MSSC has been working with the Sedgwick County Health Department to make sure there is consistent, accurate messaging about COVID-19. The following information on testing was prepared by the Health Department for MSSC.

Additional information included here was drawn primarily from the Centers for Disease Control and Prevention’s (CDC) resources and was originally compiled by the Montgomery County Medical Society in Washington, D.C.  Please refer to the resource list at the bottom of this article for reference links. 

For the most up-to-date information, contact the CDC, KDHE and the Sedgwick County Health Department.

Testing for the Novel Coronavirus

Update March 19: For patient screening for COVID-19 testing, starting at noon on March 20, please have patients dial 2-1-1 (United Way). United Way of the Plains is now doing the initial screening of patients and will transfer calls that meet initial screening criteria to the Sedgwick County Health Department Nurse Testing Triage Line. To be considered for testing at Sedgwick County Health Department, patients must be Sedgwick County residents.

 Patients requesting testing for the novel coronavirus can be screened by healthcare providers or the Sedgwick County Health Department (SCHD). Please do not direct patients to emergency departments for testing.

Healthcare providers can screen patients and collect samples for COVID-19, or providers can have patients that reside in Sedgwick County dial 2-1-1 (United Way of the Plains) to discuss symptoms and screen for possible coronavirus testing. Only Sedgwick County residents who call 2-1-1 and who meet screening criteria will be referred to the SCHD for further evaluation and possible testing. Patients must call 2-1-1 for testing at SCHD.

  • If patients meet the criteria for testing, SCHD will make an appointment with the patient. The appointment will be at the SCHD clinic at 2716 West Central, Wichita. At the appointment, a SCHD provider will collect the specimen and send for testing starting Thursday, March 19. Patients must call 2-1-1 and meet screening criteria before being tested at the SCHD clinic.
  • Alternatively, providers can collect patient specimens and send for testing to LabCorp or Quest.
    • If cost is an issue, providers can call the KDHE Epidemiology Hotline (1-877-427-7317) for approval for testing at KDHE (must meet criteria for Person Under Investigation).
    • Do not direct patients to emergency departments for testing.

Screening questions if a patient requests COVID-19 testing:

  1. Have you had close contact with a person who has been tested and is laboratory-test positive for COVID-19?

If yes:

  1. What date was the last close contact (droplet contact or within 6 feet for 10 minutes or more)?
  2. What is the name of the person who is laboratory-test positive and what state do they live in?
  1. Have you traveled outside of Sedgwick County in the past 14 days?
  2. We are really concerned about people with severe symptoms.
    1. Do you have a measured fever (greater than 100˚F)?
    2. Do you have a cough or have experienced a recent decrease in the ability to breathe?
    3. For this illness:
      1. Have you seen a healthcare provider? (Date, name of healthcare provider)
      2. Have you been diagnosed with flu or other respiratory viruses?

Current criteria for evaluating patients for COVID-19:

  1. Fever or cough or shortness of breath AND close contact of a laboratory-confirmed COVID-19 positive person within 14 days.
  2. Fever AND cough or shortness of breath with or without travel history.

Collecting patient specimens:

  1. Put on PPE when working with patients suspected of having COVID-19.
    1. Healthcare workers should wear faceshield or goggles, N95 mask (fit tested), gown, and gloves. If N95 masks are in short supply, a facemask can be worn if not performing medical procedures that will create an aerosol (e.g., intubation, suctioning).

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

  1. Follow the laboratory’s instructions for specimen collection.
    1. Specimen is a nasopharyngeal (NP) swab placed in a vial of Viral Transport Media (VTM) or sterile saline. The vial is placed in a biohazard bag, stored at 2-8˚C, and shipped on ice packs as a Category B infectious substance.
    2. A video on nasopharyngeal (NP) specimen collection and other information is found on the KDHE Coronavirus Resource Center website at http://www.kdheks.gov/coronavirus/.

 Contacting SCHD:

  • Healthcare providers with any question: Call the SCHD Epidemiology Hotline (316-660-5555 (press 1)) or email diseasereport@sedgwick.gov.
  • The public for general COVID-19 questions or screening for testing: Dial 2-1-1 (United Way of the Plains).

Beginning March 20, local screening and testing information will be available on the Sedgwick County COVID-19 website at sedgwickcounty.org.

What to Tell Patients

The Sedgwick County Department of Health created a helpful facts and information sheet that answers common questions about COVID-19. The Kansas Department of Health and Environment has several patient handouts, including Novel Coronavirus FAQs, Family Action Plan, and If You are Sick with COVID.

Practice Protocols & Preparedness

Diversion: With limited testing available and limited supplies, providers may want to encourage those who are stable and mildly ill to self-quarantine at home and not come into the office until broader testing can be obtained. Track those patients and call for updates.

Pre-Screening: When scheduling appointments, instruct patients and persons who accompany them to call ahead or inform staff upon arrival if they have symptoms of any respiratory infection (e.g., cough, fever) and to take appropriate preventive actions (e.g., wear a facemask upon entry to contain cough, follow triage procedures).

Promote Respiratory Hygiene: Take steps to ensure all persons with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit. Consider posting visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and health care personnel with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use facemasks or tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.

Provide supplies for respiratory hygiene and cough etiquette, including 60%-95% alcohol-based hand sanitizer (ABHS), tissues, no touch receptacles for disposal, and facemasks at healthcare facility entrances, waiting rooms, patient check-ins, etc.

Limit Exposure: Ensure that patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) are not allowed to wait among other patients seeking care.  Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies. In some settings, medically-stable patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.

Rapid Triage: Ensure rapid triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough):

  • Identify patients at risk for having COVID-19 infection before or immediately upon arrival to the healthcare facility.
    • Implement triage procedures to detect persons under investigation (PUI) for COVID-19  during or before patient triage or registration (e.g., at the time of patient check-in) and ensure that all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of SARS-CoV-2, the virus that causes COVID-19,  or contact with possible COVID-19 patients.
  • Implement respiratory hygiene and cough etiquette (i.e., placing a facemask over the patient’s nose and mouth if that has not already been done) and isolate the PUI for COVID-19 in an Airborne Infection Isolation Room (AIIR), if available. Additional guidance for evaluating patients in U.S. for COVID-19 infection can be found on the CDC COVID-19 website.
  • Inform infection prevention and control services, local and state public health authorities, and other healthcare facility staff as appropriate about the presence of a person under investigation for COVID-19.

The above is summary guidance for practices. Please visit the CDC’s protocol for full details; it is being updated on a rolling basis.  Also practice to utilize the CDC’s preparedness checklist for COVID-19 and the CDC’s interim guidance for community transmission preparation in various facility and practice modalities.

What to Look For

The CDC’s clinical criteria for a “patient under investigation” (PUI) for possible COVID-19 infection are based on what is known about the Middle Eastern respiratory syndrome coronavirus (MERS-CoV) and the severe acute respiratory syndrome coronavirus (SARS-CoV). The key is to look for both clinical features and epidemiologic risks before calling our local or state public health department to sound the alarm.

Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza.

When and How to Report

If you have a patient under investigation for COVID-19, immediately let your facility’s infection control department know and report it to KDHE via the Epidemiology Hotline (1-877-427-7317).

Resources for Physicians

From the Centers for Disease Control and Prevention

From the World Health Organization (WHO): WHO Coronavirus Home, which is updated on a rolling basis.

From the Journal of the American Medical Association (JAMA): Guidance for diagnosis and treatment, updated on a rolling basis.

From the AMA: A physician’s guide to COVID-19.

From KDHE: COVID-19 resource center

From KMS: Coronavirus Resources for Kansas

From AAFP:  Preparing your staff and practice for COVID-19