Alert to clinicians in Clackamas, Multnomah and Washington counties
Key Messages
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Testing capacity is strained: focus testing on symptomatic patients (regardless of severity); and as resources allow, close contacts of confirmed cases.
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Asymptomatic contacts who test negative must still do a 14 day home quarantine.
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When you provide positive test results to your patients, please 1) give clear direction for home isolation, 2) provide health education and establish a plan for follow up for clinical worsening, and 3) let them know local public health will contact them to reinforce home isolation and identify exposed close contacts.
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Health care providers do not need to do prolonged interviews to identify contacts or define exposures; this may affect an individual’s willingness to engage with public health interviews.
Local disease transmission
The regional case number is >6000 and >130 deaths. Many COVID-19 deaths in the region have been associated with long term care facility exposure. Some of the most common symptoms among lab-confirmed cases are cough, headache, muscle aches, chills, and fever. More specifics about cases in Clackamas, Multnomah, Washington and Yamhill counties are available here.
There is clear evidence that COVID-19 disproportionately affects Black/African American, Hispanic/LatinX, Pacific Islander, American Indian/Alaskan Native, and immigrant/refugee communities in our area and across Oregon. For most of these populations, there is both increased likelihood of infection and worse outcomes.
Collection of Race, Ethnicity, Language, and Disability (REALD) demographic data is paramount to our ability to understand and prevent the impacts of this virus. Please collect accurate REALD demographic data based on how patients self-identify, including those being tested for COVID-19.
The public health goal of testing is to minimize spread of the virus by:
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Early identification of symptomatic cases who are likely to be infectious
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Early identification of contacts to facilitate rapid isolation / quarantine
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Slowing viral transmission in specific communities with known or emerging viral spread
Testing
Oregon Health Authority testing guidance is broad, however testing capacity is finite and turnaround times have extended to a week or more at some labs because of high demand.
State and local public health officials are actively discouraging employers from requiring testing of well employees for return to work.
We recommend PCR testing for:
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Anyone with symptoms: Cough, shortness of breath, fever, chills, muscle pain, headache, new loss of taste or smell, congestion/runny nose, diarrhea, nausea or vomiting.
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As resources allow, anyone who reports having had close contact with a confirmed or presumed case in a non health care setting, regardless of whether they have symptoms. You do not need to confirm exposure or case name with local public health. Asymptomatic contacts with a single negative test must still do a 14-day quarantine.
Priority groups for testing include:
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Those who self-identify as Black/African American, Indigenous/American Indian/Alaska Native, Hispanic/Latinx, Asian/Pacific Islander, immigrant/refugee, and those whose first language is not English
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Those who identify as having a disability
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Workers in congregate settings, for example health care settings without dedicated employee health or infection control, long-term care, corrections, food processing, and farm workers
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Residents in congregate living settings
More about testing
There are a small but significant number of tests that result as indeterminate. These results should be treated as positives. Providers may retest at their or their health system’s discretion.
Some test systems will reject specimens that are “unsatisfactory”. This is related to the quality of the specimen and should NOT be considered to be a positive. The specimen should be re-collected if there was a strong clinical reason for it to be collected initially.
Individuals should not be tested more than once in 24 hours.
There is no established evidence based recommendation for serial testing intervals.
In general, repeat testing after clinical recovery from lab-confirmed infection is not helpful unless part of a testing strategy for release from isolation precautions in high risk settings (health care and long-term care facilities) and for immunocompromised patients.
New positive tests in the first few weeks after clinical recovery are generally thought to be false positives or non-viable viral particles. Some - but not all - experts assume some level of immunity following infection, but the level of protection and duration are unknown. For cases of possible reinfection, use isolation precautions and consult with an infectious disease specialist.
Serology
Local public health does not routinely follow up on reports of positive serology.
Antibody tests do not have a role in diagnosis of acute infection, and it is unclear if a positive result demonstrates immunity in the individual. For now, the role of serology is at the population level as a broad indicator of infection rates.
Antigen testing
Local experience with antigen testing has shown low sensitivity and high specificity, so a negative test does not rule out infection in someone who is high risk by virtue of symptoms and/or known high risk exposure.
Advice for patients
For those who have positive or pending PCR test or for individuals with clinically compatible symptoms who choose to remain home without a test:
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Please provide test results for your patients as well as medical advice and plan for further medical care as needed.
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There is no need for further contact tracing or exposure interviews to be performed by you or your staff. Please let the patient know public health will contact them (we will perform the contact tracing).
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Advise to stay home until fever-free for at least 72 hours without the use of antipyretics, other symptoms have improved, AND at least 10 days have passed since symptoms first appeared.
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Even after symptoms have improved individuals must continue to follow county and state guidance related to reopening and travel.
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Local public health will be in touch by phone to reinforce home isolation and to identify household members and other close contacts who may be offered testing and asked to stay home for 14 days.
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Asymptomatic contacts with a single negative test must still do a 14-day quarantine.
As always thank you for your partnership,
Christina Baumann, MD, Washington County Health Officer
Sarah Present, MD, Clackamas County Health Officer
Jennifer Vines, MD, Multnomah County Health Officer
