Published:  March 25, 2020 at 8:00 PM

Sonoma Public Health continues to work closely with local, state and federal agencies and healthcare partners to monitor COVID-19. At the outset, initial efforts were directed towards containment, which required us to identify cases and test suspect cases as warranted by the Centers for Disease Control and Prevention (CDC) guidance. Now that community spread of COVID-19 is occurring, Sonoma Public Health has changed its response from a containment approach to a mitigation approach. As a service to our providers, this guidance incorporates the latest information/guidance from CDC as well as other sources. As the situation evolves, this guidance may change.

 For more information, call the Sonoma Public Health warm-line at (707) 565-4567.

• Appendix A Management of healthcare personnel with potential exposure or infection with COVID19 (PDF:151 kB)
• Appendix B Home Isolation Suitability Screening (PDF: kB)
• Appendix C Home Isolation (PDF:140 kB)

Testing

Sonoma County Public Health is prioritizing testing for the following groups of people:

Individuals with signs and symptoms (fever not always present) compatible with COVID-19 AND:

1. Hospitalized and significantly ill OR
   
2. Healthcare personnel including first responders with direct contact with patients; OR
   
3. All other first responders (i.e., fire and law enforcement)
   
4. Lives in or works at a long-term care facility; OR
   
5. Is chronically homeless; OR
   
6. Is an inmate or works at a jail or prison.

Contact Sonoma Public Health at 707-565-4566 for testing consultation of individuals that meet the above criteria.  Testing of asymptomatic individuals is not recommended.

Please note: COVID-19 diagnostic testing is now available in commercial and Kaiser laboratories and does not require Public Health approval.  Clinicians can use their clinical judgment to determine whether a patient should be tested for COVID-19, especially those at higher risk of severe illness including older adults, people who have underlying medical conditions such as heart disease, diabetes, lung disease, those who are immune compromised, and pregnant women, those who self-report contact to a case, have traveled in the last 14 days, and anyone who is an essential worker that has multiple interactions with the public during their work duties (i.e. grocery store clerks).   

Specimen collection

CDC revised their guidance on clinical specimens for testing.  CDC recommendations:

March 13, 2020-Recommendation to collect and test a single upper respiratory nasopharyngeal swab (NP).

March 19, 2020-Rcommendation allowance for OP as an acceptable specimen type if NP swabs are not available.

For detailed information, please see:  https://sonomacounty.ca.gov/Health/Public-Health/Laboratory/Novel-Coronavirus/

Management of Healthcare Personnel with Potential COVID-19 Exposure

Now that community spread is occurring in Sonoma County, all healthcare personnel (HCP) are at some risk for exposure to COVID-19, whether in the workplace or in the community. The Centers for Disease Control and Prevention’s (CDC) Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with COVID-19 

( https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html ) outlines work restrictions for HCPs exposed to COVID-19 and should be followed if healthcare facilities are able to function and continue to provide essential services.  Facilities may still choose to restrict HCP with medium and high risk exposures for 14 days after their last exposure.

For situations in which the number of potentially affected healthcare personnel can be large enough to impact facility operations, including providing essential medical and prevention services, CDC has developed alternate guidance for healthcare personnel to return to work following an exposure to COVID-19. The rest of this document addresses this alternate guidance.  For facilities that choose to use the less restrictive work policy for exposed HCP a lower threshold for evaluating HCPs is used in order to quickly identify early symptoms in HCPs to prevent transmission from potentially infectious HCPs The signs and symptoms for HCP assessment are broader than those used for the general public and include, cough, shortness of breath, sore throat or rhinorrhea. Other symptoms that may be considered include fever, muscle aches, nausea, vomiting, diarrhea, abdominal pain, headache or fatigue. 

Home isolation for Health Care Personnel: Exclude from work until at least 3 days (72 hours) have passed  since recovery defined as resolution of fever without the use of fever-reducing medication AND improvement of respiratory symptoms AND at least 7 days have passed since symptoms first appeared. 

NOTE: Clearance using test based method (2 consecutive negative COVID19 tests by NP swab at least 24 hours apart) is required for HCP who work primarily with the elderly in places such as skilled nursing facilities. Please call Sonoma County Disease Control at 707-565-4566 if questions about who needs test based clearance. 

Home isolation guidelines: See appendix C:  Home Isolation

• Healthcare personnel with potential exposure to a COVID-19 case (see Appendix A1 for flowchart)
1. HCP with no symptoms consistent with COVID-19 AND identified as low risk by CDC criteria:
• HCP may return to work as long as they remain asymptomatic.
• HCP should self-monitor for symptoms for 14 days after last exposure.  HCP should ensure they are afebrile and asymptomatic before leaving home and reporting to work.
• The healthcare facility/agency could consider measuring temperature and assessing symptoms prior to each shift.
• If symptoms develop, HCP should remain at home and follow the symptomatic guidance below.
2. HCP with no symptoms consistent with COVID-19 AND identified as medium or high risk by CDC criteria:
• HCP may return to work as long as they remain asymptomatic; AND • HCP must wear surgical mask while at work for 14 days after exposure.
• HCP should self-monitor for symptoms 14 days after last exposure.  HCP should ensure they are afebrile and asymptomatic before leaving home and reporting to work.
• The healthcare facility should evaluate the HCP prior to each shift and at mid-shift by taking the HCP’s temperature and assessing for symptoms.
• If symptoms develop, HCP should remain at home and follow the symptomatic guidance below.
3. HCP with symptoms consistent with COVID-19:
   Consider prioritized testing through Sonoma Public Health. HCP should stay home and self-isolate while symptomatic.
   1. If testing was done and results are negative for COVID-19: \
      • HCP should remain at home while symptomatic.
      • HCP may return to work as soon as their symptoms resolve.
      • HCP must wear a surgical mask while at work for 14 days after last exposure.
      • If the HCP returns to work before 14 days after last exposure:
        • The HCP should continue to self-monitor for symptoms for the duration of the 14 days. HCP should ensure they are afebrile and asymptomatic before leaving home and reporting to work.
        • The healthcare facility should evaluate the HCP prior to each shift and at mid-shift by taking the HCP’s temperature and assessing for symptoms.
        • If new symptoms develop, HCP should remain at home and reconsider testing.
   2. If testing was done and results are positive for COVID-19:
   1. HCP should remain at home for home isolation while symptomatic.

HCP may return to work once the following criteria has been met:Exclude from work until at least 3 days (72 hours) have passed  since recovery defined as resolution of fever without the use of fever-reducing medication AND improvement of respiratory symptoms AND at least 7 days have passed since symptoms first appeared.

• HCP must wear a surgical mask while at work and should be restricted from contact with severely immuno-compromised patients until 14 days after symptom onset or until all symptoms are completely resolved, whichever is longer.
• NOTE: Clearance using test-based method (2 consecutive negative COVID19 tests by NP swab at least 24 hours apart) is required for persons who work primarily with the elderly in places such as skilled nursing facilities. Please call Sonoma County Disease Control at 707-565-4566 if questions about who needs test based clearance.

For the latest CDC guidance, please visit:
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html