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COVID-19

Information for Healthcare Professionals


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 Testing Guidance and CDC Interim Guidance for antigen testing.

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

For information on infection control guidance please review CDC Infection Control Recommendations, and a List of disinfectants for use for COVID-19 cleaning.

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: coronavirus.cchealth.org/for-covid-19-patients along with isolation and quarantine health officer order found on 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 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.

For 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:


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 have 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 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.

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, Quarantine Guidance, and Notification of results

Contra Costa Health 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.

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

Please review Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | CDC for guidance on patient placement and further infection control.

Additional Resources