Updated CDC Recommendations for COVID-19 Patient Care
May 04, 2020
The Centers for Disease Control and Prevention has recently made multiple updates to its recommendations for diagnosis and treatment of patients with COVID-19. The Orange County Health Care Agency recommends that providers become familiar with and adhere to these recommendations. Select updated CDC recommendations are outlined below.
Expanded Presentation Guidance for Identifying Suspect Cases of COVID-19
The CDC encourages clinicians to consider testing for COVID-19 for patients presenting with an expanded list of symptoms including fever, cough, shortness of breath, chills, muscle pain, new loss of taste or smell, vomiting or diarrhea, and/or sore throat.
These updated recommendations can be found at: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
Discontinuation of Transmission-Based Precautions for Symptomatic Patients with COVID-19
The CDC has changed the name of the ‘non-test-based strategy’ to the ‘symptom-based strategy’. For this strategy, the period for isolation for confirmed cases was extended from 7 days after symptom onset to 10 days after symptom onset. Patients in both healthcare and community settings with confirmed COVID-19 infection can have infection control and isolation precautions discontinued using the following symptom-based strategy:

  • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); AND
  • At least 10 days have passed since symptoms first appeared

This symptom-based strategy should also be used to decide when infected healthcare providers (HCP) can return to work. When returning to work, HCPs should also wear a facemask (not a cloth face covering) for source control at all times while in the healthcare facility until all symptoms are completely resolved or at baseline.

The CDC’s test-based strategy for discontinuing isolation is unchanged. This strategy still requires a combination of resolution of fever and improvement of symptoms for 72 hours and at least two negative consecutive results from PCR testing of respiratory specimens for SARS-CoV-2 collected at least 24 hours apart. However, because PCR-positivity does not consistently correlate with viral culture and may continue for extended periods after symptom resolution, this strategy frequently leads to unnecessarily prolonged isolation periods and is not routinely recommended by OCHCA.

Updated healthcare guidance can be found at:

Updated community guidance can be found at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

The updated recommendations for healthcare providers with COVID-19 infection can be found at:
Discontinuation of Transmission-Based Precautions for Asymptomatic Patients with COVID-19
The CDC also extended the duration of isolation needed for asymptomatic individuals who test positive for COVID-19 from 7 to 10 days. Asymptomatic patients with laboratory-confirmed COVID-19 should remain in isolation until 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive test.
  COVID-19 Testing Recommendations
  • The CDC now considers nasopharyngeal (NP), oropharyngeal (OP), nasal mid-turbinate, nasopharyngeal wash, or nasal swab specimens to be acceptable specimens for initial PCR diagnostic testing for SARS-CoV-2. 
  • OCHCA continues to recommend NP swab testing when it is available for patients with symptomatic infection, as the cumulative evidence indicates that PCR testing of NP specimens is the most sensitive  method of testing from the upper respiratory tract.  
  • PCR testing of upper respiratory specimens in symptomatic patients is unknown but estimated to be in the range of 60-80%. A negative test should not be interpreted to rule out COVID-19 infection. 
  • PCR testing of lower respiratory specimens such as sputum, or bronchoalveolar lavage or tracheal aspirate specimens, may increase sensitivity and should be performed in addition to NP testing if available, especially if there is high clinical suspicion for COVID-19.
 
These updated testing recommendations can be found at: https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html .
Contact Information
Providers can contact the Communicable Disease Control Division at 714-834-8180 for questions or concerns. Please note that this number is now operational 24/7 for medical providers. Please do not share this number with patients.

Case Numbers are updated daily on our website at: www.ochealthinfo.com/novelcoronavirus
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