BCHHS Public Health Provider Alert: Updated COVID-19 Guidance & Local Response

March 16, 2020

Situation Update

This remains a rapidly evolving situation of course, but as of noon today, there have been 23 cases (presumptive + and confirmed +) in NC.

Still no cases identified in Buncombe County or WNC at this time, although numerous tests are pending.  Many thanks to those of you who have implemented testing through commercial labs (LabCorp and Quest). 

Testing Criteria

There has been no change in recommendations for who should be considered for testing.

Infection Control

NCDPH updated the PPE recommendations to match what I shared a few days ago from the CDC.

Several of you have been asking how you can request PPE through the county. Buncombe County Emergency Services (BCES) is the agency that handles such requests.

o   This document outlines the process for conserving existing PPE and requesting needed supplies.

o   If you are a provider in Buncombe County who is looking for PPE, you should:

§  Review the attached document.

§  If you want to submit a request, complete the form on the last page of the attachment.

§  You will also need to answer the following questions and send your responses as well as the form to the 3 individuals listed on the 1st page of the document.

1. Have neighboring agencies/facilities have been contacted to attempt to borrow/purchase additional PPE Supplies?

2. What administrative controls are being utilized to decrease the current burn rate of PPE?

3. When is the next expected delivery of PPE?

4. What is your daily burn rate and how many hours of each type of PPE does the agency currently have (e.g., 48 hours of gowns and 96 hours of N95 respirators)?

5. What surge management considerations have been implemented (postponing all elective and outpatient procedures, etc.)?

6. How many patients are currently on isolation?

7.  For N95 respirators, OSHA requires that you have an approved respiratory protection program in place to include fit-testing, so you will also need to answer the question:

Have your employees been fit-tested for N95 respirators?  

o   If so, this testing is specific to the mask. This means if you are provided masks that are not the same ones your staff was fit-tested for you would have to fit test them for the new masks which would burn some of the stock you receive immediately.

**Please be aware that BCES does not have stock locally and this request will be forwarded to North Carolina Emergency Management. BCES does not know what resources are available through the state at this time, how they are being prioritized or any costs associated with obtaining them. 

 Testing at NC State Lab of Public Health (NCSLPH):

  • Still requires approval by local health department for the county of the health care facility or the state epidemiologist on call.
  • Have changed to only requiring a nasopharyngeal swab.
  • As commercial laboratories come online with testing, the NCSLPH will continue to work with partners across the public health systems to support identification and confirmation of COVID-19, assess the prevalence of COVID-19 in a community, and provide testing for underserved populations who may not have access to commercial testing.

 Payment for Virtual Care (Telehealth)

Here is a document from Dr. Susan Mims that summarizes the current status of payment by insurers for virtual health services.

 What is BCHHS doing about testing?

The Buncombe County Communicable Disease staff continue to perform testing for COVID-19 at the residences of those who meet criteria. We are focusing our testing on those non-critically ill individuals who cannot get tested at a primary care clinic or urgent care (e.g., uninsured, transportation barriers, etc.). Our tests are run through the NCSLPH.

o   Do NOT send PUIs to our clinic!

We will be referring individuals who meet criteria for testing and have insurance to their PCP or local urgent cares who we know have implemented testing, asking that the individual call ahead to make sure testing is available and that you/your staff are prepared when they arrive.

BCHHS is working with Buncombe County Emergency Services and local medical providers to explore the potential to establish testing site(s) in the community where providers can refer those who meet criteria for testing. We are working through the details and will keep you updated.

 What is BCHHS doing about schools?

See the attached letter that was shared with all K-12 schools and childcare centers yesterday for distribution to parents. It was based on guidance from NCDHHS and the CDC regarding school closure.

You may hear from parents of children who fall into one of the high-risk categories, asking for your guidance on whether they should pull their children from school at this time.

o   This is an individual decision of the parent/guardian made in consultation with you as their PCP.

o   Schools have been taking and continue to take proactive preventive measures to reduce exposure to infection.

o   Most of the schools that we have been speaking with over the last week also have developed or are actively working on distance learning opportunities for students in the event of school closure or the need for high-risk students to stay home.

o   I know that there are many students with asthma in our community. Just as with influenza, I consider them at high-risk from COVID-19.

o   To help reduce the potential increase in call volume from parents about this issue, you may wish to add messaging to your website, phone tree or via your patient portals about your clinic’s stance on parents pulling their high-risk children out of school.

 What else is Buncombe County doing?

We also have been communicating with all our local health systems, long-term care facilities, adult care homes and other residential living facilities; the detention facility; colleges and universities; local employers, hotels, restaurants, event organizers, human service agencies, non-profits, and the faith community to make sure all are aware of guidance specific to their situation as well as general recommendations to prevent and mitigate the spread of COVID-19 in our community.

On Thursday, March 12th, Buncombe County declared a State of Emergency which will help mobilize additional state and federal funding and resources to support outbreak preparation and response.

The county also has instituted a partial Emergency Operations Center to enable all responding governmental agencies in the county to coordinate our efforts more seamlessly.

For the most up-to-date information:

https://www.cdc.gov/coronavirus/2019-ncov/index.html

https://epi.dph.ncdhhs.gov/cd/coronavirus/providers.html

Latest provider guidance

NC Department of Public Health (DPH) and NC AHEC Weekly Webinars

Every Friday beginning March 13 | 12:30-1:30 pm

These weekly webinars, co-sponsored by DPH and NC AHEC, will provide the latest updates on COVID-19 and allow healthcare providers the opportunity to ask questions about COVID-19. The weekly webinars will continue until they are no longer needed.

Click the button below to join through your computer, or call (646) 558-8656 for dial-in access. The webinar ID is 705-979-628.

JOIN

For Buncombe County Communicable Disease Control staff

Call 828-250-5109 (available 24/7). The nurses have been experiencing a very high call volume and will return your call as soon as possible. We are working to provide them additional support.

Fax to 828-250-6169 the CDC PUI form for any Buncombe County resident you do COVID-19 commercial lab testing on. Also remember to give the person the isolation guidance documents and visitor log.

Thanks for coming together as a community to help address this significant challenge.

In solidarity,

Jennifer Mullendore, MD, MSPH

(she/her/hers)

Interim Health Director and Medical Director

Buncombe County Health and Human Services

Office:  828-250-6308

Cell:  828-989-6145

 

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