COVID-19 Guidance for Health Care Providers

For other news on COVID-19 in SLO County, please see ReadySLO.org

Infection Prevention and Control / Personal Protective Equipment (PPE)

Protect yourself: Minimum personal protective equipment (PPE) recommendations for health care providers caring for suspect or confirmed COVID-19 patients:

Situation

Minimum PPE Recommendations

Contact with patients with known or suspected COVID-19 (includes both isolation and quarantine units)

  • N95 or higher-level respirator
  • Eye protection
  • Gloves if hands-on activities with patient (e.g., physical exam, procedure) OR aerosol-generating procedure
  • Gown if close contact with patient (e.g., moving patient from bed to chair, helping patient with bathing) OR aerosol-generating procedure

Contact with patients in whom COVID-19 status is not known

  • Surgical facemask or higher-level respirator
  • Eye protection IF level of community transmission is moderate or high (greater than or equal to 5 cases per 100,000 population)

Performing aerosol-generating procedures or inducing cough with patients in whom COVID-19 status is not known

  • N95 or higher-level respirator IF level of community transmission is moderate or high
  • Surgical facemask or high level respirator IF level of community transmission is low (less than 5 cases per 100,000 population)
  • Eye protection IF level of community transmission is moderate or high
  • Gloves IF level of community transmission is moderate or high

In addition:

  • All patients and all staff in a healthcare/clinical setting should be directed to wear face coverings for source control when indoors and other individuals are present.
  • N95s should be made available to all staff for all clinical situations.
  • Eye protection (face shields or goggles) should be made available to all staff for all clinical situations.

See CDC guidance for detailed guidance on Sequence for Putting On and Safely Removing PPE

If you are exposed without adequate PPE: Health care workers who have been exposed to a suspect or confirmed COVID-19 patient without the minimum recommended PPE should be excluded from work for 14 days after exposure. However, if the health care worker is asymptomatic, they may continue to work if options to improve staffing have been exhausted and their occupational health program has been consulted. In such a case, the post-exposure, asymptomatic health care worker must wear a face mask while at work for 14 days after the exposure. If the worker develops even mild fever or respiratory symptoms, they must cease patient care activities and notify their supervisor or occupational health program.

This guidance may be modified as conditions change.

Clinical Presentation and Symptom-screening for COVID-19

​CDC and CDPH continue to recommend regular symptom-screening for patients, visitors, and staff in the healthcare setting. For updated tools to assist with symptom-screening and the current list of COVID-19 symptoms refer to the CDC's COVID-19 symptoms. Symptoms may appear 2-14 days after exposure to the virus.

Symptoms

Emergency Warning Signs

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake up or stay awake
  • Bluish lips or face

*If you have any of the emergency warning signs above, get medical attention immediately

It is not unusual to see rapid deterioration in patients one week after illness onset. In those individuals who experience acute respiratory distress syndrome (ARDS), median time from symptom onset is 8-12 days.

Children have similar symptoms to adults and generally have mild illness.


Criteria for Release from Isolation

Refer to the CDC's updated criteria for release from isolation.

Patients with mild to moderate illness who are not severely immunocompromised:

  • At least 10 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved

Patients who were asymptomatic throughout their infection and are not severely immunocompromised:

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

Patients with severe to critical illness or who are severely immunocompromised:

  • At least 10 days and up to 20 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved
  • Consider consultation with infection control experts

When advising your COVID-19 patients please emphasize the importance of cooperating with County of San Luis Obispo Public Health Contact Tracers. This is a necessary step to address issues around isolation, quarantine, and return to work/school. You can direct them to call the Public Health Department at (805)781-5500.

Testing

For the most current recommendations regarding testing, refer to the CDPH Updated Testing Guidance: Updated COVID-19 Testing Guidance (ca.gov) and the CDC: Resources for Laboratories Working on Coronavirus (COVID-19) | CDC

Laboratory-based PCR Testing

The most sensitive and specific of the available COVID-19 testing options.

If used for asymptomatic screening testing in high-risk settings (e.g., long-term care, sports, dormitories), the recommended frequency of testing is once per week.

Individuals who have tested positive for COVID-19 within the preceding 90 days should NOT participate in asymptomatic screening testing.

With the exception of skilled nursing facilities where the vaccination rate is below 70%, fully vaccinated individuals should NOT participate in asymptomatic screening testing.

Individuals are considered fully vaccinated for COVID-19 two weeks or more after they have received the second dose in a 2-dose series (Pfizer or Moderna), or two weeks or more after they have received a single-dose vaccine (Johnson & Johnson).

Point-of-Care Testing (both Antigen and Molecular Tests)

Point-of-Care (POC) tests are of varying sensitivity and specificity. Please be aware of the sensitivity and specificity of the specific brand of point-of-care test before it is used.

Generally, when a POC test is used a negative result in a symptomatic individual and a positive result in an asymptomatic individual must be confirmed with a laboratory-based PCR test. An individual in such a situation must be directed to self-isolate pending the result of the laboratory-based PCR test.

If an antigen test is used for the purposes of asymptomatic screening testing in a high-risk setting, the recommended frequency of testing is a minimum of twice a week.

Reporting

Results from laboratory-based PCR testing are reported to the state (and, by extension, the County of San Luis Obispo Public Health Department) automatically via electronic laboratory reporting (ELR).

Providers performing POC testing within the County of San Luis Obispo are responsible for reporting the results to the County of San Luis Obispo Public Health Department.

For POC antigen testing (e.g., Binax NOW, BD Veritor, Sofia SARS Antigen FIA), only the reporting of POSITIVE results is required.

For POC molecular testing (e.g., Abbott ID NOW, CUE), the reporting of BOTH POSITIVE AND NEGATIVE results is required.

To report POC testing results to the County of San Luis Obispo Public Health Department, please complete the COVID-19 CMR Form 

and FAX to 805-781-5543.

Alternatively, you may call the Public Health Department at (805)781-5500 to report results.

Community Testing 

Outbreak Response Testing and Other Testing Support

For consultation regarding response to an outbreak, please contact Rick Rosen, MD [email protected].

For questions regarding testing support and supplies, please contact Maya Craig-Lauer, [email protected]

Questions? 

For additional questions, please call the Public Health Department at (805) 781-5500.

Additional Resources 

COVID-19 Provider Health Advisories for San Luis Obispo County 

California Department of Public Health (CDPH) Guidance for Health Care Facilities

Centers for Disease Control and Prevention (CDC) Guidance for Health Care Providers

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