LHJ COVID-19 reporting: - DPHHS



Coronavirus Disease 2019 (COVID-19) Investigation GuidelinesIf the state of Montana has a lab-confirmed case of COVID-19, certain steps will help to limit the spread of disease and identify potentially exposed individuals. Namely, (1) we will isolate the case, and (2) conduct a contact investigation. Specific guidance documents are linked below, all recommendations are based upon CDC guidance. Please call the Communicable Disease Epidemiology Section with any questions: 406-444-0273.Table of Contents TOC \o "1-3" \h \z \u LHJ COVID-19 reporting: PAGEREF _Toc35360669 \h 1State COVID-19 reporting: PAGEREF _Toc35360670 \h 2Isolation of COVID-19 Case: PAGEREF _Toc35360671 \h 2Hospitalized Cases PAGEREF _Toc35360672 \h 2Cases not requiring hospitalization PAGEREF _Toc35360673 \h 2Contact Investigation: PAGEREF _Toc35360674 \h 31.Establish a timeline for the case that includes the 14 days prior to onset of symptoms PAGEREF _Toc35360675 \h 32.Identify close contacts of case and possible sites of transmission PAGEREF _Toc35360676 \h 33.Use the table below to asses a risk category for each person identified during a contact investigation PAGEREF _Toc35360677 \h 4TABLE 1. Risk Categories for Exposures Identified during Contact Investigations of Laboratory-confirmed Cases PAGEREF _Toc35360678 \h 44.Apply public health actions recommended based on risk assigned PAGEREF _Toc35360679 \h 5TABLE 2: Summary of CDC Recommendations for Management of Exposed Persons with by Risk Level and Presence of Symptoms PAGEREF _Toc35360680 \h 55.Identify healthcare personnel caring for the COVID-19 case PAGEREF _Toc35360681 \h 7Investigate source of COVID-19 exposure: PAGEREF _Toc35360682 \h 7Other Useful Information: PAGEREF _Toc35360683 \h 7CDC Case Definitions: PAGEREF _Toc35360684 \h 8Case Investigation Tools: PAGEREF _Toc35360685 \h 81.Tool to Identify Sources of Infection PAGEREF _Toc35360686 \h 82.Tool to Identify Exposed Contacts and Sites of Transmission PAGEREF _Toc35360687 \h 9LHJ COVID-19 reporting:Call CDEpi to notify them of the results immediately, 24/7: 406-444-0273Securely fax or ePass CDC case report form to CDEpiEnter COVID-19 investigation into MIDIS State COVID-19 reporting:If a confirmed case of COVID-19 is identified at MTPHL or by a private lab, refer to the CDC guidance providing Information for Health Departments on Reporting a Person Under Investigation (PUI), or Presumptive Positive and Laboratory-Confirmed Cases of COVID-19, including the case report form and instructions.CDEpi will notify CDC of the case via DCIPHERThe state will issue a COVID-19 ID to complete a PUI and Case Report Form in DCIPHER. The specimen will be considered a confirmed positive through the MTPHLThe state will work closely with the case county of residence and the healthcare facility where the case is located to coordinate isolation of the case and to conduct a contact investigation.Isolation of COVID-19 Case:Hospitalized CasesTransmission of the COVID-19 virus is presumed to occur via respiratory droplets. Patients with COVID-19 should be placed under standard and transmission-based precautions.Patients with known or suspected COVID-19 should be cared for in a single-person room with the door closed. Airborne Infection Isolation Rooms (AIIRs) should be reserved for patients undergoing aerosol-generating procedures.Healthcare personnel (HCP) who enter the room of a patient with known or suspected COVID-19 should adhere to Standard Precautions and use a respirator or facemask, gown, gloves, and eye protection.?When available, respirators (instead of facemasks) are preferred; they should be prioritized for situations where respiratory protection is most important and the care of patients with pathogens requiring Airborne Precautions (e.g., tuberculosis, measles, varicella).?For full details, CDC released Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings. Persons Under Investigation (PUIs) or COVID-19 cases who do not require hospitalization should isolate themselves at home except to receive medical care (more information below).Discontinuation of isolation CDC released Interim Guidance for Discontinuation of Transmission-Based Precautions Among Hospitalized Patients with COVID-19 for when transmission-based precautions can be lifted for hospitalized PUIs or COVID-19 cases.Cases not requiring hospitalizationPUIs or COVID-19 cases who do not require hospitalization should isolate themselves at home except to receive medical care. In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care. As much as possible, cases should stay in a specific room and away from other people in the home, also using a separate bathroom, if available. Cases in home isolation should follow these precautions:Wear a facemask – You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s officeCover your coughs and sneezesClean your hands often with soap and water for at least 20 secondsAvoid sharing personal household items (e.g., dishes, eating utensils, towels, or bedding)Clean all “high-touch” surfaces everydayMonitor your symptoms and call ahead before visiting your doctorRefer to the Interim Guidance for Preventing the Spread of Coronavirus 2019 (COVID-19) in Homes and Residential Communities for comprehensive guidance. This also includes recommended precautions for household members caring for the individual at home. Discontinuation of isolationThe decision to discontinue isolation of PUIs or COVID-19 cases should be made in consultation with MTDPHHS. This decision should consider disease severity, illness signs and symptoms, and results of laboratory testing for COVID-19 in respiratory specimens. CDC released Interim Guidance for Discontinuation of In-Home Isolation for Patients with COVID-19.Contact Investigation:Establish a timeline for the case that includes the 14 days prior to onset of symptomsUse Tool 1 at the end of this documentLocations Include work, school, social events, medical visits, etc.Ask about visits to assisted-living facilities and other places with elderly populations, or at-risk populations. Dates and times Be as complete as possibleIdentify close contacts of case and possible sites of transmissionUse Tool 2 at the end of this documentHousehold contactsSchool/after school/sports contactsWork contactsSocial contactsAsk about visits to assisted-living facilities and other places with elderly populations, schools, or other sensitive sites. A close contact is defined as—a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case– or –b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)CDC released Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposures: Geographic Risk and Contacts of Laboratory-confirmed Cases, describing the level of risk of contacts to a case and how to monitor exposed individuals based on level of risk.Use the table below to asses a risk category for each person identified during a contact investigationTABLE 1. Risk Categories for Exposures Identified during Contact Investigations of Laboratory-confirmed Cases Note: All exposures apply to the 14 days prior to assessment. A Coronavirus Disease 2019 (COVID-19) Risk Assessment and Public Health Management Decision Tree is also available to assess risk level of exposure.Risk LevelExposures Identified through Contact InvestigationHighLiving in the same household as, being an intimate partner of, or providing care in a nonhealthcare setting (such as a home) for a person with symptomatic laboratory-confirmed COVID-19 infection without using recommended precautions for home care?and?home isolationMedium(assumes no exposures in the high-risk category)Close contact with a person with symptomatic laboratory-confirmed COVID-19On an aircraft, being seated within 6 feet of a traveler with symptomatic laboratory-confirmed COVID-19 infection; this distance correlates approximately with 2 seats in each directionLiving in the same household as, an intimate partner of, or caring for a person in a nonhealthcare setting (such as a home) to a person with symptomatic laboratory-confirmed COVID-19 infection?while consistently using recommended precautions?for?home care?and?home isolationLow(assumes no exposures in the high-risk category)Being in the same indoor environment (e.g., a classroom, a hospital waiting room) as a person with symptomatic laboratory-confirmed COVID-19 for a prolonged period of time but not meeting the definition of close contact (<6 feet or contact with respiratory secretions)No identifiable riskInteractions with a person with symptomatic laboratory-confirmed COVID-19 infection that do not meet any of the high-, medium- or low-risk conditions above, such as walking by the person or being briefly in the same room.Apply public health actions recommended based on risk assigned Use Table 2, below, to determine which actions should be undertaken based on the risk of exposure. People who are being managed as asymptomatic in a particular risk level who develop signs or symptoms compatible with COVID-19 should be moved immediately into the symptomatic category in the same risk level and be managed accordingly. The risk level does not change if symptoms develop.TABLE 2: Summary of CDC Recommendations for Management of Exposed Persons with by Risk Level and Presence of SymptomsNote: definitions used in this table are available in the complete guidance online.Risk LevelManagement if AsymptomaticManagement if Symptomatic1High riskQuarantine (separation of a person exposed but not yet symptomatic) in a location to be determined by public health authorities.No public activities.Daily active monitoring of fever, cough, or difficulty breathingControlled travelImmediate isolation (separation of a person believed to be infected and potentially infectious to prevent spread of disease) with consideration of public health ordersPublic health assessment to determine the need for medical evaluation; if medical evaluation warranted, diagnostic testing should be guided by CDC’s?PUI definitionIf medical evaluation is needed, it should occur with pre-notification to the receiving HCF and EMS, if EMS transport indicated, and with all recommended?infection control precautions?in place.Controlled travel: Air travel only via air medical transport. Local travel is only allowed by medical transport (e.g., ambulance) or private vehicle while symptomatic person is wearing a face mask.Medium riskClose contacts in this category:Recommendation to remain at home or in a comparable settingPractice social distancingActive monitoring of fever, cough, or difficulty breathingRecommendation to postpone long-distance travel on commercial conveyancesSelf-isolation Public health assessment to determine the need for medical evaluation; if medical evaluation warranted, diagnostic testing should be guided by CDC’s?PUI definitionIf medical evaluation is needed, it should ideally occur with pre-notification to the receiving HCF and EMS, if EMS transport indicated, and with all recommended?infection control precautions?in place.Controlled travel: Air travel only via air medical transport. Local travel is only allowed by medical transport (e.g., ambulance) or private vehicle while symptomatic person is wearing a face mask.Low risk?No restriction on movementSelf-observation (people should remain alert for subjective fever, cough, or difficulty breathing)Self-isolation, social distancingPerson should seek health advice to determine if medical evaluation is needed.If sought, medical evaluation and care should be guided by clinical presentation; diagnostic testing for COVID-19 should be guided by CDC’s?PUI definition.Travel on commercial conveyances should be postponed until no longer symptomatic.No identifiable riskNoneSelf-isolation, social distancingPerson should seek health advice to determine if medical evaluation is needed.If sought, medical evaluation and care should be guided by clinical presentation; diagnostic testing for COVID-19 should be guided by CDC’s?PUI definition.Travel on commercial conveyances should be postponed until no longer symptomatic.EMS = emergency medical services; HCF = healthcare facility; PUI = Person Under Investigation for COVID-191For the purpose of this table: subjective or measured fever, cough, or difficulty breathing.CDC released Interim Guidance for Public Health Personnel Evaluating Persons Under Investigation (PUIs) and Asymptomatic Close Contacts of Confirmed Cases at Their Home or Non-Home Residential Settings. This outlines how to interview and assess people exposed the a COVID-19 case (PUIs). Typically, you will want to interview by phone rather than in-person. Identify healthcare personnel caring for the COVID-19 caseTo monitor and manage ill and exposed healthcare personnel, please refer to Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19). This guidance describes exposure risk categories (low-medium-high) with a handy table of risk factors that can be used to determine what monitoring should take place and any possible work restrictions needed based on the type of exposure.Investigate source of COVID-19 exposure: The CDC case report form has questions that asks about possible exposures in the 14 days prior to illness onset. These primarily pertain to:Travel historyExposure to ill-individualsContact to confirmed COVID-19 caseOther Useful Information:DPHHS Technical Guidance for COVID-19: Specimen Collection CDC Resources for State, Local, Territorial and Tribal Health DepartmentsPreventing COVID-19 Spread in CommunitiesResources for schools, colleges, at home, the workplace, community organizations, mass gatherings, healthcare setting and first responders.DPHHS Isolation/Quarantine sample orders \sCDC Case Definitions:Person Under Investigation (PUI): Any person who is currently under investigation for having the virus that causes COVID-19, or who was under investigation but tested negative for the virus.Presumptive positive case of COVID-19: Individual who has tested positive for the virus that causes COVID-19 in at least one respiratory specimen, but testing was conducted at the local or state level. Currently, presumptive positive cases must have samples undergo confirmatory testing at CDC.Laboratory-confirmed case of COVID-19: Individual who has tested positive for the virus that causes COVID-19 in at least one respiratory specimen at the CDC laboratory.Isolation: separates sick people with a contagious disease from people who are not sick.Quarantine: separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.Case Investigation Tools:Tool to Identify Sources of InfectionPatient Name:_________________________________________Date of Birth:_______________Exposure PeriodDateDayLocations (with times)ContactsEarliest Exposure Date-14-13-12-11-10-9-8-7-6-5-4-3-2-1Symptom Onset0Tool to Identify Exposed Contacts and Sites of TransmissionContagious PeriodDateDayLocations (with times)ContactsEarliest Exposure Date012345678910111213Symptom Onset14 ................
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