COVID-19 Overview and Update
Local Resources and In formatio n
March 15, 2020
Dear AAP-OC Chapter Members,
 
During this unprecedented occasion we know that recommendations for COVID-19 are changing almost daily, and it can be overwhelming to stay informed on the latest updates. AAP-OC serves as a communication resource to help our pediatric providers stay updated on key health issues affecting our community.
 
Here we have pulled the most updated information to provide our members practical guidelines & key local resources in Orange County on COVID-19.

Guidelines
Here are clinic workflow strategies for all providers who work in an office setting to help triage patients and keep providers, staff, and families safe. 

Testing Patients for COVID-19

Who to Test:
While the testing allowances have broadened, the OCHCA strongly recommends testing only patients who present with the appropriate clinical presentation and travel or exposure history as outlined by the
CDC.

"Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing); several recent local cases have experienced vomiting, prolonged anorexia and dehydration/weakness. Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza." (OCHCA) 
 
Screening should be done in your office, an urgent care, or ER. More testing locations may become available in the near future. Do not send patients to Public Health for testing.

See flow charts from the OCHCA.



How to Test:
Nasopharyngeal testing is recommended in the outpatient setting, and a sputum sample if possible. Oropharyngeal testing is no longer recommended.  Commercial testing is available through  Quest Diagnostics  and Labcorp.



Once swab is obtained, move the swab to an appropriate transport medium.  Labcorp recommends a universal transport medium (UTM) with a purple top. Quest swabs can be transported in a UTM, M4, or VCM media.
 
Sputum:
Have the patient rinse their mouth with water and then expectorate a deep cough sputum directly into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container.
 
Storage & Transportation:
Specimens should be frozen or can be refrigerated at 2-8°C for up 72 hours. Transportation should be through courier service through Labcorp or Quest.
 
The testing code for Labcorp is 139900, and Quest is 39433.
The turn around time is typically 3-4 days.
 
Infection Control Precautions:
PPE protection is recommended for providers & staff caring for patients with a high suspicion of having COVID-19, which includes masks, eye protection, gowns and gloves. Due to a shortage of N95 masks, face masks are an acceptable alternative. N95 masks should be prioritized for procedures likely to generate a high concentration of respiratory aerosols (e.g., intubation, cardiopulmonary resuscitation).

"Any provider who develops fever and cough is recommended to immediately stop working until fever has resolved for 24 hours. Providers who are concerned that they may have COVID-19 due to symptoms or suspected exposure to COVID-19 are encouraged to talk with their occupational health provider or OCHCA at 714-834-8180 to discuss potential COVID-19 testing." (OCHCA)

If you Have a Suspected Patient:
If you have a suspected patient with COVID-19, they must be instructed to self-isolate at home until results are available
 
Report all laboratory-confirmed COVID-19 cases immediately to the Orange County Health Care Agency at 714-834-8180 (after hours 714-628-7008) (do not share these numbers with patients).
 

Resources 

This website provides up-to-date information about known cases in Orange County, and provides key points about COVID-19, including print-ready handouts (multi-language) for your patients and families.

Includes and updated FAQ from pediatric infectious disease specialists. Includes information that is most relevant to pediatric patients and their families.

CDC
COVID-19 information specifically for healthcare providers. Includes protocols on evaluation, testing, and reporting patients, as well as infection control and PPE recommendations.
If you have any further questions, please contact Jamie McDonald, Executive Director at jamie@aap-oc.org 

Thank you for all you do to ensure our patients, families, and community stay in optimal health during this time.

Best,




Katherine Williamson, MD, FAAP