Coronavirus Disease 2019 (COVID-19) Outbreak Update #7

NH DPHS Health AlertsOn March 13, 2020, NH DHHS issued health alert update #7 regarding the COVID-19 outbreak.
Key Points and Recommendations:

  1. New Hampshire Division of Public Health Services (DPHS) has announced a 6th COVID-19 case in a traveler from Europe. This person was rapidly identified and samples were collected with appropriate personal protective equipment (PPE) so community exposures are minimal.
  2. The federal government is restricting travel from Europe. All travelers from Europe now need to self-quarantine for 14 days from the last day of their travel.
  3. Testing capacity is increasing at our NH Public Health Laboratories (PHL). Commercial laboratories (e.g., Quest, LabCorp) are also now testing for COVID-19, but do not collect patient samples. Some hospital laboratories are also developing local capacity to test. 
  4. DPHS has developed clinical testing guidance for providers who are seeing symptomatic patients. Please review the figure below, which prioritizes testing for persons who are at highest risk of fueling community transmission. 
    • If you are called by a symptomatic person, please evaluate this person and determine if testing is indicated.
      • Please do not direct your patients to call NH DPHS for clinical evaluation.
      • Please do not send non-urgent patients to an emergency room for evaluation or sample collection.
    • If your evaluation determines that COVID-19 testing is indicated, please call NH DPHS at 603-271-4496 (after-hours 603-271-5300) for testing facilitation.
  5. Collect the sample for testing with recommended personal protective equipment (PPE), which has been updated by the CDC.
    • For routine outpatient evaluation and sample collection for COVID-19 testing (e.g. NP and OP swab acquisition), including in emergency departments, we recommend surgical face masks for healthcare provider protection in addition to other recommended PPE. Based on our discussions with the CDC, there is no current laboratory or epidemiologic evidence that the novel coronavirus is routinely transmitted through aerosols. For patients hospitalized with COVID-19 we recommend continued N95 or higher-level respirator protection because of the frequency and intensity of healthcare contact and potential need for aerosol generating procedures. 
    • For aerosol-generating procedures (e.g., sputum induction, nebulizer use, intubation), use an N95 or higher-level respirator. 
    • For management of persons under evaluation for COVID-19, providers should continue to use gown, gloves, and eye protection.
    • Suspect patients should be placed in a single room with the door closed. Airborne Infection Isolation Rooms (AIIR) should be used for patients undergoing aerosol-generating procedures.
  6. All acute care hospitals should develop plans and procedures to facilitate triage, isolation, and testing of patients with suspect COVID-19. 
    • Triage: Patients with fever or respiratory illness have been advised to call ahead before coming into any healthcare facility. Therefore, every facility should establish a process for triaging such calls. Do not direct your patients to call NH DPHS for clinical evaluation.
    • Patient Arrival: Ask every patient presenting with fever or respiratory illness about risk factors for COVID-19, including any travel, or contact with a person with COVID-19. Immediately provide and instruct the patient to place a surgical mask over their mouth and nose, and bring them to room with the door closed. 
      • Avoid having symptomatic patients expose other patients in the waiting room. Consider dedicated entrances and exits, or texting a patient waiting in their car when you are ready to safely receive them.
    • Sample Collection: Hospitals should develop areas for sample collection on patients for whom a provider has determined a need for testing, which do not require patients to enter the facility or emergency department. This could include developing outdoor sample collecting stations. Healthcare providers collecting samples should use recommended PPE as above. 
  7. Guidance has been developed for facilities caring for patients at high risk of complications from COVID-19: https://www.nh.gov/covid19/residents/documents/covid-19-ltcguidance.pdf
  8. We will be hosting weekly calls to answer healthcare provider and local partner questions about COVID-19. The next discussion will be held on Thursday March 19th from 12:00 – 1:00 pm (noon hour), and calls will recur weekly. Call-in information for the Q&A session is:
    • Dial-in: (833) 709-6685 (Note: This is an operator assisted call; no conference code needed)

Read the Full DHHS Alert