COVID-19 Update for Virginia

COVID-19 Update for Virginia

April 6, 2020

Dear Colleague:

As COVID-19 continues to rapidly evolve, please visit the VDH website for updated epidemiological information and clinical guidance.

COVID-19 in Virginia

• As community transmission increases in Virginia, healthcare facilities should consider additional actions to reduce the risk of their employees introducing COVID-19 into their facilities.
• There is growing evidence of asymptomatic and presymptomatic spread. CDC recently changed the start of the infectious period to 48 hours before symptom onset.
• For people who must leave their home for essential needs (e.g., grocery shopping and picking up pharmacy medications), CDC recommends that people wear cloth face coverings where other social distancing measures are difficult to maintain, especially in areas of significant community-based transmission.  N95 respirators and surgical masks are not recommended in these situations so that they can be reserved for HCP and first responders
• Mildly ill patients may not need to be tested and can be managed at home. Clinical diagnoses of COVID-19 are reportable; given the volume, reporting through the VDH Online Morbidity Report Portal is preferred. Please continue to call your local health department about suspected outbreaks of COVID-19.
• For COVID-19 patients, please provide this patient handout about home isolation and encourage them to notify their contacts.
• A COVID-19 Flag Alert has been added to Virginia’s Emergency Department Care Coordination Program. COVID-19 alerts will automatically become inactive after six weeks.
• VDH has updated work restriction recommendations to allowasymptomatic healthcare personnel who have had an exposure to a COVID-19 patient to continue to work after options to improve staffing have been exhausted and in consultation with their occupational health program. More information can be found on the VDH COVID-19 Healthcare Personnel Risk Assessment Tool.

 Testing

• VDH criteria for COVID-19 public health testing at DCLS have been updated to remove requirements for influenza testing. Until testing is widely available, prioritizing testing at private labs for high risk groups should also be considered.

Personal Protective Equipment (PPE)

• Virginia continues to experience a critical shortage of PPE. CDC has defined acceptable alternative PPE for caring for patients with confirmed or suspected COVID-19. Additional shipments from the Strategic National Stockpile are not expected in the near future. For questions, individual practices, home health and CHCs/FQHCs should check with their local health districts. Hospitals and nursing homes should contact their regional healthcare coalition.

 Congregate Settings

• As of April 3, 31 confirmed outbreaks (defined as having two or more COVID-19 cases) have been reported and 12 (39%) are in skilled nursing and assisted living facilities. Answers to frequently asked questions are available on the VDH website and guidance is on the CDC website.
• Other congregate settings, such as jails, prisons, and behavioral health residential facilities also face the threat of COVID-19 introduction and spread. To date, two (7%) confirmed outbreaks have been reported in correctional facilities. CDC guidance and resources are available for correctional facilities and detention centers.

Thank you for all your efforts on the front line of combat against the COVID-19 pandemic. You are an essential part of the public health campaign to protect the health of the people of the Commonwealth.

Sincerely,

M. Norman Oliver, MD, MA
State Health Commissioner

 

Guidance for Long Term Care Facilities (LTCFs)

 LTCF residents are at greater risk for severe disease because of their age and/or underlying medical conditions.

• Implement restrictions now:
  • Limit points of entry to the facility. Visitors, volunteers, and non-essential healthcare personnel (HCP) must be restricted from the facility, except for end-of-life situations.
  • Restrict all residents to their room and enforce social distancing. Cancel all group activities and communal dining.
  • Residents should be allowed to leave only for medically necessary purposes (e.g., hemodialysis), and should wear a facemask (if tolerated) when they leave.
  • Designate a location to cohort residents with suspected or confirmed COVID-19.
• Identify cases as early as possible by actively screening all residents daily for fever and respiratory symptoms (pulse oximetry).
  • LTC residents with COVID-19 may show atypical symptoms including new or worsening malaise, new dizziness, diarrhea, or sore throat. Identification of these symptoms should prompt isolation and further evaluation.
• Institute staffing recommendations for widespread community transmission:
  • Screen HCP for fever and respiratory symptoms at the beginning of their shift. If they are ill, have them put on a facemask and leave the workplace.
  • Implement universal use of facemasks for HCP while in the facility, as supply allows.
  • Designate HCP who will be responsible for caring for COVID-19 patients.
  • To mitigate staffing shortages, exposed HCP may continue to work while wearing a facemask as long as they remain asymptomatic. Testing exposed, asymptomatic HCP is not advised.
• Follow environmental cleaning and disinfection procedures consistently and correctly.
  • Management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures.

The Centers for Medicare & Medicaid released updated guidance for long-term care facilities on April 2: https://www.cms.gov/files/document/4220-covid-19-long-term-care-facility-guidance.pdf.