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ADA CO. PUBLIC HEALTH ORDER
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RESOURCES FOR BUSINESS, CHILDCARES, GENERAL PUBLIC
CDH BOARD OF HEALTH MEETINGS | COVID-19 & SCHOOLS
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CDC COVID-19 WEBSITE | Centros para el Control y la Prevención de Enfermedades
Given the critical role of our communities' healthcare providers amidst the COVID-19 response, Central Distrct Health created this web page to help answer some of the Frequently Asked Questions we are hearing from healthcare providers, and to offer a resource hub for regional and statewide COVID-19 information.
Healthcare providers needing to reach public health during business hours should call 208-327-8625; after hours, healthcare providers should call the Idaho State Communication Center at 1-800-632-8000 and ask for the health district 4 on call representative to be paged.
To view our main COVID-19 webpage, which includes case data, click HERE.
CDC and FDA Resources
COVID-19 Health Alert Network (HAN) Messages from Central District Health
To view all CDH-issued HAN messages, see our HAN page.
Central District Health does not maintain a list of clinics that perform testing and cannot provide detailed recommendations at this time regarding where patients may seek testing. Providers are encouraged to refer patients to locations such as drive-through testing locations, urgent care clinics, or emergency departments depending on the severity of illness.
Many commercial laboratories are offering COVID-19 testing; however, demand for testing has led to allocation and/or temporary discontinuation of testing. CDH recommends that you speak with your laboratory representative to determine the status of testing at commercial laboratories you work with. The Healthcare Common Procedure Coding System code for COVID-19 laboratory tests is U0002. Central District Health does not maintain information regarding the cost of testing through commercial laboratories.
Healthcare providers should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and consult CDC testing criteria to make the determination whether the patient should be tested.
The Idaho Bureau of Laboratories (IBL) priority is to maintain 24-hour turnaround time for hospitalized patients and is only accepting specimens for patients who meet certain criteria.
IBL High Priority Specimens (includes all in CDC priority 1, select groups in CDC priority 2, and Idaho public health priority groups)
If testing was done through a commercial laboratory, and results are not available in their stated turnaround time please contact that laboratory. If testing was done through the Idaho Bureau of Laboratories (IBL), please be aware that their priority is to maintain a 24-hour turnaround time for tests on hospitalized patients.
If you are testing through a commercial laboratory, please follow their guidance.
To test specimens through IBL, public health notification is required prior to specimen submission. For patients residing in Ada, Boise, Elmore and Valley counties, call Central District Health at (208) 327-8625 or fax the specimen submission reporting form to 208-327-7100.
If the patient resides in another jurisdiction, please call the corresponding health department or call the Division of Public Health Epidemiology Section at (208) 334-5939.
Specimens must be accompanied by a completed IBL clinical test request form.
Select the Other option under Virology, and write in “COVID-19”. Many forms are being submitted with blank Onset Date and Collection Date fields. Both dates are being used to prioritize samples. Samples without these dates completed are processed last. To ensure timely and appropriate notification, the patient city or county must be provided.
Without complete information, laboratorians, epidemiologists, and infection preventionists are losing valuable time tracking down the appropriate jurisdiction for public health intervention. Please help your colleagues by completing all the requested information on the clinical test request form for specimen submissions to IBL.
Testing through the Idaho Bureau of Labs (IBL) is available for the following groups of patients:
IBL High Priority Specimens (Includes all in CDC priority 1, select groups in CDC priority 2, and Idaho public health priority groups)
IBL Routine Priority Specimens (Remaining CDC priority group 2)
(updated 3/28/20) If you are testing through a commercial laboratory, please follow that lab’s guidance on specimen type. Either nasopharyngeal (NP) swab specimens or nasal swab (NS) specimens may be tested at IBL. NP swabs are preferred.
Store specimens at 2-8°C for up to 72 hours after collection. If a delay in testing or shipping is expected, store specimens at -70°C or below.
(Updated 3/28/20) Use only synthetic fiber swabs with plastic shafts. Do not use calcium alginate swabs or swabs with wooden shafts, as they may contain substances that inactivate some viruses and inhibit PCR testing. Place swabs immediately into sterile tubes containing 1-3 ml of viral transport media.
(Updated 3/28/20) Use only synthetic fiber swabs to sample both anterior nares. Do not use cotton swabs, swabs with wood shafts, or swabs with calcium alginate. Specimens may be collected by healthcare professional or self-collected. Oral swabs may be used; NP swab shaft length and flexibility are not desirable. See https://www.youtube.com/watch?v=2cd4gg975ao from the Joint Commission and CDC for nasal swab collection video.
(Updated 3/31/20) If testing is being conducted through a commercial laboratory, contact your commercial laboratory to learn what specimen collection and transport materials are acceptable.For specimens submitted to IBL, viral transport medium, Amies transport medium, or sterile saline may be used. The volume of transport media required is 1 to 3 mls. Laboratories may aliquot media as needed.
(Updated 4/21/20) A small proportion of COVID-19 serologic assays on the market have received FDA authorization. Any serologic test for SARS-CoV-2 should not be used as the sole basis of diagnosis. Negative results do not rule out SARS-CoV-2 infection, particularly in those who have been in contact with the virus. Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E. The FDA recently published a letter to healthcare providers regarding the appropriate use and limitations of antibody testing.
Local public health is conducting detailed contact investigations for all persons with lab-confirmed COVID-19 at this time. Part of the contact investigation involves collecting information about where the person was and who they were with while infectious. This includes potential healthcare exposures. Health department staff will notify contacts of the exposure and advise them on any actions they need to take. For healthcare-related exposures, health department staff will work collaboratively with affected facilities to ensure that appropriate staff and patients are notified and advised of the actions they need to take.
Local public health is conducting detailed contact investigations for all persons with lab-confirmed COVID-19 at this time. Part of the contact investigation involves collecting information about where the person was and who they were with while infectious. If a person who works at a healthcare facility is identified through this process, local public health will work with that person and their employer to determine when it is safe for that person to return to work.
Idaho is following CDC guidance for discontinuation of home isolation of persons with COVID-19. In most instances, using the non-test-based strategy is recommended.
Under this strategy, persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions:
• At least 3 days (72 hours) have passed since resolution of fever without use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); AND
• At least 7 days have passed since symptoms first appeared.
In general, household contacts of a patient with COVID-19 will need to isolate at home for 14 days from the last exposure without using recommended precautions. Health department staff will work closely with patients and their household members to determine timeline and actions that need to be taken.
You will need to follow the same guidance as any other person to determine when to discontinue home isolation. Before returning to work, be sure to coordinate with your employee health program/contact to ensure that you are cleared. Additionally, you will need to wear a facemask while working until all of your symptoms are completely resolved and it’s been at least 14 days since illness onset. Additionally, you should not have contact with immunocompromised patients for at least 14 days after illness onset.
(Updated 4/4/20) Because serologic testing should not be used as the sole means of diagnosis of COVID-19, CDH will not be conducting epidemiological investigations on patients having serology as their sole means of testing. These patients will not be included in official COVID-19 case counts.
CDC has published Interim Infection Prevention and Control Recommendations that should be followed by facilities and healthcare providers. The guidance includes information about PPE, when it should be used, and what alternatives are acceptable if supply shortages are encountered.
Standard Precautions should be followed when caring for any patient, regardless of suspected or confirmed COVID-19. If the patient is afebrile (temperature is less than 100.0oF) and otherwise without even mild symptoms* that might be consistent with COVID-19 (e.g., cough, sore throat, shortness of breath), then precautions specific to COVID-19 are not required. However, until the patient is determined to be without such symptoms, HCP should wear all recommended PPE for the patient encounter. If the primary evaluation confirms the patient is without symptoms, management and need for any Transmission-Based Precautions should be based with the condition for which they are being evaluated (e.g., patient colonized with a drug-resistant organism), rather than potential exposure to COVID-19.
Idaho Department of Enviromental Quality (DEQ) has advised that PPE from healthcare facilites caring for confirmed or suspected COVID-19 patients should be managed as medical waste. Please refer to DEQ's COVID-19 Waste Website for more information https://www.deq.idaho.gov/waste-mgmt-remediation/solid-waste/covid-19-wastes/