Coronavirus Disease 2019 (COVID-19) Outbreak, Update # 18

On June 18, 2020, NH DHHS issued health alert COVID-19 outbreak update #18. 

NH DPHS Health AlertsKey Points and Recommendations

Viral (PCR) Testing:

  • The U.S. Centers for Disease Control and Prevention (CDC) has updated their general guidance on testing for SARS-CoV-2, the novel coronavirus which causes COVID-19.
  • The CDC has also updated their testing guidelines for nursing homes.
  • As previously recommended, providers should continue to test any patient presenting with even mild symptoms of COVID-19 using a PCR-based test. Use clinical judgement regarding testing for other potential causes; co-infection with SARS-CoV-2 and other respiratory pathogens has been documented. 
  • We recommend PCR testing for close contacts of people with suspected or confirmed COVID-19 in order to detect asymptomatic or pre-symptomatic infection to prevent spread of COVID-19. As part of the public health response to outbreaks or clusters, NH DPHS will recommend viral PCR testing for both symptomatic and asymptomatic persons. 
  • Long-term care facilities (LTCFs) and other congregate living facilities should continue to test all residents and staff in units where COVID-19 is identified, in consultation with DPHS. This testing should inform resident cohorting, isolation of infected and quarantine of exposed individuals, and the use of personal protective equipment (PPE). 
  • Hospitals and healthcare facilities can consider implementing additional SARS-CoV-2 testing processes, such as testing for patients undergoing a procedure, operation, or prior to/on admission as recommended by the Centers for Medicare & Medicaid Services (CMS). Any such testing should be performed as close to the procedure or admission as possible; however, the benefits of these testing strategies likely varies by region with greater benefit in areas seeing greater community transmission. Ensure other infection control recommendations are implemented to create layers of protection and mitigation. 
  • Patients can access COVID-19 testing through a variety of specimen collection sites in NH; testing is open for any asymptomatic person who wishes to be tested at State-run sites or contracted facilities (e.g., ConvenientMD, ClearChoiceMD).
     

Personal Protective Equipment (PPE) & Infection Control:​

  • All healthcare staff should continue to wear a surgical facemask when within any healthcare facility in order to provide protection to the staff wearing the mask, and help prevent COVID-19 transmission (source control) in the event the staff wearing the mask is asymptomatically shedding infectious virus. 
  • All visitors to a healthcare facility should wear, at a minimum, a cloth face covering when within the healthcare facility; this includes patients and caregivers presenting to outpatient settings. If patients and visitors do not have a cloth face covering, they should be provided a face mask on entry to the facility.
  • CDC’s infection prevention and control recommendations for patients with suspect or confirmed COVID-19 in healthcare settings continue to express a preference for a N95 or higher-level respirator when caring for patients with suspect or confirmed COVID-19 to protect against possible close-range droplet and aerosol transmission, and because these higher level respirators are routinely recommended for emerging respiratory pathogens. 
  • Long-range airborne transmission (such as occurs with measles and tuberculosis) has not been demonstrated to routinely occur with SARS-CoV-2. 
  • Therefore, for outpatient evaluations of patients with suspect COVID-19, including for specimen collection for COVID-19 testing (e.g., nasopharyngeal swab acquisition), DPHS continues to recommend a surgical face mask in addition to other recommended PPE (e.g., eye protection, gown, and gloves). N95 or higher-level respirators should be used when performing an aerosol-generating procedure. 
    • If available, outpatient providers should consider using an N95 or higher-level respirator when evaluating patients with confirmed COVID-19, or for symptomatic suspect patients who may be at higher risk of aerosolizing respiratory droplets (e.g., patients with significant frequent coughing, sneezing, etc.). 
  • For patients hospitalized with suspect or confirmed COVID-19 we continue to recommend N95 or higher-level respirators in addition to other recommended PPE, because of the frequency and intensity of healthcare contact and the potential need for aerosol generating procedures. 
  • Patients being evaluated for COVID-19 can be managed in a single room with the door closed. Airborne infection isolation rooms (AIIR) are not routinely recommended unless an aerosol-generating procedure is performed. 
  • For routine care of patients who are NOT suspected to have COVID-19, all providers should routinely wear a surgical facemask, and patients should wear a cloth face covering. Additionally, the CDC recommends that healthcare providers working in areas with moderate to substantial COVID-19 community transmission should wear eye protection (e.g., goggles or face shield) with all patient encounters.
    • We do not believe the current epidemiology in NH warrants universal eye protection for providers evaluating patients who are not suspected to have COVID-19, but providers can still consider eye protection given a recent systematic review and meta-analysis which found eye protection was associated with less transmission.

Communication and Partner Engagement:

  • In partnership with the New Hampshire Health Care Association, we continue to have weekly calls every Wednesday from 12:00 – 1:00 pm for LTCFs and other congregate living settings: 
  • We continue to host weekly calls every Thursday from 12:00 – 1:00 pm for healthcare providers and local partners: 

Reporting:

  • Providers and laboratories should continue to submit a completed COVID-19 Case Report Form to NH DPHS for the following people: 
    • Any new COVID-19 laboratory positive test regardless of test type (e.g. PCR, antibody, etc.). 
    • Any new laboratory-confirmed COVID-19 hospitalization, even if the patient was a previously reported positive as an outpatient. 
    • Any suspected or confirmed COVID-19 death.

Full DHHS Alert