3.26 Novel Coronavirus Health Alert COVID 19 03-26-20

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HEALTH ADVISORY: Updated Guidance for COVID-19

March 26, 2020

Background
The United States and Texas are experiencing the spread of the novel coronavirus, SARS-CoV-2,
which causes the disease COVID-19. Widespread transmission is expected. Healthcare professionals
are essential for the evaluation of patients who may be ill with COVID-19 or who may have been
exposed to the COVID-19 virus. This advisory provides guidance for healthcare providers on
community exposures, testing criteria, infection control, and disease reporting.

Community Exposures:
Given community transmission of COVID-19, the San Antonio Metropolitan Health District (Metro
Health) recommends members of the general public who have a low-risk exposure to COVID-19, and
who have no symptoms, do not need to self-quarantine. They can work if they are essential
personnel and should monitor their temperatures twice a day and self-isolate if they develop a fever
or symptoms. Please see “Interim US Guidance for Risk Assessment and Public Health
Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposures:
Geographic Risk and Contacts of Laboratory-confirmed Cases,” updated by the Centers for
Disease Control & Prevention (CDC) on March 22, 2020, and linked here.

People who are mildly ill (fever and/or cough only) are asked to stay home until their symptoms have
completely resolved and are fever-free for 72 hours without the use of fever-reducing medications
and at least 7 days have passed from the illness onset. See “Discontinuation of Home Isolation
for Persons with COVID-19 (Interim Guidance),” updated by the CDC, March 16, 2020, and
accessible here.

All household contacts of an individual diagnosed with COVID-19 are considered as high-risk
exposure. Individuals that had prolonged close contact with an individual diagnosed with COVID-19
are considered medium-risk exposure. High- and medium-risk exposures will be contacted by Metro
Health and instructed to self-quarantine for 14 days. Low-risk is defined as being in the same indoor
environment (e.g., a classroom, a hospital waiting room) as a person with symptomatic laboratory-
confirmed COVID-19 for a prolonged period but not meeting the definition of close contact. Anyone
who has not been contacted by Metro Health has at most a low-risk exposure. Because of community
transmission, everyone going out in public is at low risk for exposure to COVID-19—this is why social
distancing is critical at this phase in the pandemic. This is also, why the general public is asked to
Stay Home, Work Safe through April 9.

Healthcare Providers and Exposures:


Health care providers (HCP) who had prolonged exposure to COVID-19 should continue to self-
quarantine for 14 days. See “Interim U.S. Guidance for Risk Assessment and Public Health
Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to
Patients with Coronavirus Disease (COVID-19),” updated March 7, 2020, by the CDC. You can
reference this guidance here.

Facilities could consider allowing asymptomatic HCP who have had an exposure to a COVID-19
patient to continue to work after options to improve staffing have been exhausted and in consultation
with their occupational health program. These HCP should still report temperature and absence of
symptoms each day prior to starting work and monitor their temperature in the middle of their shift
to ensure symptoms do not develop. Facilities could have exposed HCP wear a facemask while at
work for the 14 days after the exposure event if there is a sufficient supply of facemasks. If HCP
develop even mild symptoms consistent with COVID-19, they must cease patient care activities, don
a facemask (if not already wearing), and notify their supervisor or occupational health services prior
to leaving work.

Health care providers with any symptoms of COVID-19, regardless of whether an exposure is known
or not, should stay home from work. This includes body aches after all other symptoms of an upper
respiratory infection have resolved.

COVID-19 Testing Priorities:


CDC has updated the testing priorities on March 24, 2020. Please see “Evaluating and Testing
Persons for Coronavirus Disease 2019 (COVID-19)” here.

Based on local community transmission of COVID-19 infections in our jurisdiction, Metro Health will
utilize the following priorities for testing:
PRIORITY 1
Ensure optimal care options for all hospitalized patients, lessen the risk of nosocomial
infections, and maintain the integrity of the healthcare system
• Hospitalized patients
• Symptomatic healthcare workers
• First responders with symptoms
• Symptomatic staff working in high-risk congregate settings (i.e. correctional facilities, homeless
shelters)
PRIORITY 2
Ensure that those who are at highest risk of complication of infection are rapidly identified and
appropriately triaged
• Patients in long-term care facilities with symptoms
• Patients 65 years of age and older with symptoms
• Patients with underlying conditions with symptoms
• Critical infrastructure workers with symptoms (i.e. SAWS, CPS energy, airport, VIA)
PRIORITY 3
As resources allow, test individuals in the surrounding community of rapidly increasing hospital
cases to decrease community spread, and ensure health of essential workers
• Individuals who do not meet any of the above categories with symptoms
• Health care workers and first responders
• Individuals with mild symptoms in communities experiencing high COVID-19 hospitalizations
NON-PRIORITY
• Individuals without symptoms

Infection Control Including Personal Protective Equipment (PPE):


PPE is in critical demand. The CDC has guidance on optimizing your PPE supply and the guidance can
be found at www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html. Given the current
limited availability of PPE, the following guidelines have been developed after review of the CDC
guidance documents at https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-
recommendations.html#adhere.

Reporting of Cases:
As a reminder, all suspected cases are to be reported to the local health department. Please submit
the lab results, demographics, and clinical progress notes via fax to:

San Antonio Metropolitan Health District


Epidemiology Program
Phone: (210) 207-8876
Fax: (210) 207-8807

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