This updated is intended to provide the latest information to all North Carolina clinicians and laboratory staff regarding the Coronavirus Disease 2019 (COVID-19). Please read thoroughly as there are several updates, including:
- Changes in testing recommendations: People with mild symptoms consistent with COVID-19 do NOT need testing and should be instructed to stay at home to recover. Mild symptoms defined as fever and cough without any of the following: shortness of breath, difficulty breathing, chest discomfort, altered thinking, cyanosis
- Updated procedures for testing approval from local health departments
- Updated guidance for discontinuation of isolation
- Updated categories of persons at higher risk for severe illness
North Carolina's response to COVID-19 will continue to rapidly evolve. The most up to date information and guidance can be found at https://www.cdc.gov/coronavirus/2019-ncov/index.html
The respiratory disease named "coronavirus disease 2019" (abbreviated "COVID-19"), caused by a novel coronavirus named "SARS-CoV-2", was declared a pandemic by the World Health Organization on March 11, 2020.
North Carolina now has community transmission of COVID-19. Therefore, we are moving to a different phase of our response efforts and will be further increasing our population-based community mitigation strategies. The goal of mitigation is to decrease spread of the virus among our population – especially for those who are at highest risk of clinical severity, and our health care workers – so fewer people need medical care at the same time. In addition, we need to implement strategies to conserve supplies and capacity so our health care workers can care for people who need medical attention even during the peak of the outbreak.
Rationale for updated testing recommendations:
To decrease acceleration of spread in community and exposures in healthcare settings
To preserve resources
- People infected with SARS-CoV-2 (virus causing the disease COVID-19) coming out to be tested may spread illness to others in the community, including those at higher risk of complications, and health care workers.
- People who are not infected with SARS-CoV-2 can become so when seeking testing, especially at health care sites.
No impact on management for most people
- Personal Protective Equipment and supplies will be needed for outbreaks in high-risk settings (e.g. long- term care), to protect frontline workers (e.g. health care workers, first responders), and to care for people with more severe clinical symptoms.
Alternative surveillance tools can be used to track the spread of COVID-19
- For those with mild symptoms, treatment is supportive and focused on symptom management.
- A test will not change management.
Clinical assessment, Case Investigation and Testing
- Tracking only lab-confirmed cases is not a reliable or accurate way to understand the pandemic.
- We will use influenza surveillance tools, which are designed to track widespread respiratory illness.
Testing at the NC State Laboratory of Public Health (NCSLPH):
- Clinicians should use, to the extent possible, telehealth/televideo and telephone triage to assess clinical status of patients with respiratory illnesses.
- Telehealth/televideo and telephone triage are critical tools to allow patients with mild symptoms to have safe access to appropriate assessment, clinical guidance and follow up, and self-care information, while preventing further spread of COVID-19 or exposing patients to COVID-19 in a medical setting.
- Telehealth is broadly being covered at parity for most patients with private insurance, Medicare and Medicaid and therefore should be used whenever clinically appropriate in lieu of face-to-face encounters.
- Clinicians should use their judgment to determine if a patient has mild signs and symptoms compatible with COVID-19 (e.g., fever and cough) or more severe symptoms requiring in-person medical care (e.g. shortness of breath, difficulty breathing, chest discomfort, altered thinking, cyanosis).
- In general, patients who have mild symptoms consistent with COVID-19, do not need testing for COVID-19 and should be instructed to stay and recover at home. This strategy is consistent with guidance from the Centers for Disease Control and Prevention.
- Patients should be counseled to call if they have worsening signs or symptoms of respiratory illness (e.g. increasing fever, shortness of breathing, difficulty breathing, chest discomfort, altered thinking, cyanosis).
- Patients in high risk categories for clinical severity (e.g., 65 year and older, chronic lung disease or moderate to severe asthma, heart disease, severe obesity BMI > 40, other underlying poorly controlled chronic health conditions such as diabetes, renal failure, liver disease, and immunocompromised) should have more frequent follow up to assess clinical status. Pregnant women should be monitored closely as they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk. While children are generally at lower risk for severe illness, some studies indicate a higher risk among infants.
- Escalating medical care should occur if symptoms worsen.
- Testing to detect COVID-19 is available through commercial and health system labs and the NC State Laboratory of Public Health (NCSLPH).
- Testing should not be done for asymptomatic persons.
- In general, patients with mild illness (defined above) do not need testing.
- Clinicians should use their clinical judgement and prioritize testing of patients with more severe respiratory symptoms; patients for whom clinical management would be different if they were infected with COVID-19; patients in high-risk settings (e.g., congregate care settings, long term care); and health care workers and first responders.
- For patients who have more significant symptoms and do need medical attention, clinicians are strongly encouraged to also consider and test for other causes of respiratory illness, including infections such as influenza.
Testing at the North Carolina State Laboratory of Public Health (NCSLPH) is available with prior approval by the local health department for the county of the health care facility, or the state epidemiologist on call. Patients must meet at least one of the following criteria to be considered for testing at NCSLPH:
- Fever OR signs/symptoms of lower respiratory illness (e.g., cough, shortness of breath) in any person, including healthcare workers, who has had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset.
- Fever AND signs/symptoms of lower respiratory illness (e.g., cough, shortness of breath) AND negative influenza test (rapid or PCR) and no other more likely diagnosis.
Prior approval by public health is not
required for commercial lab testing. Clinicians should use their clinical judgement and prioritize testing of patients with more severe respiratory symptoms; patients for whom clinical management would be different if they were infected with COVID-19; patients in high-risk settings (e.g., congregate care settings, long term care)
; and health care workers and first responders.
Patients undergoing testing will be considered a person under investigation (PUI). Providers should give the Person Under Investigation Guidance
) to all patients undergoing testing and ensure patients are aware that they are expected to stay in isolation until results are back and longer if they are positive. Submitters will receive results and should inform patients of result. If the result is positive, further isolation may be required in coordination with the local health department.
Patients seeking medical care should NOT be referred to the NC COVID-19 Call Center or the state epidemiologist on-call line. The Call Center line is intended to provide general information and the epidemiologist on-call line is intended for clinicians and local health departments needing consultation.