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April 29, 2020

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  • Be familiar with updated CDC list of symptoms for which COVID-19 should be considered.
  • Be familiar with new Washington DOH guidelines for COVID-19 testing to include all patients with COVID-19 symptoms when adequate testing capacity is available.

COVID-19 Symptoms (CDC)

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.

  • Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing).
  • Other symptoms may include: Chills (and/or repeated shaking with chills), muscle pain, headache, sore throat, and, new loss of taste or smell.
  • Have an increased index of suspicion for patients residing in long term care facilities and others with chronic co-morbidities associated with immune system compromise who may present with subtle and/or atypical symptoms.

Testing guidance for Washington state (Please review complete guidance at website below)

  • Healthcare providers should test all patients with new onset of symptoms consistent with COVID-19, regardless of their age or health status.
  • Symptoms of COVID-19 include:
    • Cough, or shortness of breath or difficulty breathing OR
    • At least two of:
      • Fever
      • Chills
      • Repeated shaking with chills
      • Muscle pain
      • Headache
      • Sore throat
      • New loss of taste or smell
      • Other patients should be tested per clinical judgment.
  • Rapidly testing all patients with symptoms consistent with COVID-19 is critical to identifying and isolating cases, quarantining their contacts, and suppressing community spread.
  • While this guidance expands the groups of persons eligible for testing, prioritizing testing of certain symptomatic persons may be necessary when adequate test supplies are not available.
    • Prioritize the following symptomatic patients for COVID-19 testing when necessary:
      • Hospitalized patients with severe lower respiratory illness
      • Workers in healthcare facilities, congregate living settings, critical infrastructure and public safety/first responders
      • Residents in long-term care facilities or other congregate living settings, including prisons and shelters
      • Persons identified through public health cluster and selected contact investigations
      • Persons at higher risk of severe outcome
      • Persons who are pregnant and in labor or scheduled for delivery

  • Limit testing of asymptomatic persons to those with exposure
    • Close contacts of a case (if a close contact tests negative, these individuals still need to remain in quarantine for 14 days after their last date of exposure)
    • Individuals exposed to COVID-19 during an outbreak in a congregate setting (e.g., long term care facility, shelters, correctional settings, meat-packing plants, etc.)
    • If adequate supplies are available, testing asymptomatic people can be considered for:
      • Persons who are pregnant and present in labor
      • People undergoing procedures that increase the risk of aerosolized particle spread
      • People undergoing invasive surgical procedures (within 48 hours of procedure)
      • Testing is not generally recommended for new asymptomatic admissions to a healthcare or long-term care facility, unless to a healthcare facility using the information for cohorting

  • Clinicians are encouraged to test for other causes of respiratory illness in addition to testing for COVID-19