BCHHS Public Health Provider Update: COVID-19 testing info; how to address STD and TB testing during COVID
May 5, 2020
- As of noon today, there have been a total of 79 lab-confirmed cases of COVID-19 in Buncombe County residents, including 4 fatalities. Basic demographic information on Buncombe County cases is updated daily on the Buncombe County COVID-19 data dashboard.
- At this time, there have been no lab-confirmed cases of COVID-19 in any nursing homes or congregate living facilities in Buncombe County.
Molecular (PCR) Diagnostic Lab Testing for COVID-19:
- As I mentioned in my previous update, the current guidance from NC DHHS is that clinicians can consider testing for COVID-19 in any symptomatic person in whom the illness is suspected.
- We want everyone in our county who has symptoms of COVID-19 to be evaluated and tested so that we can identify all cases, conduct contact tracing and reduce the spread in our community.
- While the message previously to those with mild symptoms was stay home and isolate, the message now is call your healthcare provider to get tested.
- Late last week, Buncombe County launched an online COVID-19 self-checker where individuals concerned they have COVID-19 can go to enter in their symptoms, health history and receive guidance on whether testing is indicated and how to get connected to a provider if they don’t have a PCP. The tool is available in English, Spanish and Russian. Feel free to post a link to the self-checker on your website or social media.
- It is especially important that symptomatic healthcare personnel, first responders, and residents and staff in congregate living settings (long-term care facilities, assisted living facilities, group homes, homeless shelters, jails, etc.) be tested for COVID-19.
- Last week, the CDC expanded their list of COVID-19 symptoms to include fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea, and/or sore throat.
- Please use this new list of symptoms when you are screening patients for COVID-19.
- Per NC DHHS, testing capacity remains strong and turnaround times short through these commercial labs in NC -- LabCorp, Mako Medical Lab (based out of Henderson, NC), and Quest.
- Consider reaching out to one of these labs to obtain specimen collection supplies.
- If your office is unable to collect specimens for COVID-19 due to inadequate PPE or specimen collection supplies, please refer individuals with symptoms of COVID-19 to one of the local urgent cares or clinics that are able to do telehealth and specimen collection for individuals who cannot be seen by their PCP or who do not have a PCP. We will keep this list updated as we become aware of additional options.
- Testing through the State Lab of Public Health remains limited to symptomatic individuals within these prioritized populations:
- Healthcare workers or first responders (e.g., EMS, law enforcement, fire departments, military)
- Persons who live in or have regular contact with a high-risk setting (e.g., long-term care facility, homeless shelter, jail/correctional facility, migrant farmworker camp)
- Persons who are at higher risk of severe illness and for whom a clinician has determined that results would inform clinical management
- Hospitalized patients
- Post-mortem specimens from patients in whom COVID-19 was suspected but not confirmed prior to death.
- Please continue to 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.
- Continue to give patients who are tested the home isolation guidance (see note below under “Release from Home Isolation”).
- If you are a non-Mission-affiliated provider reporting a suspected case, we would appreciate you completing and faxing us the CDC’s PUI form (attached to my 4/20/2020 email).
- To help us track testing by race/ethnicity, please be sure to complete that information on the PUI form.
- If a provider identifies a symptomatic person who falls into one of the prioritized populations for State Lab testing (see above) but is unable to test them, the provider should call the Buncombe County Communicable Disease line and we will facilitate getting that person tested by us or another local healthcare facility.
Updated Guidance on Release from Home Isolation
- Yesterday, the CDC updated their guidance on when individuals with COVID-19 can be released from home isolation.
- Based on evidence that suggests a longer duration of viral shedding, the home isolation period was increased to 10 days following symptom onset for those who had symptoms and to 10 days from date of first positive test for asymptomatic individuals with lab-confirmed COVID-19.
- In addition to the 10 days since onset, those with symptoms still need to have had at least 3 days without fever and with improvement in respiratory symptoms to be released from isolation.
- The state is working to update the relevant documents on the NC DHHS website as quickly as possible.
Reimbursement for COVID-19 Testing and Treatment of Individuals who are Uninsured
Serology Testing for COVID-19
- The FDA has issued Emergency Use Authorizations for several serology tests that look for antibodies to COVID-19 in an individual’s blood. However, there remain concerns about the accuracy and validity of these antibody tests based on test characteristics (sensitivity and specificity) and the prevalence of illness in the population tested. Additionally, at this time, there remain significant gaps in our understanding of the presence of antibodies to SARS-CoV-2 and immunity. The presence of antibodies is not necessarily equivalent to protection from SARS-CoV-2. An active area of research relates to understanding the presence of antibodies and immunity to COVID-19.
- Due to concerns about the potential for significant numbers of false positives based on current available test characteristics and an uncertain prevalence of COVID-19 in the general population of WNC, the recommendation from epidemiologists at the state and local level is to proceed with much caution when considering serology testing in your patient population. A test done in someone who had a history of COVID symptoms would be much more likely to be a true positive than a test done in someone who lacked symptoms. And a positive result in a healthcare worker who cared for individuals with COVID would be more trustworthy.
- This website will provide updated info on available serology tests and should be a good resource.
- NC DHHS likely will push out guidance regarding serology testing in the coming weeks.
Guidance for addressing STDs and Baseline TB testing during COVID-19 pandemic
- See the attached memos from NC DHHS. One outlines some best practices for the continuation of STD services during the COVID-19 pandemic. The other recommends deferring certain required or baseline TB testing at this time.
- BCHHS STD Clinic continues to provide scheduled visits for individuals with symptoms of STDs or those identified as contacts to someone with an STD. We are also working on establishing telehealth hybrid visits to enable STD screenings for asymptomatic individuals. Individuals can call 250-5109 between 8am-5pm for more information or to request an appointment.
Letter regarding deferring baseline TB screening for new hires
STD Services during COVID-19
Thank you for all you are doing to care for our community
Jennifer Mullendore, MD, MSPH
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.