BCHHS Public Health Provider Alert: Updated COVID guidance, including Antigen Testing Flowchart

November 9, 2020

Situation Update:

  • Buncombe County has transitioned to using the state’s dashboard for COVID-19 data display and tracking. The state continues to add to their dashboard on a regular basis, so I encourage you to check it out.
  • As has been seen across the state and country, there has been an upward trajectory in the number of cases identified daily in county residents since September.
    • Pre-symptomatic and asymptomatic spread is playing an important role.
    • We are seeing more cases reporting increased close contact with others outside of their household, such as at social gatherings, religious services, and work.
    • Increased adherence to prevention strategies (the 3 W’s), testing (including for those without symptoms), and contact tracing are important to control spread.
  • The number of COVID tests performed on Buncombe County residents continues to remain strong. For the last 4 weeks, we’ve seen an average of over 5800 tests/week on county residents, an increase of ~600/week compared to the prior 4 weeks.
  • The percent of tests coming back positive increased from 2% in early September to 4.9% the week of 10/18, demonstrating increased community spread of COVID-19 in our county. Thankfully, we saw this decrease to 4% for the week of 10/25. However, with colder weather driving people indoors more and the upcoming holidays, we are anticipating that we will continue to see elevated levels of community spread for the coming months.

 

COVID-19 Testing and Isolation/Quarantine Recommendations:

  • Recommendations on who should be tested for COVID-19 have been updated to now include anyone who believes they may have been exposed to COVID-19, including those who have been in close contact with others outside of their household (e.g., anyone who attended a gathering, protest, rally, party, religious service, sporting event, etc., where social distancing was difficult to maintain).
    • The ideal time to test asymptomatic individuals with known or suspected exposure is 5-7 days after last exposure.
  • See the NCDHHS COVID-19 Provider Guidance Update of 10-27-2020 (also attached) for the complete list of who should be tested for COVID-19.
    • Please maintain a low threshold for testing for COVID-19.
      • If someone presents with respiratory symptoms, do a COVID test. And please keep in mind all the other symptoms of COVID-19.
  • Please be sure to review and provide the handout “Steps for People to Take After COVID-19 Testing”, available in English, Spanish and Russian, to those who are tested so they know what they should be doing before and after getting their test results.
    • Public health staff are following up with all lab-confirmed cases promptly upon receiving case reports, but it is crucial that you provide patients with guidance so they prevent spread while waiting on their results.
      • Anyone tested due to symptoms or known or suspected exposure should be in isolation while awaiting their test results.
      • Anyone who was tested because they were a close contact to a lab-confirmed case or because of suspected exposure to someone with COVID-19 should be quarantined for 14 days after their last exposure, EVEN IF THEIR COVID TEST IS NEGATIVE. (There can be exceptions for critical infrastructure workers, but please defer to public health for those exceptions.)
        • Individuals are NOT able to “test out” of quarantine.
        • NCDHHS has created a document explaining quarantine, including various scenarios, that you can review with your patients; it is available in English and Spanish.
  • If you identify a Buncombe County resident who cannot safely isolate or quarantine at their place of residence, please call Buncombe County Communicable Disease staff at 828-250-5109 to inquire about obtaining free isolation/quarantine housing for that individual or family.
  • More details on COVID-19 testing in Buncombe County can be found here.

 

Guidance for Testing & Management of Students and Staff at K-12 Schools:

  • K-12 public schools are required to follow the guidance contained in the state’s StrongSchoolsNC Toolkit. (Private schools are encouraged to follow the same guidance.) Symptom & exposure screening of students and staff is a key part of that guidance.
  • If a student or staff has a positive screening, the schools follow the protocols outlined in the Reference Guide for Suspected, Presumptive, or Confirmed Cases of COVID-19.
  • NCDHHS has also developed a document focused on testing considerations for students and staff at K-12 schools.
    • Pages 2-3 of this document outline when students & staff can return to school following testing for symptoms or close contact to someone with COVID-19.
  • If a student or staff member screens +, they are sent home and directed to follow up with their healthcare provider. The following guidance determines when they (and their household members) can return to school:
    • If symptomatic and they have a negative COVID-19 PCR test, they can return to school once they have no fever for 24 hours without the use of fever-reducing medicine and they have felt well for 24 hours.
      • If they have a negative rapid antigen test, they must stay home until they have a negative follow-up PCR test, no fever for 24 hours without the use of fever-reducing medicine and they have felt well for 24 hours.
    • If symptomatic and they have been diagnosed with COVID-19 by a healthcare provider based on a test or their symptoms, they must remain out of school until they meet criteria for release from isolation (at least 10 days from onset of symptoms, and at least 24 hours since they had a fever without the use of fever-reducing medicine, and symptom improvement).
    • If they have been diagnosed with COVID-19 based on a test, but do not have symptoms, they must remain out of school until 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive test.
      • If they develop symptoms, they must remain out of school until they meet criteria for release from isolation (see above).
    • If they are determined to have been in close contact with someone diagnosed with COVID-19, they must remain out of school for 14 days since the last date of exposure, unless they test positive.
      • If they test positive for COVID-19, exclusion criteria above would apply.
      • Again, individuals are NOT able to “test out” of quarantine. They must complete the full 14 days of quarantine, even if they test negative.
    • They can return to school, following normal school policies, if they receive confirmation of an alternate diagnosis from a healthcare provider that would explain the COVID-19-like symptom(s), once there is no fever without the use of fever-reducing medicine and they have felt well for 24 hours.
      • Again, please maintain a low threshold for testing for COVID-19.
    • All members of a symptomatic individual’s household who are affiliated with a school (e.g., a sibling or child who is a student, or a parent who is a teacher) are excluded from school because they are contacts to a potential COVID-19 case.
      • If the symptomatic individual receives confirmation of an alternate diagnosis from a healthcare provider that would explain the COVID-19-like symptom(s), once there is no fever without the use of fever-reducing medicine and they have felt well for 24 hours, the household member may also return at that time, assuming they themselves have not developed symptoms.

 

Antigen Testing:

  • Continue to be mindful that antigen testing is less sensitive than PCR-based methods, in general. Therefore, antigen testing is best used when there is a high pre-test probability of SARS-CoV-2 infection.
  • The current FDA-authorized antigen tests are intended for use in symptomatic individuals within the first 5-7 days of symptom onset.
    • There are limited data on antigen test performance in asymptomatic individuals; however, there have been anecdotal reports of positive antigen test results in asymptomatic individuals followed by negative PCR test results (presumed false positives).
  • Results from antigen tests should be interpreted with consideration of pre-test probability of infection (e.g., presence/absence of clinical signs & symptoms of COVID-19, recent exposures). (Chart is from attached Antigen Testing Provider Update.)

Influenza Testing and Management Guidance during COVID-19 Pandemic:

  • For information on influenza circulation in NC, go here. This data is updated weekly on Thursday afternoons.
    • For the week ended 10/24/2020, influenza-like illness remained low across NC, including in WNC.
  • Please continue to encourage flu vaccination of everyone 6 months of age and older! If someone is in need of a free flu vaccine, please encourage them to call our Immunization Clinic at 828-250-5096 for information on where to go.

 

Reporting Test Results to Public Health:

  • Remember that, per NC statute, providers are responsible for reporting cases of COVID-19 immediately to the local health department in the county where the patient lives.
    • Please complete the Communicable Disease Report Form (attached and available online, now as a fillable PDF) and fax it and a copy of the lab result to BCHHS Communicable Disease staff at 828-250-6169.
    • This is required even if the outside lab performing the test sends results to the state.

Please continue to encourage everyone to follow the 3 W’s when they leave their home – Wear a cloth face covering. Wait 6 feet apart from others. Wash hands often or use hand sanitizer. These simple, but powerful preventive measures remain the key to our success.

This global pandemic remains an ever-changing situation. Please continue to check the CDC and NC DHHS websites for more information.

Contact the Buncombe County Communicable Disease staff at 828-250-5109 (available 24/7) or the NC Division of Public Health epidemiologist on-call line at 919-733-3419 (available 24/7) for additional consultation about COVID-19 or other public health concerns.