BCHHS Public Health Provider Alert: Clarification of COVID-19 provider guidance & Buncombe County update

April 6, 2020

As of this morning, there have been a total of 33 lab-confirmed cases of COVID-19 in Buncombe County residents, including the one fatality. We are developing a report of basic demographic info on these cases that I hope to share with you later this week.

We are well aware of outbreaks of COVID-19 in congregate living settings across the state, including in Henderson County, and we continue to work with our local facilities to try to prevent and quickly respond to reports of any symptomatic residents or staff. The Buncombe County EOC also continues to collaborate with local providers who serve individuals experiencing homelessness. We have provided guidance to the local shelters on how to screen residents for COVID-19 and what to do if they suspect someone of having COVID-19. We continue to manage a facility to provide housing for those who cannot isolate or quarantine at home or in a shelter, and are exploring the possibility of offering temporary voluntary housing to the unhoused who do not have symptoms of COVID-19.

  • If you are a medical provider in a skilled nursing facility or other residential care facility, please email Deana.Shetley@buncombecounty.org with your name and the name of the facility, as we may be reaching out to you with some specific questions and/or requests.

I also wanted to clarify some information in the provider guidance I shared last week, as well as ask for your assistance in case identification and investigation.

When should you report suspected cases of COVID-19 to BCHHS Communicable Disease staff (Phone 828-250-5109, available 24/7; Fax 828-250-6169):

  • When a Buncombe County resident is tested for COVID-19 (report at the time of testing)
  • If a provider identifies a symptomatic person who falls into one of the categories listed below but is unable to test them, the provider should call the Buncombe County Communicable Disease staff immediately and we will do our best to assist with getting that person tested (i.e, take specimen collection kit directly to the provider’s office so provider can do testing, give us specimen and we’ll send it to the State Laboratory of Public Health; get contact info/address for the person and we’ll go to the person’s home to do testing ourselves; or have the person swing by our building after leaving provider’s office and we’ll test them in their car; etc.)
    • Healthcare workers or first responders (e.g., EMS, law enforcement, fire department)
    • Persons who live in or have regular contact with a high-risk setting (e.g., resident or staff at a long-term care facility, homeless shelter, correctional facility, migrant farmworker camp)

*Whenever you report a suspected case, we would appreciate you completing and faxing us the CDC’s PUI form (attached). While no longer required by the state, it has critical info on it that facilitates our investigation, allowing us to more quickly identify close contacts and potentially reduce spread of the virus. Please continue to give patients who are tested the home isolation guidance.

I’ve also received several questions about various “rapid” testing options as commercial labs continue to become more widely available.

Here is the general guidance I’ve received at this point on what to consider when evaluating rapid tests:

  1. Is the test FDA-approved? If the company says they have an Emergency Use Authorization (EUA), check the FDA’s website
    1. Of note, the first EUA for a serologic test was issued late last week.
  2. Critically read the package insert.
    1. What type of swabs or other supplies will you need? Can you obtain these easily?
    2. What is the reported sensitivity and specificity?

Continued thanks for all you are doing to care for our community,

Jennifer Mullendore, MD, MSPH


Buncombe County Health & Human Services,

Interim Health Director and

Medical Director

p. (828) 250-6308  c. 828-989-6145

40 Coxe Ave. - Asheville, NC 28801

Respect. Honesty. Integrity. Collaboration. Equity.

Human Infection with 2019 Novel Coronavirus Person Under Investigation (PUI) and Case Report Form