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 all 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 the highest risk of developing serious COVID-19 illness.
Fever (may be subjective) or symptoms of acute lower respiratory illness such as cough and shortness of breath. Patients may also present with unusual symptoms such as fatigue, chills, myalgias, headache, sore throat, new loss of taste or smell, vomiting, nausea, or diarrhea. In addition to these symptoms, elderly patients may present with weakness, confusion, dizziness, or a subtle change from their baseline.
Acceptable testing specimens include a nasopharyngeal (NP) or oropharyngeal (OP) swab collected by a healthcare provider OR nasal mid-turbinate ar anterior nares swab collected by a healthcare provider or by a supervised onsite self-collection placed in viral transport media.
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 testing. Ambulatory care patients who are in the priority group listed above, but can get expedited testing in 24 hours or less, or are not within the priority groups, can be tested by sending specimens to a commercial or health system lab.
Serological testing for SARS COV 2 has become available through the FDA Emergency Use Authorization (EUA), and many unauthorized serology tests are also available. Please be aware that at this time, serology testing must not be used for the diagnosis of acute COVID-19 infection. The only tests which are authorized for use in the diagnosis of COVID-19 are nucleic acid amplification tests, such as PCR.
With increased testing capacity providers should test all symptomatic patients with concern for COVID-19. Please see this health officer letter for information on testing priorities with increasing testing capacity. Additionally, with the continued expansion of testing capacity, widespread testing of asymptomatic individuals is encouraged to detect asymptomatic infection, and prevent the spread of COVID-19. Please review the interim guidelines for prioritizing asymptomatic testing for more information.
Additionally, testing should be done in congregate care facilities per the health officer order requiring testing of residents and healthcare personal of certain residential care facilities.
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 the 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 10 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. Additionally, when submitting a specimen to the Contra Costa Public health lab you must also submit a Lab Requisition Form. 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 Isolation Instructions for Persons Under Investigation |Spanish.
It is the responsibility of the ordering provider to inform patients of their test results and to give instruction regarding home isolation to patients and home quarantine to close contacts. For patients who test positive, please provide patients with Home Isolation Instructions I Spanish for themselves, and Home Quarantine Instructions I Spanish for their close contacts. A close contact is defined as anyone who was within 6 feet of a person with COVID-19, while they were considered infectious, for 15 minutes or longer. A person is considered infectious from 48 hours before his or her symptoms began (or, in the absence of symptoms, from 48 hours before the date of the test) and until the patient is cleared of their infection as noted in the clearance section. Isolation and quarantine instructions are also available in multiple languages. Patients should also be given a copy of Health Order: Mass Quarantine Order|Spanish for their close contacts, and a copy of Health Order: Mass Isolation Order|Spanish for the patient when testing takes place.
If a hospitalized patient has confirmed COVID-19, but no longer requires inpatient care and is still potentially infectious, 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.
On May 14, 2020, the U.S. Centers for Disease Control and Prevention (CDC) issued a health alert regarding children with signs and symptoms of a severe multisystem inflammatory syndrome (MIS-C) potentially associated with SARS-CoV-2 infection. Cases presenting with features resembling Kawasaki disease or toxic shock syndrome have been reported in Italy, the United Kingdom, New York City and other locations in the United States, including California. Please see the Provider Alert Multi-System Inflammatory Syndrome.
Ending Isolation for Patients with Confirmed or Suspected Infection
For most patients with confirmed or suspected COVID-19, isolation can be discontinued at least 10 days after symptoms onset, or for 72 hours after symptoms resolve (fever has gone away without using a fever-reducing medication like Tylenol or ibuprofen AND their symptoms like cough, body aches, sore throat, have improved), whichever is longer.
For patients who were asymptomatic at the time of testing, they should remain in isolation for 10 days from the date the test was performed. Patients should also monitor themselves for symptoms. If any symptoms develop during this time, they should remain isolated until 72 hours after symptom resolution, as noted above.
Given that hospitalized patients and severely immunocompromised patients (e.g., medical treatment with immunosuppressive drugs, bone marrow or solid organ transplant recipients, inherited immunodeficiency, poorly controlled HIV) may have longer periods of SARS-CoV-2 RNA detection compared to patients with mild or moderate disease, patients who were hospitalized with COVID-19 or are severely immune-compromised should be instructed to remain isolated for at least 14 days or for 72 hours after their symptoms resolve (fever has gone away without using a fever-reducing medication like Tylenol or ibuprofen AND their symptoms like cough, body aches, sore throat, have improved), whichever is longer.
Additionally, patients returning to long-term care facilities or assisted living facilities may be in close contact with individuals at risk for severe disease. Given this, these patients should also be instructed to remain in isolation for at least 14 days or for 72 hours after their symptoms resolve (fever has gone away without using a fever-reducing medication like Tylenol or ibuprofen AND their symptoms like cough, body aches, sore throat, have improved), whichever is longer. For patients who remain in a skilled nursing facility, once they have met criteria for discontinuation of transmission-based precautions universal source control and enhanced standard precautions are recommended. For other long-term care facilities, once patients have met criteria for discontinuation of transmission-based precautions, they may return to standard precautions for their facility with the addition of universal source control and other recommendations per the health officer order for residential care facilities.
Note: Any patient who has confirmed COVID-19 that needs to enter a healthcare facility within 14 days of symptom onset, or before the required 72 hours after symptom resolution has elapsed, should wear a mask at all times while in the facility. In addition, staff should wear all required personal protective equipment (PPE) while caring for the patient.
There is no current 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 use of investigational therapies for treatment of COVID-19 should ideally be done in the context of enrollment in randomized controlled trials. For the latest information, see Information for Clinicians on Therapeutic Options for COVID-19 Patients. For the information on registered trials in the U.S., see ClinicalTrials.gov.
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 faces.
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 the 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
Provider Health Alerts, Health Orders, Newsletters and Health Officer Letters
COVID-19 Connection Newsletter - 6/1/2020
Provider Health Alert Update - 4/24/2020
Information for Healthcare Workers
Information for Congregate Living Facilities, SNFs, and Persons Experiencing Homelessness
Forms for Reporting and Labs
COVID-19 Confidential Morbidity Report (CMR) Form - 5/18/2020