BCHHS Public Health Provider Alert: Updated NCDHHS COVID guidance for clinicians on testing, patient education & reporting

July 13, 2020

Situation Update:

BCHHS Guidance for Providers on COVID Isolation and Quarantine -- 7-9-2020

  • As of noon on July 10th, there have been a total of 802 lab-confirmed cases of COVID-19 in Buncombe County residents, including 31 fatalities. Due to a significant increase in the volume of cases being reported over the last few days, the Buncombe County COVID-19 data dashboard, which relies on manual data entry, shows a lag in case count compared to the county data on the state’s dashboard. Basic demographic information on cases and deaths is available on these dashboards.
  • 53.9% of Buncombe County residents with lab-confirmed COVID-19 have been between the ages of 18-49. As has been seen on national and state levels, the percentage of new COVID-19 cases in this age group has increased in Buncombe County over the past few weeks.
  • The way to tell whether a rise in cases is because of increased spread in the population, rather than a result of performing more tests, is by looking at the percent of tests that are positive.
    • In NC as a whole, 10% of COVID-19 tests performed are coming back positive. This percentage has been 9-10% for the past several weeks.
    • However, in Buncombe County, since last week, we have seen a greater percentage of tests come back positive for COVID-19. This indicates that we are seeing more spread of the infection in our community.
      • Last week, 2% of COVID tests on county residents came back positive for COVID, but now we are seeing 4% of tests come back positive.
  • There are now 8 LTCFs in Buncombe County with active outbreaks of COVID-19 (meaning 2 or more lab-confirmed cases in residents or staff within 28 days). Thankfully, outbreaks at 2 additional LTCFs have ended over the last week. Residents of 4 local LTCFs account for 27 of the 31 deaths reported in Buncombe County residents. More detailed info on outbreaks in NC congregate living settings can be found on the NC DHHS website.
  • Hospitals in our region have reported an increase in COVID-19-related hospitalizations over the past week. There are no issues in our region with ICU or ventilator capacity at this point.

Testing Sites:

Increased Turnaround Time for Many Labs:

  •          As you are likely aware, due to recent increases in testing nationwide and insufficient reagent supply for some testing platforms, LabCorp and other large commercial labs have seen an increase in specimens being sent to them for testing. As a result, turnaround time at these labs has increased significantly to 5-8 days. The state continues to work on identifying labs with capacity and has asked the federal government to help with procurement of reagents.

SARS-CoV-2 Rapid Antigen Testing

  •          We are aware that some clinics and hospitals in our area are using or looking into SARS-CoV-2 antigen testing.
  •          Please review the attached guidance from the state, as well as this information from the Association of Public Health Laboratories, which caution about relying on antigen testing alone to diagnose COVID-19 due to the lower sensitivity of antigen testing compared to molecular (PCR) testing.
  •          The most appropriate use of currently available antigen testing is in symptomatic patients with high pre-test probability that they have COVID-19.
  •          Patients with a negative antigen test who are suspected of having COVID-19 should have a follow-up molecular test to confirm the results.
  •          A positive antigen test should be reported to the local health department as a case of COVID-19.

Updated NC DHHS Provider Guidance

  •          The state has replaced the PUI guidance documents with “Steps for People to Take After COVID-19 Testing”, available in English and Spanish. (We are translating the document into Russian and will make it available on our BuncombeReady.org website.)
    •    Please review and provide this new document to all patients tested for COVID-19 as it provides them with more clarity on what they should be doing before and after getting their test results.
    •    I have also developed the attached “BCHHS Guidance for Providers on COVID Isolation & Quarantine” that you may find useful in your interactions with patients at the time of testing or upon receiving their results.
      •   All lab-confirmed COVID-19 cases and their close contacts will be contacted by a public health nurse or contact tracer, who will provide them with definitive guidance on isolation or quarantine. These staff will also determine when individuals can be released from isolation or quarantine and safely return to work. Please defer to these subject matter experts. However, if you have a concern, don’t hesitate to reach out to us at 250-5109. Keep in mind that healthcare personnel have different return to work recommendations due to their use of PPE.
    • If you identify an individual who is unable to isolate or quarantine safely in their place of residence or who is unhoused and needs a place to isolate or quarantine, contact our Communicable Disease staff at 828-250-5109. Buncombe County has Isolation & Quarantine housing available for free for those in need.

New Temporary Order for Providers to Report All COVID-19 Diagnostic Tests

**THIS IS A CHANGE TO PRIOR COVID REPORTING REQUIREMENTS FROM THE STATE AND REQUESTS THAT BCHHS HAS MADE OF YOU**

This change is to improve public health’s understanding of the total number of COVID tests being performed and who is getting tested. Hopefully, it will also decrease your reporting burden which I know is a strain on your staff.

  •          A Temporary Order was issued by the State Health Director on July 7th. The order requires healthcare providers and labs who are ordering or conducting COVID-19 diagnostic testing in NC to report both positive and negative results of COVID-19 diagnostic tests to public health. It also requires that certain patient information (including phone number, sex, race, & ethnicity) be included on the lab order.
  •          Please review the associated Guidance for more details, but essentially here’s what it means based on my current understanding (further clarity is forthcoming from the state):
    •    If you are sending COVID-19 diagnostic tests to a lab that reports negative COVID test results to NCDHHS, then you are satisfying your requirement to report negatives to public health.
      •   While I can tell you that LabCorp and Quest electronically report all COVID results to the state, at this time I do not have access to a list of all labs that do so; therefore, if you use a different lab, you will need to verify with that lab whether they report negatives to the state.
      •   If the lab you use does not report negative results to the state, hopefully they will take the necessary steps to do so as a result of this order. However, until you verify that they are reporting all negative results to the state, it is your responsibility to send these results to the health department in the county where the patient resides within 24 hours of receipt.
    •    Per NC statute, physicians are required to report all positive COVID test results (both those performed through an outside lab and those performed in-house) to the health department in the county where the patient resides immediately upon receipt. This is not new and is required even if the outside lab performing the test sends results to the state.
      •   This can be done the same way you do it now for all reportable diseases – fax us a completed Communicable Disease Report form along with the lab (for Buncombe County, fax to 828-250-6169).
    •    If you are performing in-house COVID-19 diagnostic testing (i.e., using a point-of-care molecular or antigen test in your clinic), you must report all negative test results to the health department in the county where the patient resides within 24 hours of receipt.
    •    You must ensure that all the required data elements listed on the guidance document are included on all COVID-19 lab order forms.
      •   While I’m awaiting clarity on this from NCDHHS, please include as much of that information as possible along with the negative test results that you report to our health department when it is your responsibility to report these to us.
    •    Do not report any antibody test results to public health at this time.

What to report to Buncombe County Communicable Disease staff (phone 828-250-5109 or fax 828-250-6169):

  • Suspected or lab-confirmed cases of COVID-19 in Buncombe County residents (see above)
  • All negative COVID-19 diagnostic test results in Buncombe County residents (see above)

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.

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.

Continued thanks for everything you are doing to keep our community safe and healthy,

Jennifer Mullendore, MD, MSPH

(she/her/hers)

Health & Human Services,

Medical Director &

Interim Health Director

p. (828) 250-6308  c. 828-989-6145

40 Coxe Ave. - Asheville, NC 28801

Respect. Honesty. Integrity. Collaboration. Equity.

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