Novel Coronavirus (COVID-19) Guidance for Health Care Providers
The Public Health Department is working to limit transmission of Coronavirus Disease 2019 (COVID-19) in our community and to help ensure our county maintains an adequate and healthy health care workforce.
See the latest news about SLO Public Health response to COVID-19
For general updates on COVID-19 in SLO County, please see ReadySLO.org.
Keep reading for guidance specific to health care providers:
Medical Reserve Corps
We need as many people as possible to respond to the forthcoming surge of our friends, family and neighbors who are going to get sick. Whether it's manning a hot line or on the front lines, we need you now. Together, our community will work to overcome this challenge. Apply at 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:
Minimum PPE Recommendations
Performing Aerosol-Generating Procedures or inducing cough
- N95 or higher-level respirator
- eye protection
Prolonged close contact with a COVID-19 patient NOT wearing a face mask
- face mask
- eye protection
- gloves required only if collecting swab specimen from patient or conducting physical exam
- gown required only if extensive body contact with patient (e.g., rolling a patient)
Prolonged close contact with a COVID-19 patient wearing a face mask
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.
Resuming Deferred and Preventive Health Care
Please see guidance from the California Department of Public Health related to the resumption of non-emergent and non-COVID-19 health care. This document includes guidance for dental services, outpatient surgery, elective and non-urgent procedures at hospitals, and physician office visits. Providers are still encouraged to maximize the use of telemedicine.
It is important to note that providers and facilities are encouraged to gradually resume full scope of services when possible and safe to do so based upon adequate supplies of appropriate personal protective equipment and adequate processes for managing patient flow and infection control.
Dental care providers are at particularly increased risk given that so many dental procedures
generate aerosol. See specific guidance for dental care regarding infection control and recommended PPE.
CDC has updated the list of COVID-19 symptoms to include a wide range of symptoms, ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus.
Emergency Warning Signs
- Fever or chills
- Shortness of breath or difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- 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.
See more from CDC.
Criteria for Release from Isolation
On April 30, CDC updated criteria for release from isolation to:
- At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
- At least 10 days have passed since symptoms first appeared
Note this is a change to 10 days rather than seven.
The Public Health Department asks clinicians to evaluate patients for COVID-19 based on the clinical presentation (above). Clinicians do not need to consult the Public Health Department before gathering and submitting specimens. Consistent with guidance from the Centers for Disease Control and Prevention (CDC), the Public Health Department no longer requires screening for other viral respiratory illnesses prior to testing for COVID-19.
Please refer to COVID-19 Serology Testing: Indications from California’s Testing Task Force. This three-page document describes one clear indication -- to determine population-level estimates of disease prevalence -– as well as several relative indications for providers. The document also clearly states what are not appropriate indications for the use of serologic testing for COVID-19.
If you are collecting the specimen:
- If you are collecting swab specimen from patients, the recommended PPE is N95 or higher level respirator, eye protection, gown, and gloves. See PPE section above for detail.
- A nasopharyngeal swab in viral transport media is the preferred specimen for testing. Detection of SARS-CoV-2 RNA is better in nasopharyngeal samples as compared to oropharyngeal samples.
- Only one nasopharyngeal swab specimen is required to test for COVID-19.
- If a nasopharyngeal swab cannot be obtained, a nasal or oropharyngeal swab is acceptable
- Use only synthetic fiber swabs with plastic shafts. Do not use calcium alginate swabs or swabs with wooden shafts as they may contain substances that inhibit PCR testing.
- Place nasopharyngeal swab immediately into sterile tube containing 2-3 ml of viral transport media.
- Refrigerate specimens at 2-8°C and ship overnight to testing lab on ice pack.
- See complete specimen collection and transport instructions here.
If you are not collecting the specimen:
If you determine that a patient needs to be tested for COVID-19 and you wish to have the Public Health Department collect the specimen and test, you must contact the Public Health Department before the patient comes in for testing. The Public Health Department does not provide COVID-19 testing for the purposes of pre-operative clearance. Please use the Referral Form for COVID-19 Testing and fax to (805) 781-5543.
In all cases, the Public Health Department must be contacted prior to sending patients or specimens for testing. The Public Health Department may be reached at (805) 781-5500.
Send specimens to appropriate lab
- For outpatients who have health insurance or other proof of payment: Send specimens to WestPac Labs, Quest Diagnostics, Pacific Diagnostic Laboratories, or LabCorp. These commercial labs are accepting swab specimens for COVID-19 testing as long as the specimens are accompanied by documentation of health insurance or other proof of payment.
- For health care workers, staff and residents of long-term care and assisted-living facilities, staff and residents of other at-risk congregate settings, hospital inpatients, and close contacts of confirmed cases: Testing can be arranged through the Public Health Department. Be aware that the Public Health Department is only testing individuals with symptoms consistent with COVID-19.
If submitting specimens to SLO Public Health Laboratory
Fax a request for testing to (805) 781-5543, preferably on the SLO Public Health Laboratory requisition form. (You may use a standard prescription or referral form if needed.) Test requests must include:
- Provider name
- Provider contact information (including 24/7 phone number and fax number for results)
- Patient name
- Patient DOB
- Patient contact information
- Signs and symptoms that support testing
- Travel history
- Indicate if patient is a hospital inpatient, healthcare worker, or close contact of a confirmed case of COVID-19
- Indicate if patient has had any other testing (e.g., Flu, Respiratory Pathogen Panel, Chest X-ray)
- Indicate if provider is sending swab specimen with courier, or if patient will require Public Health Department to perform swab
- Indicate if you want Respiratory Pathogen Panel and COVID-19 testing, or just COVID-19 testing
See complete specimen collection and transport instructions here.
Results from SLO Public Health Laboratory
Results for most COVID-19 testing performed in the Public Health Laboratory will be returned via fax and/or phone within 24 hours of receipt of the nasopharyngeal swab specimen. However, given the rapidly increasing volume of testing and the transportation of specimens to the Public Health Laboratory, please allow 48 hours for receipt of results from the time the specimen leaves your facility.
If more than 48 hours have passed and you wish to call to obtain COVID-19 test results for your patient, please call (805) 781-4843 between the hours of 8 a.m. – 5 p.m., 7 days a week. If leaving a message, please speak clearly and leave the following information:
- Your name
- Your practice name (if applicable)
- Your call back number
- Your FAX back number
- Patient’s Last name, First name, Date of Birth
Report all cases immediately by phone
The County of San Luis Obispo Public Health Department is requiring that providers immediately report all newly identified laboratory-confirmed cases of COVID-19 for individuals residing in San Luis Obispo County. This is a needed step given that delays in reporting are causing significant difficulties with contact tracing.The diagnosis or laboratory test in question may refer to COVID-19 or SARS-CoV-2.
Clinicians must report a positive test result immediately by calling the County of San Luis Obispo Public Health Department at (805) 781-4902 or via fax at (805) 781-5543. In addition, clinicians must complete a Confidential Morbidity Report (CMR Form A) and transmit the CMR to the Public Health Department by one of three ways:
- Via Fax at (805) 781-5543
- Via Phone at (805) 781-4902
- Through CalREDIE
In addition, the Public Health Department asks all hospitals in the county to report any confirmed COVID-19 patient discharges. Approval from the Public Health Department is not required for discharge.
When discharging confirmed COVID-19 patients to long-term care facilities (SNF, ICF, AL, ARF), the hospital must first consult with the facility to confirm their ability to take the patient. If unable to find a long-term care facility that will accept the patient, please report this in your email or phone call.
For additional questions, please call the Public Health Department at (805) 781-5500.
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