As new information emerges daily around the coronavirus and as the search for answers continues, the risk management and patient safety experts with the Cooperative of American Physicians, Inc. (CAP) would like to ensure that physicians and medical communities across California have access to the most reliable resources to remain aware of the latest strategies in treatment, protection, and prevention.
Statewide Prevention Efforts
The California Department of Public Health (CDPH) is working closely with the Centers for Disease Control (CDC) to respond to the outbreak of this novel coronavirus.
CDPH is providing information to local health departments and healthcare providers across California on how to safely and effectively evaluate patients. The state will continue to monitor the situation, work with partners to identify any possible cases, provide information and consultation to ensure that possible cases are managed safely, support laboratory testing, and implement recommendations from the CDC.
Information for Physicians and Medical Practices
The CDC recommends that front-line healthcare personnel in the United States be prepared to evaluate patients for 2019 novel coronavirus (2019-nCoV). A checklist highlighting key steps for healthcare personnel in preparation for transport and arrival of patients potentially infected with 2019-nCoV is available at https://www.cdc.gov/coronavirus/2019-ncov/downloads/hcp-preparedness-checklist.pdf.
If a patient shows up at your office with a fever and/or cough, place a facemask on the patient and take them to a private room or separate area. It is also advisable to do a phone screening of patients prior to their appointments. If there is suspicion of a patient who may be ill or who may have been exposed to the coronavirus (2019-nCOV) they should contact their public health department as well as infection control personnel at their healthcare facility. Offices should have enough supplies of masks, gloves, gowns and goggles available for staff.
The links and contact information for local health departments in California are available at https://www.cdph.ca.gov/Pages/LocalHealthServicesAndOffices.aspx.
CAP has launched a COVID-19 resource page, which will continually be revised with key guidance and current best practices. You may view that page here: https://www.capphysicians.com/articles/cap-covid-19-resource-center.
Criteria to Guide Evaluation of Patients Under Investigation (PUI) for 2019-nCoV
The CDC clinical criteria for a 2019-nCoV patient under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available. For the most up to date and accurate information, please visit cdc.gov and https://www.cdph.ca.gov/.
Patients in the United States who meet the following criteria should be evaluated as a patient under investigation (PUI) in association with the outbreak of 2019-nCoV in Wuhan City, China.
1) Fever AND symptoms of lower respiratory illness (e.g., cough, shortness of breath)
–and in the last 14 days before symptom onset,
- History of travel from affected geographic areas. Relevant affected areas will be defined as a country with at least a CDC Level 2 Travel Health Notice. See all COVID-19 Travel Health Notices.
-or-
- Close contact with a person who is under investigation for 2019-nCOV while that person was ill.
2) Fever OR symptoms of lower respiratory illness (e.g., cough, shortness of breath)
–and in the last 14 days before symptom onset,
- Close contact with an ill laboratory-confirmed 2019-nCoV patient.
The criteria are intended to serve as guidance for evaluation. Patients should be evaluated and discussed with public health departments on a case-by-case basis if their clinical presentation or exposure history is equivocal (e.g., uncertain travel or exposure). More information and instructions for reporting, testing, and specimen collection is available at https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html.
The CDC has provided a helpful flow chart at https://www.cdc.gov/coronavirus/2019-ncov/hcp/identify-assess-flowchart.html to help practices implement a smooth evaluation process for proper assessment and identification of the disease.
Patient Care
CAP recommends that physicians utilize the above screening questions first and, if necessary, inform patients that the office cannot test for the virus and direct them appropriately based on symptoms (Urgent Care, Emergency Department). If patients arrive with a cough or fever, utilize a mask for them and provide a secluded place for them. Consider alternatives to face-to-face visits when possible, such as a telephone visit with a patient in need of a prescription refill. The CDC has released further guidelines for healthcare facilities to prepare for and respond to community spread of COVID-19 while protecting healthcare personnel and non-COVID-19 patients, which can be reviewed here.
Offices should have their local public health department phone numbers available for questions and other advice. A complete list of California Local Health Departments and their contact information can be found here.
All hospitals should be ready to care for Coronavirus patients. Unlike Ebola patients that require care in specialized care facilities, patients with COVID-19 may present to any hospital or urgent care clinic. Every hospital therefore should have a plan to care for a patient with possible or confirmed COVID-19. Even if confirmed positive for COVID-19, the patient will be cared for at that hospital and will not be transferred unless directed by the Department of Public Health.
The CDC has provided more detailed instructions for physicians, healthcare providers, and facilities on infection control, minimizing exposure in your facility and practice, clinical care, personal protective equipment (PPE), and more at https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html.
The CDPH has released updated guidance for schools, colleges, large public events, employers, workers and elder care/congregate living facilities to prepare and protect Californians from COVID-19, along with other information for the general public, at https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-015.aspx.
Information for this article retrieved from the California Department of Public Health, https://www.cdph.ca.gov/ and the Centers for Disease Control, https://www.cdc.gov/.