Published: April 30, 2020 at 11:30 AM
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.
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:
- Hospitalized and significantly ill OR
- Healthcare personnel
including first responders with direct contact with patients; OR
- All other first responders
(i.e., fire and law enforcement)
- Lives in or works at a long-term
care facility; OR
chronically homeless OR
- 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 10 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)
- 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.
- 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.
- HCP with no symptoms consistent
with COVID-19 who test positive may
discontinue isolation and return to work when 10 days have passed since the
date of their positive COVID -19 test (using date of collection) assuming they
have not developed symptoms since their positive test.
- HCP with symptoms consistent
with COVID-19:
Consider
prioritized testing through Sonoma Public Health. HCP should stay home and
self-isolate while symptomatic.
di) 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.
dii) If testing was done and results are positive for COVID-19:
-
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 10 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:
http://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html