Oregon continues to identify community-acquired cases of COVID-19 and reported the first COVID-19 related death in the state on 3/14/20; full results are on the OHA Coronavirus website.
Regional and statewide supplies of disposable personal protective equipment (PPE) including eye protection, gloves, gowns and masks may be depleted in approximately 2 weeks. We do not know when supplies will be replenished.
Major health systems in the Portland metro area are coordinating their response to an expected surge in patients needing hospital-level care. Based on early modeling, a surge could begin in the next 1-2 weeks.
Infection Prevention
Please review Oregon Health Authority Infection Prevention recommendations here. Practice proactive infection prevention through phone triage and providing masks to patients with respiratory symptoms if they arrive unannounced.
Testing
The lack of widely available, prompt, testing remains a major frustration and challenge. More capacity is on the horizon but additional issues related to the availability of collection supplies will persist. Clinicians should know that test results are also reported to state and local health officials BUT individual follow up with cases may be limited as reports increase. Patients will get a follow-up letter with instructions for self-isolation and recommendations on when to seek in-person care. When testing becomes more widely available, surveillance for disease in the community will expand. Non-traditional testing including ‘drive-through’ options may emerge as local testing capacity expands.
Testing at the State lab
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Testing remains limited to approximately 80 tests per day at the Oregon State Public Health Lab (OSPHL); consequently this resource is limited to specific public health investigations and hospitalized viral pneumonia patients with a negative flu test.
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Requests for testing at OSPHL do not require public health approval but a completed online form. The OSPHL virology form MUST accompany the specimen; state officials will review the form to prioritize testing.
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A single NP swab (or a nasal wash/aspirate) is acceptable for testing; lower respiratory specimens (sputum or tracheal aspirate) will have higher sensitivity. Provisionally, NP swab and nasal wash collection are NOT considered an aerosol generating procedure in Oregon.
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High risk symptomatic individuals who are not hospitalized may be tested with Oregon Health Authority approval at OSPHL via the same electronic links above.
Testing at commercial labs
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Commercial lab testing is now available without restriction by at least three labs: LabCorp, Quest Diagnostics and University of Washington Virology; results will go to the provider and public health agencies. Contact these vendors directly for details.
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Until capacity increases, we urge providers to limit testing of out-patients to symptomatic individuals to the following groups:
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Health care providers, regardless of known exposure to COVID-19.
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Symptomatic residents of a site at high risk for spread: long term care facilities, shelters, or corrections.
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Symptomatic patients at high risk for complications because of age or underlying medical condition
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Public Health strongly discourages testing of asymptomatic individuals since such low risk testing will delay results for more urgent situations.
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If patients know they have been exposed, please counsel to self-quarantine with symptom watch for 14 days
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We are asking you to
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Increase telephone or virtual health visits for all patients who do not require in-person evaluation including those with mild respiratory symptoms.
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OHA has updated guidance for phone visit billing for medicaid members, have your business officer review this link and see text appended below to this summary. Sign up here for OHA COVID Alerts for Providers that includes billing information
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Telehealth is an excellent role for licensed providers who are themselves in high risk categories (over age 60 or underlying medical conditions).
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Please be clear with patients that there is no way to differentiate between respiratory viruses without testing, but that testing is not indicated as long as they are able to isolate at home.
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Cancel non-essential medical and dental appointments that require any type of PPE.
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Continue to promote influenza vaccine since the season has not ended.
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For any ill individuals (without COVID-19 diagnosis or high risk exposure) who can safely stay at home, please recommend they stay home until they are well for at least 24 hours to prevent avoidable exposures to others. Make sure they know what to do if their symptoms get worse.
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For individuals with suspected or confirmed COVID-19 illness who can recover at home, recommend isolation until 7 days from positive test or 72 hours after resolution of fever and symptoms--whichever is longer. Make sure they know what to do if their symptoms get worse.
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Make sure your patients over 60 or who have underlying medical conditions are aware of CDC guidance recommending avoiding crowds and staying home while COVID-19 circulates in the community.
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Report exposures of concern to your facility infection prevention lead or person-in-charge.
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All OHP members are encouraged to sign up for mail order pharmacy delivery with 90 day supplies
Public Health 27-hour numbers
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Clackamas County Public Health: 503-655-8411
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Clark County Public Health: 564-397-8182
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Multnomah County Public Health: 503-988-3406
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Washington County Public Health: 503-846-3594
