BCHHS Public Health Provider Update: New COVID-19 testing guidance & updated PPE recommendation

June 15, 2020

Situation Update:

  • As of noon on 6/14/2020, there have been a total of 437 lab-confirmed cases of COVID-19 in Buncombe County residents, including 35 fatalities. Basic demographic information on Buncombe County cases is updated daily on the Buncombe County COVID-19 data dashboard.
    • 40% of these cases have been in individuals 25-49 years of age, followed by 26.8% in those 65+.
    • As is being seen in NC and nationally, there is disproportionate impact of COVID-19 on Black, Indigenous and People of Color (BIPOC) in Buncombe County when it comes to lab-confirmed cases.               
      • 28.1% of these cases are in individuals who identify as Hispanic/Latinx, although Hispanic/Latinx individuals make up 6.7% of the county’s population.
      • 21.8% of cases are in individuals who identify as BIPOC, although they make up 8.4% of the county’s population.
      • Structural racism and the inequities it leads to in housing, employment, income, education, and other social determinants of health, result in this disproportionate impact of COVID-19 and other health conditions on BIPOC and Hispanic/Latinx individuals.
  • There are now 5 long-term care facilities in Buncombe County experiencing outbreaks of COVID-19 (meaning 2 or more lab-confirmed cases in residents or staff within 28 days). Residents of these facilities account for 30 of the 35 deaths reported in Buncombe County residents. More detailed info on outbreaks in NC congregate living settings can be found on the NC DHHS website.

Monday Webinar to Discuss Updates on COVID-19 Testing Modalities, Guidance and Resources

·The NC Department of Health and Human Services will hold a webinar on Testing Modalities, Guidance and Resources tomorrow, Monday, June 15th, from 5:30-6:30pm. Speakers will include Secretary Mandy Cohen, Dr. Betsey Tilson, Dr. Shannon Dowler, Dr. Cardra Burns, Scott Shone and Jay Ludlam.  Click the following link to join the webinar:  https://zoom.us/j/92221758049

Updated NC DHHS Provider Guidance (attached)

Who should be tested?

  • Clinicians should conduct or arrange for diagnostic COVID-19 testing for:
    • Anyone with symptoms suggestive of COVID-19
    • Anyone (with or without symptoms) who is a close contact of a known positive case
    • Anyone (with or without symptoms) in the following groups who believes they may have been exposed to COVID-19:
      • Persons who live in or have regular contact with high-risk settings (e.g., long-term care facility, homeless shelter, correctional facility, migrant farmworker camp)
      • Persons who are at high risk of severe illness (e.g., people over 65 years of age, people of any age with underlying health conditions)
      • Historically marginalized populations
      • Healthcare workers or first responders (e.g. EMS, law enforcement, fire department, military)
      • Front-line and essential workers (grocery store clerks, gas station attendants, child care workers, construction workers, food processing plant workers, etc.) in settings where social distancing is difficult to maintain
    • People who attended mass gatherings (protests, marches, rallies, funerals, parties, cookouts, etc.), particularly if they were in crowds or other situations where they couldn’t practice effective social distancing
  • If you are unable to collect specimens for COVID testing in your clinic, please refer your patients who meet the above criteria to one of the local clinics that are providing testing or to one of the community-based testing sites run by Buncombe County in partnership with Western North Carolina Community Health Services.

What guidance do you give those who are tested?

  • Please review and provide the Person Under Investigation Guidance (English and Spanish) to anyone tested because they have symptoms or because they had a known or suspected exposure to a person with COVID-19.
  • Those who are tested but have no symptoms and no known exposure to someone with COVID-19 do not need to stay home while waiting on test results.
  • Buncombe County Public Health is finalizing a guidance document for providers and educational materials for patients on isolation and quarantine steps. I hope to get that out to you later this week.
  • 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.

What do you report to Buncombe County Communicable Disease staff (phone 828-250-5019 or fax 828-250-6165)?

  • Suspected or lab-confirmed cases of COVID-19 in Buncombe County residents
    • To enable us to know what our local trends are related to testing & percent positivity, we continue to track the number of tests performed in Buncombe County residents. Please fax a completed Communicable Disease Report Form to 828-250-6169 on anyone you test for COVID-19. Make sure to complete the basic demographic data on the form as we are using that information as part of an equity analysis of testing in our county.
  • COVID-19-associated deaths in Buncombe County residents
  • Any cluster of severe acute respiratory illness in healthcare workers

IMPORTANT UPDATED CDC GUIDANCE ON PPE

Given the potential for asymptomatic transmission of SARS-CoV-2, what PPE should be worn by healthcare personnel providing care to patients who are not suspected to have COVID-19?

  • The potential for asymptomatic transmission underscores the importance of applying prevention practices to all patients, including social distancing, hand hygiene, surface decontamination, and having patients wear a cloth face covering or facemask (for source control) while in a healthcare facility. 
  • To protect patients and co-workers, HCP should wear a facemask at all times while they are in a healthcare facility (i.e., practice source control). 
  • HCP caring for patients with suspected or confirmed COVID-19 should continue to wear gloves, a gown, respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator (or facemask if respirators are not available), and eye protection (i.e., goggles or disposable face shield that covers the front and sides of the face).
  • HCP working in facilities located in areas with moderate to substantial community transmission (see definitions below – We believe Buncombe County currently meets definition for moderate community transmission) are more likely to encounter asymptomatic patients with COVID-19. If COVID-19 is not suspected in a patient presenting for care (based on symptom and exposure history), HCP should follow Standard Precautions (and Transmission-Based Precautions if required based on the suspected diagnosis). They should also:
    • Wear eye protection in addition to their facemask to ensure the eyes, nose, and mouth are all protected from splashes and sprays of infectious material from others.
    • Wear an N95 or higher-level respirator, instead of a facemask, for:
      • Aerosol-generating procedures (See ‘Which procedures are considered aerosol generating procedures in healthcare settings’ FAQ) and
      • Surgical procedures that might pose higher risk for transmission if the patient has COVID-19 (e.g., that generate potentially infectious aerosols or involving anatomic regions where viral loads might be higher, such as the nose and throat, oropharynx, respiratory tract) (see Surgical FAQ below).
  • Definitions:
    • Substantial community transmission: Large scale community transmission, including communal settings (e.g., schools, workplaces)
    • Minimal to moderate community transmission: Sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases
    • No to minimal community transmission: Evidence of isolated cases or limited community transmission, case investigations underway; no evidence of exposure in large communal setting

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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