Information for Healthcare Professionals
An outbreak of respiratory disease, COVID-19, caused by a novel (new) coronavirus (SARS-CoV-2) that was first detected in China has spread to over 100 locations internationally and many states in the US. Community spread of COVID-19 has been established in Contra Costa County, and it is expected that numbers of cases will continue to increase. Mitigation strategies such as social distancing and isolation of ill individuals will be most effective for control of the spread of COVID-19. Please see the Provider Health Alert for further information on current guidance.
Based on what is currently known about COVID-19, and what is known about other coronaviruses, spread is thought to occur mostly from person-to-person via respiratory droplets. The most common symptoms seen with COVID-19 include cough, fever, and/or shortness of breath. Although the complete clinical picture of COVID-19 is not fully known, reported illnesses have ranged from mild to severe illness and death. Older people and people with underlying health conditions are at highest risk of developing serious COVID-19 illness.
Clinical Criteria: fever (may be subjective) and/or symptoms of acute lower respiratory illness such as cough and shortness of breath.
A nasopharyngeal swab only, placed in viral transport media, is sufficient for testing.
The Contra Costa Public Health Lab will continue to accept specimens for high priority patients. High priority patients are those who are at risk for poor outcomes or may expose vulnerable people, such as:
Persons who LIVE or WORK in CONGREGATE FACILITIES (skilled nursing facilities, board and care, assisted living and other congregate senior living facilities, shelters, group homes, residential treatment programs and facilities, jails) presenting in any setting- hospital or ambulatory;
HOMELESS PERSONS regardless of current status of shelter;
HEALTH CARE WORKERS and FIRST RESPONDERS;
Persons who receive DIALYSIS or CHEMOTHERAPY in clinic settings;
Persons who are HOSPITALIZED.
Please see the Provider Health Alert for the most current information on specimen submission to the Contra Costa Public Health Lab. Ambulatory care patients who are not in a priority group listed above can be tested by sending specimens to a commercial lab.
If a patient presents and is suspected of having COVID-19, or is a confirmed case, proper infection control measures should be put in place immediately:
Place surgical mask on patient and place patient in private room with door closed (optimally, a negative-pressure, airborne isolation room).
Implement all of the infection control procedures listed below for healthcare workers:
Standard precautions AND
Contact precautions (gloves, gown) AND
Airborne precautions (N95 mask or PAPR) AND
Eye protection (face shield or goggles)
CDC provides guidance for management of healthcare workers with potential exposure to COVID-19. Decisions on work exclusion or re-assignment can be made by healthcare facilities depending on staffing needs. Healthcare workers with close or household contacts to a COVID-19 case should review healthcare workers with close contact to a COVID-19 case and follow up with their employer.
Note, if a healthcare worker is diagnosed with COVID-19, they will have to isolate at home for 7 days or for 72 hours after their symptoms resolve (fever has gone away without using a fever-reducing medication like Tylenol or ibuprofen AND your symptoms like cough, body aches, sore throat, have improved), whichever is longer. It is also recommended that they wear a mask until all symptoms resolve or until 14 days after illness onset, whichever is longer; and be restricted from contact with severely immunocompromised patients until after 14 days after illness onset. Please see CDC criteria for return to work for healthcare personnel for further details.
How to Report
When submitting specimens for high priority patients to the Contra Costa Public Health Lab, a COVID-19 Confidential Morbidity Report (COVID-19 CMR, formerly PUI Form) must be submitted with the specimen. No other reporting form is required for these patients. See Provider Health Alert for details on specimen submission.
For patients who are not within the priority group and who have specimens sent to a commercial, lab please fax a completed COVID-19 CMR to 925-313-6465, if the results are positive.
If a patient has mild symptoms not requiring medical care, healthcare providers may instruct the patient to stay at home and only seek medical attention if symptoms worsen. If a patient is tested for COVID-19, but does not require hospitalization, he/she may be discharged home with instructions to isolate at home while awaiting results. Please provide patients with Home Quarantine Instructions I Spanish.
If a hospitalized patient has confirmed COVID-19, but no longer requires inpatient care and is still potentially infections, they may be discharged to home under home isolation. Please fax a COVID-19 Case Discharge Form to 925-313-6465 for CCPH tracking purposes.
It is the responsibility of the ordering provider to inform patients of their test results and to give instruction regarding home isolation. If tests results are positive or if there is a high suspicion that the patient has COVID-19 but was not tested (e.g. a contact with a known case with compatible symptoms), the patient should be informed to continue to home isolate for at least 7 days after symptoms onset or 72 hours after symptoms resolution (returned to baseline with no fever, myalgia, or shortness of breath), whichever is longer. Due to the large volume of cases, CCPH may have to limit public health follow up to high priority patients only.
There is no currently FDA approved treatment for COVID-19 outside of supportive care. Corticosteroids should be avoided, unless indicated for other reasons such as asthma or COPD exacerbation due to the potential for prolonging viral replication as has been observed in patients with MERS-CoV.
The antiviral drug Remdesivir is available for compassionate use for confirmed COVID-19 patients who have severe disease, are hospitalized, and are being mechanically ventilated. Additional information is available at https://rdvcu.gilead.com.
For additional information on clinical management of COVID-19, see CDC guidance.
Mitigation strategies such as social distancing and isolation of ill individuals will be most effective for containing the spread of COVID-19. Patients should be instructed to practice social distancing, stay home if sick, wash hands frequently, and to avoid touching their face.
Additionally, individuals such as older adults (age ≥ 65 years) and those with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease), should be advised to stock up on supplies and prescriptions, avoid large crowds as much as possible, avoid contact with ill persons, avoid non-essential air travel and cruises, and stay home as much as possible to reduce the risk of being exposed.
Preventive measures should also be taken for all clinical settings, including dental clinics, to decrease the chance of spread. Staff should be monitored for symptoms, and be instructed to stay home if sick. Additionally, practices should implement alternatives to face-to-face triage and visits; consider designating an area of the facility (e.g. an ancillary building or temporary structure) as a location for initial evaluation of patients who present with fever or respiratory symptoms; cancel group healthcare activities (e.g., group therapy, recreational activities); and postpone elective procedures, surgeries, and non-urgent outpatient visits. See more information on actions that can be taken for healthcare facilities.
For dental practices, it is also important that measures are taken to decrease spread of COVID-19. Patients should be allowed to access dental care, if needed, but considerations should be taken to reschedule non-urgent appointments such as dental cleaning. Additionally, it is up to dental practices to monitor staff for any symptoms, and to have staff who are sick remain home. Practices should also screen all patients for symptoms (fever, cough, shortness of breath) prior to them being seen, and reschedule any appointments with sick patients.
Forms & Info for Providers