skip to content, health centers and clinics, search, accessibility statement
Newsroom,    About Us,    Careers,    Employees,    Provider Information,    Contact Us,
CCHS

Coronavirus (COVID-19)

Information for Healthcare Professionals


General Information

Based on what is currently known, COVID-19 is both a droplet and an airbone virus and spread occurs mostly from person-to-person via respiratory droplets and aerosols. The most common symptoms seen with COVID-19 include fever (may be subjective) or symptoms of acute lower respiratory illness such as cough and shortness of breath. Patients have also presented with other symptoms such as fatigue, chills, myalgias, headache, sore throat, new loss of taste or smell, vomiting, nausea, nasal congestion, rhinorrheas, or diarrhea. In addition to these symptoms, elderly patients may present with weakness, confusion, dizziness, or a subtle change from their baseline. Although the complete clinical picture of COVID-19 continues to evolve, reported illnesses have ranged from no symptoms to mild symptoms to severe illness and death. Older people and people with underlying health conditions are at the highest risk of developing serious COVID-19 illness.

Laboratory Testing

Currently, the only tests which are authorized for use in the diagnosis of COVID-19 are nucleic acid amplification tests, such as PCR and antigen tests with an FDA EUA approval. For more information about testing please visit CDC Testing for SARS-COV-2 and for more information and guidance on antigen testing, along with needed follow up, please see CDPH guidance for antigen testing and CDC Interim Guidance for antigen testing. Currently, vaccination status does not change testing recommendations and individuals should continue to test as recommended after a close contact or exposure, if they have symptoms or concerns for COVID-19 infection, or if testing is recommended as screening for their workplace.

Acceptable testing specimens for PCR and antigen test include a nasopharyngeal (NP) or oropharyngeal (OP) swab collected by a healthcare provider, OR a nasal mid-turbinate or anterior nares swab collected by a healthcare provider or by the patient through a supervised onsite self-collection. There are many PCR and antigen test available to detect COVID-19 and the source, collection method, and swabs may differ based on the platform being used. Providers should consult with their submitting laboratory to ensure they are using the proper collection method and swab for the testing platform in place. In addition to this, there are several home antigen tests now available that maybe used for testing. Employees should review with workplaces if home tests can be used for workplace testing and students in K-12 setting should review with schools if home testing can be used for student testing for isolation and quarantine.

The Contra Costa Public Health Lab will continue to accept specimens for high priority patients. High priority patients are those who are at risk for poor outcomes or may expose vulnerable people, such as:

  1. Persons who LIVE or WORK in CONGREGATE FACILITIES (skilled nursing facilities, board and care, assisted living and other congregate senior living facilities, shelters, group homes, residential treatment programs and facilities, jails) presenting in any setting - hospital or ambulatory;
  2. HOMELESS PERSONS regardless of current status of shelter;
  3. HEALTH CARE WORKERS and FIRST RESPONDERS;
  4. Persons who receive DIALYSIS or CHEMOTHERAPY in clinic settings;
  5. Persons who are HOSPITALIZED.

When submitting a specimen to the Contra Costa Public health lab you must also submit a Lab Requisition Form with the indication of the priority group for public health testing noted on the lab requisition form.

For further guidance on testing and testing priorities when experiencing limited testing capacity please also review CDPH Testing Guidance.

Serological testing for SARS COV 2 is also available through the FDA Emergency Use Authorization (EUA). Along with the FDA EUA serological test there is also several unauthorized serology tests that have become available and being used. Please be aware given the uncertainty of serological testing and immunity, that at this time, serology testing must not be used for the diagnosis of acute COVID-19 infection, isolation or transmission-based precautions decisions, or management of contacts to cases.

How to Report Results

In California, laboratories and providers have a regulatory requirement to electronically report to public health lab findings suggestive of disease listed in Title 17, California Code of Regulations, Section 2505 (17 CCR § 2505). Any laboratory approved to test for SARS-CoV-2 MUST report all positive and non-positive (negative, indeterminate, and specimens unsatisfactory) test results for SARS-CoV-2 from both antigen/molecular and antibody/serology tests within 8 hours through the California Reportable Disease Information Exchange (CalREDIE) Electronic Laboratory Reporting (ELR) system or the CalREDIE Manual Lab Reporting Module (MLRM).

As noted, COVID-19 testing, which includes COVID-19 Point of Care antigen testing, should be reported through the CalREDIE electronic lab reporting (ELR) system. If your clinic or facility does not have ELR capacity lab results can be reported using the CalRedie Reporting module.

Please review resources below and the CalREDIE website as CalREDIE enrollment is coordinated by the CalREDIE team, not the local health department.

Resources for CalREDIE reporting:

Infection Control

If a patient presents and is suspected of having COVID-19, a recent exposure, or is a confirmed case, proper infection control measures should be put in place immediately and includes:

  • Place surgical mask on patient and place patient in private room with door closed (optimally, a negative-pressure, airborne isolation room).
  • Implement all of the infection control procedures listed below for healthcare workers:
    • Standard precautions AND
    • Contact precautions (gloves, gown) AND
    • Airborne precautions (N95 mask or PAPR) AND
    • Eye protection (face shield or goggles)
  • Additionally, universal masking of all staff and visitors should be implemented within the facility.

Surfaces should also be cleaned frequently using appropriate disinfectants: List of disinfectants for use for COVID-19 cleaning.

For additional infection control guidance please review CDC Infection Control Recommendations.

Clinical Management

If a patient has mild symptoms not requiring medical care, healthcare providers may instruct the patient to stay at home in isolation and only seek medical attention if symptoms worsen. If a patient is tested for COVID-19, but does not require hospitalization, he/she may be discharged home with instructions to isolate at home while awaiting results along with quarantine instructions for close contacts. Please provide patients with Home Isolation Instructions for Person under investigation, Home Isolation instructions for confirmed cases, home quarantine instructions for close contacts, found on: www.coronavirus.cchealth.org/for-covid-19-patients along with isolation and quarantine health officer order found on www.coronavirus.cchealth.org/health-orders.

Retesting of patients who were previously diagnosed with COVID-19 is NOT recommended within 3 months. This includes, outside of testing to end isolation early, NOT retesting after an infection for clearance. Patients who tested positive and have cleared their infection based on the ending isolation criteria below do not need a negative test for work, being transferred back to facilities, or other housing programs or take part of asymptomatic surveillance testing if done for their workplace. If it has been longer than 3 months since the patients' COVID-19 infection, retesting would be recommended for surveillance testing or other concerns. For patients, who develop new symptoms consistent with COVID-19 during the 3 months after the date of initial test or symptom onset, if an alternative etiology cannot be identified by a provider, then retesting may be warranted and consultation with infectious disease or infection control experts is recommended if further guidance is needed.

Multisystem inflammatory syndrome In Children (MIS-C)

On May 14, 2020, the U.S. Centers for Disease Control and Prevention (CDC) issued a health alert regarding children with signs and symptoms of a severe multisystem inflammatory syndrome (MIS-C) potentially associated with SARS-CoV-2 infection. Please visit: www.cdc.gov/mis-c/index.html for more information. Cases presenting with features resembling Kawasaki disease or toxic shock syndrome have been reported in Italy, the United Kingdom, New York City and other locations in the United States, including California.

Please see the Provider Alert Multi-System Inflammatory Syndrome and report any suspected cases of MIS- C to public health to Contra Costa Public Health by calling the Communicable Disease Program at 925-313-6740 during regular business hours (M-F, 8am to 5pm) or by submitting a completed COVID-19 CMR form, indicating MIS-C in the "Disease being reported" field, by FAX to Contra Costa Public Health at 925-313-6465.

Treatment

The spectrum of medical therapies to treat coronavirus disease 2019 (COVID-19) is growing and evolving rapidly, including both drugs approved by U.S. Food and Drug Administration (FDA) and drugs made available under FDA emergency use authorization (EUA). Please visit guidance published by the National Institutes of Health (NIH) for treatment and management recommendations that are based on scientific evidence and expert opinion and are frequently updated COVID-19 Treatment Guidelines NIH COVID-19 Treatment Guidelines home page, and CDC Information for Clinicians on Therapeutic Options for COVID-19 Patients. For further information on registered trials in the U.S., see ClinicalTrials.gov.

For more additional guidance for the care of patients with COVID-19, including care of newborns, children, pregnant and breastfeeding women please visit CDC Clinical Care Guidance for Healthcare Professionals.

Please note, Contra Costa Health Services is no longer involved in coordinating referrals or distributing drug product for Monoclonal Antibody Treatment for COVID-19. See more information on referring your patient for treatment.

Vaccines

Vaccination remains the most important mitigation strategies for prevention of severe outcomes from COVID-19. Vaccines are now approved for anyone aged 5+ and boosters are now available for those who are 12 years and older, and 5 months from their second shot of a COVID-19 mRNA vaccine [ie. Pfizer or Moderna] or 2 months after the single dose of Johnson and Johnson vaccine).

For more information on COVID-19 vaccines and updated guidance please review CDC COVID-19 vaccine website.

COVID-19 Vaccinations Adverse Reaction Reporting

COVID-19 vaccines are safe and effective, but clinicians should report any adverse reaction, including any serious and life-threatening adverse events, in patients following receipt of any COVID-19 vaccine to CDC/FDA Vaccine Adverse Event Reporting System (VAERS). These reported adverse events will be reviewed as part of vaccine safety monitoring, and if appropriate, follow up and further investigation may take place.

Due to reporting of adverse events, on April 13, 2021 CDC temporarily paused the use Johnson and Johnson vaccine to review the vaccine adverse reaction after receiving reports of a few cases of thrombosis with thrombocytopenia syndrome (TTS) following the Johnson and Johnson vaccine. The Johnson and Johnson vaccine was taken off of pause on 4/23/2021 after a thorough review by FDA and the CDC. TTS following Johnson and Jonson COVID-19 vaccine was deemed a rare event and added as a low risk associated health effect to patient education materials: CDPH Johnson and Johnson Fact Sheet. Although a rare reactions, clinicians should continue to monitor for these reactions and if a patient presents after receiving the Johnson and Johnson COVID-19 vaccine with concerns for thrombotic events or thrombocytopenia ((ie) severe headache, backache, new neurologic symptoms, severe abdominal pain, shortness of breath, leg swelling, petechiae, new or easy bruising have a high, or thrombocytopenia on CBC) TTS should be considered with appropriate follow up. Clinicians should also immediately report these adverse events to VEARS and save a copy of the report. In addition to promptly submitting a VEARS report, please also notify Contra Costa Public Health Department within one day regarding a case of TTS following receipt of Johnson and Johnson vaccine. Please contact Contra Costa Public health by sending an ENCYPTED email to cocohelp@cchealth.org (preferred method) or by calling public health at call 925-313-6740 7 days a week to reach the Communicable Disease Programs- this number is staffed 8AM-4:30PM. Please include patient demographics (name, DOB), date received vaccine, symptoms onset and symptoms, VEARS number and attach the VEARS report if sending an email.

Please also review for further information regarding Johnson and Johnson Pause:


Reinfection

Reinfection is possible and as seeing different variants maybe more common, but the scope COVID-19 infection is still being explored.

Variants of COVID-19

Viruses constantly change through mutation, and new variants of a virus are expected to occur over time. Sometimes new variants emerge and disappear. Other times, new variants emerge and persist. During this pandemic, multiple variants of the virus that causes COVID-19 have been documented in the United States and globally and a few have mutated to cause concerns for increase in transmission, potential increase in virulence, potential for immune escape, and potential decrease vaccine effectiveness. To understand COVID-19 variance and their prevalence in the community, CDC and CDPH and Contra Costa Health Services has increased efforts for whole genome sequencing and the capacity to report and monitor for variants of concern or variants of interest (variants with mutations that could cause concern but at this time have no data that suggests any concern). For more information on variants please visit www.cdc.gov and www.cdph.ca.gov

Whole Genome Sequencing (WGS)

If you have COVID-19 cases that you are interested in reviewing for possible WGS please:

  1. Contact the laboratory that preformed the testing and instruct them to hold the specimen for additional public health follow up.
  2. Contact Contra Costa Public Health at CICT-LabLiaison@cchealth.org or cocohelp@cchealth.org to review the case for possible further work-up with WGS. Please send an secure email with "WGS case of Interest" in the subject line.

Contra Costa Health Services will follow up with the provider to review the case and with the laboratory that performed testing, as appropriate. The team will ask the laboratory for the cycle threshold (Ct) or Relative Light Units (RLU) , and if the specimen meets eligible specimen criteria- (ie) it has a Cycle threshold (Ct) value ≤30 (if Ct available) or RLU ≥1150, and is a nasal or NP swabs in viral transport medium (VTM), saline, or molecular transport medium, Hologic Aptima media, sputa. Please note that dry swabs, are not acceptable for WGS.)- the team will work to forward the specimen to the Contra Costa Public Health Laboratory for further testing and WGS as appropriate. At this time, cases that will be prioritized for WGS include:

  • Concerns for reinfection and the current specimen and the specimen from previous positive result(s) are available
  • Concerns for Variants:
    • Outbreaks with high attack rate in a given outbreak or more cases then expected,
    • Cases with concerns for variants due to drop in diagnostic assay target (ex: testing with a drop in the S target ((eg) ORF1ab target detected, N targe detected, and S target not detected), any marked differences in real-time RT PCR viral target(s) cycle threshold values, or other testing changes that may suggest a variant.
    • Symptomatic Post Vaccine Infections with severe outcome (individuals who have received their booster vaccine or those who are fully vaccinated but not booster eligible) with severe outcomes.
    • Hospitalized patients (or ICU patients)
    • Concerning cases for possible variances due to clinical history (immunocompromised, prolonged infection, Cases who received Monoclonal Antibody but failed to improve, death, etc)
    • Cases with recent travel (14 days from test date) or who is a close contact to someone that had a recent international travel. Cases with international travel or contacts with international travel will be prioritized for WGS, but cases with domestic travel maybe appropriate for WGS as well and can be reviewed for possible further follow up.

When contacting the Contra Costa Public Health about potential WGS, please include in the email the following information:

  • Patient name
  • Patient DOB
  • Specimen collection date,
  • Name of laboratory the preformed testing,
  • Symptom onset date and symptoms,
  • if applicable, reason for the WGS request, and appropriate information for reason for WGS is provided such as:
    • post vaccine infection with severe outcome include vaccine dates (both vaccine #1 and Vaccine #2 date), vaccine manufacturer and outcome (ie. Hospitalized or death)
    • travel cases include travel dates and locations (international and domestic, if appropriate),
    • Reinfection cases, date or previous infection, if had symptoms during previous infection,
    • Clinical information such as hospitalization status, if immunocompromised, etc
    • And other appropriate information for WGS reason.

Please note WGS is not currently a validated assay and requesting providers or facilities will not receive laboratory reports from the Contra Costa Public Health Laboratory or California Department of Public Health (CDPH). However, the Contra Costa Public Health may reach out for purposes of Contact Tracing to control the spread of SARS-CoV-2 and certain variants.

For further information regarding process for COVID-19 Whole Genome Sequencing and reporting to local public health please review Provider and Laboratory Health Advisory COVID-19 Cases of Interest for Whole Genome Sequencing and review information on Contra Costa Public Health Laboratory website.

Isolation and Quarantine Guidance

Contra Costa Health Services has aligned with California Department of Public health guidance on isolation and quarantine. Healthcare providers should continue to review quarantine and isolation guidance with patients who have been exposed to COVID-19 or who are positive for COVID-19, and given isolation and quarantine instructions to patients.

These guidelines are for the general public and should not be used for healthcare workers and congregate living facility staff restrictions. Guidance on restrictions based on staffing and vaccine status can be found in CDPH AFL 21-08, and facilities experiencing staffing shortages with staffing needs to continue operations should review guidance found in CDPH CDPH AFL 21-08 and CDC mitigating staffing shortages, and home quarantine for Essential and Healthcare Workers. For further information on healthcare worker staff work restrictions.

Students in K-12 students should check with their schools about requirements for returning to school, as State guidance may differ for students. Teachers, school employees, and non-healthcare settings and non-congregate living settings should follow State guidance on isolation and quarantine for the general public, as listed below, along with current CalOSHA standards for work restrictions based on COVID-19 status. Individuals should be instructed to follow up with their work place to review work restrictions after an exposure or after testing positive.

Quarantine for Close Contacts

The full incubation period for COVID-19 is 14 days, but given resources and other considerations CDC has released options for reducing quarantine time and California Department of Public Health has updated their isolation and quarantine guidance to take into consideration vaccine status and changes to COVID-19 incubation period in light of new variants.

Individuals who are a close contact to someone who tested positive for COVID-19 should follow quarantine guidance based on their vaccination status.

People who are unvaccinated or not fully vaccinated:
  • Stay home for at least 5 days after their last contact with a person who has COVID-19
  • Get tested on day 5
    • If they have no symptoms AND a test taken on day 5 or later is negative: quarantine can end on day 6 (antigen test preferred)
    • If they do not get tested AND do not have symptoms: quarantine can end on day 11
    • If they test positive or develop symptoms: stay home for 10 days from their positive test or until your symptoms are getting better, following isolation instructions
  • Wear a well-fitting mask around others for 10 days, especially indoors

People who are not up-to-date on their COVID-19 vaccinations (have not gotten a booster dose despite being eligible):
  • Stay home for at least 5 days after your last contact with a person who has COVID-19
  • Get tested on day 5
    • If they have no symptoms AND a test taken on day 5 or later is negative: quarantine can end on day 6
    • If they do not get tested AND do not have symptoms: quarantine can end on day 11
    • If they test positive or develop symptoms: stay home for 10 days from their positive test or until your symptoms are getting better, following isolation instructions
  • Wear a well-fitting mask around others for 10 days, especially indoors

People who are up-to-date on their COVID-19 vaccinations (have received a booster or are not yet eligible):

People who are fully vaccinated and have received a booster and people who are fully vaccinated but aren’t eligible to receive a booster do not need to stay home (quarantine), but should follow these instructions:

  • Get tested on day 5 after being exposed to someone with COVID-19
    • If the test is positive, follow isolation instructions
  • Wear a well-fitting mask around others for 10 days, especially indoors
  • If you develop symptoms, get tested right away and stay home

Individuals who have tested positive for COVID-19 within the past 3 months, recovered from their infection, and remain asymptomatic do not have to quarantine after a close contact. Additionally, individuals should not test again if within 3 months of their infection, if no concerns, as noted above.

Management of Long-Term Care Facility Residents and Patients in Healthcare Settings

Because there is a small risk of virus transmission after the 10-day quarantine period, to lessen the risk of outbreaks in healthcare settings and high-risk congregate settings such Long-Term Care facilities (residential care facilities for the elderly, board and cares, skilled nursing facilities, etc) and detention facilities individuals who have had close contact to a case and live in these settings should remain in quarantine for the 14-day period. Residents who have had an exposure should also continue to follow quarantine and testing guidance in these settings, appropriate transmission-based guidelines, follow up testing after an exposure to someone with suspected or confirmed COVID-19, and all testing during any outbreak or response testing. Facilities should inform all healthcare settings, which includes outpatient clinical settings (dialysis, clinics, etc) and other hospital settings, of any patient who has had close contact to a COVID-19 case, regardless of the resident vaccination status, so staff in these settings can use the appropriate transmission-based precautions.

New admissions who are not fully vaccinated or who are booster eligible, but have not received their booster, still need to quarantine for 14 days on admission and follow all preventive measures. New admissions into long-term care facilities do not need to quarantine on admission if they are up-to-date on their COVID-19 vaccine, unless they are awaiting their COVID-19 test results, there was an exposure to someone with COVID-19 in the past 14 days, or there are other concerns prior to admission. Facilities should continue to monitor these residents for any symptoms and immediately isolate and test for COVID-19 if any concerns arise. Facilities should also review new admission policies and procedures from their appropriate licensing body to ensure they are in adherence with these.

Ending Isolation for Patients with Confirmed Infection

Individuals who test positive for COVID-19 and who have mild symptoms or are asymptomatic need to isolate for at least 5 days as described below.

  • Stay home for at least 5 days
    • If they do not have symptoms or symptoms are improving: isolation can end after day 5 if they test negative on day 5 or later
    • If they do not get tested and do not have symptoms or their symptoms are improving: isolation can end after day 10
    • If you have a fever: isolation should be continued until fever resolves
    • If they have symptoms (other than a fever) that are not resolving: continue to isolate until your symptoms are resolving or until after day 10
  • Wear a well-fitting mask around others for 10 days, especially indoors

Management of Long-Term Care Facility Residents and Patients in Healthcare settings

Patients in healthcare settings, and residents in both long-term care facilities and other non-healthcare congregate settings who are positive with mild symptoms or no symptoms for COVID-19 should isolate for a full 10 days and end isolation if have resolving/resolved symptoms and no fever for 24 hours, regardless of vaccination status or booster status. Patients with more severe disease requiring ICU admission or who are severely immunocompromised may need to isolate for up to 20 days, as noted below.

As noted in CDC guidance for ending isolation for patients with moderate/severe disease, patients with severe disease hospitalized in the intensive care unit may have longer periods of SARS-CoV-2 RNA shedding compared to patients with mild or moderate disease. Given this, patients who were hospitalized in the intensive care unit with COVID-19 should be instructed to remain isolated for at least 20 days and at least 24 hours after their fever has resolved (fever has gone away without using a fever-reducing medication like Tylenol or ibuprofen AND their symptoms like cough, body aches, sore throat, have improved).

A very limited number of persons with severe illness who were not hospitalized in the intensive care unit, which includes Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50% may warrant extending duration of isolation to up to 20 days after symptom onset.

As described in CDC Duration of Isolation and Precautions for adults with COVID, Decision Memo, an estimated 95% of severely or critically ill patients, no longer had replication-competent virus 15 days after onset of symptoms; no patients had replication-competent virus more than 20 days after onset of symptoms. The exact criteria that determine which patients will shed replication-competent virus for longer periods are not known. Disease severity factors and the presence of immunocompromising conditions should be considered in determining the appropriate duration for specific patient populations. For example, patients with characteristics of severe illness it may be appropriate for these patients least 15 days of isolation under Transmission-Based Precautions.

Patients who are severely immunocompromised could remain infectious more than 20 days after symptom onset. CDC defines severely immunocompromised as patients on chemotherapy for cancer, being within one year out from receiving a hematopoietic stem cell or solid organ transplant, untreated HIV infection with CD4 T lymphocyte count < 200, combined primary immunodeficiency disorder, and receipt of prednisone <20mg/day, but ultimately, notes that the degree of immunocompromise for the patient is determined by the treating provider, and preventive actions are tailored to each individual and situation. For patients who are considered severely immunocompromised, consultation with infectious diseases specialists is recommended for possible use of a test-based strategy for determining when to discontinue Transmission-Based Precautions could be considered. Please review CDC Discontinuation of Transmission Based Precautions and Disposition of Patients with SARS-COV2 Infection in healthcare settings for more details.

For patients who may remain infectious longer than 10 days, their symptoms, clinical presentation, and context should be reviewed by their healthcare provider or hospital team to determine if a longer isolation period is warranted. Additionally, consultation with local infectious disease experts can be considered when making decisions about discontinuing isolation for patients who maybe infectious longer than 10 days.

Retesting, outside of instances that are recommended to shorten isolation to 5 days, or in consultation with infectious disease, is NOT recommended to determine if the patient has cleared their infection. Patients who tested positive and have cleared their infection based on the 10 day or 20 day ending isolation criteria above do not need a negative test for work, being transferred back to facilities, or other housing programs.

Patient Notification of Results

It is the responsibility of the ordering provider to inform patients of their test results and to give instruction regarding home isolation to patients and home quarantine to close contacts. For patients who test positive, please provide patients with Home isolation instructions for themselves and Home Quarantine Instructions for their close contacts found on www.coronavirus.cchealth.org/for-covid-19-patients. A close contact is defined as anyone who was within 6 feet of a person with COVID-19 while they are considered infections for 15 minutes or longer (cumulative total of 15 minutes or more over a 24-hour period). A person is considered infectious from 48 hours before his or her symptoms began (or in the absence of symptoms, from 48 hours before the date of the test- to determine close contacts or testing plan for asymptomatic patients who live or work in a high-risk setting, such as a Long Term Care Facility, a more conservative infectious period of 10 days from the test date maybe more appropriate for these settings) and until the patient is cleared of their infection as noted in the clearance section above.

If a hospitalized patient has confirmed COVID-19, but no longer requires inpatient care and is still considered infectious, they may be discharged to home under home isolation. Public health does not need to be notified of discharges home if the patient can safely isolate at home. On discharge give the patient home isolation instruction and quarantine instructions, along with the orders, as noted above. If the patient is unable to isolate at home safely or is homeless public health can be contacted for possible PUI hotel placement. Please review provider guidance for placing person experiencing homelessness or unable to isolate safely. You may also fill out a Case discharge notification form if the patient is unable to isolate safely 48-24 hours prior to planned discharge.

For patients with planned discharge to a congregate setting please review Guidance for Hospitals Receiving and Discharge a Patient from Long Term Care Facility. As noted on this guidance, discharges should be discussed between facility and hospital to ensure patient can be isolated safely in the facility. Public health approval is not needed, as long as facility can isolate safely, and no questions or concerns arise. Public health should be notified of planned discharges into a Long-Term Care Facility of patients who need continued isolation precautions. Notifications should take place filling out and emailing (the preferred method) the Case Discharge Form to cocohelp@cchealth.org, ensuring that the email in ENCRYPTED, or by calling public health at 925-313-6740.

If a patient is moving to another facility, including congregate care facilities, please complete Interfacility Transfer form (Comprehensive Form or Abbreviated Form) and have form transferred with the patient. If patient had COVID testing attach lab results to form for transfer.

Preventive Measures

Vaccination is the most powerful tool we have to reduce the spread of COVID-19 and improve outcomes. Mitigation strategies such as social distancing, universal masking, isolation of ill individuals, and placing their close contacts in quarantine will continue to be important tools for containing the spread of COVID-19 as the vaccination efforts continue. Patients should be instructed to practice social distancing, wear mask if out, stay home if sick, wash hands frequently, avoid touching their faces, avoid crowded areas, as much as possible avoid poorly ventilated space, and to get vaccinated against COVID-19 as they become eligible for the vaccination.

Additionally, individuals such as older adults (age ≥ 65 years) and those with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease), should be advised to stock up on supplies and prescriptions, avoid large crowds as much as possible, avoid contact with ill persons, avoid non-essential air travel and cruises, and stay home as much as possible to reduce the risk of being exposed.

Preventive measures should also be taken for all clinical settings, including dental clinics, to decrease the chance of spread. Staff should be monitored for symptoms and be instructed to stay home if sick. Additionally, practices should implement alternatives to face-to-face triage and visits as appropriate and consider designating an area of the facility (e.g. an ancillary building or temporary structure) as a location for initial evaluation of patients who present with fever or respiratory symptoms; cancel group healthcare activities (e.g., group therapy, recreational activities); and postpone elective procedures, surgeries, and non-urgent outpatient visits if appropriate when there is increasing or substantial community prevalence. See more information on actions that can be taken for healthcare facilities.

For dental practices, it is also important that measures are taken to decrease the spread of COVID-19. Patients should be allowed to access dental care, if needed, but considerations should be taken to reschedule non-urgent appointments, if increasing or substantial community prevalence, such as dental cleaning. Additionally, it is up to dental practices to monitor staff for any symptoms and to have staff who are sick remain home. Practices should also provide PPE for staff and patients as needed, screen all patients for symptoms (fever, cough, shortness of breath) prior to them being seen, and reschedule any appointments with sick patients.

In Contra Costa County, vaccination and booster efforts are taking place and will be an important aspect to prevention and mitigation strategies. Although the risk of COVID-19 is lower in vaccinated individuals, individuals who are vaccinated can still get COVID-19 and at this time they should continue to do all recommended preventive measures to protect themselves and others as noted in the CDC guidance for fully vaccinated individuals, including wearing a mask, staying at least 6 feet away from others, avoiding crowds, covering coughs and sneezes, washing hands often, following CDPH travel guidance, and following any applicable workplace or school guidance, including guidance related to personal protective equipment use or SARS-CoV-2 testing. Additionally, if vaccinated individuals are found to have COVID-19 they should still follow the same guidance for anyone with COVID-19 which includes isolation and contact tracing. Please visit CDC COVID-19 vaccine website and www.coronavirus.cchealth.org/vaccine for more information on COVID-19 vaccine and vaccination efforts.

Please also review CDC How to Protect Yourself and Others for Further Preventive Measures against COVID-19.

Additional Resources