COVID-19 Novel Coronavirus: What Physicians Must Know
The following guidance is drawn primarily from the Centers for Disease Control and Prevention’s (CDC) resources for health care professionals on COVID-19. Additional information is provided based on resources from the American Medical Association, the Maryland Department of Health. Every effort is being made to keep this guidance up to date, but we recommend always referring to both MDH and CDC guidance for the most recent information. Please refer to the resource list at the bottom of this article for reference links.
MedChi has also set up a RESCOURCE PAGE that is being updated regularly.
IMPORTANT INFORMATION ABOUT COVID TESTING
Current MDH Guidance:*
- Asymptomatic persons do not need to be tested
- Mildly symptomatic patients who are otherwise healthy can self –quarantine monitoring temperature, and symptoms and check in with the provider as needed. These patients do not need to be tested
***CLINICIANS SHOULD ALWAYS USE THEIR BEST CLINICAL JUDGEMENT***
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What to Tell Patients
The Maryland Health Department has created a resource page that is a helpful guide on what to say to patients, and to refer them to if they want to learn more. The Prince George’s County Health Department has created a fact sheet for patients:
Practice Protocols & Preparedness
Pre-Screening: When scheduling appointments, instruct patients and persons who accompany them to call ahead or inform staff upon arrival if they have symptoms of any respiratory infection (e.g., cough, runny nose, fever) and to take appropriate preventive actions (e.g., wear a facemask upon entry to contain cough, follow triage procedures).
Promote Respiratory Hygiene: Take steps to ensure all persons with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit. Consider posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and health care personnel with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use facemasks or tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.
Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% alcohol-based hand sanitizer (ABHS), tissues, no touch receptacles for disposal, and facemasks at healthcare facility entrances, waiting rooms, patient check-ins, etc.
Limit Exposure: Ensure that patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) are not allowed to wait among other patients seeking care. Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies. In some settings, medically-stable patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.
Rapid Triage: Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough):
- Identify patients at risk for having COVID-19 infection before or immediately upon arrival to the healthcare facility.
- Implement triage procedures to detect persons under investigation (PUI) for COVID-19 during or before patient triage or registration (e.g., at the time of patient check-in) and ensure that all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of SARS-CoV-2, the virus that causes COVID-19, or contact with possible COVID-19 patients.
- Implement respiratory hygiene and cough etiquette (i.e., placing a facemask over the patient’s nose and mouth if that has not already been done) and isolate the PUI for COVID-19 in an Airborne Infection Isolation Room (AIIR), if available. See recommendations for “Patient Placement” below. Additional guidance for evaluating patients in U.S. for COVID-19 infection can be found on the CDC COVID-19 website.
- Inform infection prevention and control services, local and state public health authorities, and other healthcare facility staff as appropriate about the presence of a person under investigation for COVID-19.
The above is summary guidance for practices. Please visit the CDC’s protocol for full details; it is being updated on a rolling basis.
“Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza.”
When & How to Report
If you have a patient under investigation for COVID-19, immediately let your facility’s infection control department know and report it to our local public health department.
How to Test
CDC now recommends that a nasopharyngeal (NP) swab alone is adequate. You do NOT need to collect both an NP and oropharyngeal/throat (OP) swab. Maintain proper infection control when collecting specimens.
Overall, since COVID-19 testing is available at commercial and some hospital labs, clinicians should send specimens to those laboratories for testing. These labs process but do not obtain specimens.
Clinicians do NOT need approval from the Maryland Department of Health or the local health department to order, collect, or submit specimens to commercial or hospital laboratories. You do NOT need to call the health department if you use a commercial or hospital lab for COVID-19 testing. You should check with these laboratories for specific information on specimen collection and packaging requirements. LabCorp and Quest Diagnostics have each posted web pages (1, 2) that they are updating on a rolling basis.
What Precautions to Take
Health care personnel should use standard precaution, contact precautions, airborne precautions and eye protection such as goggles or a face shield before entering the room. Please note that airborne precautions specifically require “a fit-tested NIOSH-approved N95 or higher level respirator for healthcare personnel,” and these precautions do require gloves and a gown. Section 2 of this CDC web page emphasizes important PPE compliance. For full precaution guidance, refer to the CDC’s isolation precautions guideline.
Resources for Physicians
From the Centers for Disease Control and Prevention
From the World Health Organization (WHO): WHO Coronavirus Home which is updated on a rolling basis with technical guidelines on a rolling basis.
From the Journal of the American Medical Association (JAMA): Guidance for diagnosis and treatment, updated on a rolling basis.
- Maryland Department of Health’s (MDH) web page for the latest updates on the virus
- Bulletin Regarding Health Carriers During State of Emergency
- MMDH Coronavirus Clinician Letter – 3.13.2020
- MDH Coronavirus Clinician Letter – 3.11.2020
- MDH Coronavirus Clinician Letter — 2.28.2020
- The Washington Post‘s live updates page
- From the AMA Wire, “When global health emergencies strike, how should doctors respond?”
- MedChi, The Maryland State Medical Society’s press release on nCoV
For an up-to-date incidence map, see the Johns Hopkins School of Public Health GIS map.