Clinician Alert: Updated guidance issued Feb. 28 on COVID-19

February 29, 2020

Issued Feb. 28, 2020

This alert has updates on CDC criteria for testing for COVID-19, including local updated criteria of Clackamas County school exposure considered as a “close contact.”

Updated Criteria for a COVID-19 Person Under Investigation (PUI) as of 2/28/2020:

  1. Fever OR signs/symptoms of lower respiratory illness* AND close contact with a laboratory-confirmed case of COVID-19 within 14 days of symptom onset (for now, this includes enrollment or employment at Forest Hills Elementary School)
  2. Fever AND signs/symptoms of lower respiratory illness requiring hospitalization AND a history of travel from affected geographic areas** within 14 days of symptom onset
  3. Fever with severe acute lower respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization and without alternative explanatory diagnosis (e.g., influenza) AND no source of exposure has been identified.

Lower respiratory illness includes cough or shortness of breath.

Affected geographic areas include China, Iran, Italy, Japan, and South Korea.

Background

Oregon Health Authority has confirmed Oregon’s first, presumptive case of novel coronavirus infection, COVID-19. We are awaiting confirmation from CDC, but at this time we are considering this a presumptive case. Details can be found in the OHA press release linked here.

The case had neither a history of travel to a country where the virus was circulating, nor is known to have had  close contact with another confirmed case. Public health officials are considering it a likely community-transmitted case, meaning that the source of the infection is unknown.

Public health has been identifying contacts and recommending voluntary home isolation for close contacts. There appear to be few close contacts at the school. 

Out of an abundance of caution, the school has decided to suspend activities until 14 days after the case last worked there.

School employees, students, and their parents are likely to be concerned. 

We recommend that persons who think they might have been exposed:

  • Stay home at the first sign of illness.

  • Take care of mild symptoms at home. Mild illness in the setting of possible exposure is not a reason to seek medical care.

  • For symptoms like fever or cough that are severe or cannot be managed at home, call their health-care provider. 

  • Health care providers should use routine clinical judgment as to whether they need to be seen. Those with mild illness can continue home care. 

  • Those that need an evaluation should have an entry plan ahead of time that avoids exposing others.  

If you deem testing for COVID-19 appropriate, please call the local public health authority for the county in which they reside. If you can obtain a nasopharyngeal or oropharyngeal specimen (preferably both), we will test at OSPHL in the interest of better characterizing the spread of the disease if meets the above criteria. CDC guidance on specimen testing.

Healthcare Infection Control

CDC recommends standard, contact, and airborne precautions with eye protection for health care workers evaluating a possible case of 2019-nCoV.   When possible, use phone triage and assessment to do a detailed travel history and determine if patients who might have 2019-nCoV need to be seen in-person.

Follow guidance from your internal infection control practitioners which may include the following: 

  • If a person with possible 2019-nCoV arrives unexpectedly, mask the patient and room promptly

  • If the patient is already in the clinic/waiting room, mask and room them immediately 

  • If possible, schedule possible 2019-nCoV patients as the last patient of the day.

  • If feasible, consider patient evaluation outdoors at least 30 feet away from others. Once patient is masked, escort patient into the building for rooming.

  • If possible, suspected 2019-nCoV patients should be escorted into the building via an entrance that allows them to access an exam room without exposing others. 

  • Minimize the number of health care workers interacting with the patient; caregivers should follow CDC guidance, which includes an N-95 mask or higher level of respiratory protection.

  • Use a negative pressure room if available; regardless keep exam room door closed.

  • Perform all labs and clinical interventions in the exam room if possible.

  • The exam room should not be used for at least 1 hour until after the patient has left. It should be terminally cleaned before using again.

  • Patients who are under evaluation for 2019-nCoV may isolate at home if they are not sick enough to be admitted. See CDC guidance for home care.

  • Report possible cases to the county health department:

  • Clackamas County Public Health: 503-655-8411

  • Clark County Public Health: 564-397-8182

  • Multnomah County Public Health: 503-988-3406

  • Washington County Public Health: 503-846-3594

Learn More

CDC Evaluating and Monitoring Persons Under Investigation: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

OHA COVID-19 Updates: healthoregon.org/coronavirus