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7/24/20: Health Advisory – COVID-19 Updates for Providers

By July 24, 2020August 20th, 2020No Comments

Published July 24, 2020.

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Background

Last week, CDC updated its guidance on the discontinuation of transmission-based precautions and disposition of patients with COVID-19 in healthcare settings. DOH updated its patient education to reflect this guidance. The updates include:

  • Except in rare situations, CDC no longer recommends using a test-based strategy to determine when to discontinue transmission-based precautions.
  • For patients with severe to critical illness or who are severely immunocompromised, CDC extended the recommended duration for transmission-based precautions to 20 days after symptom onset (or, for asymptomatic severely immunocompromised patients, 20 days after initial positive SARS-CoV-2 diagnostic test).
  • Symptom-based criteria were modified:
    • Changed from “at least 72 hours” to “at least 24 hours” have passed since last fever without using fever-reducing medication.
    • Changed from “improvement in respiratory symptoms” to “improvement in symptoms” to address the expanding list of COVID-19 symptoms.

Test-based strategy is no longer recommended.

Research shows the test-based strategy prolongs isolation of patients who continue to shed detectable SARS-COV-2 RNA but are no longer infectious. Additionally, SARS-COV-2 diagnostic testing reagent is in short supply and this change will reduce reliance on supplies.

Use symptom-based discontinuation of isolation criteria.

Discontinue isolation of patients with mild to moderate illness who are not severely immunocompromised once:

  • At least 10 days have passed since symptom onset, and
  • At least 24 hours have passed since last fever without using fever-reducing medication, and
  • Symptoms have improved.

Discontinue isolation of patients with severe to critical illness or who are severely immunocompromised once:

  • At least 20 days have passed since symptoms first appeared, and
  • At least 24 hours have passed since last fever without the using fever-reducing medication, and
  • Symptoms have improved.

Discontinue isolation of patients who are not severely immunocompromised and who were asymptomatic throughout infection once:

  • At least 10 days have passed since the first positive viral diagnostic test.

PCR testing not recommended after discontinuation of isolation or precautions.

For people previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within 3 months after the date of symptom onset for the initial COVID-19 infection. Additionally, quarantine is not recommended in the event of close contact with an infected person.

Test all patients with new onset of COVID-19 symptoms.

Continue to test all patients with new onset of COVID-19 symptoms, regardless of age or health status. Test patients as soon as possible after seeking care, ideally within 24 hours. We strongly encourage broad testing.

Limit testing of asymptomatic people to the following priority populations.

  • Close contact of a case.
  • Exposed to COVID-19 during an outbreak in a congregate setting.
  • From a racial or ethnic group disproportionately affected by COVID-19—African American, Alaska Native, American Indian, Latinx, Native Hawaiian, Pacific Islander.
  • Pregnant and in labor.
  • Infants born to parents with suspected or confirmed COVID-19.
  • Undergoing a procedure that increases the risk of aerosolized particle spread.
  • Undergoing an invasive surgical procedure (if possible, test within 48 hours of procedure).

Patient communication

Share these materials with patients.

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