COVID-19 Provider Guidance (3-24-2020) | Eastern North Carolina Now

    Reporting
  • Effective February 3, 2020, physicians and laboratories in North Carolina are required to immediately report when a patient is tested for SARS-CoV-2 infection.
  • Any cluster of severe acute respiratory illness in healthcare workers in the United States should prompt immediate notification of local or state public health for further investigation and testing.

    Control Measures
  • Patients who have symptoms consistent with COVID-19 should self-isolate for:
    • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath), and
    • At least 7 days have passed since symptoms first appeared.
  • Patients with clinical COVID-19 infection do NOT need a negative COVID-19 test result to document recovery.
  • Additional criteria for discontinuing isolation may be required for patients requiring hospital admission.
  • Close contacts of a person with known or suspected COVID-19 should self-monitor their temperature and symptoms of COVID-19, limit outside interaction as much as possible for 14 days, and self-isolate if they develop symptoms.

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    Infection Control
  • To reduce unnecessary exposures, NC DHHS encourages healthcare facilities and providers to maximize the use of:
    • Telehealth/televideo and telephone triage to assess clinical status of patients with respiratory illnesses. Telehealth is broadly being covered at parity for most patients with private insurance, Medicare and Medicaid so should be used whenever clinically appropriate in lieu of in-person encounters.
    • Engineering and administrative controls such as prompt detection, effective triage and patient isolation. See Hierarchy of Controls for more information.
  • Patients should be asked to wear a surgical mask as soon as they are identified as having symptoms of respiratory illness.
  • Patients with known or suspected COVID-19 should continue to wear a mask when healthcare providers are present in room or if they must be moved from their room.
  • Healthcare facilities and systems are encouraged to established designated areas and teams for patients with suspected COVID-19 to the extent possible.
  • Health care teams should wipe down surfaces with EPA registered disinfectant effective against coronaviruses in between patient consults.
  • Hospitals and other healthcare settings should consider routine use of face masks and gloves for all patient interactions, if supplies are sufficient.
  • Clinicians should wear respiratory protection for interview and examination of patients with respiratory illnesses. Either surgical mask or N-95 respirator are appropriate.
  • On March 10, the CDC updated PPE recommendations for the care of patients with known or suspected COVID-19. Surgical face masks are an acceptable alternative to respirators (e.g., N95) if not performing and aerosol-generating procedure
    • Current recommendations include the use of:
      • Surgical face mask OR fit-tested NIOSH-approved N95 or higher-level respirators
      • Gowns, gloves and eye protectio (e.g., goggles or face shield)
      • Private room with the door closed
      • If conducting an aerosol-generating procedure (e.g., nebulizer treatment, intubation), then a respirator (e.g., N95) should be worn (not a facemask) and the procedure should be conducted in a negative pressure room (e.g., AIIR).
  • As the situation continues to evolve, please find updated CDC guidance.

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    Treatment
  • At this time, no vaccine for COVID-19 is available and no specific treatment for COVID-19 is approved by the FDA.
  • Hospitals caring for severely ill patients are encouraged to explore options for clinical trials or other options for access to investigational treatments.
  • Studies with small numbers of patients suggests that hydroxychloroquine could reduce the length of hospital stay and improve COVID-19 pneumonia in severely ill patients. Current data are not conclusive on patients with mild symptoms. We continue to review the evidence as it becomes available.
  • Other medications in testing for COVID-19 are FDA approved to treat serious diseases, such as tuberculosis, HIV infection, and autoimmune conditions. It is important that those medications remain available to treat the conditions for which they are FDA approved as their effectiveness for COVID-19 is being assessed.
  • Corticosteroids should be avoided unless indicated for other reasons (for example, chronic obstructive pulmonary disease exacerbation or septic shock).

    Testing
  • The following guidance only applies to testing at the NCSLPH. Refer to any commercial laboratory guidance when using those services.
  • NCSLPH is currently conducting testing to detect COVID-19 using the CDC 2019-nCoV real-time RT-PCR Diagnostic Panel which has been granted Emergency Use Authorization (EUA) from the FDA.
  • Patients must meet the testing criteria given in this document. When the criteria are met, a NC Patient Under Investigation (PUI) case file is created in REDCap and a REDCap# is subsequently generated documenting approval for testing. The REDCap# will be referenced on the laboratory testing report form under 'NC PUI Number'.
  • Point-of-Care tests, which are not FDA approved, should not be used.

    Specimen Collection
  • Specimen Collection and Shipping Instructions
  • For diagnostic testing to detect COVID-19, only a nasopharyngeal swab should be collected. The specimen should be collected as soon as possible once a PUI is identified, regardless of the time of symptom onset.
    • Nasopharyngeal swab collection:
      • Use only synthetic fiber swabs with plastic or metal shafts. Do not use calcium alginate swabs or swabs with wooden shafts, as they may contain substances that inactivate some viruses and inhibit PCR testing.
      • To collect the nasopharyngeal specimen, place the swab into the nostril parallel to the palate until resistance is encountered. Leave the swab in place for a few seconds to absorb secretions. Slowly remove the swab while rotating it. Place the tip into a vial of sterile transport medium. Aseptically cut off the applicator stick so that it does not protrude above the rim of the tube and cap. LABEL THE VIAL: NP swab with 2 unique identifiers (i.e. patient's name and date of birth) and date of collection. DO NOT LABEL THE CONICAL TRANSPORT TUBE without labeling the vial.
  • Store specimens at 2-8°C for up to 72 hours following collection. If longer storage is required, store at -70°C.
  • Additional guidance on collection, handling, and testing of clinical specimens is provided at the following locations:

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    Specimen Packaging and Shipment
  • Specimens should be packaged and shipped as UN3373 Category B.
  • All specimens approved for testing at the NCSLPH should be directly shipped to the NCSLPH via overnight commercial courier or delivered via private courier (e.g., hospital couriers). All shipments must follow these guidelines:
    • Ship refrigerated specimens to NCSLPH on frozen cold packs
    • If a specimen is frozen at -70°C, ship on dry ice. Specimen deliveries will be received at the NCSLPH loading dock from 8am-5pm Monday through Friday, and 8am-12pm on Saturday and Sunday.
    • Shipping address:
      • Attention: Virology/Serology Unit COVID-19
      • North Carolina State Laboratory of Public Health
      • 4312 District Drive
      • Raleigh, NC 27607-5490
    • Email slph.covid19.tracking@dhhs.nc.gov with the tracking number or private courier arrival information and the number of specimens being sent.
  • All specimen submissions must have a fully completed NCSLPH Virology/Serology Form, using the EIN number specific to the submitter's facility.

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