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July 5, 2020

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Be aware that COVID-19 transmission is increasing in King County and regionally. Clinicians have a critical role to play in decreasing community transmission of COVID-19 through the strategies listed below.

Have a low threshold for early testing

Clinicians should have a low threshold for testing for COVID-19. Public Health and Washington State Department of Health (WA DOH) recommend that medical providers test all patients for COVID-19 if they present with fever, cough or other respiratory complaints that are not very clearly attributable to another cause. Providers should also have a low threshold to test patients with muscle or body aches, headache, new loss or change in their sense of tastes or smell, sore throat, congestion or rhinorrhea, nausea or vomiting, diarrhea or fatigue, particularly among patients who belong to high risk groups (See testing guidance, below)

High-risk Groups for COVID-19 Testing (WA DOH)

  • Persons with signs or symptoms consistent with COVID-19.

  • Close contacts of a case: Defined as people who were within 6 feet of an infected person for a tleast 15 minutes, starting 2 days before symptom onset (or, for asymptomatic cases, 2 days prior to positive specimen collection) until the end of the infected person's period of isolation.

  • Individuals exposed to COVID-19 during an outbreak in a congregate setting.

  • Subgroups of the population with high rates of COVID-19 disease based on current local epidemiology (E.g., certain racial and ethnic minority groups disproportionately affected by adverse outcomes).

  • Persons who are pregnant and present in labor.

Test or facilitate PCR testing for household and close contacts

  • Clinicians should test or refer for testing all people who live with someone diagnosed with COVID-19, as well as other close contacts to persons diagnosed with COVID-19 even if they are asymptomatic. To avoid false-negative results, exposed persons should not be tested sooner than 48 hours after exposure to a COVID-19 case. A negative test obtained before the 14 day incubation period has elapsed does not rule-out infection developing during the remainder of the incubation period.

  • Be aware that testing is available through high-volume testing sites, including City of Seattle drive through testing sites. These sites can test household and other contacts to COVID-19. No patient will be denied testing because of lack of insurance or ability to pay for the test. A list of these sites is available.

  • Clinicians should advise patients diagnosed with COVID-19 to immediately notify the people they live with and other close contacts, including those in their workplace, that they need to test for COVID-19 and should go into quarantine.

  • Clinicians should also advise patients diagnosed with COVID-19 to notify their employer.

Emphasize and support isolation and quarantine and contact tracing

  • Clinicians should advise people suspected to have or diagnosed with COVID-19 to isolate themselves for a minimum of 10 days following their first onset of symptoms AND until they have been afebrile without antipyretics for at least 3 days AND their respiratory symptoms have improved.

  • Asymptomatic people with COVID-19 should stay in isolation for 10 days following collection of their specimen for testing.
    • Provide patients with written guidance on isolation and quarantine (see resources below).

  • People for whom clinicians have a high index of suspicion for COVID-19, including persons with symptoms and known exposure to COVID-19, should stay in isolation as defined above even if they test negative (see guidelines on isolation under Resources tab above).

  • Clinicians should advise people diagnosed with COVID-19 to expect a call from Public Health related to contact tracing, isolation and quarantine. Public Health asks that clinicians emphasize to their patients the importance of cooperating with Public Health guidance and investigations to keep our community safe.

  • Clinicians or patients should contact the King County COVID-19 Call Center at 206-477-3977, 8am–10pm for anyone needing a place to stay in isolation or quarantine. The county has isolation and quarantine facilities available for people who are living homeless or who are unstably housed, and for people who are unable to safely separate from others in their home, particularly people with family members at high risk for COVID-19 complications.

The number of cases of COVID-19 diagnosed in King County is rapidly rising. Controlling this increase and preventing recurring waves of COVID-19 transmission will require diagnosing a larger percentage of all cases than is currently occurring, and ensuring that cases and contacts to COVID-19 immediately go into isolation and quarantine. Public Health and the WA DOH are implementing a contact tracing system to promote the testing of exposed contacts and the promotion of isolation and quarantine. To be successful, this effort requires that medical providers and community members work in collaboration with Public Health to expand testing and facilitate contact tracing and the rapid implementation of isolation and quarantine.