Clinician Alert: Nov. 20 Interim guidance for patients and outpatient clinicians related to SARS-CoV-2 / COVID-19 testing

November 20, 2020

Situation update

The rapid increase in cases of SARS-CoV2 across our region means local public health will focus contact tracing and disease investigation on highest risk situations. This means that not all positive COVID cases will get full public health follow up and contacts may not hear directly from local public health. 

Ordering clinicians will need to assure that all patients tested get:

  1. Timely notification of their results

  2. Clear recommendations for the length of isolation

  3. If positive, coaching on how to immediately identify and notify their contacts. 

  4. A work exclusion letter if needed in order to stay home to isolate for 10 days after symptom onset (cases) or quarantine for 14 days from last contact to case (contacts).

See our regional COVID-19: After You Get Tested guide for detailed information in multiple languages. 

Changes in local public health follow-up include:

  • Case interviews are being abbreviated

  • Contact tracing is being limited to high-risk exposure settings

  • Most active monitoring of contacts is being suspended

  • Cases and contacts can self-refer for supportive services during isolation or quarantine

  • Cases are being asked to notify their contacts and workplaces

  • Local public health is unable to routinely send letters to all cases and contacts

Key points for patients

Anyone getting COVID-19 testing must stay home until they hear about test results. That includes people without symptoms.

If your test is positive

  • Stay home for at least 10 days AND a full day has passed since your fever is gone AND your symptoms got better. If you feel entirely well, (have no symptoms), stay home for 10 days from the day you had the test done.

  • Have a plan for how to get care if you feel worse.

  • Here is a guide to home care and ways to keep the virus from spreading in households.

  • Get help with rent, grocery delivery, other support by calling 2-1-1.

Make a list of people you spent time with starting two days before you started feeling sick (or two days before you got tested, if you don’t feel sick). Anyone who was within 6 feet of you for at least 15 minutes total in any single day is considered exposed. It doesn’t matter if you were outside or using masks. Go through your list and let your contacts know they need to stay home and away from others for 14 days since they were last with you. The sooner they stay away from others, the less likely the virus is to spread. 

We recommend that you tell your employer or supervisor about your positive test result. They are required to keep your identity confidential, but they may need to notify the other employees quickly to prevent spread of the virus. 

If your test is negative

If you are a close contact to someone who has the virus you must still stay home for 14 days since your last contact.

  • If you are a close contact to someone who has the virus and you have or develop symptoms, stay home for 10 days AND at least a full day has passed since your fever is gone and your symptoms got better.

  • If you have not had close contact with someone who has the virus and you have symptoms, stay home until 24 hours after you are better.

  • Otherwise, continue limiting the number of people you have close contact with; remember physical distancing and use face coverings.

Key points for clinicians

  • Prioritize testing for people who are symptomatic or known close contacts to COVID positive individuals.

  • Testing close contacts soon after their exposure helps identify the next round of contacts and slow transmission.

  • Contacts who test negative must still stay home for 14 days since their last exposure as test conversion may take more than 10 days.

  • An “indeterminate” or “inconclusive” test result should be considered positive.

  • Use clinical judgement to decide if an indeterminate test should be repeated in order to clarify the patient’s status. 

  • An “unsatisfactory” result is related to the quality of the specimen and should NOT be considered positive. The specimen should be re-collected if there was a strong clinical reason for it to be collected initially.

  • Close contacts to known cases who develop compatible symptoms are considered presumptive cases regardless of test results (positive or negative). OHA definition of compatible symptoms for a presumptive case:  an acute illness featuring at least two of the following: shortness of breath, cough, fever, new loss of smell or taste, radiographic evidence of viral pneumonia;

  • Create a plan with patients who are positive for what to do if they get worse.

  • Use the after testing guide to coach patients about how to let their contacts know they have been exposed and need to quarantine.

  • All patients need clear guidance about the need to isolate while waiting for test results.  Exceptions include asymptomatic individuals with no known contact who are tested as part of routine community screening or long-term care facility surveillance screening. 

If Patient is Positive for COVID-19 and Symptomatic

A patient can resume contact with others when:

  1. They have no fever for 24 hours without the use of medicine, 

  2. AND Other symptoms improve, AND

  3. At least 10 days have passed since symptoms first appeared.

If Patient is Positive for COVID-19 and Asymptomatic

A patient can resume contact with others when: 

  1. 10 days have passed since their test, and they continue to remain asymptomatic.

In addition, other members of their household should stay home for the duration of the patient’s isolation and for an additional 14 days after the ill person is no longer infectious. If the patient is able to completely isolate from other household members (no contact, no shared spaces), household members should stay home for 14 days after the patient began isolating (contact is broken). 

As always thank you for your partnership,

Christina Baumann, MD, MPH, Washington County Health Officer

Ann M Loeffler, MD, Multnomah County Deputy Health Officer

Sarah Present, MD, MPH, Clackamas County Health Officer

Jennifer Vines, MD, MPH, Multnomah County Health Officer