COVID-19 Clinical Update
Combating Corona virus while caring for you
1. Safety and health of our patients and their families is our highest priority
2. We practice highest sterilization and disinfection measures in our facility for equipment, exam and treatment rooms and all the areas.
3. We are practicing rapid and efficient and effective protocols for exams and procedures to avoid exposure to other patients, etc.
4. Together we will combat this Corona virus while continue to care for our patients and families with best possible care.
We are ready to help and care.
For any of our patients and their families of age of above 65 – please reach us/ call us, if you need any supplies at home (includes food, grocery other essentials). We would like to help by bringing them to your doorstep, to avoid you going out and getting avoidable exposure.
Covid-19 Clinical Update
As new information becomes available from the CDC regarding COVID-19, we want to keep you up to date about current recommendations (as of 3/1/20). The CDC has expanded criteria for patients under investigation (PUI) in response to multiple cases of confirmed COVID-19 in California and Oregon without any exposure history. Clinical information remains limited and recommendations for evaluation from state and federal leaders continue to change frequently.
Through ongoing discussions with NC Public Health officials, the CDC and clinical leaders from health systems across our region, we have developed community-wide clinical guidelines for the evaluation of patients who present to our Emergency Departments. This same information may be helpful to you in your practices. You may also find the latest guidance from the NC Department of Health and Human Services valuable.
First, ALL patients presenting with fever AND an acute respiratory illness should have a detailed travel and exposure history obtained.
The current CDC and WakeMed guidelines used for defining and evaluation a PUI are as follows:
|Clinical Features||Epidemiologic Risk||Precautions||Testing|
|Fever ORsigns/symptoms of lower respiratory illness||Close contact with a lab confirmed or close contact with a COVID-19 patient within 14 days of symptom onset||Airborne Full Barrier Infection Prevention Negative Pressure Consult IP/state for testing||Influenza Biofire (Respiratory Pathogen Panel with PCR) Labs/Imaging as required COVID-19 per state|
|Fever ANDsigns/symptoms of lower respiratory illness||A history of travel to affected geographical areas within 14 days of symptom onset||Airborne Full Barrier Infection Prevention Negative Pressure Consult IP/state for testing||Influenza Biofire (Respiratory Pathogen Panel with PCR) Labs/Imaging as required COVID-19 per state|
|Fever with severe acute respiratory illness that requires admission without alternative diagnosis||No source of exposure is identified (contact, lab confirmation or travel)||See below||See below|
The category at the bottom of the table is the newest addition and is the area of current concern.
While the following recommendations were prepared for the Emergency Departments, you might find them helpful should a patient present to your office:
Patients who present with fever and evidence of severe lower respiratory illness should be placed in a mask. All personnel should observe DROPLET/CONTACT precautions (see page 5 for details). If presenting in the Emergency Department, influenza swabs and Biofire (Respiratory Pathogen Panel with PCR) should be sent on all of these patients as well as laboratory testing and imaging as required. If the patient presents outside Raleigh Campus, Biofire swabs must be sent by courier to Raleigh Campus. Patients should be dispositioned by clinical determination based on severity of illness, requirement of supplemental oxygen or comorbidities in the same respect as an influenza patient would be admitted.
If a patient with severe acute lower respiratory illness is deemed to be at high risk or at the provider discretion, AIRBORNE FULL BARRIER precautions (see page 4 for details) with negative pressure isolation should be instituted immediately per protocol distributed and Infection Prevention should be consulted.
- ADMISSION REQUIRED AND SOURCE OF INFECTION IS DETERMINED: Patient will be admitted to appropriate service with DROPLET/CONTACT precautions.
- ADMISSION REQUIRED WITH NO ALTERNATIVE EXPLANATORY DIAGNOSIS: If Influenza and Biofire tests, as well as clinical evaluation, are negative, patient admitted to the appropriate service with AIRBORNE FULL BARRIER precautions and consult Infection Prevention. Further testing for COVID-19 and ongoing PPE recommendations made in consultation with Infection Prevention and state/federal authorities.
- DISCHARGE APPROPRIATE: Regardless of testing result, no further testing will be required.