April 20, 2020
Dear Colleague:
COVID-19 continues to evolve. Please visit the Virginia Department of Health (VDH) website for clinical guidance and epidemiological data. I’d like to highlight the following updates:
Health Inequities
Several reports have described a disproportionate impact of COVID-19 on minority populations in areas of the United States. To better understand the situation in Virginia, we need more complete data. Race and ethnicity information has not been reported for almost one third of Virginia’s COVID-19 cases. I ask that all providers include race and ethnicity data when ordering COVID-19 testing from a reference laboratory and when reporting COVID-19 illness to VDH (online portal).
Outbreaks in Long-Term Care Facilities
In Virginia, more than half of the confirmed outbreaks of COVID-19 have occurred in long-term care facilities (LTCFs), including nursing homes, assisted living facilities, residential behavioral health, and multicare facilities. In response, Governor Northam created the Virginia COVID-19 Long‑Term Care Facility Taskforce, which is leading Virginia’s effort to support LTCFs in their COVID-19 response. The expansions in testing criteria noted below include components relevant to testing in these facilities. For current best practices to prevent and manage outbreaks in LTCFs, please visit the VDH website, CDC Strategies to Prepare for COVID-19 in LTCFs and Considerations When Preparing for COVID-19 in Assisted Living Facilities.
Healthcare Workers Exposed to COVID-19
With ongoing transmission of COVID-19 across the United States, the feasibility and benefits of formal contact tracing for exposures in healthcare settings are likely limited. CDC’s Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID‑19) has been archived. Healthcare facilities should consider foregoing contact tracing efforts in favor of universal source control (face covering) for healthcare personnel and screening for fever and symptoms of COVID-19 before every shift.
Laboratory Testing
COVID-19 testing capability at private laboratories as well as hospital labs has been steadily increasing. Additionally, VDH has expanded the criteria for COVID-19 testing at the Division of Consolidated Laboratory Services (DCLS). Testing at DCLS still requires VDH approval and requests may be submitted through an online system (COVID-19 Testing Request Form). To request specimen collection kits for testing that has been approved by VDH, call 804-648-4480, x104. A list of private laboratories that are conducting COVID-19 testing is available here.
Fatalities
Deaths caused by COVID-19 in Virginia are natural deaths; and it is the professional responsibility of the physician caring for the patient to complete the death certificate (32.1- 263), preferably through the Electronic Death Registration System. This is true whether the patient died in a medical care facility or at home. The death certificate is necessary to provide legal documentation of the death and to allow for legal resolution of many issues involving the end of life. For capturing COVID-19 (SARS-CoV-2) deaths, all lab-confirmed fatalities due to COVID-19 should specifically list COVID-19 as the primary cause of death (Part I). Deaths suspected of being due to COVID-19 without lab confirmation should cite “presumed” or “probable” COVID-19 on the death certificate. Many COVID-19 fatalities have comorbidities, and those comorbid conditions can be listed as contributing factors to the death (Part II). Additional information can be found at www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf
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. Please consider joining or promoting the Virginia Medical Reserve Corps: www.vamrc.org/vvhs or vamrc@vdh.virginia.gov. For all other questions, contact your local health department.
Sincerely,
M. Norman Oliver, MD, MA
State Health Commissioner