Health Alert

SUMMARY

• COVID-19 commercial testing capabilities have been rapidly changing over the past week; PCR testing is now available for healthcare providers through LabCorp and Quest Diagnostics. Testing through Mayo Clinic, UVA and VCU is currently under development.
• Fairfax County Health Department (FCHD) works with the Virginia Department of Health (VDH) to approve COVID-19 testing done at the VDH lab. Testing at the public health lab is prioritized to those who are deemed at highest risk for infection/transmission, such as symptomatic contacts to a confirmed case, symptomatic individuals who are long-term care facility residents, and healthcare providers. Healthcare providers that believe they have a patient that meets high risk criteria should call 703-246-2433 to discuss public health testing options.
• FCHD does not assess patients or collect specimens for COVID-19 testing. Patients who have symptoms of COVID-19 may need a medical evaluation which is best performed by a primary care provider.
• COVID-19 testing is commercially available and health care providers should rely on commercial labs for patients who do not fall into a group where Health Department investigation and prioritization is being done.
• Providers testing commercially will need to collect specimens as commercial labs will not collect specimens at this time.
• Healthcare providers who are unable to safely collect specimens (see guidance below) or do not have access to commercial labs currently offering testing are responsible for reaching out to their affiliated healthcare facilities to find an appropriate testing location for their patient.

SUGGESTED ACTIONS

• Providers should use their judgment to determine if a patient should be tested. Factors to consider include whether the patient has signs and symptoms compatible with COVID-19, the clinical course of illness, potential exposures, and the local epidemiology of COVID-19.
  • Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing).
  • Providers are strongly encouraged to test for other causes of respiratory illness, such as influenza, before testing for COVID-19.
• Healthcare personnel caring for patients with confirmed or possible COVID-19 should adhere to CDC recommendations for infection prevention and control (https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html).
• At this time, current recommendations for collecting COVID-19 specimens include placing the patient in a single-person room with the door closed. The healthcare provider collecting the specimen should wear an N95 respirator, a face shield or goggles, gown, and gloves. If an N95 respirator is not available, a facemask can be used for respiratory protection.
• All patients who are tested for COVID-19 (commercially and through public health) should be told to stay at home and away from others until they receive test results back. Further public health guidance will be provided if the lab result is positive.
  • Household contacts to the tested patient should be advised to remain alert for subjective fever, cough, or difficulty breathing. If they feel feverish or develop cough or difficulty breathing during the self observation period, they should take their temperature, self-isolate, limit contact with others, and seek advice by telephone from a healthcare provider or their local health department to determine whether medical evaluation is needed.
• Patients that are referred for commercial testing at another facility should call ahead to identify themselves as a suspect COVID-19 patient.
• COVID-19 is a rapidly reportable condition in Virginia. Healthcare providers are legally required to report all test positive cases to the local health department immediately. To report a positive result, immediately call the Fairfax County Health Department (FCHD) at 703-246-2433.

CDC PUI FOR COVID-19

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html

Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness.

Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g.,cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza.

Epidemiologic factors that may help guide decisions on whether to test include: any persons, including healthcare workers, who have had close contact¹ with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset, or a history of travel from affected geographic areas² within 14 days of symptom onset.

¹ Close contact is defined as being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case or having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)
² Affected areas are defined as geographic regions where sustained community transmission has been identified. Relevant affected areas will be defined as a country with at least a CDC Level 2 Travel Health Notice.