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Newsletter

05 MARCH 2020   

CORONA VIRUS (COVID-19) POLICY for TENNESSEE VALLEY INTERNAL MEDICINE

MEMORANDUM FOR DISTRIBUTION

 

SUBJECT:   Coronavirus 2019 (COVID-19) Preventive Health Measures, Detection and Reporting Policy.

 

1.     SITUATION:

a.     In December 2019, a new (or novel) human coronavirus (SARS-CoV-2) type emerged in China. At this time, it’s unclear how easily this virus is spreading between people. Patients with confirmed COVID-19 infection have reportedly had mild to severe respiratory illness with symptoms of fever, cough, and shortness of breath appearing anywhere from 2 to 14 days after exposure.  The Coronaviruses are a large family of viruses that are common among people and livestock.  It is suggested that the novel coronavirus emerged from an animal reservoir in China with the initial outbreak in Wuhan, Hubei Province, China.

b.     Reported community spread of the COVID-19 in parts of the US raise the concern that the virus will continue to spread; suggestive of a global involvement or pandemic.  At this time, no COVID-19 cases have been identified in Alabama, but this may change rapidly.

c.     This is an emerging, rapidly evolving situation. The Alabama Department of Public Health (ADPH) and the CDC are providing updated information and guidance as it becomes available. For resources specific to Alabama, continue reading. See latest updates on the CDC Coronavirus 2019 (COVID-19) website: https://www.cdc.gov/coronavirus/2019-ncov/index.html.  

 

2.     CURRENT RECOMMENDATIONS:

 

a.    Risk:  Overall risk of contracting the COVID-19 in our area is low; however, the exact predictive value is not available due to the lack of readily available community testing.

 

b.    Social Isolation:  Refrain from traveling and visiting crowded areas if unnecessary.  Avoid close contact with people who are sick.

 

c.    Protect yourself:  Protect yourself by washing your hands regularly.   Avoid touching your face (eyes, nose, mouth) as this is one very common way of spreading the virus or self-inoculation.  Wash your hands often with soap and water for at least 20 seconds.  May use alcohol-based hand sanitizer with at least 60% alcohol.

 

d.   Stay home when you are sick:   If you develop symptoms of an upper respiratory infection with fevers, do not go to work or expose yourself to others or pets.  Continue to wash your hands regularly.

 

e.    Facemask use:  The routine wear of a facemask when well or clinically asymptomatic is not recommended per the CDC.  Facemasks should be used if you show symptoms of COVID-19 to prevent the spread.

 

f.     Vaccinate yourself:  There is no human coronavirus vaccination available.  It is anticipated that it may take up to one (1) year before a vaccine is safely produced.  However, we strongly encourage that you keep up to date with your Influenza Vaccine to prevent co-infection with the Flu Virus.  At present, the Flu is highly prevalent within our Community.

 

g.    Highest Risk:  The Elderly (greater than 65 years of age) and the immunocompromised (particularly those that are chronically ill) are most susceptible to the complications of COVID-19.  The overall fatality rate is approximately 2% (2 out of 100 persons), which mostly include the elderly patients.   (This number will decline as we begin to incorporate more testing in our Community; identifying those that are asymptomatic or presenting with very mild symptoms).   If your symptoms worsen, particularly with any type of respiratory distress (i.e. shortness of breath, chest pain, confusion) let your Provider know or report to the Emergency Department.  IT IS IMPORTANT TO KNOW THAT MOST PEOPLE EXPOSED TO THE COVID-19 ARE EITHER ASYMPTOMATIC (WITHOUT SYMPTOMS) OR HAVE MINIMAL SYMPTOMS.  However, the risk of spreading the virus may last up to 14 days, even if asymptomatic.  

 

h.   Asymptomatic Testing:  If you are symptom free, please DO NOT request testing at this time.  The testing is not recommended nor available at this time.

 

3.     OFFICE BEST PRACTICES FOR INFECTION SPREAD AND PREVENTION:

 

a.    We will request that any patient call us in advanced with the symptoms of any respiratory infection (cough, runny nose, fever, sputum production, shortness of breath etc.).  This will allow us to rapidly apply a mask on the patient and appropriately triage the patient in the most efficient manner.  If the patient arrives with respiratory symptoms, we will immediately place a mask and isolate the patient.  This will help ensure that patients with symptoms of suspected COVID-19 or other respiratory symptoms are not waiting among other patients seeking care at our facility. 

 

b.    Respiratory separation is defined as 6 feet (2 meters) or more.  Close contact is defined as – “being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time, such as caring for or visiting or sharing a healthcare waiting area --OR—having direct contact with infectious secretions of a COVID-19 case (i.e. coughed on).

 

c.    Emergency Medical Services (EMS) will be initiated if the patient is in severe respiratory distress or has a very significant risk for developing respiratory failure while presenting with lower respiratory symptoms.

 

d.    Testing for COVID-19 is not yet, readily available for outpatient use.   Most patients with respiratory symptoms have routine community acquired infections such as (Influenza virus, Haemophilus influenza, Moraxella catarrhalis, parainfluenza virus, Streptococcus pneumoniae etc).  Commercial PCR and/or cultures will be obtained, but they do not test for the COVID-19 at this time. However, we expect that testing for the COVID-19 will become available to our local hospitals and outpatient clinics as the incidence of the COVID-19 increases within our area.

 

e.   TVIM will allocate 2 isolation rooms within our facility for patients with upper respiratory symptoms, while utilizing personal protection equipment (PPE) for our healthcare staff.  This will help protect our staff and our patients.

 

                                          i.    Hand hygiene: Apply alcohol-based hand sanitizer

 

                                         ii.    PPE – gloves; mask (preferred N95 respirator), protective eyewear and gowns if necessary.

 

                                        iii.    Clean and disinfect the patient room after each use.

  

f.     Patient education including, placement of visual alerts at our entrances, restrooms, and hand hygiene stations.

 

4.     TESTING AND REPORTING PROCESS:

 

a.    Presently, routine testing for the COVID-19 is not available in our area; however, this will change as the testing resources become more readily available for community use.  

 

b.    We will complete the CDC Novel Coronavirus Consultation Form – Person Under Investigation (PUI) and Case Report Form, OMB: 0920-1011, Exp: 4/23/2020.

 

c.    Once a PUI is identified we will notify the ADPH’s Infectious Disease & Outbreaks Division at 1-800-338-8374.

 

d.    Fax or e-mail the PUI form to ADPH email with Subject Line: “nCoV PUI Form” to ADPH at 334-206-3734 or CDFax@adph.state.al.us.

 

e.    Patients in the United States who meet the following criteria should be evaluated as a person under investigation (PUI) in association with the outbreak of the COVID-19.

 

 

f.   Affected Geographic Areas with Widespread or Sustained Community Transmission of the COVID-19 Virus.

 

                                          i.    China

                                         ii.    Iran

                                        iii.    Italy

                                        iv.    Japan

                                         v.    South Korea

 

g.  Healthcare Providers:  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 the healthcare settings, even mild signs and symptoms of COVID-19 should be evaluated among potentially exposed healthcare personnel.

 

h. Specimen Collection:

 

                                          i.    For initial diagnostic testing for patients with symptoms potentially consistent with COVID-19, perform nasopharyngeal/oropharyngeal swabs using synthetic fiber swabs with plastic shafts placed into sterile tubes containing 2-3mL of viral transport medium.

 

                                         ii.    Store specimens at 2-8 degrees Celsius and ship to the CDC on ice pack.

 

                                        iii.    Specimens may be taken to the local county health department for shipment of the specimen:  Madison County Health Department, 301 Max Luther Drive, NW, Huntsville, AL  35811;  P:  (256) 539-3711,  F:  (256) 536-2084.

OR

                                    Shipped directly to BCL-EID, 8140 AUM Drive, Montgomery, AL  36117.

                                        iv.    Complete Requisition Form:  mark “Other Test” and write “Respiratory Panel”, then complete “Agent Suspected” by “COVID-19”.  ADPH Bureau of Clinical Laboratories (BCL), P.O. Box 244018, Montgomery, AL  36124-4018, 344-260-3400.

 

                                         v.    Until lab testing is available through commercial reference lab facilities, the collected specimen will be sent to the ADPH as above or directly to the CDC Laboratory Services in Atlanta, GA – CDC shipping address will be obtained by contacting the CDC Emergency Operations Center (EOC) at 770-488-7100.

NOTE:

All patients must be approved for testing via the consultation process, AL and all specimens must be shipped to the ADPH Bureau of Clinical Laboratories (BCL) for processing.

 

 

i.   BOTTOM LINE:  For patients with higher suspicion of COVID-19.

 

                                          i.    If Critically Ill:  immediately transfer the patient to the Emergency Department (with the understanding that our local hospitals may become overwhelmed).

 

                                         ii.    Obtain testing:  If the patient meets clinical criteria for the COVID-19 infection, the PUI Case Report will be submitted to the Alabama Department of Public Health (ADPH) for consideration of testing through the CDC.  Additionally, we will obtain commercial testing for routine upper and lower respiratory illnesses.   COVID-19 PCR testing will be obtained as it becomes more readily available from the ADPH/CDC or Commercial Labs (pending FDA approval).

 

                                        iii.    Have the patient remain isolated at home until final PCR results return (typically within 48-72 hours).

NOTE:

If the COVID-19 testing is not obtained due to availability and the other routine respiratory pathogens are not obtained, the patient will be advised to remain isolated at home for approximately 14 days or until symptoms have completely resolved.

5.     PROVIDER CHECKLIST FOR MANAGING POTENTIAL NOVEL CORONAVIRUS PATIENTS:

 

a.    See Health Care Provider Preparedness Checklist, CDC, 2020.

 

b.    Communicate the Office SOP with Staff and Patients – Utilize the Patient Portal for current recommendations.  Provide updates about changes to the policies and updates on the spread of the COVID-19.

 

6.     REFERENCES:

 

a.   The ADPH Infectious Diseases & Outbreaks (ID&O) Division can answer general questions at 334-206-5347 during regular business hours

 

b.   Centers for Disease Control and Prevention, Coronavirus 2019 (COVID-2019), https://www.cdc.gov/coronavirus/2019-ncov/index.html.

 

c.   Alabama Public Health, Infectious Disease and Outbreaks. http://www.alabamapublichealth.gov/infectiousdiseases/cov-healthcare.html.

 

d.    Madison County Health Department. 

        http://www.alabamapublichealth.gov/madison/

 

Encls.

Person Under Investigation (PUI) and Case Report Form, OMB: 0920-1011, Exp: 4/23/2020.

Health Care Provider Preparedness Checklist, CDC, 2020.

ADPH Health Alert Network (HAN), 28 FEB 2020.

ADPH Bureau of Clinical Laboratories (BCL) Requisition Form for Laboratory Testing

 

 Nicholas A. Patellis, M.D.

 Board Certified, Internal Medicine

 Tennessee Valley Internal Medicine, P.C.


Ask the Doctor

In this section, we will provide answers to the most common questions that we encounter.

Q: Will Dr. Patellis be participating in the MDVIP program?
A:  No. Dr. Patellis has no plans to participate in this program. 
Q: Which hospital is Dr. Patellis affiliated with?
A:  Dr. Patellis utilizes the services of the hospitalists at both Crestwood Medical Center and Huntsville/Madison Hospitals.  
Q:  How does Dr. Patellis handle emergencies after office hours?
A:   If there is a life threatening emergency after hours, please call 911 or go to the nearest emergency room.  If there is a serious situation that you feel needs Dr. Patellis' immediate attention, you can call the office number and you will be instructed on how to get in touch with the Dr. 
Q:  Which lab does Dr. Patellis use?
A:  As of October 30, 2015 we started doing all routine labs in-house.  More complex labs are sent out to Labcorp.  If you insurance requires you to use a different lab, please let our staff know and we will be glad to accommodate your request.   
Q:   Are walk-ins accepted?
A:   No, but our office will make every effort to "work-in" existing patients.  Please call the office so that our staff can tell you the best time to come. 
Q:   How does Dr. Patellis handle medication refills?
A:   Please make every effort to get your prescriptions refilled during your follo-up visit, however, if you have a medication that you need refilled outside your normal appointment, call the office number and leave a message on our Prescription Line.  If there are no issues, your prescription will be refilled within 24-48 hours.  Please note that Narcotics and other Controlled Substances require you to be seen by Dr. Patellis for refills. 
Q:   Does Dr. Patellis manage chronic pain? 
A:   Dr. Patellis would love to be your physician and care for all your needs, however, if you have a condition that reuqires long-term pain medication, you will be referred to one of the local pain specialists.  Dr. Patellis will continue to provide all other aspects of your care. 

Tennessee Valley Internal Medicine * 
382 Slaughter Road
 * Madison * AL * 35758

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