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Provider Responsibilities and Guidance

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​COVID Provider Case Report Form We are TEMPORARILY suspending case reporting requirements for all non-hospitalized patients and individuals not living or working in congregate residential settings. However, employers are still obligated to report employee and patron cases to Public Health in accordance with orders by the Public Health Officer. This requirement includes patients and visitors exposed at a healthcare facility or patient cases suspected to be part of a healthcare-associated outbreak. Please see below for more information. 

 

 

Isolation and Quarantine Protocols​ (PDF)

Cases
Symptomatic Asymptomatic

Case
(all cases regardless of setting)

Isolation Period: Starts immediately. If case is symptomatic, isolation can be discontinued after:

  • At least 10 days since symptoms first appeared, AND
  • At least 24 hours with no fever (without the use of fever-reducing medications); AND
  • Improvement in other symptoms.

Testing: No additional testing needed after a positive test.

Isolation Period: Starts immediately and ends 10 days after collection date of positive test.

Testing: No additional testing needed after a positive test.

Case in high-risk, congregate setting (e.g., jails, shelters, SNFs/LTCFs, dormitories)

Follow the same guidelines as above.

Follow the same guidelines as above.

Case (severely ill or immunocompromised)

Discontinuation of isolation policies in hospital settings should be determined by the individual institution. NOTE: The timeframe from symptom onset could be extended to up to 20 days for individuals who are severely immunocompromised (e.g., currently receiving chemotherapy, or recent organ transplant), or who had critical illness (e.g., required intensive care).

Close Contacts​
Symptomatic Asymptomatic
Close Contact​

Quarantine Period: Starts immediately and ends 10 days after last exposure to case AND until 24 hours after fever resolution and improvement in other symptoms, whichever is longer.

Close contacts who develop symptoms before Day 10, but who test negative, must remain in quarantine for at least 10 days AND until 24 hours after fever resolution and improvement of other symptoms.

Close contacts who develop symptoms between Days 11 – 14 must retest after symptoms began. Those who test negative must remain in quarantine until 24 hours after fever resolution and improvement in other symptoms.​

If close contact continues to be exposed to a case during their isolation, the Quarantine Period starts immediately and ends 10 days after case’s isolation period ends. This may last about 20 days.

Testing:

  • Test immediately because contact is symptomatic:
    • If positive, continue to follow Home Isolation Steps.
    • If negative and the test was earlier than 6 days after last exposure to case, repeat testing towards the end of the Quarantine Period.
    • If negative and the test was done after 6 days from the last exposure to the case, the close contact must remain in quarantine for a full 10 days.

​Quarantine Period1: Starts immediately and ends 10 days after last exposure to case.

Close contacts without symptoms may end quarantine after Day 10 from last exposure but should continue monitoring for symptoms for a full 14 days. If close contact continues to be exposed to a case during their isolation, the Quarantine Period starts immediately and ends 10 days after case’s isolation period ends. This may last 20-24 days.

Testing2:

  • Test at day 6 after last exposure to case.
  • Test immediately, if the close contact becomes symptomatic during quarantine.
  • If testing is done earlier than 6 days after the last exposure to case, repeat testing towards the end of the 10 day Quarantine Period.

1Workers with special quarantine considerations: Consult your employer if you are considered a first responder or healthcare worker and compliance with the Public Health Department’s isolation and quarantine guidance would compromise the continuity of service of your operation or department. If critical staffing shortages exist, healthcare workers may follow the recommendations outlined here​.

2The Public Health Department may provide alternative testing recommendations in congregate settings and during cluster investigations.

See the Home Isolation and Quarantine Guidelines handout for patients with detailed instructions.
(PDF): | English​ | Chinese | Spanish | Vietnamese | Tagalog​ |

 

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Managing Exposures Among Healthcare Workers

The general quarantine guidance above applies to healthcare workers under normal circumstances, and HCWs who have routine workplace exposures that are not high risk should continue to follow their employer’s guidance for returning to work. However, if critical staffing shortages exist, healthcare workers may follow the recommendations outlined below. For organizations that do not have an Infection Prevention or Occupational Health Department, please follow the guidance below:

Healthcare Workers (HCWs) who have been exposed to a COVID-19 positive person in the household or in the community, or a high-risk exposure in the workplace (e.g., not wearing required PPE), may continue to work, or return to work, under the following conditions during the Quarantine Period (defined as 10 days from the date of last exposure to the COVID+ person):

  1. The HCW is asymptomatic (or symptoms are resolved per policy).
  2. The HCW undergoes the following testing regimen:
    1. A COVID-19 test is done immediately upon learning of exposure and the test result is negative.
    2. The HCW will remain off work until the COVID-19 test is resulted.
    3. Thereafter, during the remainder of the Quarantine Period, the HCW’s COVID-19 status shall be monitored with approximately daily rapid antigen tests or RT-PCR tests every 3 days. Test type and frequency will depend on testing availability and schedules.
  3. The HCW must wear an N95 respirator and all other required PPE at all times during the Quarantine Period.
  4. The HCW must not eat, drink, or be unmasked around others at any time, regardless of social distancing.
  5. The HCW continues to monitor COVID-19 symptoms daily. If the HCW develops symptoms, the HCW must leave work, contact their Manager/Employee Health, and be tested
  6. The HCW maximizes social distancing (even beyond 6 feet) wherever possible with both patients and co-workers, maintains excellent hand hygiene at all times.
  7. The HCW does not work with severely immunocompromised patients or individuals (e.g., cancer, organ transplants).
  8. The HCW’s work duties are assigned in a manner that minimizes the number of different patients cared for by the HCW.
  9. The HCW is still under home quarantine for 10 days after last exposure except to go to work. The HCW must not carpool, taxi , or rideshare.

 

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Guidance for a Suspected COVID-19 Case

What to do if you suspect that your patient may have COVID-19:

  1. Call the Public Health Department (408-885-4214, ext. 3; ask for Provider Branch) immediately if your patient resides or recently resided (within the last two weeks) in any of the following facilities:
    1. ​Long-Term Care Facility (LTCF), including a skilled nursing facility (SNF)
    2. Other congregate residential setting, e.g., jail, homeless shelter or encampment, group home, board and care. We will call the facility to assess the situation and facilitate testing.
  1. ​​F​or p​atients who do not require a call to the Public Health Department, offer testing.
    1. ​​​​Unlike early in the pandemic, laboratory testing capacity has now increased significantly, as has the supply of nasopharyngeal swabs. Additionally, we are finding that many COVID-19 patients do not present with classic symptoms, and many are asymptomatic. Therefore, similar to the California Department of Public Health, we recommend broad expansion of testing immediately, guided by the criteria below. Testing should be performed even if the diagnosis of COVID-19 can be made on clinical and epidemiologic grounds.​ Additional testing resources can be found on Where to Get Tested.

      Healthcare providers must offer testing to the following individuals:

      1. All Symptomatic Persons*, regardless of age, hospitalization status, comorbidities, or other risk factors for COVID-19; 
      2. All persons, with or without COVID-19 Symptoms*, who report that they have been exposed to a confirmed case of COVID-19;
      3. All persons who are referred by the County Public Health Department to their provider for COVID-19 Diagnostic Testing; 
      4. All persons, with or without COVID-19 Symptoms, who are "Essential Workers" as defined by the COVID-19 Diagnostic Testing emergency regulation of the California Department of Managed Health Care, 28 C.C.R. § 1300.67.01(b)(5), also currently available at: https://wpso.dmhc.ca.gov/regulations/docs/regs/50/1594998444637.pdf.


      For more information, please see the September 16, 2020 Health Officer Testing Order

  1. ​​​If you decide that testing is indicated:
    1. ​Arrange for testing.
      1. ​Each hospital and healthcare system in the area should now have a contract with a private lab for testing. Additional Santa Clara County testing resources can be found on Where to Get Tested.
    2. Review the Home Isolation and Quarantine Guidelines with the patient and give the patient a copy of the handout.
      1. ​It is your responsibility to tell the patient to self-isolate while awaiting test results and to follow the instructions on the handout.
    3. ​Inform the patient that you will contact them with the test results.
      1. ​If the result is positive:
        1. Inform the patient of the result and instruct the patient to follow the isolation instructions in the Home Isolation and Quarantine Guidelines. In addition, instruct the patient to notify their close contacts of their exposure and provide them with the handout for guidance on how to quarantine (also found at http://sccstayhome.org).
        2. Provide close contact information on the case report form whenever possible. If close contacts cannot be elicited from the patient, please be sure to include the contact information of next of kin. 
          1. ​​​​Please note, as of 12/22/20, due to the current surge in COVID-19 cases in the county, we are TEMPORARILY suspending case reporting requirements for all living non-hospitalized patients and individuals not living or working in congregate residential settings. You must continue to submit Case Report Forms for all deceased patients, hospitalized patients and individuals living or working in congregate residential settings (i.e. jails, shelters, long-term care facilities).
          2. Also, employers are still obligated to report employee and patron cases to Public Health in accordance with orders by the Public Health Officer. This requirement includes patients and visitors exposed at a healthcare facility or patient cases suspected to be part of a healthcare-associated outbreak. To report COVID-19 cases in employees and patrons, please go here​.
          3. We recommend prioritizing the following fields if unable to complete the entire form: Contact for next of kin, Resident of congregate setting, Symptom onset date, and Date of admission. If time allows, symptom and comorbidity information should also be completed.
          4.  


      2. If the result is negative:​​
        1. ​Inform the patient of the result and instruct the patient to follow the instructions for negative tests in the "What To Do After You Get Your Results" section on the Home Isolation and Quarantine Guidelines.​

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​Guidance for Patients Leaving Against Medical Advice

Hospital providers should continue to follow their existing policies regarding patients leaving against medical advice, with additional processes noted below.

  1. If a patient who is suspected or confirmed to have COVID-19 desires to leave AMA, the Public Health Department does not need to be, and should not be, contacted.
  2. If the individual is suspected or confirmed COVID-19 case, the patient should be instructed to isolate for the following period:
    1. If symptomatic, at least 10 days from the date of symptom onset AND at least 24 hours from the date of symptom resolution (resolution of fever without the use of fever-reducing medication and substantial improvement in other symptoms).
    2. If asymptomatic or with an unclear date of symptom onset, at least 10 days from the date of specimen collection. 
​For information regarding supportive services for patients:
  1. Food delivery resources :
    1. If your patient is experiencing food insecurity, have them call 1-800-984-3663 to be screened and confirm the need for food delivery.
    2. If a need for food delivery is determined, a one-week supply of groceries will be delivered at the front door of the patient's address.​
  1. Isolation and quarantine support referrals for housed patients:
    1. If a patient is unable to self-isolate or quarantine (e.g., they share a room where they cannot adequately physically distance, or a bathroom or kitchen facility that they cannot adequately disinfect), call 408-808-7770 to obtain assistance with at-home isolation/qua​rantine or to determine placement eligibility at motels/hotels/inns. Staff are available to conduct screening of the referral 7 days a week from 8:00 a.m. to 5:00 p.m. If no staff member is available to take your call, please leave a message and it will be returned promptly. We are prioritizing housing accommodations for high risk and vulnerable individuals. 

  2. Homeless referrals including support for isolation and quarantine: 
    1. Mondays – Fridays (except holidays)
      Please call 408-278-6420 for all your referrals. Staff are available to conduct screening of the referral from 9:00 a.m. to 6:00 p.m. to determine placement eligibility at one of the shelters or motels/hotels/inns. If you are unable to reach us, please leave a detailed voicemail, including your name and phone number, and your call will be returned. 
    2. Saturdays – Sundays (including holidays)
      Please call 408-808-7770 for confirmed COVID patient referrals. Staff are available to conduct screening of the referral from 8:00 a.m. to 5:00 p.m. to determine placement eligibility at motels/hotels/inns. For any other referrals, please call 408-278-6420 and leave a detailed voicemail with your name and phone number for your call to be returned on the next business day.  
    3. If you have any questions about this process, please email housing@eoc.sccgov.org or call 408-808-7770. 

  

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Reporting COVID-19 Cases

COVID Provider Case Report Form We are TEMPORARILY suspending case reporting requirements for all non-hospitalized patients and individuals not living or working in congregate residential settings. However, employers are still obligated to report employee and patron cases to Public Health in accordance with orders by the Public Health Officer. This requirement includes patients and visitors exposed at a healthcare facility or patient cases suspected to be part of a healthcare-associated outbreak. Please see below for more information.​

Please note, as of 12/22/20, due to the current surge in COVID-19 cases in the county, we are TEMPORARILY suspending case reporting requirements for all living non-hospitalized patients and individuals not living or working in congregate residential settings. You must continue to submit Case Report Forms for all deceased patients, hospitalized patients and individuals living or working in congregate residential settings (i.e. jails, shelters, long-term care facilities).

Also, employers are still obligated to report employee and patron cases to Public Health in accordance with orders by the Public Health Officer. This requirement includes patients and visitors exposed at a healthcare facility or patient cases suspected to be part of a healthcare-associated outbreak. To report COVID-19 cases in employees and patrons, please go here.

We recommend prioritizing the following fields if unable to complete the entire form: Contact for next of kin, Resident of congregate setting, Symptom onset date, and Date of admission. If time allows, symptom and comorbidity information should also be completed.​



For confirmed COVID-19 cases fitting the criteria above, please report by secure EMAIL (coronavirus@phd.sccgov.org) or FAX (408-224-7046), by sending in a completed Case Report Form within 24 hours.

  1. Do NOT submit a Confidential Morbidity Report (CMR). Please use the Case Report Form instead.
  1. Do NOT submit a report to the Public Health Department if the patient’s residence is outside of Santa Clara County – refer to instructions from the patient’s respective county of residence.

How to submit a Case Report Form to the Public Health Department:

  1. Download the fillable form here
  2. Complete all fields1
  3. Scan
  4. Attach form and supporting labs to email
  5. Using a secure email account, send documents to coronavirus@phd.sccgov.org
  6. If you cannot send via secure email, please fax documents to (408) 224-7046

1Providers are also asked to provide close contact information on the case report form whenever possible. If close contacts cannot be elicited from the patient, please ensure that contact information of next of kin is included.

Additionally, some confirmed or suspected COVID-19 cases ALSO require a CALL to the Public Health Department (408-885-4214, ext. 3):
  1. The following confirmed or suspected cases in congregate residential settings (e.g., SNFs/LTCFs, jails, shelters) should be reported immediately (24 hours a day; 7 days a week):
    1. One (1) or more confirmed COVID-19 cases OR
    2. Three (3) or more suspected cases of acute illness compatible with COVID-19 in residents with onset within a 72 hour period.
  2. The following confirmed or suspected cases should be reported during daytime hours (8:00 a.m. – 5:00 p.m.; 7 days a week):
    1. fatal cases,
    2. cases with MIS-C (Multi-Inflammatory Syndrome in Children),
    3. three (3) or more epi-linked cases in an acute care hospital of any combination of: confirmed COVID-19 in a patient 7 or more days after admission for a non-COVID condition OR confirmed COVID-19 in a healthcare worker.

Special Considerations for Healthcare Worker Exposures in Facilities without Infection Prevention/Occupational Health
Facilities should undertake the following steps:

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Reporting the Death of a Confirmed or Suspected COVID-19 Case

The death of a confirmed or suspected COVID-19 case*:

Healthcare providers are required to report all deaths associated with COVID-19 within 24 hours, including out of hospital deaths and deaths among residents of congregate residential facilities, by doing the following:

  1. Immediately call the Medical Examiner at (408) 793-1900, ext. 2.
  2. Complete the Public Health Death Reporting Form (Note: ALL fields must be completed). If the decedent tests positive for COVID-19, include a copy of the lab result.
  3. Send the Death Reporting Form and the patient's medical records (g., H&P, discharge summary, medication list), to the Public Health Department. Send all documents by secure email to coronavirus@phd.sccgov.orgor by fax to (408) 224-7046
  4. Call the Public Health Department at (408) 885-4214, ext. 3; ask for Provider Branch.  They will review any outstanding questions about the Death Reporting Form.

*If the patient’s residence is outside Santa Clara County, please do not send a report to the County of Santa Clara Public Health Department. For contact information for other jurisdictions, please view the LHD Communicable Disease Contact Information List​ maintained by the California Public Health Department (CDPH). 

 

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Guidance for Congregate Care Settings

Congregate Settings include but are not limited to long-term care facilities, jails/prisons, retirement communities, dormitories, and shelters/encampments.

Letter from the Health Officer to healthcare workers and staff who work in congregate settings: Protecting Your Health as COVID-19 Cases Spike in Santa Clara County | English | Spanish | Tagalog |

For Infection Prevention and Preparedness

  1. Provide supplies for recommended infection prevention and control practice
    1. ​Hand hygiene supplies: 
      1. ​Put alcohol-based hand sanitizer with 60–95% alcohol in every room (ideally both inside and outside of the room) and in other common areas. 
      2. ​​Make sure that sinks are well-stocked with soap and paper towels for handwashing.​
    2. ​Respiratory hygiene and cough etiquette: 
      1. ​Make tissues and facemasks available for people who are coughing. 
      2. Consider designating staff to steward those supplies and encourage appropriate use by residents, visitors, and staff. 
    3. ​Make necessary PPE available to staff members caring for persons with undiagnosed respiratory illness or COVID-19. Put a trash can near the exit inside the room to make it easy for staff to discard PPE prior to exiting the room, or before providing care for another patient in the same room. Facilities should have supplies of: 
      1. ​Facemasks, 
      2. respirators (if available and the facility has a respiratory protection program with trained, medically cleared, and fit-tested healthcare personnel), 
      3. gowns, 
      4. gloves, and 
      5. eye protection (i.e., face shield or goggles). ​

COVID-19 Prevention and Mass Testing for Long-Term Care Facilities

Please see below for important COVID-19 infection prevention information and testing tool kit for residents and staff at long-term care facilities.

 


For Case and Contacts

  1. Reporting a case to Public Health Department:
    1. Promptly notify the Health Department about the case by calling (408) 885-4214, ext. 3; ask for Provider Branch.
  2. Isolating the case and cleaning the area:
    1. Isolate the patient and limit non-essential contact.
    2. Cleaning staff should clean and disinfect all areas (e.g., offices, bathrooms, and common areas) used by the ill persons, focusing especially on frequently touched surfaces. See the CDC's instructions on disinfecting community facilities.
  3. Begin to identify close contacts
    1. Identify close contacts and be prepared to discuss with the Public Health Department regarding appropriate quarantine instructions. 

New Directive for Long-term Care Facilities

On November 20th, 2020, Santa Clara County Health Officer issued new directive for long-term care facilities in the County. The danger of COVID-19 transmission in long-term care facilities is particularly high due to facility residents generally being at higher risk of severe illness or death from COVID-19.  Visitors to long-term care facility residents and residents returning to long-term care facilities after visits to friends or family in the community increase the risk of introducing and transmitting COVID-19 among residents and staff in the facility.  The Health Officer therefore issued this new directive to provide guidance for visitation of, and by, residents of long-term care facilities.

 

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Guidance on Movement of Patients between Hospitals and Long-Term Care Facilities

Hospitals do NOT need approval from the Public Health Department before discharging or releasing a suspected or confirmed COVID-19 patient to a Long-Term Care Facility.

Guidance for Hospitals

  1. When receiving patients from LTCF:
    1. Hospitals should perform COVID-19 testing of all patients that reside or recently resided (within the last two weeks) in a LTCF who present with symptoms of COVID-19. Call the Public Health Department at 408-885-4214, ext. 3 (ask for Provider Branch) to inform of a confirmed or suspect COVID-19 case who resides or recently resided (within the last two weeks) in a LTCF.
    2. We will contact the facility to assess the situation.
  2. When proposing to discharge patients to a LTCF:
    1. For transfers (not related to COVID-19), testing should be done prior to discharge but does not need to be resulted prior to transfer, as the patient will be entering a 10-day Observation Unit (or quarantine in apartment) at the LTCF.
    2. The acute care hospital days may count towards the 10 days of quarantine if the following criterion is met: there is no evidence of ongoing COVID-19 transmission among patients or staff at the hospital. In this case, the first day of quarantine would be the hospital admission date rather than the date of the last test.

Guidance for LTCFs

  1. When receiving transfers of patients with COVID-19:

    Testing and further isolation are not required for hospitalized patients who were positive and treated for COVID-19 and have met criteria for discontinuation of isolation precautions prior to transfer to LTCF.

    If the patient is deemed clinically stable for discharge prior to completion of isolation, the patient should be transferred to the COVID unit (or patient’s own apartment) of the facility for completion of their isolation.

  1. When receiving patients not known to be COVID-19 positive from the hospital:
    1. Patients should be tested prior to transfer and should be quarantined for 10 days and then retested before release into the general unit. Results do not need to be available prior to transfer. If the hospital does not test the patient within 72 hours of transfer, the LTCF should test and quarantine upon admission.
    2. The LTCF may consider acute care hospital days as part of the 10 day quarantine period if there is no evidence of ongoing COVID-19 transmission among patients or staff at the hospital. This would be determined by discussion with the hospital infection preventionist at the time of planned discharge. In this case, the first day of quarantine would be the hospital admission date rather than the date of the last test.
  1. When readmitting LTCF patients, who resided in a LTCF prior to hospitalization, from the hospital:

    Testing and quarantine are not required for patients readmitted after hospitalization if there is no evidence of ongoing COVID-19 transmission at the hospital.

  1. Patients who go to the Emergency Department, clinic visits or dialysis:

    Testing and quarantine are not required for patients who go to the Emergency Department, clinic visits, or regular dialysis appointments. It is recommended that patients who go out frequently to these facilities should undergo regular testing. 

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Guidance for Mortuaries and Funeral Homes

Please refer to the following resources for information on COVID-19 for mortuaries and funeral homes:

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Request of Healthcare Facility Resources and Conservation of PPE

PPE and other Healthcare Facility Resources Requests

Healthcare providers* who need PPE, antigen tests, or other resources to continue delivering healthcare services during this time can make a request through the County Emergency Operations Center (EOC).

Please fill out the 213 Resource Request (213RR) form​, save and send as an attachment to: resourcetracking@eoc.sccgov.org.

Requests for PPE/Medical Supplies (Goods & Services)

Requests for non-medical personnel/staff

Requests for medical personnel/staff


Please read "How to use the EOC Form 213RR" on page 1 of the request form:

  • Page 1 contains required information for all requests and must include signatures for "Approved By" (box 7).
  • Last page is completed by the OA EOC.​

Providers from approved skilled nursing facilities requesting antigen tests please see this sample 213 RR form​ for guidance.​

Please do not call the Public Health Department for PPE, as you will be routed to the above process.

*The Santa Clara County Dental Society (SCCDS) will manage all PPE requests from dental providers in Santa Clara County. Please email the SCCDS at info@sccds.org.

PPE Use and Conservation Strategies

Supply chains for respirators are not fully restored, however, the supply of respirators for hospitals and other employers involved with healthcare has improved. During PPE shortages with limited supply chain, refer to SCC PHD Resource Request Process. Submit a 213RR to resourcetracking@eoc.sccgov.org.

Conservation strategy for extended use of N95s refers to wearing N95s for an entire shift or during the care of more than one resident within the same respiratory pathogen cohort. Refer to Cal/OSHA August 6, 2020 interim guidance on COVID-19 for Healthcare Facilities.  PPE conservation measures also include cleaning and re-use of face-shields. The re-use of gowns is not recommended except in contingency or crisis mode​. See CDC’s Optimizing Supply of PPE and Other Equipment during Shortages and addendum for additional strategies to conserve specific PPE.


These recommendations are not intended to replace your organization's policies regarding personal protective equipment. They are intended to supplement those policies to help reduce demand of existing limited supplies. 

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Last updated: 1/27/2021 10:28 AM