Coronavirus Disease 2019 (COVID-19) Outbreak, Update # 12

On April 14, 2020, NH DHHS issued health alert COVID-19 update #12 regarding clarification of COVID-19 testing and LTCF guidance.

NH DPHS Health AlertsKey Points and Recommendations:

  • As previously recommended, healthcare providers can and should test whomever they deem appropriate based on their clinical judgement taking into account a patient’s signs/symptoms, vulnerability (e.g., comorbidities, advanced age), risk of having exposed others, ability to self-isolate, and potential need for hospitalization where a positive or negative test informs care. 
  • People in the following groups should be tested for COVID-19 if symptomatic (new additions in bold): 
    • Healthcare workers and first responders 
    • Family members of healthcare workers and first responders (because it impacts the ability for these individuals to return to work) 
    • Any person residing in, or who has worked or visited, a long-term care facility (LTCF) or healthcare setting 
    • Patients hospitalized with fever, respiratory illness, or flu-like symptoms 
    • Patients who may have had close contact with a large number of people 
    • Residents or employees of jails or prisons 
    • Essential workers who deliver, or directly support, home, community, or institutional care services 
    • Patients 65 years of age and older 
    • Patients with underlying chronic health conditions which puts them at increased risk of complications from COVID-19 
  • Specimens can be sent to the NH Public Health Laboratories (PHL) for COVID-19 testing for any patient by filling out the appropriate test requisition form
  • The State of NH and ConvenientMD have partnered to provide telehealth support and COVID-19 testing to NH residents who either do not have access to a primary care provider, or who may be appropriate for COVID-19 testing but are unable to access services through usual routes. 
    • Patients without a primary care provider can access ConvenientMD through: https://convenientmd.com/virtual-visit/ or by calling (833) 263-0131. 
    • Patients who have a primary care provider should first discuss their health concerns with their provider by phone. If the provider decides testing is indicated, they should utilize normal local mechanisms to collect specimens. Collection of specimens (see below for options) can occur at the provider office or local healthcare facility that is willing and able to collect specimens and test based on referral from community providers. 
    • If a provider elects to test a patient for COVID-19, but is unable to arrange for specimen collection, then the patient should be directed to access ConvenientMD as above. Be aware that testing by ConvenientMD requires that they reassess the patient, and it is possible that ConvenientMD will decline testing.
  • We continue to recommend (see HAN Update #11 for more details) that people entering any healthcare facility should be masked with a washable, re-usable cloth face covering at a minimum (given PPE shortages) to help prevent and minimize pre-symptomatic transmission within facilities (i.e., source control). Cloth face coverings should not be used as PPE (i.e., to protect the wearer). 
    • CDC has updated their infection control guidance to also recommend source control measures for anybody entering a healthcare facility with preference for a medical/surgical facemask for healthcare personnel over a cloth face covering. 
    • See NH DPHS mask guidance clarifying when to use cloth face coverings vs. surgical facemasks at long-term care facilities (LTCFs) and assisted living facilities (ALFs). 
  • Based on new CMS guidance (April 2nd), all patients being admitted to a LTCF should be tested for COVID-19, even if asymptomatic, because of the possibility of asymptomatic viral shedding. This policy is creating delays in discharge from acute care settings. To ease this: 
    • The hospital should collect the specimen and submit for testing, but discharge from the hospital may occur before test results are received. 
    • Whether COVID-19 test results are pending or negative, patients should still be subject to a 14-day quarantine at the LTCF per CMS guidance (March 13th). If possible, LTCFs should dedicate a unit/wing exclusively for any residents coming or returning from the hospital. This can serve as a quarantine unit where they remain for 14 days with no symptoms instead of integrating as usual. Alternatively, patients can be placed in a single room, restricted to their room, and wear a facemask during care activities for 14 days. 
    • We continue to recommend that all hospitals implement local rapid molecular testing capacity for COVID-19 (e.g., Xpert® Xpress SARS-CoV-2 test and Abbott ID NOW COVID-19® test) to facilitate testing and discharge planning. We can also prioritize COVID-19 testing for hospitalized patients if you submit to the PHL and indicate the need for prioritization on the test requisition form
  • If a LTCF/ALF resident is diagnosed with COVID-19 and you suspect transmission may have occurred within your facility, then test all residents in that wing/unit regardless of symptoms to reduce pre-symptomatic transmission and to facilitate rapid cohorting of COVID-19 positive patients. Full PPE should be used for every resident until 14 days have passed from identification of the confirmed case as long as no other positive residents or staff are identified. 
    • We will coordinate testing with your facility as a part of our case investigation. Please report cases immediately to NH DPHS. 
    • Ensure screening for and testing of symptomatic staff at the facility. All staff should continue to follow the appropriate masking policy and frequent hand hygiene. 
  • In partnership with the New Hampshire Health Care Association, we will continue weekly calls every Wednesday from 12:00 – 1:00pm for LTCFs, ALFs, and other congregate settings with vulnerable patients (next call Wednesday April 15th): 
    • Zoom link 
    • Call-in phone number: (929) 205-6099 
    • Meeting ID: 511 075 725
  • We will continue to host weekly calls to answer healthcare provider and local partner questions about COVID-19. The next call will be held on Thursday April 16th from 12:00 – 1:00 pm, and calls will recur weekly. Call-in information has changed
    • Zoom link 
    • Call-in phone number: (646) 558-8656 
    • Meeting ID: 948 4125 9025 
    • Password: 003270 
  • All COVID-19 cases must be reported to NH DPHS by filling out and faxing the COVID-19 Case Report Form to our confidential fax at 603-271-0545. 
    • Please also use this form to report any confirmed COVID-19 cases who become hospitalized or who die in your facility even if they were previously diagnosed and reported.

Full DHHS Alert