The following is an update from Dr. Morgan McDonald, Deputy Commissioner of the Tennessee Department of Health. The weekly situational report was updated on our website Friday.
Commercial laboratory testing has rapidly expanded over the last week to test for the novel coronavirus (SARS-CoV2). Providers do NOT need to consult with public health before sending a test to a commercial lab. Providers are advised prioritize testing symptomatic and not asymptomatic individuals. Information on testing decision making is here https://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/TDH-COVID-triage-and-assessment.pdf
Providers wishing to send specimens to the State Public Health Lab (SPHL) for testing should call 615-741-7247 to consult with a public health COVID-19 response team member. Testing at SPHL is prioritized for individuals who are critically ill, reside in long-term care facilities, are symptomatic health care workers or have contact with large numbers of individuals on a regular basis, are immunosuppressed or pregnant, are contacts of a laboratory-confirmed case of COVID-19, or who have traveled from a geographic area that is significantly affected by this outbreak (Italy, Japan, China, South Korea, Iran, Washington state). SPHL will also test symptomatic individuals who are without insurance coverage.
Providers can and should take care of their own patients as they are able and should maximize the use of telehealth and phone triage rather than having patients come to clinic when possible. We expect additional telehealth guidance to be coming out shortly.
Personal Protective Equipment (PPE) should be used, but N95 masks are not required except in situations where aerolization of secretions is likely (suctioning, intubation). Staff who will be within 6 feet of a suspect case should wear a surgical mask, and these patients should be taken to a private room with minimum/streamlined staff interaction as quickly as possible. Symptomatic patients should be masked immediately. Outpatient staff with direct contact with suspect patients should wear eye protection, a surgical mask, gown, and gloves. Additional guidance re PPE is in the testing link above.
Testing requires a standard synthetic oropharyngeal and nasopharyngeal swab. The swab must be polyester or dacron (not cotton or calcium alginate) and placed in viral transport medium (VTM). Label the specimen with patient name and DOB and place in the refrigerator until testing is arranged. These are not COVID-19 “kits” – use the same materials you would use for influenza or other viral lab based testing.
Any patient who is suspected of being infected with coronavirus should be masked with a surgical mask immediately. If they are deemed stable to return home after evaluation (most cases), they are to be placed in isolation until test results return.
Confirmed COVID-19 patients should remain isolated for at least 14 days after the onset of symptoms or until 72 hours symptoms free (whichever is longer). Potential scenarios are further described here https://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/Isolation+QuarantineRelease.pdf
All COVID-19 cases should be reported to TDH by calling 615-741-7247
Clinicians should defer or remotely manage other non-urgent clinical visits that do not need to come into the office (ie. Phone refills for stable or asymptomatic patients)
Thank you again for your partnership in this rapidly evolving response.
Morgan F. McDonald, MD FAAP FACP|