​​3.6.20 – ​​COVID-19 Clinician Letter from the Maryland Department of Health

Dear Colleague:

We are writing today to share important updated information and guidance about Coronavirus Disease 2019 (COVID-19).

On March 5, 2020, MDH confirmed the first three positive cases of COVID-19 in Maryland residents. These patients acquired their infections while traveling abroad. MDH is actively initiating a contact investigation for these patients. At the current time, there is no evidence of community spread of COVID-19 in Maryland. This is a dynamic situation, and we will provide updates if this changes.

In addition, CDC has released updated guidance regarding criteria to guide evaluation of PUI for COVID- 19, specifically:

“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. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness. Most patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza.”

On March 3, 2020, the MDH Laboratory began performing the CDC-developed 2019-Novel Coronavirus Real-time RT-PCR Diagnostic Panel. LabCorp announced that its 2019 Novel Coronavirus (COVID-19) nucleic acid amplification (NAA) test is now available for ordering by physicians or other authorized healthcare providers in the U.S. In addition, other commercial and hospital laboratories are also coming online with COVID-19 testing. Testing at commercial or hospital laboratories does not require health department review or approval, and is based on the clinical judgment of the health care provider.

At this time, based on current local epidemiology, MDH is using the following criteria to prioritize testing at MDH:

  1. Person who had close contact with a laboratory-confirmed COVID-19 patient within 14 days of onset AND either fever or signs/symptoms of a lower respiratory illness
  2. Person with travel to a country with a CDC Level 2 or 3 Travel Health Notice or an area with confirmed ongoing community transmission within 14 days of onset AND has fever and signs/symptoms of a lower respiratory illness AND tested negative for influenza on initial work-up
  3. Person who resides in a nursing home or long-term care facility AND who has either fever or signs/symptoms of a lower respiratory illness AND who tested negative for influenza on initial work- up AND a respiratory virus panel negative for all pathogens AND no alternative diagnosis

MDH recognizes that clinicians might have high suspicion for COVID-19 in patients that do not strictly fall into these categories, such as for critically ill patients with respiratory illness for whom there is no alternative diagnosis and who lack clear epidemiologic risk factors. In these scenarios, please call your local health department to discuss testing.

While COVID-19 testing at commercial labs does not require approval from the health department, testing performed at the MDH Lab still requires approval from the health department. Clinicians should continue to contact their local health department to obtain testing approval for these situations.

Specimens sent to the MDH Laboratories Administration without prior approval will not be tested. Information about specimen collection and shipping guidance is at https://health.maryland.gov/laboratories/Pages/Novel-Coronavirus.aspx. Positive results from specimens tested at commercial or hospital laboratories are required to be reported the MDH.

CDC guidance for healthcare personnel caring for patients with confirmed or possible COVID-19 is online at https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients.html.

Updated CDC Guidance for Returning Travelers

CDC release updated risk exposure assessment guidance, including instructions for quarantine and isolation, for travelers returning from countries other than China. Currently, this includes Iran, Italy, the Republic of Korea (aka South Korea), and Japan. Travelers returning from any of these countries, as well as from areas of China outside Hubei Province, and who do not have other High Risk exposures are considered to be Medium Risk. Asymptomatic persons in this category should remain at home or in a comparable setting, practice social distancing, and postpone long-distance travel on commercial conveyances for 14 days after their last potential exposure.

Updated CDC Risk Exposure Assessment Guidance for Healthcare Providers

CDC also released updated risk exposure assessment guidance for healthcare providers with possible exposure to COVID-19. Importantly, providers who provide care to COVID-19 patients while wearing all recommended personal protective equipment (PPE), including an N95 respirator or its equivalent, are considered to be at less than low risk (see section III.3.). However, it is still recommended that these providers perform self-monitoring with delegated supervision as described under the Low Risk category.

Updated information about COVID-19 in Maryland is online at https://health.maryland.gov/coronavirus. Updated data on U.S. and global cases is online at https://www.cdc.gov/coronavirus/2019-ncov/summary.html

We will continue to keep you updated as additional information and guidance becomes available.

Click here to view the original memo.