2019 Novel Coronavirus: Orange County Update
for Long Term Care Facilities and Assisted Living Facilities
March 9, 2020
Over 100,000 2019 Novel Coronavirus (COVID-19) cases have been identified worldwide. Over 100 countries have reported cases, and multiple jurisdictions in the United States have reported local spread. Local spread of COVID-19 has not been identified in Orange County thus far, but it is likely to occur in the coming weeks. 

An outbreak in a Seattle-area skilled nursing facility (SNF) has caused illness in both staff and residents, and at least 19 deaths have been reported related to that event thus far. It is imperative that any case in a long term care facility or assisted living facilitybe identified quickly so that appropriate preventive measures can be taken to prevent further facility spread.

Facilities in Orange County should immediately report any clusters of respiratory illness that do not have an identified pathogen to OCHCA. OCHCA’s public health laboratory can perform COVID-19 clinical testing for patients, and OCHCA will facilitate rapid testing of any ill residents for COVID-19, influenza, and any other respiratory pathogens as appropriate.
Recommendations for All Long Term Care Facilities:
  • All long term care facilities in Orange County should immediately report any clusters of respiratory illness (3 or more patients and/or staff with respiratory infection) that do not have an identified pathogen to OCHCA. 
  • Immediately report all suspect or confirmed cases of COVID-19 infection to the Orange County Health Care Agency at 714-834-8180 (after hours call 714-628-7008).
  • Institute and maintain appropriate infection control precautions (see below).
  • Ensure sick leave policies allow employees to stay home if they have symptoms of respiratory infection.
  • This situation continues to evolve rapidly; providers should consistently monitor CDC recommendations at https://www.cdc.gov/coronavirus/2019-ncov/index.html.
When to Test:
Last week the CDC expanded the criteria for evaluation of Persons Under Investigation (PUI) to a wider group of symptomatic patients. CDC’s updated guidance can be found at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html . Most patients with COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Testing for COVID-19 and influenza should be performed in any situation where a cluster or unusual increase in acute respiratory illness is identified in a LTCF patient population.
OCHCA's Public Health Laboratory Will Provide COVID-19 Testing for LTCF Residents:
Commercial laboratories are now offering COVID-19 testing and OCHCA encourages most medical providers to plan to use commercial laboratories for COVID-19 testing going forward. However, given the importance of rapid diagnosis in the LTCF patient population, OCHCA’s Public Health Laboratory will continue to offer COVID-19 and influenza testing to LTCFs and assisted living facilities. In most instances, OCHCA will be able to provide test results within 24 hours.
Laboratory Testing:
Diagnosis is confirmed by PCR testing of appropriate clinical specimens. CDC recommends the collection of:

  • Upper respiratory (nasopharyngeal AND oropharyngeal swabs)
  • Lower respiratory if available (tracheal aspirate, bronchoalveolar lavage specimens, or sputum)

If a lower respiratory tract specimen is not obtainable, upper respiratory may be submitted alone for testing. Specimens should be stored at 2-8°C and sent by courier to Orange County Public Health Laboratory prior to shipment to the CDC.
Infection Control Precautions:
  • Restrict residents with fever or acute respiratory symptoms to their room (with no roommates). If they must leave the room for medically necessary procedures, have them wear a facemask (if tolerated).
  • In general, when caring for residents with undiagnosed respiratory infection use Standard, Contact, and Droplet Precautions with eye protection unless suspected diagnosis requires Airborne Precautions (e.g., tuberculosis).
  • Post signs at the entrance instructing visitors not to visit if they have symptoms of respiratory infection.
  • Assess residents’ symptoms of respiratory infection upon admission to the facility and implement appropriate infection prevention practices for incoming symptomatic residents.
  • Any staff with fever and respiratory symptoms should be excluded from work until fever resolves for 24 hours.

For additional recommendations to prevent the spread of COVID-19 in Long Term Care Facilities, see https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html .
Contact Information:
For questions or concerns please contact the Communicable Disease Control Division at 714-834-8180.
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