BCHHS Public Health Provider Update: Additional guidance on testing for COVID-19

March 23, 2020

As you have likely heard this weekend, residents of several WNC counties, including Buncombe, were found to have lab-confirmed COVID-19. Our case count in Buncombe has continued to increase throughout the day today and we expect that to be the case for the coming days as well. Based on contact investigations that are underway, it is likely that we have local community spread.

 

I have received questions and concerns from some of you about the information on testing that I shared on Friday. Updated clinician guidance document will be distributed by NC DHHS within the next 48 hours which provides further detail about this change in testing strategy that is being recommended statewide. Here is what you can expect:

 

Testing for COVID-19

  •          Clinicians are encouraged to not test individuals with mild illness (fever and cough without shortness of breath, difficulty breathing, chest discomfort or altered mental status).
  •          Instead, recommend those individuals stay home and manage their symptoms.
    •    The goal of this change in testing is to decrease the acceleration of COVID-19 spread in our communities.
    •    Rationale:

·         We now have documentation of community transmission in NC. Additionally, there has been an acceleration in the number of cases and in instances of community transmission.

·         We need to conserve critical supplies. There is a nationwide PPE shortage. Efforts are underway to increase the supply in NC, but we need to not waste what we currently have on hand.

·         We need to limit the exposure of healthcare personnel (HCP).

  • People with mild illness due to COVID-19 who leave their homes for testing may spread the illness to others, including HCP and high-risk individuals.
  •          People who leave their homes for testing may expose themselves to COVID-19 if they don’t already have it.
    • Most people (~80%) have mild illness. Testing doesn't change management of those individuals.
    • Individuals with mild illness can call their health care provider or utilize telehealth options for assessment of their clinical status.
      • They should call their provider if their symptoms worsen.
  •          The state encourages providers to have more close telehealth follow-up with high-risk individuals.
  • Prioritize testing for those individuals with more severe symptoms, or if the test result would change clinical management, or if the individual is in a high-risk setting – congregate living (long-term care, jail, shelter), HCP, first responder.

 

An op-ed about these changes, written by several former state health directors, was published today in the News and Observer:  https://www.newsobserver.com/opinion/article241377726.html

 

Guidance for those who are exposed to someone with symptoms

·         For the general public:  Self-quarantine and monitor yourself for symptoms for 14 days after last exposure. Self-isolate if symptoms develop.

·         For HCP/first responder/essential personnel:  Self-monitor and report to your employer. Self-isolate if symptoms develop.

 

When can someone be released from isolation?

  •          Individuals with fever and respiratory symptoms (including those with laboratory-confirmed COVID-19) should isolate themselves until the below conditions are met:
    • At least 7 days since symptom onset

AND

  • At least 72 hours after their symptoms go away (no fever without the use of fever-reducing medication and improvement in respiratory symptoms)

 

 

I know how frustrating these frequent changes to guidance can be, and I know that some of you think that we should be doing more testing, not less. However, I ask that you trust the public health officials in Raleigh who are assessing the situation on the ground throughout our state, as well as what is happening elsewhere in the country and world.

 

I will share the formal updated guidance from NC DHHS as soon as I receive it, but ask that you consider moving forward with the above guidance starting now.

 

For the most up-to-date information:

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

North Carolina’s COVID-19 webpage

 

For Buncombe County Communicable Disease Control staff, call 828-250-5109 (available 24/7). If you don’t connect with a nurse, leave a message and one will return your call as soon as possible.

 

Thank you for all you do for our community,

 

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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