Philadelphia Medicine Spring 2020 - 9

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The most recent CDC case definition reflects the broadening
scope of risk and transmission. Clinicians are advised to use their
judgment to determine if a patient has signs and symptoms consistent with COVID-19 and whether the patient should be tested.
CDC currently recommends that decisions about which patients
receive testing should be based on both the local epidemiology of
COVID-19, as well as the clinical course of illness.4 Consultation
with PDPH is recommended if clinical presentation and exposure
risk factors are equivocal.
As the range of clinical illness seems to be very broad, persons
ill with the disease may present to acute care facilities, as well as
primary care settings. All facilities, including ambulatory clinics
and urgent care centers, should be prepared to evaluate and manage Persons Under Investigation (PUI), as well as accommodate a
sudden surge in patient volume.
Visual alerts should be posted at the entrance to outpatient
facilities instructing patients and persons who accompany them
to inform health care personnel of symptoms of a respiratory
infection when they first register and reminding them to practice respiratory etiquette. Surgical masks should be provided to
patients when appropriate. If a patient is suspected of having
COVID-19 based on clinical symptoms and epidemiological
history, they should promptly be given a surgical mask and

escorted to a private examination room. If available, patients with
suspected COVID-19 should be placed in a negative pressure
or Airborne Infection Isolation Room (AIIR). The clinician
should don appropriate PPE, including gloves, disposable gowns,
NIOSH certified N-95 respirator, and eye protection.
Despite predominantly mild to moderate illness and a low
CFR, a surge in cases could still overwhelm health care resources.
Patients should be advised when to seek medical care at your facility and when to seek emergency care. Health care facilities should
also review their plans to manage patient surge (i.e., through
altering staffing models, expanding hours, converting spaces for
patient treatment, leveraging telemedicine capabilities, etc.). Policies for managing workforce depletion, as well as procedures for
communicating with patients, should also be reviewed to ensure
continuity of operations.
Protecting Health Care Personnel
The protection of health care personnel (HCP) and management of potential health care exposures is also critical. CDC has
issued extensive guidance with respect to risk assessment and
management of health care personnel with potential exposure in
health care settings. The most recent CDC guidance recommends
consultation with occupational health following an exposure to
determine work restrictions and level of symptom monitoring
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Spring 2020 : Philadelphia Medicine

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Philadelphia Medicine Spring 2020

Table of Contents for the Digital Edition of Philadelphia Medicine Spring 2020
