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COVID-19 Update March 20
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Coronavirus Resources for Practices and Providers
TN Dept of Health: Coronavirus HQ - Guidance for Healthcare Providers and Public - New Data Updated Daily 2 PM
The Pediatric Management Institute (PMI) held a webinar on Thursday that discussed financial and operational issues related to COVID-19 and provided tangible action items every practice needs to consider over the coming days, weeks, and months.
Presentation Slides: BUSINESS IMPACT OF COVID-19
Presentation Video: BUSINESS IMPACT OF COVID-19
The TN Dept of Health and the CDC have provided guidance on PPE conservation:
TDH: PPE Conversation Guidance
CDC: Optimizing Isolation Gowns
CDC: Optimizing Eye Protection
CDC: Optimizing Facemasks
CDC: Optimizing N95s
TDH continues to encourage patients to seek care first from their usual site of care and to enable providers to accommodate that need. Shortages of PPE, of testing supplies, and of testing site availability are increasingly common.

TDH is looking for every opportuinty to fix those issues but permanent solutions are not immediately available and TDH needs your help in addressing shortages by implementing strategies to conserve PPE and by putting procedures into place to minimize unnecessary tests

Providers do NOT need to consult with public health before sending a test to a commercial lab. Providers are advised to prioritize testing highly symptomatic and not asymptomatic individuals.

TDH is continuing to test in the state lab, although capacity is limited, through the clinical consult line 615-741-7247. High-risk groups and uninsured patients are being prioritized.

All COVID-19 cases should be reported immediately to TDH by calling 615-741-7247.
TDH: Guidance on Testing Decision-Making
Barton Schmitt: COVID-19 Exposure Telephone Triage Protocols
If you are a clinical outpatient assessment site for the public, please use the link below to be added to the website to update the general public.
TDH: COVID-19 Assessment Sites
There has been a rapid expansion in reimbursement opportunities for telehealth, now including home-based telehealth coverage by nearly every plan in the state during this time of public health response. 

Guidance from TDH: Please utilize teleheath and telephone triage as much as possible for both sick and well patients. This is critical to minimize public exposure to illness and to optimize capacity for routine and emergent care. Utilization of telehealth and telephonic management should be optimized in all settings.
TMA: Telehealth Guidelines
TNAAP: COVID-19 Telehealth Coding Guidance
TNAAP: COVID-19 Telehealth Guidelines By Payer
TennCare Guidance on COVID-19
The CDC has adjusted recommendations for isolation of cases at home to be for at least 7 days (not 14), including afebrile and feeling well for at least 72 hoursThe TN Dept of Health has adapted this recommendation as well.

Note: Contacts should still remain quarantined for 14 days following last exposure.
CDC: Guidance for Persons with COVID-19 Under Home Isolation
TDH: Guidance for Releasing Cases and Contacts from Isolation and Quarantine
The TN Dept of Health does NOT recommend early (<24 hours after birth) discharges for newborns. Further guidance can be found at the link:
TDH: COVID-19 Update for Pediatric Providers Caring for Infants in the Newborn Nursery
Public health staff are changing their monitoring protocol to include:
  • Making initial contact with lab confirmed cases
  • Conducting a thorough interview to identify close contacts
  • Ensuring that the cases understand the requirement to remain isolated
  • Contacting close contacts to explain their exposure, and the recommendation to remain home for 14 days following their exposure
Following the initial interview, public health will no longer actively check in with the patient (or contacts) each day, but rather ask the case to get in touch with their provider if they need medical care and public health if they have exposure, isolation, or quarantine questions.

1.      If one of our patients tests positive and was in our office, what is the correct protocol and who do we have to contact?

o   Contact your local department of health. Office staff in direct contact with suspect patients should be in full PPE (mask, eye protection, gown, gloves) to prevent the need to come back and quarantine the office. Patients with symptoms of fever, cough +/- shortness of breath should be masked and immediately isolated in a room with the door closed. If staff have close exposure (within 6 feet) with a confirmed case for more than 10 minutes and did not have a mask on, they need to be quarantined for 14 days. If that patient was in the waiting room for 10 minutes and was not masked, those present in the waiting room need to be notified and quarantined for 14 days.

2.      What if an employee tests positive – what is the correct protocol and who do we have to contact?

o   Call your local department of health immediately. If the employee is at work, they should have been in isolation since the time of testing. Identify anyone who was in close proximity to that individual. Generally, TDH is seeing symptoms develop as early as 3 days from exposure and we don’t know if patients are infectious before they are symptomatic, so we would date back to the day of the infected individual’s onset. Those close contacts who were not in PPE need to be quarantined but not tested. If they develop symptoms they need to be tested. Quarantine is for 14 days.

3.      What is a provider tests positive – what is the correct protocol and who do we have to contact? Do we have to contact each patient that the provider came in contact with (even if provider was masked) and how far back?

o   See answer to question 2.

4.      We have been told that we could not use the cotton nasal swabs, but a lab we are in contact with said that we could use the cotton swabs. What is the correct nasopharyngeal swab?

o   E-swabs have been approved by some labs. Follow your laboratory service provider’s guidance. If sending to the State Public Health Lab use a polyester or dacron swab with a plastic or metal handle and submit in viral transport medium.

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Cumberland Pediatric Foundation · 5141 Virginia Way, Suite 230 · Brentwood, Tennessee 37027 · USA