Health Alert

Summary

• A Fairfax Health District resident has been identified as a presumptive positive COVID-19 case based on testing at the Virginia state laboratory; confirmation by CDC is pending. The patient is Fairfax City resident in their 80s who traveled internationally. The patient developed respiratory symptoms on February 28 and was hospitalized on March 5.
• An additional Northern Virginia presumptive positive case is a Marine stationed at Marine Corps Base Quantico who is hospitalized at Fort Belvoir. The patient was also hospitalized on March 5.
• The number of close contacts of the case-patients who would be at risk for infection is limited; the risk of COVID-19 to the general public in Fairfax Health District is still considered low at this time.
• Local COVID-19 cases also have been identified Maryland and Washington DC.
• CDC’s updated guidance for persons under investigation allows expanded COVID-19 testing for all patients in whom clinicians suspect COVID-19 (see below).
• Commercial testing for COVID-19 is available from LabCorp and is projected to be available from Quest on 3/9/20. 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 703-409-8449.
• The availability of testing at commercial laboratories remains limited at this time. Public health testing at the Virginia state lab can be approved by FCHD based on the likelihood of infection (clinical picture and epidemiological risk factors). Criteria for testing at the public health lab are described below and can be found online.
• FCHD does not provide primary care and is not equipped to evaluate and test patients. If there are barriers to obtaining testing in your practice, please call FCHD at 703-409-8449 to discuss options.
• Further alerts will be shared as the case investigation proceeds and if testing guidance changes.

SUGGESTED ACTIONS:

• 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):
  • Assess and triage patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and isolating them in an Airborne Infection Isolation Room (AIIR), if available, or a room with a closed door.
  • Use recommended PPE, including an N95 respirator, goggles or face shield, gown and gloves.
  • Perform hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves.
  • Practice how to properly don, use and doff PPE in a manner to prevent self-contamination.
  • Perform aerosol-generating procedures, including collection of diagnostic respiratory specimens, in an AIIR, while following appropriate IPC practices, including use of appropriate PPE.
• 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 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.
• Virginia Department of Health criteria for testing at the Virginia State lab include persons with:
  • Fever OR signs/symptoms of lower respiratory illness AND close contact with a confirmed COVID-19 patient within the previous 14 days.
  • Fever AND signs/symptoms of lower respiratory illness AND tested negative for influenza AND a history of travel to a county with a Level 2 or 3 Travel Advisory/Warning or an area with confirmed ongoing community transmission within the previous 14 days.
  • Fever OR signs/symptoms of lower respiratory illness AND tested negative for influenza AND had a negative viral respiratory panel AND no alternative explanation for their illness AND a history of residing in a nursing home or long-term care facility within 14 days.
• Three specimens need be collected, stored and shipped at 4°C (for public health testing):
  • Upper respiratory tract specimens (nasopharyngeal (NP) swab AND oropharyngeal (OP) swab in separate vials of VTM or 2-3 mL nasopharyngeal wash/aspirate or 2-3 mL nasal aspirate).
  • Lower respiratory tract specimen if possible (sputum or 2-3mL bronchoalveolar lavage or tracheal aspirate); note that sputum should not be induced.

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.

¹Close 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)

²Affected 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.