05 MARCH 2020
CORONA VIRUS (COVID-19) POLICY for TENNESSEE VALLEY INTERNAL MEDICINE
SUBJECT: Coronavirus 2019 (COVID-19) Preventive Health
Measures, Detection and Reporting Policy.
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.
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.
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
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.
education including, placement of visual alerts at our entrances, restrooms, and hand hygiene stations.
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
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.
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.
v. South Korea
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
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.
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.
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).
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,
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.
a. The ADPH Infectious Diseases & Outbreaks (ID&O) Division can answer general questions at 334-206-5347
during regular business hours
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.
d. Madison County Health Department.
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.
of Clinical Laboratories (BCL) Requisition Form for Laboratory Testing
Nicholas A. Patellis, M.D.
Board Certified, Internal Medicine
Valley Internal Medicine, P.C.