Guidance on Screening and Testing for COVID 19

COVID-19 (novel coronavirus) testing in Utah is now available but remains limited at this time. The Centers for Disease Control and Prevention (CDC) recommends that testing be focused on patients with high epidemiologic risk, a syndrome compatible with COVID-19 and cases with important public and healthcare impact. This new guidance (March 7th, 2020) gives specific direction to physicians and clinicians regarding appropriate screening, isolation and selection of patients for testing for COVID-19.

 

COVID-19 (Novel Coronavirus) Personal Protective Equipment (PPE) Resources:

Patients at Home

Patients with mild symptoms are encouraged to avoid healthcare facilities, treat symptomatically, and if needed, access Intermountain Connect Care providers who can evaluate for COVID-19 and give advice about additional care:

Patients at Intermountain Facilities: Screening for COVID-19

  • On arrival, all patients should undergo screening to determine if they are at high risk of COVID-19:
  • Fever, cough or dyspnea (shortness of breath) and
    1. Contact with a confirmed case of COVID-19 or a person under investigation (PUI) (e.g. test is pending) or
    2. History of travel (within 14 days of symptom onset) to highest-risk geographic areas (areas of active transmission are rapidly evolving and there are other areas that may also pose some risk; please take a good travel history and discuss any concerning travel with the COVID-19 Hotline (1-800-456-7707))

For patients presenting to care facilities with fever, cough or dyspnea (shortness of breath), assess Epidemiologic Risk:

Isolation, Clinical Evaluation and COVID-19 Testing

  1. High Risk of COVID-19
    • These patients require testing. Follow isolation guidance below and contact the UDOH COVID-19 Hotline (1-800-456-7707).
    • Promptly place patient in a procedure mask and negative pressure if available, or a private room if negative pressure is unavailable.
    • Caregivers should use Airborne-Contact protective personal equipment (PPE), including PAPR (preferred) or fit-tested N95 plus eye protection, plus a gown and gloves.
    • Take a detailed travel and exposure history and clinical assessment, with consideration for features unique to COVID-19.
    • Contact the UDOH COVID-19 Hotline (1-800-456-7707) to coordinate testing and home isolation. See the CDC’s guidelines for testing here.
    • Once the decision to test for COVID-19 has been made, these patients are classified as Persons-Under-Investigation (PUI); please fill out a PUI form and confirm isolation instructions from UDOH to provide the patient.
    • Outpatient and Admission Decisions:
      • For PUI in Outpatient clinics or Emergency Departments who do not require hospital admission, obtain swabs for COVID-19 testing, complete appropriate medical evaluation for other conditions if needed, (for example if they would qualify for antivirals if influenza positive) and prepare for discharge to home with the following safeguards:
        • Confirm self-isolation instructions from UDOH and
        • Instruct the patient to download the Connect Care app and to check in within 24 hours.
      • For PUI meeting clinical criteria for hospital admission, please call Transfer Center to coordinate bed placement and inpatient consultation
        • Admission decisions for PUI should take into account risk factors for poor prognosis: Age>60, dyspnea/hypoxia and medical comorbidities.
  2. Variable Risk of COVID-19
    • Patients in this category may have other important clinical and/or epidemiologic features not included in the High Risk category, such as:
      • Travel to or exposure to patients from areas of evolving COVID-19 transmission.
      • Lower respiratory symptoms that overlap with COVID-19, such as fever, cough or dyspnea. Note that upper respiratory symptoms are uncommon with COVID-19.
    • Variable Risk patients should be placed in a surgical mask and providers should use Droplet-Contact PPE: surgical mask, eye protection, gloves and gown, unless another diagnosis requires a higher level of precaution.
    • Providers are encouraged to use their clinical judgment to 1) conduct work-up for other diagnoses, 2) clarify risk for COVID-19, and 3) determine if COVID-19 testing is appropriate.
    • CDC guidelines encourage providers to consider features unique to COVID-19
    • Flu PCR may now be performed in clinics using strict precautions
    • If needed, a “COVID CT Protocol” is now available in Imaging Departments
  3. Decision Making
    • If an alternative diagnosis is identified, or if epidemiologic risk is deemed less likely after a thorough evaluation, proceed with routine clinical care for these patients using appropriate precautions for their diagnosis.
    • If after evaluation, a patient is determined to be at high risk of COVID-19, providers should call UDOH to coordinate testing for COVID-19. Patients undergoing testing are considered PUI.
    • Please note that the CDC recommends upgrading to airborne isolation to collect samples for COVID-19 testing.
    • See section 1 for additional guidance regarding PUI
  4. Low/Minimal Risk
    • Patients with no epidemiologic risk and symptoms consistent with an alternative diagnosis are considered Low/Minimal
    • Follow appropriate precautions and best-practice clinical management of these patients.

NOTE: This is a rapidly changing situation. Please visit the CDC for the most current clinical guidelines for healthcare professionals.

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