March 6, 2020
The Coronavirus Disease 2019 (COVID-19) outbreak continues to rapidly evolve. As of March 5, 2020, the World Health Organization reports more than 95,000 cases globally, and the Centers for Disease Control and Prevention (CDC) reports 99 presumptive or confirmed cases in 13 U.S. states. Three states have reported community spread (California, Washington, and Oregon). There are no cases in Virginia. For most of the American public, who are unlikely to be exposed to this virus at this time, CDC considers the immediate health risk from COVID-19 to be low.
As we all prepare for COVID-19 in Virginia, please be aware of several major, recent developments:
1. On March 4, CDC revised its recommendations about how to identify a suspect case or a Patient Under Investigation (PUI) for COVID-19. Clinicians should use their judgment based on the local epidemiology of COVID-19 and the patient’s signs and symptoms to determine whether a patient should be tested for COVID-19. Most COVID-19 patients have developed fever and/or symptoms of acute lower respiratory illness (e.g., cough, difficulty breathing). Influenza is still widespread in Virginia. Clinicians are strongly encouraged to test for influenza and other causes of respiratory illness before testing for COVID-19. Epidemiologic factors to help guide testing decisions include: any persons, including healthcare workers, who have had either close contact with a laboratory-confirmed COVID-19 patient or a history of travel from an affected geographic area within 14 days of symptom onset.
2. Virginia’s Department of General Services, Division of Consolidated Laboratory Services (DCLS) began testing for COVID-19 on February 29. At this point, DCLS has received a very small number of test kits from CDC, and thus has a very limited capacity for testing. Until private labs are able to provide testing and DCLS receives additional test kits, we must use clinical and epidemiologic criteria to identify patients most likely to be infected. These interim criteria are summarized in the VDH Interim Guidance for COVID-19 Testing on the VDH website. Instructions for public health testing are on the DCLS website.
3. Virginia’s local health departments do not provide primary care and thus are not equipped to clinically evaluate patients or collect specimens for COVID-19. If there are barriers in your practice to testing your patients for COVID-19, please call the director of your local health department to discuss your concerns.
4. Private laboratories will begin COVID-19 testing in the near future. Please check with your laboratory partners for testing availability.
5. COVID-19 is a reportable condition in Virginia. Healthcare providers are legally required to report all suspected cases (i.e., PUI) and confirmed cases to the local health department immediately. Laboratory directors are required to submit the initial specimen to DCLS within seven days of identification per these regulations. Healthcare providers are encouraged to report cases using our online electronic reporting tool whenever possible.
6. To allay fears, it’s important that Virginia has a coordinated message for announcing the first COVID-19 case in Virginia. If you receive a positive laboratory diagnosis from a private lab for the first case of COVID-19, immediately call the director of your local health department to discuss how this will be coordinated.
7. CDC recently updated guidance for travelers arriving in the United States from countries with widespread ongoing community transmission (i.e., those with a Level 3 – Travel Health Notice, which currently includes China, Iran, Italy, and South Korea). These travelers are being advised to stay home and avoid contact with others for 14 days from the time that the person departed the area. They should not go to work or school and should avoid public transportation and activities. Travelers from countries with a Level 2– Travel Health Notice (currently Japan) are advised to stay home to the extent possible and limit public activities for 14 days after leaving the affected area. More details are available on the VDH website (see Travelers tab).
We thank you for your assistance in helping to prepare for and respond to COVID-19.
M. Norman Oliver, MD, MA
State Health Commissioner