus Disease 2019 (COVID-19) and Pregnancy (CDC 2/21/2020)

Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19 (CDC 2/19/2020)

Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Health Care Settings (CDC 2/18/2020)

Pediatrics

Information for Pediatric Health Care Providers (CDC 3/12/2020)

FAQs: Coronavirus Disease – 2019 (COVID-19) and Children (CDC 2/22/2020)

Long-Term Care

Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes (CMS 3/13/2020)

Long-Term Care (LTC) Facility Self-Assessment Tool (CMS 3/9/2020)

Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities (CDC 3/1/2020)

EMS

Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019 (COVID-19 (CMS 3/9/2020)

Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the US (CDC 2/15/2020)

 

After COVID-19 Resources

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.