COVID-19 Novel Coronavirus: What Physicians Must Know

Posted by Alison Williams on 03/11/2020

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 Oklahoma State Department of Health, and the Oklahoma City-County Health Department. We recommend always referring to both OSDH and the CDC guidance for the most recent information. As of Wednesday, March 11: 2 confirmed cases, 15 negative cases, and 11 pending cases.

For Healthcare Providers
OSDH developed recommendations for healthcare providers. Includes recommendations and how to report known or suspected COVID-19 cases.

For Businesses/Employers
The interim guidance may help prevent workplace exposures to acute respiratory illnesses, including COVID-19, in non-healthcare settings. The guidance also provides planning considerations if there are more widespread, community outbreaks of COVID-19.

Oklahoma COVID-19 Call Center: 877-215-8336
Hours: Monday - Friday: 9:00 a.m. - 7:00 p.m. and Saturday: 9:00 a.m. - 3:00 p.m.
Call Center has the capability to connect callers to Spanish speaking interpreters.

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What to Look For
The CDC’s clinical criteria for a “patient under investigation” (PUI) for possible COVID-19 infection are based on what is known about the Middle Eastern respiratory syndrome coronavirus (MERS-CoV) and the severe acute respiratory syndrome coronavirus (SARS-CoV). The key is to look for both clinical features and epidemiologic risks before calling our local or state public health department to sound the alarm.

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 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.

Epidemiologic factors that may help guide decisions on whether to test include: any persons, including healthcare workers, who have had close contact with a laboratory-confirmed4 COVID-19 patient within 14 days of symptom onset, or a history of travel from affected geographic areas within 14 days of symptom onset.

Additionally, the CDC’s guidance notes that “fever may not be present in some patients, such as those who are very young, elderly, immunosuppressed, or taking certain fever-lowering medications” and urges physicians to use their clinical judgement in such cases.

This clinical criteria is from the CDC as of March 10, 2020. Check their clinical criteria page for the most up to date information.
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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) 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, tissues, no touch receptacles for disposal and facemasks upon request.

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.

Rapid Triage: Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) if possible.

  • 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. 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.