Sonoma County COVID-19 Management of Patients - Updated Guidance
Published: April 30, 2020
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.
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); OR
- 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) 565-4566for 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).
Management of Patients with Potential COVID-19 Exposure
Considering that community spread is occurring and it is not feasible to identify all people with COVID-19 infections or to identify all potentially exposed individuals, Sonoma Public Health is recommending the following for the management of patients with respiratory symptoms:
Additional Considerations and Personal Protective Equipment (PPE):
- Implement proper precautions, including rapid and safe triage and isolation, for patients with respiratory symptoms.
- Postpone elective procedures, surgeries and non-urgent outpatient visits.
- Explore alternatives to face-to-face triage and visits (e.g. telemedicine).
- Designate an area at the facility or identify a location in the area to be a “respiratory virus evaluation center” where patients with fever or respiratory symptoms can seek evaluation and care.
- Symptomatic patients seeking medical care should be given a surgical mask for source control upon entry into the healthcare facility.
- For aerosol-generating procedures, N-95 respirator, gloves, gown and eye protection are recommended for HCPs present in the room.
Patient Placement and Management
Home isolation information: See appendix B: Home Isolation
*Discontinuation of home isolation for patients (not HCP): Patients should stay home for 10 days after symptom onset AND 3 days (72 hours) after resolution of fever without the use of fever reducing medication, whichever is longer. Asymptomatic patients who have tested positive for COVID-19 may discontinue home isolation when 10 days have passed since the date of their positive test and have had no subsequent illness.
Patients who are ill with respiratory symptoms consistent with COVID-19, regardless of known exposure to a confirmed COVID-19 case:
- If patients have mild symptoms that can be managed without hospitalization:
- Advise patients to stay home and self-isolate. Patients should remain on home isolation until discontinuation of home isolation criteria* is met.
- Advise patients to monitor for worsening symptoms and to seek further medical care if warranted. Advise patients to call your office prior to coming to your medical office.
- Patients with laboratory confirmed COVID-19 should remain on home isolation until discontinuation of home isolation criteria* is met.
- If patients have severe illness that requires hospitalization:
- Place a patient with known or suspected COVID-19 in a single room with the door closed. The patient should have a dedicated bathroom
- AIIRs should be reserved for patients who will be undergoing aerosol-generating procedures.
- Healthcare facilities may consider designating an entire unit to care for known or suspected COVID-19 patients, with dedicated HCPs (i.e. HCPs are assigned to care for these patients during their shift).
Patients that were not tested, have pending laboratory results or were positive for COVID-19 should be placed on transmission-based precautions (for hospitalized patients) or on home isolation (for non-hospitalized patients). Patients that tested negative for COVID-19 can be taken out of transmission-based precautions.
Report any positive COVID-19 lab results to Sonoma County Public Health IMMEDIATELY by calling (707) 565-4566.
Discharge of Hospitalized Individuals with Potential COVID-19 Exposure
Below are recommendations from Sonoma Public Health on discharge of hospitalized individuals with potential exposure to COVID-19:
- For hospitalized patients that test negative for COVID-19, the patient can be discharged home when clinically indicated.
- For hospitalized patients who are clinically stable to be discharged home but whose test results are still pending:
- The patient should be under home isolation. The patient and the patient’s home should be assessed by the healthcare facility in consultation with public health for suitability for home isolation (See Appendix A for assessment template).
- For hospitalized patients who are clinically stable to be discharged home and whose test result is positive
- The patient should be under home isolation. The patient and the patient’s home should be assessed by the healthcare facility in consultation with public health for suitability for home isolation. Please fax discharge summary to Public Health at (707) 565-4565.
- If patient is being transferred to any congregate living setting, such as, a long-term care facility or prison contact Public Health prior to discharge at (707) 565-4566.
For the latest CDC guidance, please visit:
https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html