Missouri Department of Health & Senior Services Health Advisory 2020 PDF
Preview Missouri Department of Health & Senior Services Health Advisory 2020
Missouri Department of Health & Senior Services Health Health Advisory March 7, 2020 Adviso• ry: FROM: RANDALL W. WILLIAMS, MD, FACOG DIRECTOR COVID-19 Testing Criteria SUBJECT: COVID-19 Testing Criteria ***Missouri health care providers and public health practitioners: Please contact your local public health agency, or the Missouri Department of Health and Senior Services (DHSS) at 800-392-0272 (24/7), to immediately report any patients who March 7, 2020 meet the criteria for evaluation as a Patient Under Investigation (PUI) for 2019- nCoV as noted in this Advisory.*** This document will be updated as new information becomes available. The As of March 7, 2020 Missouri has not seen any cases of COVID-19, but partners across current version can always be viewed the state in public health, healthcare, schools, and businesses are preparing to respond at http://www.health.mo.gov. in the event that a case is identified. Many entities are also updating pandemic response The Missouri Department of Health plans in case sustained transmission occurs in Missouri. The Missouri State Public and Senior Services (DHSS) is now using four types of documents to Health Laboratory (SPHL) now has the capability to test for SARS-CoV-2, the virus provide important information to that causes COVID-19. The purpose of this Health Advisory is to communicate to medical and public health professionals, and to other interested providers the clinical and epidemiological factors that determine which patients will be persons. approved for COVID-19 testing in Missouri. Health Alerts convey information *** of the highest level of importance which warrants immediate action or COVID-19 Test Availability attention from Missouri health providers, emergency responders, Federal partners in this response have announced that COVID-19 testing is now public health agencies, and/or the public. available through clinical laboratories for symptomatic patients, taking into account Health Advisories provide local epidemiology of the disease. As testing resources at the Missouri State Public important information for a specific Health Laboratory are limited, the Missouri Department of Health and Senior Services incident or situation, including that will be reserving testing for individuals most at risk for disease, or with severe illness impacting neighboring states; may not require immediate action. without an alternative explanatory diagnosis, such as influenza. The full criteria chart is available as an Appendix to this Advisory and is available at Health Guidances contain comprehensive information pertaining https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus- to a particular disease or condition, lpha/pdf/mo-pui-guidance.pdf. and include recommendations, guidelines, etc. endorsed by DHSS. Before collecting and shipping specimens for COVID-19 testing, please contact your Health Updates provide new or local public health agency, or the Missouri Department of Health and Senior Services updated information on an incident or (DHSS) at 800-392-0272 (24/7), to immediately report any patients who meet the situation; can also provide informa- tion to update a previously sent criteria for evaluation as a Patient Under Investigation (PUI) for 2019-nCoV as noted Health Alert, Health Advisory, or in this Advisory. Health Guidance; unlikely to require immediate action. After consultation and determination that the patient meets the criteria for testing, specimen collection and shipping information will be provided. Office of the Director 912 Wildwood Specimen Collection P.O. Box 570 Jefferson City, MO 65102 Guidelines and instructions for the proper collection, packaging and shipping of Telephone: 800-392-0272 COVID-19 Specimens are available at; https://health.mo.gov/lab/ncov.php. Fax: 573-751-6041 Website: http://www.health.mo.gov An instructional video is available at; https://www.youtube.com/watch?v=ksGqd9qSNqA&feature=youtu.be 2 Required Forms The forms required to submit specimens to SPHL for COVID-19 testing, which are posted on the SPHL COVID-19 Testing website https://health.mo.gov/lab/ncov.php, are: 1) The Human Infection with 2019 Novel Coronavirus Person Under Investigation (PUI) and Case Report Form. This form summarizes the epidemiological and clinical picture for the patient and guides testing approval decisions. Once a form is submitted to DHSS for consideration, it will be transmitted to SPHL to verify that testing is approved. 2) The SPHL Virology Test Request Form. This form will need to be submitted with each specimen type. Specimen Transport The SPHL maintains a statewide courier system to deliver specimens to the laboratory. Information regarding the courier pickup locations and schedule can be found at; https://health.mo.gov/lab/courierservices.php. Situational Awareness The epidemiological picture of the international outbreak of COVID-19 changes daily. The World Health Organization (WHO) publishes Situation Reports (https://www.who.int/emergencies/diseases/novel- coronavirus-2019/situation-reports/) daily that summarize international case counts and key developments. CDC also provides updates from the US perspective at https://www.cdc.gov/coronavirus/2019-nCoV/summary.html. Clinical Features Epidemiologic Risk Laboratory Prioritization Shipping 3 Feve r1 or signs/symptoms of lower AND Any person, including healthcare Priority 1-Testing conducted at SPHL Shipped as soon as respiratory illness (e.g. cough or shortness workers2, who has had close contact3 same day, if received by noon possible, Emergency of breath) with a laboratory-confirmed4 COVID19 courier may be utilized patient within 14 days of symptom onset Fever1 and signs/symptoms of a lower AND A history of travel from affected Priority 1-Testing conducted at SPHL Shipped as soon as respiratory illness (e.g., cough or geographic areas5 (see below) within same day, if received by noon possible, Emergency shortness of breath) requiring 14 days of symptom onset courier may be utilized hospitalization Fever1 with severe acute lower respiratory AND No source of exposure has been Priority 1-Testing conducted at SPHL Shipped as soon as illness (e.g., pneumonia, ARDS) requiring identified same day, if received by noon possible, Emergency hospitalization and without alternative courier may be utilized explanatory diagnosis (e.g., influenza)6 Fever1 and signs/symptoms of a lower AND A history of travel from affected Priority 2-Testing conducted when: Shipped on next available respiratory illness (e.g., cough or shortness geographic areas5 (see below) within 1) A Priority 1 specimen is received courier of breath) without alternative explanatory 14 days of symptom onset OR diagnosis (e.g., influenza), not hospitalized 2) Priority 2 specimens collected will or considered severe use all lanes in test Areas with Sustained (Ongoing) Transmission International US China Japan King County/Seattle, Washington, USA Iran South Korea Italy 4 Interim Missouri COVID-19 Person Under Investigation (PUI) Definition Updated March 5, 2020 Footnotes 1Fever may be subjective or confirmed 2For healthcare personnel, testing may be considered if there has been exposure to a person with suspected COVID-19 without laboratory confirmation. Because of their often extensive and close contact with vulnerable patients in healthcare settings, even mild signs and symptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed healthcare personnel. Additional information is available in 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). 3Close contact is defined as— a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case – or – b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on) If such contact occurs while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection), criteria for PUI consideration are met. Additional information is available in CDC’s updated Interim Infection Prevention and Control Recommendations for Patients with Confirmed COVID-19 or Persons Under Investigation for COVID-19 in Healthcare Settings. Data to inform the definition of close contact are limited. Considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with COVID-19 (e.g., coughing likely increases exposure risk as does exposure to a severely ill patient). Special consideration should be given to healthcare personnel exposed in healthcare settings as described in 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 COVID-19. 4Documentation of laboratory-confirmation of COVID-19 may not be possible for travelers or persons caring for COVID-19 patients in other countries. 5Affected areas are defined as geographic regions where sustained community transmission has been identified. Relevant affected areas will be defined as a country with at least a CDC Level 2 Travel Health Notice. See all COVID-19 Travel Health Notices. 6Category includes single or clusters of patients with severe acute lower respiratory illness (e.g., pneumonia, ARDS) of unknown etiology in which COVID19 is being considered. Missouri Department of Health & Senior Services Health Health Advisory March 7, 2020 Adviso• ry: FROM: RANDALL W. WILLIAMS, MD, FACOG DIRECTOR COVID-19 Testing Criteria SUBJECT: Revised to include information on a Missouri COVID- 19 presumptive case - COVID-19 Testing Criteria ***Missouri health care providers and public health practitioners: Please contact your local public health agency, or the Missouri Department of Health and Senior March 7, 2020 Services (DHSS) at 800-392-0272 (24/7), to immediately report any patients who meet the criteria for evaluation as a Patient Under Investigation (PUI) for 2019- This document will be updated as new nCoV as noted in this Advisory.*** information becomes available. The current version can always be viewed As of the afternoon of March 7, 2020 Missouri has had one presumptive COVID-19 at http://www.health.mo.gov. case reported in St.Louis County. Additionally, Johnson County, Kansas reported its The Missouri Department of Health and Senior Services (DHSS) is now first presumptive case the same afternoon. Partners across the state in public health, using four types of documents to healthcare, schools, and businesses are continuing to prepare for any needed response. provide important information to Many entities are also updating pandemic response plans in case sustained transmission medical and public health professionals, and to other interested occurs in Missouri. The purpose of this Health Advisory is to communicate to persons. providers the clinical and epidemiological factors that determine which patients will be Health Alerts convey information approved for COVID-19 testing in Missouri now that the Missouri State Public Health of the highest level of importance Laboratory (SPHL) has the capability to test for SARS-CoV-2, the virus that causes which warrants immediate action or attention from Missouri health COVID-19. providers, emergency responders, public health agencies, and/or the *** public. COVID-19 Test Availability Health Advisories provide important information for a specific Federal partners in this response have announced that COVID-19 testing is now incident or situation, including that available through clinical laboratories for symptomatic patients, taking into account impacting neighboring states; may not require immediate action. local epidemiology of the disease. As testing resources at the Missouri State Public Health Laboratory are limited, the Missouri Department of Health and Senior Services Health Guidances contain comprehensive information pertaining will be reserving testing for individuals most at risk for disease, or with severe illness to a particular disease or condition, without an alternative explanatory diagnosis, such as influenza. The full criteria chart is and include recommendations, guidelines, etc. endorsed by DHSS. available as an Appendix to this Advisory and is available at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus- Health Updates provide new or updated information on an incident or lpha/pdf/mo-pui-guidance.pdf. situation; can also provide informa- tion to update a previously sent Before collecting and shipping specimens for COVID-19 testing, please contact your Health Alert, Health Advisory, or local public health agency, or the Missouri Department of Health and Senior Services Health Guidance; unlikely to require immediate action. (DHSS) at 800-392-0272 (24/7), to immediately report any patients who meet the criteria for evaluation as a Patient Under Investigation (PUI) for 2019-nCoV as noted Office of the Director in this Advisory. 912 Wildwood P.O. Box 570 After consultation and determination that the patient meets the criteria for testing, Jefferson City, MO 65102 specimen collection and shipping information will be provided. Telephone: 800-392-0272 Fax: 573-751-6041 Specimen Collection Website: http://www.health.mo.gov Guidelines and instructions for the proper collection, packaging and shipping of COVID-19 Specimens are available at; https://health.mo.gov/lab/ncov.php. 2 Required Forms The forms required to submit specimens to SPHL for COVID-19 testing, which are posted on the SPHL COVID-19 Testing website https://health.mo.gov/lab/ncov.php, are: 1) The Human Infection with 2019 Novel Coronavirus Person Under Investigation (PUI) and Case Report Form. This form summarizes the epidemiological and clinical picture for the patient and guides testing approval decisions. Once a form is submitted to DHSS for consideration, it will be transmitted to SPHL to verify that testing is approved. 2) The SPHL Virology Test Request Form. This form will need to be submitted with each specimen type. Specimen Transport The SPHL maintains a statewide courier system to deliver specimens to the laboratory. Information regarding the courier pickup locations and schedule can be found at; https://health.mo.gov/lab/courierservices.php. Situational Awareness The epidemiological picture of the international outbreak of COVID-19 changes daily. The World Health Organization (WHO) publishes Situation Reports (https://www.who.int/emergencies/diseases/novel- coronavirus-2019/situation-reports/) daily that summarize international case counts and key developments. CDC also provides updates from the US perspective at https://www.cdc.gov/coronavirus/2019-nCoV/summary.html. Clinical Features Epidemiologic Risk Laboratory Prioritization Shipping 3 Feve r1 or signs/symptoms of lower AND Any person, including healthcare Priority 1-Testing conducted at SPHL Shipped as soon as respiratory illness (e.g. cough or shortness workers2, who has had close contact3 same day, if received by noon possible, Emergency of breath) with a laboratory-confirmed4 COVID19 courier may be utilized patient within 14 days of symptom onset Fever1 and signs/symptoms of a lower AND A history of travel from affected Priority 1-Testing conducted at SPHL Shipped as soon as respiratory illness (e.g., cough or geographic areas5 (see below) within same day, if received by noon possible, Emergency shortness of breath) requiring 14 days of symptom onset courier may be utilized hospitalization Fever1 with severe acute lower respiratory AND No source of exposure has been Priority 1-Testing conducted at SPHL Shipped as soon as illness (e.g., pneumonia, ARDS) requiring identified same day, if received by noon possible, Emergency hospitalization and without alternative courier may be utilized explanatory diagnosis (e.g., influenza)6 Fever1 and signs/symptoms of a lower AND A history of travel from affected Priority 2-Testing conducted when: Shipped on next available respiratory illness (e.g., cough or shortness geographic areas5 (see below) within 1) A Priority 1 specimen is received courier of breath) without alternative explanatory 14 days of symptom onset OR diagnosis (e.g., influenza), not hospitalized 2) Priority 2 specimens collected will or considered severe use all lanes in test Areas with Sustained (Ongoing) Transmission International US China Japan King County/Seattle, Washington, USA Iran South Korea Italy 4 Interim Missouri COVID-19 Person Under Investigation (PUI) Definition Updated March 5, 2020 Footnotes 1Fever may be subjective or confirmed 2For healthcare personnel, testing may be considered if there has been exposure to a person with suspected COVID-19 without laboratory confirmation. Because of their often extensive and close contact with vulnerable patients in healthcare settings, even mild signs and symptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed healthcare personnel. Additional information is available in 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). 3Close contact is defined as— a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case – or – b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on) If such contact occurs while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection), criteria for PUI consideration are met. Additional information is available in CDC’s updated Interim Infection Prevention and Control Recommendations for Patients with Confirmed COVID-19 or Persons Under Investigation for COVID-19 in Healthcare Settings. Data to inform the definition of close contact are limited. Considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with COVID-19 (e.g., coughing likely increases exposure risk as does exposure to a severely ill patient). Special consideration should be given to healthcare personnel exposed in healthcare settings as described in 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 COVID-19. 4Documentation of laboratory-confirmation of COVID-19 may not be possible for travelers or persons caring for COVID-19 patients in other countries. 5Affected areas are defined as geographic regions where sustained community transmission has been identified. Relevant affected areas will be defined as a country with at least a CDC Level 2 Travel Health Notice. See all COVID-19 Travel Health Notices. 6Category includes single or clusters of patients with severe acute lower respiratory illness (e.g., pneumonia, ARDS) of unknown etiology in which COVID19 is being considered.
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